Dual Focus Therapies

Wanted to make this post as a prompt for people who have never heard of some popular therapies/techniques for emotional wellness. A dual focus therapy entails focusing on a neutral activity or stimuli while simultaneously focusing on troubling/disturbing emotions. Many dual focus therapies are evidence-based, mainstream, and administered in clinical settings for ptsd and daily stress management.

Examples of dual focus therapies:
-EMDR
-Tapping
-Music/drum therapy (common in traditional cultures)
-Progressive counting therapy (or the technique of counting while breathing/stretching)
-May include any number of activities that ground attention in the present

The author from the Trauma Institute and Child Trauma Institute summarizes one explanation for the efficacy of dual focus therapies (the "working memory account") before presenting their preferred explanation--the "mindfulness account" (Dual Focus: An Important Element of Trauma Treatments).

"Why should dual focus contribute to trauma treatment’s effectiveness and/or efficiency? The prevailing theory (van den Hout & Engelhard, 2012) is that the distraction, plus concentrating on the trauma memory, provides a certain optimal total cognitive load that taxes working memory. Working memory is like the brain’s RAM chip: it determines how much we can concentrate on, retain in awareness, in a given moment. According to the working memory account, when a trauma memory is accessed and activated, and then working memory is overloaded via distractors, the quality and emotional intensity of the trauma memory deteriorates, resulting in a less distressing memory.

I’m not convinced. Even though the results of numerous studies are consistent with the working memory account, that account is inconsistent with clinical observation of actual EMDR or PC sessions, as well as with what clients say about their experiences (Greenwald, 2012). The working memory account would presumably predict a gradual desensitization of the trauma memory, but many clients do not progress through the memory work in that particular way. Instead, we often see precipitous changes, typically following some emotional working-through or the achievement of a key insight.

I propose what I call the mindfulness account. Even if a therapy client working through a trauma memory does not become overwhelmed, it may take a lot of effort to avoid that, and that effort can slow the work down. However, by concentrating on something else (e.g., the therapist’s moving fingers in EMDR, or the therapist’s counting aloud in PC) at the same time as the trauma memory, the client is no longer only inside the memory, but also outside it concentrating on the distractor. This enables the client to be an observer of the self and of the memory while also engaging with the memory. This mindfulness effect frees the client from getting overwhelmed or bogged down, facilitating the mind’s ability to proceed with the desensitization, emotional working through, insight-making, or whatever is needed to heal from the memory."​

 

Interesting stuff, @Benjiro! And it's always nice to see you drop in

 

“If we keep experiencing an old thing in a new context, it gets reoriented to the new context.” (Brian Powell)