Have you heard of Brainspotting?

This article written by Desi Chu was recently published on Neuwrite San Diego.


Maybe some of you have heard of this technique, but this is my first exposure to the concept of brainspotting.


It is important for psychotherapists to remember that emotional pain is not just represented in our linguistic thought process, but also stored in our bodies. It is exciting to have scientists from the field of neuroscience to remind us that talk therapy is not just about talking. - Fred Chu


 

Brainspotting: Are the eyes the window to the soul?


“On the first session, I started by focusing on a difficult memory while concentrating on the pain that it caused me … This pain reached a climax, then … it died down, giving way to a feeling of peace and well-being … 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 … The effects were visible from the very next morning.” [1]

This is a direct quote from a case study of Pierre, a 30-year-old man who suffered from PTSD (post-traumatic stress disorder) after surviving a terrorist attack in Paris in 2015. For six months, Pierre struggled daily with flashbacks and nightmares, and was in a state of constant suffering when he finally decided to try a new kind of psychotherapy. After just one session, he concluded that “the daily feelings of sadness had totally disappeared,” and that “this work has considerably changed my daily life, and in a very positive way.” These effects were sustained nearly three months later in a follow-up appointment.

The process that allowed Pierre to have a life-changing breakthrough in minutes is a psychotherapy technique called brainspotting. To sum it up, the therapist guided him to maintain focus on a single spot in the room, or “brainspot,” while also concentrating on his memories of the event, until his feelings of suffering and distress subsided.

Skeptical? I get it. Something this simple almost seems too good to be true – can we really overcome our deepest emotional suffering just by looking somewhere? What evidence is there to support the validity of this technique? And if it does work, how is it possible?


What is brainspotting?

Brainspotting (BSP) is a psychotherapy technique that was developed relatively recently in 2003 by psychotherapist David Grand. According to Dr. Grand, when we experience trauma or some emotionally distressing experience, that memory fails to be processed normally, and therefore remains stored subconsciously in the brain as well as in the body. Dr. Grand theorizes that unlike normal memories, which are transformed into long-term memories through a process called memory consolidation, these unresolved emotions are repeatedly reconsolidated over time without reducing in intensity. This disruption introduces the potential for a wide range of conditions such as PTSD, depression, and anxiety [2]. Claiming that BSP is a “novel way to access the brain’s intrinsic capacity to heal disturbances of mental and emotional functioning,” he hypothesizes that these stored memories are linked with a specific eye position called a brainspot [2]. Maintaining continued focus on this brainspot is thought to activate circuits in the brain that enable access to the traumatic memory, allowing us to finally process the event: in essence, healing ourselves from the inside out.

One of the main differences between brainspotting and other more common forms of therapy such as talk therapy, CBT (cognitive behavioral therapy), or ACT (acceptance and commitment therapy) is that BSP is non-verbal: meaning the processing is thought to occur outside of conscious awareness rather than through higher-level thinking such as analyzing your thoughts and feelings [3]. This is considered to be the key behind the significant and near-immediate effects of BSP therapy. By going straight to the source of the emotional memory, you can then unlock access to issues deeply stored in the non-verbal, non-cognitive areas of the brain [4]. This process, Dr. Grand claims, allows you to release the memory from your subconscious, hypothetically rewiring your brain’s relationship to the memory.


BSP vs EMDR

If you’re familiar with unconventional psychotherapy techniques, you might recognize that brainspotting bears a lot of similarities to another kind of therapy involving the eyes – EMDR (Eye Movement Desensitization and Reprocessing: check out this Neuwrite article for more info). EMDR is a more established practice that was developed in the 1980s by Dr. Francine Shapiro. Unsurprisingly, BSP builds on foundational concepts of EMDR, as Dr. Grand originally started out as a practitioner of EMDR. In fact, one day while conducting an EMDR session, he noticed his client’s eye movements “wobbled and froze” [3]. He paused to see what would happen, and the client then processed traumatic memories that were not previously accessible. After finding a similar pattern in other clients, he went on to develop the practice of BSP. Both BSP and EMDR were originally developed for the treatment of PTSD and are based on the idea that specific eye positions allow the processing of traumatic memories [1]. Both also utilize bilateral stimulation (sounds that alternate between the left and right ear, or rhythmic tapping). However, one main difference is that while BSP requires fixed attention to one spot, EMDR consists of repetitive back and forth eye movements. Another key difference is that BSP is claimed to instigate the reprocessing of trauma much more rapidly, often starting from the very first session [1].



How does it work?

One of Dr. Grand’s primary claims about BSP is that “where you look affects how you feel.” BSP has also been described as “a long voyage into the depths of [yourself]” [1], and that it works at “a deeper level of the psyche” [3]. But what does that actually mean?


The current leading theory for BSP is that it activates subcortical pathways in our brain. The cerebral cortex is the outermost part of the brain that is typically associated with higher-level mental abilities such as thinking, planning, and decision making. Subcortical regions of the brain are involved in many other important functions including sending incoming sensory information to other areas, regulating bodily functions like breathing and heart rate, and perceiving pain.

Research has shown that experiencing social pain (feeling excluded, loss of a loved one, etc) activates the same neural circuits involved in processing physical pain [8,9]. Similarly, Dr. Grand theorizes that our response to social information may utilize networks that evolved to respond to visual stimuli [3]. One crucial part of this system is the superior colliculus (SC) – a midbrain structure that integrates visual, auditory, and touch information to initiate orienting (movement) of the eyes and head. The SC receives direct input from the retina, and controls shifts of attention. When we experience a threat or traumatic event, the orienting response begins in the SC. Other brain areas important for memory (hippocampus) and emotion (amygdala) also project to the SC. This explains why eye movement occurs when trying to locate a long-term memory, and that the eyes fixate once the information is “located” [3]. A brainspot therefore is hypothesized to be a stored oculomotor orientation (eye position) to a traumatic experience that has failed to integrate. In other words, the typical process that we use to orient and adapt to our environment is cut short. The resulting memory and physiological activation are thought to manifest in conditions like PTSD.

Additionally, both the retina and the SC project to a specific nucleus of the thalamus, an area important for relaying sensory information to other parts of the brain. This thalamic region then sends projections to the anterior and posterior cingulate cortex. The anterior cingulate is important for emotional processing, and the posterior cingulate contributes to self-related memories. Additionally, the posterior cingulate reciprocally connects to areas important for long-term memory, essentially linking gaze with memory circuits [3]. Though there are many other potential pathways and brain areas involved that won’t be delved into here, this is the basic circuit thought to form the connection between looking in a particular direction and processing emotional memories. This process is hypothesized to be initiated outside of conscious awareness.


So, does this really work?

I’ll leave that for you to determine. BSP is still a new technique, and its validity is certainly controversial. One final consideration is that a significant part of why BSP works is its use of “focused mindfulness,” not dissimilar to the practice of mindfulness meditation. Could the therapeutic effects of brainspotting in fact be due to the proven benefits of mindfulness meditation? Or perhaps the experience of active focusing in general? Or simply the act of being in a safe space to process difficult emotions? Is “activation of the brainspot” really a critical component of the therapy? The truth is we don’t know, and more research is needed to come to a definite conclusion.

Regardless, the possibility of using eye positions to gain access to unresolved trauma at a subconscious level is a fascinating idea, and if there is any truth to the claims of BSP, it could change the way we think about and treat psychological disorders. The existing research is relatively positive but many important questions remain unanswered. One study on the effectiveness of BSP for treatment of PTSD found that over 90% of the clients improved moderately or significantly after 3 sessions [5]. However, the sample size was small (22 participants) and there was no comparison or control group. Another report compared the efficacy of various therapeutic interventions [6]. BSP resulted in the highest proportion of people who found it “very effective,” at 60%, followed by EMDR at 31% and talk therapy at 25%. However, the responses were self-reported, and the study was not published in a peer-reviewed journal. It’s important to mention the major caveats of both of these studies, as a reminder that any positive results should be taken with a large grain of salt.


A clinical study compared CBT, EMDR, and BSP for the treatment of generalized anxiety disorder (59 participants, control group included) [4]. They reported that patients treated with BSP improved more than those treated with EMDR and CBT post-treatment, and concluded that patients treated with BSP obtained the best therapeutic results. Finally, a study comparing the efficacy of BSP and EMDR for treatment of PTSD (76 participants, no control group) found that after three treatments, both groups showed a significant reduction in PTSD symptoms, and BSP seemed to be as effective as EMDR [7]. While the findings of these studies are somewhat promising, they are far from convincing. But at the end of the day, if this form of therapy helps people, whether that’s through eye positions or some other mechanism, then I would consider it to be effective – and at the very least, worthy of further investigation.

References

  1. Masson, J., Bernoussi, A., & Moukouta, C. S. (2017). Brainspotting therapy: About a Bataclan victim. Global Journal of Health Science, 9(7), 103.

  2. Corrigan, F. M., Grand, D., & Raju, R. (2015). Brainspotting: Sustained attention, spinothalamic tracts, thalamocortical processing, and the healing of adaptive orientation truncated by traumatic experience. Medical Hypotheses, 84(4), 384-394.

  3. Corrigan, F., & Grand, D. (2013). Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation. Medical Hypotheses, 80(6), 759-766.

  4. Anderegg, J. (2015). Effective treatments for generalized anxiety disorder. Unpublished manuscript available from the Rocky Mountain Brainspotting Institute at http://rockymountainbrainspottinginstitute.com/wpcontent/uploads/2014/07/Effective-treatments-for-generalized-anxietydisorder. pdf.

  5. Hildebrand, A., Grand, D., & Stemmler, M. (2014). A preliminary study of the efficacy of Brainspotting–A new therapy for the treatment of posttraumatic stress disorder. Journal for Psychotraumatology, Psychotherapy Science and Psychological Medicine, 13(1), 84-92.

  6. Report of Findings from the Community Survey September 2016

  7. Hildebrand, A., Grand, D., & Stemmler, M. (2017). Brainspotting–the efficacy of a new therapy approach for the treatment of Posttraumatic Stress Disorder in comparison to Eye Movement Desensitization and Reprocessing. Mediterranean Journal of Clinical Psychology, 5(1).

  8. Kross, E., Berman, M. G., Mischel, W., Smith, E. E., & Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences, 108(15), 6270-6275.

  9. Novembre, G., Zanon, M., & Silani, G. (2015). Empathy for social exclusion involves the sensory-discriminative component of pain: a within-subject fMRI study. Social cognitive and affective neuroscience, 10(2), 153-164.

Image Sources

EMDR schematic: https://www.vcsnj.info/emdr.html

Subcortical structures: http://issacounseling.com/brainspotting-therapy-for-anxiety-new-orleans-and-chicago/

SC anatomy: https://biographicsworld.com

Brainspotting photo: https://www.chronogram.com/hudsonvalley/healing-the-trauma-body-with-emdr/Content?oid=13282628

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