Richard L. Joens, LISW
Counseling Associates of Central Iowa, PC
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 Moments of overwhelming terror can alter brain
chemistry for decades
 Persons with Post-Traumatic Stress Disorder (PTSD)
complain of almost unbearable states of physiological
arousal, emotional hypersensitivity, exaggerated
startle response and distorted memories
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They experience:
 Sleeplessness
 Hypervigilance
 Numbness
 Withdrawal
 Amnesia
 Flashbacks
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 Their brains are not working the way they use to before
the trauma occurred
 They wonder if they are going crazy
 They feel misunderstood and embarrassed
 They get irritable and angry
 They shun public places and interactions with other
people
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 During a traumatic incident, the neurotransmitters
released by the brain’s limbic system (specifically the
amygdala) signal an alarm to the autonomic nervous
system
 These hormones activate one of the branches, the
sympathetic nervous system (SNS), to extreme arousal,
fight and/or flight
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 Blood flows away from the skin and viscera and into
the muscles for quick movement
 Heart rate, respiration and blood pressure all rise to
give the muscles more oxygen
 The eyes dilate to provide sharper distant sight
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 When fight or flight are not possible, the limbic
system may further signal the autonomic nervous
system (ANS) to simultaneously activate its other
branch, the parasympathetic nervous system (PNS)
 The SNS continues its extreme arousal while the PNS
freezes the action of the body
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 Body sensations slow down and emotions are numbed
 People who have survived mauling by animals or falls
from great heights report that this kind of dissociation
reduces the physical pain and emotional terror during
such experiences
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 Stress hormones: epinephrine and norepinephrine
(also known as adrenaline and noradrenaline) increase
the brain’s alertness, enhance memory and quicken
the heartbeat
 People can do extraordinary things during the
“adrenaline rush”
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 When stress becomes overwhelming, too much
epinephrine and norepinephrine induce confusion and
impair learning and memory
 At high enough levels, these fight or flight hormones
induce amnesia
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 Repeated secretions of the stress hormones
progressively sensitize brain chemistry provoking ever
greater floods of stress hormones at LOWER
thresholds
 This sensitization can last for many years
 What may be ordinary stress to non-traumatized
persons will push trauma survivors over the edge
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 Persons with childhood abuse histories are
significantly more likely to develop PTSD from
traumas in later years
 PTSD Veterans were found to have chronically elevated
levels of stress hormones years after combat
 The same was true of sexually abused girls (7-14 years
old)
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 Another part of the limbic systems that plays a major
role with traumatic experiences is the hippocampus
 Back to the amygdala and example of seeing a snake
 The cortex evaluates the situation with rational
thought and sends an appropriate message to the
amygdala
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 The hippocampus assists the transfer of the initial
information [the image of the snake] to the cortex
 The hippocampus is vulnerable to stress hormones
 They suppress the activity of the hippocampus and it
stops functioning
 A rational evaluation of the situation is not possible
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 The hippocampus is also a key structure in facilitating
resolution and integration of traumatic incidents and
memory
 It inscribes time context on events
 A well-functioning hippocampus makes it possible for
the cortex to recognize when a trauma is over, perhaps
even long past
 Then it instructs the amygdala to stop sounding the
alarm
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 Floods of epinephrine and norepinephrine are linked
to flashbacks
 PTSD survivors have demonstrated a 30% drop in pain
sensitivity; their brains released natural opiates with
the pain killing equivalent of eight milligrams of
morphine, which may correlate with the reported
numbness
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 Animal researchers have found a link between high
cortisol (stress hormone) levels over a period of weeks
and the withering of dendrites (the feathery branches
that allow brain cells to form communication pathways
and associational networks with hundreds of
thousands of their neighbors)
 This may be associated with dissociation
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THERAPEUTIC IMPLICATIONS
 Successful trauma therapy must maintain stress
hormone levels low enough to keep the hippocampus
functioning
 Therapists can watch for physical signals of autonomic
system (sympathetic) arousal: tone of voice, skin
turning pale, breathing quickly, panting, dilated
pupils, shivering, feeling cold, etc.
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 Time to calm the client down
 Help the client pay attention to body sensations
 Directly engage the cortex: “Can you see me? Clearly?
Describe me.”
 Notice changes in your body, etc.
 EMDR
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OVERVIEW OF EMDR
 Does the client present with symptoms of PTSD?
 Establish rapport and outline what EMDR is
 Answer questions
 Establish targets: “What comes to mind when you
think about the trauma?”
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 Determine negative cognition: “What negative belief
do you have about yourself when you think about the
trauma?” Use SUD scale to evaluate intensity
 Determine positive cognition: “What would you
rather believe about yourself when you think about the
trauma?” Use SUD scale to evaluate how much they
believe this statement now
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 “What emotions come up when you think about the
trauma?” Use SUD scale to evaluate intensity
 “What do you feel in your body when you think about
the trauma?”
 Establish safe place resources and practice eye
movement – use tappers or sound substitutes as
needed
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 Begin focusing on the target with eye movement
 Monitor the movement of the eyes – include
appropriate encouragement as needed
 Stop the movement, breathe, ask client what came up
 Continue focusing on what comes up and do more
sessions of eye movement
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 Be aware of parts stepping in to protect client from
proceeding – ask the part if it will step back, etc.
 Use adult/resource interventions as needed
 Use SUD scale as needed
 Does the client feel like he or she is done with this
target?
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