I've just recently had time to follow up some web references for PTSD that someone (I don't remember who; not a regular) posted here a couple of weeks ago. I found an article which may have some relevance to the discussion of the NLP phobia cure and the issue of dissociation.
I've always considered the most important aspect of the phobia cure to be its use in helping people deal with traumatic memories. The article which I will quote below doesn't actually discuss the phobia cure as it presently exists, but instead discusses Visual-Kinesthetic Dissociation, which is essentially the first half of the present cure.
I'm only quoting the parts of the article which talk about NLP, but it also discusses other approaches, such as EMDR and Thought-Field Therapy (Roger Callahan's tapping method), which it actually recommends more highly than V-K Dissociation.
I believe that this article can be found somewhere on the Australian Trauma Web site (from the Criminology Department of the University of Melbourne). I originally found the article through the Trauma Incident Reduction website, which I in turn reached from Hope E. Morrow's Trauma Central page.
It is worth looking at an interview with Kate Sorenson, past president of the Arizona Mental Health Counselor's Association. She has done extensive work with victims of trauma. In her interview, she states that she found Visual-Kinesthetic Dissociation a valuable technique, but for several reasons now she mostly favors TIR (Traumatic Incident Reduction), althought with EMDR and TFT.
The article which I want to partially quote summarizes a report given at a conference on Active Ingredients in Efficient Treatments of PTSD held in 1995 at Florida State University and presided over by Drs. Charles Figley and Joyce Carbonell.
Reflections on Active Ingredients in Efficient Treatments of PTSD, Part 2
Fred P. Gallo, Ph.D. 40 Snyder Road, Hermitage, PA 16148
{ Brief Extract from Part 1 ]
Four therapies for PTSD were presented at the Active Ingredients in Efficient Treatments of PTSD Conference, Florida State University, May 12-13, 1995. The conference was presided over by the principal investigators of the clinical demonstration study by the same title (Figley, C.R. and Carbonell, J., 1994). The methods included Eye Movement Desensitization and Reprocessing (Shapiro, 1995), Visual/Kinesthetic Disassociation (Bandler & Grinder, 1979), Traumatic Incident Reduction (Gerbode, 1995), and Thought Field Therapy (Callahan, 1985). Each method was summarized by the developers and/or representatives, preliminary results of the demonstration project were provided, workshops were presented and penetrating discussion ensued.
The four approaches were selected on the basis of nominations by traumatology professionals in response to the investigators' request, the Internet facilitating the process. Over a dozen nominations were initially received; however, most did not fulfill criteria for inclusion in the study: verification of effectiveness by at least 300 licensed/certified clinicians who regularly treat PTSD clients; replicable under laboratory conditions at FSU; readily teachable to paraprofessionals; willingness of the principal developers to defend the approach to academic, clinical researchers at FSU; and willingness of the developers and/or principal practitioners to treat clients at FSU for a week under research conditions.
Four to six month follow-up's revealed that all of the approaches yielded sustained reduction in subjective units of distress relative to treated traumatic memories (although some rebound in SUD's was evident in many cases). The average pre-treatment SUD rating on a 10-point sacle was between 8 and 9. Noting that the follow-up evaluation time frames and N's varied considerably across treatment conditions, notably imposing variables, respective Mean Group Treatment Times and Post-Treatment follow-up SUD ratings were as follows: TFT (N14) 63 mins, 3.60; V/K D (N11) 113 mins, 3.30; EMDR (N6) 172 mins, 2.64; TIR (N9) 254 mins, 5.67. (A variety of psychometric and physiologic measures not discussed in this article were also obtained.) While strict comparisons among the methods would not be valid due to varying client selection criteria across methods as well as other variables, preliminary results nonetheless support the contention of the nominating professionals that the methods are effective in reducing distress associated with traumatic memories.
[ Now on to Part 2 ]
Part 1 of this essay summarized data and summarized the methods studied in the 'Active Ingredients' Project. Part 2 explores possible change-producing ingredients germane to each as well as across the methods. ---------------------------------------------------------------------------
An ``outside observer'' position is promoted directly with V/KD (Cameron-Bandler, 1978), while the other methods may provide this ingredient indirectly. In this respect the subject is no longer ``in'' the memory but ``outside,'' looking at it. Such a shift stimulates the acquisition of other understandings while emotionality is reduced. The associated distinction becomes clear as a memory is recalled in a similar manner in which the event was initially experienced. In this instance the image is 'seen' through the individual's eyes, as though it is presently occurring. If affect is associated with such a memory, its intensity is readily perceivable when associated. Dissociation, on the other hand, entails recalling the event with the internal image including the observer, an event that could not have occurred at the time of the original event. This position yields significant decrease in affective intensity relative to associated recall.
With V/KD, this perceptual shift appears to be a primary causal factor in promoting relief from the trauma. It should be emphasized, however, that dissociation is a temporarily induced aspect of the procedure, as the patient is later directed to re-associate and maintain the 'learning's' acquired during the dissociation phase.
Besides viewing from a dis-associated position, trauma neutralization can also be promoted via change in other facets of internal sensory representations, referred to as 'submodalities' (Bandler, 1985). For example, the visual modality can be analyzed in terms of elements such as perspective, proximity, movement, etc. V/KD induces alteration of such elements by having subjects see themselves seeing themselves in the scene. Given this shift as well as others prescribed during the process, additional imagery changes frequently follow. This may entail the memory shifting from a movie to a snap shot, from colorful to achromatic, from clear to vague, etc. Also changes in the visual modality often result in transmodal reattunement. For example, closer appearing images may entail a louder auditory component as compared to more distant appearing images. The other methods often appear to produce similar shifts.
Shapiro sites the case of a Vietnam veteran treated with EMDR reporting that the auditory component of the memory silenced, the visual aspects became like ``a paint chip under water,'' and affect calmed (Shapiro, 1995, p. 4). The author has also obtained similar reports from patients treated with TFT as well as EMDR. For instance, some patients report that the memory appears ``more distant'' or ``vague'' after treatment is completed. This is not a hard and fast rule, however, since others report being able to distinctly or even more distinctly recall the trauma, albeit without the previously reported negative affects. Of course, recalling a memory clearly does not exclude the presence of other submodality alterations. Additionally there may be a distinction between cause and effect regarding these factors, depending upon the method involved.
These phenomena warrant closer scrutiny.
Each method departs from pure exposure to varying degrees, assisting the client in feeling more comfortable during the course of attuning the trauma. The least divorced from flooding appears to be TIR, while the most removed and thus most comfortable for both client and therapist is TFT.
Comfort is an important aspect of the most rapid means of alleviating trauma. The more comfort experienced during the procedure, the more rapidly neutralization is prone to occur. While it is not entirely accurate to compare the methods studied in the AIP, since the study was not structured to yield such comparisons, the data nonetheless favor such a hypothesis in that results were most rapidly achieved with TFT and least rapidly with TIR. (Although TIR represents a definite advancement over flooding in that it achieves results more efficiently by focusing on resolving the trauma within the context of a single session and by connecting the identified trauma with earlier associated traumas, it nonetheless appears to be in closest propinquity to flooding relative to the other methods.)
While methods such as systematic desensitization inhibit anxiety via progressive relaxation while reviewing segments of the trauma (i.e., reciprocal inhibition), these newer therapies utilize other, more rapid means of interrupting associated negative emotionality. Eye movements, bilateral tapping and sounds (EMDR); tapping on meridian energy points (TFT); or dissociation (V/KD), each promote comfort by interrupting the intensity of negative affects. Comfort allows one to attend more easily on the trauma. Additionally comfort becomes associated with the trauma, quelling its effects.
Again the reader's attention is directed to the fact that while comfort appears to be a relevant factor, it can hardly account singularly for the results evidenced with these therapies or efficient therapy in general.
Expectations are promoted that the memory will be resolved within the context of the session, rather than perpetuating the notion that extended time is needed. This challenges the subject's belief to the contrary, reinforced by the fact that distress has existed over an extended period of time.
As Rosenthal and Frank suggested, ``It may well be that the efficacy of any particular set of therapeutic operations lies in the analogy to a placebo in that they enhance the therapist's and patient's conviction that something useful is being done'' (1956, p. 300). This may be a relevant ingredient with methods such as TIR and V/K D, but it is possibly less likely that odd-appearing TFT and EMDR would be conducive to promoting placebo effects. Subjects may be less inclined to believe that moving one's eyes or tapping at specific points on the body could neutralize trauma. While some may find this a plausible notion, likely most people in Western culture would be less inclined to experience positive expectation from such procedures.
--
Trying to understand learning by studying schooling
is rather like trying to understand sexuality by studying bordellos.
-- Mary Catherine Bateson, Peripheral Visions