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Psychotherapy
and Neurophysiological Measurement |
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Sponsor Link:
Conference Featuring Bessel van der Kolk, MD: Three Views of Traumatic Stress 1/26-28, 2001 Full Info |
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Home Contact Related Resources Trauma tx & physiology Trauma organizations sources of online articles, more. Recordings mentioned in this document. Hypertext Guide to Inner Work
Processes |
Interview: Mike Gismondi on the impact of neurophysiological measurement on clinical practice. Mike is coordinator of the Three Views of Traumatic Stress conference (Arvada, Colorado, 1/26-28, 2001) He has been speaking extensively with leaders in this subject area, so I persuaded him to take some time out to discuss questions and concerns about issues the conference addresses. Bob: What is happening in neurobiology now that is of interest to clinicians? Mike: At first blush, many clinicians probably wonder if brain physiology has anything to offer the practicing psychotherapist. I think the value of the burgeoning interest and research surrounding the neurophysiology of trauma has much to offer clinicians. For one thing, there is little question that traumatic stress is very real and long lasting. We now have relatively hard scientific evidence to back up our intuitions. I think I speak for al practicing clinicians when I say there are "gate keepers" out there, be they private practice physicians, mental health center administrators or parent groups, that have people claiming either traumatic stress is a myth or greatly exaggerated in its effects or chronicity. Clearly, psychotherapists who gain the knowledge of how trauma affects health and the ability to learn will open up new markets for their practice. And don't forget, the networking that will be encouraged at the conference will help therapists stay in touch with those clinicians who are already expanding their practice through this knowledge. In a sense, the future is already here. For example, Roger Callahan is already using heart rate variability equipment to not only verify treatment effects on the human nervous system, but also how such devices can help guide trauma therapists in determining when there is more trauma to be bled off or processed concerning a specific incident or theme based on the level of nervous system arousal still detected by the HRV (heart rate variability) device. Roger Callaghan's new book, Stop the Nightmares, has a chapter on this very subject. To put a finer point on it, HRV (that Dr. Porges is considered one of the leading experts on), will be a major scientific verification tool for the energy therapies much as neuroimaging is establishing the scientific validity of EMDR and its treatment effects. A conference like this allows participants to be armed with the latest research that not only goes a long way to prove the existence of traumatic stress, but points to a range of health problems that are exacerbated or even primarily triggered by traumatic stress. As Nick Cummings of managed care fame pointed out years ago, more and more psychotherapists will be dedicating a sizeable chunk of their practice to so-called behavioral medicine or psychosomatic problems. Another important contribution to clinicians is to understand on a much deeper level how psychopharmacology does or doesn't work with their clients, based on the nature and course of traumatic stress. With neuroimaging (FMRI and SPEC, for example), we can begin to understand how medications like Ritalin and Prozac work intermittently or incompletely because they only partially target traumatic stress brain processes. The point is, with a little basic knowledge of neurophysiology, clinicians can become more knowledgeable in advising their clients as to what will or will not help primarily traumatic stress driven disorders. Even more to the point, this conference will stress how psychotherapists trained in trauma therapies can use those same skills to address learning disabilities and other problems. Also, some truly innovative, state-of-the-art therapy techniques will be presented. For example, Dr. Scaer will be discussing how he has combined sensory integration techniques normally used by speech and language rehabilitation counselor as an effective trauma modality in his clinic. Also, Dr. Steve Porges will be presenting his auditory stimulation modality as a powerful treatment for autism as well as PTSD. Finally, Dr. van der Kolk will be discussing at some length the latest thinking on how trauma therapists must take into account how axis II characterological disorders and features are not only frequently a result of a trauma history, but also essential in many cases to successful trauma therapy. How many times has trauma psychotherapy fallen short after initial symptom relief because axis II factors were not an integral part of the original treatment plan. Dr. van der Kolk's suggestions, I think, could have a powerful impact on how we trauma-oriented psychotherapists conceptualize and approach our cases. Bob: Do you feel this will influence the policies of insurance and managed care? Mike: Minimally, it's reasonable to expect in the not-so-distant future, increasingly restrictive insurance companies may refuse to pay for treatments that don't have this kind of neuroscientific backing. Bob: On the other hand, I suppose it could also open the door for therapies that are not yet accepted as legitimate by these companies. Mike: Absolutely. Bob: What are the implications for those using new power therapies such as EMDR. Mike: Dr. van der Kolk is the main presenter, and EMDR is not only an important part of his therapeutic toolbar, but is the focus of much of his NIH-funded research using neuroimaging. Bob: Are there any ways that psychotherapy treatments are being refined or even created as a result of this research. Mike: In several ways. First, as we develop through viable neuroimaging a clearer picture of what parts of the brain are crucial to the production and maintenance of trauma symptoms, we can then focus on those techniques including but not limited to EMDR-style eye movements, medication and acupressure points that are known or suspected to affect these key parts of the brain. In other words, I believe the psychotherapy techniques of the future will arise directly from this research and the burgeoning knowledge of trauma-specific brain physiology. Bob: Do you see any specific developments in clinical practice coming from these developments now? Mike: I'm aware of two innovative energy therapies (LEAP and neurodynamics) that have discovered and exploit acupressure points that seem to disable the self-punishment circuits in the brain that keep trauma alive, or help it generalize into health problems. Bob: So it sounds like you're predicting more rapid innovations, refinement and development of psychotherapy techniques resulting from the use of this technology. Am I hearing some Alvin Toffler in this? Mike: Concerning this new body of research and inquiry, I think the knife cuts both ways. Specifically, neuroimaging and trauma-specific neuroscientific knowledge allows us to verify how effective therapies like EMDR work by truly changing the brain. So, our field gains that much more credibility with those conservatives and skeptics we must still reach within our profession. On the other hand, as we develop more specific models of how trauma impacts normal brain processes, we then can target our interventions that much more precisely. Bob: Is that perspective on self-punishment circuits a controversial one? Mike: Not really. The amygdala and periaquaductal gray have been well established as crucial to the production of painful emotions that surround being traumatized or otherwise overwhelmed by some threat or challenge. Bob: What is the connection to self punishment? Mike: When we fail to prevent being traumatized, our brains not only mark out that experience of overwhelm as highly memorable and recurring, but also the brain is designed to make us suffer emotionally if not physically until we somehow put the threat or loss behind us. Bob: So this is different from behavior mod? Mike: Behavior mod, as we all know, seeks to modify the rewards and punishments in the environment so that useful behavior change obtains. In this context, we're looking at the internal reward and punishment contingencies dished out by our brains. You might say we have found the master conditioner to be between our ears. Like behavior mod, once we are aware of how the brain is automatically rewarding, punishing or ignoring aspects of trauma, we can begin to target interventions that reverse this process, meaning, we use EMDR and other techniques to remove pain and to let the brain's naturally self-rewarding circuitry reinstate our pleasure in being involved successfully in everyday life. I believe EMDR, for instance, directly impacts the control center or switchboard that in turn controls the emotional pain centers in the brain. Specifically, some of Dr. van der Kolk's recent neuroimaging research has shown how this meta-control center of emotional pain, the anterior cingulate, is destimulated from its hyperactive state by EMDR. Bob: Some people may say this smacks of mind control, or a loss of individuality. Mike: The fact is, chronic emotional pain can only enslave and paralyze people. Removal of chronic emotional pain, can only empower clients. when chronic emotional pain is released, the brain is designed to provide reinforced reward and pleasure to the organism for pursuing and achieving goals in life. We're just letting the brain work properly. There has been a lot published on the web and elsewhere on CIA-sponsored mind control techniques. This technology allegedly utilizes sound, light electromagnetics and microwaves to control our experiences of pleasure and pain vis a vis certain stimuli. This same technology can be used for therapeutic purposes as well. The key is reclaiming neurophysiological knowledge for positive purposes. Bob: Do you trust the sources of information you have about mind control? Mike: Let's just say I have friends in weird places. In fact, for about two years of my life, when I was hanging out in Colorado Springs a lot, I couldn't swing a dead cat without hitting a former CIA operative, who didn't mind talking about this stuff. I also ran into Satanists who were using neurotechnology to break personalities into subparts and bring or diminish them at will (how did you word this?) Bob: Let me pull us back to implications for so-called energy psychotherapies. How do we know that acupressure affects specific part of the brain in service of trauma treatment? Mike: There is a relatively small, but impressive, body or research using EEG and other physiological measurement techniques that show acupuncture can affect specific parts of the brain. These new energy therapies simply build on this data. For more information, I suggest your readers consult my article on your web site titled Trauma Psychotherapy in a New Key, where I provide some references. Bob: This research doesn't really verify energy in the sense that it is used by Chinese medicine or energy psychotherapy, though, does it? Mike: Absolutely All you know is you touch spot "X" and the brain does something reliably. It's my rule-of-thumb to argue backwards from results, whether it's EMDR, energy therapies, sound and light machines or whatever. I don't want to be stuck with an ineffectual technique because a nice theoretical model says it should work, and I can give a nice for instance from the history of clinical psychology. For many years, the textbooks stated that clinical psychology utilized therapeutic techniques based on experimentally proven principles of learning. That's a nice idea, but it lead to a therapeutic dead end. When we could only use techniques directly inspired by experimental learning research. In other words, empirical results should drive theory, not the other way around. Bob: So you feel measurement and practice reciprocally inform one another. Mike: Exactly. EMDR worked before we had a theory. Clinicians aren't stupid. We used cognitive behavior techniques on trauma for many years with only partial results at best. We came to realize we needed to address the unconscious. We as a field started delving into hypnosis and NLP to help address and work with the subconscious. Techniques like EMDR and TFT are additional ways to deal with the unconscious, But remember, another way of thinking of the unconscious is that it's the subcortical parts of the brain that are always active but blocked to conscious awareness. |
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