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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

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Where did OEI come from? Gendlins Focusing EMDR One Eye at a Time EMDR newsletter Glitches Brain Gym Lazy 8s

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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)

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5 Building Blocks of OEI Switch Sweep Glitch Massage Glitch Hold Release Points Level I Techniques Level II Techniques

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TargetApplication Technique Switch Transference PartnersMirrors Clearing Artifact Alteration Intensity

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Video Demo - Switching Switching for alteration of trauma intensity Case examples: MVA Vividness of Sensory Recall Adult Lights & Cameras trigger CSA

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Case Examples - Transference Parents & Children Photographs Partners Mirrors Therapists Group Leaders

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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)

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LORETA L Eye Pre-Treatment Right Hippocampal-Dentate Complex Visual Memory

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LORETA L Eye Post-Treatment Right Inferior Temporal Gyrus Facial Recognition

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Now You Try It! Eye Dominance Check Arms Length, Two Fingers Vertical, Both Eyes Open Line up vertical fingers with straight edge in distance Without moving fingers, close one eye, then open it Without moving fingers, close the other eye then open it Which eye was open when the straight edge was in line? __________________________________________________________________________________________________________ Many clients report higher levels of shock, fear, & anxiety with their dominant eyes open (not all those with early onset abuse)

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Another Eye Dominance Test

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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 Im on your side ______________________________________________________ Try sitting, standing, different people (gender, race, age, etc.) Try moving a small amount closer, further away, diff. angles

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Social Connection Ventral Vagal Brake On Fight-or- Flight Ventral Vagal Brake Off (SNS) Freeze Dorsal Vagal Complex (DVC) Polyvagal Theory Stephen Porges (2001/2007) 3 Response Levels:

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Core Trauma vs Dissoc Artefacts CORE TRAUMA SYMPTOMSDISSOCIATIVE ARTEFACTS Constriction in ThroatHeadaches & Pressure in the Head Bronchoconstriction in ChestVisual Distortions, Blocks, & Blurring Nausea or Queasiness in StomachDizziness, Drowsiness, Loss of Balance Note that all of these symptoms are experienced in the core of the body (hence CORE TRAUMA SYMPTOMS) Tingling & Numbness in the Hands, Face, & Feet Yawning Sinus Pressure

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Core Trauma vs Artifacts

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TargetApplication Technique Sweep Clearing Artefact

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Brocas Area: Speech Production

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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

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Limbic System: Midbrain

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Anterior Cingulate Gyrus

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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

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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

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TargetApplication Technique Glitch Massage Transference PartnersMirrors Clearing Artifact Titration Intensity

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Classical Conditioning of Trauma Adrenalin Rush Eye Position & Movement Stored in Brain

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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.

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Extra-Ocular Muscles

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Ocular Proprioception Required!

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Occular Proprioception String demo Like pulling out a sliver

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Vertical Location in Visual Fields

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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 & re- mapped when client recalls constituting glitches).

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Video Demo Therapist comments on breathing, reddening of eyes Glitch massage with distal pulls, and vertical patterns Resolutions of intensity with Switch & Glitch work

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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

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TargetApplication Technique Glitch Hold with Bilateral Stimulation Restoration Visual Splitting Clearing Artifact Titration Intensity

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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

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Target Application Technique Release Points Respiratory (Chest) BreathingCompression Jaw Tension Gastrointestinal (Throat) (Stomach) ConstrictionNausea

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Release Points

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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

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Is there any RCT evidence? Small (N = 10) mixed gender, mixed trauma Larger (N = 25) women sexually assaulted, with PTSD

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First Study of OEI with PTSD Traumas included sexual assault, attempted homicide by ex- spouse, witnessing suicides, MVAs, assaults, accidental drug- related death Traumas included sexual assault, attempted homicide by ex- spouse, witnessing suicides, MVAs, assaults, accidental drug- related death Random Assignment to OEI Treatment or delayed treatment Control group, applying only Switching Random Assignment to OEI Treatment or delayed treatment Control group, applying only Switching Script-driven symptom provocation, Control = +2 Exposures Script-driven symptom provocation, Control = +2 Exposures CAPS and IES-R CAPS and IES-R

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Treatment vs Control: CAPS P = 0.001

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IES-R Avoidance/Numbing P = 0.014

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International Counselling Association & Canadian Counselling & Psychotherapy Association Victoria BC CANADA May, 2014 44

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Why Study Trauma? n Many of us are the victims of trauma n Prevalence: 35% of individuals who observed 9/11 will develop PTSD, (Yehuda, 2002). n Manzer (2003) Canadian rates of PTSD comparable to that of Detroit Michigan n Brunello, et al. (2001) agrees with the prevalent view that some forms of complex PTSD are unremitting and treatment resistant 45

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Past Research n Freud and Breuer n Brewin et al.s (1996) Dual Representation Theory. SAM and VAM n Identity Formation n Seven Core Vulnerable Identities n Positive Illusions Replaced n Growth From Trauma 46

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Current Trends in Therapy n Cognitive Behavioural Therapy n Eye Movement Desensitization and Reprocessing n One Eye Integration Therapy (OEI) n Research on OEI Austin (2003) n Grace (2003) OEI reduced PTSD symptomatology n Austin (2003) after three hours of OEI 4 of the 5 participants no longer met the criteria for PTSD 47

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Why Research the Process of Recovery? n Limited qualitative studies research on recovery from PTSD n Fewer long-term follow-up studies looking at the entire holistic process of recovery from PTSD n No studies that map out what helps and hinders n Study demonstrates the long term effectiveness of OEI n Provides clinicians with rich information that can be used in practice n Help others who have family members and friends with PTSD 48

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Research Questions n What critical incident helped or hindered in the process of recovery from PTSD? n What event or experience helped or hindered in the process of recovery from PTSD? n Follow-up questions which fit well with the method. 49

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Validity Reliability n Careful definition of the purpose of the research n Qualified observers n Final follow up n Independent judge sorted 25 incidents into the helping and hindering categories n Inter-rater reliability: 92% agreement between judge and inter-rater 50

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Interpret and Report n 8 people, 6 women and 2 men, ages 28 to 54 (average age 45) n 6 Caucasian, 2 Caucasian & First Nations n Diagnosed with PTSD in 2003 during a trauma therapy study n Traumatic incidents ranged from sexual assault, emotional abuse, and witnessing a death, to car accidents n Range of events and time since traumatic event 51

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Interpret and Report n 194 incidents were elicited, 128 that were helpful, and 66 that were unhelpful n Sorted into 23 categories, 12 that were helpful, and 11 that were unhelpful (see handout) 52

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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 53

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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 54

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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 55

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Categorical Descriptions (hindering) 1. Limitations in Resources 2. ICBC Is An Unhelpful System 3. When Boundaries Fall 4. Difficulty Coping 56

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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 57

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Categorical Descriptions (hindering) 9. Unexpected Negative Circumstances 10. Can Not Forgive Self 11. Sexual Difficulties 58

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Final Follow-Up Themes 1. 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 Brewins (2003) Other as Betraying 4. Other as Abandoning Brewin (2003) 59

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Latest Sexual Assault & PTSD Study Comparative Experimental Treatment Outcome 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 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 Quantitative, Qualitative & Psychophysiological Measures

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Research Design 20% of women sexually assaulted in lifetimes -- 50% = PTSD 20% of women sexually assaulted in lifetimes -- 50% = PTSD Script-Driven Symptom Provocation: 50-second audio Script-Driven Symptom Provocation: 50-second audio Random Assignment to Groups & Therapists within Groups Random Assignment to Groups & Therapists within Groups Assessors Blind to Group Assignments Assessors Blind to Group Assignments All Participants Received Control Condition (B.R.A.I.N.) & Active Therapy Participants Received 3 sessions - OEI or CPT 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) Credibility Checks for all Interventions (COTQ) Manualized Treatments Manualized Treatments

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Results - CAPS Time: F(2,21) = 49.62, p =.04, 2 =.83 Time*Group: F(4,42) = 2.96, p =.03, 2 =.22 Group: F(2,22) = 1.32, p =..29, 2 =.11

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Results IES-R Numb/Avoid Control Group Cognitive Processing Therapy * One Eye Integration

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Acknowledgements 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. Fahs-Beck Foundation for Experimental Research New York Community Trust 65

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Rick.Bradshaw@twu.ca Laurie.Detwiler@Kwantlen.ca 66

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OEI Techniques for Today n Eye Dominance Check & Informed Consent n SWITCH - Transference Check & Clearance n SWEEP Dissociative Artefacts n Release Points for Panic Symptoms/Attacks 67

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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 1 st Nations: Family members & community share Attending to quality of relationships Healing broken attachments (RHAP)

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Certified Trauma SpecialistCTS 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 http://www.atss.info/assets/pdf/FINAL_CTS_APP_1.24.12.pdf

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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