Treating Trauma and Providing Care: A Spotlight on Dr. Albert Tsai

Albert Tsai, MD is no stranger to treating PTSD and trauma. Introduced to military psychiatry after serving 3.5 years in the military following medical school, he completed his residency in the middle of the Afghanistan mission. “There's a certain special stress related to being a police officer, fire officer, paramedic, or a paratrooper at Fort Bragg who jumps out of airplanes for a living in anticipation of invading a place or getting to a very austere place full of people who want to shoot you, or more often blow you up.”

The Root Causes and Impacts of PTSD

Dr. Tsai frequently refers to those who suffer in silence as the most frequent type of trauma patients. “It’s this quiet pandemic of complex PTSD, this recurrent invalidation and resentment.” And while the military is very specific in diagnosing PTSD if and when it is very clear, Dr. Tsai states that being out of the military, he interprets anything that causes helplessness or hopelessness as trauma. “That threshold is much lower for me to diagnose.”

Dr. Tsai references patients who grew up normalized to constant critiques or judgments from volatile, explosive parents; others who considered corporal punishment as the standard. “Their norms are really shifted to the point where you have to do a lot of education and a lot of work to convince them that this is no longer the norm.”

As a clinician, Dr. Tsai falls into the category of therapists and mental health providers who don’t merely believe in a biological predisposition for mood, anxiety and trauma-related disorders. Rather, there is some social milieu in which this occurs. In his experience, if the patient hasn't shared it, or is hiding or guarding it due to vulnerability, the therapeutic relationship between provider and patient becomes increasingly critical. “It’s only with time and building up a therapeutic relationship that these stories start to come out.”

Trauma-Specific Treatment Modalities

When it comes to specific modalities used to treat trauma, Dr. Tsai has several in his arsenal. In addition to exposure-based therapies designed to talk about family-systems, he mentions EMDR (eye movement desensitization retraining) and CPT (Cognitive Processing Therapies). “A lot of ACT (Acceptance and Commitment Therapy) and DBT (Dialectical Behavioral Therapy) deals with coping skills and education about what to do with traumatic thoughts, associations with anxiety and panic, and urges to participate in certain unhealthy behaviors -- versus the cognitive processing and family systems integrations therapies that really begin to unpack the triggers.”

Of course, implementation begins with realigning with patient goals. When people arrive at residential treatment, they are often so affectively dysregulated that they are unprepared for some of these modalities. Clinicians will try to get patients in a healthier space with a focus on behavior activation and self-care. Some patients are arriving directly from situations with domestic violence, others from a toxic situation at either home or work. Dr. Tsai explains, “It takes a bit of time for them to say, ‘yes, I want to start Cognitive Processing Therapy.’”

Trauma responses can be inherently challenging: similar to training our bodies for physical activity, we begin to train new neurons to effectively handle stressful situations. In the beginning of psychotherapy, some people report troublesome new nightmares or more anxiety. From Dr. Tsai’s perspective, part of this involves giving reassurance that some of this is expected as we reawaken old muscles or old memories. “You're going to have some of these responses, but this is part of your brain getting stronger.”

Trauma Management and Destigmatization

To Dr. Tsai, trauma isn’t something you cure: it’s something that you manage over time by integrating effective medication management with the practice of mindfulness-based cognitive therapy and grounding techniques. “With mental health approaches, part of it is minute by minute, through reassurance, gratitude, deep breathing, journal-writing...and then they'll start to see this improves quality of life; they can practice it just like brushing teeth.”

Dr. Tsai reports that his objective is to shift the paradigm surrounding trauma, and to help people understand it is not shameful. He reports that trauma and invalidation of that trauma is fairly ubiquitous and widespread. When someone feels invalidated, such as a sexual assault victim who is not believed, they then suppress the realities that a trauma occurred.

Many people are often ashamed to admit to symptoms of depression and anxiety because they think that means they are emotionally weak or weak-minded. Dr. Tsai says he regularly encounters people who associate the term “mental health” with being weak-minded, rather than taking care of the brain as one would a physical illness or injury. The key to overcoming and returning to a state of mental health and resiliency lies in the patient’s ability to redirect their thoughts and engage in effective treatments by forming a therapeutic alliance with caregivers. "You never forget these traumatic events, but the way you respond changes. And if we can reduce the impact on the emergency rooms and the outpatient teams -- that's what I think our mission is about.”