Trauma: the most effective therapeutic modality?

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miriam
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Re: Trauma: the most effective therapeutic modality?

Post by miriam » Wed Sep 03, 2014 10:17 am

I'm just wanting to flag the work of Christine Courtois and people like Dan Hughes here. I know that their work mostly relates to personality disorder and attachment disorder in the current diagnostic nomenclature, but actually these are methods that work with chronic developmental trauma, and I think that is the best parallel we have for what happens within a conflict zone and much more relevant than the response to one-off unpredictable events like a transport disaster, crime or one-off violence.

At a personal level, I've been reflecting this week on how 'emotionally protected' you can become just by being worn down by stressors that are nowhere near as serious as living in a war zone. I look back at my own life and there was a 3-year period from June 2008 to September 2011 that just contained too many life events* for me to process and remain fully emotionally available. I think I just took a step back from it emotionally and built myself a bit of a bubble, which also protected me from the grot of the child protection work I do (which often contains information about non-accidental injuries, neglect, rape, domestic violence, incest, trauma and crime) but it does make it harder to be authentically in the moment and connected to all the positive feelings too. As I've started to let go of that bubble and enjoy the good bits more, and engage in some personal therapy/coaching, I've also found that the negative emotions are closer to the surface too; so I've been crying at youtube clips and films much more than normal and feeling frustrated over the little things, as well as wondering about my work choices going forward. I've found it helpful to focus on the little things that I can do that give me pleasure, rather than necessarily over-thinking what has happened. So I get great joy from singing to my kids at bedtime, or taking photographs, having a swim or lifting a new weight at the gym, getting a massage, or doing an art/craft project. I think there is a lot to be said for just resuming the stuff that is calm and enjoyable after a chaotic time.

* I gained a consultant post, had a car accident that caused whiplash, went into organisational change, found out my new dream job didn't exist, had minor surgery, got pregnant, had serious pregnancy-related health problems (SPD, sciatica and polyhydramnios), my grandfather died and my Dad had to go out to South Africa to sort out his affairs, a close colleague at work died, my twins were born very premature and spent 6 weeks in neonatal intensive care - with me visiting 4 times a day and expressing milk 6 times a day, I changed employing trust and went through a team grievance and a protracted saga about whether my job would exist and what it would involve, I found I couldn't care for my babies as I would want to (born too early to have a suckle reflex, so breastfeeding was nigh on impossible, had numb hands and pins and needles so struggled to do physical care in first year, long stay in hospital), I was treated unreasonably at work and eventually negotiated leaving the NHS, I set up my own business, my husband was made redundant and had to find a new job, I had to find premises and employees and manage the finances of a company for the first time, I was robbed and defrauded, I had major building work done on my home (including a row with some very unpleasant neighbours about our planning permission), we had a flood from a damaged central heating pipe, both of my children had serious health scares in which they had to be admitted to hospital overnight after serious breathing difficulties, and I worked an average of 60-70 hour weeks for over a year to establish my company
Miriam

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CuppaT
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Trauma: the most effective therapeutic modality?

Post by CuppaT » Wed Sep 03, 2014 11:17 am

Sorry not to reply to the actual topic, but oh my, what a list of events, Miriam! I think I'd have really struggled with the effects of chronic stress with all that!

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Re: Trauma: the most effective therapeutic modality?

Post by lingua_franca » Wed Sep 03, 2014 12:37 pm

miriam wrote:I'm just wanting to flag the work of Christine Courtois and people like Dan Hughes here. I know that their work mostly relates to personality disorder and attachment disorder in the current diagnostic nomenclature, but actually these are methods that work with chronic developmental trauma, and I think that is the best parallel we have for what happens within a conflict zone and much more relevant than the response to one-off unpredictable events like a transport disaster, crime or one-off violence.
I think you are right and I have been thinking along similar lines myself lately, but I was (a little irrationally) hesitant to apply anything associated with personality and attachment disorders to this context, especially as "If only they loved their children more than they hate us, their children wouldn't be suffering" is a common refrain around here among people who don't see any problem with an army arresting little boys from their beds in the middle of the night. For this reason I was wary of getting too close to literature on attachment disorders, for fear of reinforcing that canard. As I said, not very rational - the parallel is real, and far more relevant than a car accident or an isolated case of rape.

And frankly I don't know how you managed all those different things! I'm glad that things have eased now and you can enjoy all the nice things you've mentioned. :)
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
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Re: Trauma: the most effective therapeutic modality?

Post by miriam » Wed Sep 03, 2014 12:50 pm

CuppaT wrote:Sorry not to reply to the actual topic, but oh my, what a list of events, Miriam! I think I'd have really struggled with the effects of chronic stress with all that!
Thanks. Its weird writing it down in a list, as I always think I have such a lucky sheltered life and no right to moan, but objectively it was quite a lot to go through!
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Re: Trauma: the most effective therapeutic modality?

Post by Gilly » Wed Sep 03, 2014 1:23 pm

Pink wrote:Bump! Two years later, I've just come across a client being offered this brain spotting thing by a clinical psychologist in private practice, who is also an EMDR consultant. Anyone familiar with it/thoughts? Gilly-why 'quack'?

Pink
quack

/kwak/

noun

a person who dishonestly claims to have special knowledge and skill in some field, typically medicine.
that brainspotting stuff is 100% neuro-quackery of the stupidest kind, and I have little respect for anyone who entertains it seriously beyond the frankly stupid set of paragraphs that describe it.
You're not calling for help, are you?! ;)

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Re: Trauma: the most effective therapeutic modality?

Post by alexh » Thu Sep 04, 2014 10:00 am

BenJMan wrote:*does the EMDR dance*

There are plenty of criticisms for every type of therapy :P
Yes, and all those criticisms are of equal merit and validity?

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Re: Trauma: the most effective therapeutic modality?

Post by Pink » Sat Nov 08, 2014 1:49 pm

Gilly wrote:
Pink wrote:Bump! Two years later, I've just come across a client being offered this brain spotting thing by a clinical psychologist in private practice, who is also an EMDR consultant. Anyone familiar with it/thoughts? Gilly-why 'quack'?

Pink
quack

/kwak/

noun

a person who dishonestly claims to have special knowledge and skill in some field, typically medicine.
that brainspotting stuff is 100% neuro-quackery of the stupidest kind, and I have little respect for anyone who entertains it seriously beyond the frankly stupid set of paragraphs that describe it.
I know I'm banging on about this, but there are reasons I can't disclose because of confidentiality. Gilly, thank you for the definition of 'quack', but i guess what I'm really curious about is why this strikes you as 'neuro-quackery'? I'm horribly ignorant about neuropsych stuff (know the basics and enough to do a reasonable WAIS, but it ends there..), but the reading I have done on Nijenhuis' model of structural dissociation would fit with what he describes as the 'brainspots'-the idea that a dissociative part becomes 'trapped' in an action that needs to be played out. I have to agree that I don't like his (David Grand's) style (his book strikes me as horribly narcissistic, but that may just be a cultural difference-perhaps American marketing is more aggressive than our British shoe-shuffle). I found this article reviewing the neurological underpinnings of brainspotting and its' posited mechanisms of change-could someone with a better understanding of neuropsych than me (so, anyone..pretty please?) have a read and see if it holds up?

Corrigan, F., & Grand, D. (2013). Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation. Medical hypotheses, 80, 759-766.

(link didn't work for some reason, but it's free on google scholar).

warm wishes,

Pink
Last edited by Pink on Sat Nov 08, 2014 5:13 pm, edited 1 time in total.
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Re: Trauma: the most effective therapeutic modality?

Post by lingua_franca » Sat Nov 08, 2014 4:54 pm

My own quackometer rose to high levels when I read through the initial link and came to this bit:
A “Brainspot” is the eye position which is related to the energetic/emotional activation of a traumatic/emotionally charged issue within the brain, most likely in the amygdala, the hippocampus, or the orbitofrontal cortex of the limbic system. Located by eye position, paired with externally observed and internally experienced reflexive responses, a Brainspot is actually a physiological subsystem holding emotional experience in memory form.
My immediate reaction was 'Emperor's New Clothes' - lots of would-be impressive scientific-sounding waffle to disguise the fact that nothing of substance is actually being said. It's not coherent or logical. And then this:
The medical and psychological literature now acknowledges that approximately 75% of requests for medical care are linked to the actions or consequences of this accumulation of stress and/or trauma upon the systems of the human body.
This sounds extremely implausible to me (or to put it more bluntly, it's obviously rubbish). Where are they even getting this stat from?
Brainspotting can be useful as a complement to various body-based therapies including advanced bodywork, chiropractic, acupuncture, somatic therapies, physical therapy, nursing, medicine, and other specialized approaches to physical healing.
Advanced bodywork sounds like something you'd do to a car, and while many people report being helped by chiropractic, it's not evidence-based. (Many people also report being helped by placebos - we can acknowledge that, but it doesn't mean that we should endorse the provision of placebos as part of treatment.) I don't see any evidence for this approach - a quick search shows that no peer-reviewed studies have been done into its efficacy, the only things you find are anecdotal effusions about it that sound almost evangelical in tone. That to me is the main red flag for quackery.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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Re: Trauma: the most effective therapeutic modality?

Post by Pink » Sat Nov 08, 2014 5:42 pm

Thanks Lingua. My heart sank when I read your reply, because it's exactly what I thought too. The whole thing makes me so suspicious, and it's only the fact that a highly qualified and expert clinician I really trust and respect believes deeply in this that makes me try to engage with it at all, especially because of the implications for a client I am working with.
lingua_franca wrote:My own quackometer rose to high levels when I read through the initial link and came to this bit:
A “Brainspot” is the eye position which is related to the energetic/emotional activation of a traumatic/emotionally charged issue within the brain, most likely in the amygdala, the hippocampus, or the orbitofrontal cortex of the limbic system. Located by eye position, paired with externally observed and internally experienced reflexive responses, a Brainspot is actually a physiological subsystem holding emotional experience in memory form.
My immediate reaction was 'Emperor's New Clothes' - lots of would-be impressive scientific-sounding waffle to disguise the fact that nothing of substance is actually being said. It's not coherent or logical.
See, this is the bit I had some hope for, because it fits with Nijenhuis's model (as far as I can make out), that suggests that 'EPs' -the 'emotional parts' holding the unintegrated aspects of the trauma, are an incomplete action, frozen in time, with the associated biological, physiological and emotional responses still as powerful as at the time of the initial trauma. This makes sense to me, so often when I am doing trauma processing work with someone they become 'frozen', and helping them to move around and complete the action, or shift the body in a way that helps them to realise in that moment that they are not still trapped, 'updates' the memory, in a way that cognitive discussion when the memory is not activated can never do. That's why I am curious to have someone with an understanding of neuropsych read the article I have cited above, because he goes into this in much more detail, and I'd love to know if what he is saying is convincing. I fully agree about the webpage links, and his book suffers from similar flaws, but as I say I do wonder if that's an American marketing thing that does him no favours, rather than an actual flaw in the model.
lingua_franca wrote:
The medical and psychological literature now acknowledges that approximately 75% of requests for medical care are linked to the actions or consequences of this accumulation of stress and/or trauma upon the systems of the human body.
This sounds extremely implausible to me (or to put it more bluntly, it's obviously rubbish). Where are they even getting this stat from?
I wonder if this is from the ACE study?

Felitti, M. D., Vincent, J., Anda, M. D., Robert, F., Nordenberg, M. D., Williamson, M. S., ... & James, S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.

This was a pretty seminal study that really examined and acknowledged for the first time the multiple hideous ramifications of childhood trauma and disrupted attachments. I don't know about the 75% figure, but I'd agree with the statement, it seems pretty solidly supported in the evidence.
lingua_franca wrote: Advanced bodywork sounds like something you'd do to a car
This made me laugh out loud! You're awesome Lingua. That said, I am a huge fan of 'bodywork' in trauma, for the reasons described above, and also because of the increased capacity to regulate that they engender. I'm thinking particularly of Pat Ogden's Sensorimotor psychotherapy, and Bessel van Der Kolk's work with yoga for trauma. Where I believe TF-CBT could be improved is the incorporation of much more active 'bodywork', as opposed to just grounding techniques and movement in reliving. It'll be interesting to see how the research develops over the next few years.
lingua_franca wrote:
Brainspotting can be useful as a complement to various body-based therapies including advanced bodywork, chiropractic, acupuncture, somatic therapies, physical therapy, nursing, medicine, and other specialized approaches to physical healing.
Advanced bodywork sounds like something you'd do to a car, and while many people report being helped by chiropractic, it's not evidence-based. (Many people also report being helped by placebos - we can acknowledge that, but it doesn't mean that we should endorse the provision of placebos as part of treatment.) I don't see any evidence for this approach - a quick search shows that no peer-reviewed studies have been done into its efficacy, the only things you find are anecdotal effusions about it that sound almost evangelical in tone. That to me is the main red flag for quackery.
There are no peer-reviewed studies, and the one study I could find

Hildebrand, A., Grand, D., & Stemmler, M. A preliminary study of the efficacy of Brainspotting-a new therapy approach for the treatment of Post Traumatic Stress Disorder.

was not exactly a solid piece of research-it only had 22 participants, no control group etc. However, that's not necessarily a bad thing, it might just mean that the research hasn't been done yet, and many NHS clinicians use CAT/Psychodynamic therapy quite happily, with limited evidence bases for these-they're quite hard to research and the funding hasn't been there, but I'd consider them pretty solid and reputable. I appreciate what you are saying about the placebo effect though.

I agree with you about the evangelical quotes, and the fact that it often seems to be practiced by people with qualifications I don't respect or believe in (NLP practitioners etc.) alarms me. It triggers my whole 'only properly qualified people should ever be allowed to do therapy' thing (see previous threads). However, I know that's something I have a blind spot (brain spot??) about, and the fact remains that I do know a highly qualified and well-regarded trauma expert who does believe in this, which is what is pushing me to try to engage with it instead of dismissing it. It really helps to use the 'group mind' to debate this though, thank you for replying!

warm wishes

Pink
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Re: Trauma: the most effective therapeutic modality?

Post by eponymous85 » Tue Dec 09, 2014 4:37 pm

A “Brainspot” is the eye position which is related to the energetic/emotional activation of a traumatic/emotionally charged issue within the brain, most likely in the amygdala, the hippocampus, or the orbitofrontal cortex of the limbic system. Located by eye position, paired with externally observed and internally experienced reflexive responses, a Brainspot is actually a physiological subsystem holding emotional experience in memory form.
quote]

most likely? those are three distinct brain areas, to say they contain isolated 'spots' that equate to trauma is spurious to say the least. As far as I'm aware no-one has ever found a single brain 'spot' involved in any singular experience, there is multiple activation in multiple different areas and the idea of the engram has long fallen out of favour (even amongst the most evangelical of biological psychiatrists). I think the lack of referencing the grand claims sets off my quack-o-meter!

Regarding the idea of frozen moments in a traumatic memory, an approach can be quackery and still have elements that fit with accepted evidence.
The mind is not a book, to be opened at will and examined at leisure. Thoughts are not etched on the inside of skulls, to be perused by any invader. The mind is a complex and many layered thing.

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Re: Trauma: the most effective therapeutic modality?

Post by Pink » Fri Jan 15, 2016 10:18 am

Does this make any sense to anyone with any neuropsych knowledge please?

Brainspotting is a psychotherapy based in the observation that the body activation experienced when describing a traumatic event has a resonating spot in the visual field. Holding the attention on that Brainspot allows processing of the traumatic event to flow until the body activation has cleared. This is facilitated by a therapist focused on the client and monitoring with attunement. We set out testable hypotheses for this clinical innovation in the treatment of the residues of traumatic experiences. The primary hypothesis is that focusing on the Brainspot engages a retinocollicular pathway to the medial pulvinar, the anterior and posterior cingulate cortices, and the intraparietal sulcus, which has connectivity with the insula. While the linkage of memory, emotion, and body sensation may require the parietal and frontal interconnections – and resolution in the prefrontal cortex – we suggest that the capacity for healing of the altered feeling about the self is occurring in the midbrain at the level of the superior colliculi and the periaqueductal gray.

I'd really value anyone's opinion!

Thanks Pink
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Re: Trauma: the most effective therapeutic modality?

Post by miriam » Fri Jan 15, 2016 11:34 am

I'm not a neuro specialist, but it sounds to me like lots of fancy words being used to justify a premise that makes no sense. Why would trauma make a spot in the visual field any more than it would make a spot in the physical brain?

And there is a huge leap from "trauma and maltreatment are a significant contributor to long-term physical health outcomes (ACE conclusion) to 75% of physical problems are caused by trapped stress that our new therapy can resolve. Like chiropractic, whatever the words say to justify it make no difference if it rests on an unscientific premise. In this case the "trapped stress" concept and the resolution of it are the problem, because neither has been evidenced - there is no study I am aware of that can measure the degree of "trapped stress" or show any physical change as a result of "brainspotting" therapy.

(Reminded me of this blog which is an amazing demonstration of Poe's law - that there is a point at which satire and extremism/stupidity are impossible to distinguish).
Miriam

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