Intended for healthcare professionals

Rapid response to:

Clinical Review

Post-traumatic stress disorder

BMJ 2015; 351 doi: (Published 26 November 2015) Cite this as: BMJ 2015;351:h6161

Rapid Response:

Re: Post-traumatic stress disorder


This excellent Clinical Review on PTSD (1) asks “Are there emerging options to prevent and treat PTSD?” Dutton and Ashworth (2) suggest a model that permits new therapeutic focus: this applies not only for PTSD, but also for symptoms of stress and traumata that commonly present in General Practice. These symptoms can be disabling without meeting the diagnostic criteria of PTSD. The only neurobiological intervention described here is EMDR, a specialist treatment. We describe a simple intervention for some symptoms that can easily be applied by generalists for patients in the safety level of the Dutton Ashworth “Snakes and Ladders” model (figure 1) .

Observing that feeding babies while gazing at their mothers were extremely calm, led us to consider the importance of the Edinger-Westphal nucleus in the treatment of fear and anger. The E-W nucleus is situated between the IIIrd (occulomotor) and IVth (trochlear) cranial nerve nuclei and has an autonomic function that may go beyond its occular efferents. Our patients have described visceral feelings associated with emotions that may be autonomic in origin.

Fear and anger might be considered protective emotions (flight or fight) in appropriate proportions in the presence of external threats but, when they continue to overwhelm after the event, they become disabling for the patient. In clinical practice we have noted that by teaching patients to locate the body feeling associated with fear or anger, then asking them to concentrate on this visceral sensation while adopting a suitable “baby gaze” to stimulate the contralateral occulomotor and trochlear pathways (looking up and to the right or left), symptoms resolve, typically within 5 minutes. Appropriately instructed patients also report being able to carry out exercises at home, successfully controlling and reducing their troublesome symptoms.

1 BMJ 2015;351:h6161
2 Dutton, PV, Ashworth, AJ. The natural history of recovery from psychological trauma: An observational model. Medical Hypotheses 85 (2015) 588-590

Competing interests: No competing interests

02 December 2015
Andrew J Ashworth
General Practitioner
Philip V Dutton
Breich Valley Medical Practice
Fauldhouse Partnership Centre, Fauldhouse, West Lothian EH47 9JD