Observed & Experiential Integration (OEI):

1. Observed & Experiential Integration (OEI): 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

2. Where did OEI come from? • Gendlin’s Focusing • EMDR “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 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”)

4. 5 Building Blocks of OEI Level I Techniques Level II Techniques

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

7. Case Examples - Transference • Parents & Children • Photographs • Partners • Mirrors • Therapists • Group 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-Treatment Right Hippocampal-Dentate Complex – Visual Memory

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

11. Another Eye Dominance Test

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

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

14. Core Trauma vs Dissoc Artefacts

15. Core Trauma vs Artifacts

17. Broca’s Area: Speech Production

18. 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

19. Limbic System: Midbrain

20. Anterior Cingulate Gyrus

21. 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

22. 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

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

25. 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.

26. Extra-Ocular Muscles

27. Ocular Proprioception Required!

28. Occular Proprioception • String demo • “Like pulling out a sliver”

29. Vertical Location in Visual Fields

30. 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”).

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

32. Proximal-distal • 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

34. 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

36. Release Points

37. 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

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

39. First Study of OEI with PTSD 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 Script-driven symptom provocation, Control = +2 Exposures CAPS and IES-R

40. Treatment vs Control: CAPS P = 0.001

41. IES-R Avoidance/Numbing P = 0.014

42. Presentation byLaurie Detwiler, Faculty Member,

43. The Place of Trauma Therapy in the Process of Recovery from PTSD International Counselling Association & Canadian Counselling & Psychotherapy Association Victoria BC CANADA May, 2014

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

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

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

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

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

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