Kirsten Clark

The traditional approach to trauma involves an immediate debriefing, psychopharmacological intervention and repeated narration of the incident (van Emmerik, Kamphuis, Hulsbosch & Emmelkamp, 2002). Over the last decade, there has been some debate that immediate debriefing may be harmful to trauma survivors and that psychopharmacology may not necessarily be the best option in terms of mitigating the physical effects of the experience in the first few days. Gray, Maguen and Litz noted that “the research bearing on these traditional forms of early crisis interventions has shown that… there is no empirical support for their continued use” (2004, pg. 64). As early as 2002 it was stated that psychotherapeutic and medical interventions should only begin after a period of time had passed since post the trauma because the body and brain of the survivor need to be given time to process the experience physiologically, emotionally and cognitively (HealthFacts, 2002). It could be argued that this then creates a dilemma for most practitioners, who have been trained to provide immediate ‘preventative’ care. If the ‘normal’ approaches do not work, what are the alternatives?

Over the last decade, trauma interventions have undergone a transformation in that practitioners are no longer limited to debriefing and retelling models. As clinicians and therapists, we now have access to a variety of emerging techniques, such as Brain Working Recursive Therapy (BWRT), Eye Movement Desensitisation and Reprocessing (EMDR) and Eye Movement Integration (EMI).

EMDR and EMI are based on adaptive information processing models or neurolinguistic programming and they emerged in the 1980’s. The concept behind these techniques is that directed eye movements can be used to access different sensory systems and therefore different areas of the brain. Adaptive information processing models propose that traumatic memories become embedded in a number of sensory driven areas of the brain and by accessing and processing these different areas, the negative affect, cognitions and the physiological arousal associated with stress can be alleviated.

BWRT follows similar lines but uses audio and visual cues instead of eye movements. The process starts with desensitisation by creating a space where the trauma survivor is taken back to the experience and asked to experience the associated emotions and physical sensations. BWRT then creates an alternative scenario where the feelings of helplessness and powerlessness are removed. In essence, the patient moves between periods of exposure to the trauma to the possibility of a different, more adaptive outcome. This creates the opportunity for the brain to consider alternative thinking patterns, emotions and physical reactions in response to an event which seemed to elicit a limited response set (sourced from http://therapistsonline.co.za/brainworking-recursive-therapy).

The emerging neuroscience techniques and interventions appear to be a potential alternative to the traditional approaches. They can be done in one session and anecdotally appear to be especially effective in dealing with the aftereffects of traumatic events, such as hijackings, sexual assaults, home invasions, motor vehicle accidents and bereavement.

The simplicity and brevity of these techniques is compelling, in that most patients do not have the time nor finances for sustained periods of therapy. The application of these interventions may be even more pertinent for those clinicians who work in public service, where time, resources and expertise are often in short supply.

Many of these new techniques are supported by anecdotal evidence but there is emerging research that is being conducted with regards to these interventions. For example, Siedler and Wagner (2006) found that trauma focused CBT and EMDR were equally effective in the treatment of PTSD. The founder of EMDR, Francine Shapiro, reviewed 24 RCT’s that supported the efficacy of EMDR in the treatment of PTSD. She noted that seven studies confidently reported that EMDR was “more rapid and/or more effective than trauma-focused [CBT]” (2014, pg. 72).

Coubard (2014) conducted a meta-analysis of approximately 300 studies on EMDR and found that the majority showed that EMDR was more effective in treating the symptoms of Post-Traumatic Stress Disorder than pharmacological or other psychotherapeutic modalities. He referred to EMDR and other similar neuroscience techniques as ‘neuroentrainment’ in that they enhance the brain’s tendency to synchronise time and emotion through the processing of the sensory reactions of the trauma and then replacing these negative reactions with more adaptive cognitions and affect.

In their systematic review of literature of the health outcomes of neurolinguistics programming, Sturt, Ali, Robertson, Bourne and Bridie (2012) located ten experimental studies, five of which were RCTs and five were pre-post studies. The authors concluded that, at that time, there was insufficient evidence to determine if these interventions were effective. Metcalf, Varker, Forbes, Phelps, Dell, DiBattista, Ralph and O’Donnell (2016, pg. 88) further noted that “the majority of emerging interventions for the treatment of PTSD currently have an insufficient level of evidence supporting their efficacy, despite their increasing popularity.”

However, the field of Psychology is inherently embedded in science and academia. As such, the newer methods of dealing with trauma and other psychiatric disorders will inevitably be scrutinised and the results will either be ratified or debunked. One can only hope that the momentum towards discovering and refining new therapeutic models and methods will not be discouraged. The alchemists of old may have failed to turn lead into gold but they ultimately furthered the acquisition of knowledge and development in the fields of science. In the same way, these emerging interventions may not prove to be the illusive panacea that mental health professionals seek, but regardless, they will have contributed to the development of our field.

References:

Coubard, O. A. (2014). Eye Movement Desensitization and Reprocessing (EMDR) re-examined as cognitive and emotional neuroentrainment. Frontiers in Human Neuroscience, 8, 1035, doi: 10.3389/fnhum_2014_01035.

Debriefing after severe psychological trauma found harmful to some people. (2002). HealthFacts, 27(5), 54.

Gray, M. J., Maguen, S. & Litz, B. T. (2004). Acute psychological impact of disaster and large scale trauma: Limitations of traditional interventions and future practice recommendations. Prehospital and Disaster Medicine, 19(1), 64-72, doi: 10.1017/S1049023X00001497.

Metcalf, O., Varker, T., Forbes, D., Phelps, A., Dell, L., DiBattista, A., Ralph, N. & O’Donnell, M. (2016). Efficacy of fifteen emerging interventions for the treatment of Posttraumatic Stress Disorder: A systematic review. Journal of Traumatic Stress, 29(1), 88-92, doi: 10.1002/jts.22070.

Siedler, G. H. & Wagner, F. E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive behavioural therapy in the treatment of PTSD: A metal-analytic study. Psychological Medicine, 36(11), 1515-1522, doi: 10.1017/S0033291706007963.

Shapiro, F. (2014). The role of Eye Movement Desensitization and Reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71-77, doi:10.7812/TPP/13-098.

Sturt, J., Ali, S., Robertson, W., Bourne, C. & Bridle, C. (2012). Neurolinguistic programming: A systematic review of the effects on health outcomes. British Journal of General Practitioners, 62(604), 757-764, doi: 10.3399/bjgp12X658287.

Van Emmerik, A. A. P., Kamphuis, J. H., Hulsbosch, A. M. & Emmelkamp, P. M. G. (2002). Single session debriefing after psychological trauma: A meta-analysis. Lancet, 360(9335), 766-772.


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