Leading the Way in Trauma Therapy

Trauma Institute & Child Trauma Institute

The recently developed Flash technique enables a therapy client to rapidly and (nearly) painlessly reduce the distress level of an upsetting memory. Pending further research, Flash appears to represent an advance in trauma therapy, in that a) a client who might not otherwise have been able to face a distressing memory will be able to face it and work it through, and b) time to completion of processing is reduced.

Briefly, Flash is done by guiding the client to concentrate on a safe place or other feel-good image, then “flash” past the traumatic memory so rapidly as to be unsure as to whether or not it was viewed, and then back to the feel-good image. In the original version (Manfield, Lovett, Engel, & Manfield, 2017) this is done during slow eye movements, in conjunction with EMDR. When the therapist is using PC, the visualization sequence is done while the therapist counts aloud from one to 10 (Greenwald, 2017).

So how does it work? Manfield and colleagues (2017) posited a memory reconsolidation account relying on rapid subliminal information processing. Memory reconsolidation expert Bruce Ecker recently proposed a different hypothesis (transcript is here), summarized as follows:

  1. Memory reconsolidation requires that a mental model is activated, and then exposed to conflicting or disconfirming information.
  2. Flash does not provide sufficient engagement with the memory to allow for conflicting or disconfirming information regarding the negative cognition (e.g., I’m bad, I’m not safe, I have no value, etc.) that drives the memory-related distress.
  3. On the other hand, Flash does provide sufficient engagement with the memory to allow for conflicting or disconfirming information about facing the memory. That is, the belief, “I will not be able to tolerate facing this memory,” is repeatedly disconfirmed by repetitions of Flash.

Ecker proposes that this fear of the memory is the focus of Flash’s memory reconsolidation, and accounts for Flash’s benefit or treatment effect. Ecker further proposes that this explains Flash’s variable end point, at which no further progress is made. For example, if the SUDS (0-10 distress rating) goes from 10 down to 0, that means that the memory content was not the problem; the fear regarding the memory was the problem, which has been resolved. On the other hand, if the SUDS goes from 10 down to 7, that means that after the fear of facing the memory has been resolved, the content of the memory itself still has that much left to work through.

Ecker’s rationale is, in my opinion, overstated on three counts.

1. Ecker stated that Flash is only used for high-SUDS memories that the client is afraid of facing. However, this is not accurate. While Flash is used for such memories, it is also used for high-SUDS memories that the client is willing to face, but might prefer to get through more quickly.

2. Ecker argued that Manfield’s hypothesis that the traumatic memory itself was being processed could not be correct, because cognitions are not explicitly addressed in the Flash technique, and cognitions are the primary basis for memory-associated distress. However:

  • Cognitions are not the only basis for memory-related distress. Sometimes intense emotions, such as grief, remain with a memory, not because of an inappropriate belief, but because the emotion has not yet been worked through.
  • Cognitions do not have to be explicitly addressed by a treatment method in order to be impacted. For example, PC does not explicitly address cognitions, yet clients routinely report changes in cognitions, similar to those reported in EMDR, associated with the memory they have worked through.
  • Many people who experience a Flash session report changes in cognitions regarding the content of the memory, similar to changes reported in a PC or EMDR session.

3. Manfield et al (2017) reported finding that Flash works best when so-called source or feeder memories are not present. For example, Flash will work well on the memory of a single/discrete incident of childhood victimization, but may not work well on the same memory if that incident occurred after a number of other similar incidents. This finding implicates a mechanism of effect that is more relevant to the memory content than to fear of facing the memory.

I do not mean to suggest that Ecker’s hypothesis is wrong. To the contrary, I suspect that he has identified an important element or aspect of Flash’s effectiveness. I also think there’s more to it, consistent with Manfield’s hypothesis that Flash impacts the memory’s content as well.

References

Greenwald, R. (2017). PC Flash script. Unpublished manuscript: Author.

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.

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