EMDR: Another Tool for Your Mental Health Toolbox

SafetyNurse1968, ADN, BSN, MSN, PhD

In part one of this article, Keep What You Love, Return The Rest: Healing with EMDR, I described Eye Movement Desensitization and Reprocessing - a therapy being used to treat PTSD and other forms of trauma. In part 2, I will address some concerns surrounding mental health issues, discuss the phases of EMDR therapy, and describe my experience with EMDR for childhood trauma.

My goal in writing about EMDR is to provide nurses with options. As a nurse, I always feel empowered when I can suggest something to a patient, friend or family member who is struggling. I want to add tools to your toolbox for dealing with mental health issues. A second goal of writing about mental health issues is to work towards removing the stigma of having a mental health diagnosis. I am hoping that you might read my article and realize you are not alone. I would like to show you that a person with a mental health diagnosis can be open and vulnerable without shame. Maybe my experiences will lead someone else to find successful treatment, or at the very least provide hope that successful treatment is possible.

However you define it, not all trauma causes Post Traumatic Stress Disorder. PTSD is a psychological diagnosis, well defined in the DSM-V. The best way to get a diagnosis and find appropriate treatment for mental health issues is to see a certified, licensed therapist. I defined trauma in another article I wrote about Tapping, or EFT as an event, situation or circumstance that overwhelms ones present coping capacity. The dictionary defines it as a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury.

It is possible to experience severe mental or emotional stress or physical injury with no lasting effects. This would be the best-case scenario, since bad things do happen to people. It would be incredible if we could process stressful experiences so that we don't experience a disordered psychic or behavioral state. I am thinking of my husband, whose mother died of cancer when he was only nine years old. She was only 40 when she died after a long, painful struggle - much of which was witnessed by my husband. We have talked about her death and the circumstances surrounding it multiple times. Our marriage counselor assured me that it is possible that, though her death was painful, my husband might be just fine, with no signs of being affected emotional or physically. You might meet another person who had the same thing happen to them who has continued disturbances into adult-hood, including invasive memories, difficulty trusting, attachment issues, or phobias. There is no correct way to respond to trauma (though there are tools we can add to our emotional toolbox that can help us respond with resilience -a subject I will definitely be writing about!). We are all unique beings who respond the way...well the way we do.

My story is that I was sexually molested by my stepfather from the time I was 10 until I was 16. It's a long, messy story and I won't go into all the details here, but I will say that as a result of that traumatic series of events, I have experienced a disordered psychic or behavioral state. I have a hard time coping with some situations, despite many years of therapy. I am looking for a way to decrease my reaction to stressful situations so I can behave with professionalism no matter what the circumstances. I want to respond the way my logical mind knows I should. I began EMDR therapy about 6 weeks ago with the hope that it might solve some of my problems.

According to the EMDR Institute, EMDR is a form of psychotherapy using eye movements or other forms of bilateral stimulation to assist clients in processing distressing memories and beliefs. EMDR focuses on three things: a) Past memories, b) Present disturbances and c) Future actions. The goal of EMDR is to completely process the experiences that are causing problems, and to replace them with new, adaptive ones. Unlike many other therapies, processing doesn't mean rehashing the trauma in detail, it means setting up a new learning state; one that will allow experiences that are causing problems to be resolved and then be stored appropriately in the brain. Basically you keep what works. You keep the positive lessons you have learned from the experience, but you get rid of the negative beliefs and body sensations. Proponents state that EMDR leaves you with understanding and perspective that leads to healthful and useful interactions.

EMDRIA (EMDR International Association) describes the eight Phases of EMDR treatment. Phases one-to-three lay the groundwork for treatment for specific events. Studies show that reprocessing for a single trauma can take as few as three sessions.

1. History and treatment planning (1-2 sessions): In these sessions, you identify the target memory or memories. Keep in mind that none of the memories have to be discussed in detail. Though I am seeking treatment for childhood trauma, my therapist and I (let's call her Pam) ended up settling on a more recent memory to tackle first. We chose getting fired, which I have described in detail in a previous article. That event continues to cause me significant shame and emotional distress.

2. Preparation (1-4 sessions): these sessions involve establishing relationship and trust with the therapist. My therapist, Pam and I spent several sessions in which I talked about my current state of mind. I discussed my current state of mind, described how I am triggered, and how I deal with friends, family and life stressors. Pam led me through an interesting exercise in which I completed several drawings, which she then interpreted with me. The goal of these sessions was to create a safe environment in which I felt like I could revisit some traumatic experiences. We also worked on relaxation techniques so I could calm myself during and after a session. For me, this involved visualizing a safe place - for me this involves running in the woods at dusk, on a trail near the water with sunlight filtering through the trees into my eyes.

3. Assessment: In the assessment phase, you identify aspects of the target memory, selecting a specific picture or scene from the target event, and then express a negative self-belief associated with that event. I pictured the days leading up to getting fired, as well as the meeting in which I was terminated. I identified the self-belief I am worthless. This was hard for me, because I know intellectually that this statement is not true...though it feels true. Who wants to go back there? I want to just forget it ever happened, not relive it! I then picked a positive statement I would rather believe, like I am worthy. Another example: the negative I am in danger followed by the positive I am safe now. I then estimated how true I feel the positive belief is using the 1-to-7 Validity of Cognition (VOC) scale (1 equals completely false and 7 equals completely true). I rated my belief at a 5. During this phase I also identified physical sensations associated with recalling the target memory and rated the disturbance caused by those sensations using the 0-to-10 Subjective Units of Disturbance (SUD) scale (0 is no disturbance, and 10 is the worst feeling you've ever had). I rated my sensations (tightness beginning in my solar plexus, tingling in my hands and feet, buzzing or fuzziness in my head) as an 8.

4. Desensitization: the focus of this phase is on disturbing emotions and sensations - this is where the bilateral stimulation occurs. Anything being measured by the SUDs rating is targeted here, including other memories, insights and issues that might come up. Pam brought out a bilateral stimulation gadget

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that had a controller with two cords, at the end of each cord was an egg-shaped, green, plastic thingy that I held in each hand. Pam had me think about the target memory and asked me to really try to get into all the negative shame and beliefs of that memory, though I didn't have to express any of it out loud. During this time, the small eggs vibrated in my hands in alternating fashion. This was really, really hard for me. I tried to put myself back into the memory of being fired, but it was so scary and so painful. I kept thinking, this is stupid, this will never work, why can't I just get over it?

5. Installation - the goal here is to concentrate on and increase the strength of the positive belief, eventually accepting the full truth of the positive statement at level 7. After holding the buzzing eggs for a minute or so, Pam had me visualize my safe place, and the buzzing in the eggs got deeper and slower. It was SO. WEIRD. It also felt good, though I can't explain why. I don't think my beliefs budged an inch. I also think I didn't really get into the bad places the way I really needed to for maximum effect. I wish Pam could come over and be there with the device when I am just waking up in the morning, fully reliving the whole experience, in full-out, red-faced shame mode.

6. Body Scan: after positive beliefs have been strengthened, the next phase involves visualizing the original target and noticing any residual tension. Any leftover tension is targeted for more processing. This part is well supported by research - studies of memories of traumatic events show that information about the event tends to be stored as body memory rather than narrative memory (the body keeps the score). The goal of EMDR is to help those body memories disappear.

7. Closure: this phase ends every session. Closure ensures you leave feeling better than you entered. Pam led me through a "light installation" in which I visualized my safe place, and a beautiful blue, gold light suffusing my entire body. Calming techniques are used to help you regain equilibrium. This part was awesome. I felt truly relaxed when we were done.

8. Reevaluation: this phase opens every new session. I will be going in again this week, and since I have only had one desensitization session, I am looking forward to seeing how my first reevaluation goes. We will be checking SUDs and VOC scores, and doing a body-scan for tension and other physical symptoms.

I know that this process may take a long time, but I have decided (for now) to believe it can work for me. EMDR can work quickly for some people, but I am anticipating that until I focus on the past memories really contributing to my problems, I may never fully heal. Believing I can fully heal continues to be a problem. I keep getting stuck in this script in my head that says, "you are just broken, and you can't ever be fixed" - alternating with, "if you just tried hard enough, you would be a better person". If you have thoughts like these, then you know why I am so dedicated to getting rid of them. I am so tired of the mean voices in my head, and I am hoping EMDR will silence them at last. You can Google EMDR stories and see many different opinions about whether or not it works. I urge you to talk to a trained, licensed, certified therapist to decide if EMDR is right for you. This article is not advocating for EMDR, it's about EMDR as an option for treatment. Be gentle with yourself and others and let me know if you want to hear more.

EMDR: Another Tool for Your Mental Health Toolbox

About SafetyNurse1968, ADN, BSN, MSN, PhD

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