Split-Second Unlearning: Developing A Theory Of Psychophysiological Disease Ⅱ

DISCUSSION

The SSU model draws on a range of ideas from different disciplines, configured into a cohesive framework that connects trauma, stress and intervention. This article describes our first iteration of the model and describes its application, although the range of examples and perspectives is limited. Further theoretical and empirical work would enable theory refinement, evidence generation, and more perspectives for discussion. In this section, we explore specific elements that we find interesting and that reveal more of the ethos from which SSU was developed. 

Ontological Status of the Emotional Memory Image

Twentieth-century debates around realist and anti-realist/idealist positions have had a signifificant influence on philosophy and the social sciences. “Scientific realism” (see Putnam, 1982; Boyd, 1983) is the idea that scientific progress can be made through discussion of unobservable (i.e., theoretical) entities and that the best theories generated from these are the closest we can get to a true approximation of reality. “Entity realism” (Cartwright, 1983; Hacking and Hacking, 1983) emerges from this school, proposing that theoretical entities, subatomic particles for example, definitely exist if they can be manipulated to produce an observable effect. While empirical evidence of some particles remains scant, experiments can be designed to produce observable effects that rely on the existence of those theoretical particles, meaning that they can essentially be considered real. The experiences of the author and other practitioners indicate that clients locate their EMI in a spatial location outside of the body that therapists can interact with. Through careful manipulation, a practitioner can remove, disrupt or otherwise render harmless a client’s EMI. For this reason, we consider the EMI to be a real entity—a position also endorsed by Nanay (2019). The images we hold about an event or memory, including EMIs, are often deemed constructs—representations of an idea, shaped by our general perceptions of the world. While EMIs might be formed in a specifically filtered way (especially during childhood, when the world is a very different place), the SSU model nevertheless treats these as real, fixed entities that can be manipulated. For example, in case of study one (see “Case Study” section), the EMI of the father “turning white” may not be an exact facsimile of what the father looked like—but the EMI itself is nevertheless real and became associated with a real physiological effect.

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Prior Trauma Inscribed Into Somatic Responses

Psychodynamic theory famously promotes the idea that early experiences contribute to the formation of our adult characters and to consequent psychological wellbeing. The SSU model works on the same general premise but incorporates a critical physical component (HPA axis and the stress response). In this respect, the model bridges between its psychotherapeutic forbears and more recent theories, most notably Van der Kolk’s (1994) idea that victims of psychological trauma may exhibit bodily expressions of that traumatic memory. Van der Kolk goes further, explaining that trauma victims might be unaware of a specific memory and/or that a traumatic event has even taken place. Instead, they keep a record of physiological changes in the body and brain, which can predispose a diverse range of physical disorders. It is further claimed that traumatic memories can be “entirely organized on an implicit or perceptual level, without an accompanying narrative about what happened” (Van der Kolk and Fisler, 1995). Rothschild (2000) sums it up succinctly: “The body remembers even if the mind cannot.” The general idea is seductive, in that it allows for new therapeutic approaches that interpret physical gestures to reveal implicit memories of dissociated trauma. However, McNally (2005) argues that a lack of evidence means that this line of reasoning and the “recovered memory therapy” it inspired is “arguably the most serious catastrophe to strike the mental health field since the lobotomy era.” Nevertheless, while the causal mechanisms remain debatable, there is a growing body of research into the relationships between past psychological trauma and physical symptoms. Research on Adverse Childhood Experience (ACE) also supports the claim that early traumatic events can generate recurrent negative symptoms later in life.

Such experiences, including physical and sexual abuse, or neglect, are cited as a predictor of a wide range of physical health conditions (Felitti et al., 1998a). In particular, these include generalized stress dysregulation (Evans and Kim, 2007), which can manifest in a wide range of negative well-being outcomes. While childhood experiences can be especially profound for various reasons, we propose that traumatic events experienced at any age can lead to a persistent somatic response. Research into the effects of ACEs is ongoing, and the catalog of physical symptoms these cause undergoes regular revision (Finkelhor et al., 2015). 

Removing the Therapist

EMDR (Shapiro, 1989; Shapiro and Forrest, 2001; Shapiro and Laliotis, 2015) has drawn on empirical evidence to develop a specific therapeutic approach, with its own signifificant following (notably endorsed by Van der Kolk). While SSU shares some of the diagnostic and intervention elements of EMDR, it rests on a different set of philosophical and psychological underpinnings. One of the criticisms of EMDR is the amount of time and money it takes to qualify as a practitioner (Rosen et al., 1999). Instead of relying on signifificant interpretation and psychotherapeutic guidance from a trained practitioner, SSU takes a more mechanistic approach, focusing on the connection between a memory (as an entity) and physical response, rather than the symbolic content of that memory. SSU removes the need for extensive training or psychotherapeutic experience; the approach is altogether more accessible for practitioners, for whom the skill lies in identifying and recognizing a response, rather than in the interpretation of content or meaning. While the SSU model shares some common ground with EMDR, its ultimate aim is to gradually “remove the therapist from the room.” This approach moves away from the traditional paternalistic model of western medicine. This returns power to the patient by helping them identify their own subconscious issues and nudging them toward solving these. Our SSU model presupposes that the client has been exposed to an adverse childhood experience. A negative EMI stored inside the client’s mind is influencing their decisions and impacting their psychophysiological wellbeing. The SSU model does not rely on the interpretation of any memory content—merely on close observation and deploying an appropriate intervention with precision timing. These are tasks that can theoretically be undertaken by a machine (such as a mobile phone), giving SSU a signifificant advantage over other forms of therapy. Notably, removing the need for the “content” of memory to be analyzed by another person might make this approach far more attractive and accessible for some clients. We are conducting 

ongoing research using a mobile phone app, which combines eye-tracking scan path data with other biofeedback data to detect eye movement patterns and stress responses. The app then deploys screen-based prompts at specific times to attempt to disrupt the learned response. The challenge of using an app is achieving user engagement when there is an absence of face-to-face therapist-client interaction. At present, the app is introduced within a therapy session, so that the therapist can explain the SSU theory and the app to the client who then uses the app between clinical visits. Studies are underway to see the effect of “removing the therapist from the room” over time.

Memory, Learning, and Ethics

Research into memory reconsolidation interference has explored the effects of encouraging a subject to re-access their traumatic memory, recreating the same neurobiological processes that were present within the original consolidation (Merlo et al., 2015). This reactivated state increases neuroplasticity, creating the opportunity for an intervention to take place. It has been shown to be possible to create a beneficial impact using memory reconsolidation interference regardless of how many years the subject has suffered with the memory (Beckers and Kindt, 2017). Given the potential significance of this research, it is vital to consider ethical implications. Is “nudging” or prompting someone in a certain direction just another way of exerting power over them? Arguably yes. Memories are the foundation upon which a person builds their identity of self and their meaning of life. This might be underpinning psychophysiological stress and dis-ease. Therefore, there are ethical implications to be considered when interacting with a person’s self-narrative (Elsey and Kindt, 2016). Removing the therapist from the relationship and using machine-generated prompts to dissociate the EMI does not resolve this quandary. There is much evidence that people feel better precisely because a trained human expert has listened to their story and helped guide them. Removing human interaction from a therapeutic relationship may raise concerns and is something we are mindful of in our ongoing research.

CONCLUSION

In this article we propose a new theory that outlines a mechanism connecting prior traumatic experiences with chronic psychophysiological stress, resulting in disease. This gives rise to an intervention that disrupts or breaks the connection between a memory and a physical symptom in a “split second.” This has immediate effects on the client, bypassing the need to examine the actual content of the traumatic experience. We believe that with some refinement, SSU can be applied to a range of therapeutic scenarios in both physical and mental health domains. Most notably for people suffering from a post-traumatic stress disorder and related conditions. While the model is grounded in existing knowledge across disciplines, it requires further testing to generate more robust evidence for its individual components. In the future, we hope to investigate patient experiences, long-term outcomes, and neurochemical processes (e.g., using functional Magnetic Resonance Imaging techniques). The need for a scalable, effective, rapid and affordable physical and mental health approach is especially prescient in the wake of the 2020 COVID 19 crisis. We hope that refining the SSU model and therapeutic technique will contribute to alleviating a wide range of trauma-related ailments. 

CASE STUDIES

Because SSU does not require extensive or specialist psychotherapeutic training, testing the theory does not require a large investment, so the model has attracted both academic and practitioner interest. One of the authors of this article (MH) is a mental coach and behavioral specialist practitioner. MH was born conductively deaf, which was undiscovered for the first 25 years of his life. This influenced his observation skills so that he would observe whether the client’s spoken words matched below conscious messages conveyed in behavioral cues expressed during the consultation. This translated into MH taking no notes or case histories, in order that he could be fully present with the client and the client could have full anonymity, knowing that there was no file hidden away with their personal details attached. The SSU model was primarily developed from MH’s extensive experience working one-to-one with clients to resolve a range of psychophysiological conditions including phobias, chronic pain, anxiety, and depression (Figure 2). We describe here two case studies that illustrate the approach in action. The cases are described by MH. 

Case Study One—Male, Aged 51

The client presented with trigeminal neuralgia (chronic pain), which he had been experiencing intermittently for 30 years. The medication made him nauseous. I (MH) asked him to tell me about his pain and the client noted, “it goes back to my bicycle accident,” which he went on to describe in detail. Over the course of about 20 min, I asked things like “what are you noticing, now?” This kept the client aware of the present whilst noticing their experience of the past. Part of the recollection was: “I had a vivid recollection of my father arriving to come and pick me up to take me home. He came into the room, took one look at me, went visibly white and had to leave the room to vomit, then returned.” At this point, the client’s eyes fixated on a particular spot out in front of him, his posture adjusted, he took a sharp intake of breath, the color left his face, and his expression went blank. The total response lasted only a split second. I made a mental note of this action, which quickly faded as the client continued to recount his tale. Intervention When the client had finished his narrative, I directed him back to the point where he mentioned his father walking into the room. The client re-played all of the aforementioned body cues, suggesting that the experience of his father turning pale and vomiting was traumatic. I asked the client to pretend that he was watching the whole thing on television over to his right. This would: (a) Have the client fixate his eyes in a different direction to the original EMI; (b) Dissociate the client from the EMI; (c) 

Allow the client to observe the EMI with me guiding the process; (d) Interrupt the SSU loop, allowing the client to integrate the EMI and move on from it. The client’s eyes welled up, he breathed deeply, and it was gone. The color returned to his face and he looked a little confused, which I interpreted as the brain reorganizing and updating information—the learned response was being “unlearned.” The stored EMI had left the client repeating the same neurological response over time, preventing any change in experience and perpetuating his pain. Clearing the EMI allowed him to disengage from the survival response, enabling new learning to take place and the split second to roll forward in time. As the neurological connection with the traumatic memory fades, so do the physical effects of that memory. The client has not experienced any pain since the intervention in April 2016. During follow-ups, their story has become more general and less detailed, suggesting that the EMI has been subsumed into their everyday background memory, which tends to fade over time, and no longer causes the same physiological problem of chronic pain. In their words: “After the session, I lost the clarity of the pictures of my father coming into the hospital room. I do not seem to be able to retrieve that and much of the vivid detail of some of the experiences of the day of the accident are gone. . . I had seen my father’s face so clearly for so long but after the session, that memory was different—what remains is a very brief clip of him but no visual detail I can recall of any of the stories.” 

Case Study Two—Female, Mid-50

 During a 2-day training course, a lady asked if I would work with her. She shared, to an open audience, that she had been abused as a child by her father. She had completed various forms of therapy and by her own account did not feel traumatized; she had family and a good life. The only problem she had never been able to overcome, was her inability to have regular bowel movements. "Would it be possible for you to help me with this?” she said. As she asked this question, her eyes fixated on a point in her upperright field of vision. At the same time, she raised her right hand as if to block her gaze.

Intervention

I asked her to hold that position and then suggested to her that despite all of her years of therapy there appears to be a piece of information that her body had not allowed her to see. I asked her to slowly lower her hand and give herself permission to access the information. At this point, she began to physically tremble, closed her eyes, and reported that her brain felt like it was “sizzling with electrical connections.” After a couple of minutes, she opened her eyes, wiped away a tear and said, “thank you.” She could not explain it but knew something had changed. The next morning, in an open round of sharing feedback from the previous day, she raised her hand and exclaimed, “I can poo for Canada!” Having been to the toilet before leaving her house, she was able to have a comfortable natural bowel movement without any effort, which was ground-breaking for her. Her bowel movements remained normal at 6- and 12-month follow-up sessions. In these interventions, after identifying a set of subtle and fleeting bodily cues, the therapist relied on careful timing to deploy the interruption. Drawing on an applied phenomenological communication approach, commonly used in the caring professions (Bullington et al., 2019; Zahavi and Martiny, 2019), the therapist encouraged the client to focus on the present moment, while simultaneously prompting them to access and reflect upon their traumatic memory. This creates a discrepancy: on one hand enabling the objective witnessing of memory and its associated reflex response; while on the other, interrupting/preventing the physical cues that cause a client to revisit that memory and subjectively re-experience it. Pragmatically, a well-chosen prompt, directing the subject’s conscious attention to the present, away from their EMI, allows them to become conscious of and objectively experience their stress response. Here, they can engage in active learning a new (ideally neutral) response, rather than passively experiencing the usual traumatic reflex. 

Experiences of Using the Split-Second Unlearning Model

The SSU model is based on over 20 years of practice and has been used with success to treat phobias, allergies, chronic fatigue syndrome, acute and chronic pain, bedwetting, dyslexia, and addictive behaviors (Figure 2). Often benefits can be achieved within a single session. The underlying premise in the application of the SSU model is to focus on the process of client communication and not the content. The client is out of rapport with themselves, and the task of the therapist is to remove the negative EMI so that the client can be in balance again. The SSU model has a humanistic ethos; the client is not “broken” and therefore cannot be “fixed.” The client’s perception of the world is closed by contextual beliefs and needs to be opened to the infinite possibilities a change in perspective can bring (Cohen, 1986; Firat and Venkatesh, 1993; Schiffffrin, 1994). Curiosity, light-heartedness, and the ability to constantly reframe the client’s communication are a precursor to the therapeutic approach. Reframing is a widely adopted psychotherapeutic technique taken from NLP that can alter the way in which the client views their map of reality (see Dilts et al., 1980; Bandler and Grinder, 1982; Dilts, 1999; Neudecker et al., 2014). Clients are pre-screened to check if they have a clinical diagnosis and are willing to be curious about the approach. If a client presents with pain and no EMI is detected, they are referred. From the outset the therapist is constantly scanning the client’s non-verbal communication, are their eyes fixating on a specific spot, at which point does their breathing shift, whilst speaking are both arms moving, one or none? All of this is fed back to the client to bring their awareness to themselves to develop a deep curiosity of their phenomenological experience (Simione et al., 2017). Although, the EMI is based on the fifield of mental imagery, not all EMI events are visual images; some are auditory. A skilled practitioner recognizes this and may ask “Can you hear a voice?” or “What did you just hear or say to yourself just then?” Often this is sufficient to help the client become aware of the auditory loop that they are trapped inside. 

At the end of a session, the practitioner can evaluate change by noticing if the client began by referring to their problem in the present “is,” and now uses the past “was,” or no longer avoids the area where the EMI was stored. This “validation point” allows both the client and the therapist to acknowledge that something has changed, even though it may not be possible to articulate exactly what the change is. SSU is a specific trauma-based intervention that seeks out arousal responses to EMIs that cause psychophysiological disease. The objective for SSU practitioners is to “sort not support,” although practitioners may also be supportive during the session. This attitudinal-driven path can often be at odds with the classically paternal therapeutic approaches that we are culturally accustomed to. This may not be effective for clients who crave emotional support as SSU is a brief therapy. Sometimes the EMI does not “clear away” during a session, and this is when the spoken word needs to be applied. 

Some clients require additional consultations if their problem returns and sometimes there is a delay in a client realizing that a “shift” has taken place. For example, some clients leave the consultation believing that therapy had not worked, although at a 3-month follow up they reveal, much to their surprise, that they have been “problem-free.” The impact of trauma is a unique experience for everyone. The SSU model has the potential for adverse events from the dissociation of trauma as the fear of the unknown can be greater than the known (Carleton, 2016). In this way freedom from the trauma has the potential to be as and if not more traumatic than the actual trauma itself. If for example, a client’s early life trauma has led them to choose a certain life partner, the clearing of the EMI may free them from their past, only to leave them feeling trapped in a present. This, although not inevitable, must be considered as one of the many alternative futures, that face client who have been held captive to their own thoughts for many years.

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