• jennagosta m.d.

Data Gathering Project and Emotional Triggers Treatment(ETT)

ETT and Chronic Pain Patients and ETT Going Forward 

Emotional Triggers Treatment(ETT)is one of the treatment approaches that VoiceGuidedVisionWork offers, and the Sessions section of the site has a client-oriented information of the Treatment. Some of the principles on which ETT is based and why ETT works so well was the topic of the first blog here. That info is now in the new Methodology section on the site. For even more info on the history and methods of ETT, see also

For this blog, I want to talk about the ETT data-gathering project that VoiceGuided VisionWork has been invited to join. 

Catherine Warnock, MA, LPCC, NCC, the originator of the ETT protocol, first developed ETT from her training in and experience with memory reconsolidation work. In October 2017, Catherine began to work with an MD specializing in pain management to gather “before-and-after” reports from chronic pain patients on the effectiveness of their ETT sessions.

Because the pain specialist had found that more than 70% of her chronic pain and addiction patients had a history of unresolved trauma, she was interested in seeing if resolution of past trauma might decrease the symptoms of pain and/or pain medication dependence.

This made sense from an ETT perspective, as ETT finds that chronic pain is often rooted in trauma of some kind. Chronic pain can begin as with the shock caused to body and brain at the time of the trauma event -- whether the trauma is physical or emotional. By using memory reconciliation techniques, ETT can complete and lift or reduce that “held shock” and its imprints, ultimately reducing the associated chronic pain.

From October 2017-August 2018, Catherine Warnock and the pain specialist used questionnaires to inventory the before-and-after-ETT changes within the group of chronic pain patients. They found that in addition to a significant reduction in anxiety, depression, anger, guilt/shame and general stress levels, some chronic pain and addiction patients requested that they be weaned off of the medications they were currently taking. More information is available on the ETT website. 

Today the ETT project and VoiceGuided VisionWork LLC are exploring how we might go beyond the client “before-and-after” questionnaires to gather good data on the efficacy of the ETT protocol.  One possibility is the use of brain imaging, another is the use of neurofeedback techniques. (Sometimes called “brain mapping,” neurofeedback gives us real-time displays of brain wave activity.) Through imaging we might investigate actual changes in brain structure, and through neurofeedback, we might track changes in function. 

Using imaging (MRI? fMRI? PET?), we might focus on changes over time in the size of the hippocampus, as the hippocampus is an area of the brain strongly associated with memory, and is known to be smaller than average in those with PTSD and in those who have suffered chronic deep stress. Perhaps there is some link here between the smaller hippocampus and that person being unable to extinguish, or unable close and refile, traumatic memory. It is possible that, after traumatic memory is completed and closed through ETT, this brain structure might develop in ways visible over time through serial imaging. 

For now, however, the approach that is both more available and would yield results sooner is the brain mapping techniques of neurofeedback.  Brain mapping techniques are used in neurofeedback therapy, where the goal is to improve the brain’s ability to self-regulate and to move more easily between the different normal states of activation (relaxed vs focused, for example). 

While ETT shares this goal of improving the ability to self-regulate(a right medial pre-frontal cortex ability), ETT focuses on eliminating or reducing triggered responses (work associated with changes in the amygdala). From a neurofeedback perspective, we may be able to demonstrate that ETT is effective in shifting emotional response such that parts of the brain are not inappropriately activated, as happens in a triggered emotional response.

Because neurofeedback records brain waves in real time, we wonder if we might use this kind of equipment to record brain waves before and after treatment, and at dedicated follow-up intervals. A follow-up interval of 4-6 weeks, for example, might be ideal, as it seems that this duration is optimal for the brain to fully integrate the changes that have been made during an ETT session. We would hope to demonstrate that the brain has begun to operate with a greater degree of coherence, make smoother adjustments, shows an increased self-regulatory capacity, and no longer evinces inappropriate activation. 

We are currently exploring these various methods to determine which will be most suitable to demonstrate the effectiveness of ETT through objective data.  We will be updating the info on the projects on both websites as time goes on !

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