Treatment for PTSD: More Nightmares

“Going in for therapy at a Veterans Affairs hospital is a lot like arriving at a large airport in a foreign country. You pass through a maze of confusing signage… There are long lines you must stand in and a series of bureaucratic rituals that must be endured before anything resembling a human encounter occurs. Little did I know that the delay in treatment would be less agonizing than the treatment itself.” By D. J. Morris NYT

ESL Voices Lesson Plan for this post with Answer Key

Photo credit utahsbestterapy

Photo credit utahsbestterapy

Excerpt: After PTSD, More Trauma By David J. Morris NYT

“My first session began with my therapist, a graduate student finishing up his doctorate in clinical psychology, offering a kind of apology. Now, I’m probably going to make some mistakes and say some stupid things,” he said. Are you going to be O.K. with that?

I understood. Two decades before, as a newly minted infantry lieutenant in the Marine Corps, I’d been charged with the welfare of a platoon of 30 young Marines. Too often my best wasn’t good enough, and I made a number of errors in judgment while in command, errors that bother me to this day. Offering my therapist some grace seemed like my only option.

I’d come to the V.A. for a number of reasons…Occasionally I had weird dreams about the war that mixed people and places from my time in the Marines with my time in Iraq. But what really concerned me was something that happened a few years later. I was sitting in a movie theater with my girlfriend when the world suddenly went black. When I regained consciousness, I was pacing the lobby of the theater, looking at people’s hands to make sure they weren’t carrying weapons.

A year or so after the episode at the movie theater, with my symptoms not improving, I went to the V.A. for help.

There are two widely used treatments for PTSD at the V.A. One is called cognitive processing therapy. The other is prolonged exposure therapy, the effectiveness of which the V.A. heavily promotes. After explaining my symptoms to the intake coordinator, I was told that prolonged exposure was the best therapy for me. 

But after a month of therapy, I began to have problems. When I think back on that time, the word that comes to mind is nausea.I felt sick inside, the blood hot in my veins.

My own disappointment is that after waiting three months, after completing endless forms, I was offered an overhyped therapy built on the premise that the best way to escape the aftereffects of hell was to go through hell again.

A month after dropping out of prolonged exposure therapy, I began a treatment of cognitive processing therapy at the V.A. Here, our group was asked to examine our thoughts and feelings about our war experiences without revisiting specific traumas. This has helped.”

ESL Voices Lesson Plan for this post

Level: Intermediate – Advanced

Language Skills: Reading, writing, and speaking. Vocabulary and grammar activities are included.

Time: Approximately 2 hours.

Materials: Student handout (from this lesson)  and access to news article.

Objective: Students will read and discuss the article with a focus on improving reading comprehension and learning new vocabulary. At the end of the lesson students will express their personal views on the topic through group work and writing.

I. Pre-Reading Activities: Brainstorming

Directions: Place students in groups, ask students to think about what they already know about  Post-traumatic stress disorder (PTSD).  Next, have students look at the picture(s) in the text and generate ideas or words that may be connected to the article. Debrief as a class and list these ideas on the board.

Brainstorming chart by UIE.

Brainstorming chart by UIE.

II. While Reading Tasks:Word -Recognition

Directions: Students are to circle or underline the correct word or phrases from the article. This exercise reinforces students’ attention on words that have been introduced in the reading. Have them skim the article to check  their responses. Students should also find the meanings for all unknown words.

My first session/season began with my therapist, a graduating/graduate student finishing up his doctorate/doctor in clinic/clinical psychology, offering a kind of /apologetic/apology.

I understood. Two decades/decode before, as a newly mind/minted infantry lieutenant in the Marine Corps, I’d been charged with the welfare of a pluto/platoon of 30 young Marines. Too often my best wasn’t good enough, and I made a number of errors in judges/judgment while in command, errors that bother/brother me to this day. Offering my therapist some grace seemed like my only option.

Vocabulary: Word Inference

Directions: Students are to infer the meanings of the words in bold taken from the article. They may use a dictionary, thesaurus, and Word Chart for assistance.

  1. My first session began with my therapist.
  2. I’d been charged with the welfare of a platoon of 30 young Marines.
  3. I made a number of errors in judgment.
  4. I’d come to the V.A. for a number of reasons.
  5. I had weird dreams about the war.
  6. Post-traumatic stress disorder has stalked me for most of my adult life.
  7. You may not have PTSD, but most of your fellow citizens assume you do.
  8. Prolonged exposure therapy was developed in the 1980s.
  9. Some survivors find that the only way to feel safe is to restrict their daily routine.
  10. It was a difficult, emotionally draining scene to revisit.

 Grammar Focus: Structure and Usage

Directions: The following groups of sentences are from the article. One of the sentences in each group contains a grammatical  error. Students are to identify the sentence (1, 2, or 3 ) from each group that contains the grammatical error.


  1. After being discharged  I working as a reporter.
  2. I was nearly killed by an improvised explosive device.
  3. Occasionally I had strange dreams about the war.


  1. There are two widely used treatments for PTSD.
  2. One is prolonged exposure therapy.
  3. The treatment worked for about 85 percent of people.


  1. I had collected a number of near-death experiences.
  2. I ride in a helicopter that was nearly shot down.
  3. Within a few weeks, my body returned to normal.

III. Post Reading Tasks

Directions:  Have students use this advanced organizer from Write Design to assist them with  discussing  or writing about  the main idea and points from the article.Main idea chart By Write Design

Discussion/Writing Exercise

Directions: Place students in groups and have them answer the following questions. Afterwards, have the groups share their thoughts as a class. To reinforce the ideas, students can write an essay on one of the following discussion topics.

1. The following  three statements were taken from the article. Rephrase each one in your own words, then discuss the meaning with the members of your group.

“There are two widely used treatments for PTSD at the V.A. One is called cognitive processing therapy. The other is prolonged exposure therapy…The promise of prolonged exposure is that your response to your trauma can be unlearned by telling the story of it over and over again. The patient is asked to close his eyes, put himself back in the moment of maximum terror and recount the details of what happened. According to the theory, the more often the story is told in the safety of the therapy room, the more the memory of the event will be detoxified, stripped of its traumatic charge and transformed into something resembling a normal memory.”

“Prolonged exposure has worked for many people. It has arguably the best empirical support of any PTSD therapy currently in use by the V.A.One recent study found that among veterans who completed at least eight sessions of treatment, prolonged exposure therapy decreased the proportion who screened positive for PTSD by about 40 percentage points. But the treatment may not be as effective as the V.A. would have you believe: About a quarter of the veterans in that study dropped out of the treatment prematurely, much as I had.”

“After my experience with prolonged exposure, I did some research and found that some red flags had been raised about it. In 1991, for example,Roger K. Pitman, a professor of psychiatry at Harvard Medical School, conducted a study of exposure therapy on Vietnam veterans and observed some troubling complications: One subject developed suicidal thoughts, and others became severely depressed or suffered panic attacks.”


Directions: Allow students 5 minutes to write down three new ideas they’ve learned about the treatment  for PTSD from the reading,  two things they did not understand in the reading, and one thing they would like to know that the article did not mention. Review the responses as a class.


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