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Comment by fasthands9 | Hacker News Reader

I'm still a bit confused - sorry if I don't sound earnest.

This drug eliminates the amount of time you think about a past event. This is pitched as good. Is the model that thinking about something is bad but talking about something is good? What if talking about something changes how or when you think about something? As you said with your co-worker example (which I realize is not PTSD levels) I think it could be pretty easily argued that fixating about your current situation is actually contributing to negative mental processes.

I have done therapy for specific issues and it worked for me - but nonetheless still dont see some contradictions between therapy and a pill that makes you think about something less.

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Much of the therapy I have been involved with has been arranged not just around dealing with negative thoughts, but more fundamentally getting into a position where you can approach negative thoughts without moving into a triggered state.

I think I get what you're saying; I could, for instance, just drink a lot every day to ignore a variety of ideas, but it's much healthier in the long run to deal with those ideas directly.

Unfortunately, the reason why there are so many palliative coping strategies is that unless a person is in a state where they can examine those uncomfortable thoughts, then it's just creating more harm and the person isn't able to deal with the issue. That in turn often leads to the maladaptive coping that leads people into therapy in the first place.

So a common therapeutic goal getting people to a point where they can first recognize that they are in an upset state, second calm themselves without totally disengaging from the event and, then (if possible) work on whatever thoughts or events led to becoming upset in that manner.

That work is contingent on the first two parts of that; palliative care to help people get into a place where they can do the first two things without engaging in more harmful types of coping strategies (drinking, for instance) seems like a reasonable method.

Right. I think I mostly agree with you. Perhaps I just think involuntary/intrusive thoughts in the study is a bit of a loaded term. These words to me sound implicitly negative - but unless they resulted in serious negative behaviors then I don't see why they should be considered such a negative. From my own perspective it seems that even if my own thinking about something a lot may not be as effective as therapy or meditation, thinking about something does help process it and does help you come to a similar calmness about it.

The drug in the paper, to me, seems more like the coping strategies you talk about but without the other physical harms. Like what if alcohol made you not think about something but actually kept your physical and mental health the same/stable? Would that be desired? Isn't that what this drug is hoping to achieve?

This is a pre-clinical study that is designed to model an aspect of a "traumatic" event and assess how the treatment condition (hydrocortisone) can affect behavior. Moreover, this experiment is designed to probe the effects of trauma in the moments immediately after the traumatic event, where the stress response is initiated. This is likely the period of time where the most synaptic changes occur. Of course, this paper doesn't directly posit that forgetting thoughts associated with trauma is therapeutic, as that would require an empirical study that include patients with PTSD.

Also, the purpose of therapy, such as CBT, is not to fixate on one's current situation, but be able to unlearn feelings of trauma / anxiety from the event. This is done by engaging with a trained professional who can help the patient carefully break down their thoughts and feelings. Reflecting on a traumatic situation with a partner is different from reflecting on a traumatic situation amongst oneself.

It eliminates the times you uncontrollably think about a past event - note that voluntary recall isn't affected. So it's saying that this lets you process the trauma in a controlled environment when you're in a position to deal with it, but otherwise resume a life that isn't interrupted or dominated by it.

I think there's a difference between (mediated) constructive reflection with the goal of processing an event, and Repetitive Negative Thoughts (RNT) about an event. The latter can of course have long lasting negative effects.

I think it's probably better to reflect on and process a _potentially_ traumatic event, than it is to repress or otherwise force yourself to forget it. But either of those is preferable to dwelling on it and spiraling in negativity.

Perhaps this is just a matter of degree. For really bad trauma (mass casualty, etc) it's probably good to have stronger tools available.

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