PEP stands for Process- and Embodiment-focused Psychology. Like EFT it is rooted in Energy Psychology but it has moved away from these roots considerably and rejects the unscientific/new-age aspects. Tapping is still an important part of this technique, but it is complemented by cognitive interventions and is therefore useful for more than just emotional regulation. PEP isn’t widely researched yet but the reports we do have indicate that it is a technique that is safe and gentle in the treatment of complex trauma with high levels of dissociation up to DID. We need more techniques to treat the severely traumatized, that is why we are introducing PEP here. This is not a stand-alone technique, it needs to be embedded into a broader therapy concept.
The building blocks
PEP is process-oriented, which means there is no fixed order in which tools are used. It depends on what the patient is experiencing and how the process develops. Different tools are used as needed.
Grounding
To frame the process there is a grounding exercise at the beginning and the end. It starts with a finger exercise for bilateral stimulation and coordination that helps to arrive in the moment and with the body.
Self-affirmation
Just like in EFT we will then be guided to find a self-affirmation that fits the situation or emotion we want to process. The structure for these affirmations goes like this:
Even though + problematic feeling/thought/experience + I + self-affirmation.
It is ok to move away from the narrow concept that ‘I love and accept myself’ is the only proper affirmation. Other options aim at other needs we might have. An affirmation in PEP could just as well be ‘I am still free to make choices and I have control over my life’, an important addition to EFT procedure. Our T will make open suggestions and we can use them if they fit, adapt them or discard them and look for something that fits better. Going through these options is a process that helps us to achieve new realizations. The affirmations can be spoken while rubbing or tapping a place on the body to add a sensory stimulation.
Self-affirmation tackles the more cognitive side of our problem.
Tapping
When we are highly emotional or in a stress response tapping is used to reduce the arousal levels. It follows the traditional EFT acupressure points but it is not necessary to speak. We just focus on our experience or the emotion that came up and tap where our T shows us to tap. Having a shared rhythm and mirroring another person is regulating in itself, so is the sensory stimulation we add to the body by tapping it in different places. The dual attention, on our emotions and our body in the present, helps with the processing.
Big Five Blocks
People get stuck in the process quite regularly. The tapping doesn’t improve things anymore or the affirmation seems impossible to fully believe. That is when our T will check 5 different areas that might keep us stuck and work through them with us before returning to the main issue.
Self-blame:
If we hold our old decisions or actions against ourselves, we are guided to forgive ourselves and let go. The question ‘Were you unwilling to do it differently or unable?’ can be a great help and bring greater acceptance. Possible new affirmation: ‘Even though I still blame myself for ___ I accept myself. And now I fully and completely forgive myself, because I realize that I couldn’t have done any better in that situation and that is the truth.’
Blaming others:
That keeps us in a victim mentality and moves responsibility away from us. The intervention helps us to tell apart what is our responsibility and what belongs to other people so we can be present with ourselves. Possible new affirmation: ‘Even though I still blame ____ for ____ I am still safe and in control of my life. Even if ___ didn’t want to/couldn’t treat me any better, I honor and respect myself and I leave all the responsibility for their actions with them.’
Expectations:
Sometimes we wait for others to do things so we can feel better. It means we make ourselves dependent on their actions. These are often wishes for parents to finally show us love and affection or for perpetrators to admit the abuse. We are guided to let go of unrealistic expectations. Possible new affirmation. ‘Even though I still expect ___ to do___, I can decide what is good for me. Even though I created a goal that is not within my power to reach because it depends on others and therefore I gave them too much power over my life, I am steadfast and in control of my life. I am now letting go of all expectations that kept me captive and take care of my own happiness’
Age regression:
Our T might ask how old we are feeling when we have this emotional experience we are working on. Often people slipped into a younger Ego State. In dissociative disorders this is the chance to include dissociated parts who might be sharing their experience and foster more integration. The new affirmation includes both the younger part and the adult host and acknowledges both experiences. Possible new affirmation: ‘Even though I suddenly feel so much younger in this situation, I am safe and capable to manage it. Even though I feel a young part of me being active and anxious, I am also an adult woman who knows how to handle this. I can stay in my grown-up perspective in this situation so young parts don’t have to be stressed about it’.
Unhealthy loyalties:
We might feel like we owe someone to stay in a bad place, even like it would betray a loved one if we got better and moved on. It happens a lot in families where children bonded over the abuse. A new affirmation could honor the suffering of the others and still draw a line to separate our life from theirs. Possible new affirmation: ‘Even though I feel deeply connected to my sibling through the pain we shared, I allow myself to heal and have a happier life. Even when I leave the trauma behind, I am still connected to my sibling in love. My happiness today doesn’t diminish the experiences we shared in the past.’
Relaxation exercises
After having worked on a topic for a while there can be a little break to stimulate the brain differently and give us a moment to get grounded again. This exercise is made up of different actions, like looking into certain directions, counting and humming. It is short, with fast changes between actions but it works surprisingly well as a break.
Cognitive congruency test
Toward the end, our T helps us prepare a sentence that sums up our new understanding in an intended action. This statement can be repeated at home to stabilize the success. These sentences will be highly individual and our T will make sure that our body language shows that this is what brings relief and that there is a congruence of body and mind. The test shows if there is anything hindering us from getting the full benefits from the process we just went through. When there isn’t congruence that means there is still something to work on. When our body still feels restless and tense with a sentence like ‘I can live free of fear of abuse’ because subconsciously we know there still is an area in our life where we experience threat, that means we need to go back to that topic and work on it. Otherwise we can end the session with one more relaxation exercise.
Humor
When we work with a PEP therapist we will quickly notice the use of humor and the light-hearted nature of this treatment approach. It works with a lot of friendly provocation while searching for fitting affirmations and a good PEP therapist will call out unhelpful patterns using humor in combination with pure acceptance. It feels like a safe place to be merely human that is also deeply inviting to move beyond the current problem. That makes it more fun for both Ts and patients. Therapy doesn’t have to be hard and gloomy.
This technique can be used as self-help for all forms of anxiety and stress. The booklet for self-help is currently only available in german and arabic. You can contact the author here to express a need for an english version.
PEP for trauma processing
When PEP is used as a technique in trauma processing it needs to be embedded in regular trauma therapy and the 3-phase model. You can’t process trauma without stabilization and PEP alone is not enough to address everything that is needed.
PEP can be compared to other multi-sensory bifocal therapies like EMDR or EMI. The basic idea (to bring up traumatic memories while also using sensory stimulation/bilateral movement to foster processing) is the same. PEP might even be superior when it comes to keeping us grounded because we apply stimulation ourselves, we are constantly moving so we need to stay more aware of the present and we keep looking at our T who shows us what to do the whole time, so we add better co-regulation to the experience. Test trials also show a surprisingly big increase in self-efficacy. The self-help part of PEP can be introduced early in therapy to help with stabilization.
PEP is a bit different from mere exposure because it focuses on processing blocks that keep us back more actively. We process beliefs while listening to the body for resonance. That draws the focus away from just looking at the memory for desensitization, the goal is to find a way to move beyond the trauma.
People tend to feel more grounded when they tap, dissociation doesn’t happen so easily and gets noticed more quickly, which makes this technique more accessible for the highly dissociative. Ts also report feeling less stressed and more light-hearted during the process, since they too tap through it, so it might reduce their risk of getting traumatized by treatment.
If we put the building blocks together, a session for trauma processing could look like this:
In cooperation with our therapist we pick a present day situation where we ran into trauma-related struggles and bring up our memory for a moment to evaluate the stress levels. These can be rated in SUDs, just like in EMDR.
While we prepare the session in our conversation, our T will already look for signs of one or more of the 5 blocks and thoughts or relational patterns that might need to get changed. Then our T will propose how to start.
Say we are already experiencing high levels of stress. Then we would start with tapping the 16 places our T shows us and re-evaluate our SUDs afterward. After a short relaxation we might go back to another interval of tapping if SUDs are still high.
When things stop changing and the distress isn’t fully gone, our T moves on to the blocks and we work on creating self-affirmations that fit and lead to new realizations. When that is done we could either tap to process it or we might notice that there are more blocks we can work on right away. Self-affirmations can then be strengthened through tapping.
When we aren’t deeply stressed at the beginning our T might start directly with the self-affirmations and blocks and then move between cognitive intervals and tapping, with relaxation breaks every now and then.
The cognitive congruency test is done when it seems like we worked through everything the best we can. If it reveals another problem we take another turn with the blocks, affirmations and tapping and then check the cognitive congruence again. The process is ended when our whole being can stand behind the statement. It means being able to feel it in our body and end with a positive emotional and physiological experience.
PEP for DID
There aren’t a lot of studies using PEP for trauma processing yet. The successful test trials include people with OSDD and DID though. The sessions get prepared like any other trauma processing session for DID. It needs co-consciousness, communication and cooperation. The stress levels of inner parts and their blocks are being considered and included in the process. It usually takes longer than processing things with a singlet because there are more cognitions to work through and it is more complex, but it is possible to arrive at a place where all parts involved agree on a final statement. Patients report that integration of the memories as well as some dissociative parts was possible after treatment. You need a therapist who is trained in trauma therapy, DID therapy and PEP to do this. Look into the work of Dr. C. Wilhelm-Goessling for more info and case reports.
I personally think that this is a promising approach to trauma processing for the severely traumatized. Trials show that the most common problems can even be worked through in a group setting. It plays well with other approaches so the tools can be mixed and matched as needed. Tapping during exposure is more grounding than eye movements alone and mirroring a co-regulating other just adds to that experience. The humorous and light-hearted nature makes processing a lot easier and less scary. The lack of fixed steps to follow makes PEP very flexible and keeps the process close to the personal experience of each individual. When it comes to trauma work, PEP will be superior to mere EFT because it offers solutions for cognitive and relational problems when emotional processing gets stuck.
As always, this article is just a rough overview and does not qualify you or your T to use this technique for trauma processing. PEP is currently only available in german-speaking countries in Europe. You can use an online translator to get more info about PEP here. New techniques spread because people show interest in them. Let your therapist know that PEP exists and create a demand to bring it overseas or at least get the book translated.
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