|CenterPoint - EMDR and Life Enhancement Counseling|
The CenterPoint Newsletter
Our newsletter is intended to inform professionals, our clients, and the public about recent events and information related to CenterPoint and the world of EMDR. If you would like to subscribe to the e-mail version of the newsletter, please feel free to contact us at email@example.com. Below are selected items from the Summer 2002 issue.
Chronic Pain May Be the Memory of Pain Why EMDR Helps Chronic Pain Patients Alleviate Pain
EMDR helps to dissolve both the chronic emotional and physical pain associated with traumatic events.* EMDR therapists first noticed that chronic pain symptoms associated with traumatic memories were able to be dissolved as a result of desensitizing and reprocessing traumatic events. Later we found that other sorts of chronic pain, such as phantom limb pain in amputees, were also improved through targeting with EMDR. We began to wonder if pain, in itself, can be encoded as a traumatic event? Is it possible that our mind and bodies can learn about and remember physical pain all too well? That's the growing notion among neuroscientists and anesthesiologists, who are finding evidence that chronic pain, including the phantom pain experienced by many amputees and people with spinal cord injuries, is learned, much like our other memories.
"There's good pain and there's bad pain," says anesthesiologist Jay Yang, M.D., Ph.D., of the University of Rochester Medical Center. "Good pain, though we don't usually think of it as 'good,' is the usual kind we all experience. We cut ourselves and it hurts, or we touch a hot burner and we pull away because we feel pain. That helps us survive and protects us. Bad pain is pathological pain that persists long after your wound has healed. It serves no purpose."
Physicians like Yang are looking at the physical similarities between the way a memory is formed, and the way that pain becomes persistent and chronic. "We believe that the pain no longer originates with the tissue that was originally damaged, but that it actually begins in the central nervous system, in the spinal cord and the brain," says Yang, a professor in the Departments of Anesthesiology and Pharmacology and Physiology. "The experience changes the nervous system, just like learning. It's like a memory of pain that recurs again and again in the nervous system."
*Hekmat, H., Groth, S. & Rogers, D. (1994) Pain ameliorating effect of eye movement desensitization. Journal of Behavior Therapy and Experimental Psychiatry, 25, 121-130.
What are they saying about EMDR?
The 2001 National Book Award Winner for Nonfiction was The Noonday Demon: An Atlas of Depression by Andrew Solomon (Scribner, 2001). Publishers weekly (2002) reported that "Solomon brings a stunning breadth of research to this widely misunderstood and often stigmatized illness" The New England Journal of Medicine (2/21/02) also stated that "His insights into depression span not only autobiography, but also the scientific and historical roots of depression, its treatment, and the effect of this disorder on the Western world." Solomon offered some interesting observations about EMDR: "While many therapies - psychoanalysis for example - comprise beautiful theories and limited results, EMDR has silly theories and excellent results... I had been told that the technique 'speeds up processing' but that did not prepare me for the intensity of the experience... It's a powerful process, I recommend it".
Extending the Recent Events Protocol
Dr. Finnegan-Suler's Spotlight on Clinical Issues for EMDR Professionals
Because recent events (occurring less than 3 months ago) have not consolidated in memory, we ask that clients report a complete narrative history of the event. As the client tells us about the event, we create a list of separate, significant moments and aspects of the experience along with their associated SUDS level ("saw the flames" SUDS 6, "tried to put them out with my feet" SUDS 5, "realized that the doorway was blocked" SUDS 9). It is also important to include important sensory aspects of the experience ("smelled smoke" SUDS 9, "heard popping sound" SUDS 8).
Steven Silver* recommends that clinicians be careful to extend the narrative to include the aftermath of the incident. It is not unusual to find that the immediate aftermath of a traumatic episode was also traumatizing. While in a heightened state of vulnerability and with our nervous system primed to make use of corrective comfort and aid, we may instead face additional assaults on our sense of safety and integrity. We may overhear dire medical predictions from emergency personnel, other traumatized participants blame us, our normal support people may not appreciate the severity of our psychic or physical wounds and fail to provide the correct level of aid.
It also is important to proceed through the narrative until the individual was in a position of relative safety and security. That last scene provides the natural positive cognitions of "I'm safe (safer) now", "I survived", "It's over".
* Steven Silver, Ph.D. is the coauthor with Susan Rogers, Ph.D. of Light in the Heart Of Darkness: EMDR and the Treatment of War and Terrorism Survivors (Norton, 2001). Dr. Silver is a Senior Trainer, HAP Trainer, EMDRIA Consultant and Director, PTSD Program, DVAMC Coatesville, PA .
Alertness vs Anxiety
Hypervigilence is a hallmark symptom of PTSD. The mind and body are frozen into a state of anxious hyperarousal. Even small noises or movements result in a startle reaction and the fight or flight mechanism is barely contained. In this state our ability to discern true danger is impaired because even innocuous stimuli are triggering. When true danger appears we may miss the cue or quickly move into the next level of autonomic arousal, which is frozen terror. EMDR can be very effective at lowering the level of overall arousal and allowing the return to a more effective state of relaxed, alert responsiveness. Help clients to identify the differences between anxiety and alertness. Alertness can be useful because it is likely to lead to effective action, while anxiety often leads to helplessness. You may need to explore images that represent calm alertness - perhaps, for example, the cool and composed James Bond. What does it feel like in their body to be near such a person, to merge with them and feel that relaxed alertness in their body? Install this as a resource using bilateral stimulation. Proceed with trauma processing having this state as a resource and as an appropriate goal.
Brief Treatment for Elementary School Children with disaster-related posttraumatic stress disorder
What's New in EMDR Research
C.M. Chemtob, J. Nakashima, R.S. Hamada & J.G. Carlson. Journal of Clinical Psychology, 58, 99-112, 2002
The effects of three sessions of EMDR with children suffering the aftereffects of Hurricane Iniki were evaluated using a lagged-groups design. 32 children who had not responded to previous treatments and met the criteria for the classification of PTSD were randomly assigned to treatment and delayed treatment conditions. The children prior to the study had shown no improvement 3.5 years after the hurricane and a year after the most recent attempts at treatment. Clinical improvements were reported in both groups on measures of PTSD symptoms, anxiety, and depression. There was a 53% decrease in PTSD diagnosis at post-treatment. These changes remained stable at a six-month follow-up. In addition to the substantial reduction of PTSD symptoms, there was a marked reduction in visits to the school nurse in the year following the EMDR treatment as compared to previous years. This is the first controlled study investigating the treatment of disaster-related PTSD and the first controlled study investigating the treatment of children with PTSD.
Comparison of two treatments for traumatic stress: A community-based study of EMDR and PE
G. Ironson, B. Freund, J.L. Strauss, & J. Williams. U of Miami Journal of Clinical Psychology, 58, 113-128, 2002.
This study compared the efficacy of two treatments for post-traumatic stress disorder (PTSD) - EMDR and Prolonged Exposure (PE) - for 22 patients from a university-based clinic serving the outside community, mostly rape and crime victims. Results showed both approaches produced a significant reduction in PTSD and depressive symptoms, which were maintained at three-month follow-up. However, successful treatment was faster with EMDR as more people experienced a reduction in PTSD symptoms after three active sessions. In fact, during the initial session of EMDR, Subjective Units of Distress ratings (SUDS) decreased significantly but changed little for patients during the initial session of PE. Post session SUDS ratings were significantly lower for EMDR than for PE. Perhaps as a result of the faster relief afforded by EMDR treatment, EMDR appeared to be better tolerated as the dropout rate was significantly lower in those randomized to EMDR versus PE.