Why does ‘PTSD’ remain such a problem? What might MDMA do to help ? But first, people must know the simple facts about PTSD type 1 and PTSD type 2 to be successful with any treatment for ‘PTSD’.

Introduction.

The Question:  Since properly performed EMDR (Eye Movement Desensitization and Reprocessing) — that anyone con perform on anyone — can be shown (proved) to cure some people with PTSD, but not all people with PTSD (‘cure’ meaning a ‘pathological complete response to treatment’) can it be shown that  MDMA  (Ecstasy –it’s chemical name is methylenedioxymethamphetamine.) together with Psychotherapy (PT) cure PTSD ?

But there’s a problem always stopping the way to any answer:  What exactly is PTSD?   How is it diagnosed?

Everyone thinks they know what PTSD is — it’s an Anxiety Disorder triggered by frightening mental trauma, a post ‘traumatic stress’ disorder.   But no one knows exactly what PTSD is. What the psychiatrists and psychologists  say PTSD is in  the DSM 5 (Diagnostic and Statistical manual of Mental Disorders 5th Ed) and the ICD 11 (International Classification of Diseases 11th Ed )  doesn’t make clinical sense.

Other than it is an anxiety disorder that can be triggered by mental trauma, no one who develops PTSD knows what’s going to happen, nor exactly what to do about it.  Boys and girls of 5 or 6 can get PTSD, as can anyone older, anyone from any walk of life. PTSD can be caused by experiencing very severe mentally traumatic circumstances or from surprisingly mild  mentally traumatic circumstances or from experiences somewhere in between in severity.  PTSD itself ranges from being mild to very severe.  Some people with PTSD fully recover and some people with PTSD never do. Some people prefer suicide to continue living with it.  PTSD has been a problem ‘forever’, with endless different names (‘Shell Shock’, ‘Traumatic Neurosis’, ‘Railway Spine’) and with endless different treatments.  The ‘ancient’ Greeks talked about it.  PTSD is said to be suffered by 4% or so of the population — 120m or so Worldwide. Many people who experience mentally traumatic circumstances don’t get PTSD.

Any or all of the following can be there in PTSD: anxiousness, hyper-vigilance, exaggerated startle response, depressed moods, outbursts of anger, poor concentration, poor sleep, nightmares, intrusive thoughts, awful intrusive flashing-back memories (sometimes referred to as ‘dissociative’* flashbacks), avoidance of reminders of what happened, avoidance of thoughts and feelings associated with what happened… and deadly intrusive ideas of suicide. Why does it behave like any other anxiety disorder for some and not for others.

What is to follow is long ignored evidence that finally means something.  It’s easy to see why it’s been ignored for so long. It gives rise to ‘new ideas’ of what PTSD is — ideas that anyone concerned with PTSD can readily test out for themselves and then make up their own mind about. It’s about what some ex-soldiers from WWII with PTSD in 1946 (it was still called Traumatic Neurosis at the time) were noticing and talking about when their vision was being examined by an ophthalmologist in London, a Dr William Ross Traquair.  He wrote about it very briefly– a few words — on page 121 in his book  (An introduction to clinical perimetry (5th ed.). London: Henry Kimpton’)  Dr Traquair was too busy to be interested in Traumatic Neurosis so he didn’t look into why those ex-soldiers were noticing what they said they were noticing, but he did think it worth mentioning it in his book in case anyone else might be interested.

The clinical confusion indicates the problem caused by ignoring that one simple-to-find symptom, ignoring it because it’s a symptom that’s not expected to be there because it’s not a ‘psychiatric’ symptom.    That one simple-to-find symptom is what this website is all about — nothing complicated, it’s just an unexpected symptom.

The neurobiological implications of the clinical evidence are somewhat complicated and the new clinical evidence is counter-intuitive — first thoughts on first hearing of it are ‘doesn’t make sense’, ‘sounds stupid’, ‘best ignored’  — which is why the evidence has been ignored in the past and still is by many. But ‘clinical evidence’ can’t be ignored, can’t be left out: evidence has to be fitted in.

In 1897 ‘The Father of Clinical Medicine’, Dr William Osler of Johns Hopkins Hospital, had told all doctors “Listen to the patient.  He (or she) is telling you the diagnosis”. i.e. doctors (should) listen to what patients tell them, ask questions, listen to answers, examine the patient – and only then make a diagnosis that fits in with what the patient tells you, not leaving out any inconvenient bits, and not forgetting to follow-up the patient to see what happens.

The ‘fitting in’ of this bit of clinical evidence into PTSD took 30 years of an exploratory clinical investigation.   A psychiatrist, formerly a neurosurgeon, as interested in vision as in trauma, physical or mental, slowly worked out a simple quick and easy visual test and applied it  each of the  9000 or so of his patients, all randomly referred to him as a general psychiatrist, patients with or without any sort of PTSD, seen over the 30 years (and because he had no choice, mostly European patients).  The bare findings of the investigation were eventually published in the international journal ‘Traumatology’ 15(3) 22-33 (2009).

What it is that’s new.

The ‘new clinical evidence’ dictates that there have to be two different types of PTSD.  Two types that can be clinically very similar-appearing, often hardly distinguishable one from the other,  both with many of the same anxiety-related symptoms — but two types of PTSD that are neurobiologically very different.  There is a PTSD type 1 and a PTSD type 2.  Obviously, both are ‘post-traumatic stress disorders’ — anxiety disorders triggered by experiencing mental trauma, regardless of the severity of the disorder or source of the ‘traumatic stress’  — ‘stress’ being synonymous with ‘anxiety’ or ‘fear’ in this context.

(The details of the academic ‘argument’ and its ‘neurobiological implications’ are in Part 2 below for those interested — and in more extensive detail in < ptsd.net > and < ptsd.net/cases >.)

What is PTSD type 1 ?  It is a unique and specific anxiety disorder (a distinct categorical disorder) — an anxiety disorder that can only be triggered by experiencing the mental trauma of a ‘mental shock’. ‘Mental shock’ is defined here as ‘a sudden surge of intense anxiety from fear or disgust coming in immediate response to a sudden and unexpected perception of some out-of-control threat or other distress’.   PTSD type 1 always has two unique clinical anxiety-related symptoms — two persisting symptoms that are not present in any other disorder anywhere. One is a subtle an abnormality of vision (the one those ex-soldiers from WWII were describing to their ophthalmologist in 1946) and one of an abnormal form of abnormal memory recall — a recurrent abnormal ‘flashback’. (These two symptoms are explained in detail in Part 2 below and in < ptsd.net > Sections 3 & 7.)  A  person may have PTSD type 1 from just one mental shock, or from multiple mental shocks at different times, having a PTSD type 1 with multiple different recurrent abnormal flashbacks, one from each moment of mental shock.  These two symptoms come together with many other anxiety-related symptoms in addition.  PTSD type 1 isn’t cured by conventional medication and talking therapies, helpful as the can be for some, and PTSD type 1 persists life-long if it’s not cured.  It is PTSD type 1 that is the World’s scourge, causing endless distress and all-too-often, suicides.

What is PTSD type 2 ?   It is a generic (meaning one of many similar) anxiety disorders — it is triggered by mental trauma, including by a mental shock.  It has no unique clinical features of vision or memory and its  anxiety-related symptoms are common to other anxiety disorders, including PTSD type 1 (which always has its two unique anxiety-related symptoms).  PTSD type 2 tends to resolve spontaneously over a long time, with or without treatment.

Since they are biologically different, both PTSD type 1 and type 2 can be  present together in the same person at the same time, both having been triggered at the same time by the same mental shock.  When both are present they both have to be treated separately — just curing PTSD type 1 leaves PTSD type 2 to be cured, and vice versa.   Mental shock causes some people to have PTSD type 1 and some people to have PTSD type 2 and some people both.  Only mental shock causes PTSD type 1. . Other mental trauma, not just mental shock, can cause PTSD type 2.

In many people, mental trauma with or without mental shock causes nothing at all, or builds up their resilience to trauma. People have different vulnerabilities to the development of PTSD type 1 and/or type 2 in response to mental trauma of any type or severity.  PTSD type 1 can only be diagnosed with certainty in those of 5 to 6 years or older.

‘Complex PTSD’  cannot be just one specific clinical disorder.  It can be, for example, when PTSD types 1 and 2 are there together, as they commonly are, either from the same mental shock or different traumatic experiences at different times, or, it can be when PTSD type 1 and/or type 2 are there with any other mental disorder and/or physical disorder (e.g. physical injuries).

So, the Answer  to —  Can  MDMA+PT ‘cure’ PTSD type 1 ?   Since it can be simply proved that properly performed EMDR can cure PTSD type 1 for some people but not all people with PTSD type 1  (how it can be simply proved is explained below, and in more detail in < ptsd.net > Section 7) then it could be simply proved whether or not MDMA+PT can cure PTSD type 1.   There is plenty of anecdotal clinical evidence that EMDR+PT can certainly make PTSD type 1 very much less severe, easier to live with.  If MDMA+PT cannot cure PTSD type 1 on its own then perhaps it can be used in conjunction with EMDR to cure PTSD type 1 in some.  (The use of cannabis derivatives (e.g.CBD) may also make EMDR possible for some with PTSD type 1 by mitigating its severity for patients who cannot otherwise tolerate re-evoking an abnormal flashback .)

Can MDMA+PT or EMDR ‘cure’ PTSD type 2? Answer: EMDR has no effect on PTSD type 2. There are many conventional  ‘cures’ for PTSD type 2, and it can resolve spontaneously over time – cure itself.   Using MDMA together with likely-to-be-effective-on-its-own Psychotherapy might be be somewhat of an overkill.

(The full, fully-testable clinical evidence base for a more specific definition of PTSD types 1 and 2 is given in < ptsd.net >. What follows here is a summary of that more detained website.  The  supporting evidence can be simply tested by anyone who is involved with ‘PTSD’. )   

Part 2   

Part two (a)  The ‘new’ evidence for the two different PTSDs.

Observations, tiny bits of ‘new’ evidence coming from nowhere, are facts. Those ex-soldiers’ simple observations in 1946 are facts. Facts are evidence. When several people report, testify, that they have observed the same thing, the evidence becomes more reliable, the facts more believable. Only those reporting observations of what’s going on inside their own heads, not authoritative outsiders, can have the first-hand experience of what it is they’re observing — no matter how complicated and unexpected their observations appear to be.   And since then, since those soldiers reported it, many more people with PTSD who weren’t soldiers have reported the same observation. A very simple visual test (see < ptsd.net > Section 3 and 5 for the descriptions of the visual abnormality and the simple test for it) can now detect whether or not people with PTSD can observe and report what those ex-soldiers, and others since, say they can observe.  What was being found later in the investigation, however, was some people with PTSD when tested for it say they never observe it, and others with PTSD say they always observe it when tested for it. Not surprisingly, many have thought and still think this to be a very flimsy bit of evidence to be taking any notice of.  But: when taking notice of it, does it mean there different sorts of people with PTSD or different sorts of PTSD in different people?  Facts don’t lie. Facts aren’t obliged to make things simple.

Part two (b)  The Investigation.

Those soldiers from WWII were being told by Dr Traquair to focus their eye on the stationary dot on the visual field chart for minutes-on-end without looking away — that was the way visual fields were tested at the time.  When doing so the soldiers noticed (they had observed) that stationary objects they could see in the outer part, the periphery, of their vision appeared to be waving about as though going up and down or side to side consistently and persistently.  It appears these soldiers hadn’t noticed this odd wavy vision until their visual field test. Presumably, like us all, they never spent any time staring at stationary objects for minutes on end, and if they did and noticed something appearing to start moving in the periphery, they’d immediately look to see what it was, and if nothing was moving they’d ignore it. Dr Traquair was busy examining their vision for something else.

These patients of his weren’t soldiers – just ordinary people.  Some patients who’d been in frightening accidents, said they had notice the wavy vision now and again. Some patients with ‘PTSD’ reported that they’d never never it at all, even when asked about it.  But a few patients with PTSD, immigrants from Southern Europe, said they’d certainly noticed it, couldn’t help but notice it. They said they persisting rhythmical wavy vision of everything they looked at, there all the time, seriously affecting their vision all the time, and whether their head and eyes were perfectly still or looking around. A description of this sort of ‘oscillopsia’  couldn’t be found in any text book.

But:  many people, with or without ‘PTSD’, when feeling extra-anxious and panicky about anything, commonly report brief and wildly chaotic wavy-vision everywhere they look, making them feel giddy. They then report that this all clears completely once the anxiety settles after an hour or so and their vision stays normal and giddiness goes. All doctors know about this. Not surprisingly, most doctors, including most ophthalmologists, have tended to ignore patients’ reports of any persistent and rhythmical waviness of vision if reported by people with an anxiety disorder of ‘PTSD’ for that reason.  The doctor is likely to say ‘it’s just the anxiety, it’ll go when you’re better’, even ‘it’s just called hysterical, just your imagination’. But for those with an anxiety disorder of ‘PTSD’ who had it, it never went away, and giddiness wasn’t part of it.  Some others with an anxiety disorder of ‘PTSD’ said they never observed it.  With this questionable confusion – was it ‘real’, was it ‘not real’  — led to the investigation: could it be ‘fitted in’ to a ‘PTSD’?

The psychiatrist-formerly-neurosurgeon investigated it — with the occasional help of an ophthalmologist, The on-going exploratory investigation lasted 30 years, a heuristic (learning-on-the-way) investigation.  The patients were of all ages over 5 years, from all walks of life and from many different countries (though mostly Europeans).  All patients, with or without complaints of vision of any kind, anxious or not, complaining of ‘PTSD’ or not, were asked to undergo a very brief and simple visual examination, later using the very simple visual test — all in addition to the usual psychiatric or psychological examination. The simple visual test mimicked Dr Traquair’s Visual Field test he used in 1946: patients steadily staring for several or more seconds with one eye at a time at a dot, and at the same time paying attention to the appearance of stationary objects seen in the periphery.   (See web page < ptsd.net > Sections 3 & 6 for details of the test.)  

Part two (c)   The Results of the Investigation

(i). This subtle abnormality of vision — now called ‘persistent peripheral oscillopsia’ or ‘PPO’ (‘osi-lop-sia’ is a Greek word for ‘wavy vision’) – was reported to be persistently present by some with ‘PTSD’ and not by others with ‘PTSD’.  The simple visual test proved to be sensitive, specific & reliable for the presence or absence of PPO in anyone over 5 years old. It is a simple test that anyone can perform on anyone anywhere and needs nothing special to perform it.    (See web page < ptsd.net > Sections 3 & 6 for details of PPO — & details of the simple visual test for it.)

(ii). Those with ‘PTSD’ who report they do have this abnormality of vision, persistent peripheral oscillopsia, report that they also have one or more recurrent abnormal experiential (re-experiencing) flashing-back memory recalls of the event(s) that caused their ‘PTSD’. These are always abnormal and frighteningly vivid physical and sensory re-experiencing — a vivid re-living of exactly what had been experienced during the intense anxiety, the fear, what was seen, what physical pain was felt, what was heard, what was smelled… during the brief moments of ‘mental shock’ at the tome of the traumatic event they had experienced that had caused their ‘PTSD’. These are called recurrent abnormal flashbacks for short

A patient’s report of PPO always predicted that there would be a patient’s report of at least one recurrent abnormal flashback. [See web page< ptsd.net > Sec. 6 for definitions of and descriptions of recurrent abnormal flashbacks & of mental shock.]

(iii). Those with ‘PTSD’ who report that they do not have PPO, having been tested for it, report that they do not have recurrent abnormal flashbacks of that abnormal form.

(iv). However,  most of those with ‘PTSD’, whether or not they have both PPO and recurrent abnormal flashbacks, do report that they often have very distressing and intense, but normal-in-form, distressing intrusive memories of very distressing experiences in the past  Those with PPO and recurring abnormal flashbacks report that they can easily tell the difference between the two different sorts of unpleasant returning memories.

(v). In 1989 there an exceptional clinical observation reported by Dr Shapiro, a US Psychologist: Dr Shapiro published ‘A Cure for ‘PTSD’ (the first ever).  She had discovered accidentally that some people with ‘PTSD’ reported that they can be permanently cured of their recurrent abnormal flashbacks, and hence cured of ‘PTSD’, by a technique Dr Shapiro called ‘Eye Movement Desensitisation and Reprocessing’ (EMDR).  Following EMDR the recurrent abnormal flashback was reported by the patients to have changed change permanently to a normal form of intrusive distressing memory of that same moment. (EMDR is explained in detail in < ptsd.net > Section 7. Anyone can easily learn to perform EMDR. It costs nothing to do & nothing special is needed to do it.) Although EMDR was very effective for some patients with ‘PTSD’ and recurrent abnormal flashbacks, it was not effective for all patients with ‘PTSD’ and recurrent abnormal flashbacks. Nor was EMDR effective for patients with ‘PTSD’ who had no recurrent abnormal flashbacks. Dr Shapiro said she never tested for PPO in any of her patients, or even knew of it. Despite this exceptional report of Dr Shapiro’s, her EMDR treatment was ignored by most psychiatrists, seemingly because of the oddity of the mode of treatment and the unpredictability of its success for all patients with ‘PTSD’.

(vi). In 1990, a year after Dr Shapiro’s publication, some patients included in the psychiatrist’s investigation mentioned above reported to the psychiatrist that when properly performed EMDR was effective, a recurrent abnormal flashback was permanently changed, step by step, from an abnormal to a normal form of memory recall, and simultaneously, there was a step by step permanent disappearance of the persistent peripheral oscillopsia.  This was confirmed by the visual test being positive for PPO immediately before EMDR treatment and being permanently negative for PPO immediately after successful EMDR treatment and remaining negative subsequently. When EMDR was tried on patients with ‘PTSD’ who report no PPO on testing and no recurrent abnormal flashbacks then EMDR was reported to have had no observable effect on their PTSD.  And, inexplicably, properly performed EMDR was totally ineffective for some patients with PTSD with recurrent abnormal flashbacks and PPO.

(vii). The only conclusion that can be drawn from this last-mentioned observation: There must be a firm relationship between the two different unique and abnormal clinical features — persistent peripheral oscillopsia, and, recurrent abnormal flashbacks: they come together, they stay together and, can go together and stay gone with properly performed EMDR. In those for whom they do not go together with EMDR they stay together indefinitely.

(viii). One conclusion that must be made from all (i) to (vii) above together: There must be two forms of the anxiety disorder ‘PTSD’ – two different forms that can often appear to be superficially almost indistinguishable from each other clinically, but they must be very different biologically, Viz: –

(ix). One form can now to be called Anxiety disorder PTSD type 1  It always has two unique and abnormal clinical features: (a) a recurring abnormal flashback, an abnormal form of memory recall of the event that caused the PTSD type 1, and, (b) a subtle abnormality of vision, persistent peripheral oscillopsia (PPO).  Patients’ with PTSD type 1 report that their PTSD type 1 does not resolve (is not eliminated) spontaneously over time.  Many, but alas not for all with PTSD type 1, report that their PTSD type 1 can be eliminated i.e. permanently cured, ‘a pathologic complete response’, with properly-performed EMDR.  It can be proved to have been cured by testing for the presence of PPO immediately before EMDR treatment and testing for the absence of PPO immediately after EMDR treatment. At present, if it cannot be resolved with EMDR then patients report that it persists life-long.  This ‘proof’ is the challenge for any treatment aimed at ‘curing’ PTSD type 1, including MDMA+PT. There are many conventional palliative treatments for PTSD type 1 (i.e. helpful-but-not-curing treatments aimed at decreasing the severity of the symptoms), mainly of talking (CBT, Psychotherapy) and or medication – including some ‘medications’ not routinely prescribed, e.g. controlled MDMA, cannabis derivatives. At present, there have been many with PTSD type 1 for whom no treatment was adequate, and they have preferred suicide to continuing to live with it.

(x). The other form can now to be called Anxiety disorder PTSD type 2. (This is for all the other ‘Trauma- and Stress-Related Disorder that are not PTSD type 1 (i.e. ‘not PTSD’ as per DSM 5 and ICD 11) PTSD type 2 has no abnormal clinical features of memory or vision. For most people with PTSD type 2 it can be permanently resolved — either spontaneously over time or hastened to resolve with conventional treatments of talking and or anti-anxiety medications, medications routinely prescribed or not routinely prescribed. It is reported to persist life-long if traumatising circumstances, for example persisting physical disabilities, relationship breakdowns, unemployment, poverty, homelessness, endless overwhelming awful memories, keep it going. PTSD type 2 does not respond at all to EMDR. Some with PTSD type 2 and overwhelming traumatising circumstances have preferred suicide to continuing living with it.

(xi) Since both PTSD types 1 & 2 can have identical non-specific anxiety related symptoms, mentioned above and of any severity, then types 1 & 2 can appear clinically indistinguishable unless the presence or absence of the two uniquely abnormal clinical features of PTSD type 1 are clinically sought – the one visually tested for, the other asked about.

(xii). So-called Complex PTSD is undefinable as a specific clinical entity: It can be e.g. when PTSD types 1 and 2 are there together as they commonly are, either from the same mental shock or different traumatic experiences, or, when PTSD type 1 and or 2 are there with any other disorder, mental and or physical. If PTSD Type 1 is eliminated (e.g. with EMDR) then PTSD Type 2 and any other disorders, if concurrently present, will remain, and vice versa if PTSD type 2 and other disorders fade away and PTSD type 1 remains unresponsive to EMDR.

(xiii). The only conclusion that one can now draw from (i) to (xii) above: PTSD types 1 and 2 must have separate and different brain pathologies (different particular things having gone wrong in the brain) enabling both to be there at the same time.

 

Part two (d)  What is the neurobiology of PTSD type 1 and What is PTSD type 2 — the abductively reasoned-from-the-evidence neurobiological explanation. 

Clinically involved senior geneticists and others (two of the geneticists having themselves experienced PTSD type 1 successfully responding to EMDR), having taken into consideration all relevant reported clinical observations, abductively reasoned from the evidence their most probable neurobiology explanations for the two different neurobiological pathologies.

(i). The Anxiety Disorder PTSD type 1:  For some vulnerable people, a sudden surge of anxiety, a ‘mental shock’, can trigger an instant epigenomic alteration to the function of some DNA in that section of the brain currently concerned with the memory processing of the emotional, visual and sensory experiences during that momentary sudden surge of anxiety.  The altered  function of that functionally altered DNA causes an instant abnormal form of memory processing of those experiences of the circumscribed moment of ‘mental shock’: all the sensations, including the anxiety, that were being experienced during that circumscribed moment of mental shock, are locked-in in abnormal form, i.e. incompletely processed.  Whenever that incompletely processed memory is recalled those sensations are re-lived, not just remembered, as a recurring abnormal (‘re-experiencing’) flashback.  The ‘permanently locked-in anxiety’, being there all the time, is responsible for the symptom of persisting anxiety, and, the anxiety is responsible the persisting anxiety-related symptom of abnormal persisting peripheral oscillopsia.

Properly performed EMDR can (not always does) bring about epigenomic reversal in PTSD type 1 —  allowing normal memory processing of the contents of a recurrent abnormal flashback to proceed to a normal form of memory and memory recall of the frightening experiences (i.e. a normal memory recall with no sensorial re-living (re-experiencing) of the frightening experiences), a loss of the abnormal anxiety, and, a loss of the anxiety-related persisting peripheral oscillopsia PPO, that only re-appears if there is a further PTSD type 1 with another recurrent abnormal flashback .  That means a permanent elimination of PTSD type 1.  When there are more than one abnormal flashback, then each requirers individual EMDR epigenomic reversal before PTSD type 1 is fully eliminated.

There is no abductively reasoned explanation for how EMDR can bring about epigenetic reversal for some with PTSD type 1, nor why not for others with PTSD type 1 – responsiveness to EMDR appears related to the genome of the patient. (See < ptsd.net > Section 8 for the relationships between genome and PTSD type 1)

(ii). The Anxiety Disorder PTSD type 2.  There are no epigenomic changes, so there are no uniquely abnormal clinical features. It is reasoned to be the anxiety disorder resulting from normal fear-responses to mental shocks or other fearful or distressing mental traumas being abnormally-amplified and slow to resolve.  PTSD type 2 can resolve spontaneously over time, with the resolution time likely to be shortened by conventional treatments. PTSD type 2 does not respond at all to EMDR.

Part two (e)  In Summary:

(i). PTSD types 1 and 2, alone or together, can be of any subjective severity, triggered by a mental shock in response to experiencing an event of any objective severity. Both types may be cumulatively re-triggered later by experiencing subsequent events of any objective severity.

(ii). PTSD type 2 can also be triggered and re-triggered by experiences of non-specific mental trauma over time i.e. without a mental shock.

(iii). PTSD type 1  can be diagnosed at age over 5 years via the simple visual test for the presence or absence of PPO, and treated by EMDR, despite other disorders being present, including PTSD type 2. EMDR may or may not be effective for PTSD type 1.

(iv). The simple visual test can confirm the treatment success or failure of PTSD type 1 i.e. the confirms the conversion of all, perhaps of many different recurrent abnormal flashbacks, to memories in normal form.

(v). EMDR treatment for PTSD type 1 can be properly-performed anywhere on anyone 5 years or older by anyone having learned the simple instructions [see < ptsd.net > Section 7].

(vi). PTSD type 1 that is unresponsive to properly-performed EMDR requires life-long conventional and or unconventional palliative measures to lessen its severity. MDMA+PT may prove to cure PTSD type 1. If it does not cure PTSD type 1 then it may make it easier for properly performed EMDR to be available for those in whom the severity of the recurrent abnormal flashbacks had previously made EMDR impossible for them to tolerate. There may well be some whose human genome prevents any epigenetic reversal, even with the aid of MDMA+PT.

(vii). PTSD type 2 requires conventional psychological and or psychiatric treatments as soon as practicable and for as long as helpful, but not EMDR.

There are two currently Persisting Problems for some people with PTSD type 1

(i). Current therapists do not test for PTSD types 1 or PTSD type 2, and most ignore EMDR. This leaves some doubt as to whether or not PTSD type 1, responsive or unresponsive to EMDR, is being permanently eliminated by other treatments, including MDMA+PT, EMDR, CBT, Exposure …. or, just being temporally or permanently lessened in its severity by those other treatments.

(ii). There is no evidence of any current research specifically devoted  to other ways of bringing about epigenomic reversal for those patients with PTSD type 1 not responding to EMDR – though  there is anecdotal evidence that MDMA+PT may be doing this. 

See <ptsd.net>, <ptsd.net/cases> & blogs, incl. author c.v.  Author Email: ptsd.net@hotmail.com

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