November 28, 2017 at 9:29 PM
How long does it take to get traumatized? A few minutes? A few seconds? The brain can make profound changes very quickly – right?
So how long does it take to get untraumatized, to heal? Can the brain make that profound change quickly as well?
As it turns out: Yeah, pretty much.
EMDR set the standard for efficient, effective trauma therapy (Greenwald et al, 2017), and PC may be even more efficient (Greenwald, McClintock, Jarecki, & Monaco, 2015). Now the Flash technique (Manfield, Lovett, Engel, & Manfield, 2017) is speeding up trauma therapy even more. In some cases, a lot more.
Flash is a fairly simple technique1 that is used as a brief precursor to standard EMDR or PC. Briefly, in the EMDR version, the client is guided to a) concentrate on a safe place or other feel-good image, then b) flash past the trauma memory so quickly as to not even be sure they did it, then c) return to the feel-good image; all done during slow eye movements (Manfield et al). In the PC version, the client is guided to identify a beginning and ending to the trauma story – as is standard in preparing a memory for PC – and then concentrate on the beginning, flash past the trauma memory, and concentrate on the end, while the therapist counts aloud from 1 - 10 (Greenwald, 2017).
The thing is, after just a handful of Flash repetitions, there’s often not much left in the way of memory-associated distress. A memory that starts at a SUDS (0-10 subjective units of disturbance scale) of 10 becomes a two within a few minutes, or even a one or zero. So instead of spending the next half hour or hour (or two) on the EMDR or PC session, you may only have to do a few minutes to finish up.
It doesn’t always go that way. Sometimes Flash hits the “floor” (at which there is no further progress) at a higher SUDS level; and sometimes it just doesn’t work at all. Usually, though, it goes well, and fast.
Because the memory-related distress gets reduced so quickly and painlessly, Flash enables clients who may have otherwise been unable to face the memory to succeed in facing and resolving it. So now we’ve got improved client acceptability along with improved efficiency.
Manfield and colleagues (2017) did an excellent job of speculating how and why Flash works; read their paper. Here’s the thumbnail version:
Memory reconsolidation – the neuropsychological term for the mechanism underlying trauma healing – is believed to occur when the memory is retrieved and activated, and then during that activated state corrective information is repeatedly introduced (Ecker, Ticic, & Hulley, 2012). However, memory reconsolidation can occur even when emotionality is not present, for example when it is suppressed via medication (Barreiro, et al., 2013). This means that either activation is not actually necessary for memory reconsolidation, or alternately that it is necessary, but that emotionality is not a necessary component of activation.
The brain can process information that emerges and vanishes so quickly that it is not in conscious awareness (Mansfield, 1997) – which is why subliminal advertising is illegal.
The flash technique creates the activity sequence required for memory reconsolidation, while minimizing the conscious awareness of the memory, along with opportunity for emotional distress.
Is this as big as it seems? No. It’s bigger – assuming it pans out. The promise of trauma therapy that is effective, rapid, and relatively painless makes the overall course of treatment quicker and less costly. Mental health providers may have to adjust our business models to take into account that clients won’t be hanging around so long. So we’ll adjust.
Ultimately a quicker and easier treatment reduces cost and increases access. This engenders any number of new possibilities.
For example, twenty years ago I proposed instituting a routine annual screening of children for mental health problems, much as we already do for medical problems (Greenwald, 1997). This would nip many potentially serious problems in the bud, leading to a vastly improved developmental trajectory for many children. The problem with screening, though, is that you become responsible for what you find. This is why many schools I have worked with have avoided screening their student body for posttraumatic stress symptoms – because then what? But as therapy becomes quicker and less expensive, it becomes more economically feasible to provide treatment to those who need it2.
For another example, it may (or may not) be possible to train para-professionals in Flash, so that it can be used in parts of the world in which access to trained mental health professionals is limited (Phil Manfield, personal communication). Even if Flash does not fully clear every trauma memory, it might still be used to great effect in widely disseminating quick-and-dirty trauma therapy to those who would otherwise get no trauma therapy at all.
Obviously Flash will require considerable research before it can be widely adopted. We’ve got several research projects in progress, and I hope other researchers will be on this as well. This is an exciting time to be in the field.
1. It’s not quite this simple. If you’re a therapist already trained in EMDR or PC, please do get trained in Flash before you try it, OK? Without proper training, it’ll still work well sometimes, but not reliably.
2. In fact it is already wise, economically and otherwise, to provide effective trauma therapy to those who need it. Even so, in some contexts it can be difficult to come up with the cash, and the Flash innovation will reduce that difficulty.
Barreiro, K. A., Suárez, L. D., Lynch, V. M., Molina, V. A., & Delorenzi, A. (2013). Memory expression is independent of memory labilization/reconsolidation. Neurobiology of learning and memory, 106, 283-291.
Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York: Routledge.
Greenwald, R. (1997). Children's mental health care in the 21st century: Eliminating the trauma burden. Child and Adolescent Psychiatry On-Line. Available Internet: http://www.Priory.com/psychild.htm.
Greenwald, R. (2017). PC Flash script. Unpublished manuscript: Author.
Greenwald, R., McClintock, S. D., Hall, S. L., Verbeck, E. G., Lamphear, M. L., Seibel, S., Doss, J., Halvorsen, L., & Gray, A. K. (2017). A meta-analytic comparison of EMDR to other trauma treatments: Effectiveness, efficiency, and acceptability to clients. Manuscript in preparation.
Greenwald, R., McClintock, S. D., Jarecki, K., & Monaco, A. (2015). A comparison of eye movement desensitization & reprocessing and progressive counting among therapists in training. Traumatology, 21, 1-6.
Manfield, P., Lovett, J., Engel, L., & Manfield, D. (2017). Use of the Flash technique in EMDR therapy: Four case examples. Journal of EMDR Practice and Research, 11, 195-205.
Mansfield, D. J. (1997). Subliminal priming and mood: A preliminary study. University of Natal.
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Everyone we've trained in PC will be getting an invitation to participate in PC Flash training. You'll probably get the e-mail in January or February.