Does EMDR work on PTSD?

EMDR (Eye Movement Desensitization and Reprocessing) therapy has been gaining credibility over the past 30 years within the health community showing clinical evidences, brain imaging before and after treatment, as well as 30 gold standard studies documenting the effectiveness of EMDR in resolving PTSD.  Most studies are done on single incident traumas though through other therapeutic interventions complex PTSD can be resolved though through longer period of therapy.

EMDR approaches issues using numerous modalities that have already existed in conjunction with eye movements, alternating tapping and/or tones.  Through a patient’s own rapid eye movement which is guided by the clinician significantly reduces the emotional upset from disturbing memories of traumatic events.

Ongoing EMDR studies

According to the EMDR Research Foundation and 30 gold standard studies have documented the resolution of PTSD of those who have suffered from sexual abuse including rape, childhood neglect and trauma, life threatening accidents, various tragedies and disasters, combat trauma, and resolving anxieties, depression, and various addictions.

Uniqueness of EMDR

Unlike the majority of other psychotherapies EMDR does not involve conversation while eye movements or bilateral stimulation is being utilized.  After a session of EMDR that involves eye movements a client may experience being more sensitive to external stimuli including interactions with other people.  A person may have more vivid dreams and may experience sleep in a different manner.  Over time of having EMDR sessions where eye movement is used a person will progressively feel better.  Single incident traumas are generally resolved much quicker than those who wish to resolve pervasive trauma.

Written by: James A. Miklos, M.C.C., R.P. -   James has been counselling,  providing mental health therapy for over 30 years, is a public speaker and writer.

© 2019 James A. Miklos. All rights reserved.  To copy or quote any of this material this entire citation and credit must be posted.

Research & Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5904704/

https://emdrresearchfoundation.org/research-grants/researchers-resource-directory/#1517889857437-32b27c2e-b755

https://www.emdrhap.org/content/what-is-emdr/research-findings/

https://www.psycom.net/emdr-therapy-anxiety-panic-ptsd-trauma/

https://www.webmd.com/mental-health/emdr-what-is-it#1

To get the most out of therapy takes a few steps of preparation.  Since you are probably paying for your therapy or counselling sessions it would be prudent to come prepared to listen, participate, and to talk.

It’s important to understand that your therapist is not a magician or miracle worker though they are skilled individuals that have been trained to help connect with, be compassionate, be a good listener and facilitator in helping you with your problems.

Finding the right therapist for you can take some investigation as well as spending some of your money.  Though I am a therapist myself, I too have pursued therapy and though I am trained in this field I understand that after I have done my due diligence to search out the type of therapist I would like to see that I may end up not resonating with the therapist, this happens and that’s okay.  Be sure though to look at yourself especially if you have seen numerous therapists and have only stayed with them for a short period of time.  If possible before you book your first appointment try to find out what is the therapist’s style, what is the process that the therapist wants to take you through, be open-minded, investigate, and ask questions.  Remember nobody is perfect and no therapist can read your mind.  If your personalities don’t connect well then it may be best to pursue another therapist.

• Know that you need help, don’t come because you want to fix someone else.
• Take some notes, at least some mental notes, of what you want to discuss with your therapist from the onset of the session.
• If you have had other therapy/counselling sessions be sure that you have followed through and completed or practiced your given assignments.
• Be aware that getting upset with your progress may not be your therapist’s issue it could be your own anxiety issues projecting onto your therapist, therefore be ready to own your own stuff and take personal responsibility for your progress.  If you need to let your therapist know about your frustrations concerning your progress let them know kindly and clearly.
• Therapy is a journey more than a process or an assembly line of treatment.  Going faster sometimes means moving slower.  Relax knowing that this time is for you.

To have successful therapy it is important to note that not every session will be revolutionary or life changing but rather your consistent participation in the process will build a therapeutic momentum transpiring in overall healing and even exceptional healing moments.

Once you leave a session notice what happened, what you said, what the therapist said, what you learned, how you felt, what you need to discuss further and possibly even give your therapist some feedback to gain further clarification, especially if you didn’t like something that transpired during the session.

Why Am I Emotionally Unstable or Unavailable?

Our emotional stability has a lot to do with emotional resilience which is a combination of nurture versus nature, but nature in early development of the child both in utero and after birth plays a major role as the perception of its environment is taken on by the nature of the child or genes if you will.  This study and theory is known as epigenetics.  

In neo-natal state, new born, the child begins learning at a rapid rate through its environmental stimulus, its surroundings.  The child learns how their mother and father respond to their environmental stimulus whether safe or unsafe.  Studies of this nature have been observed by a growing number of scientists and those in the medical field some of them include Dr. Bruce Lipton, Dr. Daniel Siegel, Dr. Pat Ogden, Dr. Nigel Plummer, and significantly Dr. Stephen Porges, and some others.  

Brain wave states of learning and consciousness

Brain waves are measured by using EEG readings also known as electroencephalography.  There are four main waves to be observed:  Delta, Theta, Alpha, and Beta.

Ages of development corresponding to brain waves found in the developing brain are as follows:

Birth – 2 years of age is when Delta waves are observed which are 0.5-4 Hz.  In this stage of development their level of consciousness is more like an sleep like state when dreams occur.  That is why some people report that their memories of this stage in life is questionable and often wonder if they imagined it or if it really happened.  Memory is there and needs to be understood when it comes to life events and how it might have impacted you into adulthood.

2 – 6 years of age is when Theta waves are seen and become dominant which are 4-8 Hz and their level of consciousness is much like a half asleep to half awake adult state.  In the Theta brainwave state children are very imaginative and can live out make believe scenarios, where creativity, insights and daydreaming are the norm.

6-8 years of age is when Alpha brainwaves become observable and functional which is a frequency of 8-13 Hz.  In this state is when we experience physical and mental relaxation.  For a child though they are not quite aware of things as yet especially of time, such as yesterday, today and tomorrow or when you tell them to wait a minute they think it is never.  

8-12 years of age is when Beta brainwaves become observable and functional which is a frequency of 13-32 Hz.  When the brain matures to this level then the child will begin to become consciously alert, and will engage in active thinking.  For example that is when they can begin to engage in active and meaningful conversation, begin to make decisions, problem solving, focusing on a task and able to begin learning a new concept.  This is the beginning of conscious and analytical thinking.

The brain matures somewhere around the age of 25 but has a number of changes throughout our life.  What we do in adulthood determines whether or not we can attain to peace, hope, satisfaction, and contentment. 

What may have had an imperfect childhood does not mean that you are doomed there is hope for you.  The beauty of the brain is that it can be changed but it does take a number of therapeutic interventions to make this happen.

Changing our behaviour 

In childhood our behaviour is programmed through what Dr. Bruce Lipton calls “a simple stimulus-response mechanism.”  We learn from outward perceptions, parental behaviours, parental emotional states, parental attachment styles, which includes even complex social interactions.  All of these things contribute to the programming of a child’s subconscious behaviour which causes them to conform to the beliefs of their community or social world, specifically their “family life”.

Why am I so emotionally unstable?

The question “Why am I so emotionally unstable?”  is a loaded question as it can have many reasons some of which can include:

• in utero emotional upsets of the mother
• mother’s use of drugs or substances before and during pregnancy
• lack of emotional attunement to the child 
• lack of healthy parental response to a child’s distress
• traumatic events such as war, rape, drugs, terrorism, parental conflicts, yelling, swearing, physical violence, emotional drama, hysteria, parental PTSD, poverty, loss of loved ones, loss of security such as homelessness, and much more.

You can have emotional resiliency and stability through therapies like EMDR.  James Miklos is a Certified EMDR Therapist and can help you to move forward.  Contact us today and book your appointment to help you to move forward.  

Origin of Fraser’s Dissociative Table Technique

Fraser’s Dissociative Table Technique is an adjunct technique that James Miklos, MCC, R.P. uses in his EMDR therapy. This technique was developed by Dr. George A. Fraser who is a consultant psychiatrist with the Canadians Armed Forces Operational Trauma and Stress Support Center in Ottawa.

His developed this framework in 1991 to work specifically with those who suffer with PTSD and developed Dissociative Disorders (DD). Since that time it has been used by numerous clinicians and modified for their application purposes.

The historical road of developing this technique has its origins in ego-state therapies developed by Watkins and Watkins and further developed by Schwartz, Internal family systems therapy. This concept of the ego was first written about by Augustine of Hippo in his masterpiece, Confessions which was written between AD 397 and 400.

What is an ego-state?

The word ego comes from a Greek work which simply means self. An ego-state can be best understood as that aspect of us that comes into play when a particular role or task needs to be done. In an individual that does not have serious complications with respect to their adult-state can easily shift between various ways of thinking and acting to accommodate daily living. For example, when a woman who is a mother encounters her children she will then spontaneously put on the ego-state of being a mother, in other words she will act, feel and think as a mother. When this same woman goes to work as a bookkeeper she will then put on the ego-state of a bookkeeper/employee in order to perform her task functionally. Then when she interacts with her husband she will put on the ego-state of a wife and thus exhibit the attitude, feelings, thoughts, and behaviours of a wife. So the list of ego-states could go on. This we can do in healthy everyday living.

An ego-state is when an aspect of ourselves influences our daily living self to act and interact with their given environment, tasks, and daily encounters.

How does trauma effect aspects of our selves?

In family systems and ego-state theory there is postulated a pre-trauma conscious self that lives cognitively and consciously aware of the present and living in the present that has been called the Daily Living Self [Kathleen Martin]. Along with that we have a Defensive Self that functions along with the Daily Living Self that has co-consciousness and awareness of present time and is able to respond in a healthy manner to protect itself.

When trauma occurs this all changes, the inner self fragments, it can be understood to some degree as a person who has had a broken heart. The fragmenting of our heart in clinical terms can be understood as the transformation of the Daily Living Self to an Apparently Normal Personality or ANP and the Defensive Self which becomes fragmented becomes an Emotional Part or EP which can then create unhealthy ego-states that are stuck in the past, particularly in the history of the trauma or traumas. The person is in a fractured state where each EP holds aspects of the person’s overall ego or self. When this occurs the way a person functions is less than optimal and develops a form of PTSD along with some form or degree of dissociation whether or not it can be clinically diagnosed.

What is dissociation?

In laymen’s terms it means disconnection. When trauma occurs and there is insufficient ability within the person’s system to process through the traumatic event then a PTSD forms which one or more EP hold. The disconnection can be with some or all of the parts of self, be it the ANP or the EPs. This disconnection prevents access to the traumatic material for reprocessing by the brain.

Dissociation simply stated is the separation of normally related mental processes which results in Emotional Parts and even the Adult self, ANP to function independently of each other to some degree. This prevents integration of the EPs and the ANP back to the normal healthy ego-state model described earlier.

Having a dissociation does not imply that you are clinically classified as dissociative or that you have in any way a multiple personality MPD, or now known as DID, Dissociative Identity Disorder. This process is to help with all levels of disconnectedness so that healing can take place within.

How does this technique work?

Fraser’s Dissociative Table Technique works to heal the dissociation that is preventing the reprocessing of the traumatic material that is keeping a person stuck in their PTSD. This is a safe and gentle process that helps the EPs to begin to reintegrate into the normal healthy Defensive Self and allows the ANP to begin its journey back to the Daily Living Self.

What does this technique look like in a session?

There are 8 steps to this technique that is modified for effective EMDR therapy.

1. Introduction and a brief education of the client to understand the inner working of self in relation to life events and trauma. This is to help you to better understand the various aspects of yourself to better identify the inner struggles and conflict you have. You may have said one part of me is so mad and another part of you could be so sad.
2. To establish whether or not you can visualize and make the necessary therapeutic adjustments to help you move forward with this therapeutic technique.
3. Using some techniques to establish a state of calm that can be readily accessed as needed.
4. Develop a meeting place for the various EPs and ANP that is imaginary and that will facilitate safety and calm.
5. To make sure that your place will not be disruptive in any manner.
6. Instructions for the ANP or adult self to become present in a safe manner.
7. Instructions for the EPs or Emotional Parts to come and be present in this meeting place.
8. Over the course of time the therapist gathers information and aids in direction, comfort and healing so that integration can begin to take place.

How will this technique help me?

This is a safe and effective technique that will help you to work with aspects of yourself that have been traumatized and is used throughout the course of treatment. This process will help you to heal from the distress of feeling bad feelings. This process will heal any dissociations that are present within you.

What is the next step?

When our lives are not functioning well in our relationships, marriage, parenting, daily functioning, work place, addictions, poor self-care, and emotional distresses and dysfunctions then we need to take action to help us get better. The action you need to take is to make a call or book an appointment to begin your healing process.

At New Hope Counselling Centre we have trained therapists, psychotherapists, and counsellors to help you to heal and move forward in your life. Don’t waste your life any longer, regain your life! We are here for you!  There is hope and there is help for you!

Sources:

Fraser, G.A., Fraser’s “Dissociative Table Technique” Revisited, Revised: A Strategy for Working with Ego States in Dissociative Disorders and Ego-State Therapy, http://www.tandfonline.com/doi/abs/10.1300/J229v04n04_02

Fraser, G.A. (1991). The dissociative table technique: A strategy for working with ego states in dissociative disorders and ego-state therapy. DISSOCIATION, 4, 205-213.

Kathleen M. Martin , CLINICAL Q&A: How to Use Fraser’s Dissociative Table Technique to Access and Work With Emotional Parts of the Personality, Rochester, NY http://www.ingentaconnect.com/content/springer/emdr/2012/00000006/00000004/art00005?crawler=true

Shirley Jean Schmidt, MA, LPC EMDRIA-Approved Consultant, Internal Conference Room Ego-State Therapy and the Resolution of Double Binds: Preparing clients for EMDR trauma processing, https://www.dnmsinstitute.com/doc/db-prep.pdf

Schwartz, R.C. (1995). Internal family systems therapy. New York: Guilford.

Watkins, J.G. and H.H. Watkins (1997). Ego states: Theory and therapy. New York: Norton.

What is EMDR Therapy? 

EMDR is a bilateral stimulation of the two hemispheres of the brain that allows the disturbing information to
be reprocessed allowing the person to come to a healthy state of emotional calmness. This bilateral stimulation is achieved through one or all of three stimulations, eye movement, bilateral sound, or bilateral tactile. This allows the dysfunctionally stored information to be reprocessed.

Just as we experience REM sleep EMDR taps into that same natural ability to process through things that previously were unable to. For example the hearing of a child crunching on carrots may cause a person to have a panic attack because the sound has a “similar” sound to what happened in a car accident when he or she heard the crunching of metal. Using EMDR this can be processed through removing those types of triggers.

EMDR is a highly effective therapy in helping people overcome personal issues.

Background 

Francine Shapiro, PhD, developed EMDR in 1987 through an accidental discovery. She noticed that while observing a disturbing thought she was moving her eyes, which resulted in a reduction of her negative thoughts and emotions. This observation of hers led her to conduct a research study (Shapiro, 1989) where the efficacy of EMDR was examined in treating traumatized Vietnam veterans and those that had been victims of sexual assault. In this methodology she had her clients observe their emotionally disturbing issues while simultaneously following with the eyes the therapist’s lateral movement of their fingers (also audio and tactile stimulation is used in this process). The results of this and other studies have showed that EMDR significantly reduced the trauma symptoms within the client.

Client Response   

Client response is amazingly positive when all 8 phases are properly walked through with the therapist. 

It’s amazing ability to resolve issues is for several reasons:  

• Client-centered
• Uses brief high intensity exposure
• Nondirective approach
• Mobilizes client’s own inherent healing ability
• New and positive associations are forged between traumatic memory and more adaptive information or memories

Reason for EMDR’s effectiveness   

Exactly why and how EMDR works is not 100% clear but ongoing research indicates very strongly that EMDR facilitates reprocessing of human experience.

Present day situations and occurrences can re-stimulate old memories stored in the unconscious mind which causes the surfacing of negative thoughts, emotions, and physical sensations that have their associations to earlier distressing events in life  

The rapid processing of cognitive and emotional material has been hypothesized that EMDR works by: 

• The linking of various memory components
• Mindfulness
• Free association(s)
• Repeated access and dismissal of traumatic memory
• Eye movements, bilateral tactile and/or audio tones

For more information on the efficacy of EMDR and its validations visit:    http://www.emdria.org/

Research

EMDR is one of the most researched psychotherapeutic treatments for posttraumatic stress disorder or PTSD. Since 1989, approximately 20 controlled studies (e.g., Carlson et al, 1998; Edmond et al., 1999; Ironson et al., 2002; Lee et al., 2002; Marcus et al., 1997, 2004; Power et al., 2002; Rothbaum 1997; Scheck et al., 1998; Taylor et al. , 2003; Wilson et al. , 1995, 1997) have been conducted. Results from meta-analyses indicate that EMDR is superior to no-treatment and nonspecific treatment controls and equivalent in outcome to exposure and other cognitive-behavioral treatment approaches (Davidson & Parker, 2001; Maxfield & Hyer, 2002; Bradley et al., 2005). Empirical evidence suggests that EMDR is one of the most efficient treatments for PTSD and that it is more efficient than other trauma treatments (Van Etten & Taylor, 1998; Power et al., 2002; Jaberghaderi et al., 2004; Rothbaum & Marsteller, 2005).   

Studies indicate that EMDR may also be effective in treating various mental disorders, including specific phobias (De Jongh et al., 1999 & 2002), performance anxiety (Maxfield & Melnyk, 2000), panic disorder (Goldstein & Feske, 1994), body dysmorphic disorder (Brown, McGoldrick, & Buchanan, 1997), trauma symptoms in children (Chemtob et al., 2002), complicated mourning (Sprang, 2001), and chronic pain (Grant & Threlfo, 2002).

EMDR is now accepted by many organizations and agencies for the treatment of trauma. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder (2004) have given EMDR the same status as Cognitive Behavior Therapy as an effective treatment for ameliorating symptoms of both acute and chronic PTSD. The U.S. Department of Veterans Affairs and Department of Defense has placed EMDR in its highest category of therapies recommended for treatment of PTSD (Clinical Practice Guidelines, 2004). In addition, the International Society for Traumatic Stress Studies (ISTSS) designates EMDR as an effective treatment for posttraumatic stress (Chemtob et al., 2000). A taskforce of the Clinical Division of the American Association found EMDR as one of only three methods empirically supported for the treatment of any post-traumatic stress disorder population (1998). EMDR has been determined to be effective for the treatment of trauma by several international health and governmental agencies including the United Kingdom Department of Health (2001), the Israeli National Council for Mental Health (2002), the Dutch National Steering Committee Guidelines Mental Health Care (2003), French National Institute of Health and Medical Research (2004), (UK) National Institute for Clinical Excellence (2005), and the Medical Program Committee/Stockholm City Council, Sweden (2003).