Prior to starting the treatment protocol, the client is introduced briefly to the basic premise of how BWRT is thought to work. Verbal explanations are accompanied with visual illustrations of the brain and the contained neural networks.
The client is asked to identify their preferred/ hoped for response when confronted with their trigger situation. The preferred response needs to be plausible and fair, meet the needs of the client, and not involve harm to another.
The therapist ensures that the client can recall the troublesome memory or a memory of a time when they experienced the worst symptomatic response pertaining to their presenting difficulty. They do not have to feel the response, only remember that they felt it. This must be an actual memory, not a thought or a feeling, and the client is not required to share this in detail.
The therapist ascertains from the client their Perceived Arousal Level (PAL) on a 1 - 10 basis with 10 high, when recalling their chosen memory. If 8 or lower, it is advisable for the client to identify an alternative memory with higher associated arousal.
Create the Wait State. The client is invited to close their eyes, access the memory, ‘zoom in’ to the very worst moment of that memory and ‘freeze it’ as a static image.
The client is asked to visualise ‘dragging’ their preferred response in front of their existing frozen memory. The preferred response will ideally be accompanied by visual imagery and the preferred emotional content. At this stage, the client is encouraged to think vividly of what they preferred to happen.
Create intensity for the ‘moment of now’. The treating therapist reads a scripted narrative in quick succession encouraging clients to adopt a ‘here and now’ focus and to visualise the new feeling generated by their preferred response entering their neural pathways and physical boundaries (i.e. skin and ‘aura’). Such imagery is prompted by illustrations of neural networks shown at the start of the session during psychoeducation provision.
Create the ‘future memory’. The treating therapist reads a short script with intensity, directing the client to visualise a time in the future where they are looking back at their BWRT session and realising what a success it has been.
Recursive looping. This involves the therapist reading a scripted narrative for a minimum of 6 times with increasing speed (230 words per minute) the content of which directs the client to shift their attention from memories of the past, present and future. The speed of reading is considered essential to sufficiently overwhelm the central nervous system and prevent other extraneous information from being processed that could interrupt the installation of the new neural route representing the ‘preferred response’.
The resting phase. The client is encouraged to relax in silence for up to two minutes.
The consolidation phase. The therapist engages the client in ordinary conversation avoiding any discussion of the session to allow the brain to process the new data without interruption.
The debriefing phase. To ensure the clients preferred response meets the three-criterion outlined in stage 1, the client is encouraged to share in sufficient detail what their preferred response looks like.
PAL re-rated. The therapist will ascertain the clients PAL rating when recalling the target memory. If the PAL is >3 then further recursive looping is required.
The client is asked to try and ‘fire up’ their original response to their target memory. If any unwanted physiological or emotional responding remains further processing/ looping is required.
Maintenance of treatment gains. If the client is revisited by any of the unwanted responses associated with their target memory, they are encouraged to visualise their preferred response and boundaries (i.e. skin and aura) which is thought to reactivate the preferred neural route.