December 3, 2015 Ramona Wade, MA, LMFT, QMHP
What you can expect in this session:
Overview of trauma and PTSD in light of the brain 2.
EMDR overview How EMDR is different from other therapy models. 4.
Basic skill set to help in emergency situations Some real life trauma/healing stories What not to expect in this session: 1.
I will not be speaking about sexual violence in particular 2.
Specific training in EMDR Review of research to support various trauma treatment models
Understanding Trauma and PTSD
Trauma is the incident that puts a person in a position of perceived or real danger. It creates the physiological need for fight, flight, or freeze. Shock trauma: a single episode. We think of war, rape, murder, MVA, natural disasters, suicides, etc. Developmental trauma: those traumatic experiences that happened repeatedly, often in family of origin, contributing to a negative cognition of self. Examples of that would include a parent giving a repeated negative message through emotional, physical, sexual abuse, or neglect. The child then develops the impression he is bad or doesn’t matter.
The Triune Brain
Human, Neo-Cortex Mammalian or Limbic Reptilian
Reptilian Brain: controls the automatic functions of the body and the instinctual/reflexive responses that contribute to survival. Mammalian or Limbic Brain: controls the reception and interpretation of sensory and emotional material. Human, Neo-Cortex Brain: controls rational thought, analysis, decision making, and language.
PTS is an Incomplete Physiological Process
We have all heard of the fight, flight, or freeze response to danger. In each of these responses, the most important thing in the prevention of PTSD is the discharge of the energy surge, the rush of the chemicals, in the face of danger. It is NOT about the events of the trauma; rather it is the trapped energy that is not discharged that causes PTS.
EMDR – Eye Movement Desensitization and Reprocessing – The Theory
EMDR was discovered accidentally by Francine Shapiro in 1987. Adaptive Information Processing. As Shapiro did her research, she concluded that people have an innate neurological ability to recover from trauma. This process is jump-started by EMDR allowing a person to work through the negative and disturbing images, beliefs, emotions, and sensations and move toward health. In short, the body is wired to heal itself. Sometimes, that process is interrupted as in trauma. EMDR can jump start the brain again to complete the process. EMDRIA has conducted a lot of research to support the efficacy of EMDR. Additionally, with the use of SPECT scans, we can now see, in treatment, how the limbic system lights up in the early stages of the treatment. As the trauma is desensitized, the prefrontal cortex lights up and the limbic system quiets indicating the material is being reprocessed. The patient is no longer emotionally charge by the memory of the trauma and the patient assigns a new meaning/cognition to the experience.
EMDR – the Therapy
EMDR is an integrated therapy using aspects of talk and body therapies that value the body-mind connection. In short you use all of the skills you already have as a therapist but add the EMDR. Originally, Shapiro discovered that it was with eye movements that the brain was stimulated bilaterally. We don’t exactly know why that it is so. There are many theories such as a similarity to REM sleep eye movements, but we don’t know for certain. The research in on going. Over the course of time, as some patients have not been able to tolerate shifting eye movements, they have discovered that other methods of bilateral stimulation work as well including: auditory signals, tactile pulsers, or physically tapping people’s hands or knees.
Phases of EMDR Therapy
Phase 1: Client History Phase 2: Preparation Skill building through: safe place, containment, relaxation, diaphragmatic breathing, identifying allies, grounding, and mindfulness. Phase 3: Assessment Finding the worst image Negative belief Positive belief Validity of cognition Emotions SUDS scale – level of subjective disturbance Location of body sensation Phase 4: Desensitization – bilateral stimulation Phase 5:Installation of Positive Cognition Phase 6: Body Scan Phase 7: Closure Phase 8: Reevaluation
What to Expect
EMDR is not a miracle. Some people respond better than others. Depending on whether it is a single event trauma or a developmental trauma, the length of treatment will vary. After a session, some people report feeling exhausted, relieved, invigorated, or nothing. Usually the processing continues between sessions often outside of the client’s awareness. It is often a subtle process, a neutralization of the trauma. Often family members will note the changes before the client. For some there is a distinct awareness of how things are better.
How EMDR is Different from Other Therapy Models
Not as much focus on the details of the trauma event. 2.
No encouragement to recall everything that happened. No prolonged exposure to the trauma, rather brief exposure and dual awareness. 4.
What Can You Do/Not Do to Help in Acute Trauma
Help the person breathe. The exhalation is the release and must come first. Breathe with them. 2.
Less talk and analysis, more emotional and bodywork. EMDR is usually faster and more complete. Re-orient to the present through the senses. Identify allies. Don’t ask them what happened – they may not be able to access the prefrontal cortex for thought retrieval if they are in FFF. You will not get accurate information. Don’t touch them. Encourage a shake off of the trauma.
Case Reviews Closing: Story of Yankel
“When you warm other people’s hearts, you remain warm yourself. When you seek to support, encourage, and inspire others; then you discover support, encouragement, and inspiration in your life as well.”
Shapiro, F. (2001) EMDR: Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York: Guilford. Maiberger, B. (2009) EMDR Essentials, A Guide for Clients and Therapists. New York: Norton. Parnell, L. (2007) A Therapist’s Guide to EMDR: Tools and Techniques for Successful Treatment. New York: Norton. Levine, P. (2010) In an Unspoken voice, How the Body Releases Trauma and Restores Goodness. California: North Atlantic Books. van der Kolk, B. (2014) The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. New York: Penguin.