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Wolpe Not Woo Woo; Counterconditioning not Charlatanism: A Biochemical Rationale Acupressure (old)
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Wolpe Not Woo Woo: A Biochemical Rationale  for Using Acupressure Desensitization in Psychotherapy
       James R. "Jim" Lane Ph.D.

 Acupressure desensitization therapies designate a group of therapies utilizing acupressure to create a state of relaxation to rapidly desensitize anxiety and traumatic memories through a process of counterconditioning . The theory and practice of counterconditioning is a generally accepted paradigm in Behavior Therapy with applications for  psychotherapy (Corey).  Dr. Joseph Wolpe successfully demonstrated the  counterconditioning of anxiety producing stimuli, using progressive muscle relaxation and pairing the state of relaxation with graduated levels of anxiety producing stimuli (Corey, Wolpe & Wolpe). The relaxation response "reciprocally inhibits" the response of anxiety that was associated with the particular stimuli. The use of self-applied acupressure to bring on a state of relaxation and effect a desensitization of anxiety has been demonstrated in a number of recent exploratory studies ( Callahan & Callahan, Figley & Carbonell, Carbonell, Andrade & Feinstein, Wells et al.). Acupressure  therapies have been scientifically researched and are derived from the knowledge and practice of  acupuncture, which is part of Traditional Chinese Medicine ( Gallo). These therapies use specific acupuncture/acupressure points (acupoints), which appear to terminate the Sympathetic Nervous System's (SNS) alarm (fight / flight/ freeze) response and replace it with a Parasympathetic Nervous System's (PNS) relaxation response ( Swack, Feinstein, Ulett ).

  Acupuncture research indicates that stimulation of particular acupoints terminate the Sympathetic Nervous System's alarm response through a biochemical based feedback mechanism which stimulate the production of opiod nueropeptides, excess cortisol, and  serotonin (Swack, Ullett). Many anecdotal studies (Arenson, Craig, Gallo),  some preliminary group data (Callahan & Callahan, Figley & Carbonell), large scale clinical exploratory studies (Andrade & Feinstein) and one currently published double blind study (Wells et. al.) attest to the efficacy of this new (to Western thought) application of acupressure.

 In acupressure desensitization, clients stimulate their own acupoints through tapping or rubbing , so that no "touching" by the psychotherapist is required. Clients focus on stress producing thoughts while applying acupressure. The acupressure induces a physiological relaxation response, which reciprocally inhibits the experience of distress. The stress producing thought becomes associated with a state of induced biochemical relaxation, resulting in a rapid counterconditioning of the heretofore stress producing stimuli (thoughts, memories, external triggers).

 The purpose of this paper is to familiarize western practitioners of mental health with the theory and practice of acupressure desensitization therapies. It is hoped that mental health practitioners will become versed and fluent with this technique and integrate it into their existing toolbox for doing psychotherapy, thereby passing along the benefits to themselves and their clients/patients. This paper will discuss: the concepts of conditioning and counterconditioning;  the physiological mechanism underlying the fight/ flight/ freeze response; traumatic memories as conditioned stimuli leading to the fight/ flight/ freeze response;  how acupoint stimulation changes the physiology to bring about a relaxation response; and how acupoint generated relaxation reciprocally inhibits the fight/flight/freeze response and fosters a counterconditioning process. This paper will also review the evidence for the effectiveness of  acupressure desensitization therapy; enumerate therapies which utilize acupressure counterconditioning procedures; outline the general procedures of acupressure counterconditioning therapies; and discuss implications relevant to the integration of this technique into current psychotherapies.

Classical Conditioning

 Pavlovian or "classical conditioning", builds on the foundation of a connection between an unconditioned stimulus (UCS) which, without prior learning,  leads to an unconditioned response (UCR). For example, a very loud noise (UCS) leads to a startle and orientation response (UCR). Subsequently, a neutral stimulus is paired with the unconditioned stimulus (e.g. the visual presentation of a red pickup truck) and after one or more pairings, the once neutral stimulus is able to ellicit a startle and orientation response in the absence of the UCR (loud noise). The once neutral stimulus, now called the conditioned stimulus (CS), has the ability to elicit a startle and orientation response similar to the loud noise alone. The startle and orientation response elicited by the CS alone is referred to as the conditioned response (CR).  A scenario drawn from clinical experience follows: A relaxed driver of a car is making a left turn and is hit by another car (UCS). As the accident happens, the driver's Sympathetic Nervous System's "alarm" response fires off a rush of adrenaline and cortisol, giving the driver an experience of the fight/ flight/ freeze response (UCR). After recovery from the accident, whenever the driver begins to make a left turn while driving (CS), the driver feels a rush of adrenaline and its physiological effects (CR). Making a left turn while driving has become a conditioned stimulus  for activation of the fight/flight response.

Counterconditioning of anxiety

 Counterconditioning is the replacement of one conditioned response by the establishment of an incompatible response to the same conditioned stimulus (Corey, p.127).  In the counterconditioning of anxiety, a stimulus which has been associated with anxiety is reassociated with a response of relaxation. The response of relaxation is physiologically incompatible with anxiety, therefore the relaxation response "reciprocally inhibits" the response of anxiety. In this way, a particular stimulus once associated with anxiety can be counterconditioned. The counterconditioning of anxiety is also referred to as "desensitization", as the subject becomes less and less sensitive to the stimulus that triggered the fear (Wolpe & Wolpe, p. 50).

  Joseph Wolpe used deep muscle relaxation to produce a state of relaxation (Wolpe & Wolpe). The state of relaxation was then paired with target stimuli which elicited anxiety. The relaxation response reciprocally inhibited the anxiety and a new association was learned to the once anxiety producing stimuli. In Wolpe's therapeutic system of counterconditioning, clients construct an desensitization hierarchy by enumerating several stimuli having varying levels of anxiety associated with a desensitization target. The anxiety levels are calibrated using the client's subjective units of discomfort (SUD) on a scale of 0 (no anxiety) to 100 (maximum anxiety). Stimuli associated with low levels of anxiety were counterconditioned first, thereby providing a "systematic desensitization" of  anxiety producing stimuli. This gradual approach ensured that the patient did not get overwhelmed with anxiety and retraumatized. Stimuli associated with progressively higher levels of anxiety were then counterconditioned, resulting in the therapeutic desensitization of a particular target. The result was that the anxiety producing stimuli no longer elicited anxiety. This process resulted in greater behavioral flexibility, problem solving and enhanced performance for the client.

Therapies that utilize acupressure desensitization and shared procedures of treatment.

 Acupressure meridian based desensitization therapies are known by many different names and currently fall under the umbrella of "Energy Psychology". Energy Psychology encompasses a group of techniques which utilize activation of the body's bioenergetic systems (including acupressure meridians) for positive psychological outcomes (Gallo 1999, Gallo & Vicncente, Gruederemeyer & Gruederemeyer). Included in meridian desensitization therapies are: Gary Craig's "Emotional Freedom Technique" or EFT , John Diepold's "Touch and Breathe" or TAB, Roger Callahan's "Thought Field Therapy" or TFT ,  Greg Nicosia's "Thought Energy Synchronization Therapy" or TEST , Fred Gallo's "Edx TM", David and Rebecca Grudermeyer's "Comprehensive Energy Psychotherapy", Steve Reed's "Reed Eye Movement Acupressure Psychotherapy" or REMAP, Jim Durlacher's "Acupower", Tapas Fleming's " Tapas Acupressure Technique" or TAT , Larry Nims' original version of "Be Set Free Fast" or BSFF and other useful hybrids and variations. The basic procedures for these techniques are fairly similar in that they have the client (patient): hold a distressing thought (internal image, sensation) in mind; rate the level of perceived distress on a Subjective Units of Distress scale (SUD) from 0 (low) to 10 (high), and then stimulate specific acupoints by tapping, rubbing and/or holding and breathing deeply. The level of distress on the SUD scale is rerated after each round and/ or at the end of the proceedure. Many of these therapies begin with a statement of self acceptance while rubbing an acupoint, which ameliorates the client's resistance to treatment. For example, the client will say: "Even though I have this problem, I accept myself and chose to overcome this problem". Clinical experience shows that 90% of clients experience clinically significant reduction in distress levels without additional therapies (Andrade & Feinstein ). The subject's distress level generally decreases by two or more SUD points per round of acupoint stimulation (Craig, Gallo 1999, Feinstein, Grudermeyer & Gruederemeyer). This procedure is then repeated a number of times focusing on the same stimuli and/or different distressing "aspects" (Craig, Feinstein, Grudermeyer & Gruederemeyer) of the traumatizing material. Utilizing this approach, the SUD level is brought to 0 or stabilizes at a low SUD level, providing the client with a sense of calm, behavioral flexibility an increased cognitive problem solving capacity. The result of the therapy is that the client can think of the once distressing stimulus/ thought without feeling a sense of distress. Additionally, the mental representation of the distressing thought (e.g. the remembered visual recollection of an emotional trauma and/or body sensations, internal dialogue) often changes. The results hold over time
(Andrade & Feinstein, Figley and Carbonell, Gallo 1999, Wells et. al.), indicating that reassociation or counterconditioning, of the distressing material, has occurred.

Studies support the efficacy of meridian based desensitization.

 Anecdotal studies (Arenson, Craig, Gallo, Hover-Kramer, Fienstein), preliminary group research data (Callahan & Callahan, Figley and Carbonell), preliminary large scale clinical trails (Andrade & Feinstein) and one currently published double blind study (Wells et. al.) are part of a growing literature which attest  to the effectiveness of meridian based desensitization techniques.

 A small research study using evaluative measures, and follow ups, was done by Figley and Carbonell in l995. They evaluated the effectiveness of the acupressure method, Thought Field Therapy (TFT) and a number of other methods deemed successful by experienced psychotherapists for treating Post Traumatic Stress Disorder symptoms. Other therapies included Eye Movement Desensitization and Reprocessing (EMDR), Visual/ Kinesthetic Dissociation (V/KD) and Traumatic Incident Reduction (TIR). Subjects were chosen from a pool who responded to an add in the newspaper and were given an array of psychological tests and physiological measures. Thirty nine subjects were allotted up to 4 sessions of one of the therapies. The average treatment time by treatment mode was: 63 min. for TFT; 113 min. for V/KD; 172 min. for EMDR and 254 min. for TIR.  All subjects started with a SUD (Subjective Units of  Distress; 0=low, 10= high ) level of between 8 and 9. Four to six months later, the subjects in the study, by treatment group, reported a SUD of : 3.60 for TFT; 3.30 for V/KD; 2.64 for EMDR and 5.67 for TIR.. This study   attested to lasting therapeutic effects of  TFT along with the effectiveness of the other modalities. Of all the modalities utilized, TFT had the shortest average time of treatment. One limitation of the study was that varying methods of client selection were used, therefore limiting strict comparisons among methods.

 Wells et. al. (2003) utilized acupressure based Emotional Freedom Technique (EFT) to investigate the effectiveness of EFT in the treatment of small animal or insect phobias (mouse, rat, spider, roach) under laboratory conditions. Subjects screened had to: have a "specific phobia" as designated by the DSM IV criterion; be over 18 years old; have had this phobia for over three years; and were not receiving current treatment of this phobia. This study used a control group and a double blind rating procedure. Randomly assigned participants were treated individually for 30 minutes with either EFT  (n = 18) or a comparison condition known to reduce anxiety, Diaphragmatic Breathing (DB) (n = 17). The structure of both treatments were kept as similar as possible, with both groups visualizing the feared object while applying the treatment in individual sessions run by a trained psychologist/ experimenter. The dependent variables included: the Behavioral Approach Test, three subjective ratings of fearfulness (two using SUD scales) and pulse rate. EFT produced significantly greater improvement than did DB in the ability to actually approach the small animals (p<.02). EFT also appeared more effective when comparing  three self-report measures. Reductions in SUD levels using imagination of the feared object were: 3.8 units for EFT and 1.1 units for DB (p<.005). Reductions in SUD level when actually approaching the feared object were: 3.7 units for EFT and 1.8 units for DB (p <.02).  There was no significant difference between EFT and DB on pulse rate. The greater improvement for EFT was maintained, and possibly enhanced at 6 - 9 months follow-up on the behavioral measures.  These findings suggest that a single treatment session using EFT to reduce specific phobias can produce valid behavioral and subjective effects which last for at least six to nine months after the treatment.

 Joaquin Andrade M.D. and David Feinstein Ph.D. published the results (Feinstein) of Andrade's clinical research in South America. A five year pilot study of 5,000 patients diagnosed with a variety of anxiety disorders, used randomized, controlled, and blind rated data. Patients were randomly assigned to an experimental group using acupoint desensitization or a control group using Cognitive Behavior Therapy (CBT) with medication (benzodiazepines). Ratings were taken at 1 month, 3 months, 6 months and 12 months by independent clinicians, who were blind to whether the patients had been in the treatment or control group. Raters only knew the initial diagnosis, symptoms, and severity of patient anxiety problems. Patients were rated using categories of: no improvement, some improvement, and complete remission. At the close of therapy, 90% of the acupoint desensitization group showed at least "some improvement" compared with 63% of the control group. In the "complete remission" category, the acupoint desensitization group had a 76% success rate (i.e. of being symptom free), compared to a 51% success rate for the CBT/ medication group. At one-year follow-up, the gains observed with the acupoint tapping treatments were less prone to relapse or partial relapse than those with CBT/medication, as indicated by the independent raters’ assessments. This study had some limitations: not all the criterion in the study was defined with rigorous precision, record keeping was relatively informal and some of the source data was not maintained. However, the indications of this exploratory study clearly show the effectiveness of meridian desensitization over CBT/ medication. The mean number of treatment sessions for the acupoint treatment was 3 sessions, while the mean number of treatment sessions for the CBT/ medication group was 15. A small sampling of brain wave mapping and biochemical measures of the two groups indicate that the acupoint group demonstrated more EEG brain wave normalization than the CBT/ medication group. A similar pattern emerged in neurotransmitter profiles, with the acupoint treatment resulting in lower levels of norepinephrine (a stress related neurotransmitter) and higher levels of serotonin (a calm inducing neurotransmitter) than the CBT/ medication group. A third substudy of 78 subjects compared the efficacy of acupoint needling with acupoint tapping. The results surprisingly indicated that tapping was more effective in reducing anxiety symptoms (positive response in 78.5%) than inserting acupuncture needles into the same points (positive response of 50%).

 A few notable studies were done to rule out the placebo effect. Carbonell (1997) used control groups, double blind procedures and placebo controls to investigate the effectiveness of  TFT  in the treatment of acrophobia (the fear of height) . The control groups were instructed to tap bogus points, while the experimental group tapped legitimate acupoints. Both groups showed some improvement, with the TFT subjects showing significantly more improvement than the controls. Upon review of the study, some of the bogus points were legitimate acupoints.

Biophysiology of the Autonomic Nervous System's Fight / Flight / Freeze Response.
 The control mechanisms of the Autonomic (Automatic) Nervous System (ANS) include the thalamus, amygdala, hippocampus, and hypothalamus, which are housed in the midbrain ( Perry, Rothschild, Van der Kolk). The ANS is closely linked to Limbic System, which shares many of the same midbrain structures, and which governs emotional responsiveness ( Perry, Rothschild, Van der Kolk). The  ANS is also directly linked to the hindbrain which governs heart rate and respiration. Within the Autonomic Nervous System are the Sympathetic Nervous System (SNS), which prepares the body for vigorous physical activity and The Parasympathetic Nervous System (PNS), which generates the relaxation response ( Perry, Van der Kolk). The purpose of the Sympathetic Nervous System's alarm response is to increase the ability of the body to perform vigorous muscular activity in the event of an emergency. The SNS alarm response is often referred to as the  fight/ flight mechanism or  fight/ fight/ freeze (F/F/F) response. The SNS alarm response prepares the body for vigorous physical activity by increasing respiration, pulse rate, arterial blood pressure, blood flow to the large muscles (and away from the skin's surface), blood sugar, cellular metabolic rates, muscle strength, and blood coagulants. The F/F/F response results in limited and highly focused mental activity. Current SPECT (single positron emission computerized tomograghy) scan research indicates that there is more blood flow in the limbic system and basal ganglia than in the prefrontal cortex and other parts of the neocortex (the "thinking or analytical brain") during states of anxiety (Amen). The SNS alarm response is a survival response that fires off in fractions of a second (Van der Kolk) and often precedes awareness of this response by the frontal lobes of the brain (Perry, Van der Kolk, Rothschild). This alarm response can be triggered by physical stress, tissue damage that causes pain, and/or by strong emotional reactions (Swack). Pain stimuli travel up the brainstem and register in the thalamus. Other internal (interoceptive) and external (exteroceptive) stimuli also are registered in the thalamic region of the brain. The amygdala, called the "smoke detector of the brain" (Van der Kolk), rapidly assesses information from the thalamus and, on the basis of prior learning by association,  triggers the alarm (F/F/F) response via the hypothalamus. The hypothalamus sets off the F/F/F response through separate nerve and neuropeptide pathways to the adrenal glands      (Rothschild, Swack, Van der Kolk). The  hypothalamus directly ennervates the adrenal medulla, producing epinepherine (adrenaline) and norepinephrine. The adrenal cortex is signaled to produce the stress hormone, cortisol, an anti-inflammatory, through  neuropeptide action in the hypothalamic- pituitary - adrenal axis.  Coritsol also signals the liver to release glycogen and increase blood sugar, so the body can increase it's energy. The hippocampus, which houses memory relating to the context of the perceived threat, can be overridden by a sudden strong amygdala activation (Van der Kolk, Rothschild). The left prefrontal cortex, and general prefrontal analytical thinking, which can inhibit certain behaviors, are activated more slowly than the F/F/F response and can be preempted by amygdala activation  (Perry, Rothschild, Van der Kolk). The entire purpose of the F/F/F response is immediate activation of physical responsiveness geared towards survival. Part of the Parasympathetic Nervous System (PNS) may be involved in the freeze response, which can have survival value in certain situations (Rothschild). After the individual has taken him/herself out of danger, termination of the F/F/F response is the most adaptive response. Other systems which have been shut down by the SNS alarm response, such as digestive processes, and  the immune response, can resume and the organism can conserve it's energy for other activities and challenges.

The midbrain, the amygdala and associative learning.
 The amygdala evaluates danger associated with incoming stimuli funneling through the thalamus. The amygdala operates in an incomplete but rapid fashion and, although it involves thousands of nuerons, it is reflexlike in it's operation (Perry, Rothschild). When at great physical risk, speed and strength are primary (as is skill, but skills have to be learned and practiced over time to become solidified into behavior patterns). Certain stimuli, such as pain, extreme physical stress, or intense emotional reaction register in the amygdala and set off the F/F/F response. The amygdala learns to associate patterns of stimuli which have been paired with danger and set off  the F/F/F response (Perry, Rothschild, Van der Kolk). In fact, the ability of the brain to engage in associative learning is one of the hallmarks of our human brain (Perry). It appears that a kind of Pavlovian (classical) conditioning occurs somewhere in the midbrain, perhaps in the amygdala itself (Rothschild). When a configuration of stimuli associated with danger is perceived by the amygdala, the result is a firing off of the F/F/F response. The configuration of stimuli appear associated with prior learning. For instance, if an individual was attacked from behind, he may well develop a SNS alarm response any time he is approached from behind. The result is a heightened drive state, inhibited access to prefrontal lobe inhibitory functions and inhibited problem solving. An individual with this association will demonstrate an exaggerated startle response, physiological hyperarousal and other F/F/F responses, dependent upon prior learnings. It has been demonstrated that thinking about a stressful event can bring on distressingly high levels of Sympathetic Nervous System activation (Perry, Van Der Kolk, Wolpe). In fact, intrusive thinking that ellicits the F/F/F response is one of the indicators of  Traumatic Stress Disorder and Post Traumatic Stress Disorder (Van der Kolk). It may be that many panic attacks are triggered by interoceptive and/or exteroceptive stimuli perceived by the amygdala, that have been associated with prior trauma, thus triggering the F/F/F response.

Acupoint stimulation, neuropeptide production and the relaxation response.

  George Ulett's review of scientific acupuncture studies indicates that acupoint stimulation produces: serotonin, a mood regulator; internal opioids (endorphins, enkephalins and dynorphins) which reduce pain and slow down the heart rate; and  increases of up to 50% in cortisol, which signals the midbrain to reduce the F/F/F response. Cortisol, which is a stress hormone, is regulated as a homeostatic system. This means that the body attempts to regulate it's production within a range. So, if too much cortisol is produced, the body "downregulates" and stops it's production. The reduction in cortisol slows down and/or stops the F/F/F response. Perry, Rothschild and Van der Kolk indicate the importance of sufficient levels of cortisol production to signal the amygdala to turn off the F/F/F response. Ulett concludes (pgs. 43-44) that: "acupuncture stimulates the endogenous pain-modulating system to produce serotonin, opiod substances and other transmitters at three levels of the central nervous system, the spinal cord, the thalamus, and the cerebral cortex, thus serving to dampen the transmission and perception of nociceptive (pain) signals". Additionally, Ulett notes (p 43) that "the role of the hypothalamus is clearly indicated" in the production of Beta-endorphins, which "stimulate long reaching axones to affect midbrain pain control mechanisms." . The combination of serotonin (a calming neurotransmitter), internal opioids to reduce pain, and an excess of cortisol,  signals the midbrain to effectively shut off the SNS alarm response and replace it with a relaxation response. This relaxation response reciprocally inhibits the anxiety and emotional hyperarousal and, thereby, provides the basis for counterconditioning, .
 A variety of methods can be utilized to stimulate acupoints and induce a state of biochemical relaxation. Ulett's literature review cites studies which utilized needling techniques or electrical acupuncture. Acupoint stimulation can also be accomplished by vacuum suction, tapping, and acupressure  (Feinstein, Gallo, Ulett).  A study of subjects with Generalized Anxiety Disorder by Andrade (2003) in Feinstein, indicates that tapping acupoints is even more effective than needling acupuncture in the treatment of Generalized Anxiety Disorder. Feinstein indicates that stimulation of mechanicorecptors under the skin at acupoint sites may be responsible for the production of the neuropeptides cited (cortisol, opioids, serotonin) which signal the brain to shut of the F/F/F response. Swack surmises that mast cells, that surround acupoints, may be the mechanism involved in the release of granules which stimulate the production of these nueropeptides. Although the exact mechanism is unclear, the production of serotonin, opioids and excessive cortisol is clearly indicated. Given our current understanding, it makes sense to use the least invasive and most economical techniques for counterconditioning in psychotherapy. Therefore, having clients tap and/or rub their own acupoints, appears to be the treatment of choice.

Advantages of using acupoint desensitization.

 There are many advantages to using acupoint meridian desensitization techniques. Acupressure can be framed as techniques of stress management and/or self-comforting, making it easy for clinicians and clients to understand and incorporate into ongoing therapy. The acupressure procedures take only a short time to learn and are easy to apply. The techniques can be used to desensitize traumatic material rapidly, thereby minimizing the risk of retraumatization. The techniques can be used outside the office by the client as homework, or as a self-help tool. Effective acupoint desensitization ensures that client's alarm response is no longer spontaneously "triggered" by associated memories or conditioned stimuli. The client no longer feels compelled to avoid stimuli associated with the traumatic event or memory. The reduction of compulsive avoidance may have beneficial effects upon maladaptive behavior patterns such as addictions and other compulsive behaviors. The client is able to rethink aspects of  the traumatic event and put this information into a more reasonable and/or broader frame of reference. As Perry and Van der Kolk point out, the ability to analyze data effectively is enhanced by the reduction of the F/F/F response. The client feels a greater sense of calm, competency and self-esteem..

Beyond counterconditioning, implications for psychotherapy and health.

 Acupoint desensitization is the first step of a two step process. The first step is reducing and/or eliminating unnecessary F/F/F reactions, which frees up a client from reflexively "reacting" to stimuli. Desensitization also increases the behavioral repertoire. Reducing the SNS alarm response increases access to prefrontal lobe problem solving (Amen, Perry, Van der Kolk). As a result of the diminished F/F/F response, the client has both time and mental /emotional resources to do creative thinking and planning. The client can also engage in self-reflection. The client is not emotionally overwhelmed and can experience the sense of competency involved in successfully developing and meeting a challenge by carrying out an action plan. In short, the client is able to think more clearly, develop strategies and skills, set and achieve goals by carrying out a well formed action plan and develop self appreciation associated with successful goal attainment. 

 The reduction of chronic SNS hyperarousal has powerful implications for physical health as well. Conditions like diabetes, where the F/F/F response wreaks havoc with blood sugar levels, and numerous other conditions can be helped by the ability of acupoint therapy to reduce unnecessary SNS activation. It is well known that chronic physiological stress reduces immune function. Reduction of unnecessary stress through meridian desensitization and creative problem solving can enhance the body's own ability to heal. There are many implications for physical health that are open to future research and clinical applications.

 Acupressure Desensitization Therapies utilize acupressure to produce a biochemical relaxation response which counterconditions anxiety-producing stimuli and traumatic memories. Anxiety-producing stimuli that were associated with the  Sympathetic Nervous System's fight/ flight/ freeze (F/F/F) response are reassociated with the Parasympathetic Nervous System's relaxation response. Acupoint stimulation can be accomplished through tapping, rubbing, and/or holding and breathing deeply.  Research on acupuncture demonstrates that stimulation of acupoints results in the release of cortisol, opioid peptides and serotonin. Excessive cortisol levels give biochemical feedback to the hypothalamus to shut down the F/F/F response.  The stimulation of the opiod peptides: endorphins, enkephanlins, and dynorphins result in Central Nervous System analgesia, which also deactivates the F/F/F response. Additionally, endorphins not only inhibit pain triggers in the spinal cord and brain, but they directly down regulate (i.e. reduce) the increased cardiac reaction to pain. Serotonin production results in a sense of emotional calm. The net result is a marked reduction in Sympathetic Nervous System arousal and the development of  a Parasympathetic Nervous System relaxation response. This physiological change is experienced as a feeling of relaxation, which reciprocally inhibits anxiety and emotiol distress and results in counterconditioning the particular stimuli/ thoughts which generated the F/F/F response. The thought or memory, after counterconditioning, becomes associated with feelings of relative calm. Once calm, the client has greater access to higher levels of cortical thinking. With access to higher levels of thinking, the client can re-evaluate traumatic memories and can problem solve current issues. Additionally, there are implications for physical health for those who have experienced high levels of acute and/or chronic stress. The tools of acupressure desensitization are easily learned and provide an effective self-help tool to be used outside of medical or therapy settings.   



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Jim Lane Ph.D is an Arizona Licensed Psychologist practicing in Tempe, AZ. He can be reached at (480) 897-6261, fax (480) 897-6284 or WEHEAL4U@C.S.COM

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