How Therapists can Use the Pupil to Heal Trauma

One of the reasons that I left EMDR and started to pursue brainspotting as the primary Brain based medicine that I use as a provider was because of Pupil dilation. Years ago when I was  just starting out as a therapist I noticed that pupil dilation patterns were a good indicator of how well a patient was processing trauma.  I would use a patient’s pupil dilation and movement to see how well EMDR was working. During EMDR patients don’t talk much until the end of a cycle of eye movement. I learned that when I saw certain patterns of movement in the pupil during EMDR, that was when a patient would have a big revelation or emotional insight. When I saw the pupil tracking relatively smoothly with no movement, I knew before the patient spoke that the EMDR was not working and that we needed to adjust the target or framing of the treatment to try again. 

 I was actually doing a treatment similar to brainspotting for about three months before I knew brainspotting existed. I immediately noticed as an EMDR provider that patients’ eyes would “flutter” or rapidly expand and contract the pupil, on certain spots along the EMDR movement line. It seemed like most of the neurological change was happening in these spots. I began to slow down my finger as I passed these spots that seemed to produce the most profound change. Eventually I stopped moving on these spots completely and patients entered fugue states and emerged with profound insight. I started to experiment with the distance my finger was from the eye and this seemed to make difficult and avoided memories more clear and easier for patients to process. 

I was not seeing subtle movements of the pupil either. Some patients’ eyes moved so quickly between contracted and open they looked like a strobe light. Others dilated so wide that there was hardly any iris available at all and they saw strange colors and patterns. (Watch a video of what this looks like here). I told a friend of mine who is an ophthalmologist what kinds of things I was seeing in the eye and they told me those movements were not possible without a stroke or tumor. I felt confident the more than eighty patients I had seen by that point did not all have  a brain tumor or stroke. Something else about how the brain processes trauma and sensory input was at play. 

I looked for more and more EMDR providers to help me expand or understand this phenomenon. EMDR is very hierarchical and protocol driven. All of the trainers treated me like a heretic and told me to forget what I was noticing and return to the EMDR formula. Nevermind that patients were requesting “this” instead of EMDR even though they were not aware I was doing anything new. Never mind that patients who had benefited and completed EMDR protocol felt this new technique was leading them to new layers of understanding and healing that EMDR alone did not produce. I felt overwhelmed and alone. I had been a therapist for about three months at that point.

My understanding at the time was that trauma was a “stuck” memory in the subcortical and somatic brain. The body remembered the somatic re-experiencing of the traumatic event even though the rational and intellectual part of the brain knew that it was over. These traumatic, somatic associations affected posture, muscle tension, motion and mood, even though patients were not always intellectually aware of them. Different parts of the brain remember things in different ways, as they serve different functions. Traumatic experiences make implicit memory centers that govern emotion, kinesthetic, and somatic experience cling to physical memories not integrated with what the intellectual and conscious emotional brain is doing.  

It made sense to me then that the eye might also “remember” where it was looking during a trauma and the brain might associate eye positions with somatic, traumatic memories. These associations could have been created all at once, like the patient that watched his friend’s car explode from an IED. They could also be created in layers of association overtime, like the numerous  patients who remembered staring down at the floor or inside a classroom when they had been yelled at by an adult. 

What is Brainspotting?

I was insecure because patients were now exclusively requesting this “new” technique but I did not know what it was. After asking many peers a fellow therapist told me that what I was doing sounded like something called Brainspotting, invented by Dr. David Grand. When I spoke to  David Grand,he  said that he was also an EMDR professional who had  followed his own intuition to create brainspotting and leave EMDR behind when he saw the same cues in the eye that I had followed. 

Dr. Grand told me that I needed to experience the technique I was practicing myself at a brainspotting training, which I soon did. Brainspotting is an experiential therapy that practitioners learn how to do by going through themselves. I am enormously grateful that there was a body of academic work done  by Dr. Grand and his collaborators that I was able to  stumble upon and learn from. I would never have been able to develop the nuance and intricacy of the brainspotting technique on my own.

Now that the science of brainspotting has advanced for more than two decades it has discovered lots of tricks. Brainspotting stimulation with one eye covered means that the brain will have to pull associations from a traumatic experience from one side of the brain and allow for integration with the other brain hemisphere. This helps the midbrain “get on the same page” with what the subcortical brain used to be feeling in isolation. This is one example but there are literally hundreds of tricks brainspotting practitioners have found. 

What is Emotional Transformation Therapy (ETT)? 

Looking for fast and effective scientific modalities also led me to Emotional Transformation Therapy, developed by Dr. Steven Vazquez. Dr. Vasquez’s technique uses color, light direction, frequency and hue to integrate traumatic memory. The visual pathway’s through the brain connects directly to the oldest parts of our brain with the deepest wiring to the body and most unconscious or implicit memories. Other senses travel through more modern additions to the brain in the mid and frontal structure. This is one of the reasons that visual stimuli is such a powerful tool for profound emotional change and healing.

I’m now the second person in the state of Alabama trained in ETT, and the only one trained in EMDR, Brainspotting, and ETT that I have been able to find in the world. I hope learning these established brain based medicines can pave the way to new discoveries and the future of the psychotherapy profession.  

What happens in the Brain during ETT, Brainspotting,  or EMDR?

The human eyes, often overlooked for their complexity, play a pivotal role beyond mere vision. I would argue that we should think of eyes as extensions of the brain. Extensive scientific research has unraveled the intricate neural pathways that light-initiated impulses follow through the nervous system, influencing a wide range of brain functions. Surprisingly, there are three major neural pathways responsible for transmitting these impulses, affecting nearly every significant aspect of brain activity. By manipulating factors like wavelength, light angle, brightness, psychological state, exposure duration, and strobe rate, one can direct these impulses to specific brain functions, ultimately impacting emotional and somatic regulation.

The First Pathway: Integrating Visual Functions

Photoreceptor cells in the eyes convert light into electrical impulses, creating a connection between vision and various non-visual functions. This pathway blends visual experiences with auditory and movement functions, eye orientation, and general spatial awareness.

The Second Pathway: Sensory Integration and Regulation

This pathway begins with the lateral geniculate nucleus in the thalamus, which selects visual information to relay to the visual cortex. The visual cortex, the brain’s largest sensory area, then communicates with three major integration centers: the hypothalamus, controlling the autonomic nervous system and various bodily functions, and the pineal gland, overseeing hormones, the immune system, and more. Light exposure impacts our physiological rhythms and the “biological clock,” called the suprachiasmatic nucleus.

The Third Pathway: Broad Impact on Brain Functions

This pathway accesses previously mentioned brain functions and stimulates the brain stem, general arousal, the central nervous system, and emotions.It offers an alternative route to influence mid-brain and hypothalamus activity.

Visual Pathways and Pupil Movement

For over a century, only rod and cone cells were recognized as photosensitive in the eyes.

In the 90s new visual stimuli cells were discovered in mice, responsible for regulating circadian rhythms. In the 2000’s a new cell, the Retinal Ganglion Cell, was identified in humans. These cells are activated mainly by blue light. They transmit impulses to the hypothalamus and the mid-brain’s olivary nucleus, affecting pupil size and other behaviors.

These cells are associated with sleep regulation through melatonin, control energy and mood through glutamate release and the availability of neurotransmitters through pituitary adenylate polypeptide. These visual cells control far more in the body and brain than what we see. These neural pathways play a vital role in brain function and are a rapid and  poorly understood pathway for trauma treatment.

What can pupil dilation teach us?

The language of the pupil taught both me and Dr. Grand that there was more to the brain than the EMDR procedure made room for. Is there more that the pupil has to teach us about  trauma and the brain? I think so. Whenever I encounter someone that had no results in brainspotting I always ask them what the sessions were like. I have never met a brainspotting non responder who did sessions with a brainspotting provider that was using the pupil to find spots. Patients who had negative experiences with brainspotting have all reported to me that their provider moved the pointer to different places and asked the patient what they felt for several sessions until the patient didn’t go back. 

Francine Shapiro (EMDR), David Grand (Brainspotting), and Steven Vazquez (ETT) were not the first to connect the relationship between emotion and the pupil. Danie Beaulieu (EMI) used eye movement to heal patients’ trauma in the 1970s before EMDR when she created eye movement integration. . Richard Bandler and John Grinder, the creators of Neuro-Linguistic Programming (NLP), developed the concept of NLP “eye cues” through their observations of various therapists and their techniques. They did not base NLP eye cues on the work of a single individual but rather drew inspiration from several sources, including the work of Virginia Satir (a family therapist), Fritz Perls (the founder of Gestalt therapy), and Milton H. Erickson (a renowned hypnotherapist).

Bandler and Grinder’s approach involved studying the language patterns and non-verbal cues used by these successful therapists and modeling their techniques. This modeling process led to the development of NLP, which encompasses various tools and techniques, including the observation of eye movements or eye accessing cues.

To my knowledge there is no official record or mention of it. However, I have heard from several older therapists that Bandler (NLP), Shapiro (EMDR), and Beaulieu (EMI) attended the same somatic medicine conferences and discussed eye movement to treat trauma and how pupil dilations that could indicate trauma was present for several years before they created their own models. The idea of using eye movement in therapy has been around a long time. The confusion and disagreements come down to what the most effective metric and techniques are. 

What do pupil dilations tell us about the brain?

Pupil Dilations and Movement are Windows into Brain Function

The human eye, often called the “window to the soul,” gives us our most . Pupil dilation gives us one of the most immediate and simple ways to glimpse brain function. We have long known that pupil dilation and movement, are controlled by the autonomic nervous system (ANS), have the potential to reveal valuable insights into the type of brain activity occurring. 

Is using pupil dilation to detect brain function evidence based?

Oddly industries other than mental health are more likely to trust the science between pupil dilation and movement. Silicon valley companies trust it with billion dollar deliverables, advertising companies trust it with multi million dollar ad campaigns and movie studios trust it with summer blockbusters. Dr. Clotaire Rapaille was one of the pioneers of helping ad and tech companies tap into the pupil to see a customer’s emotional connection to their brand. 

Have you ever wondered why every movie trailer has shots of extreme emotion in close ups on faces, explosions, screams and fire? Well that is because thousands of hours of footage was used to see what made test audiences eyes dilate the most. The findings were shots of eyes, shots of fire, and shots of extreme emotion like screaming produced the strongest pupillary reaction. Google and other GUI designers use eye tracking to design interfaces that represent the way the eyes seek information naturally. Advertising companies study the potential effect of different ads by seeing if focus groups have emotional reactions to the product with pupillometry. 

We have understood that pupil movement and dilation corresponds to pupil dilation’s link to emotion has practical uses in various fields. In the entertainment industry, movie studios often screen trailers to test audiences while monitoring their pupil dilation to gauge emotional reactions. This helps filmmakers refine their marketing strategies and identify the most captivating scenes to include in trailers. Additionally, market researchers and advertisers use pupillometry to evaluate consumer reactions to advertisements and product packaging, enabling them to create more appealing and emotionally engaging campaigns.

How does brain function affect the pupil?

Pupil Dilation and the Sympathetic System

The sympathetic nervous system is responsible for the body’s “fight or flight” response during stress or perceived threats. When the brain detects danger or excitement, it activates the sympathetic system, which, in turn, affects pupil dilation:

Sympathetic Preganglionic Neurons:

 These neurons, located in the spinal cord, transmit signals to the sympathetic ganglia. When activated, they stimulate the release of acetylcholine, initiating pupil dilation.

Sympathetic Ganglia: 

These are clusters of neurons located outside the spinal cord. They relay signals from preganglionic neurons to postganglionic neurons. Activation of sympathetic ganglia leads to a rapid dilation of the pupils.

Sympathetic Postganglionic Neurons: 

These neurons release norepinephrine, which contracts the muscles of the iris, causing pupil dilation. This process enhances visual perception, allowing for better detection of potential threats.

Modern and Primitive Parasympathetic Brain Functions

Modern Parasympathetic Function: 

This response is associated with relaxation and recovery. When the brain activates the modern parasympathetic preganglionic neurons, it leads to smooth and controlled constriction of the pupils. Pupil movement is gradual and reflects a calm and relaxed state.

Primitive Parasympathetic Function: 

The primitive parasympathetic response, often referred to as the “freeze” response, is associated with intense stress or trauma. During this response, the brain may send mixed signals to preganglionic neurons, resulting in irregular pupil fluctuations. Pupil dilation and constriction may occur abruptly and unpredictably.

Interpreting Brain Function Through Pupil Dilation and Movement

The key to using pupil dilation and movement to indicate brain function lies in pattern recognition and analysis. By tracking and analyzing these patterns, researchers and clinicians may be able to make educated hypotheses about the state of the autonomic nervous system and the brain:

High-Stress Situations: 

Rapid and pronounced pupil dilation might suggest heightened sympathetic activity, indicating that the brain is responding to stress or a perceived threat.

Relaxation and Calmness: 

Gradual, smooth pupil constriction may signify the dominance of the modern parasympathetic system, indicating a state of relaxation and calm.

Traumatic Events: 

Irregular fluctuations in pupil size, including moments of rapid dilation and constriction or back and forth “jitter”, could be indicative of primitive parasympathetic responses triggered by traumatic events.

How can Clinicians Use the Pupil During Brainspotting or ETT

Changes in pupil size and activity could provide insights into a patient’s brain function, thought processes, or emotional state, although this field is still evolving, and the interpretations may vary depending on the specific context and individual variability. Here are some hypothetical scenarios on how pupillometry could be used:

Emotional State Assessment:

• Positive vs. Negative Emotions: Pupillometry might distinguish between positive and negative emotions. Research suggests that positive emotions could lead to different patterns of pupil responses compared to negative emotions. For instance, increased pupil dilation might correlate with excitement or joy, while smaller pupils might relate to sadness or fear.
• Intensity of Emotion: The degree of pupil dilation might correspond to the intensity of an emotional response. Larger dilation might indicate stronger emotions, while smaller changes may suggest milder emotional reactions.

Cognitive Load and Thought Processes:

Cognitive Load: 

• Pupillometry could potentially reflect cognitive load. Higher cognitive demand or mental effort, such as solving complex problems or deep thinking, might be associated with larger pupils. Conversely, relaxed or low-cognitive-load situations could lead to smaller pupils.

Working Memory: 

• Changes in pupil size might indicate the engagement of working memory. When someone is actively holding information in their working memory, their pupils could dilate as the cognitive load increases.

Brain Function and Task Performance:

Attention and Focus: 

Pupillometry can reflect shifts in attention. When a patient focuses on a specific task or thought process, their pupils might constrict due to increased parasympathetic activity. Sudden distractions or shifts in focus could trigger pupil dilation.

Memory Recall: 

During memory recall or introspection, changes in pupil size might indicate the brain’s engagement with the retrieval process. Larger pupils could correspond to the active retrieval of detailed memories.

Autonomic Nervous System Regulation:

Sympathetic vs. Parasympathetic Dominance: 

Pupil responses might also indicate the dominance of the sympathetic or parasympathetic branches of the autonomic nervous system. Sympathetic dominance could be associated with pupil dilation, while parasympathetic dominance might lead to constriction.

While the use of pupil dilation and movement to decode brain function remains hypothetical and complex, ongoing research in this field holds immense promise. Advances in technology, including high-resolution pupil tracking systems and sophisticated data analysis, may soon allow us to harness the potential of the eyes as a direct window into the mind. Understanding these patterns could revolutionize our ability to diagnose and treat conditions related to the autonomic nervous system, trauma, and emotional states, providing profound insights into the human brain and its intricate functions.

What happens in the brain to affect pupil dilation?

Pupil dilation is primarily regulated by the autonomic nervous system, specifically through the interplay of the sympathetic and parasympathetic branches. These branches work in opposition to control the size of the pupil.

Sympathetic Nervous System (Dilation): 

The sympathetic nervous system is responsible for the dilation of the pupils, a process known as mydriasis. When the brain perceives a need for increased visual sensitivity, typically in response to emotional or environmental stimuli, it activates the sympathetic system. The key mechanisms involved in sympathetic-induced pupil dilation include:

Dilation of the Iris: 

The sympathetic system stimulates the dilator pupillae muscles, which are radially oriented within the iris of the eye. When these muscles contract, they pull the iris outward, causing the pupil to expand or dilate. This allows more light to enter the eye, enhancing visual acuity.

Reduction in Parasympathetic Activity: 

Sympathetic activation also leads to the inhibition of the parasympathetic system, which normally constricts the pupil. By reducing parasympathetic input, the sympathetic system further promotes pupil dilation.

Neurotransmitters: 

Neurotransmitters like norepinephrine play a role in sympathetic-induced pupil dilation. Norepinephrine is released from sympathetic nerve endings and binds to adrenergic receptors on the dilator pupillae muscles, initiating their contraction.

Parasympathetic Nervous System (Constriction): 

Conversely, the parasympathetic nervous system controls pupil constriction, or miosis. When the brain perceives a need to reduce the amount of light entering the eye, such as in bright light conditions or during activities that require close-up vision, it activates the parasympathetic system. Key mechanisms involved in parasympathetic-induced pupil constriction include:

Contraction of the Sphincter Pupillae: 

The parasympathetic system stimulates the sphincter pupillae muscles, which encircle the pupil in a circular fashion within the iris. When these muscles contract, they constrict the pupil, reducing its size.

Release of Acetylcholine: 

The neurotransmitter acetylcholine plays a pivotal role in parasympathetic-mediated pupil constriction. Acetylcholine binds to muscarinic receptors on the sphincter pupillae muscles, initiating their contraction.

Inhibition of Sympathetic Activity:

Parasympathetic activation also inhibits the sympathetic system, preventing pupil dilation.

The balance between sympathetic and parasympathetic input to the iris determines the size of the pupil at any given moment. Various factors, including light levels, emotional responses, and cognitive processes, can influence this balance. Emotional and cognitive stimuli can trigger changes in autonomic nervous system activity, leading to alterations in pupil size. This dynamic regulation of pupil diameter is what allows researchers and clinicians to use pupillometry as a window into an individual’s emotional and cognitive states.

Emotion and Pupil Dilation:

Emotions play a significant role in pupil dilation. When a person experiences strong emotions, such as fear, excitement, or stress, their pupils tend to dilate.

This response is mediated by the autonomic nervous system, specifically the sympathetic branch, which activates the fight-or-flight response, causing the pupils to widen to allow more light into the eyes and improve visual awareness.

In brain spotting, therapists use changes in pupil size to gauge the emotional intensity of a client’s response to specific memories or thoughts. The therapist observes how the client’s pupils react during discussions or when focusing on certain points in their visual field.

Introverted Sensing and Pupil Dilation:

How Brain Spotting Can Uses Pupil Dilation:

In brain spotting therapy, the therapist helps the client identify and target specific points in their visual field that trigger emotional responses or lead to the emergence of traumatic memories.

The therapist observes the client’s eyes and pupils as they focus on these points. Any changes in pupil size, such as dilations or contractions, are considered significant and may indicate the activation and processing of emotional material.

By tracking pupil responses, therapists can identify when a client is accessing deep emotional content, allowing for precise targeting of unresolved issues and providing a pathway to healing and resolution.

In brain spotting, therapists guide clients through a process that involves tracking their own internal experiences and sensations. The therapist pays close attention to any shifts in pupil dilation as a client recalls and processes past traumas or unresolved emotions.

The process of observing and using pupil dilation in brain spotting can help clients access and release buried emotions, reduce the impact of trauma, and promote emotional healing.

A New Model for Eye Movement Therapy 

Just like talk therapy models there will never be a perfect model of eye movement or brain based medicine. We are alway looking for and then testing better theoretical models in soft science. EMDR paved the way for brainspotting. ETT and brainspotting contain new nuggets of insight that can enrich each modality simultaneously. EMI and NLP contain forgotten insights and pointers. 

No one modality is ever 100% correct in the assumptions that it has to make to have a theoretical framework. We are called as providers and innovators in the field of trauma to find new. After all even the worst modalities do work for some people. You would be hard pressed to find a therapy model that does nothing for no one person. Nothing works for everything despite what the zealots in this profession will tell you.  

The best models work for the most amount of patients and more conditions most of the time with less room for clinician error. In my experience brainspotting works better for more people than EMDR did. In my experience ETT can help bypass conditions that might make brainspotting from working in some cases. The science cannot stop here. In fact we have noticed several other things about the pupil at Taproot Therapy Collective since we all got trained in brainspotting and I got trained in ETT. New models and new techniques are coming. Watch the pupil. Learn to build the next revolutionary thing in the world of trauma treatment.  

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