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

A neuropsychologist expert in trauma talks about the nature of this psychological phenomenon.

Trauma is one of the concepts pertaining to psychology that generates the greatest interest in the field of neuropsychology.. Linked to emotional memory, it can damage the quality of life for years because of events that occurred long ago.

However, as mental health research evolves, forms of psychological intervention are emerging that help both to offer more comfort to patients and to understand the nature of these kinds of disorders. The expert look at trauma is always interesting, because it allows us to get an idea of the way in which our experiences leave an emotional imprint on us.

Interview to Javier Elcarte: discovering trauma

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

Q: There is a lot of talk 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 a person witnesses or experiences a terrifying, dangerous or overwhelming event.

Recently, the concept of trauma as something more complex has been gaining ground. Van der Kolk and his collaborators express themselves along these lines when they propose the concept of "Complex Post-traumatic Stress Disorders" or DESNOS (Disorder of Extreme Stress not Otherwise Specified).

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

Q: What are its effects on the sufferer's life?

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

On the other hand, if we understand trauma as a continuum, we would cover the whole spectrum, from trauma with a big "T", as explained in EMDR, i.e. extraordinary and terribly traumatic life events, to trauma with a small "t", or in other words, minor events of low stress intensity, but which happen on a daily and repeated basis, giving rise to a daily exposure where both the experience and the discomfort they generate are normalized. And of course all possible combinations between the two.

Obviously in this case, the effects of complex trauma are more profound, insidious and persistent and are at the base of a multitude of disorders. According to Cook and collaborators, complex trauma would be at the origin of Attachment Disorders, Biological Maturational Delays, Affect Regulation Disorders, Dissociative Disorders, Conduct Disorders and Impulse Control Disorders. Cognitive Difficulties and finally Low Esteem and Distortion of the Self. In other words, an enormous range of dysfunctions.

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

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

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

Q: Can you explain to us what Neurofeedback is?

It is not easy to define neurofeedback in a few lines. To speak of Neurofeedback is to speak of neurotherapy, a treatment that seeks to regulate or modify the function of the brain by acting directly on it. It does not address the psychological processes themselves, but the underlying neurobiological states. It seeks to regulate the CNS by means of equipment designed for this purpose, 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 their brain activity and modify it, achieving non-invasive and sustained improvements over time with problems of anxiety, stress, lack of concentration and/or memory, attention, hyperactivity, and many others.

Q: What about EMDR therapy?

EMDR (Eye Movement Desensitization and Reprocessing) 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 due to experiences that overwhelm us either by intensity or by their continuity or both and that we are able to process them adequately.

This incomplete or dysfunctional processing of traumatic or disturbing life experiences weakens the person's ability to integrate those experiences in an adaptive manner.

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

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

Q: Are both Neurofeedback and EMDR effective for the treatment of any psychological disorder?

It is always good to remember that in psychotherapy there are no panaceas and that no intervention can alleviate all disorders, and in turn, that all interventions can alleviate some. The therapist's art 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 finding the way to reach him/her is the great challenge of any professional.

As for Neurofeedback, 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 also hopeful indications in autism, headaches, insomnia, substance abuse, chronic pain, etc.

As for EMDR, it is a psychotherapeutic model with enormous empirical evidence, in Spain have been carried out and are being carried out several research studies in EMDR, among them I would highlight the research conducted in bipolar disorder that has had great international recognition.

It is an approach of choice for numerous treatments, such as trauma (as is obvious), 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) by the American Psychological Association (APA) as well as by the World Health Organization (WHO) and many other clinical guidelines.

Attachment trauma is not out of this research work, specifically in our center, at Vitaliza, we are conducting research to test the synergies between both interventions, Neurofeedback and EMDR in abandonment trauma with adopted children.

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

In terms of dissemination, EMDR has more presence in our country than Neurofeedback, although in both cases there is still much work to be done.

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

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