ArticlePDF Available

NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol

Authors:
  • The Research and Recognition Project
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
1
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol.
Reprinted from Suppose, the Official CANLP/ACPNL Bilingual Newsletter. Spring 2010, pp. 25-
42.
Richard M. Gray, PhD
Assistant Professor
School of Criminal Justice and Legal Studies
Fairleigh Dickinson University
1000 River Road
T-RA2-01
Teaneck, NJ 07666
Tel. 201-692-2577
Email rmgray@fdu.edu
Website: http://richardmgray.come.comcast.net
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
2
Abstract. The intrusive symptoms of PTSD Impact thousands of state and local police
officers, armed service men and women and civilians of every description. Current
treatments rooted in extinction protocols require extensive commitments of time and
money and often have limited effectiveness. This study reviews two important
mechanisms that explain when treatment does and doesn’t work: extinction and
reconsolidation. It then reviews the research regarding and suggests an explanatory
mechanism for the Visual-Kinesthetic Dissociation Protocol, also known as the Rewind
Technique. The technique is notable for its lack of discomfort to the patient, the
possibility of being executed as a content free intervention, its speed of operation and
its long term, if largely anecdotal, efficacy. Specific diagnostics for extinction and
reconsolidative mechanisms and suggestions for future research are provided.
Keywords: PTSD, PTSD treatment, PTSD models, Visual-Kinesthetic Dissociation,
Rewind technique, extinction, reconsolidation
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
3
PTSD is diagnosed in terms of four criteria. The first of the criteria is the
traumatizing event. In order to qualify as a traumatizing event both of the following
must appear: 1. the person experienced, witnessed, or was otherwise confronted with
one or more events that actually involved or threatened death, serious injury or some
other threat to the physical integrity of that individual or others. 2. The individual’s
response involved intense feelings of horror, fear or helplessness. The other diagnostic
criteria are divided into three symptom clusters, the reexperienceing cluster, the
avoidance / numbing cluster and the arousal cluster (American Psychiatric
Association(APA), 1994).
According to Foa & Meadows (1997) the intrusion or reexperiencing symptoms
include the hallmark signs of PTSD including nightmares, intrusive thoughts and
flashbacks. The avoidance group includes efforts to avoid memories of the traumatic
experience and symptoms of emotional numbing. The third symptom cluster includes
symptoms of hyperarousal including sleeplessness, irritability and hypervigilance (APA,
1994; Bodkin, Alexander, Detke, Pope, & Hudson, 2007; Davidson, & Foa, 1991;
Friedhelm & Sack, 2002; Keane, Weathers & Foa, 2000, McHugh, & Treisman,2007;
Spitzer, Wakefield, & First, 2007).
Diagnosis is made when symptoms (at least one from the reexperienceing
cluster, three from the avoidance cluster and two from the hyperarousal cluster) cause
clinically significant distress or discomfort and have persisted for a minimum of one
month (APA, 1994).
Extinction and Re-consolidation Effects in the Treatment of PTSD
If we understand PTSD as being, at heart, a group of behaviors associated with a
classically conditioned fear response, then neural models of learning and forgetting
become crucial components of our understanding. Two specific mechanisms appear to
be most important as theoretical models for the treatment of PTSD. These are extinction
and re-consolidation.
Extinction. When the memory linkage between a Conditioned Stimulus (CS) and
a fear evoking event (UCS) is extinguished, a new memory is created that communicates
the absence of the feared object and blocks access to the original memory that signaled
the onset of the feared event. These new memories tend to be context sensitive and
somewhat more fragile than the original memories. Extinction, therefore, in the classical
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
4
learning paradigm, refers to the learning of new information now provided by the
conditioned stimulus (CS) in the learning context. It does not refer to the elimination,
forgetting or modification of the memory. Extinction models in the treatment of PTSD
are characterized by four specific effects through which the behavior may be re-
established or through which relapse occurs. As they appear in the post-treatment or
relapse behavior of PTSD patients, they may be viewed as diagnostic of the fact that
extinction is the specific mechanism underlying the treatment. These effects are
spontaneous recovery, contextual renewal, reinstatement and rapid reacquisition
(Bouton, 2004a; Bouton & Moody, 2004; Dillon & Pizzagalli, 2007 ; Hartley & Phelps,
2009; Massad & Hulsey, 2006; Quirk & Mueller, 2007; Rescorla, 1988; Vervliet, 2008).
Spontaneous recovery refers to the re-occurrence of the extinguished or
unreinforced fear response after the passage of time. It was first observed by Pavlov and
is one of the first evidences that extinction does not remove the memory. As noted,
extinction involves the creation of a new contextual association to the effect that in this
context, the CS does not predict the feared stimulus (the UCS) and, therefore, the fearful
response is irrelevant. That new memory of the new contingencies, if unreinforced, is
subject to a time-based decay. It is forgotten over time and the fear re-emerges(Bouton,
2004a; Bouton & Moody, 2004; Dillon & Pizzagalli, 2007 ; Massad & Hulsey, 2006;
Rescorla, 1988; Vervliet, 2008).
Contextual renewal refers to the re-emergence of the conditioned response in a
new circumstance where the extinction memory was not created. If the patient is
subjected to unreinforced (extinction) trials in one context, so that the CS fails to evoke
the feared response in that context, a subsequent test of that same CS in another context
may show little or no reduction in expression. Even though the original fear response
may generalize to multiple contexts, extinction phenomena are much more context
dependent. Contextual renewal is contextually bound; the response is only renewed in
the contexts where the UCS has again appeared (Bouton, 2004a; Bouton & Moody, 2004;
Dillon & Pizzagalli, 2007 ; Massad & Hulsey, 2006; Rescorla, 1988; Vervliet, 2008).
Reinstatement occurs when the fearful stimulus, the UCS, is presented without
the CS. In that context where the original UCS is presented, despite the fact that the
fearful response had been fully extinguished, the CS will be restored. It will not,
however reappear in other contexts where the UCS has not been presented (Bouton,
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
5
2004a; Bouton & Moody, 2004; Dillon & Pizzagalli, 2007 ; Massad & Hulsey, 2006;
Rescorla, 1988; Vervliet, 2008).
Rapid reacquisition, as the name suggests, describes the reacquisition of the fear
memory after it has been successfully extinguished. In this case there is a net savings in
the number of trials needed to re-acquire the memory. If, for example, the original fear
association took ten trials to install, during post-extinction training, it may take only
three (Bouton, 2004a; Bouton & Moody, 2004; Dillon & Pizzagalli, 2007 ; Massad &
Hulsey, 2006; Rescorla, 1988; Vervliet, 2008).
Extinction has traditionally been held to be the tool of choice for the treatment of
PTSD. Foa and her colleagues have indicated that in its various forms, from
desensitization through imaginal and in vivo exposure, it is the most well researched
and most highly regarded of treatments and, in combination with cognitive behavioral
interventions or supplements, represents the scientific treatment of choice (Edna B.
Foa, Keane, & Friedman, 2000; Foa & Meadows, 1997a, 1997b; Rothbaum, Davis, King,
Ferris, & Lederhendler, 2003; Wessa & Flor, 2007).
Insofar as extinction-based exposure treatment is the most common form of
intervention we may expect that relapse data from extinction based studies should
provide the following predictable kinds of relapse behavior. Because PTSD and trauma
related memories are resistant to extinction, we would expect extinction effects to be
variable at best. Because the extinction memory is subject to decay over time, we may
expect extinction-based treatments to be characterized by a certain level of temporal
instability. In light of the crucial role played by the ventro-medial prefrontal cortex
(VmPFC) in the inhibition of Amygdalar function in extinction training, the decreased
function of those circuits under conditions of extreme stress mitigates against the
efficacy of exposure models. For these reasons, without further treatment, extinction
measures alone may be only partially effective(Diamond et al., 2007; Gharakhani et al.,
2006; Liberzon et al., 2007; Wessa & Flor, 2007).
An examination of the exhaustive work of Foa and her colleagues (Foa &
Meadows, 1997; Foa et al., 2000) along with data from other researchers (Massad &
Hulsey, 2006; McNally, 2007; Wessa & Flor, 2007) reflects that extinction based results
are inconsistent in their long-term effects. A review by Shalev, Bonne and Eth (1996)
finds mixed results with cognitive behavioral interventions based largely on extinction
practices. Rothbaum, Meadows, Resick & Foy (2000) reviewed 19 studies of extinction-
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
6
based treatments for PTSD at various levels of sophistication. The studies included
exposure treatments, systematic desensitization and combinations of treatments
including exposure elements. The results were uneven and ranged from little or no
effect on PTSD symptoms to 85% reductions in symptoms. Practice guidelines for the
treatment of PTSD, provided by the American Psychiatric Association (Ursano et al.,
2004) finds similar uneven results.
Pitman et al. (Pitman, et al., 1996) review several cases of Vietnam Veterans who
were subjected to multiple sessions of imaginal flooding. An average improvement
between pre and post measures of intrusion and avoidance of 26% reduced to 14% in
post treatment follow-up. In their final analysis, the authors determined that the extent
of emotional processing was unrelated to the efficacy of treatment measured in terms of
the decrease of intrusive symptoms. Despite the extinction-based treatment, for most
clients, the symptoms remained.
Reconsolidation. During the early 21st century, reconsolidation came to the
forefront of memory research when it was illustrated that propranolol, a noradrenalin
inhibitor, when injected directly into the amygdalar tissue of rats, was capable of
modifying or erasing the trace of traumatic memories. Other studies found that the
introduction of anisomysin into the basolateral amygdala had similar results. Further
chemical studies revealed that the crucial element, further upstream, was the inhibition
of NMDA production and release, preventing the continued consolidation or
reconsolidation of the activated memory (Cao et al., 2008; Jacek, Ecedil, & LeDoux, 2006;
Riccio, Millin, & Bogart, 2006; Tronson & Taylor, 2007).
This research revived a long standing debate into the nature of long term
memory. Whereas classical extinction, as noted above, held that new memories blocked
access to permanent associations between conditioned stimuli and responses in long
term memory stores, reconsolidation theory held that the process of long term memory
consolidation took place over time and that each access to the memory rendered the
association labile, subject to change. (Akirav & Maroun, 2006; Alberini, 2005; Cao et al.,
2008; Debiec, Doyre, Nader, & LeDoux, 2006; Duvarci & Nader, 2004; Forcato, 2009;
Gharakhani et al., 2006; Lee, Milton, & Everitt, 2006; Milekic & Alberini, 2002; Nader,
Schafe, & LeDoux, 2000; Riccio et al., 2006; Tronel, Milekic, & Alberini, 2005).
Insofar as the reactivated memory associations were always reinforced with the
same or similar experiences, in the same or a similar contexts (including subjective
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
7
contexts) over time, the memory grew less and less susceptible to change. If, however,
when the memory was reactivated, the organism encountered new information, the
actual content of the memory might be modified or even erased. Lee has characterized
reconsolidation as a mechanism for maintaining the relevance of learned associations
(Alberini, 2005; Hupbach, Hardt, Gomez, & Nadel, 2008; Labar, 2007; Lee, 2009; Loftus
& Yuille, 1984; Tronel et al., 2005).
Just as extinction procedures have distinctive characteristics, so reconsolidation
mechanisms also have their signature aspects. These include: diminution of or complete
elimination of the target memory, resistance to spontaneous recovery, lack of net gain in
reacquisition learning, and lack of contextual renewal.
Crucially, in order for reconsolidation to impact the structure of the original
memory, the memory must be activated by a brief exposure to a first-order cue. The
effects are time dependent and only occur within a specific window of opportunity after
the memory is activated. These changes typically do not appear in short term memory
but in measures of long term memory(Akirav & Maroun, 2006; Alberini, 2005; Debiec,
LeDoux, & Nader, 2002 ; Duvarci & Nader, 2004; Forcato et al., 2007; Kaang, Lee, & Kim,
2009; Kindt, Soeter, & Vervliet, 2009; Nader et al., 2000; Riccio et al., 2006).
Memories treated under such a reconsolidation regimen tend to be permanently
removed or permanently modified. If they are subject to spontaneous recovery, they
reappear in the modified form (Loftus & Yuille, 1984). If they have been erased or
replaced they cannot be revived without retraining de novo(Cao et al., 2008; Duvarci &
Nader, 2004; Forcato, 2009; Forcato et al., 2007; Kindt et al., 2009; Lee et al., 2006).
Reacquisition in extinction typically shows enhanced efficiency of relearning.
That is, it takes fewer trials to reestablish the subject behavior. In memories that have
been modified using reconsolidation based procedures, there is no net gain in
relearning; when relearned, they are learned as if they were totally new behaviors (Cao
et al., 2008; Duvarci & Nader, 2004; Kindt et al., 2009).
Contextual renewal does not occur. This means that even when the
unconditioned fear stimulus is presented in a novel context, the learned fear response
does not reappear. This is not enhanced extinction (Duvarci & Nader, 2004).
Procedurally, reconsolidation and extinction are initiated using distinct
protocols. The crucial difference appears to be that a single, short presentation of the
conditioned stimulus reactivates and labilizes the memory, while longer presentations
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
8
and multiple presentations activate the extinction memory. Where experiential effects
are used as amnestic agentsessentially modifying, overwriting or eliminating the
target memorytheir efficacy is in part determined by their temporal proximity to the
eliciting stimulus. That is, the sooner they are presented after activation of the target
memory, the better (Lee, 2009; Pedreira, Perez-Cuesta, & Maldonado, 2004).
In human studies of the phenomenon, it has been found that reconsolidation can
be used to eliminate or modify the emotional component of a traumatic memory while
leaving the declarative elements intact. It has also been shown that reconsolidation
processes have a direct effect on first order memories but not on associative chains
based on that original experience (Kindt et al., 2009).
Reconsolidation and the Visual Kinesthetic Dissociation Protocol.
Reconsolidation effects have been suggested as a powerful method for the
treatment of PTSD. While historically, the mechanism has been associated with the non-
pharmacological creation of retroactive amnesia, there has been little work that
explicitly links this material to treatments for PTSD. Despite other explanations, it is
reasonable to believe that the Visual Kinesthetic Dissociation Model, originally
described by Richard Bandler (1985) makes specific use of reconsolidation mechanisms
and deserves serious consideration by mental health professionals (Forcato et al., 2007;
Labar, 2007; Riccio, Millin, & Bogart, 2006).
The Visual Kinesthetic Dissociation technique (V/KD), is supported by anecdotal
reports by practitioners that cover nearly a quarter century. Among the anecdotal
reports are those provided by Richard Bandler, Steve and Connierae Andreas, Robert
Dilts, and William McDowell who severally relate that each of them has treated
thousands of persons suffering from PTSD and phobic conditions with immediate,
lasting results from this short term intervention. In many cases they report complete
symptom alleviation after long term follow-up (Andreas & Andreas, 1989; Bandler,
1985; Dilts & Delozier, 2000; McDowell & McDowell, nd).
Consistent with the pattern of memory reconsolidation, the intervention includes
minimal evocation of the problem response along with multiple overlays of new
associations that, in essence, rewrite the memory. As in previously reported
reconsolidation studies, the traumatic event either becomes inaccessible, significantly
modified, or subject to non-traumatic declarative access (Alberini, 2005; Hupbach,
Hardt, Gomez, & Nadel, 2008; Labar, 2007; Tronel, Milekic, & Alberini, 2005).
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
9
The procedure first appeared in Bandler’s Use Your Brain for a Change (1985). An
expanded version of the procedure appeared in the Andreas’ Heart of the Mind (Andreas
& Andreas, 1989). Dilts and Delozier (2000) provide a slightly different version of the
protocol in their Encyclopedia of Systematic NLP. The technique has also been
popularized in the UK as the rewind technique (Guy & Guy, 2003; Muss, 1991, 2002).
Psychological investigations of the technique are limited to three scientific
studies, two reviews and several mentions in the literature. Each of the referenced
studies recommends the technique as a valuable tool for treating PTSD and makes
suggestions for further research (Carbonell & Figley, 1999; Dietrich et al., 2000; Figley,
2002; Hossack & Bentall, 1996; Koziey & McLeod, 1987; Muss, 1991, 2002). There is
also one non-peer reviewed study that is reported on-line (Guy & Guy, 2003).
Koziey and McCleod, writing in 1987, reported their experiences in treating two
rape victims with a mixed technique employing Bandler’s three-place dissociation in
combination with hypnotic trance. An initial pretreatment session was used to review
the technique and to complete an assessment package. In a second session, the authors
used hypnotic trance to provide a resource state to ensure that the traumatic memories
would not become overwhelming. One week later, in a second treatment session, the
patients completed another set of evaluations, were hypnotized and then the
hypnotized subjects were led through the three part dissociation. Consistent with the
standard procedure, they were led through an imagined, dissociated review of the
trauma in which they watched themselves, watching themselves, watching a movie of
the trauma. The movie began with a still image of the client in a safe time before the
traumatic event, projected on an imaginary screen. The experience ended with a safe
place after the trauma with each of the clients merging their own dissociated identities
and sharing the learnings from their experience. Unspecified measures of 28 dependent
variables showed significant changes in pre-post comparisons with near total
abatement of symptoms in one of the subjects.
Muss (Muss, 1991, 2002) reports having used the technique first with 19 police
officers who met DSMIII diagnostic criteria for PTSD, and later with all manner of
traumatized persons(Muss, 2002). In nearly all of the 19 police cases, he reports
remission of symptoms. He provides no control conditions and few details of the study,
however, in long term follow ups (3 month to three years) in 15 of the 19 cases, he
reports a complete absence of intrusive imagery. Crucially, as noted by Andreas, Muss
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
10
indicates that the technique is appropriate to clients whose primary symptoms are
experienced as intense, suddenly arising experiences of the trauma symptoms usually
experienced as flashbacks or panic reactions (Andreas, 2008, Personal communication).
A third study, by Hossack and Bental (Hossack & Bentall, 1996) included five
subjects who were treated with a combination of guided visualizations, Jacobsen’s deep
muscle relaxation and two sessions of the VK/D protocol. Although one of the five
subjects was unable to complete the visualizations associated with the VK/D procedure,
the four completers all reported significant reduction of intrusive images and were able
to return to normal life activities.
Guy and Guy report that the technique (renamed by Muss (1991, 2002) as the
Rewind technique) was applied to thirty people between 2000 and 2002. All were
diagnosed with PTSD or partial PTSD. Participants were interviewed ten days post
treatment. Forty percent adjudged their improvement as extremely successful, fifty-
three percent as successful and seven percent as acceptable. None rated the treatment
either as poor or as a failure (Guy & Guy, 2003).
The following description of the basic protocol depends upon extensive personal
communications with Andeas, Dilts and Hallbom and continued reference to their
descriptions of the protocol in several written sources (Andreas & Andreas, 1989;
Bandler, 1985; Dilts & Delozier, 2000). A detailed protocol is available from the author.
The Visual Kinesthetic Dissociation. It is important to understand that
Andreas emphasizes that this technique is only effective when the client’s difficulties
are essentially a phobic, instantaneous conditioned response to stimuli related to a
traumatic event. In general, the symptoms will focus on flashbacks and other immediate
panic responses to stimuli associated with the traumatic event. In terms of classical
PTSD symptomatology we would associate this with simple PTSD. While it may be
effective in complex cases, its efficacy will be limited to the intrusive and avoidant
symptoms.
The technique begins by establishing rapport and framing the intervention as a
short visualization process. The process is ordinarily comfortable, but sometimes has a
very short period of moderate discomfort. This stage may include practice behaviors,
including the running of an innocuous, unrelated experience backwards in subjective
experience.
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
11
Insofar as the technique may be pursued content free, the clinician should decide
whether to proceed with or without content. After framing, the problem state is briefly
accessed by questioning and probing until the client responds physiologically. Access to
the problem state is typically marked by physiological and paralinguistic elements that
reflect heightened arousal and fast onset of the physiological and paralinguistic
symptoms of fear or trauma. These may include changes in breathing, heart rate, skin
tone and color, vocal pitch and speech rate.
As soon as the state is identified, the client’s attention should be refocused from
the problem state and reoriented to the present context.
The actual three part dissociation begins by asking the client to imagine that he
or she is seated in a movie theatre. On the screen is a still image of the client performing
some neutral activity in a safe context, at a time before the trauma occurred. The picture
on the screen represents one level of dissociation, while watching the picture
constitutes a second level of dissociation. Having established these initial dissociative
experiences, the client is asked to dissociate from the image of themselves sitting in the
theatre by imagining themselves floating away from their body in the theatre to a
projection booth behind a plexiglas barrier. From this vantage point, they are instructed
to watch themselves in the theatre, watching themselves on the screen.
At this point, an anchor or conditioned association is made between a specific
touch stimulus and the current dissociated experience. This is intended to reinforce the
experience of dissociation from the image on the screen. This may also be used to evoke
or enhance dissociation during later parts of the protocol.
After taking care to create a dissociated context and an anchor that can evoke
and reinforce that context, the client is instructed to observe a black and white picture
of herself on the screen of the movie theatre, at a time before anything ever happened.
As the client focuses on the imagined picture, she is directed to watch herself in the
theatre as she watches a black and white movie of the triggering event or the root
trauma. She is to continue to watch the observer in the theater, seeing herself going
through it, all the way to a point past the end of it, where she can see that she survived
and is safe once again. She is further instructed that upon reaching the end of the movie,
she should stop the movie as a still, black and white image. After signaling to the
clinician that all is well, the protocol either proceeds to the next step or is repeated until
the black and white, dissociated movie can be reviewed comfortably.
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
12
Beginning with the safe, black and white representation of herself that is on the
screen at the end of the dissociated rehearsal, the client is now instructed to imagine
stepping into the movie and experiencing the entire sequence, fully associated, in color,
in reverse, at very high speed (in two seconds or less). This step may take several
repetitions unless it has been practiced during the framing. If the client reports that the
reversed rehearsal has gone well, she may be debriefed and a determination made as to
whether further iterations are necessary.
In order to determine whether the procedure has had the desired effect, every
effort is now made to evoke the problem state using the same questions and probes that
evoked the problem state at the beginning of the procedure. Special attention should be
given to those questions that were associated with a clear physiological reaction.
Consistent with practices suggested by Foa and Kozak (Foa & Kozak, 1986), each
sensory system should be probed for possible triggers for the problem behaviors. If
there is no reaction, the intervention is presumed to have worked. When the
practitioner is satisfied that she cannot evoke the PTSD response, the basic intervention
is complete.
Some practitioners suggest the addition of a third level of novel experience that
includes a reliving of the traumatic event in which they are either protected from harm,
only acting as if they were a stunt-double in a movie of the event, or they missed the
crucial trauma altogether. This level is especially recommended in the case where
physical injury was part of the traumatic event. A schematic of the process is presented
at the end of the article.
Mechanism. Each of the authors noted above attempts to explain the mechanism
of the intervention by various means including, shifts in hemispheric dominance
(Bandler, 1985), change in the perceptual structure of the memory (McDowell &
McDowell, nd), changes in the integration of the memory mediated by the modulation of
arousal (Dietrich, 2000), and dissociation from the traumatic sequellae (Dietrich et al.,
2000).
Having reviewed the literature on PTSD, extinction and reconsolidation, the
mechanism of the VK/D intervention may be most parsimoniously explained in terms of
memory restructuring through the mechanism of reconsolidation.
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
13
In accordance with previously outlined studies of the phenomenon, the
technique begins with a short term activation of the traumatic experience. Insofar as the
experience is marked by significant changes in physiology, it meets Foa and Kozak’s
suggestion that an appropriate intervention be rooted in a full activation of the event.
Here, full activation does not imply flooding, only sufficient activation of the core
memory to render it labile. Nevertheless, in order to prevent the shutdown of the
cognitive capacities detailed by Diamond, et al. (2008), the client is distracted from the
trauma and his consciousness returned to the present time in short order. This not only
prevents re-traumatization but it limits the activation of the memory to a temporal
window that is appropriate to reconsolidation, but too brief to support extinction
(Akirav & Maroun, 2006; Alberini, 2005; Foa & Kozak, 1986; Hupbach et al., 2008; LeBar
& Phelps, 1998; Riccio et al., 2006).
This foreshortening of exposure may be crucial to the initiation of memory
labilization that allows for reconsolidative memory modification. According to Pedreira,
Perez-Cuesta, & Maldonado (2004) neither reconsolidation nor extinction is possible
without the termination of the conditioned stimulusthe fear context. According to
their research, both processes require the termination of the fear context before new
learning can occur.
Having awakened the traumatic memory, it now becomes subject to
reinforcement or modification depending upon the immediate stimulus context.
Remembering that the memory is still active in the background (through its intentional
revivification and its presence in the semantic context), the VK/D model now provides
several experiences of dissociation: the dissociative anchor, the dissociated safe
representation on the imagined movie screen and the client’s floating out of the body to
view the viewer who is sitting in the theater watching the screen. Insofar as the memory
is dissociated, and is not actively reinforcing the fear response, its novel stimulus
properties may preferentially support memory updating through reconsolidation rather
than extinction (Pedreira, Perez-Cuesta, & Maldonado, 2004).
At this point, the first of several layers of active intervention in the structure of
the traumatic memory begins. The dissociated black and white movie provides a multi-
leveled opportunity for reshaping the memory context. First, it is triply dissociated
(Dietrich, 2000; Hossack & Bentall, 1996; Koziey & McLeod, 1987; Muss, 2002). Second,
insofar as it is a voluntary re-experience of the trauma the context is restructured as
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
14
voluntary rather than involuntary. This is what various authors have described as
prescribing the symptom. It is also a direct remedy for the loss of control described by
Foa as a significant contributor to PTSD symptomatology (Bandler & Grinder, 1979;
Erickson & Rossi, 1980; Foa & Meadows, 1997; Haley, 1973). In this context, the novelty
of symptom prescription may enhance the reconsolidation response. Pedreira et al. and
Lee indicate that unexpected stimulus properties support reconsolidative updating of
memory content (Lee, 2009; Pedreira et al., 2004). Third, because the movie is viewed
in black and white, its emotional impact is further vitiated (Bandler, 1985; Bandler &
MacDonald, 1987; Kringelbach, 2005). In theory, all of these elements are incorporated
into the structure of the original memory.
Once the client has successfully completed the dissociated review, another layer
of new meanings is added to the memory through the reverse, associated rewind of the
memory. At this point, attempts have been made to recall the affect associated with the
traumatic event and by now, it should already be difficult. This rewind phase constitutes
a significant restructuring of the memory. The associated reversal of the experience
leaves the client with a subjective memory of the problem ‘undoing itself.’ This is
performed quickly. The speed takes advantage of the narrow window of memory
lability, and the heightened salience accorded to fast moving, multisensory stimuli.
Bandler suggested that the reversal of the memory sequence was a valuable tool for
undoing decisions, preconceived notions and other artifacts of temporal experience
(Bandler, 1985; Simons, Detenber, Reiss, & Shults, 2000).
As with many of the elements of this intervention, novelty may be a significant
element in its efficacy. It has already been noted how the unexpected features of the
intervention may support the reconsolidation mechanism. The complexity of this part of
the intervention may also support further modification of the experience through
simple cognitive overload. Given the limited capacity of short term memory 7+/- 2
elements), the simple fact of learning and executing the reversed rewind may not leave
sufficient capacity in short-term memory to access the fear response (Miller, 1956;
Pedreira et al., 2004).
After completing the multisensory, high speed, reversed, imaginal exposure, the
client is again debriefed and every effort is made to reaccess the trauma response. If the
intervention has been successful, the client may retain declarative access to the event,
but without the strong negative affect that characterizesPTSD (Andreas & Andreas,
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
15
1989; Bandler, 1993; Dilts & Delozier, 2000; Kindt, Soeter, & Vervliet, 2009; Muss,
1991).
In those cases where an imagined restructuring of the original event is
performed (such as reliving it as a stunt double or missing the traumatizing event
altogether), the mechanism may be as simple as layering-in another set of experiences
that are incompatible with the trauma. Moreover, the addition of modified memories
reflects one of the standard reappraisal methods of cognitive regulation strategies. Such
interventions are known to increase activity in the VmPFC that has a modulatory
influence on the amygdala. Insofar as the emotional impact of the traumatizing memory
has already been significantly modified, the new version of the traumatic event may
serve to provide a coherent narrative for the now, non-traumatizing memory (Diamond,
Campbell, Park, Halonen, & Zoladz, 2007; Hartley & Phelps, 2009; Williams et al., 2006).
Discussion
PTSD is a problem that is currently affecting as many as 15 to 17% of returning
Iraqi veterans and 11% of those returning from Afghanistan. Reports indicate that up to
40% of sufferers remain untreated. Aside from cultural issues that discourage mental
health treatment, the long term commitments required by standard treatment
modalities and inconsistent results do little to change motivation to obtain treatment
(Hoge et al., 2004).
The VK/D model is supported by 25 years or more of anecdotal reports covering
thousands of patients. The intervention does not re-traumatize the patient and can be
completed in as little as 45 minutes. Although only subject to three peer reviewed
evaluations in the last twenty-five years, each of the evaluations deemed it worthy of
further investigation. One author, Muss, has continued using the technique and through
his efforts it is now a recognized treatment for PTSD in the UK (Carbonell & Figley,
1999; Dietrich, 2000; Koziey & McLeod, 1987; McDowell & McDowell, nd; Muss, 1991,
2002; Specialists).
Until recently, the possible mechanism of action for this highly innovative
treatment was difficult to specify and was often described in terms of brain
lateralization, changes in perspective and other non-operationalizable constructs. Here,
an argument for a mechanism based upon the emerging evidence for memory
reconsolidation has been presented that is congruent with the structural elements of
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
16
the intervention and predicts similar results (Dietrich, 2000; Hossack & Bentall, 1996;
Koziey & McLeod, 1987; McDowell & McDowell, nd).
As noted, reconsolidation protocols depend upon a brief reactivation of the
traumatic memory followed, after stimulus cessation, by an intervening amnestic or
confounding event. In the VK/D protocol, the memory is briefly activated and several
layers of dissociative experience and confounding imaginal memories are introduced
during the (presumed) labile period. For experiences subject to amnestic
reconsolidation, insofar as a sufficiently intense memory is introduced during the labile
phase of reconsolidation, the memory may be disrupted, erased or modified. After the
VK/D process, the original memory becomes either inaccessible, innocuous or is
transformed into a similar but nonthreatening memory. Human studies of the
reconsolidation phenomenon have found that although the affective dimensions of
previously negative memories are gone, the events remain accessible on a declarative
level so that they can be discussed without retraumatizing the client. Similarly, clients
who have undergone treatment with the VK/D protocol retain declarative and episodic
access to the stimulus event but without the traumatic affect (Andreas & Andreas, 1989;
Bandler, 1985; Dilts & Delozier, 2000; Kindt et al., 2009; Lee, 2009; Lee, Milton, &
Everitt, 2006; Riccio et al., 2006).
This analysis leads to several falsifiable predictions and diagnostic indicators of
the underlying mechanism in PTSD treatments. Because the mechanism outlined here
depends upon the known process of reconsolidation, interventions for PTSD may be
behaviorally evaluated in terms of their results to determine whether extinction or
reconsolidation is operative. Where extinction mechanisms have been invoked,
spontaneous recovery, contextual renewal, reinstatement and rapid reacquisition will
characterize the post treatment period and further treatment will be necessary in order
to deal with the intrusive elements of the disorder (Bouton, 2004a; Bouton & Moody,
2004; Dillon & Pizzagalli, 2007 ; Massad & Hulsey, 2006; Rescorla, 1988; Vervliet, 2008).
Where reconsolidative mechanisms have been appropriately marshaled, the memories
will be transformed, rendered inaccessible and, even if accessible to declarative and
episodic recall, they will have been rendered non-traumatizing. They will not be subject
to spontaneous recovery, contextual renewal, reinstatement and rapid reacquisition
(Cao et al., 2008; Duvarci & Nader, 2004; Forcato C, January 2009; Forcato et al., 2007;
Kindt et al., 2009; Lee et al., 2006). These results may also be used for the evaluation of
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
17
mechanism where the techniques used were inconsistent and the results were variable
and may further lead to the refinement of results based upon the length and intensity of
the CS presentation and the timing of the introduction of the confounding or amnestic
stimulus (Lee, 2009; Pedreira, Perez-Cuesta, & Maldonado, 2004). Finally, these
observations may lead to new interventions based on reconsolidative mechanisms.
Future research into this technique should look towards large scale trials of the
protocol in the treatment of PTSD. The international troops returning from service in
various theaters of war could provide a significant test population for this already
established and relatively unknown treatment. There remain hundreds of thousands of
war victims, refugees from earthquakes and tsunamis who would provide a grateful
pool of subjects.
Follow-up studies and surveys to take advantage of the now anecdotal evidence
compiled by NLP practitioners would also be instructive. Such follow-up studies could
provide crucial long-term reports of the incidence of post treatment relapse that would
be capable of falsifying the proposal that the technique is rooted in reconsolidation
rather then extinction.
Further research might also investigate the construction of even shorter
interventions that depend upon reconsolidation. For instance, just as the current
technique relies in part on a conditioned resource to amplify dissociation, it may be
possible to create an even more efficient restructuring using a powerful, positive
resource state as a conditioned response whose introduction during the labile period
would create a memory transformation or erasure. The current explanation invites
further exploration of the mechanism of reconsolidation to other interventions that
have been to now, poorly understood.
References
Akirav, I., & Maroun, M. (2006). Ventromedial Prefrontal Cortex Is Obligatory for
Consolidation and Reconsolidation of Object Recognition Memory. Cereb. Cortex,
16(12), 1759-1765.
Alberini, C. M. (2005). Mechanisms of memory stabilization: Are consolidation and
reconsolidation similar or distinct processes? Trends in Neurosciences, 28(1), 51-
56.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental
Disorders. 4th ed. Washington, DC: American Psychiatric Association.
Andreas, C., & Andreas, S. (1989). Heart of the Mind. Moab, UT: Real People Press.
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
18
Bandler, R. (1985). Using Your Brain for a Change. Moab, UT: Real People Press.
Bandler, R., & Grinder, J. (1975). Patterns in the Hypnotic Techniques of Milton H.
Erickson, MD (Vol. 1). Cupertino, CA: Meta Publications.
Bandler, R., & Grinder, J. (1975). The Structure of Magic (Vol. I). Cupertino, CA: Science
and Behavior Books.
Bandler, R., & Grinder, J. (1979). Frogs into Princes. Moab, UT: Real People Press.
Bandler, R., & MacDonald, W. (1987). An Insider’s Guide To Submodalities. Moab, UT:
Real People Press.
Bodkin, J. Alexander, Detke, Michael J., Pope, Harrison G. & Hudson, James I. (2007). Is
PTSD caused by traumatic stress? Journal of Anxiety Disorders, 211, 7618.
Bouton, M. E. (2004a). Context and behavioral processes in extinction. Learning and
Memory, 11(5), 485-494.
Bouton, M. E., & Moody, E. W. (2004). Memory processes in classical conditioning.
Neuroscience & Biobehavioral Reviews, 28(7), 663-674.
Cao, X., Wang, H., Mei, B., An, S., Yin, L., Wang, L. P., et al. (2008). Inducible and Selective
Erasure of Memories in the Mouse Brain via Chemical-Genetic Manipulation.
Neuron, 60(October 23, 2008), 353-366.
Carbonell, J. L., & Figley, C. (1999). Promising PTSD Treatment Approaches: A
Systematic Clinical Demonstration of Promising PTSD Treatment Approaches.
Traumatology, 5(1), 32-48.
Davidson, Jonathan R. T., & Foa, Edna B. (1991). Diagnostic Issues in Posttraumatic
Stress Disorder: Considerations for the DSM-IV. Journal of Abnormal Psychology,
100(3), 346-355.
Debiec, J., Doyre, V., Nader, K., & LeDoux, J. E. (2006). Directly reactivated, but not
indirectly reactivated, memories undergo reconsolidation in the amygdala.
Proceedings of the National Academy of Sciences of the United States of America,
103(9), 3428-3433.
Debiec, J., LeDoux, J. E., & Nader, K. (2002 ). Cellular and Systems Reconsolidation in the
Hippocampus. Neuron, 36, 527-538.
Diamond, D., Campbell, A. M., Park, C. R., Halonen, J., & Zoladz, P. R. (2007). The
Temporal DynamicsModel of EmotionalMemory Processing: A Synthesis on the
Neurobiological Basis of Stress-Induced Amnesia, Flashbulb and Traumatic
Memories, and the Yerkes-Dodson Law. Neural Plasticity, 2007(60803), 1-33.
Dietrich, A. M. (2000). A Review of Visual/Kinesthetic Disassociation in the Treatment
of Posttraumatic Disorders: Theory, Efficacy and Practice Recommendations.
Traumatology, 6(2), 85-107.
Dietrich, A. M., Baranowsky, A. B., Devich-Navarro, M., Gentry, J. E., Harris, C. J., & Figley,
C. R. (2000). A Review of Alternative Approaches to the Treatment of Post
Traumatic Sequelae. Traumatology, 6(4), 251-271.
Dillon, D. G., & Pizzagalli, D. A. (2007 ). Inhibition of Action, Thought, and Emotion: A
Selective Neurobiological Review. Appl Prev Psychol., 12(3), 99-114.
Dilts, R., & Delozier, J. (2000). The Encyclopedia of Systemic Neuro-Linguistic
Programming and NLP New Coding. Retrieved June 25, 2006, from
www.nlpu.com.
Duvarci, S., & Nader, K. (2004). Characterization of Fear Memory Reconsolidation. J.
Neurosci., 24(42), 9269-9275.
Erickson, M. H. (Ed.). (1980). An Hypnotic Technique for Resistant Patients: the Patient,
the Technique, and its Rationale and Field Experiments (Vol. 1. The Nature of
Hypnosis and Suggestion). New York, NY: Irvington.
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
19
Figley, C. R. (Ed.). (2002). Brief Treatments for the Traumatized West Port, Conn., USA:
Greenwood Press.
Foa, E. B., & Kozak, Michael J. (1986). Emotional Processing of Fear: Exposure to
Corrective Information. Psychological Bulletin, Vol. 99, No. 1.
Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress
disorder: A critical review. Annual Review of Psychology, 48, 449-480.
Foa, E. B., Keane, T. M., & Friedman, M. J. (Eds.). (2000). Effective Treatments for PTSD.
New York: The Guilford Press.
Forcato C, A. P., Pedreira ME, Maldonado H. (2009). Human reconsolidation does not
always occur when a memory is retrieved: The relevance of the reminder
structure Neurobiology of Learning and Memory, Volume 91(Issue 1), 50-57.
Forcato, C., Burgos, V. L., Argibay, P. F., Molina, V. A., Pedreira, M. E., & Maldonado, H.
(2007). Reconsolidation of declarative memory in humans. Learning & Memory,
14(4), 295-303.
Gharakhani, A., Mathew, S. J., & Charney, D. S. (2006). Neurobiology of Anxiety Disorders
and Implications for Treatment. THE MOUNT SINAI JOURNAL OF MEDICINE,
73(7), 941-949.
Guy, K., & Guy, N. (2003). The fast cure for phobia and trauma: evidence that it works
[Electronic Version]. Human Givens Publishing Limited. Retrieved November 29,
2009 from http://www.hgi.org.uk/archive/rewindevidence.htm.
Haley, J. (1973). Uncommon Therapy. NY: W. W. Norton.
Hartley, C. A., & Phelps, E. A. (2009). Changing Fear: The Neurocircuitry of Emotion
Regulation. Neuropsychopharmacology, 35(1), 136-146.
Hoge, C., Castro, C., Messer, S., McGurk, D., Cotting, D., & Koffman, R. (2004). Combat duty
in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J
Med., 351(1), 13-22.
Hossack, A., & Bentall, R. P. (1996). Elimination of posttraumatic symptomatology by
relaxation and visual-kinesthetic dissociation. Journal of Traumatic Stress, 9(1),
99-110.
Hupbach, A., Hardt, O., Gomez, R., & Nadel, L. (2008). The dynamics of memory: Context-
dependent updating. Learning & Memory, 15(8), 574-579.
Jacek, D., Ecedil, B., & LeDoux, J. E. (2006). Noradrenergic Signaling in the Amygdala
Contributes to the Reconsolidation of Fear Memory. Annals of the New York
Academy of Sciences, 1071(PSYCHOBIOLOGY OF POSTTRAUMATIC STRESS
DISORDER A Decade of Progress), 521-524.
Kaang, B.-K., Lee, S.-H., & Kim, H. (2009). Synaptic Protein Degradation as a Mechanism
in Memory Reorganization. Neuroscientist, 1073858408331374.
Keane, Terrence M., Weathers, Frank W., & Foa, Edna B. (2000). Diagnosis and
Assessment . In Edna B. Foa, Terrence M. Keane & Matthew Friedman (Eds.),
Effective Treatment for PTSD. New York: The Guilford Press.
Kindt, M., Soeter, M., & Vervliet, B. (2009). Beyond extinction: erasing human fear
responses and preventing the return of fear. Nat Neurosci, 12(3), 256-258.
Koziey, P. W., & McLeod, G. L. (1987). Visual-Kinesthetic Dissociation in Treatment of
Victims of Rape. Professional Psychology: Research and Practice, 18(3), 276-282.
Kringelbach, M. L. (2005). The Human Orbitofrontal Cortex: Linking Reward to Hedonic
Experience. Nature Reviews: Neuroscience, 6.
Labar, K. S. (2007). Beyond Fear Emotional Memory Mechanisms in the Human Brain.
Current directions in psychological science, 16(4), 173-177.
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
20
LeBar, K. S. , & Phelps, E. A. (1998). Arousal-Mediated Memory Consolidation: the role of
the Medial Temporal Lobe in Humans. Psychological Science, 9(6), 490-493.
Lee, J. L. C. (2009). Reconsolidation: maintaining memory relevance. Trends in
Neurosciences, 32(8), 413-420.
Lee, J. L. C., Milton, A. L., & Everitt, B. J. (2006). Reconsolidation and Extinction of
Conditioned Fear: Inhibition and Potentiation. J. Neurosci., 26(39), 10051-10056.
Liberzon, I., Sripada, C. S., & E. Ronald De Kloet, M. S. O. a. E. V. (2007). The functional
neuroanatomy of PTSD: a critical review. In Progress in Brain Research (Vol.
Volume 167, pp. 151-169): Elsevier.
Loftus, E. F., & Yuille, J. C. (1984). Departures from reality in human perception and
memory. In H. Weingartner & E. S. Parker (Eds.), Memory Consolidation:
Psychobiology of Cognition (pp. 163-184). Hillsdale, NJ: Lawrence Erlbaum
Associates.
Massad, P. M., & Hulsey, T. L. (2006). Exposure Therapy Renewed. Journal of
Psychotherapy Integration, 16(4), 417-428.
McDowell, W. A., & McDowell, J. A. (nd). Neuro-Linguistic Programming Applied: The
Use of Visual-Kinesthetic Dissociation to Cure Anxiety Disorders [Electronic
Version]. Brief Treatments for the Traumatized from
http://mailer.fsu.edu/~cfigley/Book/BTT/VKDx.htm.
McHugh, Paul R. & Treisman, Glenn. (2007). PTSD: A problematic diagnostic category.
Journal of Anxiety Disorders, 21, 211222.
McNally, R. J. (2007). Mechanisms of exposure therapy: How neuroscience can improve
psychological treatments for anxiety disorders. Clinical Psychology Review, 27(6),
750-759.
Milekic, M. H., & Alberini, C. M. (2002). Temporally Graded Requirement for Protein
Synthesis following Memory Reactivation. Neuron, 36(October 24, 2002), 521-
525.
Miller, G. A. (1956). The magical number seven, plus or minus two. The Psychological
Review, 63, 81-97.
Muss, D. (1991). A new technique for treating post-traumatic stress disorder. British
Journal of Clinical Psychology, 30(1), 91-92.
Muss, D. (2002). The Rewind Technique In the treatment of Post-Traumatic Stress
Disorder: Methods and Application In C. R. Figley (Ed.), Brief Treatments for the
Traumatized (pp. 306-314). West Port, Conn: Greenwood Press.
Nader, K., Schafe, G., & LeDoux, J. (2000). The labile nature of consolidation theory. Nat
Rev Neurosci. Dec;1(3):216-9, 1(3), 216-219.
Pedreira, M. E., Perez-Cuesta, L. M., & Maldonado, H. (2004). Mismatch Between What Is
Expected and What Actually Occurs Triggers Memory Reconsolidation or
Extinction. Learning & Memory, 11(5), 579-585.
Quirk, G. J., & Mueller, D. (2007). Neural Mechanisms of Extinction Learning and
Retrieval. Neuropsychopharmacology, 33(1), 56-72.
Rescorla, Robert A. (1988). Pavlovian conditioning: It's not what you think it is.
American Psychologist, Vol 43(3), pp. 151-160.
Riccio, D. C., Millin, P. M., & Bogart, A. R. (2006). Reconsolidation: A brief history, a
retrieval view, and some recent issues. Learning & Memory, 13(5), 536-544.
Rothbaum, B. O., Davis, M., King, J. A., Ferris, C. F., & Lederhendler, I. I. (2003). Applying
Learning Principles to the Treatment of Post-Trauma Reactions. In Roots of
mental illness in children. (pp. 112-121). New York, NY US: New York Academy of
Sciences.
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
21
Simons, R. F., Detenber, B. H., Reiss, J. E., & Shults, C. W. (2000). Image motion and
context: A between- and within-subjects comparison. Psychophysiology, 37(5),
706-710.
Specialists, R. o. T. Register of Trauma Specialists. from
http://www.traumaregister.co.uk/index.htm
Spitzer, Robert L., Wakefield, Jerome C., & First, Michael B. (2007). Saving PTSD from
itself in DSM-V. Journal of Anxiety Disorders, 21, 233241.
Tronel, S., Milekic, M. H., & Alberini, C. M. ( 2005). Linking New Information to a
Reactivated Memory Requires Consolidation and Not Reconsolidation
Mechanisms. PLoS Biol, 3(9), e293.
Tronson, N. C., & Taylor, J. R. (2007). Molecular mechanisms of memory reconsolidation.
Nat Rev Neurosci, 8(4), 262-275.
Ursano, R. J., Bell, C., Eth, S., Friedman, M., Norwood, A., Pfefferbaum, B., et al. (2004).
Practice Guideline for the Treatment of Patients With Acute Stress Disorder and
Posttraumatic Stress Disorder. Washington, DC: APA Practice Guidelines.
Vervliet, B. (2008). Learning and memory in conditioned fear extinction: Effects of D-
cycloserine. Acta Psychologica, 127(3), 601-613.
Wessa, M. l., & Flor, H. (2007). Failure of extinction of fear responses in posttraumatic
stress disorder: Evidence from second-order conditioning. American Journal of
Psychiatry, 164(11), 1684-1692.
Williams, L. M., Kemp, A. H., Felmingham, K., Barton, M., Olivieri, G., Peduto, A., et al.
(2006). Trauma modulates amygdala and medial prefrontal responses to
consciously attended fear. NeuroImage, 29(2), 347-357.
NLP and PTSD: The Visual-Kinesthetic Dissociation Protocol
22
{
1. Prescreening
The problem must be 1. Personal experience of trauma
threatening death or injury to one’s self or others, and 2.
Expressed as intense, suddenly arising experience of
trauma symptoms, usually as flashbacks or panic reactions.
2. Rapport and Framing
Establish rapport; frame intervention.
3. Access problem state.
Probe until appropriate physiology is established.
4. Break State
Bring client out of state before it becomes intense.
5. Dissociation and Treatment frame
Imagine sitting in a theatre, watching neutral or positive
scene before problem arose.
Establish Dissociation by:
Floating away to a projection booth behind a
P l e x i g l a s b a r r i e r ,
Floating away from the body, standing behind
t h e ir b o d y h o l d i n g t h e i r o w n s h o u l d e r s a n d
m o n i t o r i n g t h e i r o w n s t a t e ,
Distorting the image.
6. Anchor Dissociated State
Gain permission.
Use touch anchor.
7. Run Dissociated Movie
Start with neutral image.
Watch self watching movie.
End with safe, neutral scene after event.
8. Test
Is there distress?
NO DISTRESS
Continue
Yes EXTREME DISTRESS
Break State
Return to step 6
Yes MILD DISTRESS
Break State
Return to step 7
Use alternates.
INDETERMINATE
Loop through step 7 as needed.
Criteria not met: protocol is
not appropriate
9.Associated Reversed Movie
Step into the safe representation from the end of step 7.
Run the trauma movie
In reverse,
Fully associated,
In color,
At very high speed (two seconds or less).
DISTRESS
Repeat Steps 9 and 10 as needed.
NO DISTRESS
End
10. Test
Seek to evoke the problem state.
Use the same questions and probes that were associated with a clear physiological reaction.
If there is no reaction, the intervention is presumed to have worked.
Systematically probe each sensory system for possible triggers
... During exposure, the images and sensations of the trauma are recalled in the mind without writing or speaking about them in any detail. This may enable the graduated exposure to be quicker and require fewer treatment sessions (Gray, 2011). Furthermore, its lack of discomfort to patients has been reported (Gray, 2011). ...
... This may enable the graduated exposure to be quicker and require fewer treatment sessions (Gray, 2011). Furthermore, its lack of discomfort to patients has been reported (Gray, 2011). ...
... Possible mechanisms of Rewind Gray (2011) proposed ''extinction'' and ''memory reconsolidation'' as two possible mechanisms that might explain the efficacy of VKD and Rewind, and could also apply to other established evidence-based treatments. The memory reconsolidation hypothesis suggests that original memories are made labile immediately after being retrieved during the exposure and that updating a fear memory with non-fearful information obtained from exposure could rewrite the original fear response and prevent the return of fear (Schiller et al. 2010). ...
Article
Background: Rewind is a brief trauma-focussed imaginal exposure treatment for posttraumatic stress disorder (PTSD), however evidence for this treatment is limited. Aim: The aim of this paper was to provide preliminary evidence of its efficacy in treatment of PTSD symptoms. Method: A practice-based pre-post treatment design with an intention-to-treat analysis was used. Sixty three people were treated with Rewind in three separate services. Participants were assessed using the Impact of Events Scale (IES) prior to treatment and were re-assessed at a two week follow-up. All participants who scored above 25 on the IES were included and there were no other exclusion criteria. Results: There was an overall data capture rate of 95%. After treatment 55 (87%) participants were below the IES clinical cut-off and, other than three participants with missing data, all participants showed reliable improvement using the IES Reliable Change Index. Conclusion: These preliminary findings suggest that Muss’ Rewind may offer a useful treatment for PTSD symptoms. Rewind may be cost-effective given the number of sessions that were required and the relative effectiveness of newly trained therapists in delivering the therapy. Despite methodological limitations, these results suggest that a randomised controlled trial is warranted.
... asthma with propranolol). Reconsolidation of Traumatic Memories (RTM) is a nonpharmacological approach that aims to treat PTSD through memory reconsolidation over three sessions (Gray, 2011). The proven mechanism of RTM remains unclear, however, and additional factors, such as the reactivation and redistribution of emotional memories in the neocortex during sleep, may also play a role (Schafer et al., 2020). ...
... The proven mechanism of RTM remains unclear, however, and additional factors, such as the reactivation and redistribution of emotional memories in the neocortex during sleep, may also play a role (Schafer et al., 2020). RTM (Gray, 2011) has RCT evidence of effect leading to it being recommended as a treatment with emerging evidence by the ISTSS Treatment Guidelines for PTSD and for military populations Kitchiner, Lewis, Roberts, & Bisson, 2019). RTM is a development of the Rewind Technique, another nonpharmacological approach, with many similarities in its delivery to RTM, but with an evidence base that is currently reliant on non-randomised trials (Adams & Allan, 2018;Utuza,, Joseph, & Muss, 2012). ...
... Previous pilot work has assessed outcomes 2 weeks post-intervention, while we will follow-up participants 8 and 16 weeks post-randomisation. While RTM has been investigated in randomised trials and shares many characteristics with Rewind (Gray, 2011), it is fundamentally a different intervention and both require evaluation separately. ...
Article
Full-text available
Background: An increasing body of research highlights reconsolidation-based therapies as emerging treatments for post-traumatic stress disorder (PTSD). The Rewind Technique is a non-pharmacological reconsolidation-based therapy with promising early results, which now requires evaluation through an RCT. Objectives: This is a preliminary efficacy RCT to determine if the Rewind Technique is likely to be a good candidate to test against usual care in a future pragmatic efficacy RCT. Methods: 40 participants will be randomised to receive either the Rewind Technique immediately, or after an 8 week wait. The primary outcome will be PTSD symptom severity as measured by the Clinician-Administered PTSD Scale for DSM5 (CAPS-5) at 8 and 16 weeks post-randomisation. Secondary outcome measures include the PTSD Checklist (PCL-5), International Trauma Questionnaire (ITQ), Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder-7 (GAD-7), Insomnia Severity Index, the Euro-Qol-5D (EQ5D-5 L), the prominence of re-experiencing specific symptoms (CAPS-5) and an intervention acceptability questionnaire to measure tolerability of the intervention. Conclusions: This study will be the first RCT to assess the Rewind Technique. Using a cross-over methodology we hope to rigorously assess the efficacy and tolerability of Rewind using pragmatic inclusion criteria. Potential challenges include participant recruitment and retention. Trial registration: ISRCTN91345822
... Numerous other techniques of witnessed memory replay are in clinical use for treating traumatic episodic memory, such as EMDR (e.g., Shapiro, 2001;Solomon andShapiro, 2008), Neurolinguistic Programming (e.g., Ecker, 2015c;Gray and Liotta, 2012;Gray and Liotta, 2012;Gray and Bourke, 2015;Gray and Teall, 2016), Traumatic Incident Reduction (e.g., Volkman, 2008), and Progressive Counting (e.g., Lasser and Greenwald, 2015). All of these techniques arrive at a mismatch and disconfirmation of the expected experience of the memory and also, in many cases, of generalized learnings (schemas) based on the original experience. ...
... Numerous other techniques of witnessed memory replay are in clinical use for treating traumatic episodic memory, such as EMDR (e.g., Shapiro, 2001;Solomon andShapiro, 2008), Neurolinguistic Programming (e.g., Ecker, 2015c;Gray and Liotta, 2012;Gray and Liotta, 2012;Gray and Bourke, 2015;Gray and Teall, 2016), Traumatic Incident Reduction (e.g., Volkman, 2008), and Progressive Counting (e.g., Lasser and Greenwald, 2015). All of these techniques arrive at a mismatch and disconfirmation of the expected experience of the memory and also, in many cases, of generalized learnings (schemas) based on the original experience. ...
... Therefore use of imaginal processes that replay the original scene with novel features and/or novel subjective viewpoints have much promise for dispelling traumatic memory through ECPE/TRP methodology. (A therapeutic system with a particularly rich repertoire of techniques of this kind is Neurolinguistic Programming (e.g., Gray and Bourke, 2015;Gray and Liotta, 2012;Gray and Teall, 2016). For detailed case examples of such techniques implemented within the TRP, see Ecker, 2015c;Ecker et al., 2012, pp. ...
Article
Full-text available
After 20 years of laboratory study of memory reconsolidation, the translation of research findings into clinical application has recently been the topic of a rapidly growing number of review articles. The present article identifies previously unrecognized possibilities for effective clinical translation by examining research findings from the experience-oriented viewpoint of the clinician. It is well established that destabilization of a target learning and its erasure (robust functional disappearance) by behavioral updating are experience-driven processes. By interpreting the research in terms of internal experiences required by the brain, rather than in terms of external laboratory procedures, a clinical methodology of updating and erasure unambiguously emerges, with promising properties: It is applicable for any symptom generated by emotional learning and memory, it is readily adapted to the unique target material of each therapy client, and it has extensive corroboration in existing clinical literature, including cessation of a wide range of symptoms and verification of erasure using the same markers relied upon by laboratory researchers. Two case vignettes illustrate clinical implementation and show erasure of lifelong, complex, intense emotional learnings and full, lasting cessation of major long-term symptoms. The experience-oriented framework also provides a new interpretation of the laboratory erasure procedure known as post-retrieval extinction, indicating limited clinical applicability and explaining for the first time why, even with reversal of the protocol (post-extinction retrieval), reconsolidation and erasure still occur. Also discussed are significant ramifications for the clinical field’s “corrective experiences” paradigm, for psychotherapy integration, and for establishing that specific factors can produce extreme therapeutic effectiveness.
... Similar to Ehlers and Clark (2000) who commented that "at this stage, it is unclear why reliving [a TF-CBT technique] works", we do not know exactly how Rewind works. Several potential mechanisms for Rewind treatment have been proposed: memory reconsolidation (Gray, 2010;Griffin and Tyrrell, 2004), the competing demands of dual processing and the orienting response and REM sleep (Griffin, 2005), low arousal and reduced cortisol levels enabling the hippocampus to contextualise and process the trauma memory as well as enabling the prefrontal cortex to inhibit the amygdala (Griffin and Tyrrell, 2004), psychological "distancing" using the observing self to observe the films (Dietrich, 2000;Griffin, 2005;Okhai, 2005) and extinction (Gray, 2010). It is beyond the scope of this present paper to address the current state of neurophysiological evidence from the cellular to the potential circuits involved, as well as experimental evidence for each of these proposed mechanisms. ...
... Similar to Ehlers and Clark (2000) who commented that "at this stage, it is unclear why reliving [a TF-CBT technique] works", we do not know exactly how Rewind works. Several potential mechanisms for Rewind treatment have been proposed: memory reconsolidation (Gray, 2010;Griffin and Tyrrell, 2004), the competing demands of dual processing and the orienting response and REM sleep (Griffin, 2005), low arousal and reduced cortisol levels enabling the hippocampus to contextualise and process the trauma memory as well as enabling the prefrontal cortex to inhibit the amygdala (Griffin and Tyrrell, 2004), psychological "distancing" using the observing self to observe the films (Dietrich, 2000;Griffin, 2005;Okhai, 2005) and extinction (Gray, 2010). It is beyond the scope of this present paper to address the current state of neurophysiological evidence from the cellular to the potential circuits involved, as well as experimental evidence for each of these proposed mechanisms. ...
Article
Full-text available
Purpose Human Givens (HG) Rewind technique is a graded trauma-focused exposure treatment for PTSD and trauma. The aims of this paper are to describe the technique, provide an outline of its potential benefits and present some preliminary evidence. Approach and findings This paper provides an overview of HG therapy and describes the stages of HG Rewind trauma treatment and its potential benefits. Possible underlying mechanisms are discussed and similarities and differences between Rewind and other Cognitive Behavioural Therapy (CBT) techniques are explored. Preliminary evidence suggests that Rewind could be a promising trauma treatment technique and that HG therapy might be cost effective. Practical implications The trauma does not need to be discussed in detail, making treatment potentially more accessible for shame-based traumas. Multiple traumas may be treated in one session, making it possible for treatment to potentially be completed in fewer sessions. Research implications Further research is needed to investigate proposed possible underlying mechanisms of Rewind trauma treatment; memory reconsolidation or extinction, reduced arousal, psychological distancing, and the orienting response. A randomised controlled trial on Rewind is warranted. Social implications This UK-based treatment may be cost-effective and make treatment more accessible for people who do not want to discuss details of their trauma. Originality/value This is the first description of HG Rewind in the peer-reviewed literature. Alternative explanations for mechanisms underlying this trauma treatment are also presented.
... If this occurs in interrogation and the officer is not aware of the disorder, it will appear to the officer that the suspect is lying. Other disorders that can affect the individual brain and cause the suspect to seem deceitful are anxiety, aphasia, bipolar disorder, depression, PTSD, schizophrenia, and stroke (Gray, 2010;Menn, 2012;Oltmanns & Emery, 2010). In some cases, individuals suffering from a personality disorder or mood disorders will be interrogated through the course of a criminal investigation. ...
Article
The problem of this study starts from the way in which learners deal when they learn new words, which had led to their suffering when they try to remember it, the present study aimed to find out whether a sensory cognitive program designed by the researcher has an impact on the learning of new words. The study followed the experimental method. The study sample consisted of students of faculties of education / Hantoub and Alhasahisa in the University of Gezira, which was selected by random stratified technique. The Department of English Language was representative of the language Departments, while Chemistry / Biology Department were representative of the scientific departments, and geography / history department was representative of the arts departments. The sample size was (216) students for the two experimental and control groups. The sensory cognitive program was checked for reliability and validity by specialists before the experiment was run. The data was analyzed through the (SPSS) program. The main findings of the study are: The designed Sensory cognitive program has a positive impact on learning new words. There are also significant differences in the impact of the program due to gender (Females have benefited from the application of the program more than males), while there are no statistically significant differences in the impact of the program on learning new words due to the different kind of specializations (science or art). The results of this study might assist in planning for more effective educational and language learning programs. The most prominent recommendations of this study include the establishment of units in the various ministries of education to help in evaluating and developing strategies for learning foreign languages and take advantage of various scientific research conducted in this area of practice.
... There is no conclusive answer to the question of exactly how the Rewind Technique works and research is ongoing. Currently the consensus is that it works through the process of memory reconsolidation (Gray, 2010;Gray and Liotta, 2012;Human Givens Institute, 2018), where brief exposure to a memory causes it to become temporarily labile, providing a window of a few hours for it to be changed. The briefness of the memory recall required for memory reconsolidation it is argued, is therefore ideal for treating PTSD (Ross et al., 2017) because it does not require the client to be exposed to traumatic memories for extended periods of time (Alberini and LeDoux, 2013). ...
Research
Full-text available
Rewind Technique as a potential treatment for PTSD in Emergency Services Workers. This research looks at the need for a short, non invasive intervention to suit the logistics & culture of our emergency services personnel, for whom the incidence of PTSD is higher than average due to the nature of their jobs.
Article
Background: Human Givens (HG) Rewind is a relatively unknown trauma-focussed treatment. This paper aimed to provide preliminary evidence of the effectiveness of Rewind to treat posttraumatic stress (PTS) in a variety of clinical settings in Great Britain. Methods: An observational prospective design was used in each of the four studies. Standardised questionnaires were administered in every session. Pre- and post-treatment means and effect sizes were calculated for each study, as were ‘recovery rates’ and ‘reliable change’ rates. Results: Across four studies, a total of 274 clients completed treatment and had complete data. The data capture rate ranged from 80-100%. The mean pre-treatment scores were in the severe range. The pre-post treatment effects sizes ranged from 1.90-2.68. The percentage of clients who were below the clinical cut-off after treatment ranged from 46-56% for the more conservative lower cut-offs, and ranged between 71-82% for the higher clinical cut-offs as used by Improving Access to Psychological Therapies (IAPT). Across the four studies, 83-96% of clients had ‘reliably improved’ (88-94% on trauma-specific questionnaires), with 4-17% having no reliable change on those questionnaires. The mean number of HG treatment sessions ranged from 5-6.5 sessions (range 1–24 sessions), with between 73% and 84% of participants completing treatment in six sessions or less. Conclusions: These preliminary results indicate that HG Rewind appears to be a promising trauma treatment in a variety of settings. A randomised controlled trial is now required to determine the efficacy of this treatment.
Article
Full-text available
Background: Human Givens (HG) Rewind is a relatively unknown trauma-focussed treatment. This paper aimed to provide preliminary evidence of the effectiveness of Rewind to treat posttraumatic stress (PTS) in a variety of clinical settings in Great Britain. Methods: An observational prospective design was used in each of the four studies. Standardised questionnaires were administered in every session. Pre- and post-treatment means and effect sizes were calculated for each study, as were ‘recovery rates’ and ‘reliable change’ rates. Results: Across four studies, a total of 274 clients completed treatment and had complete data. The data capture rate ranged from 80-100%. The mean pre-treatment scores were in the severe range. The pre-post treatment effects sizes ranged from 1.90-2.68. The recovery rate, or percentage of clients who were below the clinical cut-off after treatment, ranged from 46-56% for the more conservative lower cut-offs, and ranged between 71-82% for the higher clinical cut-offs as used by Improving Access to Psychological Therapies (IAPT). Across the four studies, 83-96% of clients had ‘reliably improved’ (88-94% on trauma-specific questionnaires), with 4-17% having no reliable change on those questionnaires. There was no ‘reliable deterioration’. The mean number of HG treatment sessions ranged from 5-6.5 sessions (range 1–24 sessions), with between 73% and 84% of participants completing treatment in six sessions or less. Conclusions: These preliminary results indicate that HG Rewind appears to be a promising trauma treatment in a variety of settings. A randomised controlled trial is now required to determine the efficacy of this treatment. Adams, S., Allan, S., Andrews, W., Guy, K., Timmins, J., &Barr, E. (2020). Four practice-based preliminary studies on Human Givens Rewind treatment for posttraumatic stress in Great Britain [version 1; peer review: awaiting peer review]. F1000Research, 9(1252) https://doi.org/10.12688/f1000research.25779.1
Article
Full-text available
Traumatic Incident Reduction, Visual-Kinesthetic Disassociation, Eye Movement Desensitization and Reprocessing, and Thought Field Therapy were investigated through a systematic clinical demonstration (SCD) methodology. This methodology guides the examination, but does not test the effectiveness of clinical approaches. Each approach was demonstrated by nationally recognized practitioners following a similar protocol, though their methods of treatment varied. A total of 39 research participants were treated and results showed that all four approaches had some immediate impact on clients and appear to also have some lasting impact. The paper also discusses the theoretical, clinical, and methodological implications of the study.
Article
Community studies indicate that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. The impact of gender is profound in that it increases the likelihood of developing an anxiety disorder by 85% in women compared to men. Sex difference in prevalence rates are apparent as early as age 6, when girls are twice as likely as boys to have an anxiety disorder. In the National Comorbidity Survey, the prevalence rates for panic disorder in women and men were 5% and 2%, respectively. Agoraphobia, which often coexists with panic disorder, has a lifetime prevalence rate of 7% in women and 3.5% in men. Prevalence of trauma is increased in young women as well, and is experienced earlier in life; 62% of sexual assaults are inflicted on females ≤ 18 years of age, and 29% occur in children < 11 years of age. Comorbidity of anxiety in women complicates other medical conditions as well. For example, panic disorder is highly comorbid with CHD, which remains the leading cause of death in women in developed countries. Fluctuations in reproductive hormone levels during the female life cycle is thought to be responsible for modulating anxiety. This is often implicated in the later age of onset, the more sudden and acute symptom emergence, and the more episodic course of OCD in women, and in the high prevalence (47.4%) of PMDD. Pregnancy appears to be a protective period for some anxiety disorders, including panic, while for others, such as OCD, it may be associated with onset. Hormonal changes during pregnancy, such as increased prolactin, oxytocin, and cortisol, may contribute to the suppression of stress response that occurs during this period. Despite a large and growing body of literature on anxiety disorders in general, the available data relating to women and girls falls short of informing aspects of diagnosis, treatment, and prevention that may entail sex differences. Additional work is required to understand the biological and psychosocial causes of these differences.
Article
Current thinking about Pavlovian conditioning differs substantially from that of 20 years ago. Yet the changes that have taken place remain poorly appreciated by psychologists generally. Traditional descriptions of conditioning as the acquired ability of one stimulus to evoke the original response to another because of their pairing are shown to be inadequate. They fail to characterize adequately the circumstances producing learning, the content of that learning, or the manner in which that learning influences performance. Instead, conditioning is now described as the learning of relations among events so as to allow the organism to represent its environment. Within this framework, the study of Pavlovian conditioning continues to be an intellectually active area, full of new discoveries and information relevant to other areas of psychology.
Article
Approaches to the treatment of posttraumatic sequelae are reviewed in terms of criteria for evaluating inferential validity with case studies, and where applicable, effect sizes are provided where there are data from group comparisons. The approaches covered in this paper include the Trauma Recovery Institute (TRI) Method, Traumatic Incident Reduction (TIR), Visual/Kinesthetic Disassociation (V/KD), and Thought Field Therapy (TFT). Internal validity of case studies on the TRI Method and V/KD appear controlled for, whereas reports on TFT do not meet internal validity criteria. Effect sizes are reported on one study that compared TIR to waitlist control and Direct Therapeutic Exposure (DTE), suggesting that TIR is superior to waitlist control, and shows more modest gains over DTE. The available evidence suggests TIR, the TRI Method, and V/KD are effective treatments for posttraumatic sequelae.