TraumaOnline
The newsletter of the
International Trauma Training Institute (ITTI)
Mike Dubi, Ed.D., LMHC, Editor
Jeanne Thomas, MBA, Associate Editor
 
Spring 2021, Vol. 4, No. 1

As we begin the second year of the COVID outbreak, we are mindful that many of you may have reduced hours of work. We are keeping our course fees at the same 10% reduction that we introduced last spring. We hope this helps to increase your knowledge of trauma-based treatment while maintaining your licenses and certifications.

Stay safe and well,

Mike Dubi, Ed.D., LMHC
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ARTICLE

The BIRRT Process
by
Bob Stahn, Ed.D., LCPC, ICADC, MAC

BIRRT is a technique designed to decrease or eliminate the symptoms of Posttraumatic Stress Disorder (PTSD). The original IRRT (Imagery Rescripting and Reprocessing Therapy) was created by Mervin Smucker, Ph.D. from the Medical College of Wisconsin. I have reduced the process to its essentials and call it Brief IRRT or BIRRT. With BIRRT, there is good news and bad news.
The Good News
The technique is brief to administer. It generally is done in one two-hour session per traumatic incident. That’s right, ONE two-hour session. Of the times that I have used BIRRT (over 700), only a handful of individuals have not had significant benefit or required more time than one two-hour session for any specific traumatic event.

BIRRT is very effective. A pre- and post-BIRRT self-assessment is done using a 30-item PTSD symptom list which has a 0-5 scale of severity (0=doesn’t apply and 5=applies a lot). The average baseline for non-traumatized subjects is 1.1. In the data collected from clients who come to me seeking PTSD treatment the average pre-BIRRT score is 3.8. In my follow up surveys (months or years after treatment has finished) I have found that nearly all clients who have completed the homework after the session continue to enjoy relief from most, if not all, of their PTSD symptoms and report a post-BIRRT score averaging 0.86! 

Trauma has a way of welding together the emotions of the event (what was felt) and the details of the event (what happened). So each time something triggers a memory of an event the emotions must be experienced with it! BIRRT effectively breaks that trauma weld and the traumatic emotions are released, never more to be attached to the details of that event. 

There is no hypnosis, touching, tapping, specific eye movement or holding of objects with BIRRT. The technique uses imagery only. During the process the client closes his or her eyes and talks with the therapist who listens and talks with the client. That’s it.

The results are immediate. The client does not need to wait for weeks or months to feel the benefits of the process. At the conclusion of the BIRRT session in my office nearly all clients report a feeling of relief and relaxation. When the session is finished, there are smiles on their faces and amazement in their hearts. But relief and relaxation are not the only benefits that are experienced. From that moment on there is a reduction, if not elimination of nightmares, flashbacks, intrusive thoughts, hypervigilance, high anxiety, etc. Also, the issues connected with the trauma can now be addressed without being hijacked by the emotions of the event.
 
BIRRT is not supportive therapy. It is designed to break the weld between the event and the emotions, not resolve issues or provide on-going support. However, it opens the door so issues can be much more easily addressed. Many clients report that they are able to work through the issues quite simply after the issues are free of the traumatic emotions.
The Bad News
BIRRT is event specific. Each dissimilar traumatic event must be dealt with individually. For example, if the client had three different experiences with trauma through his or her life, then he or she would need to go through three separate sessions—each traumatic event being addressed in its own session. However, if a client went through years of childhood sexual abuse where the abusive incidents were in essence the same abuse by the same person only on different days, then all of the traumatic events would likely be addressed effectively with one two-hour session.

The process is not easy. There are three steps to the BIRRT session. The first step is the hardest for the client and for me (the therapist) because the first step is experiencing the trauma again. Initially, it may appear unreasonable because the client has spent a lot of energy since the trauma purposefully avoiding anything that reminds him or her of the event—and now we are going to invite the trauma to be re-experienced? It may not make sense to purposefully go through the trauma again, but it is an essential part of the process. Going through this step requires the client to trust the process, the therapist and him/herself. (In order to feel more comfortable, if the client prefers, the client may invite trusted friends or family members to accompany and support the client during the session—as long as the guests do not detract from the experience.) If history holds true, the negative emotions experienced in the first step will not be felt again in connection with that specific event—ever. When the weld is broken, the emotions of the event are gone for good.

The second and third steps are much more enjoyable. The second step starts as the first step did but before any strong emotion is felt, a perfect ending is spliced onto the beginnings of the event through imagery. The perfect ending includes 1) keeping the client safe; 2) preventing the trauma from happening; and 3) holding any abuser accountable for the abusive behavior. The results are wonderful!

The third step consists of nurturing the individual who went through the trauma. For example, if the client went through trauma at age 6, then again through imagery, we would spend time comforting and nurturing the six-year-old. We create an environment where the client of today educates, nurtures and comforts the younger client. The outcome is deeply satisfying.

There is homework. Assigned homework from the BIRRT session includes rehearsing the “new ending” twice daily and spending time nurturing the younger client also twice a day for a week. Nearly every BIRRT client reports that the homework is very enjoyable and is not difficult to do. In fact, most clients look forward to doing the homework in order to experience again those wonderful emotions felt during the session. Doing the homework is essential to make sure the weld stays broken. After one week the new images are so deeply enough planted in the mind that it is not necessary to continue rehearsing them for the disconnection between emotion and event to be permanent.

All told, the BIRRT process is not easy but it is very much worth the effort. Just ask anyone who has experienced it. Generally clients are not eager to go through the process, but are eager to be through the process. 

I know of no quicker or more effective PTSD treatment technique!

ABOUT THE AUTHOR
Bob Stahn is the owner of a counseling practice, Wellspring Counseling, in Idaho Falls, ID.
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