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by Dr David Lake

(With thanks for inspiration from Gary Craig, and all the contributors to the EFT field at http://www.emofree.com/)

Post-Traumatic Stress Disorder (P.T.S.D.)

Time does NOT heal.

A strict definition of P.T.S.D. might refer to experiences involving wartime or deadly danger.

This condition manifests in a group of symptoms and feelings, including problems such as:

• Intrusive symptoms Nightmares Spontaneous memories of the experience Flashbacks
• Avoidant behaviours Emotional numbing Detachment / withdrawal from ordinary life
• Avoiding anxiety-stimulating situations or people
  
• Arousal symptoms Hypervigilance Anger outbursts Exaggerated "startle response"
  

A far more common and minor version of this disorder is part of universal human experience of traumatic stress. The stressful event may not have been connected, for example, with the fear of losing your life, nevertheless, the recipient has a toxic memory experience “frozen” into the nervous-emotional system in some way. The memory reliably brings great emotional distress far into the future. It is not changed much over time.

More obviously we suffer because of a defined event. This can be an accident, an assault or an experience where we became fearful and helpless. Sometimes it is an accumulation of stressful experiences over time in some occupations.

In childhood, the experience of hurt and fear in “normal” development can cause emotions to be suppressed, and stunt emotional development. This is the central idea behind psychotherapist Alice Miller’s book “The Drama Of Being A Child”. To this extent we all have “traumatic” memories and experiences worth addressing and treating if they do underlie problems in our present—often outside our awareness.

Even more importantly, we now know that the soldiers who suffered the most following war service in Vietnam tended to have the most suffering before they went to Vietnam—when they were young, often in their family of origin. In that conflict, soldiers were not able to process all that happened to them before they were flown back home, whereas in World War 2, many soldiers had a long period of time after the battles to travel home and talk with their buddies. Even so, the graphic film, “Saving Private Ryan”, set in World War 2, screened in American cinemas ‘full of weeping, older men” according to newspaper reports.

Key Features Of Traumatic Stress

(reference Professor Sandy McFarlane (Head of the Department of Psychiatry, University of Adelaide); article in the "Australian Doctor” 12 May 1998)

There is a universal pattern of response to intense fear. The consistency of reactions validates P.T.S.D. as a specific disorder. A minimum of 15% of "exposed" people develop P.T.S.D. following such fear.

• Other abnormal reactions to trauma exposure include:
  
• Dissociation (a feeling of being ‘split off” from what is happening)
• Somatisation (the body has problems and poor function)
• Affect deregulation (lack of emotional self-regulation leading to problems).
• These include:
  • Difficulty in mediating anger (outbursts)
  • Self-destructive/suicidal behaviour
  • Risk-taking behaviour o Depression (up to 50 per cent of sufferers)
  • Anxiety disorders (e.g. panic, excessive fears, agitation)

This means sufferers lose contact in their inner world with what keeps them steady and secure, and feel the loss of that previous normal way of being. As time passes the person can also begin to blame themselves for not getting better more quickly, or even for developing the personal reaction-problem in the first place.

Where someone you care for has been harmed, it is important to recognise co-existing ‘grief’ for friends and relatives in these disorders—others become disturbed by the trauma indirectly, since the horror of the experience can disturb the "object-relatedness" with the image of the loved one (the way we think and feel about them)

There is an accumulated risk from repeated exposure to traumatic events, as in emergency work, and this can be triggered sometimes by a single event, which is a particularly "meaningful" or upsetting one to the individual. Sometimes it is unpredictable—our capacity to cope with bad things is very individual. The classic example is war; often severe emotional trauma is a daily event. The role of the media in traumatizing—and re-traumatising viewers—using repeats of the nightly news should not be under-estimated. Now depictions of real and graphic violence are brought into our homes so easily. Many people and children became very afraid after ‘September 11’ according to my information, when they had no personal reason to be so scared.

Psychiatrist Anthony Feinstein from the University of Toronto contacted 140 war journalists in 2000, and interviewed one in five; he found that 27% had symptoms of P.T.S.D. (source The Walkley Magazine)

The biology of P.T.S.D. is not the biology of stress—it is much more. There is disruption of the person’s capacity to modulate stimulation ("self-soothe"), and to memory systems. We don’t tend to settle down after the danger passes. Traumatic experiences can be toxic to the brain because of direct neurohormonal influences coupled with progressive increase in the "sensitivity" of parts of the brain. This is thought to be particularly marked in children subjected to chronic abuse.

After trauma: "There is a critical transition phase, within the first few days, where the effects of trauma don't subside for some; they start to become chronic. There is a progressive escalation of symptoms rather than coping..." (quote from reference article)

Four Activity Model of Psychotherapy

(after Howard Lipke: The International Electronic Journal of Innovations in the Study of the Traumatization Process; April 1997)

"Positive integration with speed"

The primary goal of all psychotherapy may be seen as helping clients to re-process information (maladaptive beliefs, behaviour, emotions, sensations, painful intrusive images) held dysfunctionally. A consequential goal is to help clients acquire and process new information, to enhance adaptive functioning.

Francine Shapiro (originator of E.M.D./R.) has developed an "accelerated information processing " model of psychotherapy, where learning-based psychopathology is the result of incomplete processing. Removing "blocks" to processing will result in adaptive re-processing. This model also fits with the outcomes seen using EFT and SET.

Category 1: Accessing of existing information; as in:

Cognitive information, interpretative questions, physical sensations

Category 2: Introduction of new information (e.g. information about the "unconscious")

Normative data, reinforcement

Category 3: Facilitation of information processing

This part of therapy can accelerate and complete processing. I consider that his is where the Energy therapies prevail... · EFT / SET / TFT / BSFF / TAT · Hypnotherapy · Neuro-Linguistic Programming: NLP · Traumatic Incident Reduction: TIR · E.M.D./R.

Category 4: Inhibition of information accessing

Relaxation, distraction , self-hypnosis. (Medication)

All techniques must be integrated with other models of therapy since none is a panacea.

 

General Considerations

You need to be ‘centered’ and relaxed to help others by doing trauma work. Ideally your own inner world is peaceful. Your life is going well. You approach the idea of helping others and using EFT or SET with confidence.

A key feature of doing trauma work with EFT/SET is tapping simultaneously with the client, to remain calm and to avoid your own traumatisation in the session by what you hear, or think about.

Of course you need to set aside sufficient time for assessment and also for a treatment session (which may be different times).

I think it is important to demonstrate tapping on a ‘neutral’ subject if you can in such a session. This might be any tension in the body, or a physical ailment, rather than an emotional issue.

 

Relational Aspects Of The Session

Rapport

The relational aspects of healing are as important as the technique; your intentional care and respect really count. Here the importance of the therapy ‘frame’ is paramount. Being with disturbed clients in a compassionate way is healing in itself. Meet the person at their level of experiencing the world, with empathy and understanding. Introduce your strategies appropriately and thoughtfully, since most often the sufferer is willing to do anything to gain relief from their disabling problem. Your energy and your wish for the client also provide a channel for healing.

History-taking

It's very important to know as much as possible about the client's life psychologically, even if urgent treatment is required. Note whether the client has support from family or friends, and whether they have pre-existing conditions likely to affect recovery.
When trauma is treated very late, after years, any chronic problems prior to the specific events require healing too, in general terms (viz. the E.M.D./R. experience of Francine Shapiro with Vietnam Veterans in the 1990's)

Treatment

First establish security and safety for the afflicted person according to their needs.

Most of the talking therapies include the healthy aspects of common-sense education and advice (where the timing is appropriate for that). Since all behaviour occurs in a context it makes sense to establish goals of support and healing for your session.

Supply a holding therapeutic framework, which—with your help or therapy—can contain the toxic emotions which flood the survivor.

Debrief by discussing the event and developing ways of thinking actively and meaningfully about what has happened (I initially don’t want specific details of the trauma since I won’t use E.F.T. until I am ready to deal with the consequences for the client of telling the whole story). Of course this must be respectful to the understanding of the person, and their ability at each stage of treatment to process information. Many fears and anxieties are irrational. The support of friends, family and faith is crucial in healing a recent trauma.

In the example of military response to war trauma, the forces emphasise:

• Proximity : help nearby
• Immediacy : support
• Expectancy : return to full function

EFT and SET, as part of the Energy therapies and other healing modalities, offer unique opportunities to groups and individuals who need urgent treatment as part of disasters. It is possible to teach populations simple methods for self-help and immediate practical assistance. The only drawback to large-scale use seems to be the human reluctance to try new methods that are generally ‘scientifically unproven’.

 

Therapeutic modalities include:

• Cognitive Behavioural Therapy: C.B.T.
• Insight-oriented psychotherapy
• Hypnotherapy
• Somatic Therapies (e.g. Hakomi bodywork, Rolfing, Shiatsu)
• Eye Movement Desensitisation & Reprocessing: E.M.D./R.
• Energy & Meridian-Based Techniques (e.g. EFT, SET, & TFT; [BSFF]; TAT and Laser stimulation)
• Medication

You need to be ready to switch approaches if they don't seem to be working, and individualise treatment.

For severe reactions, or a reluctance to have therapeutic help when it’s necessary, medication can be very useful (a modern anti-depressant) as a facilitating step. There is still a stigma attached to having treatment for any “mental” disorder in our society.

"A significant portion of people with early symptoms - who are not motivated by compensation - do go on to develop a chronic disorder and often it is the beginning of an overall decline, in which they develop other psychiatric disorders. If ever there was a role for PREVENTION in psychiatry, this is it. The early identification and effective treatment of this condition is ABSOLUTELY CRITICAL" (article—with my emphasis)

 

Why Use EFT/SET?

"Healing is helping the Life Force (Chi) to flow freely" (Avis Burnett)

EFT and SET may be "the most comfortable therapy because it is most removed (from ‘flooding’)" (Howard Lipke on TFT — the forerunner of EFT and SET)

EFT/SET is a "Category 3" activity par excellence; it offers profound change rapidly, in experienced hands, and is a multi-level healing of mind, body and emotion. Moreover it is generally a safe, ‘containing’ and gentle modality regardless of the severity of the trauma.

It is ideal as self-help and the simple all-purpose algorithm is easy to learn and apply. Although it is a technique, and not a therapy in itself, it has the potential to facilitate great change generally. It is most unusual to find no effect with the use of EFT and SET in emotional issues.

In some 11 years of direct experience of treating all kinds of trauma with this Energy modality, I have found that in a previously well person, with a single-incident trauma (such as a motor vehicle accident, or assault) 1-2 thorough treatment sessions of an hour or so each (by a trained person) can be sufficient for full resolution of the emotional basis of the distress—such that the memory of the incident no longer provokes any dysfunctional emotional intensity, although the memory details and thoughts remain. The positive changes are naturalistic and seem to “fit” into the person’s life and personality seamlessly.

With group techniques there exists the opportunity for mass treatment in natural disasters. This is cost-effective and enables the group to be trained in self-help with EFT/SET simultaneously. I have seen that by using E.F.T. persistently, ordinary people can achieve positive outcomes for themselves and for others that are unknown in the orthodox therapeutic approaches.

 

Protocols In EFT/SET

1. Typically in Trauma work I would use the 7-point EFT shortcut alone in a mechanical fashion, which allows me to concentrate on the person in front of me. For continual tapping I choose to have the person tap either the cheek or collarbone points, the little finger point, sometimes the ‘combination’ wrist points, while they think, or process information, or feel intensely. I want the meridian system stimulated very much during treatment, without too much talking about the results until the work is over.

2. Treat global concerns first:
"Even though: I have all these problems... “ Life could be better... “ I sometimes get intense..."

Are there fears about telling the history? Many people are afraid of being retraumatised—with good reason. They know that every time they think about the event they will suffer. And sometimes well-meaning helpers inadvertently add to the problems of the sufferer if merely telling the story is the basis of treatment. For some sufferers this will bring the whole issue back up severely.

A possibility here—particularly with groups — is to use the Tearless Trauma Technique (see the website http://www.emofree.com/trauma/tearless.htm) where the problem is approached indirectly, from the “as if” position, using dissociation from the event to allow repeated EFT sequences or continual SET tapping for smooth access.

You can ask: "What emotions do you think we need to deal with first?” (Bruce Eimer)

Or: "Which emotion, if it were suddenly cleared, would make the biggest improvement in your life?" (Callie Currier)

3. Work on the physical discomforts initially. This gains rapport and is a good way to introduce the benefit of relaxation with tapping. Do the treatment on:
Tensions / headaches / racing heart / constricted breathing / body sensations generally...

You may find that there are areas of tension and pain that move around with successive EFT/SET tapping sequences; this is called "chasing the pain....”. Treat whatever is now the focus of discomfort.

4. Be sensitive to the symbolism and metaphors presented by the client or the story. Sometimes this is the best clue to the underlying issues. One client told me “I’m holding on by my fingernails”. We did several EFT sequences about her “poor fingernails” (associating to the difficulty of doing that) with productive results. Her belief was that “nothing in life really works out...” You could also ask the person how they would describe their situation to someone else, or explain it to a friend who didn’t know about it, to gain clues about their inner world.

5. Observe the person very carefully. Their posture, breathing, appearance, gestures, mannerisms and way of being will communicate what their words may not (this is particularly true of children)

6. Use your intuition about the person and situation, and the feelings ‘generated’ inside you by them

7. You can check in with the client during this treatment: "What goes with that?”

It is very productive to ask (after tapping effectively on a physical sensation for several EFT/SET sequences):

“What thought goes with that feeling?” Allow them to ‘blurt out’ spontaneously whatever comes up. Proceed with more tapping.

And when the cognitive trail seems to ‘fade’ after several sequences, you can ask:

“What feeling goes with that thought?... If there were a place in your body where it might be sitting—where do you imagine that might be?”
Proceed with more tapping, while the client places all the attention on that area...or could place a hand over the place and focus underneath it.

8. I consider that the more EFT/SET sequences used —or the more persistently-done overall amount of continual tapping, while talking through the event—the better will be the clinical outcome in a treatment session. I have found it better to delay the cognitive processing and understanding of the treatment until some time has passed after an intensive session. An intensive session of an hour or more involves some 15-20 complete sequences and much continual tapping (if necessary for persisting negative emotion) while checking in with the client about the results and consequences.

It is common that after a thorough treatment, the person may let go other fears and worries that seemed to be unconnected to the traumatic event. In treating a man only for the upset of a motor vehicle accident (where he had to assist a severely-injured and bleeding person) I found that the man’s life-long phobia of seeing blood ‘disappeared’ spontaneously after treatment with EFT for the trauma of the event. He was able that evening to watch a hospital program on T.V. for the first time without reaction.

 

Gary Craig's Model of EFT Treatment

Gary suggests that one good technique for those with good visual imaginations is to construct a movie in your mind of the event, lasting only a minute or so, which represents the whole event, from beginning to end, if possible. Then, instruct the client to "Run the movie..." step by step, such that whenever the client feels any intensity at all, you stop the movie and do EFT sequences on that intensity until there is relief, even if it is not ‘zero’. Then resume the movie. There is no need to force the issue or to be courageous on the part of the client. You can also do this technique naturalistically by “Telling the story...” in a similar way.

Use specific issues and words (from the client’s history) where possible. The person stays in the present tense when telling the story. Deal with one incident at a time, ideally. Be aware of prior trauma(s) and the likelihood of “switching" to another "aspect" of the problem during treatment. Sometimes emotional distress represents “retraumatisation" of a significant emotional event in the developmental life of the client (one problem reminds us of another). Feelings of resistance in the client may be due to the fear of losing control, or negative beliefs; treat these specifically by seeking them out and finding the words to treat them in the session Ideally the client does self-treatment regularly to gain afterwards the "generalising effect" of EFT/SET.—this may require EFT sequences up to 25 times daily or daily SET tapping of 30 minutes or more for the more distressed (and setting blocks of time aside morning and night for regular treatment)

"PERSISTENCE, PERSISTENCE, PERSISTENCE...”

 

Self Help With EFT and SET

For minor trauma experienced in day-to-day hurts or tribulations, the technique of “Telling The Story” is ideal. A short period of EFT or SET work could bring better balance to nearly all irritations.

Step 1 Treat yourself with EFT or SET sequences on any concerns or doubts related to doing this treatment, and any connected negative beliefs if you can identify these.

Step 2 “Tell the story” of what happened in your mind, step by step, such that if you feel emotional intensity at any point, stop giving the account and treat yourself with EFT or SET sequences for relief. Focus on the strongest impressions, which—for you— could be images, or self-talk, or body feelings. After gaining reasonable relief, start the account again.

Step 3 When you have finished, stop and review the story. Make sure there is no residual intensity. Now scan your body for any tension and treat that, if present.

For deeper problems, the key to achieving good results like this is to focus and to persist. It is better to do a lot of tapping on the hurt even if you are unsure about the words to say or exactly what the issues are.

Focus Either on the mental aspects of the problem (the associated memories, thoughts, ideas, images, sounds) or on feelings in the body (any tension, aching, feelings that come up in certain places)

Persistence Doing many sequences during time you set aside (say 30 minutes). Doing continual tapping (without a set-up) any time you have intensity.

N.B. You can treat yourself in public by discretely touching the points and “breathing into” each one (John Diepold’s “Touch & Breathe” technique). Just thinking about using EFT or SET will often bring relaxation and benefits.