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PTSD: why some techniques for treating itwork so fast
www.hgi.org.uk This article first appeared in Volume 12, No, 3 (2005) of theHuman Givensjournal.For training in how to use the rewind technique, see theMindFields College workshop: The Fast Trauma and Phobia CureIf you are suffering from trauma, phobias or PTSD and would like to see a Human Givens therapistnear you, please see theHuman Givens Register of qualified therapists.All our therapists are trained in using the rewind technique.
Joe Griffin suggests that post-traumatic stress disorder treatments that can yield immediatesuccess share an underlying mechanism, which explains their effect.
A MAN recalls the terrifying moment when the bomb went off that blew away the lower part of hisleg. He shakes as, yet again, the images crowd in upon him, the screaming, the smell of burning, thesudden blackness, the splintering glass. He has come to see a therapist because these images andfears, from eight years ago, still continually invade his life.Quickly, the therapist works to calm him down, relaxing him deeply, and then gradually guides himto experience himself going swiftly backwards through the trauma, as if he were a character in avideo, which is being rewound. The therapist then asks him to view the trauma as if in fast forwardon a TV screen. Just ten minutes later, after having done this a number of times, the man can think and talk about his ordeal without horror and panic for the first time since the incident. The intrusivethoughts and nightmares he had been suffering do not return.Another therapist in another therapy room requests a man to focus on a traumatic memory from theday that he nearly lost his life in an industrial accident. Simultaneously, the therapist moves her fingers to and fro in front of her client, asking him to track them with his eyes. Suddenly the man issweating and shaking and, as different images of the events surface, one after the other, rates hisdegree of discomfort and the believability to him of certain statements about self-confidence andhope that the therapist presents to him. By the end of the hour's session, the devastating power of the memories has subsided and the man is much more hopeful about going on positively with hislife.In another therapy session in another therapist's office, a woman who suffered a vicious rape is being asked to bring the occasion to mind, focus on one incident, and allow the terror sheexperienced to resurface and intensify. Then she is asked to tap parts of her face and upper body anumber of times in a particular order, and scale her degree of discomfort.To keep up her emotional arousal, the therapist asks her to repeat emotive words connected to theincident (such as "the shirt is tearing") and then to say something like, "Although I feel fearful, Ideeply and completely accept myself". All this time, she is tapping, as instructed. Quite quickly theintolerable feelings abate, but then more related images come into mind, causing her arousal to rise,and she is guided to tap and scale again and again. Soon she no longer feels traumatised bymemories of the rape.These are brief snapshots of three therapeutic methods — therewind technique, eye movement
 
desensitisation reprocessing (EMDR) [1] and emotional freedom therapy (EFT, colloquially knownas 'tapping') [2] — for which claims of success bordering on the miraculous have been made, in thetreatment of post-traumatic stress disorder (PTSD). For all have demonstrated numerous genuinesuccesses.As in the examples described above, people who for years have suffered over-whelming, intrusivememories and panics (because innocent sights, sounds or smells trigger the memory and the fear)are free of their burden after a single session. It is, indeed, a startling thing that someone can be inthe grip of, or almost consumed by, an extreme reaction to trauma at one minute and yet bemanifestly unaffected a short while later.Each of these methods has its firm adherents who proclaim it 'the best' for treating PTSD. Mostinteresting to me, however, is to find out what it is that, at a very deep level, these three techniquesmay have in common. All seem capable of achieving profound physiological change at least someof the time, and I would like to explore more closely the powerful mechanism I think mightunderlie the effects.
The three techniques
At the human givens diploma course and atMindFields Collegeworkshops, we teach the rewind technique, with which we have had a great deal of success. It has been tried out over lengthy periods in various settings, including in Northern Ireland where, for the last five years, practitionershave reported a very high success rate when working with people traumatised by the violence there.We now have literally hundreds of people using this technique and, down the years, we havecontinually improved on it, so that most practitioners are achieving a consistently high success ratewith it. But, as with any technique, it doesn't work 100 per cent of the time.The EMDR technique was 'discovered' in 1987 by Francine Shapiro, then a mature clinical psychology student in California, who refined it into a highly specific treatment for which,originally, there were numerous supporters, eminent professors of psychology among them. It wasrecently recommended as a treatment for PTSD by the National Institute for Clinical Excellence(NICE).However, over time, it has become clear that results are mixed and some researchers claim itseffectiveness is no higher than with placebo. Others have found that the eye movements do notinhibit negative emotions and that the reprocessing element doesn't play a significant role in any positive outcome. This leaves desensitisation, which is a long-known therapeutic technique, andnon-specific effects, such as therapist-client rapport.[3] (This was even acknowledged in the NICEguidelines.)Clearly, claims are controversial for this technique but nonetheless a disinterested reviewer wouldneed to be open to the fact that it does work in certain circumstances, in order to identify theunderlying mechanism.The tapping technique springs initially from the work of a clinical psychologist, Roger J Callahan,in the United States, who developed what he called "thought field therapy".[4] This techniqueinvolved tapping meridian points on the body whilst recalling a traumatic event and experiencingthe extreme discomfort associated with it. According to Callahan's version, particular meridian points release and rebalance energies preferentially for different types of trauma.The emotional freedom technique is a simplified version of thought field therapy developed byengineer Gary Craig, who trained with Callahan. It involves tapping the meridian points in turnwhilst recalling a stressful event, experiencing and identifying the nature of the feelings that comeup, verbalising them and accepting or reframing them.For instance, "Even though I am feeling a tightness in my chest because I am angry at my wife, Istill respect and love her deeply". Craig claims that stressful memories, phobias, PTSD and evenaddictive behaviours can be significantly abated by this means, thus making it the proverbial cure-
 
all. But we are concerned here only with the claims that concerntrauma and phobias.  As with therewind technique, there is no published clinical controlled trial showing that tappingworks (there are some trials that show an effect for EMDR, which is why NICE recommended it) but there are videos that demonstrate its application to patients and cures apparently being achieved.Having seen some of these videos, I have to say that they appear very convincing, although we can'tknow whether we are watching a subgroup of patients for whom the technique has worked or arandom selection of patients.Having experimented with the technique myself, I have had some success, and know of others whohave, too. So, is there a common mechanism underlying these three techniques, and any other variations that may be developed?
The role of dissociation
Dr Farouk Okhai, a consultant psychiatrist in Milton Keynes, has offered some hypotheses as towhy the tapping technique might work.[5] He suggests it might work, primarily, because it creates adissociation between the intensity of the original experience and current emotional experience.Focusing part of the attention mechanism on the tapping disengages attention sufficiently to allow areframe, a different perspective, to be taken concerning the trauma.The same thing happens in therewind technique, when people view their trauma at a distance on ascreen or imagine running backwards through it as if in a video rewind: a dissociation between the past traumatic events and the feelings they usually arouse is achieved.But the next question, then, is why would dissociation help cure trauma? Can we go beyond just thelabel? What is happening in dissociation? On one level, in creating dissociation, we are changingthe meaning of the trauma. This is achieved by manipulating the interplay between the amygdala,the hippocampus and the neocortex. The amygdala is the organ in the brain that alerts us to possibledanger and triggers the fear response; the hippocampus gives an event context and codes it in aform that can be stored as a memory in the neocortex.However, when an event occurs that is experienced as traumatic, the high emotional arousal inhibitsthe neocortex (you can't 'think straight') and also inhibits the hippocampus from functioning properly — the release of the stress hormone cortisol prevents the hippocampus fromcommunicating effectively with the amygdala, which is processing the emotional feelings. Theresult is inappropriate fear that is generated even after the traumatic event is over.In most cases, this is a temporary state of affairs and, over the next short while, the event is put into proper context. "My car was hit by a Ford Fiesta that went through a red light. Not every FordFiesta goes through a red light. It is safe to drive again." In sufferers from PTSD, however, thiscorrective phasedoesn't occur . Thus no context can be created for the traumatic memory. It is anevent that is ever in the present, all pervasive, triggered by any number of stimuli only peripherallyconnected.A car pulling up at the traffic lights with squeaking brakes may be pattern matched to a similar sound heard just before a car crashed, turned over and caught fire, and the accompanying terror. Or the flapping of a window blind brings back the sound of a wall calendar flapping in the summer  breeze, as the man held a knife to the cashier's throat.However, when re-experiencing the trauma in a dissociated way, by means of one of the methodsdescribed earlier, an individual is in a state of low arousal. In this state, the hippocampus is notinhibited and can record the context as a safe one — the person is aware of sitting in the therapist'sroom, dealing with a memory.In other words, the brain is processing the trauma at the same time as it is processing current reality,so the experience will be coded by the hippocampus as having a context that is non-threatening,even though threatening in the past. (This is rather like what happens when we wake in panic from anightmare and realise that we are safe in bed. We immediately stop being fearful because context
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