Treating Domestic Violence PTSD with Quick REMAP is a case study by Steve B. Reed, LPC, LMSW, LMFT illustrating how the Quick REMAP treatment method can be used to resolve the distress associated with a traumatic assault. Treatment results are measured with the Impact of Event Scale, the State-Trait Anxiety Inventory and Heart Rate Variability Analysis. The slides contain links to more detailed information available on www.remap.net and www.remapinstitute.org.

1. Case Study
www.remapinstitute.org www.remap.net

2. Assault by an Ex-Boyfriend
PTSD Case
• He was drunk (and on drugs)
• She found Cocaine in his closet—flushed it
• He became enraged and lost control—threw
her into a wall (11 bruises)
• She fled to bathroom, called 911 and his sister
• He kicked the door in—threatened to kill her
and the police if they came
• He grabbed the phone was ranting
www.remapinstitute.org www.remap.net 2

3. Assault by an Ex-Boyfriend
PTSD Case
• He then fell unconscious—fell like a board
• His sister arrived—he woke-up and got violent
again—tore a cabinet door off and threw it
• His sister got him to leave—the apartment
was wrecked
• Police came with hands on their guns—
he was gone
• Later he tried to commit suicide
www.remapinstitute.org www.remap.net 3

4. Treatment with Quick REMAP
See Introducing Quick REMAP
• One session
• Three rounds of treatment:
– Quick REMAP 12-point Protocol
– Quick REMAP 4-point Protocol
– Quick REMAP 12-point Protocol
• 55 minutes in length
www.remapinstitute.org www.remap.net 4

5. Psychological Measures
• Subjective Units of Distress Scale (SUD)
• State-Trait Anxiety Inventory (STAI-s)
• Impact of Event Scale (IES-r)
• Physical Symptoms of Emotional Distress
Physical Measures
• Heart Rate Variability Analysis
www.remapinstitute.org www.remap.net 5

6. Treating an Assault Related PTSD Case
SUD www. remapinstitute.org www.remap.net
Treating an Assault Related PTSD Case
with Quick REMAP
10
9
9
Subjective Units of Distress
8
7
6
(SUD)
5
4
3
3
2
1
0 0
0
1 2 3 4
Pre Tx Post Tx Follow-up Follow-up
05-03-07 05-15-07 05-22-07 06-27-07 6

7. Treating an Assault Related PTSD Case
STAI-s www. remapinstitute.org www.remap.net
Treating an Assault Related PTSD Case
with Quick REMAP
80
State-Trait Anxiety Inventory
70
70
60
(STAI-s)
50
43
40
30 25
23
20
1 2 3 4
Pre Tx Post Tx Follow-up Follow-up
05-03-07 05-15-07 05-22-07 06-27-07 7

8. Treating an Assault Related PTSD Case
IES-r www. remapinstitute.org www.remap.net
Treating an Assault Related PTSD Case
with Quick REMAP
70
Impact of Event Scale (IES)
60
60
50
40
30
20
10
2 1
0
1 2 3
Pre Tx Follow-up Follow-up
05-03-07 05-22-07 06-27-07 8

9. Physical Measures
Heart Rate Variability Analysis (HRV)
In addition to the following
slides, further information on HRV
and the meaning of the measures
that were used can be found in the
REMAP Pilot Study –
Soothing the Sympathetic Nervous
System with the REMAP process:
Results from Treating 8 Trauma Survivors
And Measuring Treatment Effect with
Heart Rate Variability Analysis
www. remapinstitute.org www.remap.net

10. Using HRV to measure
the effect of treatment
with Quick REMAP
• Electrocardiograph (ECG) data obtained during
three different 5 minute recordings:
– Baseline (neutral-positive thoughts – walk in park)
– Pre-Treatment (the traumatic event)
55 minutes of treatment with Quick REMAP
– Post Treatment (the traumatic event)
All 3 recording took place within 80 minutes
www. remapinstitute.org www.remap.net

11. Recordings were made while:
• Client breathed normally
• Sat comfortably upright
• Refrained from movement and
• Without talking
ECG signals were measured:
• With special conductive electrodes
• Placed at both wrists and one ankle
www. remapinstitute.org www.remap.net

12. Instrument Used to
MEDICORE Measure HRV
SA 3000p
Heart Rate
Variability
Analyzer
www. remapinstitute.org
www.remap.net

13. FDA
Approval
Medical
Device
www. remapinstitute.org
www.remap.net

14. Detailed RESULTS
• The results of the first 3 recordings were
compared to assess whether there were any
quantifiable changes in the SNS (Sympathetic
Nervous System) and PNS (Para-Sympathetic
Nervous System) activity as revealed through
the HRV measures.
• The following is a summary of 3 HRV
components and a comparison between pre-
treatment and post treatment results.
www. remapinstitute.org www.remap.net

15. Results 05-15-07
Physical Measures of Heart Activity (ECG/HRV)
Heart Rate
www.remap.net
85 82.4
80
75
Beats per Minute
70 67.7
63.8
65
www. remapinstitute.org
60
55
50
45
40
Walk in the Park
1 Traumatic2Memory Traumatic Memory
3
Baseline Trauma Pre Tx Trauma Post Tx 15

16. Results 05-15-07
Physical Measures of Heart Activity (ECG/HRV)
Para-Sympathetic Activity
www.remap.net
90
80 76.7
RMS-SD (milliseconds)
68.6
70
60
50
www. remapinstitute.org
40.3
40
30
20
10
0
Walk in 1 Park
the Traumatic Memory
2 Traumatic Memory
3
Baseline Trauma Pre Tx Trauma Post Tx 16

17. Results 05-15-07
Physical Measures of Heart Activity (ECG/HRV)
Sympathetic vs. Para-Sympathetic Balance
www.remap.net
1.8
1.63
LF/HF Ratio (normalized units)
1.6
1.4
1.2
1 0.87
www. remapinstitute.org
0.8
0.63
0.6
0.4
0.2
0
Walk in the Park Traumatic Memory Traumatic Memory
1 2 3
Baseline Trauma Pre Tx Trauma Post Tx 17

18. Follow-up Report on 05-22-07
www. remapinstitute.org www.remap.net
• She got home on 05-15-07 (after treatment)
and all distress was gone
• No panicky feelings that week
• No nightmares that week
• It was “just an event in the past”
• “Felt very indifferent to it”
• Her current boyfriend noticed that she was
not “freaking-out” and yelling if he
accidentally startled her 18

19. Follow-up Results 06-05-07
Physical Measures of Heart Activity (ECG/HRV)
Heart Rate
www.remap.net
83.7 82.6
85
80
75
Beats per Minute
70
65
www. remapinstitute.org
60
55
50
45
40
Walk in the Park
1 Traumatic 2
Memory
Baseline Trauma Follow-up
19

20. Follow-up Results 06-05-07
Physical Measures of Heart Activity (ECG/HRV)
Para-Sympathetic Activity
www.remap.net
90
80
RMS-SD (milliseconds)
70
60
50
www. remapinstitute.org
40 33.3 34.5
30
20
10
0
Walk in the Park
1 Traumatic Memory
2
Baseline Trauma Follow-up
20

21. Follow-up Results 06-05-07
Physical Measures of Heart Activity (ECG/HRV)
Sympathetic vs. Para-Sympathetic Balance
www.remap.net
0.9
LF/HF Ratio (normalized units)
0.8
0.7
0.6
0.48
0.5 0.43
www. remapinstitute.org
0.4
0.3
0.2
0.1
0
Walk in the Park
1 Traumatic2Memory
Baseline Trauma Follow-up
21

22. • The REMAP Institute provides training for
psychotherapists who want to develop skills in
working with Quick REMAP, the REMAP process and
the REMAP Visual Field Treatment. The training is
designed to build skills in the treatment of anxiety
disorders including PTSD.
http://remapinstitute.org/training/quick-remap-level-1-workshop/
Quick REMAP Distance Learning Materials
• For individual treatment visit www.remap.net or look
for therapists certified in Quick REMAP.
www. remapinstitute.org