Trauma is one of the concepts belonging to psychology that arouses most interest . Linked to emotional memory, it can damage the quality of life for years because of events that occurred long ago.
However, as mental health research evolves, forms of psychological intervention are emerging that help both to provide more comfort to patients and to understand the nature of these kinds of disorders. The expert view of trauma is always interesting, because it gives an idea of how our experiences leave an emotional imprint on us.
Interview with Javier Elcarte: discovering the trauma
In the following lines we interviewed Javier Elcarte, neuropsychologist and founder of the psychological center Vitaliza in Pamplona, Spain.
Q: Much is said about trauma and how it influences our lives, but what exactly is it?
At Vitaliza, we understand trauma as something that goes beyond the classic concept of post-traumatic stress. Indeed, we speak of trauma when a person witnesses or experiences a terrifying, dangerous or overwhelming event.
Recently, the concept of trauma has been gaining ground as something more complex. Van der Kolk and his collaborators express themselves along these lines when they propose the concept of “Disorder of Extreme Stress not Otherwise Specified”.
For Van del Kolk Complex Trauma would be: “the experience of one or more adverse traumatic events, in a chronic and prolonged way, in most cases of interpersonal nature, such as physical or sexual abuse, warlike conflicts, community violence, etc. and with an origin in childhood”.
Q: What are its effects on the life of the person who suffers it?
As I have already said, classic post-traumatic stress disorder (PTSD) is a widespread concept in the clinic and among the general population, as well as its effects, which we can divide into three groups; symptoms of re-experimentation (recurrent nightmares, intrusive memories, activation reactions when remembering the trauma, etc.)); symptoms of avoidance (avoiding anything reminiscent of the trauma, feelings of disconnection, hopelessness, amnesia, etc.); and symptoms of over-activation (startle response, insomnia, anticipatory worry, anxiety, etc.).
On the other hand, if we understand trauma as a continuum, we would cover the entire spectrum, from large “T” trauma, as explained in EMDR, that is, extraordinary and terribly traumatic life events, to small “T” trauma, or in other words, minor events of low stress intensity, but which occur daily and repeatedly, giving rise to a daily exposure where both the experience and the discomfort they generate are normalized. And of course all the possible combinations between the two.
Obviously in this case, the effects of complex trauma are more profound, insidious and persistent and are at the base of a multitude of disorders. According to Cook and collaborators, complex trauma would be at the origin of Attachment Disorders, Biological Maturation Delays, Affective Regulation Disorders, Dissociative Disorders, Conduct and Impulse Control Disorders. Difficulties at the Cognitive Level and finally Low Esteem and Self-Distortion. That is to say, an enormous range of dysfunctions.
Q: How do you work in Vitaliza and what techniques do you use to treat trauma cases?
In our long history of dealing with trauma, at Vitaliza we have developed an integrated intervention, which includes a triangle with three vortices; the physiological regulation of the nervous and central system through Biofeedback and Neurofeedback on the one hand, the development of resources of self-awareness and relaxation through mindfulness on the other, and to close the triangle, the intervention aimed at integrating the experiences that have led us to the symptoms of the present through psychotherapies focused on processing from the body, “botton-up” such as EMDR, sensorimotor or others.
Therefore, the therapeutic intervention is generally accompanied by individual bio-neurofeedback sessions and group minduflness sessions.
Q: Can you explain to us what Neurofeedback is?
Defining neurofeedback in a few lines is not easy. To talk about Neurofeedback is to talk about a neurotherapy, a treatment that seeks to regulate or modify the function of the brain, acting directly on it. It does not address the psychological processes themselves, but the underlying neurobiological states. It seeks to regulate the CNS using equipment designed for this purpose, with the consequent impact on the underlying psychological processes.
Technically, therefore, Neurofeedback is a training that acts on the electrophysiological activity that allows the person to be aware of their brain activity and modify it, achieving non-invasive sustained improvements over time with problems of anxiety, stress, lack of concentration and / or memory, attention, hyperactivity, and many others.
Q: What about EMDR therapy?
EMDR (Eye Movement Reprocessing and Desensitization) is an integrative psychotherapeutic approach especially aimed at trauma intervention. It is based on the theoretical model of the Adaptive Information Processing System according to which, a large part of psychopathology is due to experiences that either exceed us by intensity or by their continuity or both, and that we are able to process them adequately.
These incomplete or dysfunctional processes of traumatic or disturbing life experiences weaken the person’s ability to integrate these experiences in an adaptive manner.
Technically, EMDR attempts to stimulate that adaptive processing system to adequately reprocess and integrate such traumatic experiences through structured protocols that include eye movements or other forms of bilateral stimulation.
It’s a patient-centered approach. In a way the therapist stimulates the healing mechanisms that underlie the subject himself. Trauma in this sense would be a poorly codified overflow experience, and through the different phases of intervention, with EMDR the patient would access the wound processed in a dysfunctional way, and would incorporate new information or access information that he was previously unable to access, until integrating the traumatic or disturbing experiences.
Q: Are both Neurofeedback and EMDR effective for the treatment of any psychological disorder?
It is always good to remember that in psychotherapy there are no panaceas and that no one intervention can alleviate all disorders, and in turn, that all interventions serve to alleviate some. The art of the therapist is to find the most appropriate form and intervention for each patient. Not everyone responds in the same way, knowing how to adapt to the patient and find the way to reach him is the great challenge of any professional.
As for Neurofeedback, research endorses it as an effective intervention with ADHD and epilepsy and this is confirmed by institutions such as the American Academy of Pediatrics and others. It is effective as we have already said in everything related to anxiety, stress, lack of concentration and/or memory, attention and hyperactivity. There are hopeful signs also in autism, headaches, insomnia, substance abuse, chronic pain, etc.
As for EMDR, it is a psychotherapeutic model with enormous empirical evidence. In Spain, several research studies have been and are being carried out in EMDR, among them I would highlight the research carried out in bipolarity disorder which has been internationally recognized.
It is an approach of choice for numerous treatments, such as trauma (obviously), addictions, anxiety and panic, post-traumatic stress disorder, impulse control, psychosomatic problems, pathological grief, etc.
On the other hand, EMDR has been recognized as an effective treatment for PTSD (Post-Traumatic Stress Disorder) by the American Psychological Association (APA) as well as by the World Health Organization (WHO) and many other clinical guidelines.
Attachment trauma is not out of this research work, specifically in our centre, in Vitaliza, we are carrying out research to check the synergies between both interventions, Neurofeedback and EMDR in abandonment trauma with adopted children.
Q: Do you think these techniques are known in our country? Is it necessary to inform the general public about their benefits?
At a disclosure level, EMDR has more presence in our country than Neurofeedback, although in both cases there is still much work to be done.
Although the Bio and Neurofeedback have a long history, their landing in Spain definitely dates from a few years ago. In this sense, the Spanish Society of Bio and Neurofeedback (SEBINE) was born, of which I am president, with the aim of providing this wonderful therapeutic tool with the necessary standards of empirical rigor and clinical practice properly approved.
With respect to EMDR, the work of the Spanish EMDR Association has been fruitful and tenacious. Today the association has almost 2000 members (all health) and is one of the most numerous associations in Europe. It offers formation of quality guaranteed and contrasted by thousands of professionals of the health.