Transcending Trauma with EMDR
Energy Psychology Helps Resolve Painful Memories
by Stacy Raymond
Eye Movement Desensitization and Reprocessing (EMDR) is a quick, effective energy psychology technique used for resolving painful memories. EMDR is a mysterious name for a technique discovered accidentally in 1987 by Francine Shapiro, PhD. She was upset one day, went for a walk, and found it soothing to scan her eyes back and forth across the horizon. After the walk, she noticed she was no longer upset; she decided to formally study and standardize what she had experienced. Knowing that we process issues during REM sleep, Shapiro hypothesized that by moving the eyes back and forth during the wake state, the name natural healing tendency of the psyche was being activated while simultaneously focusing on an upsetting memory.
EMDR helps to access and activate the intrinsic healing mechanism of the mind. Knowing that we process issues during REM (Rapid Eye Movement) or dream sleep, Dr. Shapiro hypothesized that by moving the eyes back and forth during the wake state, the same natural healing tendency of the psyche was being activated while simultaneously focusing on an upsetting memory. Unlike talk therapy, EMDR is a way of neutralizing even the most embarrassing or overwhelming memories without discussing the details. It’s not uncommon for people to dodge seeking help so as to avoid feeling shame or emotional overwhelm. EMDR is a great option for those who simply do not want to or cannot discuss the details of a painful memory.
HOW IT WORKS
When a person experiences an upsetting event they enter a state of fight or flight and the body releases cortisol and adrenaline. The traumatic memory is laid down in a raw and fragmented form and remains under the command of the emotional brain or limbic system. Disjointed images, smells, sounds and sensations are recognized as part of the incident, but do not congeal into a coherent story. The irritation remains in undigested form in the mind, almost like a “splinter” in the finger. EMDR essentially removes the splinter. Alternating eye movements stimulates both hemispheres of the brain, activating the cortex which holds a lifetime of wisdom and positive experiences. The emotional brain settles down as the memory is reorganized, consolidated, and put into perspective for the first time. EMDR helps the client become unstuck and continue processing the memory until resolution. This is attained when the client no longer reports emotional distress when recalling the incident.
It later was discovered that other forms of bi-lateral stimulation (BLS) were just as effective as alternating eye movements. If a client is not comfortable with eye movements, they may wear headphones and listen to alternating tones, or hold tappers that buzz left and right. Two other hypotheses emerged to suggest why EMDR works: Desensitization and Dual Attention. When a soothing back and forth stimulus (think of a baby in a cradle) is repeatedly paired with an upsetting memory, the disturbance is eventually neutralized. Lastly, when a client is maintaining dual attention simultaneously on an internal upsetting memory and an external soothing stimulus, the mind begins to distinguish the two events. One is safe and calming, happening now, while the other was unsafe, disturbing, and happened in the past. Resolution occurs when the client fully realizes “that was then; this is now, and I’m safe now”.
Much faster than talk therapy, EMDR typically takes about three sessions to work through a single traumatic memory in an otherwise psychologically healthy adult. Therapy with adults who suffered chronic abuse as children understandably requires many more sessions. Whereas some forms of therapy (CBT and Exposure Therapy) require the client to repeatedly discuss and/or write about the details and their feelings pertaining to a traumatic incident, EMDR proves to be less humiliating and overwhelming for clients. Discussion is particularly uncomfortable if the trauma involves sexual abuse, rape, witnessing a murder or military combat. The client’s dignity and need for control are respected as they are given the option to discuss the details or simply give it a title, such as “the bathroom incident”.
First, the client chooses which form of BLS feels best (eye movements, audio tones, or the hand-held tappers). Next, a “Safe Place” is established whereby the client thinks of a place they feel calm and stress-free. (Therapy is not effective if the client does not feel safe and grounded.) Then a “target” memory is chosen by the client. It is up to the client either to describe or to simply think about the worst part of the incident. They are then asked a series of questions including what emotion they are currently feeling, where in their body they feel the emotion, how intense do they rate the emotion from 1-10, and what negative belief do they have about themselves regarding the incident. It is not uncommon for someone to believe, “It was my fault” or “I should have stopped it from happening”. As the client thinks of the worst part of the memory, the therapist offers sets of BLS that last 1 to 2 minutes. The emotion and quality of the scene quickly begin to shift away from being raw and upsetting. Once the memory is desensitized, it will no longer present itself as an intrusive images, sounds, nightmares or flashbacks. It has been reprocessed and filed in the cortex as “something bad that’s over now”. Spontaneously a positive belief emerges, such as, “I did my best” or “I’m safe now”. The client has a renewed sense of empowerment.
EMDR is known to successfully treat PTSD, panic disorder, anxiety, depression, and many other conditions. It effectively alleviates unpleasant memories, big or small, whether you were the victim of sexual abuse or were teased in middle school. EMDR can help free a person from the negative feelings and beliefs that haunt them and erode their self-esteem. In a sense EMDR is “organic” because the mind’s natural healing tendency is activated with BLS and the therapist allows it to safely unfold to resolution without interfering. Please note EMDR requires proper training. For a list of trained therapists and/or to access the wealth of research supporting EMDR, go to EMDRIA.org.
Finally, all therapists must monitor the effect of job stress on their emotional and physical well-being. Due to our own tendency to be highly sensitive and empathic, we therapists are quite vulnerable to the impact of the upsetting material our clients bring to us. It may be in our best interest to seek a brief course of EMDR therapy for ourselves in order to remain healthy, grounded and present for our traumatized clients.
IN THE EYES OF THE BEHOLDER
~ A new option in psychotherapy by Lois Street
Over the years, Margaret's heart palpitations became more fierce and frequent. Anticipatory fear of the throbbing episodes overwhelmed her with nervousness and stress. She was afraid to go out of the house. She worried about answering the phone. "I was not myself," she said. Margaret's cardiologist, finding nothing physically wrong, suggested she see a psychotherapist. Margaret chose Dr. Stacy Raymond of Raymond Psychological Services in Ridgefield "and within two sessions, we got to the root of the problem," said Margaret (not her real name), a Fairfield County resident in her seventies. Margaret told her story in an interview that included the Raymond therapists (Stacy Raymond, Psy.D., and her parents-in-law, Ronald Raymond, Ph.D., and licensed professional counselor Doris Raymond).
The Raymond's practice includes a relatively new psychotherapeutic technique that's getting a lot of attention in the mental health field. The approach, a so-called re-processing therapy, engages both brain hemispheres, enabling the left (rational) and right (emotional) sides to wrestle with a problem simultaneously. "When a disturbing event occurs, it gets stored in an isolated memory network. It just keeps reverberating in one portion of the brain. It is prevented from learning from other parts of the brain", Dr. Ronald Raymond said. Without complete processing, the theory goes, these isolated mental loops lead to anxiety disorders (such as phobias and post-traumatic stress) or depression.
Forty years ago, Margaret was devastated by the stillbirth of her first child. Afterward, inside her brain, isolated countercurrents of guilt and regret had whirled: "Something was locked in the back of my head. I put it away for many years. I couldn't believe how fast it came out in Stacy's office." Margaret's pregnancy had been problem free. During labor, however, a terrible complication arose: placenta previa, a condition in which the placenta blocks delivery. Margaret hemorrhaged profusely. She passed out. When she awoke, she asked to see her baby. She was told he did not survive. She was offered the chance to see the lifeless infant, but, wracked with shock and grief, she refused.
When people suffer trauma, their brains record memories while their bodies flood with alarm. A kind of mental processing glitch occurs. "Raw vestiges of the sights, sounds, and bodily sensations are stored in the right brain in fragmented form," Dr. Stacy Raymond explained. "Victims just want to get through the experience; therefore, logical reasoning, which takes time, is bypassed." Later, if a thought or event evokes the experience, traumatized people are stricken again, either with similar symptoms or with different ones, like heart palpitations. "The cycle continues," Dr. Raymond said, "until the isolated network in the right hemisphere is neutralized with the more rational, unemotional faculties of the left hemisphere."
In Margaret's anguish, she blamed herself. She MUST have done something wrong during pregnancy. She SHOULD have said goodbye to her son. Dr. Stacy Raymond helped Margaret bring these distorted beliefs to awareness. "I felt like I was light - no more blockages," Margaret said. Her palpitations ceased. Doctor Raymond asked Margaret to construct positive conclusions to replace the negative ones. Then, through re-processing therapy, Margaret's realistic, rational beliefs were substituted for her false, irrational ones. She realized the malfunctions in her womb were not her fault. She forgave herself for the decision made at a harrowing moment to refuse to see her dead child. "It's been two years since my treatment," Margaret said. "I feel wonderful!"
The Raymonds accept an information processing model of the brain. Negative conclusions can be "deleted" and positive ones "installed." Practitioners and patients alike refer to this therapy by its initials "EMDR" short for its unwieldy complete name, "Eye Movement Desensitization and Reprocessing." EMDR was developed by psychologist Francine Shapiro, Ph.D., who formulated the theory in 1987. A form of modern cognitive therapy, EMDR has a talk-therapy component. Together, clients and therapists develop insights into the client's problems. What's unique about EMDR is its use of bilateral stimulation. During an EMDR session, both brain hemispheres are activated by an alternating sensory stimulus, such as eye movement. To induce lateral eye movement, all a therapist has to do is move an index finger from side to side while the client focuses on it. A child counselor like Doris Raymond uses finger puppets. (Eye movement is the most often used stimulus, hence Eye Movement Desensitization and Reprocessing. Other methods include back-and-forth hand tapping, listening to alternating tones through headphones or feeling electronic impulses through hand-held pulsators.)
EMDR treatment progresses in several phases. Before any left/right stimulus is activated, clients, in dialogue with their therapists, work on solutions to their emotional predicaments. Then, "sets of bilateral movements are repeated until the client reports little or no disturbance when thinking of the original event," Dr. Stacy Raymond explained. In the final phases, she said, "the client determines the positive belief. Then the therapist installs it with eye movements while the client pictures the incident." EMDR therapists say the combination of cognitive therapy with bilateral stimulation engages the brain's natural healing abilities.
When Margaret first went to Dr. Raymond, she'd never heard of EMDR. "I thought she'd have me lying on a couch," Margaret said. "When she said, 'Follow my finger with your eyes,' I thought, 'Well, I'll try anything once. But I may never come back here!'" As re-processing progressed, however, "It was like somebody opened a safe and these things came pouring out," Margaret said. "I'm well since I left this office."
Besides trauma-induced disorders, EMDR is used to resolve less complicated problems like performance anxiety (fear of public speaking, for example) and simple phobias (such as fear of flying). Doris Raymond helps students with test-taking terrors. While drugs successfully treat many kinds of mental disturbances, EMDR practitioners prefer to avoid pills if possible. They're concerned about side-effects, "which can be powerful. Also dependence: you go off the SSRI, your depression comes back," Dr. Ronald Raymond said. ("SSRI" stands for "selective serotonin reuptake inhibitor," a class of antidepressant. Among the most commonly prescribed brand names are Paxil, Prozac, and Zoloft.) Doris Raymond mentioned another application of EMDR. "The Red Cross started using it after the Oklahoma City bombing. Now, trained people are often sent in to disaster areas because EMDR is so effective, so fast."
All forms of psychotherapy have their critics, and EMDR is no exception. Some skeptics say it's just another talk therapy - the eye movements make no difference. Others point out that, so far, no definitive science fully explains why bilateral stimulation works. But to Dr. Stacy Raymond, that doesn't mean "we should stop using it just because we don't have the equipment to identify the exact mechanism." The Raymonds need no convincing that EMDR stimulates the brain's own reprocessing capacities, resulting in shorter healing times without side effects. "People emerge feeling empowered," Dr. Stacy Raymond said, adding, "it opens the door to one's highest potential!"
For further information, including a research overview, visit http://www.EMDRIA.org.
By Ami Albernaz
Alan Lieberman, Ph.D., a consultant to the cardiology department and cardiac rehabilitation unit at St. Elizabeth's Hospital in Brighton, Mass. has been working for the past eight years to restore cardiac patients to health. He helps his clients to better manage stress, to conquer addictions to smoking and overeating and to empower them to prevent future incidents. Lieberman is one of a growing number of cardiac psychologists who focus on the emotional and cognitive underpinnings of heart trouble.
With heart disease as the country's leading cause of death, it is not surprising that a branch of psychology is emerging to mitigate some of its underlying risk factors. Cardiac psychology first garnered attention in 1996 with a book aptly titled, "Heart and Mind: The Practice of Cardiac Psychology" (edited by Robert Allan, Ph.D. and Stephen Scheidt, M.D.). The compilation of research findings sparked interest among mental health practitioners, who work with cardiac patients in private practice, as consultants to cardiologists, or within intervention teams in rehabilitation programs.
Uniting mental health and physiology, cardiac psychology is holistic, taking into account the unique sets of circumstances that each patient faces. "The guiding principle is that the mind and body are interconnected," Lieberman says. "People bring their lives and problems with them." Cardiac failure is almost always frightening and disorienting; part of Lieberman's job is to help his patients manage their fears stemming from their states of health and the sudden disruption in their lives. "Ninety percent of heart patients have had no prior experience with a psychologist," he says. "They are by and large 'normal' people in a health crisis."
Lieberman consults with his patients' physicians and family members and ensures that patients are in a frame of mind to focus on their own health. He tells of one patient who was a caregiver for his wife, who had Alzheimer's disease. After his heart attack, the patient was worried that he would be unable to care for his wife. For the man's peace of mind, Lieberman called the nursing home for reassurance that his wife was being cared for. Lieberman's patient, his fears allayed, was then able to focus on his own health.
Lieberman's courses of therapy are structured according to each patient's needs. He teaches some patients relaxation techniques such as meditation or guided imagery, which have benefits beyond helping patients cope. "We know that calming patients before surgery helps patients bleed less and need less anesthesia," he says. For patients who find it helpful to talk to others about what they are going through, he might recommend group therapy. The goals are to address the psychological components of adopting healthier lifestyles - quitting smoking, cutting fat consumption, learning to relax.
Practicing in a somewhat different capacity is Stacy Raymond, Psy.D., of Ridgefield, Conn. Raymond became interested in cardiac psychology three years ago, seeing the need for a holistic approach to heart health through her work with her husband, a cardiologist. At the time, the specialty had even less recognition that it has now. Raymond prepared for working with cardiac patients by reading up on the field and even shadowing Robert Allan in New York. Today, some of Raymond's clients are also her husband's patients.
"Like most physicians, he can't talk to his patients for half an hour," she says. "But it's always been a concern for him to provide comprehensive care."
In approaching each new course of treatment, Raymond assesses lifestyle, risk factors, and the patient's level of awareness as to how emotions and stress levels impact the heart. "A lot of people operate at a high level of stress, and don't even realize it," she says. "People need to learn how it feels to be relaxed, and how to bring themselves to that state."
For some of her patients, managing anger and depression are key components of therapy. "A person is twice as likely to have a heart attack while in a fit of rage," Raymond says. She teaches her clients cognitive skills to help them reinterpret events and to recognize that they have control of their emotional states. "It's saying that 'I'm in control of my states of stress and relaxation,'" she says.
For clients dealing with depression, meanwhile, strengthening social support networks and helping them feel less isolated is critical. "If patients feel that their bodies are failing them and they remain depressed, they have three times the risk of dying that first year after a heart attack, compared to someone who's not depressed," she says.
Raymond helps her clients feel good about taking small steps in improving their health, rather than daunted by trying to implement sweeping changes all at once. It doesn't have to be all-or-nothing," she says. "If you make modest changes, you'll see results. You don't have to eat only tofu and bean sprouts, but you do have to make changes."
Mental health is also a key component of rehabilitation programs that marry physical and emotional resilience building. At the Mind-Body Institute (MBI), an affiliate of Boston's Beth Israel Deaconess Hospital, a 13-week cardiac program offers a combination of nutrition counseling, physical training and counseling. The guiding philosophy is that physical and mental health are inextricably linked and that substantial changes in one inevitably impact the other.
"Only 50 percent of heart disease can be explained from a physical standpoint - high cholesterol, obesity, and so on," says Aggie Casey, M.S., R.N., MBI director and clinical specialist. "There's also the hostility component, and those with significant anger and depression are at an increased risk of heart disease. We tend to see optimal heart health as a balancing of three legs. One leg is pharmaceutical, the other is surgical and the third leg is self-care: What can you do to empower patients to take better care of themselves?"
The psychotherapy component is a combination of individual and group counseling. Patients learn relaxation and cognitive skills - time management and constructive coping strategies - in a group setting. For patients with specific concerns, individual counseling is available. Patients leaving the program, Casey says, typically report improvements in quality of life.
The North Shore Medical Center in Salem, Mass. offers a similar cardiac rehabilitation program. Joanne Rowley, M.S., R.N., C.S., a psychiatric clinical nurse specialist, is part of an intervention team that provides an array of services, including exercise and nutrition counseling. Rowley meets individually with each patient starting out in the program. During a comprehensive assessment, patients assess what is most meaningful to them and from there, decide to make changes.
"A heart attack is a wake-up call," Rowley says. "Some patients might decide to take early retirement or realize that appreciating their family is important."
Following the initial consultation, Rowley meets with patients individually as needed. She also teaches relaxation skills in a group setting; some patients will later turn to Rowley for help in applying the skills to their own situations. Patients will also consult with Rowley in need of support in making difficult lifestyle changes, like quitting smoking. When needed, Rowley also refers some patients to other specialists: acupuncturists, marital counselors, outside support groups - whatever service would be most beneficial for a patient's emotional, and physical, well-being.
While it is more directly related to physical health, cardiac psychology maintains the central tenet that unites all branches of psychology: to empower people to make positive changes and to feel that they are in control of their lives and health. The goal, as Raymond says, is for patients to recognize "'I'm not completely in the hands of my cardiologist. I can make changes to improve my health.'"