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Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation

Abstract

Brainspotting is a psychotherapy based in the observation that the body activation experienced when describing a traumatic event has a resonating spot in the visual field. Holding the attention on that Brainspot allows processing of the traumatic event to flow until the body activation has cleared. This is facilitated by a therapist focused on the client and monitoring with attunement. We set out testable hypotheses for this clinical innovation in the treatment of the residues of traumatic experiences. The primary hypothesis is that focusing on the Brainspot engages a retinocollicular pathway to the medial pulvinar, the anterior and posterior cingulate cortices, and the intraparietal sulcus, which has connectivity with the insula. While the linkage of memory, emotion, and body sensation may require the parietal and frontal interconnections – and resolution in the prefrontal cortex – we suggest that the capacity for healing of the altered feeling about the self is occurring in the midbrain at the level of the superior colliculi and the periaqueductal gray.


Section snippets

Introduction: Brainspotting as a therapy for posttraumatic disorders

Brainspotting (BSP) is a development in psychotherapy which was discovered by David Grand [1] in the course of a Natural Flow EMDR session in which slow eye movements are used [2]. When his client’s eye movements wobbled and froze David Grand also stopped spontaneously and waited with what happened. The client then processed traumatic material which had not been accessible previously. He followed up this observation in other clients and discovered a similar pattern of processing.

If the

“Outside Window” definition of a Brainspot

When a client discusses an area of emotional difficulty in sufficient depth to allow focus on the body feeling associated with it, the therapist asks the client to track a pointer which is slowly moved in a horizontal line in front of the eyes. The therapist can then find the Brainspot by observing a disruption of the client’s gaze. As this may be an eyeblink it is useful to look at recent findings on brain activity in relation to spontaneous blinking. Nakano et al. [7] observed that eyeblinks

Non-visual gaze patterns and memory: looking in while looking out

The spontaneous activation of eye movements and gaze fixations during mental activity with no visual component has been extensively studied by Ehrlichman and colleagues [9]. The movement of the eyes during “search” of long-term memory is followed by a gaze fixation when the information is “located”. This is seen as analogous to the search for a salient stimulus in the environment and is based in the same brain structures. Saccadic activity and gaze fixation are connected with memory through

Setting the frame

As in Sensorimotor Psychotherapy [10], Somatic Experiencing [11], Lifespan Integration [12] and, it could be argued, EMDR [13] the Brainspotting frame is based in the body feelings evoked by discussion of the traumatic memory. These are accessed through mindful attention to what is happening inside during the recounting to the therapist of the nature of the presenting problem. The activation is studied carefully and working memory involvement with it is enhanced by it being rated on a 0–10

Focused mindfulness

The client’s attention to the internal process recruits medial prefrontal regions for observing emotions, memories, body sensations and cognitions. Sustained observation of the information files which have been opened by the Brainspotting set-up allows healing change to occur. The Brainspot provides the bookmark or tag on the appropriate information file. The mindful therapist helps to maintain this internal focus by checking on the nature and severity of the activation in the body and allowing

Dual attunement

Brainspotting’s difference from other forms of talking therapy lies in its unique ability to predictably access the brain stem components of the trauma memory during the setting of the frame. Other body-based therapies are effective at a similar level but the ease with which they access the midbrain is dependent on a number of factors not necessarily integral to the treatment modality. The gaze fixation used in Brainspotting (BSP) immediately involves the superior colliculi in the midbrain and

Orienting and adaptive orientation

A Brainspot is a stored oculomotor orientation to a traumatic experience which has failed to integrate. When it is accessed in treatment there is potential for greater healing of the emotional residues of the unassimilated event. The concept of orienting – an oculomotor response to a particular stimulus/event in external space – has been expanded in relation to trauma by Levine [11] and Ogden et al. [10]. To avoid confusion with the basic orienting response we will refer to the full sequence

Interoceptive loops

During the set-up of the frame in Brainspotting, the client is asked to describe the presenting problem and then to notice the level of activation in the body. This is similar to the practice in sensorimotor psychotherapy [10] in which the body’s response during the description of the problem becomes the starting point for therapeutic intervention. In both Brainspotting and sensorimotor psychotherapy (SP) there is no need to get all the narrative details, or to elicit all the associated

Orienting and gaze fixation

Objects which make a sudden appearance attract attention and induce a saccade, a rapid movement of the eyes towards them [25]. This orienting saccade can be followed by a gaze fixation on the visual axis from the retinal fovea through the optical focal point towards the object being looked at [26]. Fixation neurons in the colliculi become more active when they reach their fixation point [27] and microsaccades prevent loss of vision through habituation [28]. This allows maximal intake of

Subcortical loops through the superior colliculi

Sensory input to the superior colliculi activates, via the thalamus, the striatum which projects back to the SC through the substantia nigra. The substantia nigra pars reticulata maintains an inhibitory control over the superior colliculi. In contrast, cortical areas project directly to the striatum and loop back to cortex via the substantia nigra and the thalamus. It is conceivable that complex events can have many different segregated loops associated with them. Whether they become integrated

Cortical projections to the colliculi: corticotectal systems

In the macaque monkey, there are two distinct corticotectal systems [38]. One system is based in the visual information sent from the retina to the superficial layers of the superior colliculi and mainly involves areas of visual cortex. The visuomotor component, in contrast, projects to the deep layers of the superior colliculi from areas of frontal and parietal cortex and mediates gaze fixation, saccades and the coordination of head and eye movements during orienting. In the human, the

Thalamic nuclei between the superior colliculi and the cingulate cortex

There are retinal projections directly into nuclei of the thalamus: we focus here on those with greater limbic connectivity. The superior colliculi are connected with the medial pulvinar and with the intralaminar nuclei. The medial pulvinar receives afferents from the deep layers of the superior colliculi and projects to areas of anterior and posterior cingulate cortex. There are also afferents to the intralaminar nuclei from the intermediate and deep layers of the SC, especially from

A nested hierarchy based in the tectum?

The deep layers of the superior colliculi have inputs from other sensory modalities and their cortical representations. Functional MRI studies of crossmodal integration in humans suggest that the superior colliculi constitute the most significant region for this function while the intraparietal sulcus has a weaker integrative capacity [42]. When the connectivity of the superior colliculi in monkeys is studied by microstimulation of the colliculi during functional MRI several areas of visual

The posterior cingulate gyrus: linking sensation and memory

Posterior cingulate area 23 has reciprocal connections with the retrosplenial cortex for long-term memory and it transfers information about head and eye movements to the caudal cingulate motor area [6]. After a saccade the coding of the position of the eye in the orbit is dependent on posterior parietal inputs to posterior cingulate cortex. The machinery for linking gaze fixation with memory circuits is therefore available in these parieto-cingulate interactions.

Vogt and Laureys [6] propose a

Memory-related imagery

Bringing a troubling memory to mind activates autobiographical memory circuits which have been established through the emotional impact of the events. The basolateral amygdala has inputs to many areas significant in recording emotionally-charged life events such as the ventromedial prefrontal cortex, the posterior cingulate cortex, and the hippocampal and parahippocampal areas. It is also reciprocally connected with the insula [22]. In Brainspotting, as in sensorimotor psychotherapy, the

Interoception and gaze

The missing step in the argument so far is for establishing neural pathways for connecting the awareness of the body feeling and the spot in the visual field. The awareness of emotions and their associated body sensations while recounting a traumatic episode is dependent on the anterior insula yet there does not appear to be any significant connection between the insula and the superior colliculi. In contrast the intraparietal sulcus has an anterior region (hlP1) which is functionally connected

Healing the deep wounds of the midbrain self

Economically-driven symptom-reduction approaches to psychotherapy work with verbal techniques and checklists at a level that has little impact on the core feelings about the self. Although still to be formally evaluated, clinical experience suggests that Brainspotting is effective at a deeper level of the psyche – one that has its neural correlates in the midbrain.


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