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Journal for Psychotraumatology, Psychotherapy Science and Psychological Medicine Journal for Psychotraumatology, Psychotherapy Science and Psychological Medicine. A preliminary study of the efficacy of Brainspotting – a new therapy for the treatment of Posttraumatic Stress Disorder Anja Hildebrand1, David Grand2, Mark Stemmler1 1 Institute of Psychology, Friedrich-Alexander-University Erlangen-Nuernberg, 91052 Erlangen, 2 Psychotherapist and Developer of Brainspotting, psychotherapeutic practice in New York, United States Version: 14.1129.05.2012 Words: 3,193 Characters including spaces: 24,488 (accepted for publication in 2014) Summary Posttraumatic Stress Disorder (PTSD) occurs frequently in people, who were exposed to extreme mental stress. Therefore, it is important to develop an effective and well evaluated treatment for this disorder. This preliminary study evaluates the effectiveness of Brainspotting (BSP) - the by David Grand newly developed therapeutic approach for the treatment of PTSD. Data were evaluated of 22 clients from Germany and the USA, who were treated with Brainspotting. Both, the client’s self-assessment as well as a general assessment by the therapist were collected by questionnaire. The symptoms of PTSD and additional mental impairments were significantly reduced within three BSP- sessions. According to the therapist a reduction of symptoms was seen in the majority of clients. According to clients’ self-reports the emotional burden decreased by less negative trauma-related cognitions. These first results show that the treatment of PTSD could be extended with Brainspotting, which provides an effective therapie. Key words: Brainspotting, trauma therapy, efficacy study, preliminary 1 Abstract Posttraumatic stress disorders (PTSD) frequently emerge in people who have suffered from extreme psychological stress. Therefore, it is of most importance to develop new therapeutic treatments and to test their efficacy. This pilot study investigates the efficacy of a newly by David Grand developed treatment for PTSD called Brainspotting. The data of 22 clients from Germany and the U.S., who were treated with Brainspotting were analyzed. Clients' self-reports as well as evaluations by therapists were assessed. Within three BSP sessions the PTSD symptoms and related psychological disturbances were significantly reduced. According to the therapists' evaluations, the majority of clients benefited significantly. According to the clients' reports, in addition, negative cognitions related to the trauma were heavily reduced. The results of this pilot study suggest that with Brainspotting the treatment of PTSD could be extended with another potent intervention method. Keywords: Brainspotting, Trauma, Therapy Efficacy Study, Pilot Study 1 Introduction The aim of this study is to evaluate the effectiveness of the newly developed method ‘Brainspotting’ in the treatment of clients with Post Traumatic Stress Disorder (PTSD). According to ICD-10 (F43.1) PTSD is a "delayed reaction to a stressful event or situation of longer or shorter duration, with exceptional threatening or with catastrohic extent that would cause almost everytime deep despair". Characteristic features of PTSD include re-experiencing (dreams, flashbacks, intrusions), avoidance (social withdrawal, loss of interest, isolation, alienation) and hyperarousal (insomnia, hypervigilance, excessive startle response, irritability, anxiety). The stressful events are classifiable into type I traumas, which are of short duration and usually only with one- time occurrence (natural disasters, accidents, technical disasters, criminal acts of violence) and/or type II traumas, which are characterized by a longer duration and in a repetitive sequence (hostage, torture, prisoner of war, repeated distinguishable sexual 2 and physical violence). PTSD is a relatively common disorder. The lifetime prevalence in population studies ranges from 1% in the older DSM-III studies and 12% in more recent studies (Helzer, Robins, & McEvoy, 1987; Schore, Vollmer & Tatum, 1989, Breslau, Davis, Andreski & Peterson, 1991; Resnick, Kilpatrick , Dansky & Saunders, 1993; Kessler, Sonnega, Bromet, Hughes & Nelson, 1995; Breslau et al, 1998. Cuffe et al, 1998. Perkonigg, Kessler, Storz & Wittchen, 2000). Over time it is often persistent and chronic. A study of adolescents and young adults in Germany resulted that 48% of the victims showed no significant reduction of PTSD symptoms over a period of three years set (Perkonigg et al., 2005). This verifies that a more effective method is needed in the treatment of PTSD to help the victims best in terms of their appealed remission. Different methods for the treatment of PTSD are available. Some methods were modified for the treatment of trauma (eg [trauma-focused] Cognitive Behavioral Therapy, Exposure Therapy, Psychodynamic methods), others have been developed specifically for this purpose (eg, Eye Movement Desensitization and Reprocessing [EMDR; Shapiro , 2001], Narrative Exposure Therapy [NET; Schauer, Neuner & Elbert, 2011 and KIDNET; reputation et al, 2007], Somatic Experiencing [SE: Levine, 1997, Levine, 1998], Psychodynamic Imaginative Trauma Therapy [PITT; Reddemann, 2003]). EMDR was developed by Francine Shapiro (1989) and consists of 8 phases (Hofmann, 2005 Overrun, 2009). The core is phase 4, in which a stressful experience has to be processed. It comprises a bilateral stimulation, which can be achieved by various techniques (preferably rhythmic eye movements, alternating sounds, but also on the right and left ear alternately "fumble" with both hands). The effectiveness of EMDR in the treatment of PTSD was confirmed empirically (Barth, Stoffers & Bengel, 2003; Sack et al, 2001. Van Etten and Taylor, 1998) and in the guidelines of the International Society for Traumatic Stress (ISTSS ) classified as effective and reliable (Foa, Keane, & Friedman, 2000). NET (Schauer, Neuner & Elbert, 2011) was developed within the field of new neuroscientific theories. Core element is the interpersonal sharing of the experience (recalled and newly actualized emotions, thoughts, facts and feelings). Available information is thereby retrieved out of the autobiographical memory (Neuner, Schauer & Elbert, 2009). However, as traumatized 3 people are often characterized by not being able to tell about the traumatic experience a professional therapist must help to overcome the speechlessness. The feasibility and effectiveness of NET could be proved in numerous studies (eg Bichescu, Neuner, Schauer & Elbert, 2007; Neuner et al, 2004; Neuner et al, 2008;. Pabst et al, 2012;. Schaal, Elbert & Neuner, 2008). It can be used for the treatment of survivors of traumatic experiences and can be assigned to different cultures and types of trauma. The integrative approach of Somatic Experiencing (SE, Levine, 1997) is body- oriented and based on biological functioning. The focus is held on biological residues of the trauma as well as on the reflexive and defensive manner, with wich the body responds to threat and fear. Levine describes PTSD as resulting from an incomplete defense-response – the cross-genre survival strategy. Objectives of SE are therefore on the one hand affect regulation to certain stimuli, as well as the reduction of excessive and in the present inappropriate reactions of the nervous system. On the other hand, the restructuring of inappropriate cognitive interpretations or reviews. Initial studies show promising results in the treatment of persons with trauma experiences (Leitch, 2007; Leitch, VanSlyke & Allen, 2009). In addition to psychotherapy the phamacotherapy may be indexed for the treatment of PTSD. Serotonin re-uptake inhibitors (SSRIs) such as Paroxetine are empirically well studied (Marshall et al, 2001, 2006; Stein et al, 2003; Tucker et al, 2003). Treatment of associated symptoms may be added. A presentation of pharmaco-therapy in PTSD and related efficacy studies are provided by Kampfhammer (2011). Cognitive behavioral therapies and other psychological techniques usually take 30-40 sessions in a period of 6-9 months (Benkert, Hautzinger & Graf-Morgenstern, 2008). With Brainspotting a method is developed that should lead to a reduction of symptoms after 1-3 sessions. Brainspotting builds on EMDR and SE (described above), but is also strongly interwoven with neurophysiology (Corrigan & Grand, 2013). Brainspotting defines itself as a neurophysiological tool in the treatment of traumatic events by identifying the neurophysiological sources of emotional or physical pain, trauma, dissociation and a variety of other symptoms, by processing them through and by releasing the emotional charge. 4 This study will examine, whether Brainspotting is suitable for the treatment of PTSD. Effects on the PTSD symptoms and additionally on the mental impairment are considered. Besides a client’s self-assessment the evaluation of the therapist is to be used. 2. Methodology 2.1 Design and sample The data for this multicenter longitudinal study were collected by independent psychotherapists in the U.S. and in Germany. The therapists were previously instructed – in written advices and/or verbally. During the treatment a set and fixed protocol had to be followed by the therapists. The study was reviewed and approved by an ethics committee of the University of Bielefeld. Treatment and data collection was performed by seven experienced trauma therapists. Data were collected both, before the first therapy session, and after the third treatment session. The sample consists of 22 consecutive clients, who were treated during the course of the years 2009 through
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