Looking inside my Therapy Toolbox – What is EMDR?


Toolbox1

In my therapy practice I offer a range of different psychotherapeutic approaches and techniques so that I can use the most appropriate tool from my toolbox to help a client with their own individual issues. Good psychotherapists are committed to continuous professional development and undertake additional courses each year to keep their skills up to date and to stay abreast of new methods, models, techniques and research in the world of psychotherapy. Perhaps you have been seeking therapy or are just interested in what is available?

If you have ever checked out various therapist websites you are probably bewildered by the strange sounding therapies and techniques they offer. Whilst hypnotherapy is now very common, other evidence-based therapies such as EMDR are less well known. I trained in using this form of therapy a few years ago, when I felt I needed an extra tool in my toolbox for dealing with distress in a fast and effective way. In this blog I am talking about EMDR and how it can be invaluable in helping people overcome serious distress.

So what is EMDR?

EMDR stands for Eye Movement Desensitisation and Reprocessing. It is a powerful psychological treatment method that was first outlined in the 1980’s by Dr Francine Shapiro, a clinical psychologist. Shapiro developed the EMDR therapeutic approach based on specific principles, protocols and procedures with the goal of reducing distress in the shortest period of time.

Substantial research has demonstrated the benefits of EMDR in treating psychological trauma and (PTSD) Post Traumatic Stress Disorder. It is now commonly used to help the victims of large-scale catastrophes around the world including experiences of war and natural world disasters. However, it is also used to help people overcome the distress experienced from childhood abuse or neglect, assaults, surgical trauma, road traffic and workplace accidents. For example, train drivers who witness fatalities on the line are treated with EMDR as it can relieve their distress quickly and effectively. It can also be used to help people experiencing emotional distress with other issues including anxiety, phobias, grief, divorce, illness, performance anxiety, self esteem or any distress from the past, which is still impacting on day-to-day life.

So how does it work?

Being involved in a distressing event can feel overwhelming and the brain may be unable to process this information in the same way as it would an ordinary memory. The distressing memory seems to become frozen on a neurological level. Recalling the distressing memory, which can sometimes be triggered when you least expect it, can cause you to intensely re-experience whatever you could see, hear, smell, taste or feel at the time of the event. Sometimes the memory is so disturbing that you avoid thinking about it so you don’t have to experience the distress. In PTSD, people experience flashbacks and nightmares that are as intense as the actual incident that created the distress.

EMDR aims to identify and process dysfunctional and unhelpful behaviours, emotions, cognitions and memories arising from recent or past trauma and distressing life experiences. The theory behind the treatment proposes that unprocessed traumatic or distressing information produces dysfunctional reactions. These unprocessed memories are stored in separate unconnected memory networks in the brain. In EMDR, bilateral stimulation allows you to make connections between these neuro-networks causing spontaneous insight and change, resulting in learning and relief of emotional distress.

For example, let’s suppose someone was bullied at school and instead of the brain making sense of that experience and letting it go, the distress experienced is stored in a separate memory network along with all the emotion, beliefs and physical sensations that were there at the time. When something happens perhaps 20 years later that the brain interprets as being similar in nature (perhaps a boss at work makes a negative comment) the brain makes sense of it by linking to the old memory and all the associated feelings come flooding back. This person may not understand why the boss being negative triggers such a distressing reaction in them because it is happening automatically and is beyond their control. In EMDR, that old memory can be processed appropriately as you learn what you need from it and let the rest go. The original memory is transformed and stored in this reconsolidated form so the person can’t be triggered any more.

The treatment phase of the EMDR protocol can seem a little strange when you first encounter it. Alternating eye movements (or sometimes tapping or sounds) are used to stimulate the brain into reprocessing the frozen or blocked information that is being triggered and creating the distress. This bilateral stimulation allows you to re-process the distressing memories more appropriately, so they lose their intensity and can be stored in the same way as normal memories. The effect is believed to work in the same way as we naturally process ordinary memories during REM (Rapid Eye Movement) or dream sleep when your eyes move rapidly and repeatedly from side to side. After treatment, past memories no longer cause you distress, allowing you to respond adaptively in the present and in the future.

What happens during EMDR treatment?

In my therapy room, I start with a history taking session during which I assess your readiness for EMDR and develop a treatment plan. Working together, we identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance (triggers) and related historical incidents.

I always ensure that every client has adequate methods of handling emotional distress and good coping skills before any processing work takes place. Hypnotherapy techniques can be great for doing this effectively and the bonus is that you learn and practice some valuable skills that can be used in everyday stressful situations, as well as during or between sessions.

Once an initial target has been identified, it is processed using EMDR procedures. This usually involves you identifying a specific visual image related to the memory, beliefs about yourself in that situation, and the associated emotions and body sensations. There are other ways of using EMDR where you don’t have to openly share distressing information with the therapist, so before any processing starts we decide together which way of working would be most beneficial for you.

When the processing stage begins you are asked to focus on aspects of the memory whilst simultaneously moving your eyes back and forth following my fingers as they move across your field of vision for 20-30 seconds. You may be asked instead to listen to alternating tones or use a tapping device, which you hold in each hand to experience the bilateral stimulation, which enables the processing to take place. You are then asked to relate whatever thought, feeling, image, memory, or sensation comes to mind. This is repeated numerous times throughout the session. As the memory is adapted appropriately you will notice things changing and the associated distress subsiding until it disappears. Depending on the complexity and severity of the distress, it may take several sessions to process the old memories in a fully adaptive way.

After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Usually they cannot recall the old memory in the same distressing way again. Importantly, these emotional and cognitive changes generally result in spontaneous behavioural and personal change, which can be further enhanced.

When I first experienced EMDR I was blown away by it’s effectiveness. I have since used it very successfully for treating many clients including people suffering from the effects of phobias, anxiety, relationship distress, and road traffic accident traumas.

I have completed all 4 parts of an EMDR Association approved course and supervised practice in Eye Movement Desensitisation and Reprocessing. Training on an approved course is restricted to mental health professionals who hold current registration to provide psychotherapeutic services (such as British Psychological Society membership). I am pleased to be able to offer this service to my clients alongside my other services.

If you are interested in EMDR there is a link on my website to find out more: http://www.mindmakeoveruk.com/links.html

I am Susan Tibbett, a Chartered Psychologist and Hypnotherapist based in York. You can reach me at: http://www.mindmakeoveruk.com

Advertisements

How can I help my loved one through Depression?


distress

I see many clients with depression in my therapy room. They bravely recognise that they need help and take those first tentative steps in coming along to see me, unsure whether anything can be done to help them. I always take time to explain what depression is and how it is maintained so they can begin to see a way forward, armed with a renewed sense of hope that this mind state can be beaten with the right help. I have also noticed that they get frustrated with well meaning loved ones who don’t understand what depression is, or the best way to help. I have been asked on many occasions if I have some information that they can share at home to help those around them understand and be supportive. I put some information together a few years ago, adapting things I have learned and useful tips I have read that worked for previous clients. As such I can’t remember all the original sources now, so apologies if I haven’t acknowledged any authors. In this blog I just wanted to share this information to help people. Perhaps you can share it to help someone you know.

What is depression?

When your loved one starts therapy for treating Depression you naturally want to support them in the best way you can. In order to do this effectively it can be helpful to gain an understanding of what Depression is, how it affects someone physically and mentally and what you can do to help.

General understanding of depression is confusingly coloured by many myths: it’s caused by a chemical imbalance in the brain; it’s anger turned inward; it takes a long time to come out of; it stems from childhood events that have to be explored before progress can be made, etc.

The rapid increase in the incidence of depression is one of the reasons we know that depression isn’t a genetic disease. Over the last 30 years, a large body of research evidence shows that most depression is learned, brought about by the way we interact with our environment. We know that the majority of people exposed to adverse life events do not develop depression. So, we know it is not caused as a result of the specific events we experience, but by the way we respond to them.

Sleep and Depression

The role of dreaming is key to a full understanding of depression, and why practical therapies help. We all dream for about two hours a night, even though we often don’t recall it when we wake up. Evidence shows that the function of dreaming, which occurs predominantly during REM sleep, is the metaphorical acting out (not the resolving) of unexpressed, emotionally arousing concerns. Dreaming allows the arousal to be discharged and frees up the brain to deal with the concerns of the following day.

In depression, however, this process goes dramatically wrong. Instead of having about 25% REM sleep, and 75% slow wave sleep (which boosts energy levels in the brain), these proportions become inverted. A depressed person has far too much REM sleep and too little slow wave sleep. The prolonged negative self-examination and rumination, which depressed people experience, creates high levels of emotional arousal and a greater need for discharge during dreaming. This increased discharge activity also depresses and exhausts the brain, leaving the dreamer lacking energy and motivation next morning. Depressed people tell me in therapy that they wake up from sleep feeling exhausted.

Emotional Thinking

Depressed people spend too much time worrying and as such, they are misusing their own imagination. I call it negative self-hypnosis. All this emotionally arousing introspection also prevents them seeing their life situations objectively. High emotional arousal inhibits the logical part of the brain, and blocks rational thought. A depressed brain is a stressed brain.

To the emotional brain, everything is either black or white, good or bad, right or wrong, safe or dangerous. This is because high arousal locks you into a negative, confined viewpoint. It is only the rational part of the brain that can inject the shades of grey and see the bigger picture.

People who aren’t habitual black and white thinkers can snap out of this negative emotional state fairly quickly. People who have a tendency towards endlessly analysing the negative aspects of their lives, catastrophising every little setback and conjuring up more, are more likely to stay locked in their depressive mind state. People who tend to blame themselves for everything that goes wrong, applying a negative thinking style to everything, are the most likely to suffer from depression.

How does Depression feel for my loved one?

Winston Churchill used to refer to depression as like a Black Dog. Having a Black Dog in your life isn’t about feeling a bit down, or sad or blue. At it’s worst, it’s about being devoid of feeling altogether.

  • It can ruin your appetite
  • Anger may flare up at any provocation
  • It can be difficult not to take anger, criticism, negativity and apathy personally
  • It likes to wake you up with very repetitive, negative thinking
  • You may have noticed they’ve lost the sparkle in their eyes
  • Displays of love, affection and intimacy may be out of bounds
  • They may create endless lists of everything that is wrong with their life
  • They may hatch plans that they believe will fix everything
  • Laughter doesn’t come as easily as it used to
  • It makes them say negative things
  • They may have real difficulty firing up and getting going
  • They may have become ultra-sensitive and cry more than usual
  • Doing anything or going anywhere requires superhuman strength
  • It can make them irritable and difficult to be around
  • Activities that used to bring them pleasure may suddenly cease
  • Although exhausted they may not be able to sit still and relax
  • A tendency to find the negative in everything may become the norm
  • There may be signs of over-indulgence

How can I help my loved one?

You may well be right when you say. ‘It’s all in your head!’ but don’t say it. Never tell them they’re ‘just looking for attention’; it’s demeaning and hurtful. They’re not looking for attention but they are probably in need of it.

If you’re genuinely worried about someone, organize a group of close friends or family members to make some sort of contact each day. It can be to help out, have a coffee or simply to say hello.

Pointing out the lovely weather is annoying and pointless.

Don’t push them into things they don’t want to do and then make excuses for their behaviour. This only feeds the despair and keeps denial alive.

They can’t just ‘pull themselves together’. If people could just ‘snap out of it’, they would. No-one ever chooses to have depression.

Learn about the condition together; knowledge is power and validation is a great healer.

Help them to develop a strategy to simplify their life both at home and at work. Stress is one of the biggest drivers of depression.

Encourage any form of regular exercise.

Be sensitive about how you approach the subject; a lot of people aren’t used to talking about their mental health.

Being thoughtful and kind will never go amiss but don’t try and jolly them along, it can often make them feel worse.

If they’re old enough, inform any children about what’s going on. They need to know that the depression isn’t here to stay. Children often think it’s their fault so reassure them that it’s not.

Together, try and learn to recognize triggers and early warning signs. Also know when to give each other a bit of space.

Try not talking. Just listen. Really being there for someone without opinion or judgement is one of the best gifts you can ever give.

Agree to a course of action to get rid of the depression. Don’t just ignore it and consult a professional if you haven’t already.

As a care-giver, compassion, empathy and understanding are vital, but recognize that you alone don’t have the power to rescue your loved one. Professional help is often what’s needed.

Depression in any relationship can be confronting, frightening and frustrating but navigated together, your relationship can become deeper, richer and better for it.

I am Susan Tibbett, a Chartered Psychologist and Hypnotherapist based in York. I specialise in helping people with depression and anxiety. You can contact me at http://www.mindmakeoveruk.com