Busting the myths about trauma banner

MYTH: You don’t get a trauma related disorder unless there’s some weakness in your personality.

Wrong. Studies have shown that trauma in early stages of development affects the brain PHYSICALLY.  Exposure to complex trauma in early childhood leads to structural and functional brain changes. Structural changes alter the volume or size of specific brain regions. Proven structural changes include enlargement of the amygdala, the alarm center of the brain, and shrinkage of the hippocampus, a brain area critical to remembering the story of what happened during a traumatic experience. Functional changes alter activity of certain brain regions. […] Many such abnormalities identified through neuroimaging that have previously been attributed to psychiatric illness have been scientifically proven to be the result of prior childhood maltreatment.

MYTH: Trauma related disorders only affect thinking, behavior or the brain.

No. The changes in the brain due to trauma during certain stages of development may affect people physically. These changes can lead to an “overproduction of stress hormones in childhood that can wear down the immune system and lead to depletion by adulthood of hormones necessary tolerate and recover from stressful situations encountered in daily life.” It can lead to the wearing down of the immune system, well into adulthood, which is “a complex network of organs, cells and proteins that defends the body against infection, whilst protecting the body’s own cells.”

MYTH: Trauma disorders stem from childhood.

False. People who are perfectly capable of dealing with trauma in a healthy manner may develop a trauma disorder if they suddenly face a number of traumas in rapid succession.

MYTH: People who suffer from trauma disorders can’t handle stress or crisis.

Not true. People who suffer from trauma disorders may deal with an acute, stand alone trauma, stressors or crisis, incredibly well. Most likely because they’ve been managing their disease, with or without help, effectively, and in a lot of cases undetected, for years. In order to survive, these people have found a range of ways to deal with stressors or crisis. And some of these survival mechanisms actually make them much more capable of taking over during crisis, and much less likely to fold under pressure in their jobs, social situation or relationships when they are free from personal triggers.

MYTH:  Trauma disorders can’t stand alone, there’s always a co-morbid other psychiatric condition.

False. A lot of trauma disorders, especially those pertaining to complex trauma, are misdiagnosed as other conditions. The problem is that complex trauma may lay at the root of other mental illnesses as well, causing overlap. Often, either because mental health professionals are not informed about trauma, let stand complex trauma, or they do not look beyond the DSM, people suffering from trauma disorders initially get diagnosed with the more well-know and often partially overlapping disorders. Personality disorders, anxiety disorders, dissociative disorders, etc.

MYTH:  How we treat people with trauma related disorders has no bearing on their ability to cope.

Absolutely not true!  When people with trauma related mental illnesses are asked “what’s happened to you” instead of being “asked” “what’s wrong with you”, it can lead to self-actualization.  Whatever is “wrong” with them is a survival mechanism. They adapted to overwhelming situations in order to survive. That requires strength, adaptivity, self-reliance, and quite a bit of out-of-the-box thinking. In some cases an enormous amount of strength, adaptivity, self-reliance and out-of-the-box thinking

Understanding EMDR and the Process of Therapy Banner

Introduction to EMDR

Eye Movement Desensitization and Reprocessing (EMDR) therapy (Shapiro, 2001) was initially developed in 1987 for the treatment of post traumatic stress disorder (PTSD) and is guided by the Adaptive Information Processing model (Shapiro 2007). EMDR is an individual therapy typically delivered one to two times per week for a total of 6-12 sessions, although some people benefit from fewer sessions. Sessions can be conducted on consecutive days.

The Adaptive Information Processing model considers symptoms of PTSD and other disorders (unless physically or chemically based) to result from past disturbing experiences that continue to cause distress because the memory was not adequately processed. These unprocessed memories are understood to contain the emotions, thoughts, beliefs and physical sensations that occurred at the time of the event. When the memories are triggered these stored disturbing elements are experienced and cause the symptoms of PTSD and/or other disorders.

Unlike other treatments that focus on directly altering the emotions, thoughts and responses resulting from traumatic experiences, EMDR therapy focuses directly on the memory, and is intended to change the way that the memory is stored in the brain, thus reducing and eliminating the problematic symptoms.

During EMDR therapy, clinical observations suggest that an accelerated learning process is stimulated by EMDR’s standardized procedures, which incorporate the use of eye movements and other forms of rhythmic left-right (bilateral) stimulation (e.g., tones or taps). While clients briefly focus on the trauma memory and simultaneously experience bilateral stimulation (BLS), the vividness and emotion of the memory are reduced.

The treatment is conditionally recommended for the treatment of PTSD.

EMDR therapy uses a structured eight-phase approach that includes:

  • Phase 1: History-taking
  • Phase 2: Preparing the client
  • Phase 3: Assessing the target memory
  • Phases 4-7: Processing the memory to adaptive resolution
  • Phase 8: Evaluating treatment results

Processing of a specific memory is generally completed within one to three sessions. EMDR therapy differs from other trauma-focused treatments in that it does not include extended exposure to the distressing memory, detailed descriptions of the trauma, challenging of dysfunctional beliefs or homework assignments.

The Phases of EMDR

History-taking and Treatment Planning

In addition to getting a full history and conducting appropriate assessment, the therapist and client work together to identify targets for treatment. Targets include past memories, current triggers and future goals.

Preparation

The therapist offers an explanation for the treatment, and introduces the client to the procedures, practicing the eye movement and/or other BLS components.  The therapist ensures that the client has adequate resources for affect management, leading the client through the Safe/Calm Place exercise.

Assessment

The third phase of EMDR, assessment, activates the memory that is being targeted in the session, by identifying and assessing each of the memory components: image, cognition, affect and body sensation.Two measures are used during EMDR therapy sessions to evaluate changes in emotion and cognition: the Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale. Both measures are used again during the treatment process, in accordance with the standardized procedures:

Desensitization

During this phase, the client focuses on the memory, while engaging in eye movements or other BLS. Then the client reports whatever new thoughts have emerged. The therapist determines the focus of each set of BLS using standardized procedures. Usually the associated material becomes the focus of the next set of brief BLS. This process continues until the client reports that the memory is no longer distressing.

Installation

The fifth phase of EMDR is installation, which strengthens the preferred positive cognition.

Body Scan

The sixth phase of EMDR is the body scan, in which clients are asked to observe their physical response while thinking of the incident and the positive cognition, and identify any residual somatic distress. If the client reports any disturbance, standardized procedures involving the BLS are used to process it.

Closure

Closure is used to end the session. If the targeted memory was not fully processed in the session, specific instructions and techniques are used to provide containment and ensure safety until the next session.

Re-evaluation

The next session starts with phase eight, re-evaluation, during which the therapist evaluates the client’s current psychological state, whether treatment effects have maintained, what memories may have emerged since the last session, and works with the client to identify targets for the current session.