Beyond the Art of BART: Bilateral Affective Reprocessing of Thoughts as a Dynamic Model for Psychotherapy Across the Lifespan
This paper sets out to discuss the neurobiological underpinnings of BART psychotherapy which is a new therapy developed by the author over the last 8 years and which is used primarily to treat traumatic stress and dissociative disorders across the lifespan. It begins by presenting a brief overview of BART psychotherapy. It then sets out key historical descriptions of the autonomic nervous system from Darwin in 1872 down to Porges in the 1990s. Porges' Polyvagal theory of safe, unsafe and life threatening environments has made a key contribution to the development of BART. BART also draws on the neuroscience model of genomics and proteonics developed by Prof Ernest Rossi. It moves on to describe some neurobiological foundations that have contributed to the development of BART psychotherapythese include neuroception, brainstem evolution and in utero and early infant development. The use of BART psychotherapy in patients with post traumatic stress disorder is explained in terms of both a myelinated and unmyelinated vagal response. The hierarchical processing dynamics of the autonomic nervous system are described. In this context, the author's quintessential model of the brain is introduced. The different types of information processing relating to trauma are explained. This includes the interplay between top down and bottom up processing as described (indifferent ways) by Prof Panksepp and Prof Adolphs, both of which are discussed in relation to the proposed mechanism of action of BART psychotherapy. The links between trauma, attachment and dissociative disorders are explained using the BART model of altered levels of arousal and dissociation linked to the window of affect tolerance, emotional regulation and stability (acronym WATERS) This is complemented by the use of allied acronyms RAPIDS (racing thoughts affective dysregulation, partitioned personality, impulsivity, distress and Suicidality) and FROZEN (freeze reaction, oblivious, zonked, emotionally numb) In a therapeutic context, these are accompanied by the use of visual descriptions are easily understood by patients and clients experiencing these symptoms. Areas into which the theory and practice of BART psychotherapy might be extended are discussed. In particular research might usefully look at recently discovered links between the human immune system and central nervous system. This includes information. The author has included some feedback from patients who have been treated with BART psychotherapy to indicate some of the profound changes that occur following treatment. Some general conclusions are drawn from this feedback and preliminary results of treated families are outlined.