OEI:%20Observed%20

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OEIObserved Experiential Integrationfor
Trauma A New Trauma TherapyRick Bradshaw,
PhD, RPsychTrinity Western Universityrickphyl_at_te
lus.net Laurie Detwiler, M.A., C.C.C.Kwantlen
Polytechnic University(laurie.detwiler_at_kwantlen.c
a)
CCPA Annual Conference Ottawa, ON May 18, 2011
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Polyvagal Theory Co-Activation of Sympathetic
Parasympathetic

• Stephen Porges (2001, 2007) Polyvagal Theory
• Social Connection Ventral Vagal Complex (VVC)
  Brake On
• Fight or Flight Sympathetic Nervous System
  VVC Brake Off
• Freeze Dorsal Vagal Complex
• OEI Neuro-Activation Micro-Attunement
  together
• Mirror Neurons, Embodied Simulation, Intentional
  Attunement
• OEI Switching for Titration, Glitch Massaging,
  Transference
• Extraocular muscles, Intraocular muscles, and
  Proprioception
• OEI Switching for Artifacts, Release Points,
  Sweeping
• Feigned Death (Freeze) responses Chest, Airway,
  Stomach

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Observed Experiential Integration (OEI) What
is it?

• SWITCH Alternately covering uncovering the
  eyes
• SWEEP Covering one eye, guiding other eye
  across
• TRACK Guiding one or both eyes, watching for
  glitches
• GLITCH MASSAGE Guiding eye(s) over/out of
  glitches
• GLITCH HOLD Bilaterally stimulating, holding in
  glitches
• RELEASE POINTS Places to guide eyes for release
  of
• Hyperventilation temporary cessation of
  breathing
• Chest compression throat constriction (LR
  Abducens)
• Nausea, queasiness, abdominal cramping (SO
  Trochlear)
• Jaw tension and tooth grinding

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OEI What is it used for?

• Rapid de-escalation of affective somatic
  intensity
• Assessment treatment of negative transference
• Avoidance of, and relief from, panic attacks
• Overcoming addictions, including self-harm
• Dissolving barriers to performance

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The Self-Trauma Model Briere

• Flashbacks constitute natural attempts of the
  human brain to desensitize traumatic material,
  but
• In those with severe, prolonged childhood trauma
  there is often a developed capacity to dissociate
  when overwhelmed (Lanius)
• This leads to cycles of abreaction and
  dissociation (PTSD, CPTSD, DDs)

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OEI the Abreaction-Dissociation Cycle

• Dissociation
• Abreaction

Therapeutic Window
Staying within the
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Once upon a time.

• Two psychotherapists in Vancouver Canada
• (Audrey Cook Rick Bradshaw)
• Working with abuse, neglect and other trauma
• Finding talk therapies ineffective for PTSD,
  Complex PTSD, and Dissociative Disorders
• likely because
• Psychological trauma affects different areas of
  the brain than speaking and listening.

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1994 95 Audrey Cook found that

• EMDR wasnt working with some CPTSD/DD clients
• Those with lazy eyes couldnt track their
  therapists fingers with both eyes at the same
  time
• Some clients were too dissociated disconnected
• Some clients were overwhelmed by intense
  abreactions
• Thought I wonder if it would work one eye at a
  time - Led to OEI Switching (alt covering
  eyes)
• SWITCHING VIDEO DEMO

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OEI and EMDR Differences
EMDR Doesnt address negative transference between therapist patient OEI Includes transference checks clearances for individuals groups
No acknowledgement of tiny halts or hesitations in eye movements Involves identification and resolution of tiny halts or hesitations-eye movement
No recognition of side effects of trauma processing on additional aspects of the past Techniques for resolving artifacts like headaches, dizziness/drowsiness, and visual distortions
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OEI and EMDR Differences
EMDR Mechanism eye saccades and rhythmic sounds or taps (PGO region of the brain) OEI Mechanism different than eye saccades and rhythmic sounds / taps Can involve simple covering of eyes
Cognitions are essential in protocol Negative Cognition, Positive Cognition, SUDS, VoC Cognitions not in protocol. Numbers optional rather than required. Observe Intensity Conflict Markers
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OEI and EMDR Differences
EMDR Requires use of both eyes simultaneously OEI One eye at a time or two eyes
Vision not required. Can use sound or touch to stimulate the brain mechanism Requires vision to sense light track movement across both visual fields
Does not acknowledge or address nausea, hyperventilation cessation of breathing, chest tightening, or jaw clamping Includes release points for nausea, hyperventilation cessation of breathing, chest tightening, and jaw clamping
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OEI and EMDR Similarities
Can be performed using both eyes. Procedures in both therapies involve the tracking of a moving object (therapist finger, wand, etc.)
Involves focusing on trauma in multi-sensory fashion to expose individual to the intensity of past experiences
Involves arousal of fight-or-flight response and/or freeze response via midbrain forebrain.
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Speech Area Speech Production
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Listening Area Understanding Speech
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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

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Limbic System Midbrain
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Anterior Cingulate Gyrus
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Eye Brain Connections

• Both eyes have connections to both halves of the
  brain
• Half of each visual field in each eye is
  associated with half of the brain, and the other
  half of each visual field is associated with the
  other side of the brain. Integration can occur
  with one eye at a time or both eyes

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OEI Techniques Applications

• An Overview of OEI Procedures
• with
• Treatment Targets
• by
• Dr. Rick Bradshaw

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5 Building Blocks of OEI
Level I Techniques
Level II Techniques
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OBSERVATIONS DISCOVERIES 1

• Core Trauma Symptoms
• Encountered during processing of traumatic
  material
• In the center or core of the body. Symptoms
  include
• Hyperventilation
• temporary cessation of breathing
• chest compression
• throat constriction
• nausea
• OEI switching reduce glitch work dissipates
  intensity
• Intensity, type of emotion, location of body
  sensation usually differs, depending on which
  eye is covered

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Core Trauma vs Artifacts
p. 30
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OBSERVATIONS DISCOVERIES 2

• Dissociative Artifacts
• In response to intensity of trauma processing
• Outside (peripheral to) the core of the body
• Symptoms include
• visual blurring occlusions
• headaches pressures
• tingling numbness (hands, face, feet)
• Dizziness, lightheadedness, loss of balance
• drowsiness
• Usually dissipated quickly with switching
  sweeping
• Balance boards to assess minimize dissociation

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OBSERVATIONS DISCOVERIES 3

• Shock Can you believe it.?
• Incongruence Severity of incident not
  accompanied by expected emotional physical
  intensity markers
• Process seems blocked by shock
• Switching and asking the questions
• Can you believe __(name)__ did that to you?
• Can you believe ___(name)___ was killed?
• Can you believe you cant believe it?
• Can you believe any man would do that to
  anyone?
• Shifts clients out of disconnected states
• Not unusual for clients to be connected to the
  reality of an event with one eye open but not
  with the other open

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OBSERVATIONS DISCOVERIES 5

• Eye Dom. Affective/Somatic Differences
• Dominance check The Dominance Factor (Carla
  Hannaford)
• Majority of clients more fear anxiety w
  dominant eye
• sadness
  despair w non-dominant
• If much early onset abandonment/abuse, less
  predictable
• Often sad
  mad or sad afraid
• Difficulty holding gaze shame or fear of
  disapproval

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OBSERVATIONS DISCOVERIES 4

• Transference Checking Clearing
• During switching for core trauma symptoms and
  dissociative artifacts, clients disclose
  differences in perceptions of therapists,
  depending on which eye is covered, including
  differences in
• Perceived proximity of person (close, distant)
• Color (green or gray to red or yellow)
• Perceived age or facial expression (angry,
  caring)
• Perceived proportions of head body
• Perceived attitude or mood of therapist
• Switching dissolves these perceptual distortions
• Sometimes add glitch work for resistant
  distortions
• Extended to
• Mirror work - body/facial dysmorphic disorder
• Body image perceptions eating disorders
• Families groups (couples/parenting/attachment)
• Substitutions (photos, videos, symbols objects)

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OBSERVATIONS DISCOVERIES 6

• Release Points
• Glitches most intense place in most intense eye
• Release least intense place in least intense
  eye
• Respiratory system cover Dom eye, lowest rib, ND
  side
• Gastrointestinal cover Dom eye, lowest rib, Dom
  side
• Jaw Tension alt cover eyes, level of lips, 180º
  to 90º
• VIDEO OF RELEASE POINTS

P. 27
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Release Points
P. 27
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Key External Events 1

• 1999 Audrey has discovered use of both objective
  and
• subjective applications for glitch
  resolution
• EMDR International Association
  Conference, Las
• Vegas First Clinician Manual, First
  Video
• Audrey demonstrating subjective glitch
  track hold
• w bilateral audio stimulation in Las
  Vegas (video)
• 2002 2nd ed. of OEI Clinician Manual His,
  Los, I/O, H/V/D
• 2003 OEI Training DVD, first OEI RCT (delayed C)

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Key External Events 2

• 2004 Combine OEI with body therapies
  (massage)
• Start arc patterns to reduce lens
  refocusing
• 2005-6 Comparative experimental RCT (18-mo RCT)
• Titrate with therapist body face,
  postures
• 2007-8 20 conference papers, OEI Client
  Handbook
• Glitch massage proximal-distal
  movements

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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

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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 problems
• Somatic symptoms less loss of face
• Medical procedures to treat symptoms
• 1st Nations
• Family members community share
• Attending to quality of relationships
• Healing broken attachments (RHAP)

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Glitch Tracking Massaging

• Saw note (EMDR listserve) skips/halts in eye
  movement
• Resolution of intensity dissociation with
  massage
• Patterns were associated with different
  targets/events
• Glitches seem to clear after massaging stuck
  points
• Thought I wonder if continued work will bring
  healing? Led to OEI Tracking Glitch
  Work/Massage
• TRACKING GLITCH MASSAGE VIDEO DEMO

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The Future of OEI - Part I

• Unique Contributions of OEI
• Easily quickly integrated with other therapies
• Reduces interference with cognition speech (top
  down)
• Psychological Emergency Room procedures
• Self-help procedures facilitate affect regulation
• Increases midbrain-to-prefrontal integration
  (bottom up)
• Reduces addictive self-harming urges

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Complex PTSD Symptoms OEI(CPTSD was defined by
Herman, elaborated by Curtois)

• There are OEI techniques that address these
• Affect Dysregulation
• Dissociation/Numbing
• Negative Self-Perceptions
• Internalized Perpetrator Beliefs
• Difficulties in Relationships with Others
• Somatic Symptoms Abuse-Specific, Other
• Despair Shattered Assumptions of Hope

See one-page handout for details
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Observed Experiential

• Observed
• Therapist watches for glitches while tracking
• Therapist watches for conflict intensity
  markers
• Therapist watches for visual splitting/dilation
• Experienced Client cues therapist during
  tracking (Track-to-Target)
• Client notices reports all artifacts
• Client notices reports level of intensity

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Integration

• Equalization intensity, colour, light, body
  tension
• Combination emotions (mad sad) blend or
  dissolve
• Joining alters (infant, child, teen, adult)
  merge
• Sensory double vision clears, pains resolve
• Dissolution visual distortions clear
• Resolution objects that were invisible
  materialize

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First Study of OEI with PTSD

• Mixed Traumas (witnessing suicides, MVAs,
  assaults, accidental deaths) and mixed gender
• Random Assignment to OEI or delayed treatment
  control group, only switching
• Script-driven symptom provocation, C 2 Exp
• CAPS and IES-R

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Treatment vs Control CAPS
Clinician-Administered PTSD Scale (CAPS) scores
from Time 1 to Time 2 for control group (n 5)
and treatment group (n 5). The dashed
horizontal line reflects a threshold for
clinically significant levels of PTSD symptoms
(Orr, 1997).
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IES-R Avoidance/Numbing
Impact of Event Scale-Revised (IES-R) Avoidance
Numbing subscale scores, Time 1 to Time 2 for
control group (N 5) and treatment group (N 5).
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Presentation by Laurie Detwiler, Faculty
Member,
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The Place of Trauma Therapy in the Process of
Recovery from PTSD

• CCPA Annual Conference
• May 18, 2011

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Research Questions

• What critical incident helped or hindered your
  process of recovery from PTSD?
• What event or experience helped or hindered your
  process of recovery from PTSD?
• Follow up questions fit well with the method.

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Validity Reliability

• Careful definition of the purpose of the research
• Qualified observers
• Final follow up

• Independent judge sorted 25 incidents into
  helping and hindering categories
• Interpreter reliability 92 inter-rater
  agreement between judge and primary rater

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Interpret and Report

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

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Categorical Descriptions(helping)

1. Awareness of Recovery Coming From Involvement in
   Trauma Therapy Study
2. Resources, including Spirituality,
   Marital/Family, Financial, Physical
3. Coping Strategies
4. Developing New Positive Relationship With Self

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Categorical Descriptions(helping)

• Growth From Trauma
• Understanding Your Own Life Experience
• The Importance of Being Listened to, Cared For,
  Validated and Accepted For Who You Are by a
  Professional Helper
• Making Personal Choices to Lead a Healthy Life

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Categorical Descriptions(helping)

• Unexpected Positive Circumstances
• Knowing That You Are Not Alone
• Talking Today Was Impactful
• Forgiveness

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Categorical Descriptions(hindering)

• Limitations in Resources
• ICBC Is An Unhelpful System
• When Boundaries Fall
• Difficulty Coping

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Categorical Descriptions(hindering)

• Fear Magnification
• The Physical Pain Cycle
• Harmful Healers
• Being In Situations Similar to the Original
  Trauma

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Categorical Descriptions(hindering)

• Unexpected Negative Circumstances
• Can Not Forgive Self
• Sexual Difficulties

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Follow Up Themes

• Recovery is a process which includes more than
  therapy, and all categories are important
• However, OEI was very important in recovery for
  all 8 (two said 10/10, average score 8/10)
• Lack of Social Support as a theme was big, in
  particular Brewins (2003) Other as Betraying
• Also Other as Abandoning Brewin (2003)

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Latest Sexual Assault PTSD Study

• Comparative Experimental Treatment Outcome
• 1 year to recruit 137 women, screened to 33, 18
  Months from Start to Finish, Participants
• Quantitative, Qualitative Psychophysiological
  Measures in cross-over design

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Research Design I

• Selected Trauma of Interest 20 of women
  sexually assaulted in lifetimes and almost 50 of
  those develop PTSD
• Script-Driven Symptom Provocation 50-second
  audiotape of most intense portion of trauma
  played on 4 occasions TMI-PS
• Cross-Over Design CPT-R in phase I gets OEI in
  phase II, OEI in phase I to CPT-R

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Research Design II

• Controls Random (Wave) Assignment to Groups and
  Therapists within Groups
• Assessors Blind to Group Assignments
• All Participants Receive Control Condition
  (B.R.A.I.N.) and Active Therapy Participants
  Receive 3 sessions of OEI or CPT plus 4 hours of
  Psychoed (sessions groups videotaped)
• Credibility Checks for all Interventions (COTQ)
• Manualized Treatments

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Results - CAPS
Time F(2,21) 49.62, p .04, ?2
.83 TimeGroup F(4,42) 2.96, p .03, ?2
.22 Group F(2,22) 1.32, p . .29, ?2 .11
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Results IES-R Numb/Avoid
? Control Group ? Cognitive
Processing Therapy
One Eye Integration
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Qualitative Interview Findings

• Randomly selected cases from OEI CPTSD groups,
  interviewed at 3-month follow up
• OEI More profound reduction of PTSD symptoms
• CPT-R Improved coping self-referencing
  beliefs
• When participants interviewed after cross-over
• Majority of participants ( 75) chose OEI as
  most beneficial of the two therapies after
  having both
• Therapy preference Interesting trend by
  MBTI-Thinkers to prefer CPT-R (makes sense,
  logical)

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Limitations

• Small N significant screening process
• Females, mainly Caucasian, sexual assault
• Manualization may have affected bond OEI
• Script-driven symptom provocation 1 trauma
• Small treatment doses (3 hrs. individual plus 4
  hours group per therapy, along with exposure
  psychoeducation components)
• Extended periods with no active treatment (3
  months 3 months), additional traumas

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The Future of OEI - Part II (You)

• Diffusion of Innovation Theory
• Diffusion of Innovations 5th ed. (Rogers, 2003)
• Lovejoy, Demireva, Grayson, McNamara (2009)
• Relative Advantage better job performance s
• Compatibility congruence with existing frames
• Complexity difficulty in learning, comprehending
• Trialability pilot testability on small scale
• Observability visibility of positive outcomes

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Acknowledgements
Fahs-Beck Foundation for Experimental Research
New York Community Trust
Dr. 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.