Ask the woman doing EMDR therapy for PTSD

In My Humble Opinion
1

Thought if I was going to suffer, I might as well do it for someone else’s amusement (enlightenment?)

In the vein of past threads on various mental health treatments I have employed, I am hoping someone looking into EMDR treatment might get a google hit and find something useful here. I’m also stressed by this process, and want to talk about it.

To get the ball rolling…

Who are you?
I am a 34-year-old woman with a looooong history of PTSD and major depressive disorder. I am pretty well-adjusted considering the clusterfuck that was my childhood, but I have difficulties with mood and emotion regulation, PTSD-related sleep disturbances, and existential angst. I’ve had long periods of depression (1+ years) where I could not function or hold down a job/attend school. I am now relatively functional, succeeding at a part-time job that I love, writing fiction on my own at home, engaged socially, and in a stable enough place that I think I can take on this emotionally challenging therapy. It wasn’t a decision we made lightly.

Why are you doing this?
Because I have PTSD and it sucks. I had significant improvement with prolonged exposure therapy until a jarring series of events in March 2016… three grand mal seizures followed by the end of my relationship with my (historically abusive and very mentally ill) mother. Since ending my relationship with her I’ve gone into a sort of grief spiral and have found the resulting sadness and rage to be difficult to manage on my own.

Because my mother subjected me to so much of her rage growing up, I have an unhealthy relationship with my own anger, preferring that it not exist and feeling guilty when it does. I feel rage toward my mother at times when rehashing the end of our relationship, and I also feel rage when someone on the internet says something dismissive or minimizing or ignorant about another person’s pain. That is especially true regarding damaging attitudes toward rape or sexual abuse. I’ve had interactions here on the Dope that haunt me for months because I can’t get over my rage or my sense of responsibility for changing their minds (i.e. I feel morally obligated to protect others from the same harm.) I’ve been having a lot of trauma-related nightmares and wake up screaming or shouting. I had the grandaddy of bad Mommy dreams last night and woke up screaming, ‘‘Don’t tell me what to fucking do!’’ because my dream-self is stuck in a state of permanent adolescence.

In short, I got issues.

What is EMDR?

EMDR is an evidence-based treatment for PTSD, and I say ‘‘evidence-based’’ because when I describe it to you, it’s going to sound woo as hell. This is definitely one of the weirder things I’ve done.

From here.

[QUOTE=EMDR Wiki]

Eye Movement Desensitization and Reprocessing therapy is a form of psychotherapy developed by Francine Shapiro that emphasizes the role of distressing memories in some mental health disorders, particularly posttraumatic stress disorder (PTSD).[1] It is an evidence-based therapy used to help with the symptoms of PTSD.[2][3] It is thought that when a traumatic or distressing experience occurs, it may overwhelm normal coping mechanisms. The memory and associated stimuli are inadequately processed and stored in an isolated memory network.[1]
[/QUOTE]

The purpose of the eye movement component is to aid in the reconsolidation of traumatic memory. It is believed that a primary function of REM sleep is to consolidate memory, so the treatment attempts to recreate the REM eye movement patterns, usually by having the client track a moving light with his/her eyes while they focus on a particularly distressing memory or thought. For those who are not visually inclined, there are options to use auditory signals or hand buzzers (kinesthetic) for the same effect. I chose the blinkie lights.

A common criticism of EMDR in psychotherapy circles is that it’s essentially ‘‘prolonged exposure with a yellow hat,’’ meaning the eye-movement stuff is unnecessary. However, as someone who has also done prolonged exposure therapy for PTSD, I can tell you that they are, at least experientially, two entirely different things. They both use a Subjective Units of Distress Scale (SUDS) to track progress, but that’s about all they have in common.

2. How long have you been doing this?
So far I’ve had five sessions. Sessions are once a week for about an hour.

3. What treatments have you tried other than EMDR?
For PTSD, I have tried prolonged exposure therapy and cognitive therapy. For other mental health issues, I have done psychodynamic therapy, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Transcranial Magnetic Stimulation and more medications than I can count. Most have helped me in some way. I’m pretty sure I’ve made Ask The… threads for a lot of these.

Ask the… Prolonged Exposure Therapy for PTSD (helped a lot)
Ask the… Transcranial Magnetic Stimulation for Depression (catastrophic failure)

At the present moment, I’m neither super fantastic nor completely falling apart, so ask away.

2

The obvious question then is “how are they different?” Even if you don’t cover it all, you can cover what stuff is done differently.

And I definitely would try it, even if it was just the same thing dressed up, because a different context can make it subjectively feel different, and thus override any feeling of “I’ve already tried this.” If it works, and it does have evidence behind it, then I wouldn’t care one bit if part of it is placebo.

And I myself have felt some connection between my eyes and how I think–brain zaps. Move your eyes too quickly when you’re withdrawing from drugs, and it causes the zaps. And the zaps definitely seem to be connected to my emotions. Also, when I’m at my worst, I feel like I have eyestrain even when I don’t.

But I guess I should stop rambling. My question is already up there. :slight_smile:

3

  1. Super glad to hear from you. I have missed seeing you around the boards.

  2. Is this a form of reliving the events in an attempt to reprocess them?

4

I did this after my dad died, I can’t recommend this therapy enough. It literally saved my life.

5

Well, to begin with, prolonged exposure therapy is much more emotional and time-intensive. The purpose is to get you to a subjective level of 9 or 10 on the SUDS scale (meaning as distressed as you could possibly be… panicking, weeping, whatever) on a daily basis. You focus on one specific memory you find distressing, you articulate it in vivid detail to the therapist, record your retelling, and you rehash it, and the negative reactions associated with it, over, and over, and over, until it no longer upsets you… the daily goal is to do it until your SUDS reaction has been cut by one-half.

Generally, the focus is on that one specific memory and stays on that memory. You would focus on that memory for about an hour a day every day for several weeks, until it bores you. It does have a generalizing effect - by focusing on a single memory, I experienced a significant, permanent decrease in my overall hypervigilance (jumping at sudden noises, always expecting danger, etc.) I had the therapy in 2010 and that has been a pervasive positive permanent improvement. The memory of focus was specifically one in which my life was threatened by my mother - it was about physical danger, so I’m not surprised it had that effect on hypervigilance.

When I told my EMDR therapist that I had done prolonged exposure therapy, he cringed and told me no way he’d ever have the courage. It’s generally regarded as very emotionally intense and difficult even within therapeutic circles, almost to the extent that it is stigmatized and controversial. It’s also difficult to find trained therapists to administer it, and the potential to backfire is so great that it’s imperative that it be done with a skilled clinician. I had it done at world’s most renowned clinic for prolonged exposure therapy, so I’m a lucky duck.

That’s prolonged exposure.

EMDR also starts with a focus on a single memory, but it is much more free-form as you go through the cycles. You start by giving your SUDS level associated with that memory, identifying a negative cognition you might be feeling (‘‘I did something wrong’’) and something positive you would like to replace it with (‘‘I am safe’’ for example) but the goal is NOT to achieve maximum distress. It is to stay within a therapeutic range of maybe 5-7 on the SUDs scale. Unlike exposure therapy, you do not give the therapist vivid details, you are just remembering in your own head, though they might check in and ask things like ''what are you thinking?"

Where it significantly diverges is that your brain will take you just about anywhere from the starting point of that memory. You just sort of follow the brain links (I think they are called nodes in some of the literature) which feels like a great ADD emotional adventure. The memory of focus we’re starting with is one with a lot of emotional content, kind of a long story but basically an incident which eventually led to the end of my relationship with my mother. It was not life threatening, but had its tendrils in every bad experience with her I’ve had in the past, so probably a good starting point.

So I went from there, when I was about 32, to a memory when I was aged 16, to a long series of thoughts pertaining to stuff I’m going through in the present, including the pervasive feeling that I’m responsible for others’ happiness, that I’m weak, that I’m a failure, etc. etc. After every cycle, you go back to that core memory but during the blinkie light part, you can think about/remember virtually anything. And a lot of it is really profound stuff, the kind of stuff you might work out over the course of years but it’s all being crammed into one session. It’s overwhelming, and much more cerebral than I expected it to be, much more attacking faulty cognitive schemas and weirdly self-guided (I came into all these insights on my own, just by following my train of thought from that core memory.)

So to use an abbreviated example:

Etc. That last part might seem like a total non-sequitor but the idea is my brain knows intuitively how to sort it all out, I just have to let it do the work.

I think the side effects for me are a bit worse than the average client, but they aren’t as bad as prolonged exposure so I am okay. I don’t leave the office terrified of my own shadow, but just stuck in a kind of emotional fugue state. And my nightmares have gotten a lot worse since I started. This kind of temporary worsening is generally normal for treating PTSD, but no cake walk in the meantime.

Sunny Daze, hope the answer is somewhere in the above. The short version is you are re-living your memories but you are sort of doing it from the vantage point of the present, if that makes any sense. I never feel like I’m trapped in the past, in fact I’ve found past memories come up a lot less often than I expect them to… it’s usually some place I’m emotionally stuck in the present that is related to my past.

6

I’d be interested in hearing your experience and if/how it differed from mine. I’ve heard EMDR can be excellent for grief. It’s generally good for all sorts of emotional stuckness, even if it wasn’t strictly speaking a life-threatening experience.

I expected this process to be a lot less cognitive than it is. I didn’t expect so much of it to focus on the present-day, and I’ve even had times where my thoughts were largely positive as I went through it.

7

Does anyone refer to complex PTSD anymore, or is it all seen as PTSD with some number of traumas? Feel free to ignore the question if this is not the right place for it.

8

The issue with complex PTSD is that it was never officially recognized in the DSM. One of the foremost champions of complex PTSD was Judith Herman, an expert on traumatic experience who did, in fact, shape the accepted definition of PTSD in the DSM-IV. But the diagnosis was never fully embraced by the psychological community at large. It’s not exactly a fringe movement, but there is no billing code for C-PTSD.

I was diagnosed with Complex PTSD at the age of 18, by a clinician who did accept it as a valid diagnosis, and when I read the symptoms in Herman’s book Trauma and Recovery I found the similarities to my own life experience downright chilling. Complex PTSD essentially posits that repeated exposure to traumatic experience, particularly in situations of ongoing captivity like child abuse, domestic violence, or prisoners of war, result in symptoms that are far more pervasive and disruptive than single instances of trauma. So a person with C-PTSD would have additional symptoms such as:

This is all extremely true to my own experience, especially the bolded parts. I recommend Herman’s book Trauma and Recovery for anyone who connects with this diagnosis.

With regard to EMDR specifically, I should note that the ideal candidate is one who has a single traumatic incident, like a death, a car crash or a rape. I do not fit that definition by a long shot, but my regular therapist recommended me to my EMDR therapist because I tend to be especially good at applying therapeutic techniques. I would say if you have a lot of self-insight and a vivid imagination, it’s worth looking into even if you have repeated trauma.

9

Can you go into why you consider it a catastrophic failure a bit more? I read your thread on it and it seemed from what you said there that you were experiencing some mild improvements?

10

Because I relapsed pretty quickly when the treatments stopped, and we ran out of money to pay for additional treatments, and we were dropped by the company that was supposed to help us recoup the money from insurance, so we were never reimbursed for the $10,000 we paid out of pocket. We knew it was a risk going in that we wouldn’t be reimbursed, and we were desperate enough to try the more fringe stuff, so it’s not like I think we should have made a different decision. But I can’t exactly feel great about dropping $10k on a treatment that had no long-term positive impact.

It does work for some people. It did not work for me.

11

Ouch, ok that does make sense.

12

I am so gobsmacked by this. I found one cite on Amazon that explained the dispute is not whether such a thing exists, but how and where to classify it, which is somewhat more palatable if you ignore that we don’t actually have a system equipped for treating adults who were abused as children, due to…I dunno. Accounting?

I would be interested in knowing to what degree you’ve had to educate yourself into proper treatment plans, coping skills, and so forth if that applies to you and you’re up for it. If not, I understand.

13

Jeez, I could write a book about the process of figuring all this out. How to even start?

I started with a really understanding and supportive therapist when I first started having PTSD symptoms in college. This would be the year 2002. She was great as a person and in helping to educate me about C-PTSD, but her treatment modality, psychodynamic therapy, was not effective for me. It was a lot of navel-gazing, I would talk about difficult things I had been through but there was no real emotional processing or therapeutic direction with it, and I would inevitably end up feeling helpless and bad. I ended up hospitalized at one point due to suicidal ideation and withdrew from college.

I was pretty freaking messed up at the time. I had a diagnosis of C-PTSD, Major Depressive Disorder, Dysthymia, and Anxiety Disorder Not Otherwise Specified. I was constantly dealing with the side effects of new medications and I was on the receiving end of crazy pressure from my family to reconcile with my mother’s husband, who had sexually abused me. I remember Sr. Weasel would beg me to get dressed and take a walk with him down to the end of the block. That was the hardest thing ever, in those days. I graduated 2nd in my class in high school and now I couldn’t even hold down my job at the dorm cafeteria.

There was then a confluence of events when I was 21ish. My mother invited my goddamn abuser into my bedroom one day after enlisting his help to move a television, and I snapped and told her I couldn’t have any contact with her as long as she was married to him. I concurrently decided to withdraw from college again, and not return until I had my life sorted out. Sr. Weasel was a psychology student at the time (he got his Ph.D. in 2015) with a heavy focus on evidence-based interventions. He told me if I got CBT, he would pay for it. My therapist at the time discouraged me from doing CBT, stating that it was for more simple cases than mine and that I wasn’t likely to get much traction from it due to the complexity of my issues.

She was wrong. It was life altering. I basically taught myself how to function through the use of those techniques and gained the stability to return to school and graduate with high marks. From then on, I wished to focus on evidence-based interventions only. Basically what I learned is that even for the most messed-up, complex issues I was dealing with, you could usually break it down to some kind of cognitive or behavioral dysfunction. For quite a while I took a pretty giant step back from the issues of my past and just tried working with what I had going on in the present.

So when looking at the problem of my depression, it wasn’t so much, ''How can I heal from my past?" but more, “What things do I do that make depression worse? What makes it better?” It’s a fairly painstaking process, but I acquired various tools from ACT and cognitive therapy as I went. This does not mean that my PTSD disappeared, only that I got better at functioning in the day to day, going to work or school, showering, cooking myself meals, the sort of things that most people do automatically.

That is, in essence, my ‘‘secret’’ when I encounter a mental health problem. It’s not very sexy and dramatic to say, ‘‘I’m going to deal with my lifelong depression in this moment by taking a shower,’’ but that’s basically what it comes down to.

I was in graduate school when I finally did prolonged exposure for PTSD. I was a social work student interning as a counselor of severely mentally ill people who had abused or neglected their children (a placement I specifically requested NOT to have) and I was falling apart from the stress of dealing with people who were essentially just like my mother. I used to obsess about home invasion at night. I think my breaking point came one night before an important exam. I was lying awake freaking out as usual, when something crashed to the floor in the bathroom. I knew it was the damned cat, but I bolted to the door, slammed and locked it, turned on the light and stood cowering with a metal pipe outside the door for a good fifteen minutes. My husband woke up, asked me what happened, and I basically said, ‘‘Don’t worry about it, I’m just freaking out.’’ My brain knew exactly what was going on, but my body didn’t care. I couldn’t let go of that pipe.

I woke up exhausted the next morning, still in a state of panic, and was just thinking, prolonged exposure may be difficult, but I’m already reliving this shit every damned day as it is, I might as well do it for a reason. I’m glad I went through with it because I made more progress in that three months than I had in the past ten years. It resolved a lot of my issues with feeling perpetually unsafe, the home invasion fears went away and I could just go about my daily life without worrying as much about imminent doom. I am happy to report that I had no interruptions in my graduate schooling. I graduated in 2011.

It’s been up and down ever since, usually the depression was at its worst during long periods of unemployment and I was happy as a clam when I had a job I liked. Things were pretty good until 2014, when I had a miscarriage, went off all my medications and spent a year in a bizarre state of unfeeling, uncaring depression. I quit two jobs in rapid succession and for the first time, my marriage suffered. Things were just getting back on track in 2016 when I had those seizures and the PTSD came back with a vengeance, things came to a head with my mother and I was put on a terrible, terrible anticonvulsant medication that sapped my will to live.

I’m mostly fine now, but the aftermath of that had enduring consequences, including more grief and anguish over my mother, especially, I think, because it wasn’t an ‘‘I need temporary distance from this person’’ sort of decision, it was a ‘‘holy shit I just realized who you are is not who I need you to be and I can’t be healthy with you in my life.’’ It’s kind of heavy stuff. Also, we’re in the middle of the adoption process, which adds another layer of ‘‘thinking about my own childhood experiences.’’

So Sr. Weasel recently attended a workplace seminar on EMDR and it cleared up a lot of misconceptions he had about it (like exposure therapy with a yellow hat) and he thought it might really help with all the emotional stuckness I’ve been feeling with regard to my mother. Sure enough, the guy right down the hall from my current therapist does EMDR. So, I started with him a couple of months ago. It was a few sessions of him getting to know and understand my issues, a few sessions of ‘‘resource installation’’ which is teaching self-soothing techniques for moments of overwhelm, and then we got down to business.

I guess the short answer is I married a clinical psychologist. :stuck_out_tongue:

14

Worked well for me…so there’s that! I did it in 1996 - 1997 helped get rid of symptoms of PTSD, including the depression, survivor guilt, anorexia and other “fun”…

15

A great resource! I’m so glad you have him in your life. Thanks for answering, it seems like you did have to figure it out most of it on your own and it’s been a painful process.

My own great resource was this woman, who I met when I was in high school. Nowadays I work with addicts who use to cope with damage others have inflicted on them, years or decades ago They have few options to use in trying to become whole again, but everyone is doing their best with what they have and I like to know what’s out there for them.

It’s the people who aren’t self-destructive who really blow my mind though. I don’t fully understand it, but this:* I got better at functioning in the day to day, going to work or school, showering, cooking myself meals, the sort of things that most people do automatically* – is the sort of unyielding attitude and regeneration that I wish everyone could have, but they don’t. It has nothing to do with your spouse; it’s all you and it’s amazing.

16

So the original treatment is basically flooding, while EMDR seems more mindfulness-based, just with a chosen starting point.

The reason I ask is that my psychologist was one of those who thought it was just dressed up exposure therapy, with the eye movement as distractions to help you cope. He did not consider it evidence-based.

Then again, that was in 2003-2004.

17

I mean, if he believed it was dressed up exposure therapy, it would be by definition evidence based. I think part of the skepticism toward EMDR is because nobody is really sure why it works, and its origin story is pretty woo – Shapiro was basically walking through the woods and pulled the idea out of her ass. And it’s often couched in language like “intuition” and “natural healing” and stuff you would find in a holistic medicine store. I did actually start EMDR once before, but I quit in the very early stages because the therapist failed to convince me of the treatment’s legitimacy. My theory is that Shapiro got lucky.

But at this point, EMDR has a strong evidence-base. My husband is the Clinical Research Director at his practice, so he is kind of an uber-skeptic to the point of annoying me any time I get too excited about something new. Apparently, he found the arguments presented to him compelling enough to recommend that I try it. Not that we expected miracles, in fact, we had a long conversation about exactly what we expected. And it kind of boiled down to recognizing that I need some extra support right now with cautious optimism because this is a thing I haven’t seriously tried before.

I will say there is an element of exposure to EMDR, it’s just lower-level. Like, I’m definitely feeling things while I’m going through the process, usually on a 5-7 SUDS scale, anxiety or some measure of distress, and even when I’m in a positive frame of mind, the feeling is still quite intense. But it is definitely not the same sort of thing, and it feels… weird. Even that time I started and stopped EMDR, I was seriously affected by the process, I remember after my first session, which was basic resource installation/safe space stuff, I couldn’t drive for half an hour because I just felt… funky. Pretty sure that’s the scientific term. With this new therapist, I can drive just fine, but I always leave feeling strangely altered.

[QUOTE=Tee]
I am so gobsmacked by this. I found one cite on Amazon that explained the dispute is not whether such a thing exists, but how and where to classify it, which is somewhat more palatable if you ignore that we don’t actually have a system equipped for treating adults who were abused as children, due to…I dunno. Accounting?
[/QUOTE]

Just an alternate point of view to consider… I brought this up to Sr. Weasel, whose major area of expertise is treating OCD in children and adolescents. He said that inclusion of a variation of a disorder in the DSM isn’t as important as recognizing something as an important conceptual framework and that the DSM in general tries to remain neutral on theoretical orientation. There are many recognized variations of OCD and the approaches to treatment are different in some cases, but there is only one billing code. On the flip side, Bipolar and Depression have a zillion different billing codes even though they have no impact on insurance coverage, and he finds it unnecessarily complicated. Like apparently if you bill under Bipolar, you have to specify whether the last episode was manic, depressive, or mixed, and Depression is billed based on severity and whether its an acute one-time deal or a chronic deal. Perhaps there is something we’re missing on the insurance end, but he finds it all rather pointless and in no way benefitting the client.

However, considering that most people seeking treatment for PTSD are likely to have multiple traumas, he thinks it might make the most sense to treat C-PTSD as the default conceptual framework with a specification code for single trauma incidents.

Again, he is no expert on PTSD. I just thought it was an interesting general take for consideration.

[QUOTE=Tee]
It’s the people who aren’t self-destructive who really blow my mind though. I don’t fully understand it, but this: I got better at functioning in the day to day, going to work or school, showering, cooking myself meals, the sort of things that most people do automatically – is the sort of unyielding attitude and regeneration that I wish everyone could have, but they don’t. It has nothing to do with your spouse; it’s all you and it’s amazing.
[/QUOTE]

Thank you for your incredibly kind words. That is the stuff that keeps me going. I will definitely check out that book. Sometimes the right book or person or idea at the right time can make all the difference.

18

From a recent comprehensive Cochrane review:

*"Previous reviews have supported the use of individual trauma-focused cognitive behavioural therapy (TFCBT) and eye movement desensitisation and reprocessing (EMDR) in the treatment of PTSD. TFCBT is a variant of cognitive behavioural therapy (CBT), which includes a number of techniques to help a person overcome a traumatic event. It is a combination of cognitive therapy aimed at changing the way a person thinks, and behavioural therapy, which aims to change the way a person acts. TFCBT helps an individual come to terms with a trauma through exposure to memories of the event. EMDR is a psychological therapy, which aims to help a person reprocess their memories of a traumatic event. The therapy involves bringing distressing trauma-related images, beliefs, and bodily sensations to mind, whilst the therapist guides eye movements from side to side. More positive views of the trauma memories are identified, with the aim of replacing the ones that are causing problems.

TFCBT and EMDR are currently recommended as the treatments of choice by guidelines such as those published by the United Kingdom’s National Institute of Health and Clinical Excellence (NICE).

Study characteristics: This review draws together up-to-date evidence from 70 studies including a total of 4761 people.

Key findings: There is continued support for the efficacy of individual TFCBT, EMDR, non-TFCBT and group TFCBT in the treatment of chronic PTSD in adults…
Quality of the evidence: Although we included a substantial number of studies in this review, each only included small numbers of people and some were poorly designed. We assessed the overall quality of the studies as very low and so the findings of this review should be interpreted with caution."*

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003388.pub4/abstract;jsessionid=58C31EF2AB8899EF17692CEB67CE8043.f04t02

19

Thanks,** Jackmannii.** I don’t want to overstate my case for the evidence.

Really just trying to establish that it’s not totally-out-of-left-field woo nonsense and I’m not a sucker for trying it.

20

Having checked out a few descriptions of EMDR, I’m a little confused. Is it something like this?

  1. recall a distressing memory or thought
  2. while recalling it, follow bilateral sensory stimulus for 1-2 minutes during which you let your brain go into free association mode
  3. Stop bilateral sensory input. Check what you’re thinking at that point in the free association chain
  4. Choose a thought you’d like to have instead
  5. while thinking that thought, follow the bilateral sensory stimulus for 1-2 minutes

Is that it?

It sounds like open monitoring meditation + eye movement followed by mantra meditation + eye movement.