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School of Social Service Administration Magazine

Bringing New Approaches to Treating Vets with PTSD Belleruth Naparstek uses guided imagery to help relieve anxieties for vets and others

BelleruthWhen waves of military personnel scarred by trauma started returning from overseas, Belleruth Krepon Naparstek AB '64, AM '67, believed she could help them find relief by learning how to use the mind to heal.

The psychotherapist and author is a pioneer in the field of guided imagery, a practice that combines body awareness, breathing exercises, and imagination to bring about a state of calm and manage emotional or physical pain. "Think of it like directed day-dreaming," she says.

"Guided imagery turned out to be absolutely the perfect technique to reach this audience because of how post-traumatic stress affects certain parts of the brain that traditional therapy—talking, thinking, and analyzing—won’t touch," says the author of the award-winning book on posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal.

Research has shown that people who practice guided imagery have lower levels of the stress hormone cortisol, which floods the body whenever a threat or perceived threat is imminent. "Additionally, findings have shown that the practice can decrease depression, anxiety, and pain, ease medical procedures, heighten immune function, and helps people lose weight or quit smoking," she explains.

Naparstek has produced guided imagery audio recordings that are used at numerous medical institutions, including the Cleveland Clinic, Johns Hopkins, and Memorial Sloan Kettering. But it is at the nation's veteran's hospitals where some of the most exciting work is being done, she says.

Those conclusions are echoed by Edgardo Padin-Rivera, a clinical psychologist at the Louis Stokes Veterans Affairs Hospital in Cleveland, Ohio, which has used Naparstek's guided imagery recordings since the 1990s to alleviate the most debilitating symptoms of PTSD.

"At the VA Hospital, patients increasingly carry around the audio self-help for whenever they need to lower their anxiety, like when they're out in crowds, or when they need to achieve or maintain sleep," says Padin-Rivera, who uses guided imagery in conjunction with psychotherapy.

"While there are many different authors of guided imagery recordings, I have found Belleruth's soothing voice and music combinations to be especially well-received by our veterans," he says. "She has studied combat PTSD by talking with veterans and soldiers on active duty and has consulted with multiple therapists to ensure she gets it right when it comes to empathy and understanding the specific needs of this population."

Naparstek is also a faculty member at the University of Arizona Center for Integrative Medicine, where she travels several times a year to teach sessions in guided imagery to physicians. She is the creator of Health Journeys, a website that offers some 200 guided imagery audio recordings that target dozens of conditions—from anxiety to anger to addictions.

Listen to any of the titles and you may hear Naparstek's soothing voice, urging you to divert your attention from a stressful situation and focus on a serene spot or activity—like a walk in the woods. To enjoy the colors, the light, "the subtle yet elegant arrangement of clouds, trees, or grass."

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Empathy and understanding have always come easily for Naparstek, who can't remember a time when she didn't want to be a social worker. As a child, she always befriended the most marginalized classmate, the one alone at the lunch table or playground. As an adolescent, she volunteered at a state school and hospital.

Far less clear, however, was where she would launch her ambitions. She came from modest circumstances (her dad died when she was 16) and, despite being valedictorian of her Sharon, MA high school class, she didn't have a post-secondary road map.

"All I knew was that I wanted a co-ed school with a progressive agenda that attracted edgy students and would give me a lot of money."

That was how Naparstek, who had never been west of the Hudson River, found her way to the University of Chicago College, and later, SSA, where she would be exposed to completely different cultures and attitudes.

In her high school senior class of 125 students, Naparstek was accustomed to being a big fish in a little pond, routinely praised for her writing skills. When her first English composition paper in the College was returned with a D-plus, she was in shock.

"My professor told me, 'You can sling together a really good sentence, but if you can't organize your thinking, it doesn't matter.'" That feedback turned out to be "one of the most valuable lessons of my life," says Naparstek, who now lives in Shaker Heights, OH. It continues to serve her well today as a speaker, author, and therapist.

After receiving her undergraduate degree in psychology, she took a year off to work at the former Tinley Park State Hospital in Tinley Park, IL. Naparstek also performed in a professional musical comedy revue for a year in Chicago before she interviewed at SSA with the late Janet Kohrman, AB '40, AM '49 who was then the Director of Admissions. "I'm not sure how promising a student I appeared to be, with my Actors Equity card and other irrelevant qualifications! But she fortunately accepted my application," says Naparstek. Her first-year field placement was at Newberry House, a neighborhood settlement house on the Near West Side, where she worked with young children from public housing.

In DCShe enjoyed her placement, but realized that she had a problem. "I fought rescue fantasies 24/7," she says. "I wanted to adopt them all."

She found a better fit at her second year placement, at the Charles F. Read Zone Center (now Chicago-Read Mental Health Center) on the Northwest Side. The late 1960s ushered in a golden era for mental health, when bleak state institutions had been shuttered and abundant resources flowed into community centers like Read, where intellectual luminaries came weekly to train staff and clients had their own swimming pool.

Around this time, she met her husband, Art Naparstek, who also shared her professional passion. The couple moved to the Boston area in 1969 so Art could pursue his PhD. Belleruth worked at Cambridge Hospital supervising second and third year Harvard psychiatry residents in how to do group and family therapy, along with conducting case work, group work, and community mental health consultation. Art Naparstek was a highly influential social worker and policy maker, authoring the Home Mortgage Disclosure Act and legislation for the National and Community Service Act and HOPE VI. Naparstek, who died in 2004, brought the family to Cleveland, where he was Dean of the Mandel School of Applied Social Sciences at Case Western Reserve University.

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"I fell in love with psychotherapy," she says. "There's an art to having people tell you their stories…and I couldn't believe they were paying me to do this."

By the 1980s, her psychotherapy work evolved into guided imagery. With the client's permission, she started making individual tapes "just out of curiosity," she said. "I wanted to see if I could facilitate or speed their growth by tapping into their psyches with a hypnotic intervention they could take home."

Naparstek combined what she had learned of hypnosis, mixed in a sampling of the few audiotapes that existed, and added her own clinical experience, along with her knowledge of the client. The results? A personalized recording.

"I loved the idea that I could give them a 'take-home' intervention and still do. In the jargon of my peers, the cassette was the ultimate transitional object—like a blankie or teddy bear—to be able to take your therapist's voice home with you."

Speaking EventOne client with advanced breast cancer asked Naparstek for help: Could she make a tape of her most comforting childhood memories? It should evoke feelings of safety, such as her father slipping his hand into hers; or her mother ferociously cleaning, visualizing the vacuum sucking up and destroying those malignant cells.

The cancer stayed stable and did not progress for an unexpected two and a half years. The client touted the benefits of the tape to her fellow patients. Soon, they were requesting tapes.

Naparstek knew she was on to something—but could never have imagined that her humble tools would grow into such a large business. Of Health Journeys' extensive catalog, she wrote and narrated 63 titles and produced or curated another 82.

At The Gathering Place, a cancer support center in the Cleveland area, Director Ellen Heyman says the cancer-specific recordings are among the most popular. "We hear many stories of how Belleruth's CDs have made all the difference in preparing for a frightening surgery or calming patients before radiation or chemotherapy." --Bonnie Rubin