Technology is evolving in unexpected ways to assist trauma and torture survivors.
(Transcript from World News Australia Radio)
Getting to a place of safety is only the first step for a person who has experienced the trauma associated with war.
Learning to cope with the intrusive thoughts and memories that often accompany the victims of war into their futures is another matter.
Peggy Giakoumelos takes a closer look at how technology is evolving to assist trauma and torture survivors.
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"I was looking further out and then I saw two male soldiers and a man walking in front of the two soldiers, walking towards myself, and I kept staring at them, closer and closer. And I recognised that it was my brother. I was shocked. I didn't know what to do and I was just racing towards my brother and then I stopped in front of him. And then I was crying and sobbing the whole time. He spoke to me and said, 'This is the last time that I will see you'."
That's Leakhena Suos recalling the last time her she saw her brother, one of those killed by the Khmer Rouge in Cambodia.
It's estimated that around 1.7 million people died during the rule of the Khmer Rouge, including many members of Leakhena Suos's family.
"Pol Pot soldiers were standing there yelling and screaming to my brother and to me, 'That's enough crying and sobbing. Let's go', and then I turned back and they took him away, and I've never seen him ever since then."
Leakhena Suos was 17 years old when she was forced to work in a Khmer Rouge labour camp.
Along with her brother, many other members of her family were killed including her father and numerous cousins.
Her way of coping with her ordeal was to keep her mouth shut and her thoughts to herself.
"During the day I never open my mouth complain or say anything to anyone. At night-time when I go to sleep, I cry all night."
Soldiers chose not to shoot her, as she was so frail from starvation that she was expected to die anyway.
But she didn't die and after spending some time in a refugee camp arrived in Australia in 1983 as a refugee.
Leakhena Suos settled into life in Australia as best she could, but it wasn't until 2013 that she decided to seek help after experiencing a severe episode of depression.
She found her way to the New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors, or STARTTS.
She started on a course of psychotherapy before moving on to another psychological treatment, called neurofeedback.
"After I spoke to the counsellor for quite some time, then I was introduced to a different treatment, called neurofeedback. Neurofeedback has helped me a lot, because my problem is that I have a lot of anxiety, I'm fearful all the time, I don't speak to people and I don't sleep."
STARTTS, a government funded health service, is considered a global pioneer in the use of neurofeedback treatment for torture and trauma survivors.
While forms of neurofeedback have been around since the 1960s, the rapidly expanding field of study known as brain plasticity is informing new uses of the treatment.
Brain plasticity is the idea that the brain changes and moulds itself in response to the demands placed upon it - a bit like muscles do with regular exercise.
Neurofeedback is monitored by placing Electroencephalography, or EEG, sensors on the scalp to measure brain waves.
Negative brain patterns causing problems are then identified and fed directly into a computer game.
The theory is repetitive playing of a game wil cause the brain to unconsciously learn the right brainwaves to produce and after a period of time, be able to recreate these brainwaves.
CEO of STARTTS Jorge Aroche, explains.
"It essentially relies on creating a situation by the use of a computer where people can get direct feedback from what we call brainwaves, basically the electrical activity inside the brain. By getting that interaction usually in the form of a game or the form of a video something that gives them an idea of what those brain waves are doing, they can begin to change that. In a way it's almost like physiotherapy for the brain."
Jorge Aroche says advances in technology have seen traditional treatments such as psychotherapy complemented by these more recent approaches, such as neurofeedback.
Jorge Aroche says while neurofeedback has become more accessible, at this stage it is still only a small number of STARTTS clients who are being treated with this approach.
"For some people we ascertain that there has been an impact on the brain that actually means that the hardware has been affected. This is where neurofeedback comes into its own. It provides us with the ability to help people change the hardware so that they can benefit later from what we call talking therapies or therapies that rely on their learning from their interaction with a counsellor or interaction with other people in their surroundings."
Chilean doctor Jose Quiroga is the medical director of the Program for Torture Victims in Los Angeles in the United States.
He is a survivor of torture during the rule of Augusto Pinochet in Chile in the 1970s.
He says the torture and trauma treatment movement is a recent one, begining in Chile and Greece both of which experienced a culture of widespread torture under previous governments.
He says the effects of torture and trauma can be long-lasting.
Dr Quiroga believe countries where torture was practised in the past need to fund programs for people who may still be suffering from its effects.
"Until now you have victims after 40 years, and still they have symptoms. And this is very important because it shows that people who have been tortured is something that is going to go with you, your whole life. You cannot cure a torture victim. People are finally going to function in society, but this is still in the background fixed in their brain because you can't forget something like that. And in Chile still we have all these background history and people still some of them are in therapy, and now the state is taking care of them and the national health service has a special area continuing the care of these victims."
Jose Quiroga says he is in Australia to assess how STARTTS is using neuroscience technology to treat traumatised people.
"Basically most of the centres around the world has a multidisciplinary approach. It means there has mostly been a medical approach, a psychological approach but in relation to neuroscience, this is very important, the only centre in the world that is doing this is here in STARTTS basically. And one of the reasons I am here now is because of that. I am really trying to learn about the experience that STARTTS has in this moment."
Associate Professor Jim Lagopoulos is with the Brain and Mind Institute at the University of Sydney.
He says in relation to post-traumatic-stress disorder, little research has been done of the impact of neurofeedback treatment.
"The truth is the results have been mixed. In part that's due to methodological differences: in part that's probably due to some studies not having enough statistical power. Now it's fair to say in neurofeedback in terms of PTSD is relatively new, but in other conditions such as anxiety and to a lesser extent depression has been around for a little bit longer, and again the results are somewhat mixed. You've got some results that are showing some very good effects and some that are showing that it's not so good. The truth is I don't believe that in PTSD there has been a large enough random controlled trial which can actually definitively say one way or another. Now having said that, a lot of these treatments are psychologically based and there's no doubt that a lot of patients are actually deriving some benefit from these treatments. In that respect I think they're tremendous."
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