Summary: The clinical phenomena of the conduct of EMDR and Thought Field Therapy were interpreted in light of concepts in the field of classical conditioning with emphasis on the orienting reflex and its external inhibiting effects on conditioned responses. A model was proposed using the temporary suppression through external inhibition of the fear and avoidance conditioned responses to disturbing memories. The clinically helpful effect proposed is the emergence of previously suppressed competing responses to the troublesome memories. Those newly emerged responses are responsible for spontaneous cognitive restructuring of the meaning attribution of the memories, thus lowering SUDS ratings. [Word Count:2057]
This is a speculative model proposal which is not an endorsement of the therapies mentioned as being the most efficacious but is an attempt to develop an empirically testable hypothesis of a possible common underlying factor of two new therapies. The first of the two therapies is EMDR (Eye Movement Desensitization and Reprocessing). This therapy arose quite recently as the result of personal observations by Francine Shapiro, Ph.D. (Shapiro, 1989). The second of the referenced therapies is Thought Field Therapy (TFT) developed by R. Callahan and J. Callahan (Callahan and Callahan, in press). Each of these two therapies were part of a recent project at Florida State University (Figley, 1995) in which PTSD relevant therapies were invited to participate in a study to isolate possible underlying common factors between "successful" approaches. Both EMDR (Montgomery. & Ayllon.,1994) and TFT, among others, were looking very promising (Figley, 1995). EMDR and TFT were chosen for inclusion because their common procedures appear to embody elicitation of the orienting reflex (OR) in a repetitive and "trial-like" manner reminiscent of learning trials. A well reasoned model for EMDR based on classical conditioning has been developed by Dyck (1993) but so far deconditioning results (Boudewyns, 1993) do not confirm the model. This model uses a similar approach but does not assume deconditioning of emotional arousal as the effective mechanism.
In EMDR the therapist asks the patient to tell what memories are disturbing to them and to rate them on a SUDS (subjective units of distress scale) while focusing on the bodily sensations and other changes aroused by the recollection of the memory by means of being asked to form a "picture" of it. The patient is encouraged to keep a "picture" of the memory in mind as vividly as possible while performing rapid eye tracking movements. This procedure is repeated in sets with only short intervals between them.
In Thought Field Therapy the patients are also asked to identify memories or thoughts which are disturbing, then keeping it in mind simultaneously performing a number of operations in sequence partially consisting of finger and hand tapping, including moving eyes in a circle. Different action sequences are used for different categories of situations.but in most cases these procedures are repeated in sets and with ratings obtained on a SUDS . The focus of the proposed model in this paper is upon the common features in the two models of sets, repetitions, performance of distracting tasks, and keeping a troublesome memory/thought simultaneously in mind. It is acknowledged that both therapies are much more complex than can be described here and have other significant features which contribute to clinical effect.
The central thesis of this paper is that both EMDR and TFT have embedded at their core systematic methods for elicitation of the OR which results in external inhibition, a condition which partially suppresses the CR's of arousal/fear/anxiety to conditioned stimuli (CS's, traumatic memories) which accomplishes similar clinically desirable results as attained by implosive or flooding therapies (Lyons & Keane, 1989). The posited causal mechanism is a long known but little noticed property of the orienting reflex to inhibit ongoing CR's , called external inhibition (Pavlov, 1912). Repeatedly eliciting the CS (traumatic memory) while simultaneously eliciting the OR inhibits or suppresses the CR to some degree, which permits, after several repetitions of sets of such OR's, previously suppressed alternative responses to the traumatic memory to emerge. Only partial suppression would be required to permit "cognitive restructuring" to proceed. This is hypothesized as producing the patient verbal reports that they "feel better" after EMDR and TFT even though some measures of post treatment arousal show little difference in pre-and post-treatment physiological arousal (Boudewyns, 1993) .
The OR was discovered by Pavlov in 1910 and described in 1927 as follows: "It is this reflex which brings about the immediate response in man and animal to the slightest changes in the world around them, so that they immediately orientate their appropriate receptor organ in accordance with the perceptible quality in the agent bringing about the change, making full investigation of it."
The OR was described by Pavlov (1927) and developed into a model by Sokolov (1963). This conception is of a complex organized response of many sensory modalities and their supportive systems (including hormonal, vascular, skeletal, muscular, eye movement, visceral, and neural systems) that compel the organism to cease ongoing routine behavior and immediately devote "attention" and its supportive resources to a "new" or especially salient stimulus (Germana, 1986). One manifestation of the OR is a freeze of ongoing behavior, reorientation of sense organs to scan the environment, and heightened arousal. This response is of such pre-emptive character that whatever was going on before is immediately abandoned (at least momentarily, until danger or importance is ruled out by environmental scanning). In this connection Anokhin (1965) has formulated the exclusion principle: "Every holistic activity of the organism has a tendency to be the only one present at a given time and to exclude all other acts. The organism cannot combine simultaneously two or three holistic activities". Another view of this is given by Lynn (1966) in which there is "reciprocal inhibition" between the OR and the CS in which the CR is inhibited in order to give the organism "time to evaluate the stimulus".
Recent information processing research has made use of the OR as a mechanism for the allocation of scarce information processing capacity in humans (Filion, 1991) and in the formation of memories (Goldwater and Van Doren, 1987). The salient use of the OR construct in the model proposed in this paper concerns the finding (Pavlov, 1927) that in the hierarchy of reflexes it takes precedence over conditioned reflexes Thus if an organism has a conditioned fear response to felt brown hats due to an experience of great fear in the presence of such a hat, it could be temporarily suppressed by a strong elicitation of the OR.
Since the "reprocessing or reinterpretation" of memories is a central aspect of most traumatic memory work, including EMDR and to some extent TFT, it is important to exam how even partially and/or temporarily desensitizing traumatic memories could lead, on its own, to therapeutic results. It appears that, normally, memories do change (Bartlett, 1932) in character, organization, and clarity in the usual course of things, even memories of events which were quite important and presumably "fixed". As any psychotherapist will attest, much of the content of therapy consists of examining memories of events (i.e., that fight last night with the spouse) and often developing completely new interpretations. The "to be changed" memories are sometimes referred to as distortions (usually a more felicitous interpretation is the goal). The memory of the proverbial "fight last night" with its accompanying remembrance of rage, wounded pride, and righteous indignation may well give way to guilt, shame, humbleness, and incredulity at one's own behavior. Thus the reinterpretation or "cognitive reframing" of most memories needs no special mechanism postulated other than that of commonly observed processes.
However, traumatic memories of the sort associated with Post Traumatic Stress Disorder show a tenacity and perseverance that seem impervious to the change processes outlined above (Van der Kolk, Boyd, Crystal,&Greenberg, 1985) The vividness and visceral involvement of the person experiencing such a memory replay suggest a "reliving" quality quite different from other memories. These memories seem highly resistant to reinterpretation and assimilation into the net of other memories of the individual. Indeed, they seem impossible to forget (Levonian, 1972). Thus a special class of memory is revealed that is unique among memories in that it does not show the accessibility or malleability of other memories .
This model holds that the sort of memory reprocessing phenomenology hypothesized to be characteristic of EMDR and TFT may occur spontaneously with subtraumatic memories in most persons without the intervention of therapists although their assistance may be useful. The core phenomenon is the reminiscence of an event and coming to interpret it entirely differently to the extent of modifying emotions experienced (i.e., from rage to shame or acceptance) and to radically shifting the cognitive structure associated with the memory (i.e., from "I have been wronged and should get you back" to "I have foolishly overreacted and owe you an apology" or "we both had a problem that day"). This may account for the wisdom some attain about their life by re-examining their memories or writing an autobiography.
In this proposed model, the phenomenology of EMDR and TFT's success with lowered SUDS ratings is attributed to the change in cognitive attribution of meaning to the memory structure itself, when it is re-experienced in directed reminiscence, allowing "normal" processes of memory accommodation, transformation, and reinterpretation to proceed. The causal agent is credited as being the elicitation of the OR in the midst of the traumatic memory reminiscence resulting in the partial inhibition or suppression of the experience of the visceral/affective components, thereby permitting competing responses (new meaning) to the CS to emerge. The CR inhibition capability of the OR could be optimized by the various distracting procedures to prevent the emotional components from reaching their previously high level. Since the OR elicitation episodes are done in repetitive sets (short enough to forestall habituation) a learning curve may be established such that the traumatic memory itself is at least partly modified in regard to meaning attribution. This seems consistent with the anecdotal reports that without verbal interaction with the EMDR or TFT therapist, patients often report spontaneous alterations in the memory, changes in the emotions they feel about the memory, and new cognitive interpretations about the memory. This could possibly be tested by looking for the signature of the OR during trials leading to reduced SUDS versus trials not leading to reduced SUDS, perhaps varying the magnitude of the OR.
Anokhin, P.K. (1965), The role of the orienting-exploratory reaction in the formation of the conditioned reflex. In: Russian monographs on brain and behavior nr. 3. Orienting reflex and exploratory behavior. Ed. American Institute of Biological Sciences, Washington.
Bartlett, F.C.(1932). Remembering. Cambridge (England): Cambridge Univ. Press.
Boudewyns, P.A., Stwertka, S. A., Hyer, L. A., Albrecht, J.W., & Sperr, E. V. (1993). Eye movement desensitization for PTSD of combat: A treatment outcome pilot study. The Behavior Therapist, 16, 1-33.
Callahan, R. and J. Callahan (in press). Thought Field Therapy. In C. R. Figley, B. Bride, and N. Mazza (Eds.) Death and Trauma, (publisher pending).
Dyck, Marray J. (1993) A proposal for a conditioning model of eye movement desensitization treatment for post traumatic stress disorder. Journal of Behavioral Therapy and Experimental Psychiatry, 24( 3), 201-210.
Figley, C. (1995) Personal communication.
Filion, Diane L., et al (1991). The relationship between skin conductance orienting and the allocation of processing resources. Psychophysiology 28(4), 410-424.
Germana, Joseph (1986). A systems view of the orienting reflex. Pavlovian Journal of Biological Science. 21(2):65-66.
Goldwater, Bram C. & Van Doren, Jon (1987). The effects of selective inattention upon the electrodermal orienting reflex: A test of information processing theory. Biological Psychology 25(2):119-133.
Levonian, E.(1972), Retention over time in relation to arousal during learning: An explanation of discrepant results. Acta Psychologica, 36,290-321.
Lynn, R. (1966), Attention, arousal and the orientation reaction. Pergamon Press: Oxford.
Lyons, J.A. and Keane, Terence (1989). Implosive therapy for the treatment of combat-related PTSD. Journal of Traumatic Stress,2(2), 137-152.
Montgomery,R.W. & Ayllon,T.(1994). Eye movement desensitization across subjects: Subjective and physiological measures of treatment efficacy. J. Behav. Ther. & Exp. Psychiat.,25(3),217-230.
Pavlov, I. P. (1927). Conditioned Reflexes. New York: Dover.
Shapiro, Fracine (1989)," Efficacy of the Eye Movement Desensitization Procedure in the Treatment of Traumatic Memories." Journal of Traumatic Stress, 2,(2), 199-223.
Sokolov, Ye. N. (1963) Perception and the Conditioned Reflex. Oxford, England: Pergammon Press.
Van der Kolk, B., Boyd, H., Crystal, J.,Greenberg, M. (1985). Post-traumatic stress disorder as a biologically based disorder: Implications of the animal model of inescapable shock. In van der Kolb, B. (ed.), Post-traumatic Stress Disorder: Psychological and Biological Sequelae, American Psychiatric Press, Washington, D.C., 123-134.
Van Olst, E. H. (1971) The Orienting Reflex. Mouton-The Hague-Paris: Psychology Studies-Minor Series 2.
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