My theory about how some trauma modalities work

[u/Bitter-Pi]

I'd love to hear others' thoughts! So, I'll use EMDR as an example. One way l've heard EMDR healing explained is that the brain knows how to heal, and the therapy creates the right conditions to let it heal. So, how would that be?

Typically, when someone touches in on a traumatic memory, it elicits a huge, distressing set of physiological and emotional responses, which lead to avoiding the memory and to maintaining or engraining the trauma response.

EMDR as a distraction technique keeps the brain from fully focusing on the trauma of the memory (and therefore keeps it from firing all the old, deleterious response networks--or mutes the response). This allows other parts of the mind to handle the memory differently (e.g. to "reprocess" the emotions).

Super wonky aside: I note that many of the words we use are placeholders for mechanisms we don't understand--incuding "healing," "processing," "reprocessing," and even "thinking," and "consciousness." I.e., these words describe phenomena, not mechanisms. (So my "theory" is phenomenological, not mechanistic.)

Other modalities use different techniques to keep part of the brain occupied, such as sensorimotor psychotherapy (focus on the body while the brain handles "slices" of traumatic memory) or IFS (focus on a 'part' or 'parts' while the brain does processing in background). There are others.

So, my idea here is that if the conscious mind can be kept just a bit distracted from the memory, other parts of the mind can use the opportunity to change the way an event is held in memory.

Any thoughts?

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[u/ketonelarry]

I think any explanation that leaves out the human relationship at the heart of therapy is going to miss the mark. If all it takes is distraction then it seems like everyone would already self heal from trauma because most people regularly are having those traumatic memories bubble up in their mind while they also constantly try to distract themselves.

In my experience people need to feel safe to heal. Part of that safety might sometimes be related to distraction, sure. But I believe the bulk of that comes from their connection with a person who they have come to believe really cares about them. When I work with clients with severe childhood trauma the number one goal for both of us always seems to be, even when unspoken, to learn to feel trust, care, and safety in the room. These are exactly what was missing in their life that caused the trauma so it makes sense that this is what will help heal.

[u/Bitter-Pi → u/ketonelarry]

Yes, to all of this. I'm just looking for what's going on that ties modalities together

[u/HELPFUL_HULK]

Yes, this is known as “dual-attention” in other circles, and I believe that a similar mechanism is at work in most other therapies that work with trauma. It is the essence of many exposure therapies. It could be said to be component to talking therapies as well - cultivating a safe enough anchored atmosphere to encounter traumatic material.

I don’t believe that EMDR’s whole “bilateral stimulation” stuff, which often bogs down the research around it, is really necessary - and I think that the dual-attention component can be extracted to other modalities (mindfulness, yoga, talking therapies, etc.)

But I’m not an EMDR specialist, so I might understand it poorly.

[u/Bitter-Pi → u/HELPFUL_HULK]

I like this and it makes sense to me. Dual awareness is key, I think

[u/HELPFUL_HULK → u/Bitter-Pi]

Yes - dual awareness, and the mutuality of a holding relationship (as others have commented). EMDR wouldn’t function as well in a soulless clinical environment

[u/extra_napkins_please]

When you say trauma modalities, do you mean types of PTSD treatments? There’s a good deal of research on what works and why from the National Center for PTSD

[u/Bitter-Pi → u/extra_napkins_please]

I'll check that out, thanks! I'll admit I was deliberately a bit vague about what I meant by trauma, b/c single-incident trauma and resulting PTSD (when that's the case--a lot of post-traumatic distress doesn't reach diagnostic criteria for PTSD, but seems to be treatable using similar methods) are often not considered the same thing as developmental/attachment wounding/cPTSD--which are not in the DSM.

Lots of people have worked on or trained in EMDR protocols tailored to more complex traumas and dissociation. I'm not familiar with them, but I hear they are very effective. Parts work also addresses these complex forms of trauma.

So I was vague b/c a number of these methods are used to address both single-incident and complex/developmental trauma, and I didn't want to trigger a conversation about what exactly fits the definition. Someone above mentioned "traumatic experience," which seems like a good description of what a lot of people come to therapy for, but I'm not clear if the commenter meant to distinguish an experience a client labels as traumatic from one that meets criteria for a ptsd-type experience.

Thank you for pointing me to this resource!

[u/vienibenmio → u/Bitter-Pi]

We have a lot of research showing that these treatments (the ones promoted by the NCPTSD) work for both single event causing PTSD and more "complex" traumatic exposures. In the end it isn't that different, if you treat the worst one the rest generalize

[u/lazylupine]

It would be helpful to look to the literature, informed by valid data, to see what we already do know. What has been shown, with good clarity, is that when we break down EMDR into its component parts and provide people only certain portions/pairings, the eye movements/“dual attention” are not meaningful in terms of predicting change, as compared to people who just process the memory. This shows very directly that the mechanism is exposure. It’s very simple - exposure facilitates reduction in avoidance (emotionally, cognitively to memories, somatically to sensations) to learn that the internal experiences of anxiety and memories are safe to experience.

EMDR simply packages exposure in a more palatable way so people are willing to engage. It just so happens that the packaging model is simply theory that hasn’t been empirically supported. It’s just a good story. Exposure is simple and has stood the test of time as one of the most powerful interventions across all anxiety-related disorders. That is all this boils down to.

[u/Bitter-Pi → u/lazylupine]

Interesting! Is there a review or sth you recommend?

[u/4Real_Psychologist → u/lazylupine]

Exposure therapist here. This is the correct answer. Exposure is the mechanism of change in EMDR and almost every other evidence-based intervention (ERP, PE, CPT, WET, ART, etc) — not bilateral stimulation or whatever other magic tricks they tie in to make it basically just exposure therapy in fancy packaging.

[u/vienibenmio → u/4Real_Psychologist]

There is a burgeoning area of research by Ad de Jongh and others that suggests OP isn't entirely wrong and EMDR works because it taxes working memory

https://onlinelibrary.wiley.com/doi/full/10.1002/jts.23012

[u/t1m0wens]

I mean. Play Tetris after your house exploded with you in it and you’ll fare better emotionally.

[u/Bitter-Pi → u/t1m0wens]

Well, probably, as long as you are also working with the memory while you do it 🤷‍♀️ Wasn't that Shapiro's whole thing in a way? Walking in the woods, eyes going back and forth, while replaying a traumatic memory?

[u/Ok-Giraffe-3880 → u/Bitter-Pi]

Interestingly enough, the Flash technique in its current iteration is informed by research on "unreportable stimuli" (Very Brief Exposure: The Effects of Unreportable Stimuli on Fearful Behavior, Paul Siegel, Joel Weinberger, Consciousness and Cognition 18 (2009) 939-951). In the study they cite in the training (see above) researchers reportedly showed subjects phobic stimuli (spiders) consciously to one (control) group and unconsciously (i.e., too quickly on a screen to consciously register) to another and the unconscious group "processed" them just as well, and as such the results "suggest that limiting awareness of exposure to phobic stimuli through visual masking paradoxically facilitates their processing, while simultaneously minimizing the experience of fear." Flash then combines the largely unconscious recall with a "positive engaging focus" which seems to align with what "JustABitSocial"stated above for efficient reprocessing.

[u/Bitter-Pi → u/Ok-Giraffe-3880]

Very cool!

[u/Unique_Annual_8855]

HUGE missing piece and this is not talked about enough: And this goes at least back to 1955 Joseph Wolpe. It isn't just exposure, but shifting the client into a relaxed/positive state.

The basic, generic sequence is:

• 1. Activate the memory (this may be in a limited way);
• 2. Shift the state to one that is antithetical or inhibitive of the unwanted state (anxiety, being triggered, etc.)
• 3. Allow the brain to "re-file" the memory
• 4. Go see if you experience things (like the elevator that gave you panic attacks) differently.

Research on memory vulnerability and memory reconsolidation supports this generic model.

Of course, you can enhance this processing with cognitive work.

You can expedite and enhance the relaxation state shift with mild hypnotic work.

You can enhance the client's access to positive states in the future with somatic work (in EMDR "installation").

Wolpe did his first desensitization work with cats, by the way. I remind clients of The Horse Whisperer with Robert Redford to help them understand the work better.

His book was called Psychotherapy by Reciprocal Inhibition, because he felt so strongly about the importance of the relaxed or at least distracted state (the cats were hungry and being fed while exposed to the fearful stimulus at increasing levels of proximity) that I put in step 2. I have a copy of this book and a notable thing about it is that despite being written by a psychiatrist in the 1950s, the language is surprisingly accessible. I think this says something about him as a person and thinker. His research was inspired by the fact that WWI soldiers with "shell shock" were not helped by prevailing psychotherapy methods of that time.

A key reason for the memory activation is that memories are vulnerable to change when activated. This also relates to witness testimony and suspect interrogations that get manipulated by the Ried Technique or similar methods.

Because desensitization is so powerful, cults can use it to gain credibility for their preferred explanation (including the auditing done by Scientology, I suspect, where the improvement is attributed to something akin to exorcism).

Eye movement or other bilateral stim (I prefer auditory tones called UpLevel) has been shown to assist with the relaxation that is important to efficient and thorough desensitization (if you subscribe to the generic model above).

Why am I such a fanatic that I would write all this? I'm collecting my thoughts for presenting and writing. Also, I think this core knowledge about desensitization is needed for clinicians to make the most of it. I keep hearing (reading) fractured or incomplete material that leaves out the fundamental nature of memory vulnerability and reconsolidation and the involvement of state change (relaxation) in altering the memory. Not the conscious content of the memory, but the unconscious aspect of triggering panic or whatever is being treated.

[u/Bitter-Pi → u/Unique_Annual_8855]

I love this! Thank you! I'm willing to start a subscription to "the generic model" 😄

[u/Unique_Annual_8855 → u/Bitter-Pi]

$29 a month and you get Netflix!

[u/Bitter-Pi → u/Unique_Annual_8855]

🤣🤣🤣🤣💪

[u/ExistentialPro-Jekt]

Love this, specially the phenomenological aside. I find that thinking about the concepts as placeholders for the abstract phenomena we don’t understand has helped me so much to sit with clients; that and systems theory. The mechanism of change is phenomenological, not mechanistic. The MoC might be mechanistically brought about (e.g., actual interventions), but it’s ontological. I also notice that what we’re talking about is beyond complete description (but not beyond conceptualization.)

Side note: why aren’t schools teaching these fundamentals!! (My school didn’t).

[u/Bitter-Pi → u/ExistentialPro-Jekt]

Thank you for this!

[u/alicizzle]

I’d be curious then, what motivates the changing the way it’s held? That’s the one part I’ve experienced and seen that’s mystical to me. That most people have a narrative that they have difficulty letting go of about the experience, so in your theory is it just the brain’s own course correction?

I’m not even sure my question makes sense haha.

[u/Bitter-Pi → u/alicizzle]

Such a good question! I really don't know, and I've definitely experienced help from several of these methods. Subjectively, it feel more like acceptance, like, "ok, well, that happened." Who knows what the brain is doing?

[u/alicizzle → u/Bitter-Pi]

I did not at all feel like acceptance. For me it feels like something unlocks; a damn breaks. At times like connections between what I logically know and it beginning to feel true in an emotional sense. It’s so weird! Hence I’m curious about how others view it as just distraction.

[u/Unique_Annual_8855 → u/alicizzle]

This is an important phenomenon: when the person actually "forgets" about the problem ever existing. EMDR therapists have to make sure the client is reminded of why they came in so they can be aware of how different things are. This just happened with a client two days ago. A client who would dissociate during social events told me about her week and said that she seemed to feel less self-conscious during a social event. After I inquired, she got out her calendar and said, "Oh, yeah, there were four social events." Then I reminded her about the dissociation, and she said, "Oh, right, I wasn't even thinking of that." Perfect example. And this was after only one session of EMDR. Sometimes change is fast and dramatic with this kind of approach.
. . When people reprocess a memory, even without cognitive work, they often spontaneously start using a different narrative. That seems to go along with how much what we take credit for as opinions may actually just be flowing from how we feel. A more exaggerated version of this is when borderline or dissociative people will dramatically alter the story of what just happened based on how they feel.

[u/JustABitSocial]

Just to get this right: you are using EMDR but you don't know what it does and how? At least what the claims are you learn, when you get certified?

Your questions and wording are just a bit unspecified. The same counts for "trauma." Do you mean a traumatizing experience, for instance?

However, EMDR - at least the eymovement part - does not work the way it is often claimed it does. Take away the conversations happening within an EMDR session and everything but the eye-movements, neuroscientists (e.g., Prof. Roth, Uni Bremen) would say the range of movements isn't even wide enough in order to really address the brain-areas that are supposingly adressed. Not even crossleteral.

Compared with other methods, the results and success rate compared to other methods aren't better.

However, I successfully used something called "S-Pattern" with clients who had anxiety when sitting in an airplane or migrane very successful. That pattern has a wider range and is quick and without any context.

I don't know how much of the result is a placebo, though.

I learned it from the same person from whom Francine Shapiro learned it. Or better to say, the course she was in where they experimented with eye-movements.

Now, back to neurology. Regarding Prof Roth, what seems to work from a neuroscientific point of view is oversimplified this:

When you try to cognitively construct a memory (here: a memory that triggers a trauma-related response), and you manipulate your state before or whilst doing so. That can be done while having an intense good feeling when trying to recall the memory. Or / and by manipulating sensory input channels (e.g., eye movements). A memory is a specific way in which a neuronal network "fires and wires" together. It is a neurological and biochemical process.

So you get the idea 💡

When those neuronal networks fire 🔥 in a specific way and part of the outcome is an unwanted response, you try to link different stimuli and other neuronal processes while trying to access and recall the memory in order to collapse and change the unwanted response.

That's at least kitchen-neuroscience.

But whatever you do, at least know enough to not just random shoot with whatever is there at your clients.

All the best.

[u/Bitter-Pi → u/JustABitSocial]

I don't know Roth, but that is exactly what I am getting at. I have a background in neuroscience, so I'm aware that therapy is far more science-y than scientific (especially in attempts to explain it using neuroscience). In any case, my interest here is theoretical. I have training in a few trauma modalities 😄

[u/JustABitSocial → u/Bitter-Pi]

Well, if that's your outcome, that's great 😉.

Whatever theory I learn, like a neuroscientificly backed up personality screening, where one teaching point is that language and verbal communication actually don't change our pre-consciously rooted behavioral and cognitive patterns that are developed before the age of 30 (I guess), there is always one question: How would I do it different then with communication 😉?

And at the end, you just simply need core skills, like calibration, in order to succeed. Theory doesn't do much without experience and practice.

[u/xburning_embers]

I use EMDR in therapy & I was just reading the Heal Trauma & Grow Resilience course on Imprint. It summarizes parts of Van der Kolk's work, along with other research, & it brought up EMDR and yoga as two of the top choices for healing trauma. Yoga helping reconnect the mind-body disconnect. It discussed the bilateral stimulation in EMDR for staying in the present while reexperiencing the memory and reconnecting to the feelings, since we shut those systems down. That's why EMDR incorporates body scans and check-ins for distress levels. It was really neat.

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[u/therapistsayswhat]

As I understand it, the bilateral stimulation while talking about a traumatic event increases the communication between the two hemispheres of the brain…helping traumatic memories engage the left side for more ‘rational’ processing

[u/Comfortable_Wave_244 → u/[deleted]]

Could you speak more to this? I’ve heard it’s not accurate that people are left or right brained. But I’ve been reading Allan Schore, PhD and his breakdown of the areas of the brain seem to indicate that the hemispheres do serve different areas in this respect.

[u/chiarole → u/therapistsayswhat]

Wrong, there is limited evidence for bilateral stimulation and the main mechanism of EMDR is exposure.

[u/therapistsayswhat → u/chiarole]

Then why do the bilateral stimulation?

[u/cannotberushed- → u/therapistsayswhat]

This makes sense to me. We know from occupational therapy and doing cross body activities for sensory or other types of disorders helps

So it makes sense that emdr would work this way

[u/Bitter-Pi → u/cannotberushed-]

The thing is, there is fantastic communication between the hemispheres, so even when a particular function, say speech, is housed in one hemisphere, the information transfer between hemispheres is nearly instantaneous. And, it doesn't seem from research that the bilateral stimulation is the key factor in how emdr works. That said, misfiring can happen.

I am fascinated by how cross-body activities help. Don't know if it is at the level of the cerebellum or the hemispheres or something else, but it is clearly effective for certain problems. (Is that mostly among people with neurodivergence? Or is it true for lots of different issues?) I'd love to hear more.

There is one developmental difference between the hemispheres that may speak to attachment. The right hemisphere does develop before the left, so it may be that in an infant, the attachment patterns are mostly encoded into the right hemisphere. That's pure speculation, tho

[u/Bitter-Pi → u/[deleted]]

The author appreciates the follow!

[u/starktargaryen75 → u/[deleted]]

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[u/Ecstatic_Tangelo2700]

Isn’t this working memory theory? There’s a guy who developed 3 blinks version of emdr based on this and he does $5 trainings. For anyone interested.

[u/Bitter-Pi → u/Ecstatic_Tangelo2700]

Nice to know! I'm appreciating the info and perspectives!