Traumatic memories can shape our responses to stress triggers in everyday life. It can influence our decisions and behaviours, whether we are conscious of it or not. A neuroscience-informed approach to therapy, which has gained attention internationally and is now available in South Africa, offers hope for changing patterns of thought connected to past trauma. It offers patients the opportunity to break free from the habitual responses underlying anxiety, post-traumatic stress disorder (PTSD), phobias or addiction.
“Whether directly or indirectly, many of us have been affected by traumatic events,” says Jonelle du Plessis, a clinical psychologist practising at Netcare Akeso Umhlanga who has undergone special training in Brain Working Recursive Therapy (BWRT).
She continues: “When faced with danger – whether real, perceived or imagined – our brain and body go into ‘survival mode’, which is activated in the most instinctual and primitive part of the brain.”
“This leads to the stress response of ‘fight, flight or freeze’ being triggered, and, at the same time, forms strong memories that the brain will use to create a response for dealing with similar scenarios of real or perceived danger in future. As there is no awareness of time, the response to the danger remains active.”
Ongoing cycle of trauma
“This may result in the traumatic memory being re-triggered by anything that has some association to the initial traumatic event,” Du Plessis explains. “Sounds, places or smells linked to the original trauma can trigger flashbacks and hypervigilance. The primitive brain signals increased danger, essentially creating an ongoing trauma cycle, leading to unwanted behaviours and thoughts, which can manifest in a number of mental health disorders.”
BWRT is an evidence-based technique that has gained attention internationally in recent years and is used by specially trained psychologists and psychiatrists to assist patients to develop new responses when faced with traumatic triggers. The approach seeks to empower the person to break out of their default thought patterns through working with them to create new connections, or neural pathways, in the brain.
“What makes BWRT especially helpful in working with people who have suffered psychological trauma is that it aims to work directly with the traumatic memory in the primitive part of the brain, eliminating or neutralising the urge to activate the fight, flight or freeze response of the traumatic incident. This is useful in diffusing the control that the traumatic memory has had on the person’s life,” says Du Plessis.
The question of ‘free will’
A pioneering scientist in the field of human consciousness, Benjamin Libet, suggested that we do not have free will in the way we think we do. Instead, he proposed the existence of a ‘cognitive gap’ based on a fraction of a second’s delay between when a thought enters our awareness, giving us the ability to make a decision; and when the neurological pathway is activated, before we can make a ‘conscious’ decision.
“Developed by Terence Watts, a United Kingdom-based therapist, in 2011, BWRT focuses on disrupting, reorganising or neutralising the specific problematic neural pathways. The aim is to prevent our brains from making decisions and acting on these deeply engrained mental processes before we become consciously aware of them. This allows us to regain ‘free will’, in the sense that our responses are no longer based on the reflex response to trauma built up in our minds over time.”
Who can potentially benefit from BWRT?
People with a wide range of mental health conditions – from mild depression to more complex, pervasive conditions such as PTSD, alcohol or drug addictions – may benefit from this form of treatment for breaking out of the habits of thoughts that have been ‘hard-wired’ into the brain. In addition, it can be useful in overcoming exam stress, fear of failure and performance anxiety; anxiety related conditions such as panic disorder, generalised anxiety disorder and obsessive-compulsive disorder.
“People struggling with grief and loss may re-live their trauma every day for many years, but this technique can offer a way to redirect one’s thoughts – not to forget their loss, but to help make it a little easier to move forward,” she says.
Du Plessis explains that notions of low self-worth or poor self-confidence often have their roots in traumatic memories, which may continue to negatively affect a person’s ability to function effectively in their relationships or work life. Working with the patient to help them retrain their brain can open up a whole new approach to life by escaping the fight, flight or freeze stress response, allowing the person to start thinking outside of this automatic thought ‘loop’.
“The average length of BWRT treatment depends on the individual and the intensity and complexity of the difficulties or condition with which they are dealing. The therapy may be used alone or in combination with other treatments, either in an inpatient or outpatient setting. For some people, improvement can even be noted after only one or two BWRT sessions, while others require more sessions to unseat the established neural pathways.
“BWRT has been termed a ‘quick fix’ as it can yield improvement in just a few sessions, but there is a good foundation of clinical evidence to show that BWRT produces lasting effects that have been helpful for many people.”