Time Perspective, Time Perspective Therapy, and PTSD
By Philip Zimbardo
Some years ago a young man I’ll call James came to see me in my Stanford University office for help with his shyness. In the course of our conversation about the origins of his awkwardness around people, he told me that almost everyone he met reminded him of someone who had hurt him or rejected him in the past, so he could not risk being open to them. And then he related a very interesting image: his life, he said, was organized around the eighty slides that he had arrayed in what he called his “Kodak Carousel mental slide projector.” Once the slide show started, the images were projected into his current consciousness in a predictable and reliable sequence. So his present sense was the slide on his mind’s screen, his past sense was the slide he just viewed, and his future sense was determined by the slide or slides coming up next. My first thought was that this seemed like a reasonable metaphor for memory.
What he told me next, however, was quite unsettling: James’s slide tray was filled with slides of negative experiences only—rejections, failures, missed opportunities, mistakes, miscalculations, bad deals, and more. His present sense, then, was always of a past negative event; his past sense was also of a negative event; and his anticipated future slide was always a predictable negative event from his past! Worse, his mental slide show was out of his conscious control—it could be turned on at any time by a triggering experience; so repeatedly viewing all of these horrific images of his past negative experiences, so vividly projected, further burned them into his brain.
I thought hard about a treatment plan, and arrived at a solution that seemed to fit his particular imagery. I informed James that Kodak had just developed a 120-slide carousel, which meant that he would now be able to add 40 new slides to his old show. I encouraged him to explore his memory to find any events that were positive: successes, good birthdays, friends, favorite foods, movies, books . . . and for each positive image he was able to recall, we created a new, vividly bright slide and inserted it randomly into his mental carousel. Although the negatives still dominated the set, there was now some occasional relief. He could see that his life had many good people, experiences, successes, and more that were balanced against the bad.
We gradually replaced more and more of the bad slides with good ones from recent positive experiences. Over a period of months, this impromptu treatment program began working to provide James with a more balanced, nuanced conception of his life over time and of his ability to shape his current life. It also had a profound impact on me, encouraging me to think more deeply about the nature of our temporal orientation and the real impact that our individual concepts of past, present, and future have on our lives.
In the early 1970s I began to investigate aspects of time perspective in earnest. This fascinating two-plus-decade journey (which you can read about in Chapter Two) led to the development of Temporal Theory and, in 1999, to the Zimbardo Time Perspective Inventory or ZTPI: a valid, reliable, and easy-to-administer measure of individual differences in time perspective.
By 2008 the ZTPI was being used by researchers around the world. The time had come to really go public—beyond academic publication for psychologists to trade book publication for the general public. The Time Paradox, coauthored with John Boyd, was the exciting culmination of much theoretical speculation and proposed new research projects. I thought this was the end of my professional journey with time perspectives, but it was not—I had yet to meet Richard and Rosemary Sword.
The Swords’ Work with PTSD and Time Perspectives
I was filled with joy when my first public presentation of our book was scheduled for a workshop at the Hawaii Psychological Association in Honolulu in 2008. At the end of my presentation, I was satisfied with how the session went and was looking forward to getting my reward—sunning on the beach in Waikiki. As I was packing up my gear, however, one of the participants came up to me nearly breathless with excitement over something I had said. Actually, it turned out his excitement was about everything I had said.
He told me that his name was Richard Sword, and that he was a therapist from Maui. For years, he said, he and his wife and colleague, Rose, had been working along the very same lines I suggested in the the Time Paradox with war veterans who had suffered from debilitating PTSD for years—some for over seventy years, since World War II—and having good results. He said that he envisioned using my ideas as a therapeutic strategy for curing that terrible affliction. I politely gave him my card and invited him to stay in touch. Although I was busy, I said, I would be alert for his e-mails if marked URGENT on the subject line. I assumed he was like many others who get enthused by my dramatic talks but then fade from sight. I could not have been more wrong.
It turned out that our guy, Rick, was a man of his word, and his words were filled with an intoxicating blend of optimism and wisdom. He had an uncommonly intense dedication to helping American veterans of many wars overcome their suffering. He would not be satisfied just ameliorating their suffering and trauma, he said—he wanted to manage their PTSD to enable them to return to fulfilling, meaningful lives. It was not enough for him to change their negative existence to a zero state of no bad focus. He would not be satisfied until these courageous vets could return to the positive state they had enjoyed before their service and sacrifice for their nation. That was Sword’s definition of a complete “cure” for PTSD in vets.
I have to admit, I first thought he was a bit of a wild-eyed visionary. I knew that PTSD had never been overcome by any therapeutic treatment; at best, it might be made somewhat more bearable. But I remained an open-minded skeptic, eager to be proven wrong (a view of what it meant to be a good scientist that had been drummed into me from my graduate training in the Yale University Psychology Department). We communicated a great deal via e-mail, ideas flowing back and forth.
Now, following the model of Temporal Theory, Rick and Rose began to put into practice a new form of time metaphor therapy treatment with their clients in Maui. I was encouraged, but was hardly a true believer. Their time metaphor therapy revolved around getting clients to reconceptualize their problems using visualizations in which they would become “unstuck” from the traumatic past and move smoothly into a more positive present and future. The Swords put all of this in the context of the importance of time in our lives, and the importance of balancing our past, present, and future time perspectives. The Swords’ notion of being able to shift flexibly from one timezone to another—depending on circumstances, current needs, and realities—seemed to be taking ZTPI into a new and exciting dimension of practical use. Still, ever the scientist, I was still skeptical of this simple therapeutic approach.
Time Perspective Therapy in Action
After I returned home from the conference I began receiving letter after letter from the Swords’ vets, describing to me the amazing changes they were experiencing from their treatment. They were euphoric, able for the first time in years to enjoy their wife, family, friends, former activities, going shopping, and more. They were no longer stuck in that horrible past that had gripped them for so long. They were starting to plan vacations and meet people they had been ignoring for years. They told me that their flashbacks had stopped and their smiling had resumed. And they were very eager to share their transformational experience with other vets who were still suffering from the agonies of PTSD.
Such astounding testimonials are rare for any kind of psychological treatment, and especially so when they come after only a few months of treatment. Yet my research training insisted on hard evidence to bolster these personal accounts. I encouraged the Swords and associates to gather pre- and post-treatment metrics on a variety of standard assessments of PTSD with a sufficiently large sample of Time Perspective Therapy–treated vets. They did, and the data supported what the vets had told me: the measurable impact of Time Perspective Therapy is highly statistically significant across a battery of standardized measures. It works!
And not only does it work but also it can be shown to have an enduring positive effect for years— at least three years (the current follow-up duration). Most of the initial salutary effects stayed in place for the majority of these Time Perspective Therapy–treated veterans over this extended time period. Presumably these effects will remain longer and ideally permanently when measured subsequently, perhaps complemented by some “booster shots” occasionally if there is backsliding.
Meanwhile, the testimonials kept coming. At the 2009 American Psychological Association convention in Toronto, I wrapped up my presentation on time perspectives by talking about the Swords and their groundbreaking work with veterans. As I scanned the audience, I saw someone waving at me—a woman in a wheelchair. She looked excited and clearly wanted to tell me something. After I finished my talk she came to the podium and told me enthusiastically that she was a veteran previously suffering from PTSD who had undergone Time Perspective Therapy with the Swords. She said it had helped her tremendously and that she was moving on with her life. Imagine my surprise—here, in Toronto, was a veteran to verify what I had just been sharing with this room full of thousands of mental health professionals!
Now we had a decision to make: Should we tell the world about this new form of therapy immediately, to give hope to those who have stopped hoping for improvement? Should we give guidance to therapists to add this type of therapy to their protocols for treating not only PTSD in vets but also all other time-synced traumas and abuses? Or is it better to wait until we conduct a formal clinical trial with hundreds of participants that will test our Time Perspective Therapy against several of the most used current treatments, with random assignments and systemic assessments?
Ordinarily I would have lobbied my colleagues for that latter option. However, such an ambitious project requires a multi million-dollar grant. These are hard to obtain and time consuming—a year in the getting and at least another few years in the doing. So we opted to apply for a major military grant to put our treatment plan into a testable practice setting in the military, and to go forth with writing this book. We are currently waiting for what we hope is good news from the military. But while we wait and hope, we have forged ahead and written the book you now hold in your hands.
The book you are about to enjoy and learn much from is unique. Its goal is simple: to provide an exposition of Temporal Theory, which I developed, and then to elaborate on how the Swords transformed these ideas into the most effective of any current practical treatments for relieving the suffering associated with PTSD. You will find the treatment plan clearly laid out, as well as much supporting evidence in vivid, memorable case studies and solid quantitative data.
Time Perspective Therapy is demonstrably effective, its impact is relatively quick—a few months or less—and it is cost effective. It does not require expensive MDs, or even PhDs, to administer. Masters-level practitioners can effectively use it, as can practical nurses or intelligent and committed caregivers.
Behind all of these words, ideas, plans, and agendas is the driving passion of these two healers, Rick and Rose Sword, whose life mission is to use their training and talents to relieve suffering and work tirelessly to improve the quality of daily life of every client with whom they work. Their all-embracing arms reach out not only to veterans but also to many others who come to them for help—survivors of both physical and sexual abuse, of cardiac illnesses, of traumatic natural disasters, and more. It has been my pleasure to be touched by their passionate wisdom and endlessly optimistic view of what is best in human nature.
We hope that what you read here will help you or your loved ones move forward to a more positive life, and that you will share what you have learned on this journey with others you care about. The very act of your doing so reaffirms, strengthens, and expands the human connection.