The External Screen Model – The site of the Emotional Memory Image
Abstract
This paper proposes that emotional memory images (EMIs) – mental visualisations of the objects of our phobias or traumatic memories – are unconscious pictures viewed on an external screen (ES). Ideomotor movements represent a sensory feedback that the body experiences in response to these EMIs. EMI visualisations can be compared to the shadows projected onto the wall of Plato’s allegorical cave. They are not real, just an illusion, yet they still influence the thoughts and behaviour of those witnessing them. The ES model outlines how EMIs – which are created through the homeodynamic process of General Adaptation Syndrome (GAS) – affect the body when an emotional association is made. We provide biological and psychological justification for the ES model, in anticipation of exploring real-world applications for the ES framework through therapeutic approaches.
Introduction
Homeodynamics underpins how our body and mind dynamically interact in response to environmental instability (1). It is an important principle that aids our understanding of the functioning of the brain and the body as a unitary whole, rather than simply a summation of its parts (2). It is also integral to Selye’s General Adaptation Syndrome (GAS); the way in which the mind and body responds to, and processes, stress (3). Different stages of GAS are regulated by the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis – hence, depending on the precise source of stress, specific (physical) adaptations are elicited (4-5).
Equilibrium of the endocrine HPA axis is essential to maintaining a healthy stress response. If an individual persists in the resistance stage of GAS, allostatic overload may occur; resulting in an individual entering the exhaustion stage (where stress adaptation diseases commonly arise). The exhaustion state is an emotional brain response, also known as the amygdalin survival stress state, which activates the HPA axis (6). The HPA axis is responsible for the neuroendocrine adaptation component of the stress response – releasing catecholamines that stimulate cortisol production (6).
The HPA axis, when over stimulated, keeps the system locked in the primal survival mode of fight or flight or the freeze response (7). If the endocrine stress reaction mechanism is impaired, such as in Post Traumatic Stress Disorder (PTSD), physiological control of cortisol production is disrupted (6). Behavioural problems and low emotional resilience are also associated with changed cortisol levels – often made in response to adverse social experiences in early life, thereby altering the ability of a person to deal with stress. In line with this, cortisol levels are below normal in individuals suffering from burnout syndrome, whereas they are heightened in persons39
The External Screen model
suffering from acute and chronic stress. This means that our reaction to stress (or perceived stress) is learnt and simply picturing the stressor can place a person into a survival state (8). Picturing stress essentially involves an emotional memory image (EMI); a mental visualisation of something that has strong emotional links (such as the object of a phobia or a traumatic memory). In this paper we suggest that EMIs have a spatial location distinct from the human body: ‘the screen’.
The Emotional Memory Image (EMI)
Emotional memory images (EMI) are unconscious pictures that are constructed in response to traumatic events (9). These pictures/memories are likely encoded by neuronal networks that, when activated, trigger a re-experience of the event (a recollection). This process involves interactions between different regions of the brain in response to stimuli. Initially visual signals from the retina are relayed to the superior colliculi, before the messages are passed to the amygdala (10). The amygdala conveys information about the specific threat to regions of the sensory cortex; in order to alter or adjust on-going behaviour to protect against further perceived/actual trauma or injury (as registered by the HPA axis).
Emotional events are often remembered with greater accuracy and/or vividness (11) due to interactions between the amygdala, hippocampus and prefrontal cortex (12). The constructed EMI stimulates the amygdala limbic system and hence the chemical cascade associated with the fight or flight response. Consequently use of the prefrontal cortex (the region linked to rational thinking) is reduced and the HPA axis is overstimulated, resulting in increased cortisol production. Functional magnetic resonance imaging (fMRI) has also linked EMIs with Brodmann’s area 19 (B19): part of the occipital lobe cortex responsible for image recognition (13). Raw images registered in B19 are diffused to other areas in the brain; rekindling the trauma as if it were actually occurring in real time (13).
Consistent with these findings, activation of B19 results in altered cortisol secretions. Given that cortisol is a key stress regulator (of the GAS system), overcoming the effects of EMIs is critical in addressing stress-induced health conditions (3, 14).
Current therapeutic methods for treating EMIs
Eye movement desensitization and reprocessing (EMDR) is a psychotherapy approach designed by Shapiro to alleviate the stress associated with EMIs (15). EMDR is based on the observation that specific hand and eye movements occur when an individual accesses traumatic memories (16). These ideomotor movements represent a sensory feedback experienced by the body in response to the EMI. EMDR works by disrupting this feedback loop. Shapiro, asked patients to track her hand (mimicking specific eye movements) whilst accessing the traumatic memory. Afterwards she noted a reduction in the vividness and emotional component of that (patients) particular memory.
The process provided near instantaneous treatment of the trauma by addressing unprocessed memories and has been empirically proven to treat a range of mental and physical problems and disorders (including pain)(15). In line with this observation, many studies have reported how taxing working memory whilst recalling a negative emotional memory often lessens its vividness and intensity during subsequent recollections (17-18). EMDR does not however, engage with the specific content of the traumatic memories (EMIs). Instead it offers a well documented method for uncritically erasing them (EMIs) and has thus become popular amongst therapists working with PTSD.
The EMDR approach to addressing EMIs is beneficial to the therapist as they have less emotional stress to contend with. Yet, if the treatment was more bespoke (to the subject) – more patient-centric – the efficacy of EMDR could be increased. Currently the (EMDR) method essentially fades the EMI (by altering the mental link between the brain and the EMI) but the underlying cause (of the EMI) is not addressed, it is just hidden, which arguably only worsens the situation.
The External Screen Model
Recent research suggests EMIs should be accessed during trauma therapy (18). Given that EMIs are mental visualisations of objects with strong emotional links (traumatic memories) that form unconsciously, it is important to understand where these images manifest. Bernheim noted an external focal point for the image; suggesting a component of the mind ‘exists’ outside of the body (9). Historically, psychiatry had tended towards the monist paradigm that psychological phenomena were physical (19). Dualism however, implies that mental phenomena are non-physical and the ‘mind’ is distinct from the body; extending beyond the boundaries of the skin (20).
Dualist thinking is evident in Plato’s allegory of the cave. Essentially it suggest that: men imprisoned in a cave experience visual stimuli as shadows cast on the wall by objects passing in front of a fire. These shadows are the only reality that the men encounter until they exit the cave. They are not real – an illusion – but they influence the thoughts and behaviour of those witnessing them. The ‘illusion of perception’ is the central concept underpinning the stress-related illnesses caused by EMIs (8). By working directly with the EMI, therapists can help the mind overcome its prejudices (and hence counteract the negative effects of stress). To do so, requires an understanding of where we access EMIs.
We propose that EMIs have a distinct location, termed the external screen (ES). The ES is a (conceptual) two-dimensional area, located approximately 18 inches in front of, and six inches above, the eyes. The idea of a screen is not new. Accounts by world war II veterans suffering from PTSD describe how “the horror remained on their screen” (21); implying the immediacy of the EMIs that manifest (visually) on the screen. The proposed location of the screen is based on the following observations. Firstly, therapists noted patients looking at, and making hand gestures within, a space approximately the size of a television screen (within reaching distance) slightly above eye-level.
Patients working with problematic imagery visibly ‘shrunk’ away from the image, looking upwards at it, as if from the perspective of a smaller person (to a larger person). These emotional drivers also support a temporal-spatial explanation for the location of the screen. Secondly the issues being dealt with are relevant to the present time. In terms of ‘depth of field’, the EMI must be located in the immediate vicinity, directly in front of the patient. Finally, there is the concept of manageability. Problematic thoughts that require addressing must be physically proximal in order to be ‘handled’. This places the EMI within arm’s length (in front of) the patient.
The ES model outlined here, consolidates and strengthens the connection between EMDR and EMI by working directly with the image visualised on ‘the screen’. Since the image is a separate phenomenon (that exists distinct from the body) the therapist is able to interact, in an almost physical manner, with the EMI. Instead of the ‘blunt instrument’ approach of wiping it entirely (as occurs in traditional EMDR approaches), the therapist can instead diffuse the traumatic association, dissociating the emotional component from that image. In doing so, neither the capacity for emotion, nor the image, are removed – just the association between the two.
In line with the ES model, a therapist (EMH) noted that a patient with a wasp phobia flinched and pulled her head back at the mention of the word ‘wasp’. When asked if she could see a wasp, the patient replied to the affirmative. Taken together, these reactions would imply that the patient was visualising an EMI of a wasp on the screen. When the therapist moved his hand into the space directly in front of her (the site of the imagined wasp) it caused her distress (whilst moving his hand away from the site calmed her). This supports the idea that the spatial location of the EMI on the screen has a direct impact on the physiological stress levels of the patient (by activating B19 and increasing cortisol secretions). The therapist then placed his hand containing the EMI of the wasp into his back pocket; thus preventing129 the patient from re-accessing the EMI in its original form. This eradicated the lifelong wasp phobia in under two minutes1. Demonstrating that the EMI can be treated as distinct from the client.
Effect on client outcomes
Dissociating the emotional component of the EMI requires the therapist to ask the patient to ‘try’ (meaning attempt or fail) to focus on the EMI whilst maintaining direct eye-contact with them (the therapist). Asking the patient to essentially focus on two competing foci simultaneously disrupts the emotional connection with the image. In this way, treatment protocols either interrupt, re-categorise or otherwise banish the EMI from the patient’s mind. The EMI is, therefore, no longer able to stimulate a stress response, rendering it benign like many of the other images that constitute the visual component of human memory.
Critically, this intervention does not prevent genuine stress responses (such as the fight or flight response), but instead addresses stress caused by rogue thoughts such as traumatic memories or phobias, as well as potentially more serious psychological problems. Averting EMI- related stimulation of the amygdala (in particular the B19 area) allows cortisol levels to return to normal and thus diminishes the negative health effects of prolonged (or elevated) cortisol exposure.
Empirical research we have conducted to test this theoretical framework supports these ideas. 47 patients (from 4 different practitioners) were asked to rate their comfort level and quality of life (with respect to their specific presenting problem) – on a scale from 0 (extremely uncomfortable/ unbearable) to 10 (extremely comfortable/great) – prior to, and after, treatment using the ES model1. Although the sample size was small, after intervention we found that the average level of comfort increased by 400% and the average quality of life by 200%. In addition, we observed that for 30 of the cases, the patients presenting problem was rectified in only 1 session; whilst the remaining 17 patients were all treated within 3 sessions1. Taken together, these observations suggest that the ES model would enable therapeutic practitioners to address a range of stress-related conditions.
Discussion
This model is centred in humanistic therapeutic approaches, which aim to find natural explanations to human conditions. The ES model suggests that stress-induced illnesses occur as a consequence of long-term exposure to an EMI on the screen; resulting in overstimulation of the amygdala (and HPA axis) and sustained cortisol secretions. Understanding how EMIs, and their underlying role within homeodynamic control networks, regulate interactions between the mind and body is crucial in determining how individuals dynamically self organise in response to environmental instability (1).
This is important given the complexity of the human mind and body; meaning that emergent phenomena are not, generally, predicted from isolated parts (22). Mental and physical conditions are hence not simply a sum of individual parts, but a problem created by a combination of factors that are biological, psychological, societal and environmental in nature (23-25). The ES model is a singular approach that aims to effectively combat the impact of EMIs on homeodynamic systems. Despite the obvious subjectivity that can arise from definitions of comfort and quality of life, the rapid change in patient well-being reported here following just one treatment is significant (63% of patients questioned)1.
We suggest that therapists engage with patients, and their EMIs, in a more meaningful manner – promoting cognitive transformation – which can effectively interrupt, remove or disengage the emotional content from that image (and thus the stress-inducing component). Further, since the therapist does not need to know the precise content of the EMI, the “signal value” stimulus is a predictor of original conditioning (26-27). 1 Hudson, E.M. (2017). Hudson Mind Process. Available: www.bodymindworkers.com last accessed 10th April 2019 Compared to talking therapies, the ES model ensures that the EMI (on the screen) is neutralised – to increase resilience and decrease trauma (to future events) – rather than supporting hard-wired information (caused by the EMI) through the use of language.
In support of this view, 20% of patients were found to be worse-off after psychotherapy, than prior to starting ES model treatment (28). Similarly it was found that students attained lower grades (than the control group) following an intensive CBT-based group workshop (specifically for low-achieving students) (29). Talking therapies can lead to limbic system inflammation, as a client developing a narrative of an explicit memory reactivates the implicit, somatosensory components of the memory, often causing disregulated physiological and emotional arousal which is left unresolved (30). In contrast, the ES model allows the effects of traumatic subconscious chemical loops – created and maintained by talking therapies – to be examined. Hence the clearing of (unconscious) EMIs is individualistic (non-standardised); reducing arousal through the application of neuro-regulatory somatic interventions.
Conclusion
The ES model outlined in this paper brings together a number of relatively isolated/individual theories. It is based on empirical evidence collected from its application and utilisation by a number of therapists (treating individuals with various presenting conditions1). The ES model provides insights into how the body processes EMI-related stress responses. EMIs are constructed as part of the GAS process and subconscious ideomotor movements suggest that they (EMIs) are located in a space directly in front of the individual – termed here the external screen (ES).
These EMIs, if left untreated, have a direct link to the HPA axis and consequentially heightened physiological stress levels. We propose that since EMIs are held externally to the body, they (EMIs) can be manipulated and reconfigured, interrupting the link with the physiological stress reaction; reducing the health effects associated with elevated cortisol levels. The extent to which the ES model can be applied to other (stressful) situations is as yet undefined and requires further research. Our ES model could, for example, be used to address barriers to learning that arise from the negative individual experiences associated with both school and home life for many children.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Author Contributions
EMH, JP and LM wrote the manuscript.
Acknowledgments
The authors would like to thank Dr. P Burrows for her comments on earlier versions of the manuscript. We also thank Henk Beljaars BA Clinical Chemistry, BA Biochemistry: Laboratory of St Jans Gasthuis, Netherlands, who completed the questionaires and carried out the statistically evaluated data analyses via a Standard Normal Distribution & T-Test.214
