Interview with Javier Elcarte: what do we know about trauma?

Trauma is one of the concepts belonging to psychology that arouses the greatest interest.. Linked to emotional memory, it can damage the quality of life for years due to events that occurred long ago.

However, as mental health research evolves, forms of intervention emerge that help both to offer more well-being to patients, and to understand the nature of this kind of disorders. The expert gaze directed towards the trauma is always interesting, because it allows us to get an idea of ​​the way in which our experiences leave an emotional mark on us.

• Related article: "Emotional memory: what is it and what is its biological basis?"

Interview with Javier Elcarte: discovering trauma

In the following lines we interview Javier Elcarte, neuropsychologist and founder of the Vitaliza psychological center from Pamplona, ​​Spain.

Q: Much is said about trauma and how it influences our lives, but what exactly is it?

At Vitaliza, we understand trauma as something that goes beyond the classic concept of post-traumatic stress. Indeed, we speak of trauma when the person witnesses or experiences a terrifying, dangerous or overwhelming event.

Recently, the concept of trauma has been imposed as something more complex. Van der Kolk and his collaborators express themselves in this line when they propose the concept of “Complex Post-Traumatic Stress Disorders” or DESNOS (Disorder of Extreme Stress not Otherwise Specified).

For Van del Kolk Trauma Complex would be: “the experience of one or more adverse traumatic events, in a chronic and prolonged way, in the most cases of an interpersonal nature, such as physical or sexual abuse, armed conflict, community violence, etc. and with an origin in childhood ”.

Q: What are its effects on the life of the person who suffers it?

As I have already said, the classic disorder of post-traumatic stress disorder (PTSD) It is a generalized concept in the clinic and among the general population, as well as its effects, which we can divide into three groups; re-experiencing symptoms (recurring nightmares, intrusive memories, activation reactions when remembering the trauma, etc.); avoidance symptoms (avoiding anything reminiscent of trauma, feeling disconnected, hopeless, amnesia, etc.); and symptoms of overactivation (startle response, insomnia, anticipatory worry, anxiety, etc.).

On the other hand, if we understand trauma as a continuum, we would cover the entire spectrum, from trauma with a large “T”, as explained in EMDR, that is to say Extraordinary and terribly traumatic life events, even trauma with a small “t”, or in other words, minor events of low intensity of stress, but that happen on a daily and repeated basis, giving rise to a daily exposure where both the experience and the discomfort that they generate. And of course all the possible combinations between the two.

Obviously in this case, the effects of complex trauma are deeper, more insidious and persistent and are at the basis of a multitude of disorders. According to Cook et al., Trauma complex would be at the origin of Attachment Disorders, Maturational Delays at the Biological level, Affect Regulation Disorders, Dissociative Disorders, Conduct and Control Disorder Impulses. Difficulties at the Cognitive Level and finally Low Esteem and Distortion of the Self. In other words, a huge range of dysfunctions.

Q: How do you work at Vitaliza and what techniques to use to treat trauma cases?

In our long history of approaching trauma, at Vitaliza we have been developing an integrated intervention, which includes a triangle with three vortices; the physiological regulation of the central and nervous system through Biofeedback and Neurofeedback on the one hand, the development of resources for self-awareness and relaxation through mindfulness or mindfulness on the other, and to close the triangle, intervention directed at the integration of the experiences that have led us to the symptomatology of the present through psychotherapies focused on processing from the body, "botton-up" such as EMDR, sensorimotor or others.

Therefore, generally, the therapeutic intervention is accompanied by individual bio-neurofeedback sessions and group minduflness sessions.

P: Can you explain what neurofeedback is?

Defining neurofeedback in a few lines is not easy. Talking about neurofeedback is talking about neurotherapy, a treatment that seeks to regulate or modify the function of the brain, acting directly on it. It does not address the psychological processes themselves, but the underlying neurobiological states. It seeks the regulation of the CNS by means of equipment designed for it, with the consequent impact on the underlying psychological processes.

Technically, therefore, Neurofeedback is a training that acts on the electrophysiological activity that allows the person to be aware of her brain activity and modify it, non-invasively achieving sustained improvements over time with problems of anxiety, stress, lack of concentration and / or memory, attention, hyperactivity, and much others.

Q: What about EMDR therapy?

EMDR (Reprocessing and Desensitization Through Eye Movement) is an integrative psychotherapeutic approach especially aimed at trauma intervention. It is based on the theoretical model of the Adaptive Information Processing System according to which, a large part of psychopathology is It is due to experiences that exceed us either by intensity or by their continuity or both and that we are able to process them in a adequate.

These incomplete or dysfunctional processing of traumatic life experiences or disruptive, weaken the person's ability to integrate these experiences of adaptive way.

Technically, EMDR tries to stimulate this adaptive processing system to reprocess and properly integrate these traumatic experiences through structured protocols that include eye movements or other forms of stimulation bilateral.

It is a patient-centered approach. In a way, the therapist stimulates the healing mechanisms that underlie the subject. Trauma in this sense would be an overflowing experience badly coded, and through the different phases of intervention, with EMDR the patient would access the wound processed from dysfunctional way, and would incorporate new information or access information that before was not able to access, until gradually integrating traumatic experiences or disturbing.

Q: Are both Neurofeedback and EMDR effective for treating any psychological disorder?

It is always good to remember that in psychotherapy there are no panaceas and that no intervention works to alleviate all disorders, and in turn, that all interventions serve to alleviate some. The art of the therapist is to find the most appropriate form and intervention for each patient. Not all of us respond in the same way, knowing how to adapt to the patient and find a way to reach him is the great challenge of any professional.

Regarding neurofeedback, the research endorses it as an effective intervention with ADHD and epilepsy and this is confirmed by institutions such as the American Academy of Pediatrics and others. It is effective as we have already said in everything that has to do with anxiety, stress, lack of concentration and / or memory, attention and hyperactivity. There are hopeful signs also in autism, headaches, insomnia, substance abuse, chronic pain, etc.

As for EMDR, it is a psychotherapeutic model with enormous empirical evidence, in Spain several studies of research in EMDR, among them I would highlight the research carried out in bipolar disorder that has been widely recognized international.

It is an approach of choice for numerous treatments, such as trauma (obviously), addictions, anxiety and panic, post-traumatic stress disorder, impulse control, psychosomatic problems, pathological grief, etc.

On the other hand, EMDR has been recognized as an effective treatment for PTSD (Post-Traumatic Stress Disorder due to American Psychological Association (APA) as well as by the World Health Organization (WHO) and many other guides clinics.

Attachment trauma is not outside of this research work, specifically in our center, in Vitaliza, we are carrying out an investigation to verify the synergies between both interventions, Neurofeedback and EMDR in abandonment trauma with children adopted.

Q: Do you think these techniques are known in our country? Is it necessary to inform the general public about its benefits?

At the dissemination level, EMDR has more presence in our country than Neurofeedback, although in both cases there is still a lot of work to do.

Although Bio and Neurofeedback have a long history, their final landing in Spain dates back to a few years ago. In this sense, the Spanish Society for Bio and Neurofeedback (SEBINE) was born, of which I am president, with the aim of providing this wonderful therapeutic tool of the necessary standards of empirical rigor and clinical practice conveniently approved.

With regard to EMDR, the work of the Spanish EMDR Association has been fruitful and tenacious. Today the association has almost 2000 members (all health) being one of the largest associations in Europe. It offers quality training endorsed and verified by thousands of health professionals.