Treatment of DID with Neurotherapy

My understanding is that EMDR somehow works on the neurological networks within the brain (how and why still up for debate?). I stumbled across the following article and am curious of any thoughts from professionals regarding this therapy especially in relation to EMDR and its affects on the neurological system.

The following is cut and pasted (partial) from an article located at

http://www.snr-jnt.org/journalnt/jnt(2-4)4.html

"Discussion

This study retrospectively investigated the clinical changes in personality and behavior in 11 female DID subjects who received neurofeedback treatment and group, using data from the MCMI-II (Millon, 1987) and the DES (Bernstein, 1986). The highest mean MCMI-II Base Rate (BR) Scores (70 and above) before treatment were on categories Schizoid, Avoidant, and Self-Defeating. According to Fink (1991), "Most DID patients are actively avoidant." Their isolation, seclusiveness, and detachment from others and the world are an active defensive effort to avoid emotional injury and the pain of interpersonal involvement. It represents and adaptive stance resulting from feelings of extreme vulnerability. Millon (1987) described individuals with self-defeating character types as relating to others in a self-sacrificing manner. They allow, and perhaps encourage others to exploit or take advantage of them, focusing on their worst features. They typically act in an unassuming and self-effacing way and often intensify their deficits and place themselves in an inferior light. Five of the 11 subjects met criteria for the diagnosis of Borderline Personality Disorder due to their unusual thinking, dyscontrol, and deviant reasoning caused by intrusive post traumatic stress disorder symptoms (Putnam, 1986). Current evidence suggests that Schizoid personality disorder may reflects the interplay of trauma, including the dissociative responses, with specific sets of vulnerabilities related to the individuals psychobiologic substrate (Fink, 1991).

These improvements in the Millon scores were still evident from 7 to 25 months, following unification (see results in Table II). As a group, no significant amplitude changes in alpha, theta, or beta were noted. However, a statistically significant increase in alpha threshold was observed between initial threshold settings and the threshold setting employed by the end of the 30 neurofeedback training sessions. Of 10 subjects, the alpha threshold level employed increased in 8 individuals with training (this gave a Fisher exact probability of 0.01). This suggests that subjects identify some specific frequency component in the EEG for enhancement. Thus, to maintain a consistent level of performance reinforcement, the threshold setting must be increased. The standard EEG frequency bands used in these studies (i.e., alpha, theta and beta) contain multiple narrow width frequency bands, one of which could closely correlate with clinical changes and account for the increase in alpha threshold with training. An increase in one component along with a comparable decrease in another would explain why the broad, standard frequency bands employed do not show a consistent, significant change with training.

The DES (Bernstein, 1986) was administered to determine the long term integrated effects of Neurofeedback training and group on prevention of decompensation and relapse. As evident in Table III, all subjects scored in the normal range after 13 to 27 months following treatment, suggesting that the subjects were able to maintain their post treatment gains over time. Subjects reported that the neurofeedback treatment process enabled them to bring their dissociated memories into conscious awareness and to develop co-consciousness with their alters without dissociating.

In summary, Armstrong and Lowenstein (1990) reported that treatment models for this disorder that focused on eliciting and working with state changes that occur naturally permit better access to the patients health and adaptiveness. Neurofeedback teaches the patient to learn to recognize, feel and regulate states of arousal. It enables them to synthesize into conscious awareness the dissociated knowledge, affect, sensations and behaviors that allow their continuous consciousness to emerge and to re-associate these experiences in the present, thus having more flexibility of choice. Recent research studies have shown that unconscious processes influence emotional reactions and affect judgement (Freiberg & Meirkle, 1993). The treatment enabled the subjects to consciously perceive their trauma and use the information to direct their activities and behavior. All unified subjects have reported that previous therapeutic experiences in which they were addressed and treated as if they had separate personalities exacerbated their condition and prolonged the recovery process by enabling them to continue to use dissociation to cope with both internal and external conflicts in the here and now. It was their predilection for isolation, dissociation, and self-defeating acts which made it difficult for them to relate to people and cope with life in a rational manner.

The subjects in this study were able to resolve the conflicts that were maintaining their dissociative defense symptoms. All subjects were free of their Post Traumatic Stress symptoms after 30 neurofeedback and 10 group sessions, and able to maintain these changes over time. This is in contrast to the normally 6-7 years of mental health contact normally spent in treating DID. The procedure described in this study allowed the DID subjects to rapidly coalesce their separate personalities and pursue basic psychotherapy as a unified person, thus significantly shortening treatment time. It is concluded that the administration of protocols which train the dissociative patient to control brainwave activity, combined with verbal self-exploration of the content of each neurofeedback session, enabled the subject to reassociate and reorganize their own experiences without intrusion by the therapist and bring about unification in a short period of time.

Achieving unification allowed the subjects to gain access to their psychological resources in a manner that allowed them to form and direct their emotional and behavioral responses in a rational manner, which prevented relapse into their dissociative defense system.

Present results support the need for empirically controlled research studies with large sample sizes and a control group to confirm these findings. The senior author has employed these methods to treat 57 patients who met the DSM-III-R and DSM-IV criterion for DID over a period of 5 years. All 57 patients were successfully treated using unification as a criterion of success. As shown in figure 3, 4, or 7% of the patients relapsed. One patient relapsed within the first three months and the other three were unable to unify. The 53, or 97% of the patients treated, remain unified, with the period of post treatment ranging from 2 to 13 months."

Replies:

Re:Treatment of DID with Neurotherapy, by Sandra Paulsen Inobe PhD, 09/02/03

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