Abstract

Background
Trauma exposure is common throughout the world, yet only a small minority of people in the population develop post-traumatic stress disorder (PTSD). Increasingly research has demonstrated that adverse life events (e.g., relationship breakdowns) that do not meet PTSD diagnostic criterion, can produce effects comparable to major trauma causing significant psychosocial impairment. Existing trauma therapies recommended by National Institute of Clinical Excellence (NICE,2005) are limited to Trauma-focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation Reprocessing (EMDR). Whilst both therapies have achieved evidence-based status having accumulated a large body of research supporting their use, their tolerability and longevity of effects remain questionable. Brain Work Recursive Therapy (BWRT) is a new addition to the psychotherapy arena. Not yet subject to controlled research, the positive claims regarding the effectiveness of BWRT are limited to anecdotal evidence. Yet, BWRT appears to share procedural elements compatible with EMDR, namely dual taxation of working memory (WM) which is a key mechanism considered to influence outcome in EMDR. However, questions remain regarding if, and how, BWRT works, therefore, this current study is considered an important piece of work towards the efficacy and evidence development of this nascent therapy.

Method
This exploratory study utilised a multiple single-case experimental design (n=6) and implemented a psychosomatic, mixed-method approach. An A-B-C design was adopted which included baseline, intervention, consolidation and two follow-up phases, at one month and two months post-intervention for each participant to evaluate the stability of any effects.

Results
Four participants showed reliable and clinically significant reduction in traumatic stress symptomology from pre-intervention to 1-week post-intervention, which were maintained or further improved at subsequent follow-ups. Overall, concurrent improvements were also found on measures of psychological distress and Quality of Life. In-session ratings of memory vividness and arousal decreased markedly following the introduction of recursive loop(s), offering potential support for the WM account of dual taxation. All participants experienced a rise in parasympathetic activity and a decrease in heartrate (HR) at the end of treatment, indicative of arousal reduction which was coherent with reductions on self-reported arousal ratings. Furthermore, four participants showed an increase in heartrate variability (HRV) variables from pre- to post-treatment. Qualitative findings revealed five participants had found BWRT helpful and considered the intervention responsible for change. In particular, limited exposure to the trauma memory and the immediacy of improvement experienced by participants was cited as positive aspects of the therapy.

Conclusion
To conclude, this was an exploratory study offering the first controlled research of BWRT. The results demonstrated an overall improvement with both psychological tests and HRV measures. Despite the limitations identified with regards to measurement, these initial case series findings offer support for the effectiveness of BWRT for non-complex trauma; a finding that was substantiated by participants’ qualitative reports. Future research recommendations include the use of additional physiological measurement, working memory assessments to determine the effects of working memory capacity on outcome and the use of dismantling studies to decompose the multi-components of this nascent therapy.