The Instinctual Trauma Response Model TM The Instinctual Trauma Response TM (the ITR) was developed by Louis Tinnin, M.D., and art therapist Linda Gantt, Ph.D., ATR-BC, two researchers in trauma treatment and art therapy.[1] The ITR is the term for what they understand as a universal human response to a life-threatening situation. The model was derived from studies of animal survival instincts and brain research. They developed the ITR Model TM from early clinical trials conducted at Chestnut Ridge Hospital at West Virginia University, Morgantown, West Virginia, and the Louis A. Johnson Veterans Administration Medical Center in Clarksburg, West Virginia.[2] While the specific details of traumatic events may differ widely, humans have a predictable response. Whether a person experiences combat, a car accident, physical assault, a natural disaster, or a medical trauma, the typical sequence is a startle, an attempt to fight or flee, a feeling of being trapped and going into a freeze, an altered state of consciousness, a state of submission, and eventually self-repair. Much of a trauma experience is nonverbal and therefore, difficult to describe in words. Many troubling symptoms are also nonverbal. When those symptoms are traced back to the ITR and put into the context of the event, they cease. These evolutionary survival responses include the startle, a thwarted intention to fight or escape, the freeze, an altered state of consciousness, body sensations that are not attached to words, automatic obedience, and self-repair. When people learn this basic outline of the ITR components, they can process their traumas by putting them into a series of drawings called the “Graphic Narrative.” When the story is re-told in third person, the trauma survivor can see with his or her own eyes that the event is truly over. Finishing the story and reversing the dissociation that occurred during the freeze brings relief without re-living the trauma. ITR Phases of The Instinctual Trauma Response begin with a “Startle." The person becomes hyper-alert and apprehensive as a potentially dangerous situation begins.Next, there is an attempt to fight or flee. This is a supreme effort to escape, accompanied by a rush of adrenaline, a pounding heart, and rapid breathing. If escape is impossible, then the efforts for "Fight or Flight" are thwarted, and the person goes into a “Freeze.” Being trapped comes with an endorphin rush, like a hit of morphine, causing a stupor, physical and psychological numbing, and waning of normal bodily functions (such as digestion). The verbal brain shuts down, and for many people the “Freeze” is like dying. At the same time the mind experiences an “Altered State of Consciousness.” Time slows down or stops. There may be a feeling that the world is unreal or the person is detached from the body and is watching the event from above. A person may have distorted perceptions of the environment or their senses (such as macropsia or micropsia). Often when another person is involved in the trauma (such as a perpetrator or medical personnel), the traumatized person cannot act with intention, but will follow orders. This is termed “Automatic Obedience.” The person’s actions may seem like those of a robot. After the trauma is over, the final phase is “Self-Repair” as the person comes out of the ITR. This is like an animal licking its wounds, as body sensations and a normal state of mind return. Some examples include eating, sleeping, rocking, using alcohol or drugs, and withdrawing from the company of others. [3] ITR model of trauma treatment was developed in the 1990s when Dr. Tinnin conducted clinical studies to compare different methods of accessing traumatic material. He compared hypnosis, sodium amytal, and nitrous oxide. He discovered that the catharsis of reliving a trauma was not the curative element as he had predicted. He realized that the key to a person’s improvement was being able to finish their trauma story. Those whose stories were told in an unemotional fashion recovered more quickly and fully than those whose stories were told emotionally but interrupted before the ending. With this important finding, Dr. Tinnin and Dr. Gantt began working on specific methods to keep a person from reliving painful events. They devised and incorporated an art therapy approach (which they later called the Graphic Narrative), which drew upon the strengths of the right brain. They soon discovered that incorporating the components of the Instinctual Trauma Response TM as an outline for each story enabled them to identify many of the fragments of a story that caused troubling symptoms.FOOTNOTE Once the stories were complete and then told back to the patients (a process called a “re-presentation”), the patients often spontaneously commented that they felt the event was truly over. The Graphic Narrative along with the Externalized Dialogue are the basic methods of treatment used in this model. The Graphic Narrative Processing traumas using the Graphic Narrative is a way to tell the verbal and the non-verbal story of the traumas. The creation of a detailed, coherent narrative with a beginning, middle, and end brings together the fragmented images of the trauma. Drawing the story from start to finish, complete with all the non-verbal details is crucial to helping bring closure to the traumatic memory. One does not need to be an artist to use this process. The Externalized Dialogue Most people who have survived a trauma become aware of separate parts or aspects of themselves that they may try to ignore or disown. These states may represent the traumatized part that now experiences flashbacks. There may have an internal part that manifests in a strong thought or in a voice that has a distinct point of view. The task of reversing dissociation is to engage in an active dialogue between these separated parts that are different or even opposed to other conscious thoughts. Tinnin and Gantt call this the Externalized Dialogue. This simple and rapid procedure is effective in reversing dissociation and bringing unity. This can be accomplished by recording the dialogue with video or handwriting.[4] This orderly, back-and-forth process ultimately brings about internal peace. References 1 Jump up ^ Tinnin, Louis and Gantt, Linda "The Instinctual Trauma Response; Dual Brain Dynamics: A guide for trauma therapy." Gargoyle Press 2014 2 Gantt,l., & Tinnin, L., (2009). Support for a neurobiological view of trauma with implications for art therapy. The Arts is Psychotherapy, 36, 148-153.--[3] Tinnin & Gannt, "The Instinctual Trauma Response and dual-brain dynamics: a guide for trauma therapy --[4]Jump up ^ Tinnin,L.,Bills,L.,and Gantt,L. "Short-Term Treatment of Simple and Complex PTSD" in Williams,M., and Sommer,J., (eds.) Simple and Complex Post-Traumatic Stress Disorder Hayworth 2002