06 Aug Using SDR Therapy in Your Practice
Deciding Which SDR Technique to Apply
As you master and practise the various SDR techniques, you’ll find that you quickly develop an excellent sense of which may be more appropriate in different types of situations. This article will hopefully speed that process.
Keep Principles Firmly in Mind
SDR Therapy has one mechanism only: it is purely a rapid extinction mechanism for conditioned feelings, thoughts, and behaviours. Although incredibly powerful and able to eliminate unwanted feelings, thoughts and behaviours very rapidly, SDR does not work unless it is used with precision because it relies utterly on effective disruption of a conditioned stimulus which is actively being triggered. It is not like inhibition strategies like CBT, where you hope to “wear away” a problem over time. SDR actually gets rid of issues immediately and permanently, without the client having to learn or practice new behaviour.
This means that SDR will fail if we:
- Don’t identify and trigger a precise conditioned stimulus which is complicit in the problem (vague instructions to “think about” something, or “keep your mind on” something are not useful)
- Don’t apply an intense enough disruptive factor (a feather touch or a quiet sound is not going to disrupt a strong viscerally-felt conditioned response)
- Don’t precisely trigger and disrupt simultaneously (the conditioned stimulus cannot be disrupted if it is not even active)
Some people wonder if SDR “installs” more adaptive responses and the answer is that it does not. This thought of “installing” has its genesis in new-age pseudoscience including NLP (neuro-linguistic programming) and is echoed in some of the more modern research projects on extinction mechanisms involved in memory and learning, where some researchers claim that a “new memory” can effectively suppress an old one, so that a conditioned response is not really extinguished, but is “overwritten”.
This concept of installing or overwriting is just that, a fanciful concept, which has not been demonstrated to be actually true.
Conditioned responses are not stored in the brain and therefore are not overwritten. They must actually be accurately recreated each time, and this process of recreation is called “reconsolidation”. If the reconsolidation process is disrupted (please note that disrupt and distract are two very different processes and if all we do is distract then it will not work) then the conditioned response is extinguished immediately and permanently.
There Are Many SDR Techniques
The definition of SDR is as the name suggests, sensory disruption of reconsolidation of conditioned responses.
But what is “sensory”? Sensory can be any external or internal stimulus that is related to sound, sight, touch, smell, or taste, including bodily felt sensations of all kinds. This is possibly infinitely broad, since we can only experience the world through our senses, real or mentally imagined.
So any time we use a bodily experienced sensation, whether real or imagined, as a disruptive factor, we have the “sensory” part. This could be:
- Physical touches (brushing, tapping, scratching, pulling, rubbing, pinching, squeezing)
- Movement (walking, running, dancing, jumping, spinning)
- Taste (real or imagined)
- Sound (real or imagined)
- Sight (evocative images, real or imagined)
- A different conditioned stimulus which evokes a very different feeling to the unwanted conditioned response
So even EFT or EMDR, if applied according to the principles of SDR and not according to their spurious theoretical bases or flawed practices, could be considered to be SDR techniques.
Below are the techniques taught in the SDR Therapy Training Program, along with contraindications which require avoidance or delay in using SDR, followed by some descriptions of suitable applications ….
SDR Therapy Techniques May Be Contraindicated
Some SDR techniques are generally contraindicated for:
- Severe unipolar depression
- Dissociated identity disorder
- Bipolar disorder
- Borderline personality disorder
- Sociopathy or psychopathy
These are NeuroStim, the Disruption Triangle, and Anchoring. Because these types of SDR techniques are effectively dealing with unconscious material in a stimulatory way, they have the potential to create abreaction, and while abreaction is possible in any therapeutic interaction, these specific techniques increase the possibility.
In addition there can be important reasons to delay application of any intervention, and some of these are:
- Insufficient understanding of the presenting issues – more exploration required
- Insufficient rapport and therefore potential difficulties with trust/compliance
- Complexity of presentation/s, particularly where identity issues or defence mechanisms could sabotage any process
The Complex Client
In the SDR Therapy Training Program we spend considerable time outlining and discussing issues which can prevent progress. Complexity of presentation/s should signal a warning to slow down and avoid intervening too soon because of the risk of triggering feelings of threat.
A client who consciously or unconsciously perceives their symptoms to be part of their identity, or an important defence mechanism, is most likely going to react unhelpfully if you simply eliminate one of those symptoms very quickly. Or they may sabotage the intervention and not engage with it even though on the surface they may appear to do so. Such a client can end up discharging themselves from the program in order to avoid the result that they initially said that they wanted.
You may spend several sessions simply getting to know the client and gain what feels like a comprehensive understanding of the etiology and characteristics of the full range of symptomatology, and also gain the client’s trust. This will most likely include helping the client to experiment with perceiving some things differently, coaching them on issues like sleep or communication for example, giving them time to actually experience benefit from working with you.
In the case of issues such as chronic pain or anxiety, where the client is dealing with a hyper-alert or over-aroused nervous system, you may need to work systematically to resolve stress factors in the client’s life, before tackling the pain or anxiety head on. This is because you’re going to make little or no progress if the client is continuously traumatised or distressed because of lifestyle or environmental problems. The great majority of clients with non-malignant chronic pain without clear etiology can quickly eliminate that pain altogether, but not if we rush at it like a bull at a gate.
NeuroStim is useful when we discover an extremely evocative phrase that the client uses in association with an unwanted feeling, thought, or behaviour, or which someone else has used in their hearing. It is very effective in the treatment of non-malignant chronic pain without clear etiology.
It is also very effective when the client has a strong visceral reaction which they can describe sensorially in their own words, or a strong visceral response to someone else’s words. For example you might notice that the client keeps putting their hand to their throat, or wrapping their arms around themselves, or rubbing their temples. What is the bodily felt sensation that has caused them to do that and how would they describe that in their own words?
NeuroStim can be an appropriate intervention for some of the sequelae of PTSD or trauma, and also for OCD.
The Disruption Triangle
The Disruption Triangle is very useful for fears or phobias, for anger/rage, for reluctance, and for negative beliefs about self. It is a superb way to eliminate maladaptive habits in minutes rather than days.
Anchoring provides a way to use a specific conditioned response as a disruptive factor for another conditioned response, and is particularly useful for “addictive” eating, anger or grief/loss. With anchoring we simultaneously trigger two very strong conditioned responses.
For example an “over liking” for chocolate could be paired with the thought of drinking blended snails. Anger could be paired with the thought of the sleeping face of one’s child. Grief/loss would be trickier and depend on the client’s unique conditioned responses.
Some people will dispute that the aspect of Logotherapy which we teach is actually an SDR technique. I maintain that it is, because it uses language to disrupt a troubling thought or belief (which in fact is a conditioned response).
An example could be an intrusive and repetitive thought that the client may or may not know is untrue but nevertheless cannot stop replaying.
Taught as an SDR technique, this style of focussing disrupts the conditioned responses by introducing client-led metaphors over the top of them. It can be useful for any troubling body sensation associated with an issue, even including non-malignant chronic pain without clear pathology.
Like focussing, GaugeWork also works by introducing a client-led metaphor to the unwanted conditioned response. I tend to use it in cases of generalised anxiety as an adjunct to more targeted applications such as NeuroStim or the Disruption Triangle.
The “Break It” Technique (similar to franctionated trance induction)
This one is non-verbal and not at this time actually in the course because I forgot that I used it until I was doing some co-facilitation with a student to help implement SDR Therapy into her practice.
I ask the client to try really hard to get upset again over something that had been upsetting previously, and my demeanour and voice match his/her previous expression. Just as they’re getting there, I giggle and/or change my demeanour/voice to totally mismatch in a humorous way. I apologise and once again try to get the client to feel the distress. I repeat this perhaps three times.
Here’s an example:
The client is in tears as he recounts some criticism he had received. I make a note of the exact words used by the critic, and continue with the discussion around this event. Later I ask if the client would like to keep the hurt feelings or would prefer to feel unaffected – more on this below in “Checking in with Your Client Before the SDR Intervention”.
So I ask the client to see if they can get in touch with that event again, and I begin to repeat the words used by the critic so that it seems that I’m trying to help them to focus well. But I accentuate in a playful way, or make myself look ridiculous, and crack up before quickly apologising and becoming serious again. And so on.
Now when we use something like NeuroStim on these words, the SUDS will reduce quite quickly and easily and the client will be unable to raise any distress no matter how hard they try. This is normally accompanied by new cognitions which the client feels compelled to express.
Checking in with Your Client Before the SDR Intervention
Almost always, just in case I’m trampling over something that’s ecologically/dynamically important for the client, even though it may seem maladaptive, I ask the client “would you like to keep that feeling or would you prefer to feel a different way” “do you need that feeling in order to be safe or to cope, or are you fine without it” or “that pain in your neck, do you want to keep it for any reason or would you prefer to not have it any more”.
Rarely this can result in a conversation about defence mechanisms. More typically it allows the client to really feel the OKness of letting something go, and I’ve introduced some cognitive dissonance or a factor of permission around that agreement which may help to ensure their co-operation in doing the intervention well, and making the important changes that are necessary to get their stress levels down permanently.
Keeping Score and Keeping it Real
I cannot stress enough that when a conditioned response has been extinguished the client does not generally feel any different. They simply don’t have the response any more. They may even deny that they ever had the response because it just doesn’t “fit” for them now. They may rationalise the lack of response by creating a reason such as “I just changed my mind”.
In addition we don’t want to kid ourselves about progress, so we want to put our work to the test in a very rigorous way. If it’s going to break we want it to break in our office, not when the client gets home and has to deal with it alone.
So we keep score, both in order to have a benchmark, and in order to avoid kidding ourselves over progress. The SUDS or VAS are typically excellent ways to get a benchmark for an issue pre-intervention, check progress during an intervention, and check again post intervention, sometimes even exploring whether the work holds true even under imagined threat/stress conditions.
Likewise test instruments such as the Beck Depression Inventory, and several others, are more comprehensive indicators of whether or not intrinsic changes are being made.
Therapists Ask Such Great Questions
I put this article together as a result of questions asked of me by students going through the SDR Therapy Training Program. Great questions provide an opportunity to deliver more clarity so thank you for asking!
Free SDR Therapy Training
A great way to test out SDR Therapy for yourself is to do the free training which you can enrol in HERE.