Volume VI, Issue 2, Article 1 (August, 2000)

Editorial Note         The lead research article in this issue focuses on the critically important clinical problem of internalized shame.  The authors, Dennis Balcom,  Elizabeth Call, and Deborah N. Pearlman (2000) point out that the role of shame remains an intractable treatment problem, even though it has been studied for more than twenty years.  The shamed are typically prone to misreading social and interpersonal communications. They view the world from the perspective of someone who is terribly flawed. Because the traumatized are most often burdened by some aspect of internalized shame and because it is often associated with various drug addictions, anxiety disorders, depression, major mental illness and personality disorders, finding treatments to counteract internalized shame is vital. Yet, the state of the arts in managing, if not eliminating internalized shame is rather poor and the treatments are rarely evaluated. reports on a small study of how a brief therapy session affected perceptions of internalized shame. Though far from a systematic, this phase-one clinical trial suggests that the treatment for shame is promising and warrants further study.
        The next article, Anne M. Dietrich (2000) helps the reader consider a relatively new technique for helping clients desensitize from a highly traumatic event. Visual/kinesthetic Dissociation (V/KD) was invented by Richard Bandler more than thirty years ago. It was one of the first applications of "Neurolinguistic Programming," a revolutionary approach to correcting unwanted, disturbing thoughts, emotions, and behaviors. We have utilized this technique for more than five years in our teaching clinic here at Florida State University, where the author was a resident fellow last year.  This technique is known variously as the "Rewind Technique," the "Quick Phobia Cure," and the "Double Dissociation Method." The technique enables the client to be exposed to troubling memories of their trauma in a way that is less disturbing than more formal flooding techniques. In the most frequently used protocols, the client is asked to imagine being seated in the front row of a large movie theater. The client is then asked to imagine seeing themselves on the screen in a scene just prior to the traumatic event occurring. The client is then asked to imagine first viewing themselves seated from the projector's booth, then viewing their trauma from the projection booth fast forwarding the film through the traumatic event and stopping at a point where they feel safe again, then rewind back to a safe point prior to the trauma and so forth until they become desensitized. Dietrich reviews and discusses the few published articles that discuss this technique and voices concerns about using the technique with some especially vulnerable clients. As with the previous article, the is a call for more systematic research on the technique and its underlying theoretical properties.
        John H. Diepold's (2000) article proposes another potentially useful technique, the "Touch and Breathe (TAB)" method.  After reviewing the origin of the use of tapping on acupoints in the treatment of psychological problems, he introduces an alternative treatment approach that can be incorporated into several other treatment methods that are meridian-based, such as Thought Field Therapy (TFT). The latter is the focus on an article published in the next issue of this Journal (Pignotti, 2000).  Diepold suggests that tapping is not the necessary activity to activate the bioenergy system. He asserts that his method of touching and breathing appears to be superior to tapping. He suggests that the TAB technique is consistent with traditional acupuncture meridian theory that holds that Chi (bodily energy or Life Force) enters the body from the outside through breathing as well as numerous acupuncture points. He notes that breath facilitates the flow of chi in its most natural state.  With TAB, the patient is invited to touch lightly the diagnosed treatment sites along the acupuncture meridians with 2 fingers and to take one complete respiration (at their own pace, usually through the nose) while maintaining contact at each treatment site. Thus, it is argued in this article, that the TAB approach is an effective replacement for tapping in all TFT, EFT, EDxTM and other meridian based psychotherapy procedures. Diepold cites several studies that support this approach, in principle. Although the TAB appears to require more time than touch-based energy/meridian-based techniques, he believes that there are significant benefits. He and the editor hopes that this article will stimulate sufficient interest among practitioners and investigators to test this approach with the traumatized.
        In the final article Michael Lamport Commons (2000) reviews a group of brief trauma treatment approaches that have at least one thing in common, they appear to be quite promising in quickly helping clients to reach desensitization from a highly distressing memories. In this quite provocative and thought provoking article, Commons proposes a mechanism for how these various treatment approaches work. The theory he offers suggests that the approaches establishing "competition among stimuli." That is, although the clinical innovators who offer these approaches do not suggest it, their treatment procedures all interrupt old habits and conditioned reflexes in some way and provide new habits and conditioning. These approaches, and I might add, most other desensitization methods, help clients overcome prior-stimulus dominance, the fear of the trauma-associated reminders. He also asserts that these treatment approaches, so called "power therapies," reduce the intensity of emotional responses "through working at the subcortical level of brain activity to interrupt the negative emotional responses elicited by the trauma stimuli." The final section of the paper offers some guidance in testing his theory. In doing so he provides a useful summary of its essence. He suggest that the firings at the subcortical level preempt and overwhelm the frontal-lobe function and, consequently, the sufferer.  If so, any of the treatment approaches may compete with and successfully interfere with the overwhelming emotional responses and delay the conditioned stimuli from directly eliciting fears and phobias until the frontal lobes can perform their interpretive function. He further suggests that investigators examining the effectiveness of the treatment approaches should first examine the entire protocol that appear to affect the subcortical level of brain activity. He suggests the use of a psychological placebo ("Carry out the steps (e.g., eye-movement or tapping, etc.) at non-prescribed points in the procedure for one set of problems. . . .") as well as a multiple base line design to investigate the procedures as well as the overall effectiveness of the approach.  Finally, he urges investigators to use brain-imaging technologies. This would not only help test his theory but also go beyond the typical self report data that his highly subjective and unreliable.
        The important advances in the neurobiology of trauma, together with continuing innovation in the assessment and treatment of the traumatized, offer great hope that PTSD and other trauma-related anxiety disorders can be prevented as well as treated efficiently. These articles appear to be a means to that end.

References

        Balcom, D., Call, E., and Pearlman, D. N. (2000). Eye Movement Desensitization and Reprocessing Treatment of Internalized Shame. Traumatology, Volume 6, Issue 2, Article 2.

        Commons, M. L. (2000). The Power Therapies: A Proposed Mechanism of Their Action with Suggestions for Future Empirical Validation. Traumatology, Volume 6, Issue 2, Article 5.
 

        Dietrich,A. M. (2000). A Review of Visual/Kinesthetic Disassociation in the Treatment of Posttraumatic Disorders Theory, Efficacy and Practice Recommendations. Traumatology, Volume 6, Issue 2, Article 3.

        Pignotti, M. (2000). Helping Survivors Of Destructive Cults: Applications of Thought Field Therapy. Traumatology, Volume 6, Issue 3, Article 5.