Observed & Experiential Integration (OEI): - PowerPoint Presentation

1. Observed & Experiential Integration (OEI):A New Trauma Therapy Theory/Research, Demonstration,& Hands-On Experience Rick Bradshaw, PhD, RPsychLaurie Detwiler, MA, CCCInternational Counselling Association & Canadian Counselling & Psychotherapy Association May 2014

2. Where did OEI come from?Gendlin’s FocusingEMDR “One Eye at a Time”EMDR newsletter – “Glitches”Brain Gym – “Lazy 8’s”

3. OEI: What is it used for?Engaging people about their own internal processesRapid alteration of emotional & physical intensityAssessment & treatment of negative transferenceAvoidance of, and relief from, panic attacksOvercoming addictions, self-harm urgesRe-ordering the alarm system (“stirred up” & “stuck”)

4. 5 Building Blocks of OEILevel I TechniquesLevel II Techniques

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6. Video Demo - SwitchingSwitching for alteration of trauma intensityCase examples:MVA – Vividness of Sensory RecallAdult Lights & Cameras trigger CSA

7. Case Examples - TransferenceParents & ChildrenPhotographsPartnersMirrorsTherapistsGroup Leaders

8. 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)

9. LORETA L Eye Pre-TreatmentRight Hippocampal-Dentate Complex – Visual Memory

10. LORETA L Eye Post-TreatmentRight Inferior Temporal Gyrus – Facial Recognition

11. Now You Try It!Eye Dominance CheckArms Length, Two Fingers Vertical, Both Eyes OpenLine up vertical fingers with straight edge in distanceWithout moving fingers, close one eye, then open itWithout moving fingers, close the other eye then open itWhich 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)

12. Another Eye Dominance Test

13. Try This in Pairs Transference Check & ClearanceProximity: Notice how far away I appear to youAppearance: Notice how I look to you (color, expression)Body/Emotion: Notice how you feel physically & emotionallyCognitive Proj: Notice whether it seems like I’m on your side…______________________________________________________Try sitting, standing, different people (gender, race, age, etc.)Try moving a small amount closer, further away, diff. angles

14. Social ConnectionVentral Vagal Brake “On”Fight-or-FlightVentral Vagal Brake “Off” (SNS)Freeze Dorsal Vagal Complex – (DVC)Polyvagal TheoryStephen Porges (2001/2007) 3 Response Levels:

15. Core Trauma vs Dissoc ArtefactsCORE TRAUMA SYMPTOMSDISSOCIATIVE ARTEFACTSConstriction in Throat Headaches & Pressure in the HeadBronchoconstriction in ChestVisual Distortions, Blocks, & BlurringNausea or Queasiness in StomachDizziness, Drowsiness, Loss of BalanceNote that all of thesesymptoms are experiencedin the core of the body…(hence CORE TRAUMA SYMPTOMS)Tingling & Numbnessin the Hands, Face, & FeetYawningSinus Pressure

16. Core Trauma vs Artifacts

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18. Broca’s Area: Speech Production

19. Limbic & Paralimbic StructuresThe parts of the brain most involved in producing intense symptoms, like:Panic, flashbacks, startle response, nausea, and throat or chest constrictionAre not directly affected by talking or listening

20. Limbic System: Midbrain

21. Anterior Cingulate Gyrus

22. Neurobiology of AttunementMirror 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

23. Coactivation of SNS & PNS I“Tonic Immobility” = co-activation of Sympathetic & Parasympathetic Nervous SystemsIn “Freeze” response, frequently changing pupil widths and increases in pulse rate from 60-70 to 110-120 bpmChildhood sexual abuse = 50%Sexual assault victims 35-40 % some immobility10-12 % extreme often w opioid-mediated analgesia

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25. Classical Conditioning of TraumaAdrenalin Rush Eye Position & Movement Stored in Brain

26. Ocular Proprioception IProprioceptors = 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.

27. Extra-Ocular Muscles

28. Ocular Proprioception Required!

29. Occular ProprioceptionString demo“Like pulling out a sliver”

30. Vertical Location in Visual Fields

31. Ocular proprioception IIIntraocular 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”).

32. Video DemoTherapist comments on breathing, reddening of eyesGlitch massage with distal pulls, and vertical patternsResolutions of intensity with Switch & Glitch work

33. Usually massaging toward the client triggers abuseSometimes massaging away triggers abandonmentTrack across the visual field until you see a glitchThen move vertically until you see another halt or skipThen pull out of the centre of that “cross-hair” ( + )Keep going until you see a fluttering of the eyesThere is often a concommitant breath releaseSometimes there is an emotional release as wellProximal-distal

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35. Add Acupressure PointsTriple Warmer – For Shock: “Can You Believe It?”Cold & Hollow – Underarm tapping to warm the coreShame, Shame, Shame – Tap side of index finger, even with the bottom of the fingernail. Opens throat

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37. Release Points

38. New Applications & CombinationsProcess & chemical addictions, eating disorders (urges)Inner voices, self-loathing, and self-harming behavioursPeak performance (focus on goals, target interferences)Dissociative disorders & attachment difficulties (states)Somatic symptoms (fibromyalgia, MS, PNES, chronic pain)Combined w language acquisition & accent reductionCombined w systematic desensitization & psychodrama

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

40. First Study of OEI with PTSDTraumas included sexual assault, attempted homicide by ex-spouse, witnessing suicides, MVAs, assaults, accidental drug-related deathRandom Assignment to OEI Treatment or delayed treatment Control group, applying only SwitchingScript-driven symptom provocation, Control = +2 ExposuresCAPS and IES-R

41. Treatment vs Control: CAPSP = 0.001

42. IES-R Avoidance/NumbingP = 0.014

43. Presentation by Laurie Detwiler, Faculty Member, 43

44. The Place of Trauma Therapy in the Process of Recovery from PTSDInternational Counselling Association & Canadian Counselling & Psychotherapy AssociationVictoria BC CANADA May, 201444

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

46. Past ResearchFreud and BreuerBrewin et al.’s (1996) Dual Representation Theory. SAM and VAMIdentity FormationSeven Core Vulnerable IdentitiesPositive Illusions ReplacedGrowth From Trauma46

47. Current Trends in TherapyCognitive Behavioural TherapyEye Movement Desensitization and ReprocessingOne Eye Integration Therapy (OEI)Research on OEI Austin (2003)Grace (2003) OEI reduced PTSD symptomatologyAustin (2003) after three hours of OEI 4 of the 5 participants no longer met the criteria for PTSD 47

48. Why Research the Process of Recovery?Limited qualitative studies research on recovery from PTSDFewer long-term follow-up studies looking at the entire holistic process of recovery from PTSDNo studies that map out what helps and hinders Study demonstrates the long term effectiveness of OEIProvides clinicians with rich information that can be used in practiceHelp others who have family members and friends with PTSD48

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

50. Validity Reliability Careful definition of the purpose of the researchQualified observersFinal follow upIndependent judge sorted 25 incidents into the helping and hindering categoriesInter-rater reliability: 92% agreement between judge and inter-rater50

51. Interpret and Report8 people, 6 women and 2 men, ages 28 to 54 (average age 45)6 Caucasian, 2 Caucasian & First NationsDiagnosed with PTSD in 2003 during a trauma therapy studyTraumatic incidents ranged from sexual assault, emotional abuse, and witnessing a death, to car accidentsRange of events and time since traumatic event 51

52. Interpret and Report194 incidents were elicited, 128 that were helpful, and 66 that were unhelpfulSorted into 23 categories, 12 that were helpful, and 11 that were unhelpful (see handout)52

53. Categorical Descriptions(helping)Awareness of Recovery Coming From Involvement in the trauma therapy study2. Resources, including Spirituality, Marital and Family, Financial and Physical3. Coping StrategiesDeveloping a New and Positive Relationship with Self53

54. Categorical Descriptions(helping)Growth From Trauma Understanding Your Own Life ExperienceThe Importance of Being Listened to, Cared For, Validated and Accepted For Who You Are by a Professional HelperMaking Personal Choices to Lead A Healthy Life54

55. Categorical Descriptions(helping) Unexpected Positive Circumstances Knowing That You Are Not Alone Talking Today Was Impactful Forgiveness55

56. Categorical Descriptions(hindering)Limitations in ResourcesICBC Is An Unhelpful SystemWhen Boundaries FallDifficulty Coping56

57. Categorical Descriptions(hindering)Fear MagnificationThe Physical Pain CycleHarmful HealersBeing In Situations Similar to the Original Trauma57

58. Categorical Descriptions(hindering)Unexpected Negative CircumstancesCan Not Forgive SelfSexual Difficulties58

59. Final Follow-Up ThemesRecovery is a process which includes more than therapy and all categories are important; however, OEI was very important in recovery, two said 10/10, average score 8/10Lack of Social Support as a theme, in particular Brewin’s (2003) “Other as Betraying”“Other as Abandoning” Brewin (2003)59

60. Latest Sexual Assault & PTSD StudyComparative Experimental Treatment Outcome 1 year to recruit 137 women, screened to 33, lasted 18 Months from Start to Finish (25 by end of study), ParticipantsQuantitative, Qualitative & Psychophysiological Measures

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62. Research Design20% of women sexually assaulted in lifetimes -- 50% = PTSDScript-Driven Symptom Provocation: 50-second audioRandom Assignment to Groups & Therapists within GroupsAssessors Blind to Group AssignmentsAll Participants Received Control Condition (B.R.A.I.N.) & Active Therapy Participants Received 3 sessions - OEI or CPTCredibility Checks for all Interventions (COTQ)Manualized Treatments

63. Results - CAPSTime: F(2,21) = 49.62, p = .04, η2 = .83Time*Group: F(4,42) = 2.96, p = .03, η2 = .22Group: F(2,22) = 1.32, p = . .29, η2 = .11

64. Results – IES-R Numb/Avoid ▲ Control Group ↑ Cognitive Processing Therapy * One Eye Integration

65. AcknowledgementsDr. 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 Trust65

66. Rick.Bradshaw@twu.caLaurie.Detwiler@Kwantlen.ca66

67. OEI Techniques for TodayEye Dominance Check & Informed Consent“SWITCH” - Transference Check & Clearance“SWEEP” – Dissociative ArtefactsRelease Points for Panic Symptoms/Attacks67

68. 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’ problemsSomatic symptoms = less loss of face Medical procedures to treat symptoms1st Nations: Family members & community shareAttending to quality of relationshipsHealing broken attachments (RHAP)

69. Certified Trauma Specialist (CTS) designation from ATSSProfessionals & 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 reviewGo to the ATSS Web site and download the CTS application: http://www.atss.info/assets/pdf/FINAL_CTS_APP_1.24.12.pdf

70. More Info on OEIVisit our Web site for FAQ videos, books, seminars, resources, memberships, Web site listing of clinicians, research summaries, information on OEI publicationswww.sightpsychology.com