"There is a tiger coming after you, Nancy," "Run toward that tree; climb it and escape." To my amazement, Nancy's body began to shake and tremble. Her legs started making running movements. After several minutes, she took a few spontaneous breaths. This response, which was scary for both of us, washed over her in waves for almost an hour. At the end she experienced a profound calm, saying she felt "held in warm tingly waves."

Nancy reported to me that during this hour she saw mental pictures of herself at the age of three being held down and given ether anesthesia for a tonsillectomy. The fear of suffocation she experienced as a child-and that she remembered and revisited during her session with me wasterrifying. As a child she felt overwhelmed and helpless. After this one session with me, a whole host of debilitating symptoms improved dramatically, and she felt "like had herself again."

Another mind-body exposure approach is called the sensorimotor approach to psychotherapy. Here the somatosensory component is brought to awareness and then treated. Pat Ogden and colleagues9 describe this process in their book Trauma and the Body. In this therapy, talking is not of importance. Neither are the a.s.sociations, fantasies, narratives, and defenses the individual has. Rather, it is the unregulated body experiences that are the focus of this therapy. For traumatized individuals, although the narrative of the event may be dissociated, the somatic experience is available. Using this approach, the memory can be safely reevoked and empowering actions are executed. These exposure methods use emotions and body sensations to activate the specific glutamate-encoded pathways, causing them to be subject to disruption.

Are there other ways that we can disrupt this encoding?

Disrupting the Amygdala Component of a Traumatic Event: A Neurobiological Mechanism.

Early researchers such as Janet and Freud10 felt that traumatization caused their victims to become fixed in the past, in some cases becoming obsessed with the trauma. Janet observed behaviors and feelings that included nightmares, intense reactions to benign stimuli, terror without reason, and grief without relief to reminder cues arising from the original event. These are people stuck in their past with no escape, for whom the past is always present. These memories do not decrease over time and they elicit responses decades after the event.

Sonia, the daughter of an employee of Homeland Security, heard frightening stories about terrorists and potential threats to the country as she grew up. After getting married, Sonia's husband would be awakened in the night by her screaming. He would find her curled in a fetal position in a corner of the room screaming, yet she was asleep. These are called night terrors (see Appendix D). He couldn't awaken her, and the episode could last several frightening minutes. She didn't recall those moments. Sonia also found that she didn't like to leave the house. She would only go for a walk with her new and very large bulldog. Her life was becoming more and more constricted. It was clear from her history that she could not find a safe place; chased, she could not escape.

A potential model for the disrupting an encoded glutamate pathway comes from Rasolkhani-Kalhorn, Harper, and Drozd, on the mechanism for the efficacy of EMDR and amygdala de-potentiation (see Appendix F). These researchers believed that EMDR disrupted the activated glutamate receptors by a mechanism called de-potentiation. The princ.i.p.al mechanism for depotentiation is the removal, by internalization, of activated glutamate receptors by the production of a low-frequency signal produced by eye movement. These receptors, now internalized within the neuron, cannot transmit a signal and the pathway is disrupted.

Activated BLC glutamate receptor Eye movements Induction of low-frequency signal Depotentiation and internalization of BLC glutamate receptor Inability to transmit a signal Traumatic memory disrupted Are there other forms of sensory input that can accomplish this?

The Extrasensory Response to Touch.

The first experiences we have with fear, especially abandonment, seem to respond to touch. What does this touch do? In addition to temperature, vibration, consistency, shape, texture, pressure, and of course pain, touch provides comfort, sensuality, relaxation, and experiences that have nothing to do with the cla.s.sic neurobiology of ascending pathways. The consequences of the sensation of touch in mammals must therefore affect pathways that involve cognition and emotion.11 These are the extrasensory properties of touch.

For example, if I stroke the bottom of my foot, or I have a friend stroke the bottom of my foot, the ticklish response is much more intense when my friend strokes it. If someone you hated stroked your head, the response would be much different than someone you loved doing the same thing. So the context of the touching matters, but in the beginning, right after birth, a gentle soothing touch feels good no matter who is doing it because the context doesn't matter; this touch means we are not abandoned. Studies have demonstrated that infants who were stroked smiled, vocalized more, and cried less than infants who were tickled or poked.12 Infants preferred stroking to tickling and poking. Positive touch includes stroking, holding, hugging, kissing, hand-holding, and care giving. Lack of positive touch negatively affects growth, development, and emotional well-being. Conversely, soothing ma.s.sage therapy with preterm infants enhanced weight gain. The areas of the body where ma.s.sage was found to be most effective were the forehead, the scalp, the back of the head, the upper arms, and the hands.

Touch has meaning not just for humans but for other animals as well. Cats purr when petted. Dogs roll on their backs, I suspect, to get their tummies rubbed. All animals are quieter when held. Touch clearly gives pleasure, and it affects the stress axis. It is not just the individual who is touched that benefits; under most circ.u.mstances, the person who touches also benefits. See how good it feels to pet a dog.

There are many ways we touch in our culture. The most common is the handshake. The handshake has many meanings, from everything is all right, to we have a deal, to goodbye. The point is that touch bonds individuals. Its intent is contextual, but its meaning is personal; it creates an attachment. Shaking hands with an enemy is not done until peace is accepted on both sides. Comparisons between preschool-aged children in the United States and France revealed that French children were aggressive to their peers on playgrounds only 1% of the time, compared to 29% for American children. This finding correlated with the amount of time parents touched their children: the French, 35%, and the Americans, 11%.13 Our current legal system in this country actively discourages unsolicited touch in this culture. It is impossible to determine what an individual's response is to someone else's touch, so we refrain from touching anybody.

Touch is reputed to have many healing qualities, and these have been organized into therapies. The most commonly used touch therapies include chiropractic, osteopath, cranial sacral therapies and acupressure, ma.s.sage, Reiki, Rolfing, and so on. Some of these are discussed in more detail later. What is interesting is that when we touch and are touched, we experience sensations that are not directly a.s.signed to the physical act. Even more remarkably, watching someone being touched can be relaxing.

What is the neurobiology of soothing touch? How does this soothing touch, what we call havening touch, produce a feeling of safety and allow us to escape from the inescapable? The technique that most resembles havening is Swedish ma.s.sage. Swedish ma.s.sage techniques include long strokes, kneading, friction, tapping, percussion, vibration, effleurage, and shaking motions: Effleurage-Gliding strokes with the palms, thumbs, or fingertips.

Petrissage-Kneading movements with the hands, thumbs, or fingers.

Friction-Circular pressures with the palms of hands, thumbs, or fingers.

Vibration-Oscillatory movements that shake or vibrate the body.

Percussion-Brisk hacking or tapping.

Studies from the Touch Research Inst.i.tute in Miami, Florida, have shown14 that ma.s.sage therapy enhances attentiveness, alleviates depressive symptoms, reduces pain, and improves immune function. Patients in the intensive care units of hospitals describe touch as critical to their feeling safe. There are measurable physiological changes a.s.sociated with touch. Cortisol secretion, the stress hormone, is diminished with a soothing touch such as ma.s.sage. There is an increase in dopamine (thought by some to also act as a reward chemical) and serotonin, as well as a decrease in norepinephrine, during ma.s.sage. While these studies looked at peripheral concentrations of these chemicals, it is not unreasonable to a.s.sume that they are also altered centrally in the brain. If, as described earlier, depotentation occurs because of the production of a low frequency wave, is there a relationship between the neurochemicals released and the electrical activity in the brain? There is an abundance of data to support that serotonergic modulation of GABA neurons15,18 and increased GABA release is a.s.sociated with an increase in low-frequency (delta) waves in the amygdala.16,17 Can havening touch, the touch that tells us we are safe, be used to create a neurobiological equivalent of a haven, and also produce a depotentiating signal? If so, then we will have found a powerful method for treating a traumatization.

References.

1. Aston-Jones, G., Akaoka, H., Charlety, P., and Chouvet, G. (1991). Serotonin selectively attenuates glutamate-evoked activation of noradrenergic locus coeruleus neurons. J. Neurosci. 11:760769.

2. Baddeley, A. (1998). Recent developments in working memory. Curr. Opin. Neurobiol. 8:234238.

3. Sarno, J. E. (2006). The divided mind. The epidemic of mindbody disorders (p. 159). New York, NY: Regan Books.

4. Callahan, R. (1981a). A rapid treatment for phobias. Collected papers of international college of applied kinesiology. (ICAK).

5. Shapiro, F. (Ed.)(2002). EMDR as an integrative psychotherapy approach. Washington, D.C.: American Psychological a.s.sociation.

6. Levine, P. (1997). Waking the tiger. Healing trauma. Berkeley, CA: North Atlantic Books.

7. Levine, P. (1997). Waking the tiger. Healing trauma (p. 67). Berkeley, CA: North Atlantic Books.

8. Levine, P. (1997). Waking the tiger. Healing trauma (pp. 2830). Berkeley, CA: North Atlantic Books.

9. Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body. A sensorimotor approach to psychotherapy. New York, NY: W.W. Norton & Co.

10. Van der Kolk, B. A., Weisaeth, L., & van der Hart, O. (2007). The history of trauma in psychiatry. In (Eds.), Traumatic stress. The effects of overwhelming experience on mind, body and society.

11. Hertenstein, M. J., Verkamp, J. M., Kerestes, A. M., & Holmes, R. M. (2006). The communicative functions of touch in humans, non-human primates, and rats: A review and synthesis of empirical research. Genet. Soc. Psychol. Monogr. 132:594.

12. Field, T., Diego, M., and Hernandez-Reif, M. (2005). Ma.s.sage therapy research. Dev. Rev. 27:7589.

13. Field, T. (1999). American adolescents touch each other less and are more aggressive toward their peers as compared to French adolescents [Statistical data included]. Retrieved from http://findarticles.com/p/articles/mi_m2248/is_136_34/ai_59810232/.Adolescence. Winter.

14. Field, T., Hernandez-Reif, M., Diego, M., Schanberg, S., & Kuhn, C. (2005). Cortisol decreases and serotonin and dopamine increase following ma.s.sage therapy. Int. J. Neurosci. 115:13971413.

15. Ciranna, L. (2006). Serotonin as a modulator of glutamate- and GABA-mediated neurotransmission: Implications in physiological functions and pathology. Curr. Neuropharmacol. 4:101114.

16. Halonen, T., Pitkanen, A., Koivisto, E., Partanen, J., & Riekkinen, P. J. (1992). Effect of vigabatrin on the electroencephalogram in rats. Epilepsia 33:122127.

17. Gasanov, G. G., Melikov, E. M., & Ibrginov, R. Sh. (1981). Effect of serotonin injected into the amygdala on conditioned and unconditioned food reflexes and the EEG of cats. Neurosci. Behav. Physiol. 11(3): 207212.

18. Stutzmann, G. E. & LeDoux, J. E. (1999). GABAergic antagonists block the inhibitory effects of serotonin in the lateral amyadala: A mechanism for modulation of sensory inputs related to fear conditoning. J. Neurosci. 19(11):RC8.

8.

HAVENING.

Havening involves imaginally activating the emotional or other component of a traumatized event. This is followed by application of havening touch, other sensory input, and a set of distracting tasks. If havening is successful, recall or reexperiencing of the traumatized component is altered or eliminated.

Havening can be considered to be a form of treatment grouped under the general term of exposure therapies. The most studied approach is called extinction training. Exposure of an animal to a neutral stimulus that is followed by an unconditional fear stimulus (UFS), such as a shock, conditions the animal to respond to the neutral stimulus with fear. Research attempting to eliminate the fear response to the neutral stimulus has shown that by exposing the animal to the neutral stimulus without the UFS, the animal will soon not respond to the neutral stimulus with fear. Credit for the discovery that reexposing the individual to a feared situation/object/memory could alter one's response to emotion- producing stimuli belongs to Wolpe,1 in a therapy called counterconditioning or systematic desensitization. Here, the feared object was made less fearful by being presented in a safe surrounding. Both methods require exposure to a fear stimulus and both produce a diminution of fear responses. These approaches, however, do not remove the memory of the a.s.sociation, but merely provide a new learned response. While havening and extinction training require exposure to the emotion producing the fear, they produce fundamentally different results.

A New Approach.

The use of touch after imaginal reexposure was first described by Dr. Roger Callahan. His seminal observation is recounted in his book The Five-Minute Phobia Cure.2 Here, he reportedly had a woman who was thinking about her fear of water, tap herself under the eye. The phobia instantly disappeared. To explain this stunning result, he developed a theory based on acupuncture, energy fields, and meridians, very much an Eastern model. He calls his method Callahan TechniquesThought Field Therapy (CT-TFT; see www.tftrx.com). It is grounded in traditional Chinese medicine, where the long-held belief is that energy courses through our body over certain well-defined pathways called meridians. If energy flows smoothly, we experience health and well-being. If, however, the energy is blocked from flowing, illness occurs. These meridians have special locations along their pathway called acupoints. These points are believed to regulate flow. Inserting needles or applying pressure at those locations restores healthy energy flow. According to Callahan, recalling a traumatic event creates a "thought field," an energy field that is perturbed because energy is blocked along the meridians. By having the individual tap an appropriate points in a specific order, healthy energy flow is restored, the pertubation removed, and the individual cured. In CT-TFT the points stimulated and the order in which they are stimulated depend on the problem to be solved. For example, phobias need points different from panic disorder, and different from chronic pain. In CT-TFT, tapping is combined with a Gamut procedure that includes a variety of distracting cognitive and eye movement processes and various mental tasks (Figures 8.1 and 8.2).

CT-TFT requires a person to "tune in to" the trauma and generate a subjective unit of distress (SUD) score.1 SUD is a self-evaluated measure of the intensity of the recalled traumatic memory. The scale goes from 0 to 10, where 0 is no distress and 10 is extreme distress. The individual then taps 5 to 10 times on a set of predetermined points (see Figure 8.1) on the body, different points being used for different problems. After a round of tapping points, the individual taps on his hand at the Gamut spot, performing a Gamut procedure: 1. Close eyes 2. Open eyes 3. Point eyes down to left Figure 8.1 Tapping points. (Adapted from Callahan, R. and Trubo, R. 2002. Tapping the Healer Within: Using Thought Field Therapy to Instantly Conquer Your Fears, Anxieties, and Emotional Distress. New York: McGraw-Hill.) 4. Point eyes down to right 5. Big circle with eye 6. Big circle the other way 7. Hum "Happy Birthday"

8. Count to 5 aloud 9. Hum "Happy Birthday"

After several rounds of this tapping on points and the Gamut procedure, the problem resolves. The ready dismissal of CT-TFT by traditionally trained therapists can be appreciated. It makes no sense from a Western perspective. But Callahan's ideas struck a chord in other pract.i.tioners. Gary Craig, an engineer and student of Callahan, concluded that one set of points sufficed for all problems. He has Figure 8.2 Gamut spot and hand-tapping points. (Adapted from Callahan, R. and Trubo, R. 2002. Tapping the Healer Within: Using Thought Field Therapy to Instantly Conquer Your Fears, Anxieties, and Emotional Distress. New York: McGraw-Hill.) produced an important Web site for his version of Dr. Callahan's discovery and has named it Emotional Freedom Techniques (EFT) (see www.eftuniverse.com). Here, problems are activated by statements made by the patient and include affirmations such as "Even though I have this pain, I truly love and accept myself." His site has many clinical observations, suggestions for improving outcomes, and teaching DVDs. His biweekly newsletter describes successful case histories for a wide range of problems. He is well known for saying "Try it on everything." He claims EFT has fixed everything from broken toilets to the rash of poison ivy. The following interesting example was contributed to his web site.

Case Study.

Arden Compton.

Recently I took my family bowling. The bowling alley here in Brigham City was giving away a turkey to anyone who bowled three strikes in a row. So off we went to try our luck. Now, I am not a serious bowler; throughout my life, I have probably gone bowling about once a year ... maybe less. I usually bowl somewhere between 100 and 120. If I get over 120, it is a good game for me-if I get into the 130's-that's a really good game.

So getting three strikes in a row wasn't likely-I might get two or three strikes in a game, but not in a row. In my first frame, I knocked over eight pins, not bad. But I thought about how fun it would be to win a turkey and I decided to try some EFT. On my next turn, as I held the ball in my right hand, I tapped with my left hand on the face points and repeated in my mind, "This fear of not making a strike."

It took a little over five seconds to tap through that. This time I bowled a spare (meaning I knocked all the pins over in two tries), but was only one pin away from getting a strike. Each turn for the rest of the game, I went through the same tapping process. The next frame I bowled a strike! But on my next two frames I bowled a spare-I needed three strikes in a row.

I was feeling pretty good about my game at this point; I was on track to an above-average score for me. Then the next frame I bowled a strike, and the following frame I bowled another strike! At this point I did a little tapping before my next turn, there was a little pressure because I was going for the turkey on this one. I tapped on Fear of messing up the third strike ... fear of not getting a strike. I also tapped five seconds or so after I picked up my ball. And sure enough, I got a third strike!

I was so excited, I yelled loud enough for everyone in the bowling alley to hear me, "I won a turkey!" My wife and kids all gave me high fives. I ran over to the desk and had all the bowling alley employees give me a high five, there were some friends of mine several lanes down, and I ran over to them and had them give me high fives. So, the next time I got the ball I tapped again, and I got another strike! Four in a row! And then I got another strike, and another one, and another one! Seven strikes in a row by the time the game ended. I bowled a 236, 100 points beyond what I thought would be a really good game. Our friends even asked me to come bowl on their lane so I could help them win a turkey. On their lane, I bowled another strike. However, I started having some uncertainty because I didn't think the bowling alley wanted me to win a turkey for other people-thus the next frame I ended the streak with a spare. I excused that by saying, "The ball slipped from my fingers," which it had, but I am almost certain it was because of those inner doubts about winning a turkey for someone else that I "sabotaged" it.

The statistical probability of me bowling eight strikes in a row has to be near zero. EFT really works! It calms us down, removes doubt and fear, which in turn allows us to perform at the level we are capable of. Not only can it help with bowling, but also every aspect of life-relationships, spirituality, money, professional goals, happiness & peace of mind, and the list could go on and on! EFT can help with so many things; it is awesome! When appropriate, try EFT for yourself and others-miracles can happen!

There are several other methods, all based on the idea of meridians, energy flow, and the use of acupoints and sensory input, such as tapping. These methods have led the a.s.sociation for Comprehensive Energy Psychology (ACEP), an organization devoted to exploring various forms of bodily energetics, to adopt tapping on meridians as an important method of healing (for more information, see www.energypsych.org). As one might imagine, this therapy and its theoretical structure are considered controversial.

Andrade's Research.

In the 1990s, Dr. Joaquin Andrade began organizing clinics in Uruguay to study this therapy. In the end over 29,000 patients were treated in 14 years. The results were remarkable.3 For a wide range of problems, these methods were deemed successful in 76% of the subjects. By "successful," they were judged symptom free. This compares to 51% in the standard care group of cognitive behavioral therapy (CBT) and medication. The tapping procedure required a mean of 3 sessions, while the standard of care required a mean of 15 sessions. The patients were randomized, and the reviewers of the outcome were blinded as to what therapy was used. As close to a double-blind study as possible, the follow-up data included subjective scores after the termination of treatment by independent raters. The ratings, based on a scale of 1 to 5, estimated the effectiveness of the interventions as contrasted with other methods used (cognitive behavioral therapy or medications, or both). The numbers indicate that the rater believed that the tapping interventions produced: 1 = Much better results than expected with other methods 2 = Better results than expected with other methods 3 = Results similar to those expected with other methods 4 = Worse results than expected with other methods (only used in conjunction with other therapies) 5 = No clinical improvement at all or contraindicated It must be emphasized that the following indications and contraindications are tentative guidelines based largely on the initial exploratory research and these informal a.s.sessments. In addition, the outcome studies have not been precisely replicated in other settings, and the degree to which the findings can be generalized is uncertain. Nonetheless, based upon the use of tapping techniques with a large and varied clinical population in 11 settings over a 14-year period, the following impressions can serve as a preliminary guide for selecting which clients are good candidates for acupoint tapping.

Rating of 1: Much Better Results Than With Other Methods.

Many categories of anxiety disorders rated responded to tapping interventions much better than to other modalities. Among these are panic disorders with and without agoraphobia, agoraphobia without history of panic disorder, specific phobias, separation anxiety disorders, post-traumatic stress disorders, acute stress disorders, and mixed anxiety-depressive disorders. Also in this category were a variety of other emotional problems, including fear, grief, guilt, anger, shame, jealousy, rejection, painful memories, loneliness, frustration, love pain, and procrastination. Tapping techniques also seemed particularly effective with adjustment disorders, attention deficit disorders, elimination disorders, impulse control disorders, and problems related to abuse or neglect.

Rating of 2: Better Results Than With Other Methods.

Although obsessive-compulsive disorders, generalized anxiety disorders, anxiety disorders due to general medical conditions, social phobias, and certain other specific phobias, such as a phobia of loud noises, were judged as not responding quite as well to energy interventions as other anxiety disorders, they still rated as being more responsive to an energy approach than to other methods. Also in this category were learning disorders, communication disorders, feeding and eating disorders of early childhood, tic disorders, selective mutism, reactive detachment disorders of infancy or early childhood, somatoform disorders, fact.i.tious disorders, s.e.xual dysfunction, sleep disorders, and relational problems.

Rating of 3: Results Similar to Those Expected With Other Methods.

Energy interventions seemed to fare equally well as other therapies commonly used for mild to moderate reactive depression, learning skills disorders, motor skills disorders, and Tourette's syndrome. Also in this category were substance abuserelated disorders, substanceinduced anxiety disorders, and eating disorders. For these conditions, a number of treatment approaches can be effectively combined to draw upon the strengths of each.

Rating of 4: Worse Results Than Expected With Other Methods.