How eye movement could be key in treating PTSD
When President Woodrow Wilson in 1919 proclaimed Nov. 11 as the first observance of Armistice Day (now Veterans Day), some soldiers home from World War I were said to suffer from "shell shock." Following World War II, returning soldiers had "battle fatigue." It wasn't until 1980 that the American Psychiatric Association added post-traumatic stress disorder (PTSD) to its manual of mental disorders.
The inclusion of PTSD stemmed from research involving returning Vietnam War veterans, Holocaust survivors, sexual trauma victims, and others. Today the U.S. Department of Veterans Affairs operates more than 200 specialized programs for the treatment of PTSD and in 2013, more than a half million veterans diagnosed with PTSD received treatment at VA medical centers and clinics, according to the National Center for PTSD.
One recent development in treating those recovering from trauma and PTSD is Eye Movement Desensitization and Reprocessing. Local psychologist Marloes Verhoeven answers some questions about EMDR treatment:
Q: What is EMDR?
A: EMDR stands for Eye Movement Desensitization and Reprocessing and is a well-researched treatment modality that trained clinicians can use as part of their treatment plan to help individuals overcome trauma. It uses the eye movements that we also experience in our dream sleep, or REM sleep, to help the brain process information or memories.
Many individuals who have experienced traumatic events may say that they feel "stuck" or don't know "how to get over it" and may remember the events vividly and in great detail.
In fact, remembering the event may feel as bad today as when they first experienced it, as if it is happening all over again. Because EMDR allows healing to occur at a deeper (physiological) level in the brain and nervous system, memories of these negative events will finally be allowed to be reprocessed, or "digested," so that they become less disturbing (desensitized) and so that there is a recognition that they belong in the past and are not currently happening.
Q: When and how did you first become familiar with EMDR and why did you start offering it?
A: During my undergraduate years in the early 2000s I wrote a research paper about EMDR and became intrigued by the promises of this treatment and the solid research supporting its effectiveness. During my graduate training I became increasingly interested in treating individuals who had experienced trauma and in my last year became an intern at a psychiatric hospital where trauma was the norm rather than the exception.
While this training thoroughly prepared me to become a trauma-informed therapist, I couldn't wait to be licensed and receive my training in EMDR to solidify my skill set. Since then I have done advanced training in EMDR as well as other continuing education classes to apply EMDR to special populations, such as people with dissociation.
Q: What could a patient expect in a typical EMDR session?
A: There are eight phases of treatment, starting with thorough history taking, treatment planning, and preparation.
I often use the metaphor of a zero-depth pool in therapy, and explain that we first need to learn how to swim before we jump in the deep, choppy waters of trauma work. So we start at zero depth and dip in our toes, then recover, wade in deeper, then recover, and so on.
The time it takes to prepare for the actual reprocessing depends on a person's history. People with single, discrete episodes of trauma (for example, a car accident or a frightening health experience) can move through these first couple of phases rather quickly and will start reprocessing after just a few sessions, whereas clients with a more extensive trauma experience, or trauma that occurred early on, i.e. in childhood, may need more time to learn how to cope with emotional disturbances that may occur as the result of targeting disturbing memories.
During the actual "desensitization" or reprocessing phase, the therapist will use eye movements or other bilateral (left-right) stimulation to resolve the disturbing memories and their associated negative beliefs (for example: "I am powerless," "I am worthless," or "It's my fault") as well as emotions (i.e. sadness, anger, shame, anxiety, fear) and physical sensations.
The eye movements or other bilateral stimulation allows the clients to experience dual awareness, meaning that they can access the disturbing memory but are also aware that it is not happening now.
During reprocessing, the negative beliefs will be replaced by more adaptive or healthier beliefs, such as "I have some power now," "I am OK just as I am" or "I did the best I could."
Q: Is EMDR similar to hypnosis? How is it different?
A: The target memory for reprocessing is determined by the client, who is in control the whole time. The therapist is merely facilitating, which is different from hypnosis, where the therapist makes suggestions.
In addition, dual awareness is a key element in EMDR, whereas hypnosis allows for an altered consciousness (i.e. deep relaxation). Hypnosis can greatly assist people in the preparation phases of EMDR, however, as it teaches them to relax even in stressful circumstances, or it can help clients visualize positive outcomes. Therefore, I often integrate hypnosis in EMDR treatment.
Q: What types of patients might benefit from EMDR?
A: EMDR was originally developed to treat PTSD (Post Traumatic Stress Disorder) often seen in combat veterans, but has since been researched and applied to many other conditions including anxiety (panic, phobias, performance, social), depression, personality disorders, grief and loss, (chronic) pain, dissociation, compulsive or addictive behaviors, and any kind of disturbing memories.
Q: Can you share some success stories you have seen with EMDR?
A: In a relatively short amount of time I have helped individuals overcome fear of driving after experiencing motor vehicle accidents; I have facilitated people coming to terms with the loss of a loved one, for example by suicide, illness, or accidents; or helped people overcome traumatic memories of health-related experiences such as cardiac arrests, medical procedures, or diagnoses.
I work longer term with individuals who have been exposed to multiple traumas, and have successfully treated war veterans, children of alcoholic, abusive, or mentally ill parents, sexual abuse survivors, or survivors of domestic violence.
In virtually all of these cases clients expressed a sense of hopelessness and helplessness at the start of therapy, and it was incredibly rewarding to see them grow and become increasingly empowered over the course of treatment.
The moment they share with me that they were able to sleep, noticed a significant reduction in panic or anxiety, have felt more energized and less depressed, have better relationships, are able to stand up for themselves, understand themselves better, and feel hopeful about their future, consistently reaffirm for me how powerful EMDR can be.
I particularly remember one client with a significant trauma history starting in childhood tearfully telling me at the conclusion of an EMDR session that, "My voice is powerful" and "I matter" after spending years believing that she is not important or worthy.
Q: Why is EMDR a good treatment option for veterans with PTSD? Why do some other treatments fail to help veterans with PTSD?
A: Sometimes people (including veterans) are referred to our office for EMDR when more traditional forms of therapy have failed to yield significant progress. This has to do with the neurobiology of trauma. Traumatic memories are stored differently in the brain and may not necessarily be accessed or worked through by just "talking about it."
In fact, traditional talk therapy may at times do more harm than good, because it can potentially re-traumatize individuals. In addition, there are often "no words to describe" the trauma, or the events are literally "unspeakable."
One of the benefits of EMDR is that no words are needed to process or work through traumatic memories. It is a physiologically-based treatment approach, meaning that we trust the healing powers of our own brain and nervous system. After all, when we fall down and scrape our knee, we don't have to "tell" our knee to bleed to clean the wound, form a crust to protect the injury, and create new skin. The body knows how to heal - and no words are necessary. The same is true for traumatic memories. EMDR facilitates people's own ability to heal them selves.
For veterans specifically it is noteworthy that the Department of Veterans Affairs and Department of Defense placed EMDR in the "A" category as "strongly recommended" for the treatment of trauma.
Q: Where can readers find more information about EMDR?
A: The EMDR institute has a website with information for the public at emdr.com. General information and research about the efficacy of EMDR can be found at the EMDR Research Foundation's website as well: emdrresearchfoundation.org
The U.S. Department of Veterans Affairs also provides a section about EMDR for the treatment of PTSD in war veterans: www.ptsd.va.gov/public/treatment/therapy-med/emdr-for-ptsd.asp
On our website, we also provide a video explaining what EMDR is: www.oasis-mental-health.com/emdr.html
Marloes Verhoeven, Psy.D. is a licensed clinical psychologist who started her own practice (Oasis Mental Health, 1900 Ogden Ave, Suite 106, Aurora) in 2013 and was quickly joined by other clinicians who shared her passion to offer trauma-informed care to a growing population in the Western suburbs. There are currently four clinicians at Oasis who provide EMDR treatment to children, adolescents, and adults.