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Brainspotting (BSP) is a psychotherapeutic treatment procedure developed by American psychotherapist David Grand in 2003. This method identifies, processes, and releases core neurophysiological origins of emotional/physical pain, such as traumas. Brainspotting aims to help patients by helping them position their eyes strategically to locate brain spots which are thought to activate the brain. These brain spots represent the body's physiological reaction to the emotional dysfunction that occurs when a patient's eyes are in a particular position. This form of therapy comes from two other methods called Somatic Experiencing and Eye Movement Desensitization and Reprocessing (EMDR). The main difference between EMDR and BSP is that EMDR stimulates processing of stress through eye movements while BSP assumes that processing can be stimulated by eye fixation and specific eye position.

History
Brainspotting was developed by David Grand who is trained as a psychoanalytic psychotherapist in Long Island, New York and was most of the time involved in cases of PTSD, especially 9/11 victims. This therapy approach is a combination of methods like EMDR by Shapiro or Somatic Experiencing by Levine with psychoanalysis. BSP was first used in a case of a competitive ice skater; during that case and the use of Shapiro’s method of EMDR, Grand developed his revised version of “natural flow EMDR”. This method seemed to improve the symptoms of the ice skater and was used by many others; later Grand called this method brainspotting. The first international conference about brainspotting was in 2016 in Buzios, Brazil.

Medical uses
Brainspotting is mainly used to help people with processing distressing or traumatic experiences. Traumas often have far-reaching effects, for example, PTSD, attachment issues, substance use, chronic pain, dissociation, attention-deficit/hyperactivity disorder and major depressive disorder. These issues can be treated with brainspotting as well. Generalised anxiety disorder can also be treated with brainspotting.

PTSD cases
Brainspotting is thought to be an efficient treatment for post-traumatic stress disorder (PTSD). PTSD itself can be an economical burden to the patient and early intervention has the positive effect of cost reduction; It can be seen as useful to help individuals who suffer from PTSD with BSP from two viewpoints: their personal life and in the interest of society. Over three sessions of BSP, PTSD symptoms and accompanying symptoms of anxiety, were reduced in most patients, according to therapists and patients who assessed their well-being with the help of Subjective Units of Disturbance Scale (SUDS).

Addiction
There is an increased risk of substance use disorder in people who have experienced trauma. By treating the trauma via brainspotting, psychologists can begin treating the possible origin of the addiction.

Procedure
In the first step of the brainspotting process, the patient describes the issue he is dealing with. Then, the therapist helps the patient to localize the physical pain he is feeling related to the issue and to localize the negative feeling in their body. In the following, the therapist points with a rod or his finger to different points to guide the patients vision into different areas. The patient indicates when he is feeling a relief or a stronger negative feeling in eye positions. Those "brain spots“ with the unsteady eye movement are noted by the therapist. While the patient fixates on those unsteady spots he shares related thoughts, feelings, and memories as deeply as he wishes to. The critical points where the patient should focus on can either be determined by the therapist in the "Outside Window“ approach where he observed the "brain spots“ in the patients eye movement or they can be determined by the patient himself in the so called "Inside Window“ approach.

Evidence
A study published in 2022 compared the effects of three interventions: 1) Eye Movement Desensitization and Reprocessing (EMDR), 2) brainspotting (BSP) and 3) Behavioral Sleep Medicine (BSM). These three methods were compared to a control group. Improvements were measured using Subjective Units of Disturbance Scale (SUDS) and Memory Telling Duration (MTD), measured four times: the Baseline, Pre-Intervention, Post-Intervention and a follow-up two months after the intervention. In the study all three techniques were more effective than the control group: immediately after the intervention and at the follow-up EMDR led to the most improvement in the SUDS, but was closely followed by BSP. The difference between the results of EMDR and BSP were unsignificant. BSP seems to be an effective alternative to EMDR for treating individuals with PTSD or patients who suffer from traumatic experiences in different ways. It seems lead to improvement regarding the therapists’ or patients’ subjective evaluation and regarding objective measurements: After a session with a duration of 40 minutes, the BSP groups had better heart rate variability (HRV) than before; the control group showed no such improvement in the pilot study.

Brain substrates
This treatment works on the midbrain by directly accessing the autonomic and limbic systems within the body's central nervous system. Visual, auditory, and motor functions are handled by these areas. Traumatic events cause this area to go into freeze mode to conserve resources for the body. This results in aspects of the experience to become stuck and unprocessed in the subcortex of the brain. Through brainspotting, these memories can be accessed again.

Criticism
In 2022, brainspotting is not a widely and rigorously researched therapy strategy and therefore, only hypotheses are available. No long-term research that supports or refutes the effectiveness of the method is available. Though there have been positive reports on its effectiveness, these are mainly anecdotal. The fact that all therapeutic material originates from BSP's creators and colleagues confounds examination of BSP at this level, which risks inherent bias. This therapy is not suitable for everyone. In order for brainspotting to be effective, the brain must be intact in order for certain neurological processes to occur. This method is not suitable for patients with attention disorders or focusing problems, such as ADHD. Working memory and medial prefrontal areas for monitoring emotions, memories, body sensations, and cognitions must be intact for this therapy. Only patients with adequate eyesight can participate in this therapy, as the therapist moves the client's eyes across the field of vision with a pointer to identify an optimal eye position ("Brainspot") to "activate" the response to a traumatic memory. Blindness is an exclusion criterion for this therapy since the patient listens to a BioLateral Sound continually during the processing, not only the eyes but also the hearing must be fully functional. There are numerous health conditions that must be met in order to carry out brainspotting.