When the Past is Always Present Part 1

When THE PAST Is Always PRESENT.

Emotional Traumatization, Causes, and Cures.

RONALD A. RUDEN.

Series Editor's Foreword.

For more than 40 years, starting with Stress Disorders Among Vietnam Veterans (1978), the Routledge (originally Brunner/Mazel) Psychosocial Stress Series has published important breakthroughs in the study and treatment of the traumatized.

The book When the Past Is Always Present: Emotional Traumatization, Causes, and Cures by Ronald Ruden, MD, PhD, an internist and clinical research scientist in New York City, is a welcomed and appropriate addition to the series. Ruden's work was familiar to me because of his theoretical treatises published in Traumatology between 2005 and 2009. Each were widely read and considered by the editorial board and ad hoc reviewer specialists to be significant contributions to an emerging field in the treatment of traumatization.

For the series, I suggested that Dr. Ruden formulate a book for the busy professional, so that pract.i.tioners would be able to pick up the book and quickly get the feel for what he had to say, and then be able use the therapeutic procedures he describes to help their clients. The publisher and I agree that Dr. Ruden has succeeded in this task.

Some who read this book will be incredulous, as were most of the reviewers for Traumatology, in the beginning. Eventually, the journal reviewers and those who reviewed the proposal for the book and this final version grasped the importance of this new paradigm and began to appreciate the positive implications of this orientation.

Dr. Ruden presents a neurobiological theory for the effectiveness of a type of exposure therapy that involves emotionally reexperiencing a trauma coupled with sensory stimulation. This theory synthesizes evolutionary biology with current neuroscience research and provides an explanation for the mysterious success of some odd and still controversial alternative therapies. Importantly, he offers suggestions for recognizing symptoms that could arise from a traumatization, and concludes that once recognized, a therapist should actively seek their traumatic origin so the event can be recalled and treated. Dr. Ruden then takes his findings one step further and suggests a new biologically consonant therapy he calls havening. This curious word, derived from the word haven, means to put into a safe place. Dr. Ruden and others believe that the ability to find a haven, while experiencing an intense emotional event, is at the core for both preventing and de-encoding a traumatic memory.

How is this accomplished? Why should this work? This book introduces the concept of psychosensory therapy, the use of sensory input to alter an emotionally traumatized brain. Before operationally defining traumatization, Dr. Ruden describes the conditions necessary and sufficient for a traumatic encoding moment. The consequences of this encoding are then illuminated. Dr. Ruden outlines in a general fashion the biology for curing a traumatization. He then specifically ill.u.s.trates how applying havening fools the brain into believing a haven has been found, leading to a cure of the direct consequences of traumatization. For Dr. Ruden, a cure means that stimuli that had previously released stress chemicals and caused the reexperiencing of some or all of the encoded traumatic event are no longer able to do so. He does this without drugs or talk therapy.

The Psychosocial Stress Series, the oldest of its kind in the area of traumatic and systemic stress, welcomes this book with enthusiasm. While not the final word, it offers a different approach that will ultimately allow us to make traumatic memories a thing of the past.

Charles Figley, PhD.

Series Editor.

New Orleans, Louisiana.

Foreword.

A single concept is destined to dominate the field of psychotherapy for the rest of this century. That concept-emerging from profound breakthroughs in our understanding of the biological foundations of human emotion, thought, and motivation-is neuroplasticity. The brain is continually changing, learning, and evolving, and it is capable of changing itself in ways that could not even be imagined a few decades ago. As summarized by Columbia University neurologist Norman Doidge, MD: "The discovery that the human brain can change its own structure and function with thought and experience, turning on its own genes to change its circuitry, reorganize itself and change its operation, is the most important alteration in our understanding of the brain in four hundred years."

Freud's "talking cure" utilized insight and the uncovering of unconscious motivations, all within the container of the therapeutic relationship, with its transferences and countertransferences waiting to be a.n.a.lyzed. Sometimes this led to profound changes in behavior and life satisfaction. More often it just led to greater insight into the roots of one's misery. A hundred years later, we are able to identify many of the neurological shifts that are required to overcome depression, phobias, generalized anxiety disorders, obsessive-compulsive behavior, posttraumatic stress disorder (PTSD), and a host of other psychiatric maladies. Being able to facilitate desirable changes in the brain's chemistry trumps insight, willpower, and therapeutic rapport.

So the race is on. What therapies are able to most effectively, efficiently, and noninvasively shift the neurological underpinnings of problems people cannot overcome through willpower alone? Among the most promising of these new clinical modalities are descendents of Roger Callahan's Thought Field Therapy (TFT). By simply tapping on acupuncture points on the skin of traumatized patients while they were bringing to mind a distressful memory or trigger, something amazing seemed to occur. The memory or emotional trigger lost its ability to activate the fight-or-flight response that keeps people trapped in traumatic stress disorders. While initial case reports were met with tremendous skepticism, recent controlled trials support the early claims. Forty-seven of 50 Rwandan orphans who scored within the PTSD range 12 years after their parents were slaughtered in the genocide of 1994 were no longer above the PTSD cutoff after a single session of TFT according to caregiver ratings. Nor were they plagued by unrelenting nightmares, flashbacks, concentration difficulties, aggression, withdrawal, bed-wetting, or other symptoms of posttraumatic distress. Their improvements held on one-year follow-up. Abused male adolescents showed comparable improvement after a single session of tapping on acupuncture points, with 100% of the treatment group starting in the PTSD range and dropping below it after one treatment session. A wait-list comparison group showed no changes. Other studies are reporting similar findings.

How is this possible? That question has been engaging the fertile mind of the author of this book for the past half-dozen years. Dr. Ruden, a physician with a PhD in organic chemistry, worked early in his career with n.o.bel laureate E. J. Corey at Harvard, pioneering computer models of chemical synthesis. Now after three decades of practicing internal medicine and having established himself, with his book The Craving Brain, as one of the leading authorities on how advances in the neurosciences can bolster the treatment of disorders such as addictions and obesity, Dr. Ruden's career has taken an unconventional turn.

I met Dr. Ruden when he was newly into the approach discussed in this book. He confided to me that although he had established a substantial reputation for treating addictions rapidly and effectively, this new approach was producing stronger outcomes than anything else at his disposal. And it was deceptively simple to apply.

How can tapping on the body help people overcome long-standing, severe psychiatric disorders? The explanations that were being posed reached back thousands of years to acupuncture theory or postulated "thought fields" that cannot be detected or measured. Extraordinary results were being produced with no coherent scientific explanation. Dr. Ruden was deeply puzzled. This book is the fruit grown from that puzzlement.

With When the Past Is Always Present: Emotional Traumatization, Causes, and Cures, Dr. Ruden has done no less than to redraw the Eastern healing maps-written in the elusive ink of energy fields, energy centers, and energy pathways-with the neurologist's precise concepts and language for understanding therapeutic change. This monumental accomplishment will stand as the pioneering reference on the relevant neurochemical mechanisms as we move into a future where the techniques presented here become mainstays of psychotherapy and healing. The first eight chapters provide a laudable first formulation of the neurological foundations of trauma-based disorders, their cure, and how the methods featured bring about that cure with unprecedented effectiveness.

The ways to apply these methods, the best protocols, and the necessary ingredients are all areas of controversy. The original approach used specific acupuncture points. It stimulated them by tapping them in a given order. Now more than two dozen discrete variations have been developed, each with its own proponents, literature, and training programs. Many still use acupuncture points, although not necessarily those originally prescribed, nor are they tapped in the order that was originally suggested. In fact, some no longer use tapping, or acupuncture points for that matter. Some focus on other energy systems familiar to Eastern healing and spiritual traditions, such as the chakras or the aura. Some believe that almost any innocuous sensory stimulation, combined with the mental activation of a problem or a goal, can lead to desirable neurological change. Dr. Ruden enters his preferred approach, called havening, into the ring with this book. It is built upon his experimentation with numerous formulations in treating literally thousands of patients. Perhaps the most interesting thing about these approaches, however, is not whether or not havening is better than the others, but that they all seem to obtain similarly strong results. One day research studies will have distinguished the most important elements in the almost unbelievable effectiveness of these methods, but this book already provides strong and illuminating hypotheses for how they impact the brain.

David Feinstein, PhD.

Ashland, Oregon.

Preface.

To permanently eliminate chronic physical and emotional pain without drugs or surgery, literally in minutes, where all else has failed, should be considered under the heading of "miraculous." At the core of these miracles, I believe, is the ability to erase the emotional response to a traumatic event. Is this really possible? Until recently, traumatization encoded enduring memories, emotions, and sensations in our mind and body that produced lifelong distress. Because of the way a traumatization is embedded, we are often at a loss to understand why our thoughts, feelings and even our physical bodies behave the way they do. The lack of awareness as to the origin of these problems is of enormous import as it prevents individuals and healthcare providers from considering that the symptoms and behaviors are of traumatic origin. This leads to unnecessary suffering as traditional therapeutic interventions almost always fail.

Herein we describe a therapy that cures suffering arising from trauma. It is rapid and has no side effects. It can be self-applied. Like the ancient shaman1 and the modern faith healer,2 it uses touch and other sensory input as one of its primary therapeutic tools. While Western medicine views these somatic therapies with skepticism, I know that it works.

This therapy arose from research seeking to uncover the neurobiology of tapping, a therapeutic approach first described by Dr. Roger Callahan3 and further developed by Gary Craig.4 Tapping, literally tapping, on acupuncture points after recalling an emotional event produced remarkable relief for both psychological and physical problems. Uncovering the neuroscience behind tapping has led to a therapy called havening. Havening, the transitive verb of the word haven, means to put in a safe place. During havening, our responses to stimuli that remind us of the trauma are changed forever. In its most basic form, havening is a process that involves three phases. First is the generation of affect by cognitive retrieval of the event or one of its components. Second is a special form of touch, havening touch, comforting and soothing, applied after retrieval of the memory. Havening touch is intermixed with other forms of touch, such as tapping. Third, accompanying the havening touch, the individual follows a set of instructions designed to distract. Each phase plays a role in extinguishing the consequences of traumatization and freeing us from the chains of remembrance. The moment this is accomplished, one is havened.

This book describes the process and conditions necessary to encode an event as a traumatic memory. Understanding this allows us to more readily diagnose certain symptoms as arising from a traumatic event. For example, one should consider that a painful condition is the result of a traumatization if there is no evidence for a recent injury, if the pain is nonanatomical in distribution, and if the response to traditional therapy is poor. Certain psychological conditions, such as phobias, panic disorder, and of course, posttraumatic stress disorder, alert us to the probability of a traumatic origin. A history of an unresolved, highly emotional event makes the diagnosis of a trauma-related disorder more likely. Seeking the earliest recollection of symptoms and even earlier events that may have set the stage for the traumatization is necessary. This requires thoughtful and recursive questioning.

To Western eyes, havening therapy might appear bizarre, but to watch pain instantly disappear, psychological problems resolve, and disturbing memories fade into the irretrievable past is nothing short of astonishing. While some forms of this therapy have been around for over two decades, many mental health professionals remain skeptical, given that it involves no medication, talking, or prolonged exposure to the original traumatizing event. It is certainly at odds with currently accepted biological principles of healing. It is hoped that putting this therapy within a neurobiological framework will open the way for acceptance of these new methods of healing.

Notes and References.

1. The term shaman is believed to have originated among the Siberian Tungus (Evenks) over 30,000 years ago. The literal translation of shaman is "he (or she) who knows."

2. Randi, J. (1989). The faith healers. Amherst, NY: Prometheus Books..

3. Callahan, R. (1985). The five-minute phobia cure. Wilmington, DE: Enterprise. Retrieved from www.tftrx.com.

4. Craig, G. Emotional freedom techniques. Retrieved from www.emofree.com.

Acknowledgments.

I am grateful to Dr. Paul McKenna, who six years ago asked whether I had heard of Dr. Callahan's approach for the treatment of psychological problems that involved tapping on various parts of the body and face. I hadn't. His direction led me to read several books on the method, and I later spoke with several pract.i.tioners, including Mary Sise, MSW, then president of the a.s.sociation for Comprehensive Energy Psychology (ACEP), and Steven Reed, PhD, a psychotherapist from Texas. I was intrigued and curious to understand how this therapy worked.

During the course of my research I encountered Dr. Joaquin Andrade, an internist with training in traditional Chinese medicine from Uruguay, and one of the authors of a paper discussing the use of this therapy with 29,000 patients over 14 years. He, along with his colleagues Dr. Christine Sutherland and Dr. Martin Alberese, guided my early thinking about this therapy. I also had the good fortune to discuss this methodology and other ideas with Dr. David Feinstein, the other author of that paper.

I began exploring the research on conditioned fear and its extinction. Researchers such as Joseph LeDoux, James McGaugh, Denis Pare, Karem Nader, Michael Fanselow, Elizabeth Phelps and others provided useful neurobiological data. Later, as the de-traumatization hypothesis described here was being formulated, the clinical literature by Bessel A. van der Kolk, Mark E. Bouton, Onno van der Hart, Peter Levine, Robert Scaer, and others offered insights into the consequences of traumatic stress. I am particularly appreciative to Dr. Scaer for personally sharing his thoughts and work with me. The research carried out by these brilliant scientists is outlined in this book.

Through hours of patient contact, reading, and discussion with other individuals, I was able to formulate a potentially useful model on why tapping works. By far the most important was my brother, Dr. Steven Ruden. He, too, was amazed at what he was able to do and contributed much to my understanding. My colleagues Vera Mehta, PhD, Vera Vento, MSW, and Barbara Barnum, RN, PhD, also read many versions of this ma.n.u.script and were insightful and encouraging. These discussions led me to formulate a new approach, which I call havening.

Also of great importance was my spouse, Jacalyn Barnett, who as every author knows, had to deal with the obsessive determination needed to complete the task. I am beyond grateful to her for making our home a place where I could do this. Marcia Byalick superbly line edited the ma.n.u.script, making it more readable. Steve Lampasona ([email protected]) is the talented artist who provided many of the book's images and the cover. Clara Joinson, my editor while developing the ma.n.u.script that was presented to the publisher, was instrumental in helping me clarify my thinking. Anna Moore, my editor at Routledge, guided this project with a loving hand. She gave the ma.n.u.script to Dr. Mel Harper, a brilliant researcher whose investigations involve understanding how trauma is de-encoded within the brain. His review was illuminating, to say the least. He helped add precision and an additional view, that of electrical de- potentiation, making the work richer and clearer. Judith Simon, my senior editor at Taylor and Francis, displayed uncommon patience with the continued revisions of this book. Dr. Charles Figley, as editor-in-chief of the journal Traumatology, provided a forum for my early efforts and was invaluable in encouraging Routledge to publish the book.

Finally, I thank my patients, who generously provided feedback as to what worked and what didn't. Their trust allowed me to experiment and explore.

Author's Note.

This book speculates about how and why emotionally reexperiencing a traumatic event coupled with the simple laying on of hands and other sensory input can cure trauma-based illness. The content is primarily for clinicians, but lay readers may also find it of interest. It is not an academic book in the traditional sense; rather, it is a primer that introduces a neurobiological theory on how trauma is encoded and gives practical advice on how to cure its consequences. While clinicians will be readily able to apply these methods, untrained individuals may also be able to self-administer these techniques for simple problems. For individuals suffering from complex trauma, it is best to work with a trained therapist.

Throughout this book is information that is somewhat technical in nature and highlighted in bold italics. Examples and ill.u.s.trative stories within the body of the text are italicized. Bolded text indicates the introduction of a new term; these terms can be found in the glossary. In addition, bold text is used for emphasis.

This book uses references directly from the Internet because they are easily accessible by readers. One reference that has been useful in providing overviews of topics is Wikipedia, the free online encyclopedia. Appendix I provides notes and additional references for the interested reader.

1.

A THIRD PILLAR.

This chapter introduces a group of therapies that treats emotional and physical disorders encoded in the brain as a result of traumatization. We term this group the psychosensory therapies. This term ties together techniques that have long since been introduced by others. It is suggested here that the psychosensory therapies be included along with the psychotherapies and psychopharmacology as one of three pillars for the treatment of physical and emotional suffering. While language in the psychotherapies and drugs in psychopharmacology are the tools that are used to produce change for these two pillars, it is the extrasensory response to sensory input that effects change in psychosensory therapy. In the psychosensory therapy havening, touch produces the change. It is not just the simple act of touch and the brain's concomitant response that is therapeutic; it is the meaning the brain ascribes to the touch that appears to be critical.

Memories are the stuff we are made of. They consist of acquired knowledge, the forms, faces, and personalities of people we have met, things we have seen, and things we can do. There are memories that provide pleasure, and others that cause pain. We are traumatized when, reminded of a painful memory, we reexperience the original emotions and feelings.

Traumatization Appears to Produce Immutable Feelings, Thoughts, and Behaviors as if Written in Stone.

You cannot find a safe place. Everywhere you go there is danger and distress. You wish for safety and seek it continually, but it never comes, for there is no rest without a haven. Anita, the granddaughter of a Holocaust survivor, won't leave home without a loaf of bread in her purse. Every night before going to sleep Sarah checks under her bed for snakes. Marty has suffered from a nonstop headache for two years. Rosa panics whenever she leaves her home. Josie worries about low-flying planes crashing into her apartment. John's left nostril has been congested for seven years. For these individuals, this is life following their traumatization. Strange behaviors, unremitting pain, extraordinary physical sensations, and irrational fears are the consequences of the pathological brain-mind-behavior-body connections caused by traumatization. These abnormal connections produce distress beyond words. What causes this to happen? How does it happen? Why doesn't it get better? While there are currently few answers, two facts are secure: Traumatization changes the individual, and the place where the change takes place is the brain.

Traumatization Always Involves Intense Emotions.

We remember things because they are a.s.sociated with strong feelings. There is no traumatization without them. Yet our entire life is filled with emotional events that aren't traumatizing. What is unique about a traumatizing event? Ultimately, traumatization is about being trapped in the uncompleted act of escape. Here, in this book, we will describe a method to help the traumatized escape from the inescapable and find a safe haven. It is here, in this safe place, that our response to the memory of the event is changed forever.

How does one gain entry into the brain systems encoding those memories that produce abnormal behavior, thoughts, emotions, and feelings so they might be altered? We offer the psychosensory therapies as another approach, a third pillar (along with the two current pillars, the psychotherapies and psychopharmacologies) if you will, to change our response to these memories. To understand why the psychosensory therapies deserve to be called a third pillar, a brief review of the two current therapies is necessary.

The First Pillar: The Psychotherapies.

Lady Macbeth's physician failed. He could only watch as she sleep-walked, rubbing her hands, trying to remove the "d.a.m.ned spot" of the murdered king's blood. Aware this behavior was beyond his understanding, he was nonetheless prescient when he commented, "Infected minds to their deaf pillows will discharge their secrets."1 The physician who spoke Shakespeare's words was referring to what happens during sleep. Three hundred years later Freud2 listened to those secrets in the imaginary world of sleep, in stories we call dreams. Dreams, Freud declared, were the "royal road to the unconscious" that led to where the infection lay buried. By bringing these memories to conscious awareness and a.n.a.lyzing them, the unconscious would yield its secrets, thus uncovering both their origin and an approach to treating the problem. This could be accomplished, according to Freud, by talking with a trained professional who helped decipher the metaphorical clues in dreams. His ideas are described in his 1899 book The Interpretation of Dreams. Other early researchers, including Jung3 and Janet,4 also dug into the dreams arising during sleep to find the moment of traumatic encoding.

Over the last century, various methods for talking to patients as a way of treating problems became grouped into an approach called the psychotherapies. By using language, as in conversation, it was hoped the response patterns to memories could be altered. The pillar of psychotherapy attempts to deal with distressing emotions arising from life experiences. 5 In general, most pract.i.tioners use the problem-cure model. The goal is to help the individual understand the origin of his or her feelings and reframe them so that they are no longer distressful. Psychotherapy uses only spoken conversation and occurs within a structured context. I do not know any talk therapy that encourages the therapist to touch the patient. In fact, it is generally forbidden-the cordial shaking of hands being the only exception. Research reveals that the quality of the relationship between the therapist and the client has a greater influence on client outcomes than the specific type of therapy used by the therapist. Below are listed several systems of psychotherapy.

Cognitive behavioral.

Person centered.

Psychodynamic.

Psychoa.n.a.lytic.

Rational/emotive.

Systemic (including family therapy).

The Second Pillar: The Psychopharmacologies.

Decades later, armed with research showing that thought, mood, and behavior were a function of the amount and types of chemicals in the brain, physicians attempted to heal the mind by altering the brain's chemistry. It was found that different substances (drugs) entering our bodies, by either ingestion or injection, could correct an imbalance of these chemicals. By doing so, symptoms arising from these abnormal levels could be ameliorated. These drugs, instead of reframing the underlying problem, restored normal levels of the chemicals needed for information processing, which in turn changed how we felt. For most symptoms, if the underlying issues are not resolved, the beneficial effect of the drug lasts only as long as the substance remains in the brain.

Psychopharmacology6 is the study and use of chemicals to change mood, sensation, thinking, and behavior. The brain is a complex chemical soup. Dozens of substances are found to influence information processing and perception. The consequences of chemical imbalances include most of the disorders we consider psychological in nature, such as anxiety, depression, paranoia, and bipolar disorder. Thus, we have antianxiety drugs, antidepressant drugs, drugs that help us focus better, drugs that inhibit compulsive behavior, drugs that stop hallucinations, drugs that help us sleep, and drugs that help keep us awake. There are no drugs proven to cure a traumatization.

In psychopharmacology, the therapeutic relationship between the drug prescriber and the drug taker is of little consequence. The patient relates the effect of the drug, and the therapist adjusts the medications accordingly. This approach does not deal with the causes of the problem; rather, it relies on a diagnosis based on the manifestations in thought, behavior, and mood, which in turn, we have learned, reflect levels of the neurochemicals. This then leads to the choice of drugs. Below are listed some psychopharmacological drug cla.s.ses.

Antidepressants.

Antianxiety.