The value of visioning: Augmenting EMDR with alpha-band alternating bilateral photic stimulation for trauma treatment in schizophrenia

Abstract

The value of addressing trauma-related issues in psychosis with therapies such as ṇEMDR is being increasingly recognised. The hypothesis of this paper is that augmentation of EMDR with alternating bilateral photic stimulation (ABPS) is especially suited to those on the schizotypal spectrum. Not only does Alternating Bilateral Photic Stimulation (ABPS) at alpha frequencies (8–12 Hz) directly compensate EEG deficits of schizophrenia by photic driving, it also stimulates pseudo-hallucinatory visual imagery (visions) and a waking dream state. In contrast to the REM-sleep state, the dorsolateral prefrontal cortex remains activated during the flicker-induced waking dream and its functions of reflective thought and insight are preserved. Recent EEG and neuroimaging studies are providing empirical support for the long-held conjecture that psychosis is caused by a conflation of REM-sleep / dreaming and waking states. Llewellyn's theory of de-differentiation between sleep-dreaming and waking accounts for both the creativity and psychopathology of the schizotypy spectrum. It is hypothesised that flicker-induced hypnagogic imagery reinforces the EMDR mechanism of action proposed by Stickgold, namely facilitation of memory integration during sleep, by creating greater linkage between EMDR therapy and dreaming. With ABPS-induced visioning EMDR progresses seamlessly from initial targeting of trauma and adversity to desensitisation of emotionally-charged brain-disturbing material related to identity, selfhood, and embodiment. Desensitisation of the affect allows the self-regulatory dynamics of sleep-dreaming to restore embodied selfhood by an integrative process of resynchronisation. This in turn leads to re-differentiation of waking embodiment from dream-embodiment. Evolutionary theories as to the aetiology of the schizotypy spectrum are positing a genetic origin in indigenous shamanic religions which are based on visioning ability. Patients with schizophrenia score better than normal controls on vividness of visual imagery and ability to generate, inspect, and manipulate mental images. Self-help EMDR glasses can be provided to patients for long-term regular practice of ABPS-induced visioning. It is proposed that many on the schizotypal spectrum, including some at the severe end, can improve and maintain their mental health by the regular practice of ABPS-induced visioning, and thereby transition progressively over time from negative to positive schizotypy.