The wheel may well have already been invented!
In this blog, I explore the research that has already been done looking at the effectiveness of approaches that use the same underlying method as that of the NLPs fast phobia cure (the history of this is the subject of my previous blog in this series). There is some fascinating work being done in America, which is ongoing.
The work we are going to unpack and examine is being carried out in America. The doctor who initiated the work was inspired by his experience of working with over 250 people who had direct experience of the September 9/11 tragedy. In the aftermath Dr Franke Bourke was invited with a number of other professionals to help.
From an article reporting the on history his work:
"Dr. Bourke realised that whatever he did, it must stop the terror filled nightmares and flashbacks, if it were going to be really helpful. Most of the well-established therapeutic tools being used by his peers, such as “talking therapy” and drugs, were doing little to help. However, he quickly discovered that a modified version of the phobia treatment he had learned years early had a dramatic effect. Using it, he was able to relieve the flashbacks and night- mares much quicker and more thoroughly than the 30 or so other therapists he was working with. In fact, while they were working with clients for weeks and months on end, Dr. Bourke found he could completely relieve the PTSD symptoms in five sessions or less. (* ref. 1)
Like many of the World Trade Centre professional volunteers, Dr. Bourke stayed on for 10 months and treated over 250 PTS survivors. By the end of the year, he was convinced that this technique could be an important treatment tool. Imagine being able to work with soldiers, first-responders, rape victims – people whose lives were altered by traumatic events – and cure their symptoms in as little as five sessions! No drugs. No long-term complicated therapy. This is it, he thought. He decided to bring what he considered to be “the largest advance in the treatment of PTSD” into the hands of therapists through scientific research and widespread recognition."
The decision Dr Bourke made that day in 2001, to share his discovery with his colleagues has taken over 10 years to begin to be accepted within main stream psychology. Often those who work in our professional helping institutions need time to realise the power that new ways of thinking can have to potentially transform the lives of ordinary people suffering from the devastating effects of traumatic experiences.
The process Dr. Bourke developed was base on the Fast Phobia Cure from the model of NLP (as is the MAM 3 Step Rewind Process). This process takes a traumatic memory and seeks to re-adjust it using several simple mind experiments. When this process is taught to a client they are then able to be guided by a trained practioner as they implement the process themselves. These mental experiments involve structural changes in how the client has been remembering the stressful event until now. The experiments involve mental activities like visualising the memory as a black-and-white movie, seeing themselves in the movie rather than experiencing it like they were there again and other structural changes.
This revised memory is thought to take the place of the original memory. The technical name for this change is structure reconsolidation. Recent neurological research into reconsolidation (* ref. 2) seems to show that this altered memory is strong and lasting. Dr. Bourke’s team refined and named the technique as the Reconsolidation of Traumatic Memories Protocol (RMT).
Here are some quotes taken from people that have been through the RMT process:
Client 3032 (9/21/15): “I used to sit in the dark all day and go over and over the trauma. After treatment with the RTM Protocol, my wife says I am a lot happier. Another friend I have known for six years and see every Sunday says I look and sound so much happier. I feel more alive. No more day- mares and nightmares...and the nightmares I have had for the past 40 years have stopped."
Client 3024 (8/25/15): “After three treatments I feel different. I have stopped carrying around the duffel bag of misery. I no longer have a recurring nightmare I have been having for the past 30 years. I feel more positive and feel like my future is in my hands in whichever direction I take. I’ve noticed if I put out good vibes and self-conﬁdence, it is reciprocated. I’m not going to sit still and feel depressed anymore. I just got a new job and I attribute this to the work I did with the RTM Protocol.”
Client 3011 (8/25/15): “I notice a difference in myself. I was sitting around depressed and apathetic and angry about events in Iraq. Instead of having terrible ﬂashbacks, I now think of the event as just a memory. I feel more enjoyment of life and am starting my own business. I have started a golf program... something I would have never done prior to the treatment.”
You can find the links to all the research articles that have been conducted so far by The Research and Recognition Project, they include some small Randomised Controlled Trial’s (RCT), a Prospective Study (PS) and some very encouraging work using EEG imagining at the end of this blog.
I want now to give you the opportunity to compare the protocol developed by Dr. Bourke (RMT) firstly with the process that Mia Scotland and I teach The MAM 3 Step Rewind Practitioners. The similarities between the two are very striking indeed. Then in the next and final blog I will compare what Mia and I teach with the broad practice guidance offered by the NICE Guideline for supporting those with PTSD (*ref. 6). What follows in the tables below is an outline of the steps taken by people educated in the RMT method, and then those used by birth proffesionals trained by MAM Learning. The consistency of approach is evident.
The RTM Process
- The client is asked to briefly recount the trauma.
- Their narrative is terminated as soon as autonomic arousal is observed.
- The subject is reoriented to the present time and circumstances.
- SUDs ratings are elicited for the just-related narrative.
- The clinician assists the client in choosing times before and after the event (bookends) as delimiters for the event: one before they knew the event would occur and another when they knew that the specific event was over and that they had survived.
- The client is guided through the construction (or recall) of an imaginal movie theatre in which the pre-trauma bookend is displayed in black and white on the screen.
- The client is instructed in how to find a seat in the theatre, remain dissociated from the content, and alter their perception of a black and white movie of the index event.|
- A black and white movie of the event is played and may be repeated with structural alterations as needed.
- When the client is comfortable with the black and white representation, they are invited to step into a two-second, fully-associated, reversed movie of the episode beginning with the post-trauma scene (bookend) and ending with the pre-trauma scene (bookend).
- When the client signals that the rewind was comfortable, they are asked to relate the narrative or are probed for responses to stimuli which had previously elicited the autonomic response.
- SUDs ratings are elicited for the just completed trauma narrative
- When the client is free from emotions in retelling, or sufficiently comfortable (SUDs ≤ 3), they are invited to walk through several alternate, nontraumatising versions of the previously traumatising event of their own design.
- After the new scenarios have been practiced, the client is again asked to relate the trauma narrative and his previous triggers are probed.
- SUDs ratings are elicited.
- When the trauma cannot be evoked and the narrative can be told without significant autonomic arousal, the procedure is over. Taken from: Evaluation of the reconsolidation of traumatic memories protocol for the treatment of PTSD: A randomised, wait list controlled trial
Step 1 Session 1 - Pre Work
- Listen to your client’s story using empathetic listening
- Scale their memory using a SUDs
- Ask how they would like to feel if they didn’t have their current feelings
- Use Outcome Focused Questions to evoke a goal state, What do they want see, hear and feel that is different to what they have been experiencing until now?
- Practice relaxation if necessary
Step 2 Session 2 - Rewind
- Explain the Rewind process if you haven’t already
- Make sure your client is aware that they can open their eyes and stop at anytime should they wish to
- Go through the entire exercise, ensuring that your client is relaxed throughout Scale afterwards using a SUDS
Step 3 Session 3 - Recap and re-scale
- Ask your client how they have been since you last met and did the Rewind exercise
- Pay attention to the changes you can see and hear in their physiology
- Re-scale the memory using a SUDs
- If you think it is necessary repeat Rewind or focus on relaxation using visualisation of them in the future with their goal state in place.
When I approached the Research and Recognition Organisation recently to discuss the possibility of collaborative working, they were quick to point out that the RTM method was not NLP, but based on NLP principles. We at MAM Learning would say the same thing regarding our teaching.
It is plain to see however, that the protocols are very similar and stay very close to the principles and practices developed by Dr Grinder and Dr Bandler (* ref. 8 Grinder & * ref. 9 Bandler)
The RTM Process
The MAM Learning 3 Step Rewind Process
The client is asked to briefly recount the trauma.
Their narrative is terminated as soon as autonomic arousal is observed.
The subject is reoriented to the present time and circumstances.
Listen to your client’s story using empathetic listening. Scale their memory using a SUDs. Ask how they would like to feel if they didn’t have their current feelings. Use Solution Outcome Questions to evoke a goal state. Practice relaxation if necessary.
The Rewind Process
See above numbers 5-11 which describe the steps taken to restructure the memory. This is covered by the MAM Process with the comment, go through the entire process. In the MAM approach a script is used by the Practitioner to guide the client through the kinds of structural changes indicated by the RMT process
The Rewind Process
Explain the Rewind process if you haven’t already.
Make sure your client is aware that they can open their eyes and stop at anytime should they wish to.
Go through the entire exercise, ensuring that your client is relaxed throughout.
Scale afterwards using a SUDS.
When the client is free from emotions in retelling, or sufficiently comfortable (SUDs ≤ 3), they are invited to walk through several alternate, non-traumatising versions of the previously traumatising event of their own design.
After the new scenarios have been practiced, the client is again asked to relate the trauma narrative and his previous triggers are probed.
SUDs ratings are elicited.
When the trauma cannot be evoked and the narrative can be told without significant autonomic arousal, the procedure is over.
Ask your client how they have been since you last met and did the Rewind exercise.
Pay attention to the changes you can see and hear in their physiology.
Re-scale the memory using a SUDs.
If you think it is necessary repeat Rewind or focus on relaxation using visualisation of them in the future with their goal state in place.
The procedure is over.
All professional regulatory bodies like the Nursing & Midwifery Council (NMC) are vigorously committed to their members practicing in a research aware way and that is right and proper.
I have sought to highlight the fact, that the process Mia Scotland and I teach is rooted in a growing evidence base. Even though we (Mia and I) have personal experience of the MAM 3 step process’s effectiveness in practice, that is not enough. We also need to reassure those in our professions that its use is both efficacious and safe.
We are very excited by the work of MAM learning. A growing number of birth professionals have trained with us and have entered our accreditation process. For the many women and their partners who have been suffering after a brith experience that they consider traumatic, but who do not fit the current diagnostic criteria (* ref. 7) for the formal diagnosis of PTSD, our practitioners represent new hope.
The research discussed in this blog is in the context of those who have been given a formal diagnosis of PTSD. It is important to note that MAM Learning does not train birth professionals to become trauma therapist.. It is acknowledged that the treating of those diagnosed with PTSD (* ref. 7) following a traumatic birth experience is the domain of professional therapists; Experts who have pursued an extensive course of study taking years of learning and experience to complete.
The MAM 3 Step Rewind process may, of course, be used by a professional therapist as one of the tools that she has available to her in the context of her work, but it needs saying that becoming a specialized trauma therapist can not be achieved in days, weeks or even months.
What MAM Learning does do is train already experienced birth professionals to teach a client a learning process and then guide them through it. The process is seen as way of enhancing the clients ability to learn a new way of structuring their memory. This new structure potentially acts to reduce the painful effects of their traumatic memory to such an extent, that their suffering is significantly diminished and may even disappear while leaving the memory intact.
TO BE CONTINUED…..The next and final blog in the series will conclude with an outline of the recommended treatment protocol described by NICE (* ref. 6). It will then seek to compare the NICE guideline with the steps of the MAM 3 step rewind process. Going on to outline the diagnostic criteria for PTSD (* ref. 7), concluding with an explanation of why learning and practicing the MAM 3 step rewind process is both safe and needed in our current birth context.
The reference links below are listed in the order that I suggest you read them. The Videos are, in my opinion, a must watch if you want to delve deeper into how the MAM 3 Step Rewind Process works:
- Breakthrough Found In Treatment
- PTSD: Extinction, Reconsolidation, and the Visual-Kinesthetic Dissociation Protocol
- Remediation of intrusive symptoms of PTSD in fewer than five sessions: a 30person pre-pilot study of the RTM Protocol
- Reconsolidation of Traumatic Memories for PTSD: A Randomised Trial of 30 Females
- A Pilot Study of Quantitative EEG Markers of Post-Traumatic Stress Disorder -- Baseline Observations and Impact of the Reconsolidation of Traumatic Memories (RTM) Treatment Protocol
- Post-traumatic stress disorder: management Clinical guideline [CG26] Published date: March 2005
- The ICD-10 Classification of Mental and Behavioural Disorders
- A 4 minute video of Dr. Richard Bandler demonstrating the NLP Fast phobia cure (FPC) (Note: Richard is a bit like marmite, people tend to either love him or hate him. That being said, this video is worth a watch. In it the doctor clear works through each step of the FPC brilliantly. Warning, there is strong language in this video).
- Another Longer video (15 minutes) of Dr John Grinder demonstrating the FPC