Apostila Fase 2 Completa

Capas Apostila.
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MANUAL DE TREINAMENTO Fase 2
Formação em
David Grand, Ph.D.

Criador e Treinador
Cristiane Ramos Damaso

Treinadora de Brainspotting e Neuropsicóloga
Training Inc, David Grand

Neuropsicóloga e Treinadora de Brainspotting
www.brainspotting.pro CRP 01 9039
www.cristianeramos.com
Brainspotting Trainings Inc.
Fase 2
Manual de Treinamento
David Grand, Ph.D.

Criador e Treinador
2415 Jerusalem Avenue, Suite 105, Bellmore, NY 11710

www.brainspotting.com
FORMAÇÃO EM BRAINSPOTTING – FASE 2
CRONOGRAMA DAS ATIVIDADES
Sexta-feira
Horário Atividade
09:00 às 9:15 Recepção e Credenciamento
09:15 as 13:00 Breve Revisão da Fase 1
13:00 as 14:30 ALMOÇO
14:30 as 18:30 Demonstração, práticas e esclarecimento de dúvidas:
Técnica de Brainspotting de um Olho – uso dos óculos
Sábado
Horário Atividade
09:00 as 13:00 Demonstração, práticas e esclarecimento de dúvidas:
Técnica de Brainspotting do Eixo Z – 3 D
13:00 as 14:30 ALMOÇO
14:30 as 18:30 Demonstração, práticas e esclarecimento de dúvidas
Técnica de Brainspotting Janela Externa e Interna
Técnica do Brainspotting de Rolamento
Técnica do Brainspotting de Olhos fechados e abertos
Domingo
Horário Atividade
09:00 as 13:00 Breve resumo sobre o Modelo de Recurso do
Brainspotting
Demonstração, prática e esclarecimento de dúvidas:
Modelo Avançado de Recurso: BSP de um olho e Eixo Z
12:40 as 14:00 ALMOÇO
14:00 as 18:00 Revisão Geral de todo o assunto.
Fechamento e entrega dos certificados do Curso.
3
Brainspotting Fase 2 (3 Dias)

Copyright 2017
Slide 1
4
Publicado pela Sounds True,

2013.
Slide 2
Publicado em português pela

Trauma Clinic Edições, 2016.
Slide 2
5
RELATÓRIO DOS RESULTADOS DO

SURVEY
REALIZADO NA COMUNIDADE EM
SETEMBRO DE 2016
A missão da Fundação é se dedicar a promover

e apoiar operações e atividades que atendam a
necessidades de indivíduos e da comunidade
de Newtown, decorrentes dos eventos trágicos
ocorridos na Escola Primária Sandy Hook em
14 de dezembro de 2012.
Fonte: http://www.nshcf.org/wp-content/uploads/2016/09/2016-NSHCF-Community- Assessment-Report.pdf

Slide 3
Os resultados demonstraram que o Brainspotting foi

a modalidade de terapia mais efetiva usada em
Newtown-Sandy Hook, Connecticut para os sobreviventes
do tiroteio na escola em 14/12/12.
4
Slide 4
6
“Brainspotting: Uma hipótese neurobiológica”
(Frank Corrigan, David Grand)

Publicado na revista Medical Hypotheses (Maio, 2013)
Título Original: Brainspotting: a neurobiological hypotesis Slide 5
“Brainspotting: atenção sustentada, tratos espinotalâmicos, processamento tálamo-cortical, e a

recuperação da orientação adaptativa truncada pela experiência traumática.”
(Frank Corrigan, David Grand e Rajiv Raju)

Publicado na revista Medical Hypotheses (Maio, 2015)
Título original: Brainspotting: Sustained attention, spinothalamic tracts, thalamocortical processing, and the
healing of adaptive orientation truncated by traumatic experience Slide 6
“Um estudo preliminar da eficácia do Brainspotting – uma nova terapia para o tratamento de
Transtorno de Estresse Pós-Traumático”
Por Hildebrand, Grand e Stemmler Slide 7
Journal for Psychotraumatology, Psychotherapy Science and Psychological Medicine, 2015
Título original: A preliminary study of the efficacy of Brainspotting – a new therapy for the treatment of Post
Traumatic Stress Disorder
“Brainspotting – a eficácia de uma nova abordagem terapêutica para o tratamento do

Transtorno de Estresse Pós-Traumático em comparação com o EMDR (Dessensibilização e
Reprocessamento por meio de Movimentos Oculares) ”
Por Hildebrand, Grand e Stemmler Slide 8

Mediterranean Journal Of Clinical Psycology MJCP – Vol 5 No 1 (2017)
Título original: Brainspotting – the efficacy of a new therapy approach for the treatment of Post Traumatic
Stress Disorder in comparison to Eye Movement Desensitization and Reprocessing
7
13.000 TERAPEUTAS TREINADOS EM BRAINSPOTTING
 75 Treinadores de Brainspotting no mundo
ÁFRICA DO SUL
AMÉRICA CENTRAL: Costa Rica e El Salvador,
AMÉRICA DO NORTE: Canadá, México, Panamá e EUA.
AMÉRICA DO SUL: Argentina, Brasil, Chile, Equador, Peru e Paraguai.
ÁSIA: China, Indonésia, Israel, Japão, Filipinas e Taiwan
EUROPA: Bélgica, Áustria, Alemanha, França, Grécia, Itália, Espanha, Portugal, Suécia,
Reino Unido, Ucrânia, Letónia, Hungria, Holanda, Noruega, Roménia, Eslovenia e Suíça
OCEANIA: Austrália e Nova Zelândia

Slide 9
INFORMAÇÕES:
Cristiane Ramos - www.cristianeramos.com
Associação Brasileira – www.brainspotting.org.br
Site Internacional – www.brainspotting.com

Slide 10
8
REQUISITOS PARA CERTIFICAÇÃO EM BSP
 Fase 1 e 2
 50 horas de sessões de Brainspotting com clientes
 5 horas de supervisão com um supervisor ou treinador de BSP autorizado
pela Brainspotting Trainings Inc. ou
 Intensivo de BSP com David Grand Slide 11
BSP FASE 2
 BSP de Um Olho
 BSP com Eixo Z (3-D) Slide 12
 BSP de Janela Externa e Interna

 Brainspotting de Rolamento
 Janela Externa Avançada
 Olhos Abertos – Olhos Fechados
 Modelo Avançado de Recurso
Slide 13
9
BREVE REVISÃO DA FASE 1 DE BRAINSPOTTING Slide 14
Ἓν οἶδα ὅτι οὐδὲν οἶδα”
“A única coisa que sei é que nada sei. ” (Sócrates)
O Princípio da Incerteza. (Heisenberg)
Slide 15
A incerteza promove e é necessária para a

sintonia
Slide 16
Qualquer forma de certeza, ainda que sutil,

compromete a sintonia
Slide 17
10
O cliente é como a cabeça de um cometa, e

o terapeuta sintonizado é como a cauda do
cometa que segue a cabeça
Slide 18
O Brainspotting estabelece e mantém uma Moldura

de Sintonia Dual, relacional e neurobiológica, em
torno do cliente
Slide 19
A SEQUÊNCIA DO BRAINSPOTTING
1. O início – escolha o tema focado
2. Verifique se há ativação
3. Nível do SUDS (0 a 10)
4. Localize a ativação no corpo
5. Localize a posição ocular que gera maior coerência no SN (recurso ou ativação) através da:
Janela Externa, Interna ou Mirada
6. Mindfulness Focado (Processamento)
7. Volte ao início para avaliar a mudança
8. Esprema o limão Slide 20

11
JANELA EXTERNA
Na “Janela Externa” o terapeuta

observa e rastreia de forma muito
lenta os olhos do cliente,
procurando reflexos não
conscientes (tremores nos olhos,
congelamentos, piscadas, tiques,
movimentos da cabeça e do corpo)
Slide 21
Slide 22
No Brainspotting de Janela Interna, terapeuta e cliente trabalham juntos para localizar

Brainspots por meio da sensação sentida de maior ativação somática. No Brainspotting de
Janela Interna, as posições oculares são divididas em dois eixos, X e Y.
Olhar fixamente enquanto pensamos ou falamos

é um Brainspotting natural, e pode ser
aproveitado.
Slide 23
12
FATOS SOBRE OS OLHOS
Fonte: Trataka Meditation: Still Eyes,

Still Mind, by Giovanni Dientsmann
(http://liveanddare.com/trataka/)
Slide 24
A retina se origina como uma projeção do cérebro

em desenvolvimento. É parte do sistema nervoso
central (SNC), e é composta por neurônios.
Slide 25
Quase metade do cérebro é dedicado à

visão
Slide 26
13
Depois do cérebro, os olhos são os

órgãos mais complexos no corpo,
com 200 milhões de componentes
Slide 27
Os músculos extraoculares são os

mais rápidos do corpo, e podem
funcionar a 100% de capacidade
em instantes.
Slide 28
ANOTAÇÕES
14
Damir Del Monte no 1º Congresso

Internacional de Brainspotting
http://bit.ly/damir2016
Slide 29
O objetivo de toda psicoterapia é

levar os clientes da desregulação para
a regulação.
O Brainspotting tem como objetivo
engajar as regiões do cérebro
envolvidas com a regulação, e evitar
as regiões que não estão.
Slide 30
Contribuições de Damir Del Monte para o Brainspotting (damirdelmonte.de)
Sensação sentida,
Sintonia Dual Foco visual,
Consciência corporal orientação
Consciência focada – Ativação
Mindfulness focado – Processamento
Delmonte, 2017 Auto-organização

Regulação
Slide 31
15
Uma fibra (via neural) entra no cérebro

da periferia enquanto há 100.000 fibras
no cérebro. Como resultado, o cérebro
se engaja em um intenso auto-diálogo,
com input mínimo da periferia. Assim,
nossas intervenções têm efeito mínimo
sobre o processo do cliente
(Del Monte)
Slide 32
Portanto, a moldura de sintonia dual é estabelecida

e mantida para influenciar terapeuticamente os
diálogos internos do cérebro
Slide 33
O isocórtex agranular (córtex pré-frontal

ventromedial, córtex órbitofrontal e giro
cingulado anterior) e o alocórtex estão
envolvidos nos processos contínuos de
regulação. Já o isocórtex granular (neocórtex)
não está.
Slide 34
ANOTAÇÕES
16
Isocórtex Granular (Neocórtex)

Córtex não-límbico
CPF Dorsolateral Área frontal média Pólo frontal Área de Broca
Cognição – racionalidade
 ligado à memória de longo prazo
(colocar a informação online)
 memória de trabalho
 antecipação
 planejamento de ação, movimento
 linguagem, sintaxe
 propósito (objetivo) dos processos de regulação
 nenhuma conexão direta com a amígdala Slide 35
O isocórtex granular tem 6 camadas, e a 4ª camada

é granular. Isso contribui para o processamento de
ordem superior, mas não para a regulação.
Camada granular IV
O isocórtex agranular tem de 3 a 5 camadas, sem

nenhuma camada granular. Está, portanto,
altamente envolvido na regulação.
Slide 36
17
O sistema límbico tem seu próprio córtex,

conhecido como alocórtex (córtex límbico), que
está altamente envolvido na regulação
Delmonte, 2017
Slide 37
CÓRTEX LÍMBICO (INCLUI O ISOCÓRTEX AGRANULAR)
 representação da ativação autonômica

 representação de marcadores somáticos
 sentimentos
 autorreflexão, auto-consciência
 empatia
 controle de processos autonômicos e
endócrinos
 sistema inibitório medial
 autorregulação
 forte conexão direta com a amígdala, o hipotálamo e a substância cinzenta
periaquedutal
Delmonte, 2017
Slide 38
O TEPT complexo crônico leva à produção

excessiva de cortisol. Isso causa a supressão
da neurogênese e a atrofia do hipocampo.
Quando a regulação é restaurada, a produção
de cortisol é reduzida, promovendo a
regeneração hipocampal.
Slide 39
18
O Brainspotting acessa a capacidade de

regulação do alocórtex (que inclui o isocórtex
agranular) ao estabelecer e manter a moldura de
sintonia dual.
Slide 40
Teoriza-se que o BSP acesse as camadas

visual (1a) e tátil (3a) dos colículos superiores.
Pode ser que o Som Biolateral acesse a
camada auditiva (2a).
Slide 41
O Brainspotting parece promover coerência

entre a ativação simpática e a parassimpática
Slide 42
19
Slide 43
Delmonte, 2017
ANOTAÇÕES
20
O processamento cortical leva de 500 a 600

milissegundos (ms), e o processamento
subcortical leva 50ms. Assim, os processos
cognitivos seguem e respondem sequencialmente
aos processos somáticos do subcórtex.
Slide 44
Oriente seus clientes – “não reaja às suas

reações – observe-as com curiosidade, e
observe com atenção e sem julgamento para
onde as coisas vão”.
Isso ajuda a quebrar o bloqueio de desempenho
e as tentativas vãs do neocórtex de ter controle
(falso controle).
Slide 45
ANOTAÇÕES
21
BSP DE UM OLHO
Of Two Minds (Schiffer)
Slide 46
BRAINSPOTTING DE JANELA INTERNA DE UM OLHO:

1. Escolha o tema focado
2. Verifique a ativação
3. Avalie o nível do SUDs – intensidade da ativação
(0 nenhuma intensidade a 10 intensidade máxima)
4. Localização da ativação no corpo
5. Verifique qual olho carrega o nível de ativação mais alto
6. Começando com o olho de ativação, encontre o ponto de ativação mais alta, no eixo X
(horizontal), ao nível dos olhos .
7. Então rastreie no eixo vertical (eixo Y), procurando o local de maior ativação, para localizar
o brainspot.
8. Processe no olho primário de ativação até que o SUDS seja 0
9. Esprema o limão até que não haja ativação
10. Mude para o outro olho, e explore os eixos X e Y para encontrar o Brainspot no olho de
recurso
11. Processe até o SUDs 0, e então esprema o limão até que não haja ativação
12. Termine o processo com os dois olhos abertos.
Slide 47
22
O Brainspotting de Um Olho pode

começar no Olho de Recurso para
aqueles que precisam de mais
estabilização.
Uma vez que o SUDs chegue a um
zero de limão espremido, o
processamento pode ser feito no
Olho de Ativação.
Slide 48
Há diversas variedades de
combinações entre o Olho de
Ativação e o Olho de Recurso e o
Ponto de Ativação e o Ponto de
Recurso
Slide 49
DEMONSTRAÇÃO DE BRAINSPOTTING DE UM OLHO Slide 50
PRÁTICA DE BRAINSPOTTING DE UM OLHO Slide 51

23
BSP COM EIXO Z (3-D)

Slide 52
No BSP com eixo Z, acrescentamos

a terceira dimensão da distância
Slide 53
O BSP com eixo Z usa distâncias

perto/longe,que acrescentam a 3ª
dimensão à moldura.
Slide 54
Os músculos extraoculares são seis

músculos que controlam os
movimentos dos olhos.
Esses músculos são altamente

coordenados e contêm muitos reflexos.
Slide 55
24
O reflexo óculo-cardíaco ativa

diretamente o nervo vago e o
sistema nervoso parassimpático,
diminuindo a frequência cardíaca
e outros processos metabólicos
(Bowan)
Slide 56
Alguns clientes dissociativos, que

não respondem a muitas formas
de Brainspotting, respondem à
abordagem de Eixo Z de perto e
longe, e ao movimento mais
rápido convergente e divergente.
Slide 57
25
ABORDAGEM DE EIXO Z
Após encontrar o Brainspot (geralmente com Janela Interna), o cliente começa olhando para a
ponta da ponteira.
Oriente o cliente a olhar diretamente através da ponteira para o ponto mais distante na sala
(geralmente a parede mais distante, atrás da ponteira).
Oriente o cliente a verificar onde a ativação é maior, se perto (na ponteira) ou longe. Comece
onde a ativação for menor (geralmente o ponto mais distante).
Depois de uns 5 minutos, mude para o outro ponto. Fique progressivamente cada vez menos
tempo em cada ponto (3, 2, 1 minuto).
Por fim, o ir e vir entre os dois pontos é rápido (cerca de 3 a 10 segundos em cada ponto (em
inglês, isso é chamado vergence).
Slide 58
VERGENCE THERAPY
Após encontrar o Brainspot (geralmente com Janela Interna), o cliente deve olhar para a ponta
da ponteira.
Oriente o cliente a olhar diretamente através da ponteira para o ponto mais distante na sala
(geralmente a parede mais distante, atrás da ponteira).
Oriente o cliente a deixar o olhar fluir para trás e para frente, entre a ponteira e o ponto distante,
a cada 3 a 10 segundos, e a observar seu processamento.
Isso pode ser feito de forma mais lenta, se o cliente relatar náusea ou tontura (efeitos colaterais
ocasionais).
Slide 59
26
Vergence therapy é uma terapia poderosa, que

pode diminuir rapidamente os níveis de ativação.
Alguns clientes respondem muito bem a ela.
Ela pode ser usada a qualquer momento para

reativar um processo que parece ter se lentificado,
e pode ser usada continuamente durante a sessão.
Slide 60
DEMONSTRAÇÃO DE EIXO Z E VERGENCE THERAPY Slide 61
Slide 62
PRÁTICA DE EIXO Z E VERGENCE THERAPY
27
JANELA EXTERNA AVANÇADA

Como encontrar o ponto de Janela Externa ótimo?
Embora qualquer ponto reflexo seja eficaz, pause em cada ponto e espere para ver se aparece
uma série de reflexos, um após o outro. Isso é chamado uma “cascata” de reflexos.
Slide 63
BSP DE JANELA EXTERNA E INTERNA Slide 64
Muitos terapeutas de Brainspotting perguntam: “Quando

usar Janela Externa, e quando usar Janela Interna?”
Slide 65
Na verdade, o Brainspotting de Janela Externa e o de

Janela Interna podem ser integrados. Muitos terapeutas
de Brainspotting descobrem isso sozinhos.
Slide 66
SEQUÊNCIA PARA O BSP DE JANELA EXTERNA E INTERNA
1. Oriente o cliente que você vai escanear o campo visual dele, na altura dos olhos, parando
quando você observar uma resposta reflexa. Informe o cliente de que você pedirá
feedback dele sobre o que ele sente naquele ponto. Também oriente o cliente para ter
em mente que ele decidirá o ponto no qual processar, e que ele pode fazer uma escolha
intuitiva do ponto que sente que mais o ajudará.
2. Então proceda à escolha da questão, ativação, avaliação do SUDs, localização corporal

da ativação, seguida da exploração descrita no passo 1 para determinar o Brainspot de
janela externa e interna.
Slide 67
28
DEMONSTRAÇÃO DE TERAPIA DE BSP DE JANELA EXTERNA E INTERNA

Slide 68
PRÁTICA DE BSP DE JANELA EXTERNA E INTERNA Slide 69
BRAINSPOTTING DE ROLAMENTO Slide 70
O Brainspotting de Rolamento (BR)

envolve o rastreamento ocular lento,
parando brevemente em cada Brainspot
de Janela Externa, e ficando nele por um
período de tempo, seja
momentaneamente (1 a 2 segundos), ou
por períodos mais longos (1 a 2 minutos).
Slide 71
Sacrificar o poder do
descondicionamento completo é
compensado pela facilidade, rapidez e
efeito sinérgico do Brainspotting de
Rolamento.
Slide 72
29
Slide 73
Uma segunda alternativa é perguntar ao cliente, em cada Brainspot de Rolamento, o que

está vivenciando. Onde uma ativação mais intensa estiver presente, permaneça por mais tempo
no Brainspot. Se um Brainspot for muito poderoso, mude para o Brainspotting de Janela
Externa, e permaneça nesse ponto até que a ativação seja zerada.
BREVE DEMONSTRAÇÃO E PRÁTICA DE BRAINSPOTTING DE ROLAMENTO

Slide 74
OLHOS ABERTOS - OLHOS FECHADOS Slide 75
O Brainspotting pode ser feito não apenas com olhos abertos ou “Persianas Levantadas”
ou com olhos fechados, “Persianas Abaixadas”. Slide 76

30
Outro facilitador para clientes que

parecem estar emperrados ou
processando lentamente, pode ser
orientá-los para, olhando para um
Brainspot, fechar e abrir os olhos a
cada 3 a 10 segundos. Isso promove
um mudança de estado cerebral, no
ponto, em relação à questão.
Slide 77
OLHOS ABERTOS – OLHOS FECHADOS: VIVÊNCIA EM GRUPO Slide 78
ANOTAÇÕES
31
REVISÃO DO MODELO AVANÇADO DE RECURSO Slide 79
O Brainspotting é um Modelo de Recurso
Slide 80
A presença sintonizada, consciente, compassiva

(empática) e observadora do terapeuta é a base do
Modelo de Recurso do Brainspotting.
Slide 81
Um Brainspot (inclusive um ponto de ativação)

é um recurso neurológico, uma vez que fornece
uma âncora sintonizada, focada e emoldurada de
acesso ao mesencéfalo (Corrigan e Grand), e
está fundamentado na experiência do corpo
Slide 82
32
O recurso essencial é o instinto de

sobrevivência, que é profundamente
subcortical, e se desenvolveu ao longo de
bilhões de anos.
Slide 83
Todos os animais, inclusive os seres humanos,

possuem habilidade formidável para se
adaptarem, e para atingirem a homeostase.
Slide 84
A JANELA DE TOLERÂNCIA DO BRAINSPOTTING
TEPT SIMPLES
TEPT
COMPLEXO
TEPT MUITO
COMPLEXO Slide 85
TEPT Extremamente Complexo

(TDI e transtornos graves de apego)
33
O modelo básico do BSP é eficaz para a maioria dos

clientes dentro da Janela de Tolerância do
Brainspotting
Slide 86
Um Recurso Corporal é uma área do corpo onde

há uma sensação de calma e centramento.
Slide 87
O Recurso Corporal e o Ponto de Recurso

podem ser necessários para clientes com TEPT
muito complexo.
Slide 88
34
Um Ponto de Recurso é uma posição ocular

de Janela Interna, que corresponde (dá
acesso) ao Recurso Corporal
Slide 89
O TEPT Extremamente Complexo está fora

da Janela de Tolerância do Brainspotting, e
requer de um Modelo de Recurso de BSP
tanto modificado, quanto expandido
Slide 90
Em clientes com transtornos dissociativos

e de apego graves, a presença sintonizada
do terapeuta é o núcleo do Modelo
Avançado de Recurso
Slide 91
35
O Brainspot mais potente para clientes

altamente dissociativos é o Ponto de
Contato Visual
Slide 92
Frequentemente um cliente em flashback
vai desviar os olhos numa determinada
direção
Slide 93
Colocar nosso rosto na direção em que o cliente

olha pode imprimir uma nova imagem no
flashback
Slide 94
36
MOLDURA DE RECURSO DA COMBINAÇÃO DO BSP DE UM OLHO E DE EIXO Z

Slide 95
Tanto o BSP de Um Olho quanto o de Eixo Z têm um poderoso componente de recurso.
Com o BSP de Um Olho, o olho com SUDs menor é o Olho de Recurso.
Com o Eixo Z, a distância com o SUDs menor é a Distância de Recurso.
A combinação dos componentes de recurso do BSP de Um Olho e de Eixo Z junto com o

Recurso Corporal, pode servir como uma Moldura de Recurso efetiva para clientes no limite (e
até fora) da janela de tolerância do Brainspotting.
Lembre-se, a presença sintonizada do terapeuta na aplicação desses modelos combinados

ainda é o recurso central. Slide 96
SEQUÊNCIA PARA A MOLDURA DE RECURSO DA COMBINAÇÃO DO BSP DE
UM OLHO E DE EIXO Z
1. Tema focado, Ativação, Nível do SUDs, Identificação do Recurso Corporal
2. Encontre o olho com o menor SUDs (o olho que corresponde ao Recurso Corporal)
3. Encontre o Ponto de Recurso no Olho de Recurso, primeiro no eixo X, depois no eixo Y
4. Encontre a Distância de Recurso no eixo Z, perto ou longe
5. Processe no Olho de Recurso, Ponto de Recurso, Distância de Recurso e Recurso Corporal

Slide 97
37
A combinação do BSP de Um Olho e Eixo Z estabelece uma Moldura de Recurso resultando

em um recurso dentro do recurso, dentro do recurso. Isso dá suporte para que clientes
vulneráveis possam processar questões com as quais talvez não conseguissem trabalhar de outra
forma.
Slide 98
ANOTAÇÕES
38
DEMONSTRAÇÃO DE MOLDURA DE RECURSO DA COMBINAÇÃO DO BSP DE

UM OLHO E DE EIXO Z
Slide 99
PRÁTICA DE MOLDURA DE RECURSO DA COMBINAÇÃO DO BSP DE UM OLHO

E DE EIXO Z
Slide 100
ANOTAÇÕES
Pag. 51
TREATMENT
OF
PANIC ATTACK Digite seu texto
WITH VERGENCE THERAPY

AN UNEXPECTED VISUAL-VAGUS CONNECTION
 Merrill D. Bowan, O.D. INTRODUCTION Patients who are susceptible to panic dis-
Panic Attack order may have inherited brainstem loci
P
ABSTRACT that are relatively more hyper-excitable or
anic attacks are sudden episodes of anomalous. Stress then appears to have an
Panic attacks are a fact of life in today’s
multiple sensations that come upon a undue effect and excites the brainstem
culture. As much as 10% of the healthy
person who is under stress. The primary loci.3
population can suffer a panic attack with-
cognitive symptom of a panic attack is Parasympathetic innervation of the heart
in a given year. Various methods of treat-
extreme, anticipatory anxiety. The suf- is via the vagus nerve. The vagus has also
ment have been described in the literature
ferer can have the perception of a real or been shown to affect the EEG in a
to counteract these panic attacks. It has
imagined threat to themselves or others, frequency and intensity-dependent fash-
been noted that it is possible to alleviate
fear of dying, “going crazy,” and the most ion when electronic vagal nerve stimula-
panic disorder anxiety by performing
frequent worry is the fear of having an- tion is used. The precise mechanism for
convergence therapy. This somatic inter-
other panic attack.1 The emotional stress this effect however, remains uncertain.4,5
vention functions as a vagal maneuver,
causes excessive activation of the auto- The vagus nerve controls a few skeletal
activating the oculocardiac reflex (OCR)
nomic nervous system. This is manifested muscles, as well. This means that the va-
by medial recti traction. It results in bra-
by a parasympathetic overcompensation gus nerve is responsible for such varied
dycardia and other parasympathetic re-
for the strong response of the sympathetic tasks as heart rate, gastrointestinal peri-
sponses. I have found it possible to allevi-
nervous system associated with the stress. stalsis, perspiring, and a fair number of
ate panic attack, non-cardiac chest pain
They generally last no longer than about motor movements in the mouth, including
and other vagally mediated symptoms by
30 minutes and the somatic symptoms can speech, and keeping the larynx open for
using convergence activity with patients
include increased heart rate/palpitation, breathing.6 The vagus nerve also receives
who suffer from panic attacks. I have
non-cardiac chest pain, tremor, breathing some sensation from the outer ear. Physi-
extended this technique to address non-
difficulty, difficulty with or an inability ological responses with vagal stimulation
cardiac chest pain and it may be further
to speak, nausea or stomach irritability, are known to be almost instantaneous, and
extended to patients with other anginal-
and severe perspiration.2 The inherent re- this aspect seems to support, at least in
like pains. It may be possible to alleviate
sponse can also lead to temporary loss of part, the clinical observations being re-
panic attacks, non-cardiac chest pains,
bladder control under moments of extreme ported here.
and other vagally-mediated symptoms
fear. The vagal portion of this reaction can The parasympathetic innervation to the
with this technique. The risk-to-benefit
cause fainting (syncope) because of a sud- heart comes from cardiac branches of the
ratio is nil. Research is needed to further
den drop in blood pressure and heart rate. vagus nerves. Vagal stimulation slows the
elaborate the full spectrum of benefits of
Vasovagal syncope affects young children rhythm of the sinus node of the heart while
this novel technique.
and women more frequently than adult simultaneously decreasing the ex-
males, with the female to male ratio about citability of the internodal pathways.7 The
Key Words 2:1. Up to 10% of otherwise healthy indi- net result is a slowing of the heart rate and
angina, extraocular muscles, non-cardiac viduals may experience an isolated panic some decrease in the power of heart
chest pain, oculocardiac reflex, panic at- attack per year. 2 muscle contraction. Very strong stimula-
tack, somatic interventions, visual con-
Mechanism For Panic Attack tion can cause cardiac arrest for ten sec-
vergence therapy, vagus nerve. onds or more.
The vagus nerve is the major source of
parasympathetic stimulation to the vis- Treatment For Panic Attack
cera. It supplies sensory parasympathetic Somatic interventions have long been
fibers to all the organs, except the supra- used to control the body’s responses to
renal glands, from the neck down to the stress.6 They are often, but not always,
second segment of the transverse colon.
Journal of Behavioral Optometry Volume 19/2008/Number 6/Page 155
Pag. 52
7, 16
non-invasive strategies for altering physi- therapy might specifically decrease a sen- ing after enucleation. This is believed to
ological and psychological processes by sation of panic. There must be plausible be mediated by the trigeminocardiac
working directly with tissue systems. reasoning for why the observations might reflex.18
Mild degrees of intermittent vagal nerve be associated, a rationale to support the OCULOCARDIAC
stimulation by daily performance of cer- responses. It is my belief that the most CONVERGENCE TECHNIQUE
tain breathing exercises, over a period of reasonable explanation is the oculocardi-
ac reflex (OCR). OCR stimulation of the Mechanism
several weeks, has been known to lower Via the relationships described above, Oc-
blood pressure and heart rate in persons vagus nerve through convergence therapy
offers another, perhaps more practical, ulocardiac Convergence Therapy (OCT), as
with elevated blood pressure or heart rate. a somatic intervention, appears to result in
The same breathing technique may also type of somatic intervention.
the stimulation of the primary parasympa-
stabilize mood and affect. Another effec- Oculocardiac Reflex thetic vagus nerve, resulting in bradycar-
tive method used is to take a deep breath, To understand the probable mechanism of dia (Table 1). The somatic interaction of
and forcefully blow out through a small the OCR, we should consider the neurol- the OCR offers a credible mechanism for
hole in your mouth, puffing one’s cheeks.6 ogy of the eye. The ophthalmic division the reduction of stress with its associated
The Valsalva maneuver (attempt to exhale of the trigeminal nerve is the afferent limb panic symptoms, including non-cardiac
against a closed glottis, or to bear down as of the OCR. The major pathway mediat- chest pain. The palliation may also em-
if having a bowel movement) also acti- ing the OCR6 consists of an afferent link brace the diverse symptoms of pulmonary
vates the vagus nerve.8 These techniques through the ophthalmic portion of the tri- and gastric distress that can accompany
stimulate the vagus nerve, telling it to geminal nerve to the vagus nuclei and an congestive heart failure patients. Vol-
reset. Other examples of somatic inter- efferent link through the vagus nerve to untary convergence stimulates the EOM
ventions are: electroconvulsive therapy, the heart. Impulses pass through the re- insertions, especially those of the medial
transcranial electrical stimulation, tran- ticular formation to the vagus nerve’s vis- recti, plausibly resulting in vago-depres-
scranial magnetic stimulation, deep brain ceral motor nuclei. The efferent limb mes- sive responses. The site of origin for this
stimulation, and electronic vagal nerve sage is then carried by the vagus nerve phenomenon, most likely, is the muscle
stimulation.9 to the heart and stomach.16 The OCR is insertion into the globe, since topical an-
Optometric Therapy Effects On usually understood to refer to a decrease esthesia will greatly reduce the OCR.25
The Central Nervous System in pulse rate (bradycardia) upon ocular OCT as reported here has been seen clini-
Central nervous system effects of vision stimulation—even to the point of actu- cally to result in amelioration of non-car-
therapy (VT) have been reported for about ally stopping the heart (asystole). This diac chest pain and also the symptoms
three decades.10 In the family of binocu- phenomenon is associated with traction of panic attacks and anxiety disorder in
lar dysfunctions, both vergence and ac- applied to extraocular muscles (EOMs) humans. The strategy is employed for a
commodative problems can be treated by and/or compression of the eyeball. This minute or less when any distress is sensed
VT.11,12 Recently, a study of convergence reflex is especially sensitive in newborn in either its prodromal stages or during an
insufficiency (CI) has reported that vari- and children and cardiac arrest may result active attack. It does not replace medi-
ous symptoms associated with CI were as a major consequence. The mechanism cations, but can be employed in conjunc-
resolved with VT and statistically demon- may come from stimulation of the nerve tion with or, if it is possible to intervene,
strated the superiority of in-office VT to endings of the EOMs.17 There are many prior to, the use of pharmacologicals. It
other forms of treatment.13 nerve endings in the EOM insertions in- is strictly an intervention technique to
Ludlam used convergence therapy to re- cluding Golgi tendon organs, palisade be used spontaneously, at any needful
store proper alpha blocking in several pa- endings, stretch receptors, muscle spin- moment. To this point, there have been
tients indicating a reduction in stress and dles, trigeminal nerve terminals and other no reports of adverse reactions while us-
an increase in attention.10 He empirically afferents.18 These sensors are thought to ing this technique, though it theoretically
introduced convergence techniques to as offer positional information to the EOM might be possible to create transient asys-
many patients as possible. He used con- nerve nuclei and to higher processes. 18, 19 tole if performed too vigorously, or for a
vergence techniques with those patients Veterinarians have used the OCR for some prolonged period of time. This potential
who showed attention deficit disorder or time, compressing the globes of the eye as transient asystole has not been reported,
attention deficit hyperactivity disorder a vagal maneuver to reduce tachycardia however.
(ADD/ADHD) and where normal patterns in their patients.20 Strabismus surgeons
and anesthesiologists are quite aware of CASE STUDY
of electroencephalogram (EEG) rhythms A 62-year-old white female, with a history
are often disrupted.14,15 the risks of OCR stimulation. Medicine
has devised tests to predict which patients of panic attacks over a period of over six
Based on the experiences with the patient years or more has remained essentially
in this report, I have since found that con- are particularly sensitive to the OCR.21, 22
Anesthesia is then adjusted based upon panic attack-free after about half a dozen
vergence techniques are particularly useful episodes and OCT interventions over a
with individuals who have anxiety, panic the test results to reduce the possibility of
an untoward event.23, 24 Other areas of the year’s time. The activity was performed
attacks or panic symptoms. Convergence strictly as necessary when the symptoms
innervation has consistently shown good head and face can result in vagal changes:
pressing on the mandible, maxilla, eye lid were experienced. The patient later began
results with these patients. These clinical to suffer classic effects of what were then
experiences might seem spurious without or other facial bony structures can produce
bradycardia. One may demonstrate OCR thought to be congestive heart failure, in-
describing a unifying neuro-physiological cluding what were initially thought to be
mechanism to explain how convergence by pressing on the muscle mass remain-
angina attacks. The attacks were not clas-
Volume 19/2008/Number 6/Page 156 Journal of Behavioral Optometry

Pag. 53
ple procedure has the potential to reduce

Table 1. the distress from both physical and emo-
tional factors. It has the potential to reduce
OCULOCARDIAC CONVERGENCE THERAPY not only tachycardia, but also non-cardiac
METHOD: This technique may be done in any posture but is probably best per- chest pain and similar cardiac responses in
formed while seated. Any target, a finger, a pen, or a printed card of any sort, is perhaps a majority of sufferers.
centered before the face at a distance of about four to six inches. A downward gaze Many of the medications used in ame-
position is not a preferred posture, since that angle reduces the role of the medial liorating the conditions mentioned above
recti in convergence and they are the muscles that are most stimulatory to the OCR. have varying side effects. An effective so-
The patient is to converge to the near-point target and hold the fixation for about matic intervention like the one described
two seconds, then look to a distant target ten or more feet away, for about two here should be welcome to those who ex-
seconds. This is one cycle. (A “tromboning” movement will not be as effective, perience side effects while taking those
because of the reduced intensity level.) medications. The risk to benefit ratio of
These near-to-far cycles are repeated for 20 to 60 seconds. If there has been no re- this technique is virtually not a factor.
lief of the panic attack or chest pain in a minute or less, then the usual medications CONCLUSIONS
should be taken. The procedure may be repeated as necessary. The response appears This new and novel method of employ-
to be further enhanced by having the patient attempting to visualize, be mentally ing convergence therapy in panic disor-
aware of, the distance between the near and distance targets (stereoscopic depth der attacks may be extended to non-car-
becomes involved). diac chest pain sufferers. It may also be of
merit to make an attempt to apply the
sic angina, in part because the pains did patterns using heart rhythm biofeedback technique as a palliative to those who
not come on with or after exertion, nor did equipment (HeartMath FreezeFramer® suffer gastric disturbances, situational
resting relieve them substantially. Nitro- 2.0).28 This is especially true when the breathing distress, and perhaps even with
glycerine sublingual tablets were moder- medial recti are engaged by appropriate the prodromal stages of migraine. The re-
ately effective in relieving the pains. head posture (thus isolating their action sponse in panic disorder and non-cardiac
A Cardiolite Stress test and, subsequently, field) while the heart rate is being moni- chest pain has been seen to be swift and
a heart catheterization revealed a healthy tored. Regulation of heart rate variability effective. Panic attacks and pain began to
heart with minimal to no obstructive dis- has been called cardiac coherence training subside within 20 to 60 seconds. The re-
ease, so she continued to do OCT with the and is seen when the intervals between sults lasted from hours to days and upon
onset of any angina-like pain or even the beats become more consistently regular continued practice, weeks and months.
prodromal signs of pressure or tingling, as through entrainment exercises (activities Alterations in vagal tone have been pro-
she described it. The results were gratify- that can influence neural frequencies to posed as a factor in the origin of panic
ing in that within four to six cycles, the adjust themselves to other functional fre- attacks.30 This technique for stimulation of
somatic awareness dissipated. This tech- quencies, such as respiration).28 the vagus, and its tentative hypothesis, is
nique rarely, if ever, failed to work for her The use of oculocardiac convergence ther- based upon an initial set of observations
and continues to do so for the rare occa- apy may be used as a possible treatment, a and empirical clinical applications in a
sions that require intervention. She no somatic intervention, in the event of non- limited population. One case is reported
longer needs nitroglycerine tablets. The cardiac chest pain, panic disorders and above. Any stronger assertion will neces-
patient has even begun to use this so- vagally-mediated stomach and breathing sitate rigorous trials. Research in the form
matic intervention with mild respiratory problems. And, because of the efferent fi- of controlled or cohort studies and/or ad-
and gastric distresses that she more rarely bers to the striated muscle of the pharynx ditional case studies can be designed to
experiences, with comparable results. Re- and larynx, OCT may even treat globus explore and verify the precise mechanism
lief is experienced within a few cycles of hystericus, a lump-in-the-throat sensation of this intervention technique and the de-
OCT. This would be consistent with a that causes difficulty in swallowing in the gree of amelioration that occurs. In doing
generalized vagal response, in all likeli- absence of a physical cause. This maneu- so, it is difficult to conceive of how a true
hood. This has been clinically replicated ver is an interesting and novel use of OCR placebo control group might be designed.
in our office with a number of similar suf- activation, because it appears to manage The patient is always aware that the treat-
ferers. symptoms of autonomic hyperactivity. ment and traction upon all of the EOMs
OCT appears capable of providing a quick can stimulate the OCR, though to lesser
DISCUSSION degrees than the medial recti.19 It would
“Noncardiac” chest pain is present in palliation to these distressing symptoms in
many situations. It is quite likely that there also be of great interest to verify if there
about 20-30% of patients complaining of is—indeed—an accumulative result.
chest pain but who have no or insignifi- may be a conditioning—an accumulative
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Volume 19/2008/Number 6/Page 158 Journal of Behavioral Optometry

Pag. 55
International Journal of School and

Cognitive Psychology Patrícia, Int J Sch Cog Psychol 2015, S1:1
http://dx.doi.org/10.4172/2469-9837.S1-002
Case Report Open Access
Persistent Genital Arousal Disorder as a Dissociative Trauma Related Condition

Treated with Brainspotting – A Successful Case Report
Patrícia FM*, José FP, de F and Marcelo M
Universidade Federal de São Paulo Rua Borges Lagoa, 570 - Vila Clementino, São Paulo - SP, Brazil
*Corresponding author: Patrícia Ferreira Mattos Rua Dr. Nicolau de Souza Queiroz, 406 apto 16 Vila Mariana, São Paulo – SP, 04005 001, Brazil, Tel: +55 11 98381
5281; E-mail: mattos.patricia@gmail.com
Rec date: Apr 21, 2015, Acc date: Jun 08, 2015, Pub date: Jun 15, 2015
Copyright: © 2015 Patrícia FM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Introduction not quite understand what was happening. At 7 she learned about oral
sex and spontaneously told her mother that she had experienced
Persistent Genital Arousal Disorder (PGAD) or Persistent Sexual something like that with her uncle. Only then, upon her parents’
Arousal Syndrome (PSAS) is characterized by excessive genital arousal reaction, did she understand that something bad had happened. As a
for long periods of time without desire or associated sexual stimulation. consequence, her aunt broke up her marriage and expelled her husband
Intrusive orgasms arise spontaneously and very frequently, which from home.
hinders the patient’s daily routine, work and sleep and leads to
significant functional impairment. This condition is unwanted by the She had grown up in an evangelical Christian family and had always
individual and perceived as unpleasant and impossible to control. Since been an excellent student, dear to teachers and therefore marginalized
it was first described in 2001 [1] several potential causes have been by colleagues. She had her first period at the age of 11 and remembered
suggested: psychological, pharmacological, neurological and vascular her early adolescence as an utterly sad period. Her behavior was
ones [2]. It was once believed that PGAD only affected women, but melancholic, introspective and she reported having few friends. She
recently two cases have been described in men [3]. The embarrassment used to spend most of her time in "her little world", either reading or
and prejudice experienced by the patient, family and sometimes even writing about her feelings. Memories connected with the abuse became
physicians delay diagnosis and treatment. more vivid as she comprehended the sexual violation she had suffered
and its meaning. At 13 the patient reported having her first depressive
Suggested treatment strategies have also been diverse: psychotropic episode; she was successfully treated with sertraline, thioridazine and
drugs, such as antidepressants, clonazepam [2], topiramate [4], midazolan but experienced several side effects.
analgesics, anti-inflammatory, transcutaneous electrical nerve
stimulation (TENS), botulinum toxin [5] and electroconvulsive therapy She had made plans to study psychology, but influenced by her
(cases associated with severe depression and bipolar disorder) [6], father, she studied medicine. Although she pleased helping patients, she
hypnosis, behavioral therapy, mindfulness, meditation, acceptance had trouble dealing with them and their illnesses and resented the
therapy [7] and even clitoridectomy [8]. inadequacy of health services. She would flee practical classes and that
hostile world to fully concentrate on the medical books. She reported
This is a successful case report - after informed consent - for having "survived" the course by switching to an “automatic mode”.
treatment of PGAD with Brainspotting [9], a brain-based psychotherapy
intervention that provides access to sensorimotor memories of traumatic At 21 she had a car accident and sustained injuries to her skull and
activation. face and also lost some teeth. Following this event, she suffered from
orthodontic complications, chronic pain and depression. She was treated
Keywords: Botulinum toxin; Electroconvulsive therapy; Depression; with herbal medication and Citalopram and recovered, but had a lot of
Orgasms drowsiness.
By the time of this evaluation, though the patient had already fallen
Case Report in love, she had never had a boyfriend or even kissed a boy because she
believed that her "symptoms" could disrupt a relationship. Her social
History life was very restricted.
A young 26-year-old single, nulliparous, female sought psychiatric She had no concentration to study or work as her symptoms emerged
help to improve her "sexual symptoms". However, she felt extremely all the time, throughout her menstrual cycle and at any time of day. She
embarrassed to even describe them to a physician. She had never felt unable to attend courses for which she had already paid. She used
undergone a gynecological examination. Her symptoms had appeared 3 to study for eight hours a day and yet at the time of this evaluation she
years before, but had become so unbearable in the last 6 months that she could study no longer than one hour and a half daily.
was unable to work. During her first consultation she agreed to provide
some background information but did not detail the "symptoms". As well as not being capable of describing her "symptoms" in detail,
the patient did not want to use psychotropic medication as she had
She had been born vaginally and was the eldest of three children. She already suffered much from side effects in previous treatments.
had enjoyed a childhood with healthy development and was a very
active child alongside parents and sisters. She vaguely remembered
Hypotheses and diagnosis
being sexually abused by an uncle, a dear family member, at the age of
4. The sexual abuse had occurred repeatedly over two years or so. She From the information provided by the patient it was possible to
reported having certain pleasure during those events, though she did determine a history of multiple sexual abuse events at an early age,
Int J Sch Cog Psychol Applied Psychology and Behavioral Changes ISSN: 2469-9837 IJSCP, an open access
Pag. 56
Citation: Patrícia FM, José FP, de F, Marcelo M (2015) Persistent Genital Arousal Disorder as a Dissociative Trauma Related Condition Treated
with Brainspotting – A Successful Case Report. Int J Sch Cog Psychol S1: 002. doi:10.4172/2469-9837.S1-002
Page 2 of 4
from 4 to 6 years old approximately and two depressive episodes at 13 At her first session she reported extremely unpleasant bodily
and when she was 21 years old. The hypotheses of Conversion Disorder sensations and requested that the process be interrupted before the
or PGAD were considered on her first consultation were yet to be estimated time. We opted for a series of relaxation exercises in order to
confirmed. change their activation state to a more bearable level (SUDS=5).
Concerning this case, we interpreted the symptom of genital hyper At her second session the patient commented that she had found the
arousal as a conversion symptom. Conversion symptoms are previous session very unpleasant, but also reported that orgasms in the
dissociative symptoms that can be classified as dissociative phenomena previous week had been less frequent and that she even had managed to
of compartmentalization. Some examples of compartmentalization are: do some physical activity. She also felt more comfortable to talk about
amnesia, paralysis, convulsive pseudo seizures, sensory loss, pseudo- the symptoms of genital arousal. The patient was able to better
hallucinations, as well as other unexplained neurological symptoms and characterize both her current symptoms and early traumatic events. She
all those so-called conversion symptoms or somatoform dissociation. remembered more clearly that the sexual abuse had begun when she was
According to Holmes [10], compartmentalization prevents the 3 years old and described them in detail in a 6-page- letter. An excerpt
individual to bring a normally accessible information or registration to from the letter describing the first episode and the time when
consciousness. The compartmentalization processes are reversible at peritraumatic dissociation ocurred can be found in Figure 1.
first and continue to operate normally, but are inaccessible to voluntary
control.
The hypothesis that the Conversive Disorder would correspond to
PGAD as a restatement of intrusive somatosensory memories of trauma
was the guiding basis for treatment with Brainspotting (BSP). The
difficulties of verbalization and the patient’s decision not to use
Figure 1: Description of the first episode of sexual abuse. The
psychotropic drugs were also taken into account to choose this
peritraumatic dissociative experiences occurred during the oral sex.
intervention.
Even the patient at the present time is able to remember her negative
feelings, at that exact time of sexual abuse she felt anesthesia in the
Brain-based treatment mouth and she reports amnesia about that happening.
Brainspotting (BSP) is considered a brain-based therapy which arises
from a predominantly neurobiological stimulation with
psychophysiological effects [11]. A brainspot corresponds to an
oculomotor orientation associated with a neuronal network that contains The patient characterized her symptoms as spontaneous orgasms
stored traumatic memory that failed to be integrated. This eye which would occur more frequently at night, but that also troubled her
orientation is found by scanning the visual field and is called the throughout the day in such a way that prevented her from studying or
relevant eye position. When this point is accessed, the autobiographical working. Her private parts were swollen and painful, including her
memory circuits that were established during that traumatic experience nipples. She would masturbate in a mechanical, empty way, only to
are activated. This brainspot also resonates with somatic disorder that relieve herself and get to sleep. She would not even tremble and faint as
emerges as patients remember their traumatic experience. she did not feel any sexual desire, nor imagined anything related to sex.
She also reported avoiding people. Walking or underwear rustling were
Upon locating the brainspot, the patients are asked to pay full very disturbing triggers, she would even remain naked at home to
attention to their internal processes as they may arise, freely and prevent that from happening. The sensations were inconvenient and
spontaneously, while they also keep their focus on the relevant eye disconnected. She did not have the will to perform any task whatsoever.
position that accesses their neuronal network. BSP, unlike other forms She could neither sleep, nor interact with other people.
of verbal therapy, can access the components of the traumatic memory
to the subcortical level in a predictable and unique way. The patient's At this session there were still many unpleasant somatic sensations
attention to the internal process recruits medial prefrontal regions to (SUDS=7). However, throughout the process she began to experience
observe emotions, memories, body sensations and cognitions related to more pleasant reactions in her body. She compared them to the freedom
this network. BSP facilitates sustainable observation of information she felt when she rode a bike against the wind (an activity that she had
files that were opened on a particular aspect into the body residues of been avoiding for very long). The process continued until all somatic
aversive experiences which allows them to be processed to a healing disorder disappeared (SUDS=0).
resolution at the fundament of the brain’s midline self-systems [9]. At her third session she was asymptomatic. She had not experienced
Regarding this specific patient, the treatment goal was address her spontaneous orgasms in the previous week. She was able work and
persistent genital arousal which she preferred to call "those symptoms." study better. She would no longer stare into emptiness. On the next day
When she remembered this situation, she felt a disturbance that could she noticed that she had gained a different attitude at work; she would
be described as a malaise with a sensation of discomfort in the chest and no longer allow colleagues to exploit her. At a certain night at bedtime
head. This disturbance had its corresponding brainspot in the visual she had many unpleasant memories of her trauma up to 5 am. She
field of the left eye above the horizontal line (relevant eye position). realized she had had several abusive relationships in her life and felt that
she needed to talk about them. When we approached the target subject
The patient rated the disruption or activation level on a scale of again, the patient did not report any disturbance.
disturbance subunits. (Subjective units of distress scale - SUDS) [12]
Initially her distress reached the maximum level and it was submitted to After 3 BSP sessions the patient presented no symptoms of genital
BSP stimulus and processed until to be attenuated. (SUDS=0). hyper arousal, but not believing she had fully recovered, she still
Pag. 57
with Brainspotting – A Successful Case Report. Int J Sch Cog Psychol S1: 002. doi:10.4172/2469-9837.S1-002
Page 3 of 4
remained traditional verbal psychotherapy and took two more months The patient was evaluated after six months and one year after BSP
to resume cycling, one of her favorite sports. sessions. She did not present any new manifestation of persistent genital
arousal, except when she made use of Bupropion 75 mg nine months
Upon realizing that her symptoms had stabilized, she scheduled her
after the intervention. Upon suspending the antidepressant, the patient
first gynecological exam. All results came back normal. The patient got
returned to the asymptomatic stage. BSP sessions are summarized on
another job, resumed studying for her medical residency exam, and took
Table 1. All gathered clinical information was reported here, after
up English, French and guitar.
patient´s informed consent.
Brainspotting
Target Genital Hyperarousal - “those symptoms”
Somatic disturbance Overall malaise, discomfort in the chest and head
Relevant eye position Left eye above the horizontal line
Session 1 Session 2 Session 3
Initial SUDS 10 7 0
Final SUDS 10 (5)* 0 0
*after relaxation exercise
Table 1: Summary of weekly sessions of Brainspotting.
Discussion This early trauma case also includes peritraumatic dissociation

experiences described as sensory anesthesia and amnesia of event
At her first evaluation, we considered PGAD as a conversion details (Table 1) that evolved into a late psychopathological condition
disorder, but we were only able to confirm PGAD diagnosis in the with two depressive episodes (at 13 and 21 years old).
second session when the patient had detailed her symptoms more
accurately. It was determined that all the diagnostic criteria for PGAD The peritraumatic dissociation has been related to the development
were met as described below [1,13]. of PTSD and late psychopathology and has also been considered a
predictor of severity and poor response to treatment [15].
(1) Characteristic signs of sexual arousal (genital fullness/swelling
and high sensitivity with or without nipple erection or swelling) that The etiology of PGAD is still unknown and there is no consensus
persist for an extensive period of time (hours or days) and do not about the factors involved in the emergence and permanence of these
completely disappear. symptoms. PGAD in medical literature is associated with moderate and
severe stress as well as with symptoms of depression, psychiatric
(2) Physiological arousal signals, which can not be relieved by disorders such as major depression and bipolar disorder and has also
normal orgasmic experiences and multiple orgasms or that can take been linked to increasing intake of soy [16]. Craig [17] proposed a
hours or days to disappear. method consisting of five diagnostic subcategories based on the most
(3) Physiological arousal signals are not connected with any probable etiological hypotheses: (1) pelvic hypersensitivity/sexual -
subjective feeling of arousal or sexual desire. there is a dramatic increase in inappropriate sexual neurological
sensations causing an intense and prolonged sexual excitement; (2)
(4) Persistent genital arousal can be triggered not only by sexual variant of pelvic congestion syndrome - there is a disorganized dilation
activity, but also by non-sexual stimuli and even without any apparent of veins in the system responsible for draining blood from the pelvic
stimulus. and genital organs, leading to blood congestion in these areas; (3)
(5) Symptoms are unbidden, intrusive and unwanted neurological types - both due to a neurological failure caused by a subtle
lesion or an alteration in a neurotransmitter response; (4) associated with
(6) Symptoms cause at least moderate degree of distress. endocrine conditions – the refractory phase is either absent or minimal
This intrusive, spontaneous and unwanted character of symptoms is following orgasm or increased sexual arousal due to hormonal
quite similar to the traumatic re-experience described in Post- Traumatic problems; may coincide with the onset of menopause or the first
Stress Disorder (PTSD). Despite her history of multiple sexual abuse, symptoms may be present at certain stages of the menstrual cycle; and
this patient did not produce data that could fully meet the criteria for a (5) TEGP variant of Tourette's syndrome - associated with tics,
diagnosis of PTSD throughout life. One possible explanation is that the compulsive masturbation, intrusive thoughts and family history of
diagnosis of PTSD symptoms does not value conversive dissociative Tourette or similar disease or a type of obsessive compulsive disorder
symptoms as part of the diagnostic criteria, even including the new (OCD) presenting symptoms that are similar to PGAD. There are no
dissociative subtype created in DSM V which considers only specific studies on trauma and PGAD. Some cases of women suffering
depersonalization and derealization as dissociative symptoms [13,14]. from PGAD and with a history of sexual abuse do not relate their
Conversion symptoms are in general underrated by the medical symptoms to their history, although many of these patients report
community and patients tend to hide these complaints out of shame or varying degrees of anxiety, depressive, dysphoric and even suicidal
because they have already been treated with little or no consideration. ideation symptoms [18]. This suggests that a possible dissociative
phenomenon should be studied in these patients.
Pag. 58
with Brainspotting – A Successful Case Report. Int J Sch Cog Psychol S1: 002. doi:10.4172/ijscp.S1-002
Page 4 of 4
Ramic M (2013) A case of persistent genital arousal disorder successfully
Concerning this case, we considered the conversive dissociative
treated with topiramate in a physically healthy individual. J Clin
traumatic related origin hypothesis. Dissociation as a primary Psychiatry 74: 693.
mechanism causing psychosomatic symptoms was observed by Nemiah 5. Hakan Nazik, Murat Api, Hakan Aytan, Raziye Narin (2014) A new
[19] in traumatized individuals. These symptoms of dissociation and medical treatment with botulinum toxin in persistent genital arousal
somatization were common and often associated. Dissociation could be disorder: successful treatment of two cases. J Sex Marital Ther 40: 170-
a key clue to explain the traumatic origin of these symptoms. This points 174.
to the importance of seeking the history of early age trauma as well as 6. Yero SA, McKinney T, Petrides G, Goldstein I, Kellner CH (2006)
the need to consider peritraumatic dissociation in clinical research. Successful use of electroconvulsive therapy in 2 cases of persistent sexual
arousal syndrome and bipolar disorder. J ECT 22: 274-275.
This patient did not wish to use psychotropic drugs because she 7. Facelle TM, Sadeghi-Nejad H, Goldmeier D (2013) Persistent genital
considered that they would cause limitations to her life. She was also arousal disorder: characterization, etiology, and management. J Sex Med
unable to talk about the symptoms due to intense emotional distress. 10: 439-450.
Approaches aimed at reducing symptoms deploy verbal psychotherapy 8. Waldinger MD, Venema PL, van Gils AP, Schutter EM, Schweitzer DH
(2010) Restless genital syndrome before and after clitoridectomy for
techniques and often lead to unbearable traumatic re-exposure and have
spontaneous orgasms: a case report. J Sex Med 7: 1029-1034.
little impact on the integration of somatosensory memories of the self,
9. Corrigan F, Grand D (2013) Brainspotting: recruiting the midbrain for
which has its neural correlates in the midbrain. BSP first manifests itself accessing and healing sensorimotor memories of traumatic activation. Med
through conscience events at the cortical level and integrates with deep Hypotheses 80: 759-766.
subcortical records that allow healing to take place at the most basic 10. Holmes EA, Brown RJ, Mansell W, Fearon RP, Hunter EC, et al. (2005)
level of the self. Clinical experience suggests that BSP can successfully Are there two qualitatively distinct forms of dissociation? A review and
access and integrate somatosensory memories of traumatic activation in some clinical implications. Clin Psychol Rev 25: 1-23.
a deeper level of the psyche [9]. 11. Grand D (2001) Emotional healing at warp speed: the power of EMDR,
New York: Ramdom House.
12. Wolpe J (1969) The practice of behavior therapy, New York: Pergamon
Conclusion Press.
Since PGAD is still considered a diagnosis under construction and is 13. Goldmeier D, Mears A, Hiller J, Crowley T; BASHH Special Interest
Group for Sexual Dysfunction (2009) Persistent genital arousal disorder: a
still poorly documented, this report aims to contribute to the review of the literature and recommendations for management. Int J STD
understanding of its etiology and to point to a possible treatment for this AIDS 20: 373-377.
disorder. Conversion symptoms can be understood as a somatic 14. Diagnostic and statistical manual of mental disorders: DSM-52013 APA.
sensorimemory of traumatic origin. BSP intervention has proved useful 15. Marshall RD, Spitzer R, Liebowitz MR (1999) Review and critique of the
for relieving disabling symptoms of patients even after 6 months and 1 new DSM-IV diagnosis of acute stress disorder. Am J Psychiatry 156:
year of the intervention with full remission. Trauma history and 1677-1685.
dissociative peritraumatic experiences should be carefully investigated 16. Pereira VM, Silva ACO, Nardi AE (2010) Transtorno da excitação sexual
in PGAD cases. persistente: uma revisão da literatura. Rev Bras Psiquiatr 59: 223 -232.
17. http://www.psas.nl/artikelen/craig.pdf
The authors declare no conflicts of interests. 18. Waldinger MD, Venema PL, van Gils AP, Schweitzer DH (2009) New
insights into restless genital syndrome: static mechanical hyperesthesia
References and neuropathy of the nervus dorsalis clitoridis. J Sex Med 6: 2778-2787.
19. Nemiah J (1995) Early concepts of trauma, dissociation and the
1. Leiblum SR, Nathan SG (2001) Persistent sexual arousal syndrome: a unconscious: Their history and current implications, in Trauma, memory
newly discovered pattern of female sexuality. J Sex Marital Ther 27: 365- and Dissociation, Bremner D, Marmar C, Editor, American Psychiatric
380. Press: Washington DC.
2. Thubert T, Brondel M, Jousse M, Le Breton F, Lacroix P, et al. (2012)
[Persistent genital arousal disorder: a systematic review]. Prog Urol 22:
1043-1050.
3. Waldinger MD, Venema PL, van Gils AP, de Lint GJ, Schweitzer DH
(2011) Stronger evidence for small fiber sensory neuropathy in restless
genital syndrome: two case reports in males. J Sex Med 8: 325-330.
4.
This article was originally published in a special issue, entitled: "Applied

Psychology and Behavioral Changes", Edited by Binega Haileselassie
Pag. 59
Global Journal of Health Science; Vol. 9, No. 7; 2017

ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education
Brainspotting Therapy: About a Bataclan Victim

Joanic Masson1, Amal Bernoussi1 & Charlemagne Simplice Moukouta1
1
Center of psychology (EA 7273), University of Picardy Jules Verne, 80025 Amiens, France
Correspondence: Dr Joanic Masson, Center of Psychology, UFR Sciences Humaines et Sociales, Chemin du Thil,
80025 Amiens Cedex, France.
Received: February 7, 2017 Accepted: March 16, 2017 Online Published: May 29, 2017
doi:10.5539/gjhs.v9n7p103 URL: https://doi.org/10.5539/gjhs.v9n7p103
Abstract
Brainspotting psychotherapy (BSP), elaborated by Grand in 2003, aims at managing patients suffering from
psycho-traumatic syndromes: Post-Traumatic Stress Disorder, emotional dysregulation, anxiety and/or depressive
syndromes.
This original approach combines features of hypnotherapy and EMDR (Eye Movement Desensitization and
Reprocessing) and is based on the concept of eye positions capable of soliciting the psychological assimilation
processes of traumatic memories. We briefly present this therapeutic tool (framework, protocol, expected effects)
and propose certain hypotheses which may explain its efficacy. For this, we draw on research into the practice of
Mindfulness and the theory of mnesic malleability. Finally, the follow-up of a victim of the 2015 attack on the
Bataclan in Paris supports the discussions developed here.
Keywords: brainspotting therapy, psycho-traumatic syndromes, mindfulness, memory re-consolidation
1. Introduction.
Brainspotting therapy (BSP) is a psychotherapeutic approach elaborated by Grand (2013) from EMDR (Eye
Movement Desensitization and Reprocessing, Shapiro, 1989) and Somatic Experiencing. (SE, Levine, 2010) This
psychotherapeutic tool aims essentially at managing psychological traumas and their associated effects: Post-
Traumatic Stress Disorder, emotional dysregulation, anxiety and depressive disorders, etc. (Masson, Bernoussi,
Cozette Mience, & Thomas, 2013; Masson, Bernoussi, Gounden, Moukouta, & Njiengwe, 2016) Grand
hypothesizes that the visual field may be used to activate the “Adaptive Information Processing” system (Shapiro,
2001), i.e. a process of assimilating dysfunctional information, or traumatic memory. This consists of localizing
strategic eye positions in the patient's visual field, known as “Brainspots”, considered to correlate to neurological
activation and the dysphoric experience. The “Brainspot” is as it were a neurophysiological response to the targeted
activation (emotional dysregulation) associated with a specific eye position. According to Grand, it consists of
sub-cortical cerebral activity in response to sustained attention at a specific eye position.
2. Presentation of Brainspotting.
In order to determine these “Brainspots”, the practitioner guides the patient towards an emotional and somatic
activation linked to the problem to be treated, in particular a traumatic memory. The subject is encouraged to focus
attention on the inner experience, so as to elicit the suffering to a maximal degree. It is recommended, as in EMDR,
to evaluate its intensity using a subjective scale (SUD, Subjective Unit of Disturbance) from 0 to 10 and to localize
the most intense corporal activation. Moreover, naming the localization tends to deepen the emotional feeling.
The practitioner carries out a slow back-and-forth sweeping movement with his fingers (or with a stick)
horizontally across the visual field of the patient, who is guided to follow the movement with the eyes and keep the
face still, while focusing attention on the activation felt. At a specific point, or “Brainspot”, an eye reflex may be
observed (eye-jerk, freezing, blinking, etc.) and/or a body movement (facial tic, frown, sniff, swallow, nod, shifting
of part of the body, rapid breathing, etc.), indicating increased activation. It is also possible to use patient feedback
to localize the point more precisely within the visual field.
Then, as in EMDR, the patient is asked to focus continually on the object (fingers, or the tip of the stick) while
concentrating on what s/he is feeling: thoughts, emotions, sensations. Particular attention is drawn to corporal
sensations, which tend to amplify the introspective process. The associated processes are followed – ideally – until
a 'SUD = 0' is reached when the subject focuses attention on the original target memory. According to Grand, the
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specific feature of BSP – also found in EMDR and other psychotherapies – is guiding the patient's attention towards
what s/he is feeling. He suggests calling this attitude one of “focused mindfulness”. Analogous to the practice of
meditation, the subject continually focuses attention, thus preventing any avoidance attitudes. It consists of a
confrontation of oneself, a confrontation of what is most often avoided: the suffering and its origin. The author of
Brainspotting therapy has progressively elaborated different variants, detailed in his book. (Grand, 2013) These
diverse procedures aim at broadening the search for Brainspots to the whole visual field, rather than to just its
horizontal element (“Inside Window BSP”, “Outside window BSP”, “Gaze-spotting”, “Z-Axis BSP”), or using a
comfort zone as the departure point (“Resource BSP”) for accentuating psychological resources. It's also possible
to work with only one eye (“One Eye BSP”), considering that there is one eye conducive to comfort and the other
to traumatic activation.
Brainspotting psychotherapy draws on a Dual Attunement Frame:
 A “relational tuning” referring to the therapeutic tuning: the secure, inclusive attachment to the therapist,
which is the base of psychotherapy in general, soliciting social engagement;
 A “neuro-biological tuning” which requires attention to the neuro-physiological aspects solicited via
somatic behavior in order to provide better guidance of the therapeutic process.
We have observed, compared to our long experience of EMDR (nearly 10,000 sessions undertaken), that BSP
induces an in-depth treatment of the traumatic memory more rapidly and that this is experienced generally less
painfully than with EMDR: rapid access to a somatic encoding of the dysfunctional information, an effect most
often felt right from the very first session. This is a clinical observation, derived from consultants' remarks and
observations, which would benefit from being studied more rigorously.
3. Clinical Case
Below we present the rapid management of Pierre, aged 30, suffering from a post-traumatic stress disorder. The
patient has given his written permission for this session and his notes to be used for the purpose of this publication.
Pierre was present during the terrorist attack at the Bataclan in Paris on November 13th, 2015. Having gone with
friends to see the concert by the American band Eagles of Death Metal, the patient remained nearly an hour and
twenty minutes lying motionless in the stage pit, while heavily-armed gunmen were carrying out the massacre.
Rescued by the police and army, Pierre and his friends sustained some injuries in the attack. Seven months later we
met the patient, who had rapidly been taken into psychiatric care. He had been seen in consultation by a psychiatrist
on a more or less weekly basis. This initial psychological support consisted essentially of psychotherapy
consultations following the psychopathology assessment, which revealed a post-traumatic stress disorder. We had
arranged to meet for a session of around two hours to carry out a psychopathology assessment and an initial session
of BSP. Pierre also wished to express what he had experienced during the attack, as well as his suffering and the
BSP therapy:
“On November 13th, 2015, I was in the Bataclan concert hall, towards the front right of the stage pit, when the
gunmen entered around 9:40pm. I got out 1 hour and 40 minutes later, around 11:20pm. During this time and
without being exhaustive, what I experienced can be summarized in 7 points:
I was hit by a bullet on the chin as I turned towards the gunmen when they opened fire.
I experienced about 12 minutes of intense firing.
After that I remained for around an hour and twenty minutes lying on the floor in the stage pit, unable to
see: just hearing. I was on top of a group of about ten people at most, lying one or two deep. I was thus
permanently and potentially exposed to the gunfire.
During this time, one of the gunmen activated his explosive belt a few meters away from us, then the other
gunmen continued firing one or two rounds a minute into the stage pit from the upper balconies.
I discovered what it was to lose all hope of getting out of the stage pit alive and of surviving.
When the agents of the Search and Intervention Brigade (BRI) and the Search, Assistance, Intervention
and Deterrence squad (RAID) entered the stage pit without speaking, we first thought that it was the
gunmen, coming to load us with explosives.
 When I picked myself up, I looked for my friends in the stage pit, without finding them: what I saw became
rapidly unbearable.”
The assessment revealed a characteristic psycho-traumatic syndrome: flashbacks, pain, dysregulation of the
autonomous nervous system, increased anxiety and depressive affects, as well as avoidance behavior.
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“Six months after the Bataclan, I was still having lots of nightmares: two or three a week. The memories which
were coming back to me on a daily basis were causing me severe pain, particularly in my chest. These memories
were always the same: the images, the moments or even the screaming at the first sound of gunfire. In addition I felt
a certain sadness every day, especially when I was alone. It was these things which motivated me to undertake
some work on a technique like BSP.”
We then proceeded with the psychotherapy treatment:
“On the first session, I started by focusing on a difficult memory while concentrating on the pain that it caused me.
By keeping my hand on my chest, I felt a burning sensation getting stronger and stronger, and also my heart beating
harder and harder. This pain reached a climax, then … it died down, giving way to a feeling of peace and well-
being. This well-being materialized in my thoughts as a vision of a beautiful peaceful meadow by the sea. My mind
then switched straight away to another memory: the effects were identical. I sometimes felt myself shedding tears,
but for each memory, the pain climaxed then diminished, giving way to a feeling of well-being and the urge to
smile… I came out of the session exhausted… The effects were visible from the very next morning. It was the first
morning (as every morning since then) that I didn't think about the Bataclan as soon as I woke up. I woke up
smiling, with pleasant music in my head. At breakfast, my girlfriend told me I was looking well ... for the first time
since the Bataclan.
Weeks later, I can recap the effects of this work in six points:
I can think back on these memories without the pain coming back.
The daily feelings of sadness have totally disappeared.
I am in much better physical shape.
I once again feel like chatting with people - at work, at the store, with friends - and it makes me feel good.
I feel much more connected to my physical and relational environment, much more concentrated on the
present moment too.
My posture in public spaces has changed: I no longer walk in the street with that sense of insecurity.
To conclude, I would say that this technique doesn't resolve everything, but it resolves the main things. And that is
already quite enough to feel a real 'before and after' effect. This work has considerably changed my daily life, and
in a very positive way.”
The BSP session enabled assimilation of the traumatic memory. This can be observed through precise criteria:
disappearance of flashbacks, extinction of pain, anxiety and depressive affects, disappearance of avoidance
behavior and the feeling of insecurity. Furthermore, these modifications are reflected through Pierre's gesture, his
relationship with the environment, the disappearance of fatigue, and the absence of any suffering when he thinks
back over what he has gone through. We note that these effects are still present nearly three months after our single
session of treatment, as the patient relates:
“Three months after our sessions, the pains have not come back. The memories come back on a daily basis, more
or less significantly, depending on the day, but I no longer feel the pains associated with those memories -
especially in my chest. That's something really positive.
I don't have anything like as many nightmares: I would say about one nightmare every two or three weeks, even
four. Before our sessions, the nightmares were about gunfire and shooting. These days, the few nightmares that I've
had over the last three months present a feeling of being “trapped”: it's impossible to get out of a situation which
will cause my death. I sometimes cry the day after these nightmares. As I have explained to my girlfriend, they
bring back the feeling I had when I was lying in the stage pit, unable to get out.”
Several sporadic nightmares persist, demonstrating that a second session might enable a further assimilation of the
remaining dysfunctional information. It's possible that over time this process will operate spontaneously and
naturally. We note that the patient did not wish to participate in a second session: possibly considering that the
obtained result was sufficient.
4. Discussion.
The clinical practice of Brainspotting demonstrates a flux of psychological and emotional as well as physical
processes. The patient describes an alteration in consciousness associated with the absorption derived from the
hypnotic focalization induced by visual fixation. The associations of ideas are fertile, as are the emotional and
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somatic feelings. The abreactions experienced are often less intense than in EMDR and hence the sessions are
better tolerated. Few rigorous studies have been carried out to date but clinical experience demonstrates a near
constant resolution of traumatic experiences: detachment from memories, disappearance of painful emotions (SUD
= 0), a profound physical relaxation even when focusing attention on the initially painful memory. Furthermore,
we observe a sustainable and progressive attenuation of the symptoms which brought the patient to consultation.
This assimilation occurs through a process of letting-go, favored by the proposed framework: alteration of the state
of consciousness; abandon to the experience without feeling under control; constant attention to emerging feelings.
In effect, focused mindfulness constitutes a lever mechanism essential to this approach, while localization of the
“Brainspot” with constant concentration on it favors a hypnotic state and “letting-go”. (Masson, Bernoussi, &
Regourd-Laiseau, 2016)
This is not unlike what is proposed in Acceptance and Commitment Therapy (ACT, Hayes, Strosahl, & Wilson,
1999), which considers psychological suffering associated with weak detachment as internal experiences lived out
as the reflection of reality. The patient remains focused on a painful past or/and an anxiety-provoking future and
continuously seeks to avoid the suffering, which in turn helps to maintain it. Furthermore, ACT aims at developing
acceptation of the emotional experience, a disconnection from it, an enhanced contact with the present moment
and, hence, a change in perspective.
Just as with ACT, BSP enables development of psycho-somatic-emotional flexibility, conducive to a beneficial
internal reorganization. This flexibility is enabled through attentive presence, so characteristic of ACT and BSP.
Traditionally, attentive presence is a Buddhist spiritual practice (meditation) allowing one to realize the nature of
consciousness - for its part impermanent and ephemeral - as well as the origin of suffering.
Gregoire, Lachance & Richer (2016) qualify Mindfulness as a secular practice, i.e. without spiritual and religious
reference, capable of regulating attention, favoring enhanced treatment of information, modulating reactions to
emotions, reinforcing executive control and consequently favoring improved mentalization.
Memory re-consolidation theory proposes a complementary hypothesis capable of explaining the efficacy of BSP.
This theory considers that a memory becomes sensitive to degradation when it is re-memorized. The activity of
remembering renders the memory labile as it were and can thus favor a different biological re-encoding of this
same information. Furthermore, memory is a constant process of reconstruction which re-actualizes what has been
encoded according to the emotional experience of the present moment. (Levine, 2015)
The emotional state at the time of re-actualization of the memory will transform the memory in question. Hence,
working in attentive presence within a therapeutic framework and a reassuring relationship with the therapist brings
the patient to re-actualize the traumatic memory within a comforting space. This facilitates an accentuation of
emotional tolerance, enhanced auto-regulation and the possibility of transforming not only the experience, but also
the beliefs and perspectives attached to the memory.
A clinical observation, also reported by Grand (2013), requires mention due to its substantial interest. With
numerous patients, we have proceeded to BSP sessions on target memories already treated by EMDR. These could
be considered to have been resolved in terms of EMDR criteria: SUD = 0, Validity of cognition = 7, body scan =
complete relaxation. Nonetheless, new psychological matter emerged in BSP that the subjects weren't aware of. It
seems that the initiated treatment is localized at a deeper level than in EMDR. What's more, the subjects describe
an impression of having delved even deeper into themselves. Of course, it is possible that this same type of
observation might have been manifested by further EMDR sessions. Nevertheless, the descriptions given by the
subjects having experienced one or more sessions of BSP conjure up, over and over again, this impression of a long
voyage into the inner depths of themselves, where they were able to grasp a trouble, a suffering, which had been
there for a long time, and of which they had not been able to rid themselves.
This particularity is possibly linked to an observation made by Grand: that's to say a 'SUD = 0' does not designate
complete assimilation of the dysfunctional network. The author has thus developed a procedure, called “squeezing
the lemon”, which in some way enables the adaptive mechanisms of resistance to be 'overcome'. The patient is
asked to focus on him/herself and to do everything possible to re-activate the suffering, ready to be re-treated by
BSP. This procedure is repeated until no further activation can be generated. “Squeezing the lemon” appears to be
a strategy to counter the subject's defenses and to force an even deeper treatment of anything that hasn't been
assimilated.
5. Conclusion.
Brainspotting psychotherapy constitutes a clinically fertile holistic approach which nevertheless requires further
106
Pag. 63
rigorous study in order to validate its efficacy and determine the operating factors. To that effect, our team is
currently initiating research to assess this therapeutic tool with victims of sexual abuse. As a first step, we have
sought to demonstrate in this article a factor that might explain its effectiveness: focused mindfulness, which would
favor a re-treatment of the mnesic memory. Furthermore, the BSP clinic leads us to believe that traumatic matter is
encoded at different levels within the individual. Indeed, we think that various spheres are solicited: psychological
(thoughts, beliefs, memories, representations); emotional (fear, anxiety, sadness, anger, shame, guilt, etc.); and
somatic (dysregulation of the autonomous nervous system in particular, somatic defense reactions)
It is also legitimate to consider various levels within each of these spheres that psychotherapy should be able to
affect, in order to claim complete resolution of the traumatic experience. (Ogden, Minton, & Pain, 2015)
Brainspotting therapy seems to enable this and thus appears to be a naturalistic approach, capable of reactivating
the subject's resilient resources.
Competing Interests Statement
The authors declare that they have no competing or potential conflicts of interest regarding the publication of this
paper.
References
Grand, D. (2013). Brainspotting: The revolutionary new therapy for rapid and effective change. Boulder: Sounds
True.
Gregoire, S., Lachance, L., & Richer, L. (2016). La présence attentive (mindfulness). Québec: Presses de
l’université du Québec.
Hayes, S.C., Strosahl, K. & Wilson, K.G. (1999). Acceptance and Commitment Therapy: An experiential approach
to behavior change. New York: Guilford Press.
Levine, P. A. (2015). Trauma and memory. Brain and body in a search for the living past. A practical guide for
understanding and working with traumatic memory. New York: North Atlantic Books.
Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. New York:
North Atlantic Books.
Masson, J., Bernoussi, A., & Regourd-Laiseau, M. (2016). From the influences of trauma to therapeutic letting-go:
the contribution of hypnosis and EMDR. International Journal of Clinical and Experimental Hypnosis, 64(3),
350-364. https://doi.org/10.1080/00207144.2016.1171108
Masson, J., Bernoussi, A., Cozette Mience, M., & Thomas, F. (2013). Complex Trauma and Borderline Personality
Disorder. Open Journal of Psychiatry, 3, 403-407. https://doi.org/10.4236/ojpsych.2013.34044
Masson, J., Bernoussi, A., Gounden, Y., Moukouta, C. S., & Njiengwe, F. E. (2016). Psycho-traumatic evaluation
of identity (PEI): Example of depressive disorder. Open Journal of Psychiatry, 6, 262-272.
https://doi.org/10.4236/ojpsych.2016.64031
Ogden, P., Minton, K., & Pain, C. (2015). Le corps et le trauma. Bruxelles: De Boeck.
Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories.
Journal of Traumatic Stress, 2, 199-223. https://doi.org/10.1002/jts.2490020207
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New York: The Guilford Press.
Copyrights
Copyright for this article is retained by the author(s), with first publication rights granted to the journal.
This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution
license (http://creativecommons.org/licenses/by/4.0/).
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MANUAL DE TREINAMENTO Fase 2

David Grand, Ph.D.

Cristiane Ramos Damaso

Training Inc, David Grand

www.brainspotting.pro CRP 01 9039

David Grand, Ph.D.

2415 Jerusalem Avenue, Suite 105, Bellmore, NY 11710

Brainspotting Fase 2 (3 Dias)

Publicado pela Sounds True,

Publicado em português pela

RELATÓRIO DOS RESULTADOS DO

A missão da Fundação é se dedicar a promover

Fonte: http://www.nshcf.org/wp-content/uploads/2016/09/2016-NSHCF-Community- Assessment-Report.pdf

Os resultados demonstraram que o Brainspotting foi

“Brainspotting: Uma hipótese neurobiológica”

(Frank Corrigan, David Grand)

“Brainspotting: atenção sustentada, tratos espinotalâmicos, processamento tálamo-cortical, e a

(Frank Corrigan, David Grand e Rajiv Raju)

Por Hildebrand, Grand e Stemmler Slide 7

Journal for Psychotraumatology, Psychotherapy Science and Psychological Medicine, 2015

“Brainspotting – a eficácia de uma nova abordagem terapêutica para o tratamento do

Por Hildebrand, Grand e Stemmler Slide 8

13.000 TERAPEUTAS TREINADOS EM BRAINSPOTTING

 75 Treinadores de Brainspotting no mundo

AMÉRICA CENTRAL: Costa Rica e El Salvador,

AMÉRICA DO NORTE: Canadá, México, Panamá e EUA.

AMÉRICA DO SUL: Argentina, Brasil, Chile, Equador, Peru e Paraguai.

ÁSIA: China, Indonésia, Israel, Japão, Filipinas e Taiwan

OCEANIA: Austrália e Nova Zelândia

Cristiane Ramos - www.cristianeramos.com

Associação Brasileira – www.brainspotting.org.br

Site Internacional – www.brainspotting.com

REQUISITOS PARA CERTIFICAÇÃO EM BSP

 BSP de Janela Externa e Interna

BREVE REVISÃO DA FASE 1 DE BRAINSPOTTING Slide 14

Ἓν οἶδα ὅτι οὐδὲν οἶδα”

“A única coisa que sei é que nada sei. ” (Sócrates)

O Princípio da Incerteza. (Heisenberg)

A incerteza promove e é necessária para a

Qualquer forma de certeza, ainda que sutil,

O cliente é como a cabeça de um cometa, e

O Brainspotting estabelece e mantém uma Moldura

1. O início – escolha o tema focado

3. Nível do SUDS (0 a 10)

4. Localize a ativação no corpo

6. Mindfulness Focado (Processamento)

7. Volte ao início para avaliar a mudança

8. Esprema o limão Slide 20

Na “Janela Externa” o terapeuta

No Brainspotting de Janela Interna, terapeuta e cliente trabalham juntos para localizar

Olhar fixamente enquanto pensamos ou falamos

FATOS SOBRE OS OLHOS

Fonte: Trataka Meditation: Still Eyes,

A retina se origina como uma projeção do cérebro

Quase metade do cérebro é dedicado à

Depois do cérebro, os olhos são os

Os músculos extraoculares são os

Damir Del Monte no 1º Congresso

O objetivo de toda psicoterapia é

Contribuições de Damir Del Monte para o Brainspotting (damirdelmonte.de)

Consciência focada – Ativação