Lessons Learned Through a Failed Effort to Remediate Reactive Attachment Disorder (RAD)
My earlier research with combat veterans with PTSD (Lindenfeld et al, 2015a, Lindenfeld et al., 2015b, Miller, J. C., & Lindenfeld, G. 2017, Lindenfeld et al, 2019a, Lindenfeld et al., 2019b, Lindenfeld et al, 2019c, Lindenfeld et al., 2021) established framework principles for further scientific inquiry into the utilization of binaural beats to address multiple mental health issues. The developed intervention referred to as RESET therapy (Reconsolidation Enhancement by Stimulation of Emotional Triggers) validated efficacy in rapidly remediating the effects of PTSD among the pilot study participants. The essence of the intervention was to have a uniquely tuned-in binaural beat delivered through headphones to resonate with aberrant cortical brain circuitry created by prior exposure to trauma. A notable consequence of this intervention was a rapid return of resiliency in the previously afflicted participant.
The brain plasticity referred to in RESET therapy is derived from a process called Memory Reconsolidation (Singer, 2009). An opportunity to change key emotional aspects of a disturbing trauma-induced memory occurs through the action of neuronal memory circuits reforming after they have been consciously or unconsciously recalled or activated (triggered). Once the distressing memory has been revitalized, it becomes possible to disrupt the memory reconsolidation process. With RESET therapy, this window is temporary and occurs through the introduction of an individually determined binaural sound, before the newly altered memory reconsolidates. Specifically, the sound intervention causes the negative emotional aspects of the traumatic memory to ‘drop out’ or erase, during the new memory reconsolidation phase. Often, the intervention results in immediate, permanent, and significant symptom reduction or relief.
As a practicing Diplomate in Clinical Psychology, I was asked to clinically participate in a Reactive Attachment Disorder (RAD) case in a pre-adolescent through telehealth means. My initial Google Search inquiry into this topic revealed it to be quite prevalent during the childhood period (Ainsworth, et al. 1978) and that the condition was later associated with romantic attachment disturbance in adulthood (Brennan & Shaver, 1995). The case study I present in this article was my first effort to alter the RAD condition in a child. To address this matter, I developed a modification of RESET therapy that I have come to call RESET-RAD.
My reasoning for this alteration was that if we were first able to neutralize prior trauma effects including non-verbal incidents experienced during an early age (Phase 1), we might then introduce a sense of unconditional love and acceptance through a surrogate mother physically encountering the patient (Phase 2). The surrogate’s task was to lovingly hold & comfort the patient as if he were an infant seeking nurturance from the birth mother. Admittedly, my first effort failed due to a number of factors. However, important learning points emerged that established guidelines for later success with RESET-RAD for both an adolescent and adult participant. These successful case studies are to be submitted to a peer-reviewed journal at a later date. In the interest of full disclosure, I provide the following case study of eleven- year-old Pete as conveyed through his mother’s (Betty) verbalizations. Please note that this material was conveyed over a three-month period of time.
Case Study “We had to take Pete to the ER for an emotional outburst on a Friday night. They did a blood draw and his lab work was fine, of course. Then, the ER had me talk via telehealth to a psychologist for 3 minutes, who was angry at me for not doing enough for Pete! He and the ER physician accused me of not intervening sooner when Pete was having his outburst rage. I was disgusted, and we got home by midnight that night. So much for the state of mental health in this country! I will never take him to the ER again for mental health concerns.
Pete was placed on Prozac 10 mg/day by his family doctor although he still continued to have all of his RAD behaviors. He had a rage event this past Thursday evening that only lasted 20 minutes, with John (father) staying in constant contact with him through a locked door because he had become physically combative with us. It was over a food issue. I didn’t get Pete what he wanted right away at dinnertime–taco pizza sauce! He mumbled his need; I didn’t hear him. He went to get it himself, which was against a dinner rule (he cannot get up without having permission during a meal), and then he was disrespectful to me, and I got mad (I was very tired) and yelled at him to go up to his room (after he was extremely disrespectful, back-talk). That was when everything flipped-he told me he was going to take his food up to his room and started to do it. I was concerned he would throw his food all over upstairs, so I reached to get it and he went into a rage. This led to a call to the sheriff as we were unable to constrain him.
Pete provided me with a lot of information following the sheriff’s visit after his rage reaction. It seems like Pete was reenacting an old trauma so I need to share this with you. He remembered being stuffed in a locked and dark basement for hours, without a toilet– only having a pot to pee in, and a metal tub to bathe in, and only being allowed upstairs for food, etc. When Pete had his rage reaction at dinnertime, he started hyperventilating, had flashbacks to the basement he was earlier put in.
John’s anger is very intense right now towards Pete when Pete loses emotional control. He threatened divorce because I didn’t call the sheriff soon enough (according to John) as we agreed. Anyway, all that to say–THINGS ARE COMPLICATED AND VERY VOLATILE RIGHT NOW! Doing RESET therapy with Pete is TOO MUCH for me to do alone! I told Pete that we were going to have him remember the basement memories. Right away, he went into 2-year-old Pete (he was on his bed) and put his legs up into the fetal position on his back, and rolled away from me, put the blanket over his head, and said, “I don’t want to remember that!” After a few more encouraging words, he then said he didn’t remember a basement. Then something I said made him think that we were going to actually go to the basement, and that really threw him into anxiety and he shouted out “what?!?!”. Then I had to reassure him that I meant “go-to” in his memories. In other words, he does remember! So, we now know that that is a MAJOR trigger, of course.
He expressed concern about you (Dr. Lindenfeld) watching us “cuddle” with the RESET device and said he felt embarrassed when people watched him cuddle with me. I reassured him that you really liked seeing kids and parents cuddle-that was a nice thing. He was VERY CONCERNED that you might tell others about what happened in the basement. He said he’s VERY EMBARRASSED that that happened. I reassured him that it wasn’t his fault. He also wondered aloud if you knew that he couldn’t love his parents (i.e., us) because of what happened to him when he was young. I said, yes, you knew this and this is why we are doing this - to “unlock the memories so he can be free and live normally.”
After Thoughts Unfortunately, I totally missed what should have been Phase 1 of a three-part intervention. I’ll call the missing phase, ensuring the vitality of the marital bond prior to the RESET-RAD intervention. Having been previously trained in Family Systems Therapy, this turned out to be a fatal error that resulted in the total collapse of the treatment effort. As suggested in Betty’s verbalizations, the deteriorating relationship between her and John resulted in the termination of their marriage as well as in their RESET therapy effort.
Secondly, I advise against attempting this form of treatment through telehealth means. The subtle relationship clues are missed without direct observation of marital interactional nuances. Thirdly, I advise that the surrogate mother be a person other than the adopted parent. Too much hurt and anger has been accrued for this person to fully convey without hesitation an atmosphere of total nurturance and acceptance.
Based on this perspective, with upcoming cases of this type, I found a retired social worker who filled this role in my successful applications of the RESET-RAD process. My remaining regret is that we appeared to be on the verge of a therapeutic breakthrough related to Pete’s rage triggering events. Hopefully, the mistakes made in this initial treatment effort will ultimately serve to create a promising therapeutic opportunity that can alter the attachment difficulties of those families with RAD children who seek help.
References Ainsworth M. D. S., Blehar, M. C., Waters E, Wall S: Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale, NJ: Erlbaum; 1978.
Brennan, K. A., Shaver P. R., 1995, Dimensions of Adult Attachment, Affect Regulation, and Romantic Relationship Functioning, Personality and Social Psychology Bulletin, http:// psp.sagepub.com/content/21/3/267
Lindenfeld, G., Rozelle, G., (2015a) PTSD: Brain on Fire: A RESET Therapy (QEEG) Brain Map Analysis Case Study of an Afghanistan Combat Veteran. https://www.academia.edu/ 19524765/PTSD_Brain_On_Fire
Lindenfeld, G. L., Rozelle, G., Hummer, J., Sutherland, M. R., & Miller, J. C. (2019a). Remediation of PTSD in a Combat Veteran: A Case Study. NeuroRegulation, 6(2), 102– 102. https://doi.org/10.15540/nr.6.2.102e
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Lindenfeld G. L., Hummer J. T., Billiot K., Anger and Aggression: A New Beginning? Family Court Review, 2021, Volume 59, Issue 1, p. 161-170, https://doi.org/10.1111/fcre.12538
Lindenfeld, G., Rozelle, G., Soutar, R., Hummer, J, & Sutherland, M. (2019b). Post-traumatic stress remediated: A study of eight combat veterans. New Mind Journal: Winter, 2019, www.nmindjournal.com
Miller, J. C., & Lindenfeld, G. (2017). Auditory Stimulation Therapy for PTSD. Presented at the 88th Annual Scientific Meeting of the Aerospace Medical Association, Denver CO. https://www.academia.edu/32861964/Auditory_Stimulation_Therapy_for_PTSD
Singer E., 2009, Manipulating Memory, MIT Technology Review, https://www.technologyreview. com/2009/04/21/213600/manipulating-memory-2/