Dr. David Bullard on Trauma, Resilience, Memory and Consciousness, June 2020

A lot of bad things have happened to us in life, but we've evolved in a certain way. If everything bad that happened to us was available to us in our memory and we could remember how bad it was, and in our nervous system, especially the sympathetic nervous system, had a reaction— like when I remember this auto accident that I actually had about 6 weeks ago. No one was injured. Airbags went off, but everybody was, was fine. It was a pretty significant event. I've never had that happen before. And if I remembered it in my nervous system like that, and if my nervous system did that with every single bad thing that's ever happened to me, I don't think I would leave my bedroom. I'd be kind of curled up on the fetal position in the bed. So evolution wants us to be able to remember but not be triggered into a bad body state. We need to learn. In Buddhism, we learn from suffering, and we learn the most important things. We learn compassion and wisdom. So I have to right off the stop say, right off the start say, I'm not, I don't consider myself a good Buddhist, but I've been a really great dilettante Buddhist because I've been to Bhutan with Robert Thurman and learned about from him about Tibetan Buddhism. Going way back, I learned Alan Watts from Psychotherapy East and West. And later, when I arrived in San Francisco, my mentor was a drinking buddy of Alan Watts. So some of that Zen kind of came over me. And years later, about 12 years ago, I found out that an old high school friend from Michigan was the vice president of the Zen Center, and we reconnected— Susan O'Connell— and we've done some workshops together. I also have enjoyed the works of Stephen Batchelor, who writes about being a secular Buddhist, and it's more about consciousness. I recommended his book to a gathering that Robert Thurman had in upstate New York, and near the end of the workshop I said, oh, I'd like to recommend this book I've been reading. And after I recommended it, Robert said, no, no, that's the worst book. So there, There are different schools of thought in all of these communities. The other part that we're going to be touching on is the psychedelic experience. And I've had the great pleasure of being able to interview and meet with and get to know Bill Richards, who's at Johns Hopkins University. He's one of the foremost researchers in the use of psilocybin with cancer patients who have death or existential anxiety. I mentioned something about them. I have a couple video clips that I'm hoping that the sound will come through for you. Okay, so, but what really makes up a trauma memory? At least a few components that I can think of. One is visual. So think of— take a moment and I want you to think of something difficult in your life. You may not bring it to the level of a trauma in your mind, may not reach that definition, but think of something that makes you cringe a little bit. It could be a regret, could be a disa— big disappointment, or it could be something kind of scary. Okay, for most of you, you probably had a visual component to your memory. When I do this, I don't. I'm one of those, uh, maybe 10% or 15% or 20% of people whose memory doesn't work like most people. You also can have an audio component to your memory. Perhaps mine is very much that way, or a cognitive understanding or a conceptualization of what it was. I was telling you about the auto accident, but I really didn't see it. I mean, I didn't see it when I was telling you the memory of it. The flash technique that we're going to get to do has a way of bringing a memory that, when you bring it to mind, makes you cringe. You feel it in your body, tightness in your chest or your stomach, and it corrects it to help you know that it's in the past. I think I should, uh, mention my involvement with Phil Manfield and Louis Engel, who developed the FLASH technique about 3 years ago. And Louis has been my officemate for 40-some years, so I was kind of hearing about it from the beginning. Phil is an EMDR therapist who's trained around the world 25 years doing advanced EMDR training. But there are people who cannot even do EMDR. That's the Eye Movement Desensitization Reprocessing technique that's been around for about 30 years, and it's very powerful. There are quite a few people who've been trained in it, but like all other trauma therapies or techniques, it involves exposure to the bad memory. To the trauma memory. You've got to bring it to mind. A January 2018 article studied the treatment outcome at the VA medical centers system-wide, so all the VA medical centers have big trauma treatment programs, of course, to treat the veterans who've been in Iraq, Afghanistan, before that, the Vietnam War. To do that kind of work that they were doing called cognitive processing therapy— they didn't even do EMDR, but they did another one called prolonged exposure. So if I was a veteran who came to the VA and I was going to be treated, and I was in Iraq and an IED went off, my buddies blew up, and I saw grisly things and body parts, and I can't get that out of my mind, and I've had a lot of difficulty with alcohol and drugs, trying to get away from the intrusive imagery of that. In the therapy, I've got to go over that in great detail, over and over and over with my therapist. So when they studied outcomes, they found 40% or more dropped out of that kind of therapy because the trauma memory was overwhelming to them. One way to look at a trauma memory is to imagine that there's a perceptual error in the nervous system. It's that if I have that memory of being in Iraq and it makes me— it's really overwhelming to me, I feel it— it's as if my nervous system thinks it's just happened, big surprise, or it's happening now. That's an error because, um, in the present moment, I'm not even in Iraq. So Phil and other EMDR therapists had to grapple with that issue of how do we work with people. Sometimes it would take them a year of establishing rapport and contact so that they could feel comfortable enough to begin to approach the worst traumatic memories. But along the way in the last 3 years, Phil primarily, and then with Louis's help, and then I chimed in, found that if they subliminally looked at the bad memory but then filled their working memory, which is present consciousness, with positive engaging focus and not, not think at all of the trauma memory, they were able to, after they did this brief 10 or 15 minute experience, then look at the trauma memory and it had none or much, much diminished anxiety and cringing that it had before. That's what we're going to do after the break, give— have you have a chance to do it. Now this is such a strange thing. It's a technique, it isn't therapy, but it's transformed some of the work that many of my friends have been doing, and, and it's transformed some of my own work. I'll give you an example: a 94-year-old woman a couple of years ago, who— brilliant and retired scientist. I had worked with her 15 years before that doing some EMDR work on a particular trauma, and she didn't want to do therapy, she didn't want to talk and explore her childhood. She was— at that point, she was about 80 years old. She just wanted to fix this disturbing anxiety that she had that was based on a memory. And we did that 15 years ago. But she came back to see me again and said that her daughter, older daughter, had been through cancer treatment. And was in remission and was fine, but she couldn't shake the anxiety about that. And I asked her, is there a particular moment in time that that was difficult for you? And she said, well, the worst moment was when my other daughter told me about it. As I had her explore this memory, it was clear she was very visual, and when she remembered her daughter telling her that her first daughter had cancer, she could see it and she could feel it and she could hear her daughter speaking. It was disturbing to her. So I said, great, forget that. She agreed she wanted to try this new crazy technique because it can't hurt and maybe it would help. So she forgot about that, and I had her 'Come up with a memory that's positive and engaging, something that really grabs you.' And she said, 'Oh, that's easy. I was 13 years old with my father on a pier in Los Angeles, and we caught a 50-pound tuna, and that's one of my happiest memories. He died a year later.' but that's still a very positive memory. So I had her do it, and we'd add bilateral stimulation. It can be something instead of the eye movement, something as simple as this, while she's telling me out loud verbally what she was experiencing. And she told me, well, there I am, it's a beautiful day, I see the sea, my father's with me, he's smiling, 'Then suddenly we bring in this 50-pound tuna.' So she did that, and it was very successful in being able to then go back to the memory of her daughter, and her anxiety was very greatly diminished. We use a 0 to 10 scale called the Subjective Units of Discomfort, and I'll have you use that in a moment. 10 is when I think of it, it's just the worst. I can't imagine being more upset. And zero is, yeah, I can remember that auto accident or that bad thing, and I don't, I don't have a body reaction. I wish it hadn't happened, the accident. I loved my little Mini Cooper, but it happened, and I'm here, I'm safe. So I'm in the present moment. What's wonderful is after that one session, she came back, I think it was, uh, yeah, just a week later, and she said, you know, I went home that night and I thought, that's so simple, I can do it myself. And I've been having trouble going to sleep at night, so I sat on the edge of the bed and I did this little thing, and I thought of my dad, and I had some other wonderful memories that came up as I was thinking about him. And then I laid down and went right to sleep. And previously, for quite a while, I've been troubled. Every time trying to go to bed, my mind would race, mostly about anxiety about my daughter. But this night it didn't happen. So the second night I thought, well, I'm going to do that silly thing again. So I sat there and I sat on the edge of the bed, did this for about 5 minutes, and then laid down, went right to sleep. She said, some of the best sleep I've had in a long time. And then the third night, I sat on the edge of the bed and I just laid down, went to sleep. So she didn't have to continue doing it. I taught this technique at a group called Cancer Survivorship and Wellness at UCSF, about 20 people, including some physicians and nurses who'd been who had survived cancer, and they wanted me to talk with them about fear of recurrence. So with this trauma focus, I was able to ask them, are there any memories you have about cancer diagnosis or treatment or afterwards that you when you think of it, it's an upsetting memory that you can feel in your body. And people nodded. And when I asked them what they were, one person I remember saying, oh, I can— the worst, the worst was when we were with the oncologist and he told my husband and I that it was cancer. And I saw the look of fear in my husband's eyes. That's the worst memory. Another person, a dear friend who subsequently has died, a younger woman, said that she would go to chemotherapy and deal with her nausea and had a pump that she took home with her. And when she would— at home, when she'd look at the pump, she'd get a little nauseous. So we did it with her, we did it with a group of people, Many of them got very powerful changes of less anxiety or less body reaction. Now, this allows me to say something that I really enjoy saying. Remember perceptual error? That term comes out of something called memory reconsolidation research. Perceptual error is the way I think of— if I have a memory that's obviously from the past and it makes my body react, the error is as if my nervous system thinks it's happening now, or just learned about it. When you're typing on your computer and you misspell a word, there's an error, right? And then it autocorrects. Where is the error now? I like that analogy because, well, I think most people would say the error is gone. Maybe Nick would say, well, I'm a programmer and I know how to get— I could get in there and see the keystrokes and find out that there was an error and that you corrected it. That may be true, but for most intents and purposes, you don't worry about the correct spelling reverting to the error. You don't finish what you're typing and then say, "I better check because in the very beginning I misspelled a word, and even though it autocorrected, I better check and make sure it didn't revert to an error." In other words, when these things happen, when you do the Flash Technique, it's a correction. And then you're able to still have the memory but without that reactivity. One of the most dramatic examples of this technique working was one of the early ones that Phil wrote about in, in an article. By the way, I'm going to send you all, after this is completed, a list of resources of some research and, uh, some other— maybe some— a couple of videos and things like that. This sounds a little difficult. It's a difficult story to tell, but I'll sum it up pretty quickly. A couple contacted him that they had— their son had committed suicide a year before, and they had been to several therapists including EMDR, and they couldn't, couldn't get help that they needed yet. And Phil is pretty renowned in Berkeley for being a trauma therapist. He set up a double session with them initially to meet with them. It was a tragic story. Their son died by jumping off a roof with his phone while he was talking with them. So just Heartbreaking. And the woman said she's been crying every day for a year. It's been so terrible for her. And they told the story to Phil. As you all understand, the best any of us could do in hearing such a sad, tragic, terrible, traumatic story is to bear witness. We can't fix that. We could just be with, with them in hearing the depth of this story and how it's affected them. But with about— so, and he had a double session, but they had to get a lot of the story out. With about 20 minutes to go in the, in the session, Phil said, you know, I hate to have you be having to share yet again this terribly sad story without getting any help. I, I hate to have you leave just having filled me in on the history of what you've been through. So I have this new technique, and I'd like to have you try it. I know it will not hurt. It won't make things worse. Nothing could be worse than what happened to you a year ago. But it might help. Would you be willing to try it? And they did. Within a few minutes of doing this technique, the mother started to giggle, and Phil stopped the session and inquired, are you okay? And she said, yeah, I'm not giggling because my son died. Because I've known that for a year. I'm giggling because in doing this silly little visualization technique, in just, just a few minutes, something has lightened up for me. I feel so much— I feel better. That's written about in a journal article, the first journal article that came out about this approach, but again, it's still not known. We've got— there's so much to talk about, and I regret— I know that I over-promised in talking about psychedelics and its influence, but I'll try and get to some of that as well. I might pause for a moment and see if anyone has a question or needs a clarification or wants to correct me for something I said. I'd be open to any of that. I like the Tibetan Buddhist idea that all learning is group learning. So does anybody want to raise their hand and let me know if you have a question, or we'll keep going? And in, um, in about 15 minutes we'll have a 5-minute break. Any question for clarification so far? Okay, um, let's talk about some consciousness things, because what I love about this technique is using it with people who are long-time meditators. And I've, I've, I've shown it to Thupten Jinpa, who's the Dalai Lama's main English translator and editor of many of his books. And particularly not to deal with one of his traumas, but to show him about it. And I asked him, in the pantheon of all the Tibetan meditations that he knows of, is this particularly reminding him of anything? And at the time he said it didn't remind him of anything yet. I'm sure there are other people who've, in the course of history, maybe shamanic people, or just people we haven't run across yet have done something similar because it's so simple. But in about 2 and a half years ago, a friend of mine who came to our house where we had one of these meetings about the Flash Technique, and Phil and Louis presented, and we had researchers from the VA Medical Center and UCSF clinicians and researchers And my friend George was there. George is a psychologist and clinical professor of psychiatry at UC, and he's been president of something called the San Francisco Psychotherapy Research Group, but also president of the Society for Psychotherapy Research, which is an international group. And if anybody in the world knows about research in psychotherapy, it's George. And he said, in his opinion, 50% of what works in therapy is the relationship. And interestingly, Bessel van der Kolk, who's probably the world's most renowned trauma expert and friend, and I've gotten to know a bit, also says there's something about human engagement with another human being that creates safety for us. Maybe we're herd animals after all. So I want to recognize that the relationship be— in therapy between the therapist and the person is vital, maybe 50%. And George is very psychoanalytically minded otherwise, so I didn't think he'd leap at trying out this technique-y thing on any of his patients. But a while after this exposure to the Flash Technique, he let me know that he was talking with a patient and he just offhandedly described what the Flash Technique is and kind of ran through it casually with the person who had an airline phobia of being on an airline. And the guy went home and tried it out more on his own and reported back to George that it really worked really well for him. So we never know how much we're dealing with placebo or not, and there's a group at York University, a guy named Paul Ritvo, who's setting up a randomized control study. Now why would he do that? I've talked about this with a lot of trauma researchers, and they haven't been particularly interested Some of them have $5 million grants to use a psychedelic medicine, MDMA, with trauma. Other people have other big grants or training programs where they're training people in a certain technique that's very complicated. This is not complicated. If you have an investment in your particular skill set derived over many years that you're teaching to other people, I went through a 3-year training program in somatic experiencing. That group, through Peter Levine, it's wonderful training to deal with trauma, but they're also making a lot of money from all the people who are paying them for all that. Nobody— it's hard, I think, for them to hear that something so simple can be so powerful. Trying to think of other examples. What do I want to tell you? Okay, yes, I want to tell you about some research, because back to my friend George, who's got such a background in psychotherapy research, he alerted me a few months after he learned about the Flash Technique to some research in memory reconsolidation, and then On my own, we found some research. No, actually George helped me find this one too. There are people at State University of New York in Purchase, upstate New York, UCLA, and a group in Japan, and they've been exploring in their laboratory something called very brief exposure. And I'll tell you the most elegant study that they had, very briefly. 21 women who were spider-phobic. And there are ways of measuring that with self-report inventories, but also they can measure it by having them in a room with a spider, a tarantula, and see whether they'll even go in the room, first of all. So the Diagnostic and Statistics Manual has certain criteria for phobia. The 21 women all made that list. They were definitely clearly spider-phobic. They also had 21 non-phobic women. The reason they chose to do this research just with women is that 75 to 80% of the spider phobics are women. So they, they also were able to do functional MRI scans, and here's what they did. While these subjects were in the MRI scanner, they showed them— half of them, they would show a photograph of a tarantula so quickly, I think it's 400 milliseconds, that it did not register. They did not recognize that they saw anything, or they didn't recognize what they saw consciously. Another group got to see the photograph long enough that it registered. They recognized, "Oh, that's tarantula." And another group saw a flower, so that was kind of a control group. Through the functional MRI scan, they saw that the ones that got it shown to them subliminally, so quickly they didn't understand what it was, it went to the dorsolateral prefrontal cortex and to somewhat to the default mode network, which is a system in the brain but didn't go to the amygdala, which is the fear center. And the people who saw and recognized the spider, it went to both. The results were a much greater reduction in anxiety and phobic response to tarantulas in the people who didn't even know they saw the photograph of a tarantula. How did they measure that? Well, both by self-report —but also by bringing— again, they brought a tarantula into the room and they measured the distance from the subject, how close they could get to the tarantula. To me, that's the closest, you know— flash kind of technique started because it worked, and we didn't know how it worked. We don't completely know how EMDR works or other trauma therapies, but it seems to be something along the lines of that research that they're calling less is more. And I'll, I'll send you a 2017 article about their work because it's, it's fascinating. But I really think it has something to do with why this flash technique works. Um, okay, here's what I'd like you to do. Could you get a— if you have a possible— if you could get a piece of paper and a pencil And again, you're not going to have to talk about a disturbing memory to the group at all. In fact, I saw a client once that I hadn't seen for many years, and I, I would see him every, every once in a while because he primarily was working with medication, medication, and sometimes his therapist would leave or retire, and he'd come to see me again to— because I knew him— to, to ask for a new referral. For new psychiatrists. And I was telling him about this. He'd had some depression and other things, and I told him about this just offhandedly. "Ah, there's this new technique that we've been using that's very interesting because it works right away, and you get to experience it, and you don't even have to think about the bad memory. In fact, you don't have to tell the therapist what the bad memory is." He said, "What?" And I said, "Yeah, yeah, you can get benefit from this approach without— you don't even have to tell people, your therapist, what it is." He said, "You know, I did something one time. I've had 15 years of therapy with 3 different psychiatrists, and I liked them a lot, but I never told them this one thing that I did, and I'm not going to tell you either." And I said, That's okay, you don't have to. And he said, um, I just knew afterwards I felt so bad at what I had done. I was in Las Vegas, that's all I'm going to say, but I had done something bad. I knew I could never tell anyone. I could never tell anyone. So imagine he's got it in a compartment in his brain saying, don't tell anyone, don't tell anyone. What else is in there? Shame, right? So at some level of his consciousness, he's carrying around shame. So I said, do you want to, you want to try this little technique right now? And we did it. And a week later, he came back. He wanted to tell me what the bad memory was. And of course, it wasn't nearly as bad as— we're all human beings, we'll do things, especially if we've had alcohol and all of that. And the immense power it had over him greatly diminished. I'm going to ask you all, what high school did you go to? And I'm pretty sure most of you, if not all of you, are going to be able to tell me what high school you went to. But I'll bet this whole morning you not once in your working memory, in your present consciousness, came up with the names of your high school. Right? Nod your head if that's true. Okay, um, where did it come from? Long-term memory. Was it hard to get those words? No. I think there are other things that are in long-term memory that are not present and not conscious but involve pain, sorrow, difficulties. If it's unresolved grief, if it's complicated grief, it's in there. If it's a trauma memory of any kind, it's in there as a feeling. We see this a lot in therapy, that working in couples therapy, for example, someone is upset and kind of gets upset that he thinks his wife was being critical just then, and she may have thought she wasn't critical at all. And then we find out, well, yeah, my dad was very critical of me, and I've always hated that. So what happened in today's world, in present moment, triggered, even when they don't know that they got triggered, because it's a feeling memory. They may not have the visual part, they may not have the conceptual or cognitive part, they may not be able to label it. They can't say, "Oh, you know, what you just said made me think of my dad," but they have the feeling response to it. You remember Maya Angelou, She has this great quote about people longer remembered not what I said, but how I made them feel. And I work a lot with couples, and I often have heard them say something like, well, we had a big fight a few days ago, and they'll agree, yeah, we had a big fight, so let's talk about it, see if we can deconstruct it and feel better about it. And then they'll say, 'What, what was that fight about?' And the other one will say, 'Um, you know, I don't remember either, but I mean, we were pretty angry.' 'Yeah, how do we get— so you wanted to be right about something.' Well, you— they couldn't even remember what they were arguing about, but they knew, they could feel the feeling was still there. So that's that one component of a memory. That's of great interest to me. So would you take a moment and write down just a couple of words, two words maybe, that would represent for you a difficult memory, like, uh, third grade teacher. I guess that's three words. Now I want you to think of that 0 to 10 scale. 10 is, oh, I don't want to think about it, I can't, it's, um, 'Oh, it's— if I tell you about this memory, it's the most— it's the most upset I can ever, ever feel.' And zero is, 'I can tell you about the memory. It's no big deal. It's in the past, and I learned from it.' Who I am now— we can have a whole, whole session on who are we, right? Robert Thurman really helped me because I've been doing couples therapy for 30 years, and we were up in Bhutan, and every morning he would give a talk about Lam Rim, which is a Tibetan Buddhist practice of meditation that people spend 3 years learning— 3 years, 3 months, 3 days— and it's all about the sanctity and preciousness of life, but then the inevitability of death and all of that. But in that teaching— oh, so we had the teaching in 18 days, and I've done it with people in about 5 minutes. Probably loses a little bit in being diluted, but anyway, what I learned from him is that we don't have an absolute self. There's no real David, right? We only have a relative self. It's pretty easy to see that, that your best friend would describe you one way, and someone that doesn't like you would describe you in another way. Which is the real you? We impact each other. What— that's why it's relational. That's a whole other thing to get into. But in terms of memory, let me say one more thing about memory. I think it's fake. Do you remember willing suspension of disbelief? That's the term we use when we go to the theater. My daughter was an actor, and I got to the same performances many times over. I just loved the opportunity to see the actors, see what's really acting— things you get from multiple viewings of the same play. But you're sitting there and you're giving yourself over to the experience. The willing suspension of disbelief means I'm sitting here, it's a real family up there, these are real people interacting and talking with each other. If I was skeptical, if I was— if I didn't have that, I'd be sitting there thinking, oh, these are actors. I'm sitting in an auditorium with a bunch of people, somebody's coughing, and That might happen if it's a bad play, but if it's something that's engaging, you give yourself over to it, you're part of it. Okay, I think we have an unconscious willing suspension of disbelief when it comes to memory. So my auto accident that happened a month ago, right? First of all, I'm blessed because I don't have a good visual memory, so I'm not seeing it right now, but I'm, I'm conceptually remembering the wonderful people I ran into. They were so cool about it. I mean, I ran into them because they stopped very suddenly when I was reaching for the radio. Bam! Their car had virtually no damage, but it hit the hood of my Mini Cooper and crashed it back, so I had quite a bit of damage. They were really cool about it. It turned out later he was a retired beekeeper. He'd been a teacher, but he kept bees. And when I wrote to him afterwards and said, you were— you guys were so kind, I'm not so sure I could be so kind to somebody who ran in the back of me. And they were an older couple, and he said, well, beekeeping is my Zen. So I have this image of walking through life protected, but there are all these things going on, these bees that I can't control. It really helps you not need to control things. Back to the point I was trying to get to: if I have a trauma memory, if I told you about the accident and I was, "Ooh, it was— oh, I can see it, it was terrible, my body— oh," um, that's fake. In the present moment, there's no such thing. And it's not really about the car or the accident or the month ago. I'm— it's a perceptual error. My nervous system is pre— is tricking me. My brain is doing coordinated efforts through different brain networks to create this thing that we call a memory. But it isn't really happening. If I think about Auschwitz, it isn't happening now. I can think about other things that are happening now, which brings me to— I've been telling people to experiment with this thing, even about things that are going on now that are disturbing to you. So we'll get to that in a moment. You've written that down. When you look at your memory that you want to work on, that again, that you're not going to share with anyone here unless you care to afterwards, what's the number of disturbance? And did you— if you wrote it down earlier, like 10 minutes ago, write it down again. It may be the same number or maybe it's changed a little bit. So shall we take a 5-minute break and we'll come back and do this thing? Okay, see you in 5 minutes.