Sexual trauma survivors may develop enduring perceptions of themselves, others, and the world and associated coping strategies that unconsciously lead to re-experiencing and replicating certain interpersonal dynamics. Thus, without being aware, survivors may find themselves repeating certain abuse dynamics in multiple relationships over time. Because of the interpersonal nature of sexual trauma, Warrior Renew is grounded in the principles of the interpersonal trauma treatment called Holographic Reprocessing (HR) (Katz, 2001; Katz, 2005; Katz, Snetter, Hagler, Hewitt & Cojucar, 2008; Basharpoor, Narimani, Gamari-give, Abolgasemi & Molavi, 2011; Katz, et al., 2014-c).
Compared with other treatments for trauma, in HR, there is no exposure component. Also, rather than identifying a specific event of trauma, participants in HR, examine how living through one or multiple traumas have influenced reenactments in relationships. HR focuses on healing the internal working model that forms as a result of trauma and maltreatment. In HR, the internal working model and theme of reenactments that stem from the model are termed experiential holograms (also referred to as holograms). According to HR theory, some common holograms are neglect, rejection, betrayal, and endangerment. One of the techniques to produce change is for clients to examine oneself and trauma-related circumstances in its context. Similar to Narrative therapy, this moves the conceptualization of trauma from something personal (e.g., it happened because of the client) to one that is impersonal and includes other people’s agendas and motives distinct from anything about the client. These shifts occur by considering context, multiple points of view, understanding what happened with hindsight advantage and from the perspective of one’s current age. Participants come to realize that their thoughts, feelings, and behaviors may have “made sense” given the context of their holograms, but that their past trauma no longer has to define or dictate their current beliefs or future behavior. Through perspective taking, and reframing they can have global shifts about their understanding of themselves and others.
In Warrior Renew, participants identify their own interpersonal themes. In subsequent weeks, they write a letter to their younger-self such as communicating understanding, encouragement, forgiveness, and/or support. Then, they engage in imaginal reprocessing (Katz, 2005). This is an imagery-based exercise where participants remain anchored to their current age-self and imagine visiting their younger-self. This is a similar technique used by Smucker and Dancu (1999) but it is delivered in a group where each person guides their own imagery of what they would like to say to their younger-self and what they would like to do (e.g., give her a hug, or bring her to a garden).
Participants learn that their trauma-based perceptions are distinct from their true identity and distinct from what is possible and who they can choose to be. This sets the stage for participants to develop new internal working models about themselves, others, and the world. With a new self-perception, they are equipped to consider how they may want to move forward in their lives. Participants are also encouraged to consider topics such as “their purpose” and how they are a unique contribution to the world.
Outcome Studies on Holographic Reprocessing
In the first study, Katz, et al (2008) conducted a pre- to post-treatment study to test the feasibility to train therapists and run a protocol using HR to reduce negative thoughts associated with PTSD for women Veterans who have had sexual trauma and/or abuse. The study assessed pre- and post-scores on the Posttraumatic Cognitions Inventory (PTCI) (Foa et al, 1999) in a naturalistic VA clinical setting with five therapists. The protocol consisted of screening for PTSD followed by an average of nine HR treatment sessions. Twenty-two women were referred to the study, 17 enrolled and completed treatment (0% dropout rate). Significant decreases were found on all scales of the PTCI with large effect sizes (e.g., Total negative thoughts, t(16) = 4.42, p < .001, Cohen's d = 1.52) and 47% of the sample had reliable change (decreased negative thoughts) (RC < -1.96).
In the second study, Basharpoor, et.al (2011) conducted a randomized clinical trial comparing HR to Cognitive Processing Therapy (CPT: Resick & Schnicke, 1996) and a control group to treat symptoms of trauma in adolescent males in Iran. Katz’s (2005) HR book was translated into Farsi and used as the treatment manual for the study. From over 10,000 high school students, 1,000 were randomly selected and screened, 129 reported at least one trauma event. Of those, 60 were selected and randomly assigned to one of the three treatment groups. Dropout rates were as follows: 5 Control group, 4 CPT, and 2 HR. Both HR and CPT were equally effective in reducing scores on the PTCI and significantly more effective than the control group, and HR was slightly stronger at reducing self-blame. Authors conclude that HR and CPT were effective for treating adolescent males with diverse events of trauma.
In the third study, Katz, et al (2014) conducted a randomized clinical trial comparing HR to Prolonged Exposure (PE: Foa & Rothbaum,1998) and to a person-centered (PC) control group to treat symptoms of distress in female veterans with sexual trauma. Fifty-one female veterans with sexual trauma histories were randomly assigned to one of three treatments and completed pre- and post-treatment measures of psychiatric symptoms (anxiety, depression, and PTSD) and post-traumatic cognitions. Analysis of variance was used to analyze the data and found significant decreases on all variables. Post-hoc comparisons revealed that HR and PE treatments demonstrated significantly greater decreases in symptoms compared to the PC control group. Chi square analyses revealed that HR produced a significantly lower dropout rate 1 (6%) compared to PE 7 (41%) and PC 6 (35%).