Joe Griffin suggests that post-traumatic stress disorder treatments that can yield immediate success share an underlying mechanism, which explains their effect.
A MAN recalls the terrifying moment when the bomb went off that blew away the lower part of his leg. He shakes as, yet again, the images crowd in upon him, the screaming, the smell of burning, the sudden blackness, the splintering glass. He has come to see a therapist because these images and fears, from eight years ago, still continually invade his life.
Quickly, the therapist works to calm him down, relaxing him deeply, and then gradually guides him to experience himself going swiftly backwards through the trauma, as if he were a character in a video, which is being rewound. The therapist then asks him to view the trauma as if in fast forward on a TV screen. Just ten minutes later, after having done this a number of times, the man can think and talk about his ordeal without horror and panic for the first time since the incident. The intrusive thoughts and nightmares he had been suffering do not return.
Another therapist in another therapy room requests a man to focus on a traumatic memory from the day that he nearly lost his life in an industrial accident. Simultaneously, the therapist moves her fingers to and fro in front of her client, asking him to track them with his eyes. Suddenly the man is sweating and shaking and, as different images of the events surface, one after the other, rates his degree of discomfort and the believability to him of certain statements about self-confidence and hope that the therapist presents to him. By the end of the hour’s session, the devastating power of the memories has subsided and the man is much more hopeful about going on positively with his life.
In another therapy session in another therapist’s office, a woman who suffered a vicious rape is being asked to bring the occasion to mind, focus on one incident, and allow the terror she experienced to resurface and intensify. Then she is asked to tap parts of her face and upper body a number of times in a particular order, and scale her degree of discomfort.
To keep up her emotional arousal, the therapist asks her to repeat emotive words connected to the incident (such as “the shirt is tearing”) and then to say something like, “Although I feel fearful, I deeply and completely accept myself”. All this time, she is tapping, as instructed. Quite quickly the intolerable feelings abate, but then more related images come into mind, causing her arousal to rise, and she is guided to tap and scale again and again. Soon she no longer feels traumatised by memories of the rape.
These are brief snapshots of three therapeutic methods — the rewind technique, eye movement desensitisation reprocessing (EMDR)  and emotional freedom therapy (EFT, colloquially known as ‘tapping’)  — for which claims of success bordering on the miraculous have been made, in the treatment of post-traumatic stress disorder (PTSD). For all have demonstrated numerous genuine successes.
As in the examples described above, people who for years have suffered over-whelming, intrusive memories and panics (because innocent sights, sounds or smells trigger the memory and the fear) are free of their burden after a single session. It is, indeed, a startling thing that someone can be in the grip of, or almost consumed by, an extreme reaction to trauma at one minute and yet be manifestly unaffected a short while later.
Each of these methods has its firm adherents who proclaim it ‘the best’ for treating PTSD. Most interesting to me, however, is to find out what it is that, at a very deep level, these three techniques may have in common. All seem capable of achieving profound physiological change at least some of the time, and I would like to explore more closely the powerful mechanism I think might underlie the effects.
The three techniques
At the human givens diploma course and at MindFields College workshops, we teach the rewind technique, with which we have had a great deal of success. It has been tried out over lengthy periods in various settings, including in Northern Ireland where, for the last five years, practitioners have reported a very high success rate when working with people traumatised by the violence there.
We now have literally hundreds of people using this technique and, down the years, we have continually improved on it, so that most practitioners are achieving a consistently high success rate with it. But, as with any technique, it doesn’t work 100 per cent of the time.
The EMDR technique was ‘discovered’ in 1987 by Francine Shapiro, then a mature clinical psychology student in California, who refined it into a highly specific treatment for which, originally, there were numerous supporters, eminent professors of psychology among them. It was recently recommended as a treatment for PTSD by the National Institute for Clinical Excellence (NICE).
However, over time, it has become clear that results are mixed and some researchers claim its effectiveness is no higher than with placebo. Others have found that the eye movements do not inhibit negative emotions and that the reprocessing element doesn’t play a significant role in any positive outcome. This leaves desensitisation, which is a long-known therapeutic technique, and non-specific effects, such as therapist-client rapport. (This was even acknowledged in the NICE guidelines.)
Clearly, claims are controversial for this technique but nonetheless a disinterested reviewer would need to be open to the fact that it does work in certain circumstances, in order to identify the underlying mechanism.
The tapping technique springs initially from the work of a clinical psychologist, Roger J Callahan, in the United States, who developed what he called “thought field therapy”. This technique involved tapping meridian points on the body whilst recalling a traumatic event and experiencing the extreme discomfort associated with it. According to Callahan’s version, particular meridian points release and rebalance energies preferentially for different types of trauma.
The emotional freedom technique is a simplified version of thought field therapy developed by engineer Gary Craig, who trained with Callahan. It involves tapping the meridian points in turn whilst recalling a stressful event, experiencing and identifying the nature of the feelings that come up, verbalising them and accepting or reframing them.
For instance, “Even though I am feeling a tightness in my chest because I am angry at my wife, I still respect and love her deeply”. Craig claims that stressful memories, phobias, PTSD and even addictive behaviours can be significantly abated by this means, thus making it the proverbial cure-all. But we are concerned here only with the claims that concern trauma and phobias.
As with the rewind technique, there is no published clinical controlled trial showing that tapping works (there are some trials that show an effect for EMDR, which is why NICE recommended it) but there are videos that demonstrate its application to patients and cures apparently being achieved. Having seen some of these videos, I have to say that they appear very convincing, although we can’t know whether we are watching a subgroup of patients for whom the technique has worked or a random selection of patients.
Having experimented with the technique myself, I have had some success, and know of others who have, too. So, is there a common mechanism underlying these three techniques, and any other variations that may be developed?
The role of dissociation
Dr Farouk Okhai, a consultant psychiatrist in Milton Keynes, has offered some hypotheses as to why the tapping technique might work. He suggests it might work, primarily, because it creates a dissociation between the intensity of the original experience and current emotional experience. Focusing part of the attention mechanism on the tapping disengages attention sufficiently to allow a reframe, a different perspective, to be taken concerning the trauma.
The same thing happens in the rewind technique, when people view their trauma at a distance on a screen or imagine running backwards through it as if in a video rewind: a dissociation between the past traumatic events and the feelings they usually arouse is achieved.
But the next question, then, is why would dissociation help cure trauma? Can we go beyond just the label? What is happening in dissociation? On one level, in creating dissociation, we are changing the meaning of the trauma. This is achieved by manipulating the interplay between the amygdala, the hippocampus and the neocortex. The amygdala is the organ in the brain that alerts us to possible danger and triggers the fear response; the hippocampus gives an event context and codes it in a form that can be stored as a memory in the neocortex.
However, when an event occurs that is experienced as traumatic, the high emotional arousal inhibits the neocortex (you can’t ‘think straight’) and also inhibits the hippocampus from functioning properly — the release of the stress hormone cortisol prevents the hippocampus from communicating effectively with the amygdala, which is processing the emotional feelings. The result is inappropriate fear that is generated even after the traumatic event is over.
In most cases, this is a temporary state of affairs and, over the next short while, the event is put into proper context. “My car was hit by a Ford Fiesta that went through a red light. Not every Ford Fiesta goes through a red light. It is safe to drive again.” In sufferers from PTSD, however, this corrective phase doesn’t occur. Thus no context can be created for the traumatic memory. It is an event that is ever in the present, all pervasive, triggered by any number of stimuli only peripherally connected.
A car pulling up at the traffic lights with squeaking brakes may be pattern matched to a similar sound heard just before a car crashed, turned over and caught fire, and the accompanying terror. Or the flapping of a window blind brings back the sound of a wall calendar flapping in the summer breeze, as the man held a knife to the cashier’s throat.
However, when re-experiencing the trauma in a dissociated way, by means of one of the methods described earlier, an individual is in a state of low arousal. In this state, the hippocampus is not inhibited and can record the context as a safe one — the person is aware of sitting in the therapist’s room, dealing with a memory.
In other words, the brain is processing the trauma at the same time as it is processing current reality, so the experience will be coded by the hippocampus as having a context that is non-threatening, even though threatening in the past. (This is rather like what happens when we wake in panic from a nightmare and realise that we are safe in bed. We immediately stop being fearful because context has been created. That was a dream. This is now.)
So a new message is put into memory and, while still in this state of low arousal, the neocortex can be engaged in reinforcing the new learning, by drawing further distinctions between the traumatic (but now non-emotionally arousing) event and present-day life.
For instance, the individual might be guided by the therapist to focus on how, although the event was life threatening at the time, it does not affect the present or the future. Thus a feedback loop is set in place that can allow the template in the amygdala to be reprogrammed. So, when we use a word like dissociation, it is just a term that encompasses a number of processes. …
See this related post for more on how to recover from traumatic events.