This chapter describes maneuvers to access the internal system of the patient as well as means to accelerate or decelerate the work in that process of accessing the self-system. Eye movement desensitization and reprocessing (EMDR), ego state therapy, and somatic therapy fit together like hand and glove. An extended preparation phase is often necessary before trauma processing in complex traumatic stress presentations and attachment-related syndromes, particularly when dealing with the sequelae of chronic early trauma. Clinical practice suggests that the adjunctive use of body therapy and ego state interventions can be useful, during stabilization and later on in increasing the treatment response to EMDR. Traditional treatment of complex posttraumatic stress disorder (PTSD) and dissociative disorders has usually included hypnoanalytic interventions, during which abreaction is considered an important part of treatment.

This chapter describes different approaches to fractionating and titrating trauma processing to facilitate efficient information processing. Fractionation in the treatment of dissociative disorders specifically refers to the direction of attention to aspects of traumatic experience to attenuate the intensity of abreaction. In eye movement desensitization and reprocessing (EMDR) parlance, refers to setting up a "target" for trauma processing specifying the image, cognitions, affect/emotions, and sensations associated with the traumatic memory. A strategy in somatic work involves oscillation between the traumatic state and the resourced state. Bottom-up processing is characterized by an absence of higher level direction in sensory processing, whereas top-down processing reflects higher level neocortical processes such as cognitions. TOTEMSPOTS uses channels as described in the approaches noted earlier to fractionate an intense traumatic memory, to make it more manageable. Somatosensory processing is bottom-up, as it is suggested that sensation is foundational to the experience of emotion.

Safe embodiment is a concept that is at the core of successful treatment of traumatic stress syndromes and dissociation. Therapy with eye movement desensitization and reprocessing (EMDR) requires a potential patient or client to have access to an imaginary safe place to support calming if there is a danger of overwhelm. The experiences of belonging, safety, mindful awareness, and compassion for self and others create or restore the body state of security displaced by trauma, abuse, or neglect. Neuroplasticity can also promote some degree of repair to the brain, not only through altered function of specific brain areas but also through neurogenesis. The primary advanced human awareness may be that engendered in the anterior insular cortex (AIC) with the experience of one’s own existence as a sentient being. The evolution of the cortical mantle provides ample scope for the compartmentalization of areas of conscious awareness in the dissociative disorders.

Working toward an understanding of the nature of information processing, as purported to occur in eye movement desensitization and reprocessing (EMDR) can ultimately enhance our understanding of traumatic stress syndromes and dissociative disorders. Impaired information processing reflects the inability of the brain to recognize and integrate external stimuli. The hyperpolarization of the thalamus is likely associated with profound effects on brain wave activity. The adaptive information processing (AIP) model is a neurobiological heuristic based on the notion of neural networks and represents a paradigm shift from psychological theory toward neuroscience. Shapiro argues that pathology results when traumatic or stressful events interfere with information processing and the forging of connections between different neural networks. This chapter reviews the literature on sensory stimulation and suggests that sensory stimulation and associated sensory awareness are involved in modulating oscillatory activity in the brain, which has been linked to information processing.

This chapter describes an approach to fractionation and titration of traumatic material, specifically the use of the time domain. The approach is informed by our understanding of neural development and the integration of mental experience using developmental time sequence. The chapter explains the early trauma (ET) approach of complex cases, specifically dissociative disorders. Maladaptive lessons learned at very early ages will effect decisions for a lifetime and form the basis for certain Axis I and Axis II symptom configurations. Temporal integrationism is the term established by Paulsen to describe the approach to resolving very ET and attachment injury, including neglect in the absence of declarative or explicit memories. For eye movement desensitization and reprocessing (EMDR) practitioners, it is challenging to obtain subjective units of disturbance (SUD) levels and usually impossible to derive cognitions or narratives for very ET and neglect.

This chapter focuses on how to effectively integrate somatic interventions during the different stages of trauma treatment, such as stabilization, trauma processing, and reconnection, and how to integrate their use to maximize the effectiveness of eye movement desensitization and reprocessing (EMDR). Ventral vagal connectedness between and within people is the name of the game to enhance association and integration. The EMDR standard protocol integrates cognitive, emotional, and sensory information. Information processing breaks down, likely due to significant peritraumatic dissociation (PD) that co occurs with the apparent hyperarousal. Social engagement reflects a ventral vagal response that results in increased self-regulation and calming, thereby decreasing the likelihood of a dorsal vagal response. To facilitate both dual focus and body mindfulness, both exteroceptive and interoceptive awareness are required. Olfactory pathways travel directly to the limbic system and amygdala, and from there olfactory information is likely conveyed to lower brain structures.