Healing Trauma with EMDR
ViveraeHealth Webinar May 05, 2015
Trauma Memory vs. Regular Memory Ordinary memories from the past feel like they are in the past with a far-away quality
Trauma memories can feel like they are happening right now, in the present
Even long ago events have original emotional heat when we touch on them because they remain “frozen in time” split off and disconnected from time and space. Time doesn’t heal these wounds.
This is why we try so hard to avoid them!
2
Trauma and Memory Storage Whatever the persistent negative emotion, belief or behavior
that has been bothering you, it’s not the cause of suffering— it’s the symptom.
The likely cause is the memory that’s pushing it. Our memories are the basis of both negative symptoms and of mental health.
The key difference is the way the memories are stored in the
brain: If unprocessed, they can cause us to overreact or act in a way that hurts us or those around us.
If they are “processed,” we are able to react in ways that serve our loved ones and ourselves well.
3
Adaptive Information Processing System: Brain “Digestion” ? We expect the body to heal – that’s why we allow surgery
incisions. The brain is part of the body, and also has a natural healing process in place unless there is something in the way.
We all have hardwired into our brains a mechanism— an
information processing system— for healing— geared to take any sort of emotional turmoil to a level of mental health or “adaptive resolution.”
Adaptive resolution includes the useful information that
allows us to be more fit for survival in our lives. The information processing system is meant to make connections to what is useful, and let go of the rest.
Similar to what the body does with food during digestion.
4
Trauma Causes Brain “Indigestion” Some events overwhelm the system and get stuck and “undigested” by the brain.
Certain disturbing experiences, whether major traumas or
other kinds of upsetting events, can overwhelm the system. Intense emotional and physical disturbance caused by the situation prevents the information processing system from making the internal connections needed to take it to a resolution.
Instead, the memory of the situation becomes stored in the brain as you originally experienced it.
What you saw and felt, the image, the emotions, the
physical sensations and the thoughts become encoded in memory in their original, unprocessed form
5
Unprocessed Trauma & Irrational Behavior Reactions that seem irrational often are – but not because there is no reason for them. They come from a part of our brain not governed by the rational mind, from within memory networks that are totally separate from our higher reasoning power.
Irrational but understandable and, more important, fixable. In general, the basis of the suffering is the way our memories of past experiences are stored in the brain, and this can be changed.
People with PTSD clearly have the negative experience stored in their brain in a way that is highly disturbing.
Appropriately stored memories are the basis of joy and mental health.
6
How triggers activate trauma memory Reactions to upsetting reminders refuse to go away in the
present, because they are linking into unprocessed memories from the past. These unconscious connections occur automatically.
Similar situations can link into the memory network and
“trigger” the emotions & physical sensations that are part of that stored unprocessed memory because the information processing system did not function properly after the trauma.
The disrupted information processing system has stored the memory in isolation— un-integrated within the more general memory networks. It can’t change since it is unable to link up with anything more useful and adaptive.
You may still feel anger, resentment, pain, or sorrow about
events that took place years ago. They are frozen in time. The unprocessed memories can become the foundation for emotional and sometimes physical problems.
7
Francine Shapiro’s Walk A psychologist who had been studying the mind and
body connection for 10 years was taking a walk one day in the mid-1980’s, thinking about something bothersome while moving her eyes rapidly back and forth. It made the bother mysteriously go away.
“When my thoughts changed unexpectedly, it caught my attention. I believed I’d stumbled onto the brain’s natural healing process.” – Francine Shapiro PhD
“After I found that I could change the feelings connected to my thoughts by deliberately using the eye movements, I wondered if it would work for other people.”
8
EMDR: Controversial New Treatment Back in 1987, PTSD had only been accepted as a diagnosis for seven years! At that time, there were no rigorous scientific studies validating any form of therapy for this disorder, and it was considered extremely difficult to treat, so Dr. Shapiro chose to test the effectiveness of her new procedure with people suffering from PTSD.
The results of the first randomized controlled research study
on EMDR were published in the Journal of Traumatic Stress in 1989.
Since Dr. Shapiro’s article described a brand-new kind of therapy that included the use of eye movements and reported very rapid benefits for trauma victims, it created a great deal of controversy.
People asked: Why should eye movements have any effect? How can any therapy show results within just one session?
9
What is EMDR? EMDR is an evidence-based psychotherapy for Posttraumatic
Stress Disorder (PTSD). Successful outcomes are also welldocumented for EMDR treatment of other psychiatric disorders, mental health problems and body symptoms.
Based on Adaptive Information Processing (AIP) model:
Psychological problems are result of maladaptive encoding and/or incomplete processing of traumatic or disturbing adverse life experiences. Impairs one’s ability to integrate these experiences adaptively
Now over 25 years of international research documenting the effectiveness of EMDR therapy.
Most insurance companies cover it as an evidence-based treatment for PTSD.
Training and certification are through the EMDRIA where
practitioners of EMDR may be found all over the world via the international institute: www.emdria.org
10
8 Phases of EMDR Therapy Facilitates the normal information processing and integration. Targets past experience, current triggers and future potential challenges
Results of EMDR Therapy alleviation of symptoms decrease/elimination of distress from the disturbing memory
improved view of the self
relief from body disturbance resolution of present and future anticipated triggers
11
EMDR Heals the Wounds Time Couldn’t When they think of the incident before reprocessing, it
can feel as though it’s happening all over again, or they can be fearful and anxious when around certain people or places.
But regardless of how long ago something happened, and regardless of how long symptoms have been there, it doesn’t need to be permanent.
After reprocessing, thinking about the incident no longer has the emotional charge and people find they think differently – more positively – about themselves.
12
EMDR and REM Sleep Dr. Shapiro wondered whether what she’d noticed with the rapid eye movements could be related to the processes that occur during REM sleep.
Since eye movements happened spontaneously during that period of dream sleep, and we often awaken feeling better about situations in our lives, maybe they have the same effect when we are awake.
After she found she could change the feelings connected to her own thoughts by deliberately using the eye movements, she wondered if it would work for other people. She asked people to think of things that bothered them and began researching the results.
13
20 years of EMDR Research Today more than 20 scientifically controlled studies of
EMDR have proven its effectiveness in the treatment of traumatic and other disturbing life experiences.
At this point, a wide range of organizations worldwide,
including the American Psychiatric Association and the US Department of Defense, have recognized EMDR as an effective treatment for trauma.
Research has established that the memory control center
of the brain (the hippocampus) shrinks in people with PTSD. For some time it was believed that the condition might be permanent. Happily, as brain scans have now shown, it is possible for the hippocampus to re-grow.
Although there has been limited research in this area, one study recently showed that 8 to 12 sessions of EMDR memory processing for people with PTSD were associated with an average 6% increase in the volume of the hippocampus. These effects were maintained 1 year later.
14
EMDR steps
Dare to be present. If you don’t know how, be willing to learn, and to tell your therapist if you notice you’re “checked out.”
Build self-soothing skills like Calm Safe Place, Breathing Techniques and the Butterfly Hug so you can stabilize yourself when you need to.
Identify the event(s) you wish to target for reprocessing with your therapist
Reprocess your trauma with bilateral stimulation so you can dismantle your triggers and rewire your brain.
Install the more adaptive beliefs you have chosen for your event(s).
Scan your body for places it is holding distress and clear with BLS
Identify future challenges to prepare your brain to succeed.
Become able to live adaptively in the present - with the past in the past, and new positive insights and beliefs about yourself.
15
EMDR Calm Safe Place -1 A Safe or Calm Place In adaptive information processing terms, what we’re doing is increasing your access to positive memory networks. These are the networks that have within them the pleasurable experiences you have had in your life. For instance, the kinds of experiences where you felt calm and relaxed. That way, if you feel disturbed at any time and want to stop, there is immediate access to positive emotions.
These are basically emotional state-changing techniques where we can shift our focus of attention and shift our state of mind at the same time— like counting to ten when you are angry can sometimes calm you down enough to deal with things. It doesn’t change the reason you got angry or upset, but it gives you a breather between the cause and your automatic response.
We all need ways of coming back into balance regardless of the reason we got upset. So to begin, we’ll learn a “Safe Place” technique. It involves guided imagery commonly used in hypnosis and meditation techniques. But with this technique you’ll be totally awake and aware. It will give you a nice self-control procedure.
16
EMDR Calm Safe Place - 2 Start with a positive image. What we’re looking for is an image of a positive experience that you’ve had in the past. Maybe going to the beach makes you feel really good, or maybe the forest or a mountaintop holds nice memories for you. It should be a positive experience that is not connected to anything negative.
Identify a place that gives you a feeling of safety. Or if you prefer, it can be a feeling of calm. What we are looking for at this point is a memory that will help you retrieve a positive emotion that you can bring up and use to replace a feeling of disturbance.
Please do not continue with the exercise if you cannot identify a place
of safety or calm that is not connected to anything negative. Also, stop if negative feelings emerge. In those cases there are clearly unprocessed memories that will need the help of a therapist to address.
If you feel comfortable that you have a good memory connection that can bring up the feelings of safety or calm, we can do the exercise.
17
EMDR Calm Safe Place -3 Close your eyes and bring up an image of that scene, and notice the colors and any other sense experiences that may go with it. Notice the feel of it, and notice the sensations that come up in your body— your chest, stomach, shoulders or face. Notice if you’re feeling nice, good, positive feelings, then open your eyes. Now try it.
Did you find that bringing up an image and allowing yourself to be with it, noting the colors, noting what was in it, allowed those feelings to emerge? If the positive feelings came up, now identify a single word that would go with this feeling— such as “peaceful,” which may describe the feeling, or “forest,” which would describe the scene. That’s a label for the experience. Close your eyes again, and bring up the image, notice the pleasant feelings, and say the word in your mind.
Just notice the feelings as you allow yourself to merge into the
scene while you repeat the word in your mind. Then after a moment or so, open your eyes. Now close your eyes and do it. If those positive feelings came up, then do it again for another moment or so by closing your eyes, bringing up the image, and then bring back the word to pair with it. Continue to do this for five times, spending about one minute each time. This should help strengthen the connections. Try it now.
18
Breathing Shift Technique Breathing Shift Technique - Now let’s try the Calm Safe Place
exercise again, but this time notice the change in your breathing when you bring up the image and word.
After you feel the positive emotions emerge, place your hand over the part of your stomach or chest where your breath begins. This is the breathing pattern you get when you are feeling safe or calm.
That is also a useful technique because whenever you feel
stressed, your breathing pattern will change. It will usually move higher up in your body. If you notice that happen, you can bring your breath back lower to that relaxed pattern. So close your eyes and try it now.
If you bring up something that bothers you mildly, close your eyes and notice your breathing pattern, then change your breathing back to the relaxed pattern by breathing from the area you previously noticed when you were relaxed.
19
Butterfly Hug The Butterfly Hug was developed in Mexico to work with groups of children following a hurricane. It has since been used all over the world to help increase the positive feelings of a “safe place.” To do it, you cross your arms in front of you with your right hand on your left shoulder and your left hand on your right. Then you tap your hands alternately on each shoulder slowly four to six times. To try it, bring up the image of the safe or calm place along with that positive word that you’ve connected with it and allow yourself to go into that state of safety or calm. And when you have that sense, tap alternately on your thighs or with the Butterfly Hug four to six times, then stop and take a breath and see how it feels. Try it for one set. Then open your eyes. If the positive state increases, once again try a set. Not too fast or too long.
20
EMDR Advantages Much gentler than other approaches to trauma therapy No homework – all work done in session Self-soothing and grounding resources are built first You don’t have to talk about the trauma in order to heal. People who feel debilitated by shame about their trauma find that it still works even without talking because it directly accesses their own brain’s adaptive information processing system.
Rapidly allows a person to take what they “know” in their head and to “feel it to be true” in their gut as well. The feelings match.
Only reprocesses maladaptive distress – not adaptive fear. Effects of reprocessing are lasting
21
EMDR caveats Must be present, not dissociated, for healing to occur Intense feelings may be released but for brief time Therapist should be experienced and properly trained to know how to tailor the approach to your needs and what to do to facilitate your process
Attorneys in cases where victims have received EMDR
must know how to explain to the jury that there has been EMDR treatment, because after reprocessing, people can often discuss horrific experiences in a very calm matter-offact manner and jurors may not know what to make of that. Brain scans of traumatized brains look more like normal brains after EMDR. Pre- and post-testing is advised in cases where psychological harm needs to be assessed.
22
Selected International Treatment Guidelines Designating EMDR Therapy as an Effective Trauma Treatment:
American Psychiatric Association (2004). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Arlington, VA: American Psychiatric Association Practice Guidelines.
Bleich, A., Kotler, M., Kutz, I., & Shalev, A. (2002). A position paper of the (Israeli) National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community. Jerusalem, Israel.
California Evidence-Based Clearinghouse for Child Welfare (2010). Trauma Treatment for Children. http:// www.cebc4cw.org
CREST (2003). The management of post traumatic stress disorder in adults. A publication of the Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, Belfast.
Department of Veterans Affairs & Department of Defense (2010). VA/ DoD clinical practice guideline for the management of post-traumatic stress. Washington, DC: Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense
Dutch National Steering Committee Guidelines Mental Health Care (2003). Multidisciplinary guideline for anxiety disorders. Quality Institute Heath Care CBO/ Trimbos Institute. Utrecht, Netherlands. Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2009). Effective treatments for PTSD: Practice guidelines of the International Society for Traumatic Stress Studies. New York: Guilford Press.
INSERM (2004). Psychotherapy: An evaluation of three approaches. French National Institute of Health and Medical Research, Paris, France.
23
EMDR Dismantle the Triggers – Rewire the Brain
You can find a properly trained EMDR therapist through the EMDR International Association’s website: www.emdria.org .
24
2015 Dr. Cheryl Arutt, All rights reserved.
25