Book Review: The Time Cure

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Most scientists are reluctant to talk about “curing” mental illness, and rightly so. The mountain is too steep: These disorders have a range of genetic and environmental causes, and symptoms vary widely from person to person. But for post-traumatic stress disorder (PTSD) — in which people are haunted for months or years by memories of a life-threatening event — that framework is all wrong.

So says The Time Cure, a book out later this month claiming that people with PTSD can find long-lasting relief by simply re-framing their concept of time. The authors outline a new clinical approach, dubbed Time Perspective Therapy or TPT, which they say is far more effective than any other treatment.

The book includes a lot of common-sense advice: Focus on good rather than unpleasant memories, find enjoyable hobbies, fraternize with a supportive community, make realistic goals. Following these simple directives would no doubt help many people, sick or not, improve their lives. Still, given the millions of people who suffer from PTSD, heralding a cure seems an act of hubris — especially when the evidence is limited to a small (and not peer-reviewed) clinical trial and more than 100 pages of poignant personal stories.

One of the authors, Philip Zimbardo, became super-famous in 1971 with his Stanford Prison Experiment, in which volunteers pretending to be guards became cruel while those playing prisoners became severely depressed. Since then, Zimbardo has turned his attention to the way we perceive time.

As he described in The Time Paradox, released in 2008, Zimbardo’s research suggests that each of us has a biased time perspective. Some are stuck in the present, reveling — or stewing — in their current sensory experience with no sense that their actions will matter later on. This is the perspective in which he was raised, he says, by immigrant parents who never made it out of poverty. But other people, like the typical Stanford undergraduate, are oriented toward the future, constantly making to-do lists or fretting about how to make the best possible decision. Happiness, Zimbardo says, means finding a healthy balance.

After The Time Paradox came out, Hawaiian therapists Richard and Rosemary Sword told Zimbardo that they had successfully applied many of these principles to their clients, mostly war veterans with PTSD. Zimbardo wanted to see “hard data.” So in 2009 the trio began a study in which 30 of the Swords’ clients, all veterans, took an array of psychological tests — including the Zimbardo Time Perspective Inventory, a questionnaire that quantifies how much you focus on the past, present or future — before, during and after TPT.

In the new book, the Swords and Zimbardo present what appear to be stunning results from this pilot study. After six months of therapy, 89 percent of participants showed fewer symptoms of depression, 70 percent had less anxiety and 52 percent showed less trauma. The authors also explain how to carry out TPT and describe in detail the success stories of 15 people who tried it.

Take, for example, Aki, an 88-year-old Japanese American who suffered from flashbacks and insomnia six decades after fighting in the front lines in Germany during World War II. Aki was fixated on the night in 1945 when all of the other soldiers at his base camp were accidentally killed by American friendly fire.

A big part of TPT treatment is framing. Rather than use the charged words of “anxiety” and “depression,” for instance, the authors prefer to describe clients like Aki as “stuck in the past negative.” Rather than calling PTSD a mental illness, which seems oppressive and hopeless, they call it a mental injury.

In Aki’s first TPT session, he was told that whenever his mind took him to that awful night, he should think instead of the happy times with his war buddies, like the day they were camped near an onion field and made a foul-tasting onion soup. In the second session, the therapists nudged him to join a morning meeting of other local vets. In later sessions, they focused on how he could improve his future, by walking three miles a day and planning for a veterans convention in Las Vegas.

Aki’s therapy, we learn, was “surprisingly easy for him to do,” and was far more effective than the years he had spent using the current gold-standard treatment for PTSD, cognitive behavioral therapy or CBT. With CBT, the patient evaluates specific thoughts and feelings, ferrets out those that aren’t rational, and sets goals for the future. Sounds an awful lot like TPT, no?

And there lies the most troubling aspect of an otherwise harmless self-help book. The authors repeatedly and explicitly claim that TPT is more effective than CBT. Not only do they fail to fully explain how the two therapies are different, but they dismiss the fact that several large and placebo-controlled clinical trials have found that for a subset of people with PTSD, CBT works.

In the introduction, Zimbardo admits that he would have preferred to hold the book until conducting a formal study, but didn’t because he lacked the necessary funding of several million dollars. In choosing to publish now, he may create a buzz around this new therapy, and that buzz may lead him to funding and, eventually, to solid evidence for TPT. But in the meantime, the book could just as easily push people with PTSD to choose an untested treatment over a proven one. Only time will tell, I suppose.

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Photo of onion field by Dick Thomas Johnson

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6 thoughts on “Book Review: The Time Cure

  1. “In the introduction, Zimbardo admits that he would have preferred to hold the book until conducting a formal study, but didn’t because he lacked the necessary funding of several million dollars. In choosing to publish now, he may create a buzz around this new therapy, and that buzz may lead him to funding and, eventually, to solid evidence for TPT.”

    It’s a bold new take on the scientific method, ladies and gentlemen! First you publish your conclusions. Then you devise your experiment. Then you secure funding for testing your hypotheses. Genius – it’s bizarre that other scientists have been using the boring normal method for so long rather than this ass-backwards but far more convenient variant.

  2. Thanks for this thoughtful post!
    I’m always interested in the newest pop psychology on PTSD. Based on my limited experience (I did about 5 years of CBT treatment for PTSD with occasional tune-ups since), TPT sounds like a new age take on CBT.

    I took the two inventories on the TPT website. At the risk of being TOO self-revealing, my scores are below.

    A few observations about the inventories…
    The authors use six scores of “temporal dimensions” to rank my “time perspective.” An average score and a score of “an ideal time perspective” are provided for comparison. The “ideal” perspective is SUBSTANTIALLY above (or below) average for 5 of the dimensions; 3 at 90% and 2 at 80%. The other dimension, “Transcendental-future Time Perspective,” seems to be a measure of religiosity and their “ideal” score is set at 50%. Thus, the hope seems to be that mentally injured individuals will not attain a mere average “time perspective,” but an extraordinary one.

    Here’s what I learned about myself.
    1. I’m WAY below average on “present-hedonistic.” I am currently developing personal goals to raise my score.
    2. I flunked “Transcendental-future Time Perspective”. I don’t believe in fate, spirits or life after death. I’m an atheist. The cards were stacked against me on this one.
    3. My “past-negative” dimension reveals that I have negative memories and thoughts about my past. They nailed it! Indeed, my past is far above average in negatives. That is why I spent 5 years in PTSD therapy. This particular dimension seems dishonest to me. It’s a respectable goal to replace negative thoughts with positive thoughts, but the goal of replacing nearly all negative memories with positive ones, well, there’s a limit to that if one wants to stay in touch with real life.
    4. On the other 3 dimensions, I’m right on target for “ideal.” In those cases, I’d say that CBT treatment did me some good. Also, I am an optimistic and future-oriented person by nature.
    5. I’ll admit that I didn’t have the patience to figure out my Time Perspective Type. That part was like reading the longest Cosmo quiz EVER.

    Overall, TPT looks to be a watered down repackaging of CBT explained in creative new language. I can see that the language would appeal to many – it is much more optimistic and less clinical that the language I used in treatment (I was asked to rate my level of mania, for example). Aside from the explicit religious/spiritual content of the Transcendental-future Time Perspective, concepts I never encountered in CBT, this presentation of TPT doesn’t add anything noticeable to the approach.

    Zimbardo Time Perspective Inventory
    (with my score, average score (set to 50%), “ideal” score*, percentile of “ideal” score)
    Past-negative: 2.90, 35% (avg. 3.0, ideal 2.1, 10%)
    Past-positive: 3.56, 80% (avg. 3.22, ideal 3.67, 90%)
    Present-fatalistic: 1.67, 10% (avg. 2.33, ideal 1.67, 10%)
    Present-hedonistic: 3.13, 5% (avg. 3.93, ideal 4.33, 80%)
    Future: 3.62, 70% (avg. 3.38, ideal 3.69, 80%)
    Transcendental-future Time Perspective: 2.10, 15% (avg. 3.4, ideal 3.4, 50%)

    *The “ideal” score is marked with a red dot on the Time Perspective Scale: “The red dots and lines are not associated with the data in any way. It is simply our idea of what an ideal time perspective looks like.”

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