A Model for the Flash Technique Based on Working Memory and Neuroscience Research

Constant installation of present orientation and safety (CIPOS) - subjective and physiological effects of an ultrashort-term intervention combining both stabilizing and confrontational elements

Objectives

Constant Installation of Present Orientation and Safety (CIPOS) is a Eye Movements Desensitization and Reprocessing (EMDR)-derived technique, which is often used to prepare for the treatment of post-traumatic stress disorder (PTSD). It differs from the latter by involving cyclically recurring exercises in reorientation to the present, interspersed between brief periods of exposure to the traumatic material.While EMDR is well established as a therapeutic method, the efficacy and mechanisms of action of CIPOS have not been investigated so far. In this pilot study, an experimental setting was used to record the subjective and physiological effects of the CIPOS intervention compared to a control condition with pure mental exposition.

Methods

The study was performed on 30 healthy volunteers aged from 20 to 30 years. Distress was induced using audio files of subjectively stressful situations. Subjective distress was measured via the Subjective Units of Distress Scale (SUD), while physiological indicators (noise-induced startle reflex, skin conductance level) were used as measures for objective stress. For each condition, pre- and post-intervention comparisons were calculated.

Results

In both groups, startle reflex potentiation and mean skin conductance level significantly decreased. In the group with CIPOS intervention, but not in the control group, a significant decrease in the SUD value was found.

Conclusion and significance

The results show that the CIPOS technique is as effective as pure mental exposition in reducing physiological stress. In addition, a superiority in reducing subjective distress (indicating a simplified reassessment of the stressful material) was found compared to pure mental exposition. Possible explanations of these effects are discussed.

Trauma as Absence: A Biopsychosocial-AIP Definition of Trauma and Its Treatment in EMDR

This paper advances the biopsychosocial adaptive information processing model (BPS-AIP) and theory (Cotraccia, 2012) by adding consciousness as a mechanism of action activated via social behavior in EMDR. An attention schema is conceptualized as content integrated with dynamic self-models that maintain subjective mental states of biopsychosocial connectivity or disconnectivity. These implicit self-models are portrayed as determining 1) the disposition of the BPS-AIP system of clients presenting for EMDR as more or less connected or disconnected prior to, at the time of, and following, a stressful event; and 2) whether or not stressful events become traumatizing over time. Attention schema theory (Graziano, 2021) is integrated to further describe how establishing and enhancing attentional agency when addressing simple and complex-PTSD facilitates consolidation of autobiographical memory. Self-integration in the context of an attuned therapeutic relationship is described in terms of patterns of tracking attention to promote heightened states of self/other consciousness and activate the innate healing system. Attention schema theory, as a prominent theory of consciousness, adds to BPS-AIP’s compelling description of how an innate neurophysiological system can be integrated with psychosocial components that explain how both subjective and intersubjective experiences are causally relevant to the processing of autobiographical memory.

Doing the Flash Technique Without Bilateral Stimulation and Without Prompted Blinking: Two Vignettes

This article presents two vignettes on the successful use of the Flash Technique (FT) without bilateral stimulation and prompted without blinking. FT was first developed as a protocol to quickly bring down the emotional distress of a traumatic memory during the preparation phase of eye movement desensitization and reprocessing (EMDR) therapy, so that EMDR could proceed. A recent model for FT (Wong, 2021) proposes that, with FT, traumatized clients may be able to access their traumatic memory briefly, reflexively, and without the fear response, during blinking. This sets up a prediction error which, with repeated blinking, may lead to memory reconsolidation and processing of the traumatic memory. Since the access to the traumatic memory is reflexive and brief, the processing of the memory is outside of the awareness of the client and of the therapist, which is consistent with the practitioner’s and the client’s experience with FT. Wong’s model is based on published fMRI data from neuroscience and established concepts in working memory research, and the model will be reviewed in some detail in the article. However, it is also based on fMRI data for spontaneous and not-prompted blinking, and does not require bilateral stimulation, implying that processing could occur using FT without bilateral stimulation and without prompted blinking, relying instead only on spontaneous blinking. Our two vignettes provide two data points that support this aspect of Wong’s model.

A Randomized-Controlled Trial of EMDR Flash Technique on Traumatic Symptoms, Depression, Anxiety, Stress, and Life of Quality With Individuals Who Have Experienced a Traffic Accident

The Flash Technique of Eye Movement Desensitization and Reprocessing (EMDR) is widely recognized for its effectiveness in reducing the effects of emotional responses associated with traumatic memories. Using a randomized-controlled trial methodology, this study attempts to establish the efficacy of the EMDR Flash Technique. This study’s sample includes volunteers who were involved in traffic accidents and were given the randomized EMDR Flash Technique and Improving Mental Health Training for Primary Care Residents (mhGAP) Stress management module. The participants were given a socio-demographic data form, the Depression-Anxiety-Stress 21 scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the WHOQOL Quality of Life scale. Participants were evaluated using measurements taken before and after the application, as well as a one-month follow-up. The mean age of the participants was 36.20 (11.41) years and 82.1% (n = 32) were female. The DASS-21 Anxiety (η² = 0.085), IES-R Intrusion (η² = 0.101), Avoidance (η² = 0.124), Total (η² = 0.147), and WHOQOL-BREF Psychological (η² = 0.106) score improvements of the EMDR Flash Technique group were shown to be statistically significant when compared to the mhGAP group. However, no statistically significant difference in the DASS-21 Depression, Stress, Impact of Event Scale-Revised Hyperarousal WHOQOL-BREF General Health, Physical, Social Relationships, and Environment component scores was reported between the two groups. The present study’s findings clearly demonstrate that the EMDR Flash technique, when applied to persons involved in traffic accidents, is successful in improving anxiety, intrusion, avoidance, total traumatic stress, and mental quality of life symptoms for at least 1 month. We believe that these findings will improve the reliability and applicability of the EMDR Flash Technique, which was tested for the first time in a clinical randomized-controlled trial (RCT).