Transcript (OEI): A New Trauma Therapy - Canadian Counselling and

A New Trauma Therapy
Theory/Research, Demonstration,
& Hands-On Experience
Rick Bradshaw, PhD, RPsych
Laurie Detwiler, MA, CCC
International Counselling Association & Canadian
Counselling & Psychotherapy Association May 2014
Where did OEI come from?
 Gendlin’s Focusing
 EMDR “One Eye at a Time”
 EMDR newsletter – “Glitches”
 Brain Gym – “Lazy 8’s”
OEI: What is it used for?
 Engaging people about their own internal processes
 Rapid alteration of emotional & physical intensity
 Assessment & treatment of negative transference
 Avoidance of, and relief from, panic attacks
 Overcoming addictions, self-harm urges
 Re-ordering the alarm system (“stirred up” & “stuck”)
5 Building Blocks of OEI
Level I Techniques
Switch
Sweep
Release
Points
Level II Techniques
Glitch
Hold
Glitch
Massage
Technique
Application
Target
Partners
Transference
Mirrors
Switch
Alteration
Intensity
Clearing
Artifact
Video Demo - Switching
 Switching for alteration of trauma intensity
 Case examples:
 MVA – Vividness of Sensory Recall
 Adult Lights & Cameras trigger CSA
Case Examples - Transference
 Parents & Children
 Photographs
 Partners
 Mirrors
 Therapists
 Group Leaders
The Future of Psychotherapy
 “Brain Therapy” (Prochaska & Norcross, 2010)
 “The burgeoning field of neuroscience will
likely dissolve the gap between mind and brain.
It will also require a whole new way of thinking
about, and talking about, how psychotherapy
works”
(Norcross, Freedheim, & Vandenbos, 2011, p. 755)
LORETA L Eye Pre-Treatment
Right Hippocampal-Dentate Complex – Visual Memory
LORETA L Eye Post-Treatment
Right Inferior Temporal Gyrus – Facial Recognition
Another Eye Dominance Test
Try This in Pairs
Transference Check & Clearance
 Proximity:
Notice how far away I appear to you
 Appearance:
Notice how I look to you (color, expression)
 Body/Emotion:
Notice how you feel physically & emotionally
 Cognitive Proj:
Notice whether it seems like I’m on your side…
______________________________________________________
Try sitting, standing, different people (gender, race, age, etc.)
Try moving a small amount closer, further away, diff. angles
Polyvagal Theory
Stephen Porges (2001/2007) 3 Response Levels:
 Social
Connection
 Ventral Vagal
Brake “On”
 Fight-or-
 Freeze
 Ventral Vagal
 Dorsal Vagal
Brake “Off”
(SNS)
Complex –
(DVC)
Flight
Core Trauma vs Dissoc Artefacts
CORE TRAUMA SYMPTOMS
DISSOCIATIVE ARTEFACTS
Constriction in Throat
Headaches & Pressure in the Head
Bronchoconstriction in Chest
Visual Distortions, Blocks, & Blurring
Nausea or Queasiness in Stomach
Dizziness, Drowsiness, Loss of Balance
Note that all of these
symptoms are experienced
in the core of the body…
Tingling & Numbness
in the Hands, Face, & Feet
Yawning
(hence CORE TRAUMA SYMPTOMS)
Sinus Pressure
Core Trauma vs Artifacts
Technique
Sweep
Application
Target
Clearing
Artefact
Broca’s Area:
Speech Production
Limbic & Paralimbic Structures
 The parts of the brain most involved in
producing intense symptoms, like:
 Panic, flashbacks, startle response,
nausea, and throat or chest constriction
 Are not directly affected by talking or
listening
Limbic System: Midbrain
Anterior Cingulate Gyrus
Neurobiology of Attunement
 Mirror neurons
 Embodied simulation
 Attunement – “social biofeedback”
 Winnicot – “Holding Environment”
 Multigenerational severe early relational trauma –
insecure attachments often leads to dissociation
(alexithymia & somatoform dissociation)
 OEI – 200 times a session – feedback cycle to close gap
Coactivation of SNS & PNS I
 “Tonic Immobility” = co-activation of Sympathetic &
Parasympathetic Nervous Systems
 In “Freeze” response, frequently changing pupil widths
and increases in pulse rate from 60-70 to 110-120 bpm
 Childhood sexual abuse = 50%
 Sexual assault victims 35-40 % some immobility
 10-12 % extreme often w opioid-mediated analgesia
Technique
Application
Target
Partners
Transference
Mirrors
Glitch
Massage
Titration
Intensity
Clearing
Artifact
Classical Conditioning of Trauma
Adrenalin Rush
Eye Position & Movement
Stored in Brain
Ocular Proprioception I
 Proprioceptors = Nerve cells in muscles sending
signals to the brain about muscle positioning.
 Exist in large numbers and high densities in 6
extraocular muscles that control the movements of
each eye & neck.
 Individual cells fire in response to eye movements
tracking objects. Torsional (curved) movements
emanate from a different area of the brain than
vertical/horizontal eye movements.
Extra-Ocular Muscles
Ocular Proprioception Required!
Occular Proprioception
String demo
“Like pulling out a sliver”
Vertical Location in Visual Fields
Ocular proprioception II
 Intraocular muscles control curve & thickness of
lenses (accommodation) & constriction & dilation of
the pupils.
 Additional extraocular muscles elevate the eyelids
 Psychosensory schemata organize touching, hearing,
seeing, & moving associations into episode-specific
patterns, recorded in the brain, then retrieved & remapped when client recalls – constituting “glitches”).
Video Demo
 Therapist comments on breathing, reddening of eyes
 Glitch massage with distal pulls, and vertical patterns
 Resolutions of intensity with Switch & Glitch work
 Usually massaging toward the client triggers abuse
 Sometimes massaging away triggers abandonment
 Track across the visual field until you see a glitch
 Then move vertically until you see another halt or skip
 Then pull out of the centre of that “cross-hair” (
 Keep going until you see a fluttering of the eyes
 There is often a concommitant breath release
 Sometimes there is an emotional release as well
+)
Technique
Glitch
Application
Restoration
Hold with
Target
Visual
Splitting
Bilateral
Stimulation
Titration
Intensity
Clearing
Artifact
Add Acupressure Points
 Triple Warmer – For Shock: “Can You Believe It?”
 Cold & Hollow – Underarm tapping to warm the core
 Shame, Shame, Shame – Tap side of index finger,
even with the bottom of the fingernail. Opens throat
Technique
Application
Target
Respiratory
Breathing
(Chest)
Release
Points
Compression
Gastrointestinal
(Throat)
(Stomach)
Jaw
Constriction
Nausea
Tension
Release Points
New Applications & Combinations
 Process & chemical addictions, eating disorders (urges)
 Inner voices, self-loathing, and self-harming behaviours
 Peak performance (focus on goals, target interferences)
 Dissociative disorders & attachment difficulties (states)
 Somatic symptoms (fibromyalgia, MS, PNES, chronic pain)
 Combined w language acquisition & accent reduction
 Combined w systematic desensitization & psychodrama
Is there any RCT evidence?
 Small (N = 10) mixed gender, mixed trauma
 Larger (N = 25) women sexually assaulted, with PTSD
First Study of OEI with PTSD
 Traumas included sexual assault, attempted homicide by ex-
spouse, witnessing suicides, MVAs, assaults, accidental drugrelated death
 Random Assignment to OEI Treatment or delayed treatment
Control group, applying only Switching
 Script-driven symptom provocation, Control = +2 Exposures
 CAPS and IES-R
Treatment vs Control: CAPS
100
80
Mean CAPS Scores
60
P = 0.001
40
GROUP
20
Treatment Group
0
Control Group
Pre-Treatment
Post-Treatment 1
IES-R Avoidance/Numbing
2.2
2.0
1.8
1.6
1.4
P = 0.014
1.2
GROUP
1.0
Treatment Group
.8
Control Group
Pre-Treatment
Post-Assessment 1
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International Counselling Association & Canadian
Counselling & Psychotherapy Association
Victoria BC CANADA May, 2014
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Why Study Trauma?
 Many of us are the victims of trauma
 Prevalence: 35% of individuals who observed 9/11
will develop PTSD, (Yehuda, 2002).
 Manzer (2003) Canadian rates of PTSD
comparable to that of Detroit Michigan
 Brunello, et al. (2001) agrees with the prevalent
view that some forms of complex PTSD are
“unremitting and treatment resistant”
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Past Research
 Freud and Breuer
 Brewin et al.’s (1996) Dual Representation Theory.
SAM and VAM
 Identity Formation
 Seven Core Vulnerable Identities
 Positive Illusions Replaced
 Growth From Trauma
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Current Trends in Therapy
 Cognitive Behavioural Therapy
 Eye Movement Desensitization and Reprocessing
 One Eye Integration Therapy (OEI)
 Research on OEI Austin (2003)
 Grace (2003) OEI reduced PTSD symptomatology
 Austin (2003) after three hours of OEI 4 of the 5
participants no longer met the criteria for PTSD
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Why Research the Process of Recovery?
 Limited qualitative studies research on recovery from PTSD
 Fewer long-term follow-up studies looking at the entire
holistic process of recovery from PTSD
 No studies that map out what helps and hinders
 Study demonstrates the long term effectiveness of OEI
 Provides clinicians with rich information that can be used
in practice
 Help others who have family members and friends with
PTSD
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Research Questions
 What critical incident helped or hindered in the
process of recovery from PTSD?
 What event or experience helped or hindered in the
process of recovery from PTSD?
 Follow-up questions which fit well with the method.
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Validity
Reliability
 Careful definition of the
purpose of the research
 Qualified observers
 Final follow up
 Independent judge
sorted 25 incidents
into the helping and
hindering categories
 Inter-rater reliability:
92% agreement
between judge and
inter-rater
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Interpret and Report
 8 people, 6 women and 2 men, ages 28 to 54
(average age 45)
 6 Caucasian, 2 Caucasian & First Nations
 Diagnosed with PTSD in 2003 during a trauma
therapy study
 Traumatic incidents ranged from sexual assault,
emotional abuse, and witnessing a death, to car
accidents
 Range of events and time since traumatic event
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Interpret and Report
 194 incidents were elicited, 128 that were helpful, and
66 that were unhelpful
 Sorted into 23 categories, 12 that were helpful, and 11
that were unhelpful (see handout)
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Categorical Descriptions
(helping)
1.
Awareness of Recovery Coming From
Involvement in the trauma therapy study
2. Resources, including Spirituality, Marital
and Family, Financial and Physical
3. Coping Strategies
4. Developing a New and Positive
Relationship with Self
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Categorical Descriptions
(helping)
5.
Growth From Trauma
6.
Understanding Your Own Life Experience
7.
The Importance of Being Listened to, Cared
For, Validated and Accepted For Who You Are
by a Professional Helper
8.
Making Personal Choices to Lead
A Healthy Life
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Categorical Descriptions
(helping)
9.
Unexpected Positive Circumstances
10.
Knowing That You Are Not Alone
11.
Talking Today Was Impactful
12.
Forgiveness
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Categorical Descriptions
(hindering)
1.
Limitations in Resources
2.
ICBC Is An Unhelpful System
3.
When Boundaries Fall
4.
Difficulty Coping
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Categorical Descriptions
(hindering)
5.
Fear Magnification
6.
The Physical Pain Cycle
7.
Harmful Healers
8.
Being In Situations Similar to the Original
Trauma
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Categorical Descriptions
(hindering)
9. Unexpected Negative Circumstances
10. Can Not Forgive Self
11. Sexual Difficulties
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Final Follow-Up Themes
Recovery is a process which includes more than
therapy and all categories are important; however,
2. OEI was very important in recovery, two said 10/10,
average score 8/10
3. Lack of Social Support as a theme, in particular
Brewin’s (2003) “Other as Betraying”
4. “Other as Abandoning” Brewin (2003)
1.
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Latest Sexual Assault & PTSD Study
 Comparative Experimental Treatment Outcome
 1 year to recruit 137 women, screened to 33, lasted 18 Months
from Start to Finish (25 by end of study), Participants
 Quantitative, Qualitative & Psychophysiological Measures
Visual Overview of Study
Second Phase Tx Assessment
Posttreatment Assessment
3-Month Follow up Assessment
6-Month Follow Up Assessment
OEI
B.R.A.I.N. Psychoeducation
Recruitment & Screening
Pretreatment Assessment
CPT-R
Interviews
OEI
B.R.A.I.N.
qEEG & SDSP
CPT-R
OEI
Research Design
 20% of women sexually assaulted in lifetimes -- 50% = PTSD
 Script-Driven Symptom Provocation: 50-second audio
 Random Assignment to Groups & Therapists within Groups
 Assessors Blind to Group Assignments
 All Participants Received Control Condition (B.R.A.I.N.) &
Active Therapy Participants Received 3 sessions - OEI or CPT
 Credibility Checks for all Interventions (COTQ)
 Manualized Treatments
Results - CAPS
GROUP
80
Control
Cognitive Processing
One Eye Integration
CAPS Total Score
70
60
50
40
30
20
Pretreatment
Posttreatment
3 - Month Follow up
Time of Assessment
Time: F(2,21) = 49.62, p = .04, η2 = .83
Time*Group: F(4,42) = 2.96, p = .03, η2 = .22
Group: F(2,22) = 1.32, p = . .29, η2 = .11
Results – IES-R Numb/Avoid
Avoidance (IES-R) Scores
2.50
2.00
▲ Control Group
↑ Cognitive
Processing
Therapy
* One Eye
Integration
1.50
1.00
0.50
1
2
Time
3
Acknowledgements
Fahs-Beck Foundation for Experimental Research
New York Community Trust
Dr. Marvin McDonald, Dr. Paul Swingle, Dr. Jose Domene,
Kristelle Heinrichs, Dave Grice, Marie Amos, Karen Williams,
Kiloko Ndunda, Jessica Houghton, Jake Khym, Becky Stewart,
Jen McInnes, Darlene Allard, Tanya Bedford, Heather Bowden,
Gillian Drader, Brenda DeVries, Danielle Duplassie, Sandra
Dykstra, Ida Fan, Esther Graham, Maren Heldberg, Nadia
Larsen, Michael Mariano, Beverly Ogden, Steivan Pinoesch,
Mandana Sharifi, Nidhi Sharma, Chris Tse, Dana Vanderwiel,
Dawne Visbeek, Melissa Warren, Linda Gibson, Andrea Busby,
Melissa Ducklow, Kwantlen nurses, TWU UG Psych students.
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[email protected]
[email protected]
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OEI Techniques for Today
 Eye Dominance Check & Informed Consent
 “SWITCH” - Transference Check & Clearance
 “SWEEP” – Dissociative Artefacts
 Release Points for Panic Symptoms/Attacks
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Cross-cultural applications
Indonesia:
 GAM vs Military conflict & Tsunami expatriates vs locals
 “Massage your brain using your eyes to lift your heavy heart”
 Gender differences (vulnerable vs guarded emotions)
Korea:
 ‘Expert’ professionals ‘fix’ problems
 Somatic symptoms = less loss of face
 Medical procedures to treat symptoms
1st Nations:
 Family members & community share
 Attending to quality of relationships
 Healing broken attachments (RHAP)
Certified Trauma Specialist (CTS)
designation from ATSS
 Professionals & paraprofessionals without masters degrees
can get OEI training through the Association of Traumatic
Stress Specialists (ATSS) “Certified Trauma Specialist” (CTS)
 Document courses, experience, supervision, training related
to psychological trauma, sent to an ATSS sponsor for review
 Go to the ATSS Web site and download the CTS application:
http://www.atss.info/assets/pdf/FINAL_CTS_APP_1.24.12.pdf
More Info on OEI
 Visit our Web site for FAQ videos, books, seminars,
resources, memberships, Web site listing of clinicians,
research summaries, information on OEI publications
www.sightpsychology.com