Ruth Buczynski, PhD - Rethinking Trauma: The Third Wave of Trauma Treatment

This comes from the National Institute for the Clinical Application of Behavioral Medicine (NICABM) website. There is nothing new here for those of us who follow developments in PTSD research and treatment, but it's still interesting.

Rethinking Trauma: The Third Wave of Trauma Treatment

By Ruth Buczynski, PhD

As someone who’s been practicing for a while, I’ve seen our view on the treatment of trauma go through substantial development. Our research, theory and treatments have all advanced considerably in the last 40 years.

And as I reflect upon this, I’m seeing 3 waves in the evolution of our outlook.

Looking back at when I first began to practice (in the late 70’s) our understanding of trauma was really quite limited. Of course we recognized the fight / flight response ever since Hans Selye introduced the notion back in the 50’s.

But our prevailing treatment option was talk therapy.

The thinking at the time was that by getting clients to talk about their traumatic event, we could “get to the bottom of” their issues and help them heal.

We were aware of the body and knew it held some power. But few practitioners used it in treatment (except the relatively few who worked with Bioenergetics, Rolfing, Feldenkrais, Rubenfeld, and to some extent Gestalt therapy).

But we were very limited in our ability to explain how body work, or for that matter, a talking treatment, affected the brain (and we had very little evidence-based research for it either). We just didn’t have much of a roadmap to guide us where we wanted to go.

That was the first wave.

Over time, researchers and clinicians started to recognize the limits of talk therapy. We realized that talking about a traumatic event held certain risks. At times, we inadvertently re-traumatized patients, especially if interventions were introduced too soon, before the patient was ready.

We also saw the memory of trauma as more often held in the right brain, the part that doesn’t really think in words.

So we began to use interventions that weren’t as dependent upon talking, interventions like guided imagery, hypnosis, EMDR, and the various forms of tapping.

And as the science surrounding the brain’s reactions to trauma became more sophisticated, clinicians grew to understand more about what was going on.

We began to realize that not everyone who experiences a traumatic event gets PTSD. In fact, most people who experience a traumatic event don’t get PTSD.

And so researchers started to develop studies to determine who did and who didn’t get PTSD. We looked for what factors might predict greater sensitivity to trauma.

And we modified our thinking to add freeze (later known as feigned death) to the fight/flight reaction.

Just adding that piece clarified our thinking about what triggers PTSD.

It also began to expand our treatment options to include sensory motor approaches.

And we started to see how more vastly intricate and multifaceted multiple trauma was compared to single incident trauma.

But I believe a third wave of trauma research and treatment innovations has just begun to crest.

And it’s only come recently.

In just the past year and a half, pioneers in the field of trauma therapy have once again discovered more effective methods for working with trauma patients.

Because of all the research that’s been done, we are much better able to predict who gets PTSD and who doesn’t. Not only that but we’ve got a good handle on why certain people get PTSD.

And as brain science has revealed how different areas of the brain and nervous system respond to traumatic events, we don’t think so often about whether trauma is stored in the left vs right brain.

We think in terms of three parts of the brain, the pre-frontal cortex, the limbic brain and the lower, more primitive brain. And we’re much more sophisticated in thinking about which part needs our intervention.

We understand that the lower brain can command the shutdown response, totally bypassing the prefrontal cortex, totally bypassing any sense of “choice” for the patient.

And we see more clearly the part that the vagal system plays in this shutdown response.

We understand more of the role neuroception plays in feeling safe.

Knowing how the body and brain react to trauma opens the door for the third wave.

We are now beginning to use techniques like neurofeedback (based upon but a long way from the biofeedback we used years ago,) limbic system therapy, and other brain and body-oriented approaches that include a polyvagal perspective.

These are techniques I couldn’t have dreamed of when I began clinical practice, and for the most part, they weren’t prevalent five years or even two years ago.

But these are powerful tools that can offer hope to those who have been stuck in cycles of reactivity, shame, and hopelessness.

I’d like to share with you some of the leading edge research and treatment options that this third wave has introduced – for more information, just click here.

And I’d like to hear from you: What changes have you seen in your work with the treatment of trauma? Please leave a comment below.

All in the Mind - Too Much Reality (on PTSD)

A good episode of All in the Mind this week that looks at PTSD, particularly as related to war and combat. They also examine one of the newer treatment approaches, neurofeedback.

Too much reality

Lynne Malcolm  |  Sunday 27 April 2014

• Listen now

• Download audio

• show transcript

Image: (Steve Jacobs (Getty))
It used to be known as shell shock but we now know that post traumatic stress disorder can develop in a range of contexts, and that the devastating symptoms are not only psychological and emotional, but can severely effect our physical health as well. Meet a retired SAS military commander and a Cambodian refugee who both know this only too well. We also hear about the latest treatments including neurofeedback.

Guests 

• Leahkhana Suos - Cambodian refugee & client at the NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTS) 
• Stuart Bonner - Retired SAS military commander 
• Professor Sandy McFarlane
• Mirjana Askovic - Psychologist & Senior Neurofeedback Counsellor at the NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) 

Publications

Redback One: The True Story of an Australian SAS Hero by Robert Macklin

Further Information  

• NSW Service for the treatment and rehabilitation of torture and trauma survivors
• Veterans and veterans families counselling service
• Department of Veterans Affairs
• Lifeline 131114

Tracy Brandmeyer and Arnaud Delorme - Meditation and Neurofeedback

This is a very cool open access article from Frontiers in Psychology: Consciousness Research on the interplay of meditation and neurofeedback. In addition to discussing the current uses of neurofeedback devices for clinical and contemplative training, they also touch on the limitations of the current technology, which relies almost entirely on electro-encephalography (EEG) measures that are not highly reliable , so far, in either clinical or contemplative uses.

But with better technology, good things are possible:

Assuming that reliable and reproducible EEG signatures are associated with specific meditation practices, we may expect that training subjects to reproduce these signatures would support and strengthen their meditation practice. Clinical neurofeedback protocols are aiming toward comparing patients' EEG with large EEG data sets from normal subjects in order to produce a neurofeedback algorithm which rewards subjects (patients) whose EEG becomes closer to that of the normal population (Thornton and Carmody, 2009). Similarly, it might be possible to train users to make their EEG brainwaves similar to the brainwaves of an expert practitioner in a given meditation tradition.

The article is worth a few minutes to read.

Full Citation: 
Brandmeyer T, and Delorme A. (2013, Oct 7). Meditation and neurofeedback. Frontiers in Psychology: Consciousness Research, 4:688. doi: 10.3389/fpsyg.2013.00688

Meditation and neurofeedback

Tracy Brandmeyer [1,2] and Arnaud Delorme [1,2,3,4]

1. Centre de Recherche Cerveau et Cognition, Paul Sabatier University, Toulouse, France
2. CerCo, Centre National de la Recherche Scientifique, Toulouse, France
3. Swartz Center for Computational Neuroscience, Institute of Neural Computation (INC), University of California San Diego, San Diego, CA, USA
4. Institute of Noetic Sciences, Petaluma, CA, USA

Dating back as far as 1957, the academic investigation of meditation and the Asian contemplative traditions have fascinated not only the likes of philosophers and religious scholars, but researchers in the fields of neuroscience, psychology, and medicine. While most of the contemplative traditions are comprised of spiritual practices that aim to bring the practitioner closer to self-actualization and enlightenment, from a neuroscientific and clinical perspective, meditation is usually considered a set of diverse and specific methods of distinct attentional engagement (Cahn and Polich, 2009).

Over the last decade, we have witnessed an exponential increase in the interest in meditation research. While this is in part due to improvements in neuroimaging methods, it is also due to the variety of medical practices incorporating meditation into therapeutic protocols. With the general aim of understanding how meditation affects the mind, brain, body and general health, particularly interesting findings in recent research suggest that the mental activity involved in meditation practices may induce brain plasticity (Lutz et al., 2004).

With its increasing popularity, many people in Western societies express an interest and motivation to meditate. However, for many it can often be quite difficult to maintain a disciplined and/or regular practice, for various reasons, ranging from a lack of time to general laziness. It is possible that machine assisted programs such as neurofeedback may help individuals develop their meditation practice more rapidly. Methods such as neurofeedback incorporate real-time feedback of electro-encephalography (EEG) activity to teach self-regulation, and may be potentially used as an aid for meditation.

While Neurofeedback and Biofeedback have been used since the 1960's, previous neuroscientific and clinical research investigating its efficacy has been limited, lacking controlled studies and significant findings (Moriyama et al., 2012). However, a recent overview of the existing body of literature on neurofeedback research has now led the American Academy of Pediatrics to recognize Neurofeedback, as well as working memory training, as one of the most clinically efficacious treatments for children and adolescents with attention and hyperactivity disorders (ADHD) (Dename, 2013). Neurofeedback has been used to treat a wide variety of other disorders such as insomnia, anxiety, depression, epilepsy, brain damage from stroke, addiction, autism, Tourette's syndrome, and more (Tan et al., 2009; Coben et al., 2010; Cortoos et al., 2010; Messerotti Benvenuti et al., 2011; Mihara et al., 2013). As with all therapeutic interventions it is important to note that individuals who are seeking neurofeedback for diagnostics or for clinical and medical purposes seek qualified and licensed practitioners, as adverse effects of inappropriate training have been documented (Hammond and Kirk, 2008).

Interestingly, many of the conditions that benefit from Neurofeedback treatment are consistent with the conditions that improve with regular meditation practice. For example, both ADHD patients and individuals diagnosed with depression benefit from meditation training (Hofmann et al., 2010; Grant et al., 2013) as well as neurofeedback training protocols (Arns et al., 2009; Peeters et al., 2013). In addition, both meditation and neurofeedback are methods of training mental states. Thus, it is plausible that the mental training involved in meditation may be fundamentally no different than other types of training and skill acquisition that can induce plastic changes in the brain (Lazar et al., 2005; Pagnoni and Cekic, 2007).

One hypothesis to explain the similarity between meditation and neurofeedback is that both techniques facilitate and improve concentration and emotion regulation, for which both attentional control and cognitive control are necessary. When one aims to alter attentional control, one must learn to manipulate the amount of attention that is naturally allocated to processing emotional stimuli. Similarly, when an individual is attempting to exercise or gain some form of cognitive control they must alter their expectations and judgments regarding emotional stimuli (Braboszcz et al., 2010; Josipovic, 2010). These core principles are central to both meditation and neurofeedback, with the distinguishing feature being that meditation is self-regulated, and neurofeedback is machine aided. It is worth noting that the alpha and theta frequency bands trained in most cognitive enhancement neurofeedback protocols (Zoefel et al., 2011) share many similarities with the EEG frequency bands that show the most significant change during the early stages of meditation practice (Braboszcz and Delorme, 2011; Cahn et al., 2013).

The integration between meditation and neurofeedback has already happened in popular culture. Numerous neurofeedback companies already provide so-called “enlightenment” programs to the public. The programs developed by these companies, however, are not all based on the scientific study of meditation and/or neurofeedback, and the reliability and accuracy of signal detection in many of the portable devices currently on the market remains questionable. While many of these companies are relying on the intuitions of their founders for various neurofeedback protocols, it is necessary for these programs to adopt a more rigorous scientific approach, such as those developed for clinical patients being treated using neurofeedback (Arns et al., 2009).

Assuming that reliable and reproducible EEG signatures are associated with specific meditation practices, we may expect that training subjects to reproduce these signatures would support and strengthen their meditation practice. Clinical neurofeedback protocols are aiming toward comparing patients' EEG with large EEG data sets from normal subjects in order to produce a neurofeedback algorithm which rewards subjects (patients) whose EEG becomes closer to that of the normal population (Thornton and Carmody, 2009). Similarly, it might be possible to train users to make their EEG brainwaves similar to the brainwaves of an expert practitioner in a given meditation tradition. Note that we do not argue that the task of the user should be only to up-regulate or down-regulate their EEG. Instead, they would perform a meditation practice and the neurofeedback device would act in the periphery, providing users with feedback on how well they are doing. For this to be feasible, there needs to be a clear identification of the EEG neural correlates of specific meditation techniques and traditions. As evidenced in the literature, there are an abundant number of meditation traditions and styles, many which have vastly differing techniques, methods, and practices. As the mental states associated with particular meditations differ, so does the corresponding neurophysiological activity (Cahn and Polich, 2006). Recent research suggests that complex brain activity during meditation may not be adequately described by basic EEG analyses (Travis and Shear, 2010). Thus, more research and the use of more advanced signal processing tools are needed in order to understand the differences in meditative techniques, and to better define a normative population which EEG brainwaves could be used in a neurofeedback protocol.

Another type of neurofeedback program could help detect mind-wandering episodes. In all of the meditation traditions, practitioners often see their attention drifting spontaneously toward self-centered matters. These attentional drifts are termed mind wandering, and have recently been focused on in neuroscientific research (Braboszcz and Delorme, 2011). Interestingly, in this study on mind wandering, EEG changes in the alpha and theta frequency bands have been observed. A neurofeedback device could provide an alarm to users when their mind starts to wander, therefore supporting and improving upon their meditation practice. Although future research should assess the reliability of these measures to detect single mind wandering episodes, such a neurofeedback system might help support users in their meditation.

Most neurofeedback systems provide auditory or visual feedback that fully engage and demand the attention of the subject. For neurofeedback-assisted meditation, the goal would be to provide subtle cues that do not disturb the subjects' meditation. For example, white noise could be made louder as the subject's EEG departs from the EEG of the normative population of meditators. Similarly, the same white noise amplitude could also reflect the likelihood of the subject's mind wandering. As mentioned earlier, the neurofeedback device would not be a substitute to meditation practice, but rather a means to facilitate and support it in its early to middle states of practice.

Over the last century, and ever more so at present, machines have become extensively integrated into a vast range of human activity. The practice of meditation requires sustained attention that is often hard to achieve for novices, as compared to more advanced practitioners (Brefczynski-Lewis et al., 2003). Therefore, an inspiring application of machine-aided learning may be to help offer alternatives for beginners who struggle with maintaining a regular meditation practice. Learning how to meditate faster and more easily may facilitate access to meditation techniques to a wider audience. Still, it may also be beneficial for more experienced meditators who are interested in deepening their meditation practices. Even the Dalai Lama has publicly stated that he would be the first to use this type of technology, and believes that neuroscience will improve Buddhist practices (Mind and Life Institute, 2004).

This type of application also has the potential of reaching the masses as neurofeedback could be introduced to the domain of smartphones and apps (Szu et al., 2013). In fact, some EEG systems are already compatible with portable and smartphone technology, and it will not be long before we start seeing neurofeedback-based programs for smartphones. Community building over social media using cloud based computing could help users support one another and their meditation practices. In addition to supporting meditation practice, neurofeedback applications can help track the progress of users over weeks and years and assess changes that users may not be consciously aware of, thus encouraging users to pursue their practice. Using neurofeedback to learn meditation truly reflects new, cutting edge science, and via real time feedback we may be able to develop a precise ways to rapidly learn and achieve deeper states of meditation.

In conclusion, it is our belief that mobile neurofeedback systems and protocols that are derived and extend upon meditative traditions and practices offer a promising new direction and platform in mobile technology. These technologies would be not only for people who have taken interest in these kinds of practices or people who have already established themselves in a meditative practice, but for people who are looking for new methods to train, improve, and develop attention and emotion regulation. We want to emphasize that neurofeedback should be used as an aid to meditation while people perform their meditation and not as a replacement to meditation, and that while these devices may aid and assist those in their meditative practices, the goal of these practices themselves is ultimately the decrease of reliance on objects and constructs that provide support. This type of research should also integrate neurophenomenological approaches that take into account first-person reports of subjective experience in conjunction with the experimental investigation of brain activity (Braboszcz et al., 2010; Josipovic, 2010). Real time feedback of brain activity as implemented in neurofeedback may help develop new frameworks for the scientific investigation of embodied consciousness and the interactions between mind and body.

Acknowledgments

This research was supported by a grant from the Agence Nationalle pour la Recherche (ANR-12-JSH2-0009-03).

References available at the Frontiers site.

Shrink Rap Radio #319 –On The Frontier of Neurotherapy with Paul Swingle PhD

Dr. David Van Nuys (the host of Shrink Rap Radio) visits with Dr. Paul Swingle about the coming integration of neuroscience and psychotherapy to create a more comprehensive approach to treating mental illness, an approach being called neurotherapy by some - Swingle refers to his own approach as Clinical psychoneurophysiology, which he defines as follows:

Psychoneurophysiology is a natural and holistic approach to the treatment of many conditions. We normalize and optimize brain functioning using various neurotherapeutic techniques including brainwave biofeedback, brain stimulation, cranial sacral therapy and self-regulation procedures. Treatment methods include brainwave biofeedback, brain stimulation and self-regulation to optimize brain functioning and correct inefficiencies in brain activity. Psychoneurophysiology corrects problems where they reside, in your head. The clinic treats numerous disorders such as ADD, ADHD, epilepsy, stroke, learning disorders, traumatic brain injury, depression, fibromyalgia, autistic spectrum disorders, to name but a few without dangerous and largely ineffective drugs.

CRANIAL SACRAL THERAPY
Cranial Sacral Therapy (CST) is a gentle hands-on therapy which uses a light touch and gentle movements to monitor the rhythm of cerebral-spinal fluid (CSF) throughout the body. CSF surrounds, safeguards and provides nourishment for the brain and spinal cord and membranes. The pumping motion of this fluid creates a subtle pulse (detected through the palpation of bones) similar to that of a heartbeat which can be felt throughout the body. This rhythm is monitored by applying light pressure at specific evaluation points through the length of the body (head, neck, spinal cord, lower back and ankles). With CST, the natural rhythm of the cranial sacral function is restored, blood and oxygen flow are improved, toxins are removed more efficiently and brain cells function more effectively as they are receiving the nutrients they require. With CST individuals generally feel a release from stress and anxiety and begin to enjoy a renewed sense of well-being which facilitates neurotherapeutic treatment.

SOMATOEMOTIONAL RELEASE
SomatoEmotional Release (SER), an advanced form of Cranial Sacral Therapy, is a therapeutic process which locates and releases the mind and body from previous trauma and past negative emotional experiences. The body often retains physical and emotional imprints as the result of trauma. These imprints become isolated and dysfunctional and create energy cysts in body tissue. Initially, the body is able to adapt to these energy cysts, however, over time, the body loses its ability to adapt effectively and additional energy is required to carry out the most basic of functions. Suppressed physical and emotional trauma lay the foundation for many ailments. By locating and releasing the energy cysts, internal energy is able to flow freely and can markedly accelerate the neurotherapeutic process.

This sounds a little more integrated than other forms of neurotherapy I have seen - although I would need to know more to fully endorse this model. Still, it's an interesting podcast.

Shrink Rap Radio #319 – On The Frontier of Neurotherapy with Paul Swingle PhD



Paul G. Swingle,PhD was Titular Full Professor of Psychology at the University of Ottawa prior to moving to Vancouver. A Fellow of the Canadian Psychological Association, Dr. Swingle was Lecturer in Psychiatry at Harvard Medical School, an Attending Psychologist at McLean Hospital (Boston) where he also was Coordinator of the Clinical Psychophysiology Service. Dr. Swingle is a Registered Psychologist in British Columbia, Certified in Biofeedback and Neurotherapy. His latest book “Biofeedback for the Brain” is published by Rutgers University Press.

Check out the following Psychology CE Courses based on listening to Shrink Rap Radio interviews:

• Jungian Psychotherapy Part 1 (6 CEUs)
• Jungian Psychotherapy Part 2 (7 CEUs)
• Jungian Psychotherapy Part 3 (7 CEUs)
• Jungian Psychotherapy Part 4 (6 CEUs)
• Jungian Psychotherapy Package of the Four Above (26 CEUs)
• Wisdom of The Dream (4 CEUs)
• Positive Psychology (6 CEUs)
• Pros and Cons of Positive Psychology (5 CEUs)
• CERTIFICATE PROGRAM IN POSITIVE PSYCHOLOGY (32 CEUs)
• Body-Mind: Goodbye to Dualism (6 CEUs)
• Spirit-Meditation: Nurturing The Inner World (8 CEUs)
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A psychology podcast by David Van Nuys, Ph.D.
copyright 2012: David Van Nuys, Ph.D.

 

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Posted on August 31, 2012