Traumatic Incident Reduction (eBook)

Psychological Foundations of TIR
By Robert H. Moore, Ph.D.

Introduction

Developed by Frank A. Gerbode, M.D. TIR is a regressive desensitization procedure for reducing or eliminating the negative residual impact of traumatic experience. As such it finds major application in cases of post-traumatic stress disorder (PTSD). A one-on-one guided imagery process, TIR is also useful in remediation of specific unwanted stress responses, such as panic attacks, that occur without significant provocation. “Thematic TIR” traces such conditioned responses back through the history of their occurrence in a client’s life to the stressful incidents primarily responsible for their acquisition. The resolution of the primary incidents then reduces or eliminates the target stress response.

As an intervention technique, TIR is both directive and client-centered. It is directive in that the therapist who is called a “facilitator” guides the client who is called a “viewer” repetitively through an imaginal replay of a specific trauma. It is client—or, as Dr. Gerbode prefers, “person-” - centered, in that a TIR facilitator doesn’t interpret or critique the viewer’s experience or tell him how he should feel or what to think about it. A methodical and systematic anamnesis, TIR unsuppresses the trauma being addressed to provide the viewer the opportunity to review and revise his perspective on it. TIR’s uniqueness lies, in part, in the fact that a session continues until the viewer is completely relieved of whatever stress the target trauma originally provoked and any cognitive distortions (e.g., observations, decisions, conclusions) embedded within the incident have been restructured. (Gerbode, 1989)

TIR’s Philosophic Roots

TIR and virtually every other contemporary regressive and imaginal desensitization procedure used in the remediation of trauma—including “sequential analysis” (Blundell and Cade), “direct therapeutic exposure” (Boudewyns), “prolonged imaginal exposure” (Foa and Olasov), “gradual dosing” (Horowitz), “dianetics” (Hubbard), “flooding” (Keane and Kaloupek), “repetitive review” (Raimy), and “implosion” (Stampfl and Lewis)—derive directly from principles clearly articulated in the earliest writings of Freud and Pavlov. Although the latter, Pavlov, is properly credited with the identification of the “conditional reflex” and its chain-linked “secondary signaling system” (the model most commonly referenced in connection with PTSD acquisition), Freud earlier had made the equivalent observation about the development of the traumatic neuroses. He wrote:

The essential congruity of the Pavlovian and Freudian observations, in this connection, prompted Astrup (1965) to note that:

As TIR draws heavily on these same well-established principles, Dr. Gerbode, who was originally schooled in psychoanalysis, and Dr. Robert H. Moore—a cognitive-behaviorist colleague, and author of these notes—routinely reference this intersection of the Freudian and Pavlovian constructs in presentations of TIR to the mental health professions.

PTSD And Imaginal Procedures

Whether favoring the remedial logic of “abreaction“ or of “extinction,” dedicated trauma workers display a strong and growing philosophic and clinical consensus regarding the importance of addressing traumatic experience with a guided imagery procedure like that employed by TIR.

In their review of theoretical and empirical issues in the treatment of PTSD, Fairbank and Nicholson (1987) conclude that, of all the approaches in use, only those involving some form of direct imaginal exposure to the trauma have been successful.

Roth and Newman (1991) describe the ideal resolution process as one involving “a re-experiencing of the affect associated with the trauma in the context of painful memories.” Such a process, the authors point out, brings the individual “to both an emotional and cognitive understanding of the meaning of the trauma and the impact it has had...and would lead to a reduction in symptoms and to successful integration of the trauma experience” (p. 281).

Grossberg and Wilson (1968) have shown that repeated visualization of a fearful situation produces a significant drop in the physiological response (GSR) to the threatening image.

Folkins, Lawson, Opton, and Lazarus (1968) have demonstrated the efficacy of rehearsal in fantasy in reducing the physiological response (GSR) to a frightening movie.

Blundell and Cade (1980) independently confirm that repeated visualization of an anxiety-provoking situation produces a significant reduction in the physiological (GSR) response to the threatening image. Frederick (1986) used a very TIR-like desensitization procedure with trauma victims:

He contended that such incident-specific treatment is essential to overcoming PTSD. Using mental images, the client reviews, frame by frame, the entire sequence of the traumatic experience. During the process, the client is able to recall and disclose significant thoughts and feelings related to the trauma and, consequently, anxiety associated with the trauma dissipates. (Hayman, Sommers-Flanagan, and Parsons, 1987)

R. D. Laing concurs:

Some trauma therapists employ hypnosis as an accessing tool. Although this is not the case in TIR, it is interesting to note the similarity of the hypnotic and non-hypnotic approaches to resolution, once the client has contacted and begun to unsuppress a traumatic incident.

The Ericksonian procedure for addressing the content of a traumatic incident employs a trance state. Following hypnotic induction, his retrospective “jigsaw” technique guides the client in recovery of the cognitive and emotive components of a painful memory in whatever order the client can most easily confront:

MacHovec (1985) confirms that hypnotic regression can be used to help clients recall and revivify a traumatic incident, vent emotions, and gradually reintegrate the experience with improved coping skills.

PTSD And Cognitive Restructuring

Like other effective trauma resolution processes, TIR is not primarily a cathartic technique. Gerbode (1986) affirms the professional consensus that cognitive restructuring is prerequisite for thorough trauma resolution. Raimy (1975) concurs:

Speaking specifically to the use of imaginal exposure in the rational-emotive treatment of PTSD, Warren and Zgourides (1991) report that:

Beck (1970) lends additional support to the importance of cognitive restructuring during what he calls “rehearsals in fantasy” in his observation that: