PTSD: why some techniques for treating it work so fast

continued...

not. We have to have the mechanism to disengage attention, and this originally was crucial to our survival. So, when we talk about disassociation, what we're actually doing is disengaging attention; we're clearing out the working memory and creating temporary amnesia. And sudden or unfamiliar movement, above all, is a strong means of triggering that.

Of course, if we were to lose track of what we were doing every time the orientation response is fired, that would clearly be counterproductive and a risk, not an aid, to survival. If we are reading or baking a cake or mending a bike, we have associative links — the book, the cake mix, the tools — to draw us back to where we were.

But when we are talking or thinking, there is nothing to orient ourselves by. This is why so often we may decide on an action, such as collecting an item from upstairs, become engrossed in another thought en route and find ourselves unable to remember what we had set off to get. Similarly, if we do remember dreams, it is usually when something happens that brings dream content to mind — in effect, a context is created for remembering.

Unfamiliar movement that fires the orientation response also occurs, I suggest, during the rewind technique. In our mind's eye, we are seeing images going by very fast on a screen and, especially curious, going backwards as well as forwards. In effect, individuals are imagining themselves doing a series of physical movements that they have never done before.

This is surely going to fire off a massive number of orientation response signals, which will provide temporary amnesia or clear out the attic, so to speak. The therapist has aroused the pattern (the fear), dealt with it through dissociation and now it is cleared out of consciousness. But the therapist has also established an expectation — that the trauma will be resolved by this imagination exercise — and the neocortex is curious as to how. In the temporary amnesia created, the brain is open to alternative meaning.

A good therapist will start to add in reframes at this point — for instance “You are physically a different person from the one whom that man raped 10 years ago. Cells in your body have been renewed a number of times since then. There is not one part of your skin today that that man touched.”

A straightforward explanation

So, I suggest, at the heart of curing PTSD is the mechanism of the dream state known as the orientation response, which fires while we are dreaming to help facilitate the forgetting of emotionally arousing expectations from the previous day, and also in waking life enables us temporarily to forget whatever we are focused on, so that we can attend to a new stimulus.

In PTSD, the orientation response temporarily withdraws attention from the high levels of emotional arousal and thus frees up blocked communication between the hippocampus, the amygdala and the neocortex. This allows the cortex and the hippocampus, in a state of low arousal, to work with the amygdala to provide a new context for understanding the trauma, which then changes its meaning, and to recode the memory accordingly. (This would only occur if the traumatic experience were genuinely in the past and not an ongoing one, such as living with an abusive partner.) If this is the correct understanding of what lies at the heart of curing trauma, we have a straightforward scientific explanation of what is going on.

This, I believe, will be highly reassuring to people, particularly those used to a commonsense, scientific, logical way of understanding the world, such as people are in the West. We don't have to import ideas about moving energy sources, which belong to ancient metaphysical systems that have little relevance to today. It also enables us to look dispassionately at the different techniques for treating trauma and see that they are using a common set of mechanisms.

Which technique is best?

If, then, there is a common set of mechanisms, does it matter which technique practitioners use? Is one more appropriate than another, or in certain contexts? I would say yes.

For instance, we have had reports from therapists that patients with symptoms of psychosis found the experience of tapping or being tapped highly threatening. Also, when the therapist does the tapping, some people find the experience unpleasantly invasive. Others are reluctant to be touched, if they have in the past experienced sexual abuse or if it goes against their culture. (However, when the therapist guides them to do the tapping for themselves, this problem is easily circumvented.)

Yet others find tapping uncomfortable because it seems 'weird'. However, if it is explained to them that the tapping action is firing off the brain's curiosity reflex, which distracts attention and causes brief amnesia for the trauma, so that they can put it into perspective as an event in their past, they may find it less threatening.

Another important caveat, however, is the piece-meal way that traumatic memories appear to come to light when using both tapping and EMDR. (Indeed, Shapiro has in the past urged against using the method with multiple traumas because of the amount of emotionally disturbing material that can surface during its use.)

On one of the videos I have viewed, in which Craig demonstrates the tapping technique with a male client, the man accessed the pain and anger aroused by the fact that his ex-wife had stopped him from seeing his daughter and, on a scale of 1 (low) to 10 (very high), managed to get his arousal down to the level of 2. However, almost immediately, another painful memory surfaced of the affair his ex-wife had had while they were still married.

Craig makes a comment to the effect that “This always happens. As soon as you cut down one tree, another one pops up ...  As soon as you cure a headache, the patient becomes conscious of a toothache, then a stomach ache.” He then proceeds to deal effectively with each 'tree' with apparently good results and client satisfaction. However, the phenomenon does raise the possibility that a client could leave a therapist's office hyper-aware of new concerns or, having dealt with smaller concerns, vulnerable to other larger ones rushing into consciousness later, when immediate help is no longer available.

With our lengthy experience of the rewind technique, however, we know that a skilled therapist can use the technique to detraumatise a whole range of traumas in just one rewind, without these needing to be verbalised in turn or even necessarily brought to consciousness.

Another advantage of the rewind technique is that practitioners produce a profound level of calmness in the patient beforehand, so that they have much more control over keeping emotional arousal down once the patient gets in touch with the traumatic template. By monitoring their emotional state closely and, if arousal increases, guiding them to take a break from 'viewing' the trauma and to return in their imagination to the 'safe place' identified prior to starting the procedure, we have a means to stop the patient getting too fearful and emotional.

Furthermore, it is easy to integrate and activate other ancillary therapeutic procedures alongside the rewind technique, such as the use of metaphors and story-telling while the person is still in a deeply relaxed state and the 'trying out' of new learning. However, the rewind doesn't work for everyone, particularly those who have difficulty relaxing or with visual imagery or who have difficulty getting in touch with feelings associated with the original trauma. This might especially apply to people on the Asperger continuum, who don't seem to store and have access to specific emotional memories in the way that the average person's brain does.

If the rewind technique doesn't work, it would certainly not be unreasonable to try the tapping technique, if the client agreed and felt comfortable with it (although, for the reasons described above, it may not be helpful for people on the Asperger continuum). In the light of the explanation I have offered in this article, it is unlikely that any particular order is required for the tapping and, indeed, Dr Okhai has pointed out that therapists have had success with the method even when tapping in a random order.[5]

Although my own experience of EMDR is limited, Martin Murphy of NOVA, the Barnardo's charity in Northern Ireland that works primarily with victims of the political conflict, has trained in both EMDR and use of the rewind technique, and has found the latter to be more acceptable to clients, and more effective.[7] He has just completed and is in the process of writing up a major piece of research on it, carried out with the University of Ulster, which very positively highlights its effectiveness with this client group.

Tapping without the taps

Finally, I have been experimenting recently with another possible method of achieving the same effect; it draws on the same principles as tapping but may be more acceptable to some people.

If it is indeed the orientation response that is the effective dynamic underlying the successful treatment of traumas by these techniques, we can elicit it another way. Tiny finger and toe movements often accompany the firing of the orientation response during dreaming, in the same way that rapid eye movements do. (This can be observed in animals too, when they are dreaming.) Also, when we introspect and jump from one image to another inside our minds, rhythmic movements of the fingers and toes can often be observed, and they can be seen in hypnotised subjects as well.

On the basis of these observations, I tried out the following.

When I was angry with someone about something, I brought to mind the incident, and then gently and rhythmically moved my fingers to and fro, towards the palm and back again. At the same time I verbalised the exact feeling I was having (for instance, “I feel very angry with my daughter at the moment”) and then, as in the tapping technique, put in a reframe, such as, “Even though I am feeling angry with my daughter for saying such and such a thing, I deeply and completely accept her”.

When I kept this going for a couple of minutes, along with the rhythmic movements, I found that my anger levels started significantly to diminish. I have tried this method out with a few people and found each time that arousal levels go down. It's as if, when the arousal levels go down, the cortex has to find some way to resolve what appear to be two conflicting positions, anger and acceptance — what psychologists would call cognitive dissonance. It has to look for a bigger frame of reference because the curiosity reflex is fired and is looking for meaning.

So, at this stage of lowered arousal, provided the cortex knows how to see things in a more realistic frame, you find yourself spontaneously taking a new perspective. For instance, “I may be angry now but just think of all those kind things so and so has done for me in the past”, etc.

If anger levels go down only a certain degree and seem to be stuck there, I suggest the chances are that the anger aroused was actually a pattern match to an earlier significant traumatic memory involving anger. It is then necessary to create what is known as an 'affect bridge' — to do this, you go back into the feeling where you are stuck, be aware of it and focus on it, and tell yourself that you are going to leave your mind open to any memory connected to it. Very often a memory from an earlier time, even childhood, about which anger persists, floats into mind. This is called a sub-traumatic memory.

For example, I was trying this rhythmic finger movement technique with a friend, to deal with his anxiety about responding to recorded messages on his answering machine. First, using the tapping technique, he found that he could diminish his anxiety by about 50 per cent but he was still stuck at that point and hardly shifting. So then we tried the version I have just described, making the hand movements, and the anxiety reduced from a level 5 to a level 4, where it remained.

So I asked him to focus on the residual feeling, and see if a memory would come back into his mind. The memory that surfaced was of the presents he used to receive from his grandfather as a young boy, and the fact that, on a number of occasions, he didn't write to thank him. He would feel highly anxious and guilty afterwards, particularly if he was going to see his grandfather again before having thanked him. So his reluctance to deal with the recorded messages on his answering machine was a pattern match back to experiences in his childhood when he hadn't done something that he thought he ought to have done, and the residual guilt attached to those memories.

I brought those memories and guilty feelings back into consciousness and, while he was doing the hand movements, I asked him, as he is himself a father, how enthusiastic he thought his own children would have been at the age of six about thanking grandparents for presents. He started to smile and acknowledged that they would be very unenthusiastic. I said, “Given that your grandfather was a father, do you think it was likely that he realised that, even when you wrote thank-you letters, you were doing it under pressure from your parents, and that this was a chore? Do you think that he really expected you to write these letters with enthusiasm? Do you think that six-year-olds do this?”

He reported that his arousal level had gone down markedly and within a minute it was a 1. So what we seem to be seeing here is a firing of the orientation response by yet another means, allowing communication between the cortex, the hippocampus and the amygdala that enables a new frame of reference for understanding the old traumatic memory. However, the possibility that additional traumatic memories may swarm into consciousness (as Craig describes occurring during tapping), and perhaps at a time when help is not available, is equally a risk element in this method.

To sum up, there is likely to be a significant degree of effectiveness in all the techniques for the swift resolution of PTSD that have been described, as they seem to have the same under-lying operational mechanism.

We strongly recommend, though, that the rewind technique should be the treatment of choice — not only because of its high efficacy, but because of the additional safety factors built in for lowering arousal. However, we remain open minded about all such techniques and any helpful refinements that may be developed, and will continue to keep abreast of research.

© Joe Griffin and HG Publishing (2005)

References

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This article first appeared in Volume 12, No, 3 (2005) of the Human Givens journal.

JOE GRIFFIN is a research psychologist and psychotherapist. He is, with Ivan Tyrrell, co-founder of the human givens approach.

A scientific explanation of how people become traumatised and how this can be removed, is included in Joe Griffin's and Ivan Tyrrell's book: Human Givens: A new approach to emotional health and clear thinking

PLEASE NOTE:
The HGI strongly recommends that the rewind technique be the treatment of choice for anyone suffering from a traumatic memory or full-blown PTSD. This is not only because it is the most consistently effective, non-intrusive technique, but also because it has additional in-built safety factors for lowering emotional arousal.

> For training in how to use the rewind technique, see the MindFields College workshop:

The Fast Trauma and Phobia Cure

> The HGI ONLINE REGISTER of human givens practitioners, lists all fully qualified human givens therapists in private practice. Human givens therapists areo are fully trained in using the rewind technqiue to lift trauma and phobias

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