Post Traumatic Stress Disorder and The Lowdown on EMDR
Many of my clients come to my practice because they have experienced something in their lives that has left an impression on their minds and although its in the past it still presents itself in the present. This most often happens when this past event or events is traumatic. By traumatic, meaning that they felt that their own or someone they care about safety was at risk. Traumatic events run the gambit of child abuse, domestic violence, sexual assault, medical trauma or natural disaster or war. It can be experienced first hand or witnessed either in person through the senses or as a told story.
Trauma symptoms are usually pervasive and Debilitating.
Nightmares Hyperstartle
Intrusive thoughts Somatic Changes
Flash Backs Changes in Mood
Hypervigilance Avoidance
What happens in our brains that is causing all these symptoms? To understand we must look at the three main parts of the brain that come into play when a trauma is experienced are the Amygdala, Hippocampus and Prefrontal Cortex.
Amygdala
The Amygdala is the stress reactor. It is the alarm system of the brain. When a traumatic event is perceived it sends out a danger signal to the body. This initiates the "flight or fight" response, stores stimuli associated with the event such as sights, sounds, smells, feelings and thoughts. Your amygdala is a primitive, animalistic part of your brain that’s wired to ensure survival.
Prefrontal Cortex
Your prefrontal cortex is the executive functioning center of the brain. It helps you think through decisions, observe how you’re thinking, and put on the “brakes” when you realize something you first feared isn’t actually a threat after all. Your prefrontal cortex helps regulate emotional responses triggered by the amygdala. Once triggered by the Amygdala this part of the brain slows down to accentuate the fight or flight response.
Hippocampus
The hippocampus is responsible for the ability to store and retrieve memories. Your hippocampus is a lot like your computer’s memory that writes files to its hard drive. After a trauma, your hippocampus works to remember the event accurately and make sense of it.
Putting It All Together
When your brain detects a threat, the amygdala initiates a quick, automatic defensive (“fight or flight”) response involving the release of adrenaline, norepinephrine, and glucose to rev up your brain and body. Should the threat continue, the amygdala communicates with the hypothalamus to release cortisol.
Meanwhile, the prefrontal cortex consciously assesses the threat and either accentuates or calms down the “fight or flight” response. When the prefrontal cortex decides that there is a threat, it slows to allow the "fight or flight" response system to activate and attempt to keep us safe. In this state it becomes very difficult to reason. If the memory is not filed properly through the hippocampus a constant state of alert ensues and PTSD develops. The brain starts applying anything that "triggers" the traumatic memory as something that is happening right now. Over time all three areas of the brain involved are altered by this chronic state of threat.
Eye Movement Desensitization and Reprocessing
Depending on what a client's challenges are Eye Movement Desensitization and Reprocessing, EMDR, may provide relief. Developed by Francine Shapiro, EMDR has proven to be a highly effective and evidenced based treatment for not only PTSD but also grief and loss, eating disorders, panic and phobia disorders, anxiety and depression and substance use disorders. EMDR therapy helps the brain process disturbing memories, and allows normal healing to resume. The experience is still remembered, but the fight, flight, or freeze response from the original event is resolved.
The process of EMDR is broken down into eight stages discussed below. Sessions are usually 60-90 minutes. Course of treatment is effected by many factors and can last for a few sessions to as many as needed to clear out the memory. Once the client and therapist decide EMDR is the appropriate course of treatment. Attention will be given to a negative image related to the disturbing event, belief, and body feeling related to this event, and then to a positive belief that would indicate the issue was resolved.
The Eight Phases
Phase One ~ History and Treatment Planning
In this phase a thorough history is taken that includes:
the event(s) from the past that created the problem
the present situations that cause distress
the key skills or behaviors the client needs to learn for his future well-being
One thing that stands out throughout EMDR is that the client does not need to discuss any of their trauma in detail and the client is in charge of setting limits around each session. Once this information is gathered the therapist develops a treatment plan.
Phase Two ~ Preparation
Therapist will explain the theory of EMDR, how it is done, and what the person can expect during and after treatment. In addition, the therapist will teach the client a variety of relaxation techniques for calming him or herself in the face of any emotional disturbance that may arise during or after a session. Other skills may be taught as well to regulate emotions or survive any crisis situations. CBT. DBT and grounding skills are often taught in this phase.
Phase Three ~ Assessment
The first step is for the client to select a specific image or mental picture from the target event (which was identified during Phase One) that best represents the memory. Then he or she chooses a statement that expresses a negative self-belief associated with the event. The client then picks a positive self-statement that he would rather believe.
At this point, the therapist will ask the client to estimate how true a positive belief feels using the 1-to-7 Validity of Cognition (VOC) scale. “1” equals “completely false,” and ” 7″ equals “completely true.” The desired outcome of the reprocessing and desensitization will be that the client will come as close to a 7 as makes sense.
Next the client identifies the negative emotions (fear, anger) and physical sensations (since as we learned above the trauma is held not only in the mind but also the body) she associates with the target.
The client also rates the negative belief, but uses a different scale called the Subjective Units of Disturbance (SUD) scale. This scale rates the feeling from 0 (no disturbance) to 10 (worst) and is used to assess the disturbance that the client feels.
All sounds like a lot of information but this formula is necessary in the hands of a skilled therapist to achieve the desired relief from the symptoms.
Phase Four ~ Desensitization
During desensitization, the therapist leads the person in sets of eye movements, sounds, or taps with appropriate shifts and changes of focus until his or her SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). This can be done virtually or in person. Starting with the main target, the different associations to the memory are followed. It is important to note that the client can verbalize or not and that they have complete control to stop the session if they need to.
Phase Five ~ Installation
Once no new material comes up and the SUDS scale drops to as close to one as possible and the VOC is at or close to seven then the positive cognition is ready to be installed. The goal is to concentrate on and increase the strength of the positive belief that the client has identified to replace his or her original negative belief.
Phase Six ~ Body Scan
After the positive cognition has been strengthened and installed, the therapist will ask the person to bring the original target event to mind. If there is any residual tension in the body. If so, these physical sensations are then targeted for reprocessing. Remember that trauma is stored in the body as well and it is important to resolve any leftover sensations.
Phase Seven ~ Closure
At the end of each session, despite the fact that the process may not be complete, the therapist provides self calming techniques and containment exercises both in session and between. As the client will continue to process between sessions the therapist will ask that the client keep track of new thoughts, memories or sensations that come up.
Phase Eight ~ Revaluation
Revaluation begins every session. It is important to go back to target and to access SUDs and VOCs to mark progress towards treatment goals.
““Changing the memories that form the way we see ourselves also changes the way we view others. Therefore, our relationships, job performance, what we are willing to do or are able to resist, all move in a positive direction.””
As an EMDR therapist I have had the privilege to help many clients resolve their traumas through EMDR. Remember you are not alone. EMDR therapist are trained and know how to help. We are here to guide you through recovery gently and safely. We absolutely understand that it might feel scary and yet we invite you to find the courage to reach out anyway. Recovery from trauma is most definitely possible!
GERALDINE VIGGIANI, LCSW, LCADC, PMH-C
Geraldine founded Lotus Blossom Psychotherapy as a place for women to feel supported on their journey toward wellness and personal healing. Along with her staff - specialties ranging from trauma to eating disorders to Perinatal Mood Disorders (PMAD)—particularly traumatic birth experiences—Geraldine’s approach to treatment modalities is eclectic, and includes EMDR, DBT, Brainspotting, and trauma and compassion focused therapies. She is also certified in perinatal mood disorders. Geraldine is on the board of directors for PostPartum Support International (NJ Chapter) and chairs their Education and Training committee. She is also on the board for the Entrepreneurial Think Tank for Women Foundation. A regular contributor to BELLA Magazine's Mind and Body section, she also sits on their Medical Advisory Board. Geraldine provides supervision and also lectures and provides workshops on a variety of topics including birth trauma.
Lotus Blossom Psychotherapy, Mental Health + Wellness for Women
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Your past does not define you, but it can be the springboard to new and surprising growth, expanding your awareness and propelling you toward becoming a stronger, healthier person.
At Lotus Blossom Psychotherapy, we employ a holistic approach to help women heal from their past traumas, present struggles, and future worries—one that fully incorporates the mind, body, and spirit. Our unique approach to women’s wellness is both comprehensive and effective, geared toward instilling lasting change. Whether you’re struggling with PTSD, Postpartum Depression/Anxiety, Self Esteem Issues, Depression, Anxiety, or Eating Disorders, we’re committed to giving you the roots to grow, the tools to thrive, and the confidence to bloom into your intended self.