Therapy for Trauma, PTSD, Anxiety and Depression
EMDR can be used to resolve or provide relief from almost any symptom, problem or behaviour that is causing distress in the here and now. This includes but is not limited to anxiety, depression, phobias, symptoms of PTSD, grief and addiction.
EMDR usually begins with targeting past memories that have laid the groundwork for dysfunction. We then look at present day triggers, finally moving on to future situations you want to be able to handle differently. Not everyone knows the root cause of their problems; this is not a problem in EMDR, as during the assessment phase, we can use a range of techniques to help us pinpoint earlier experiences that have contributed to here and now problems.
When an event first happens, it is received by a part of your brain (the amygdala) that is responsible for emotions, survival instinct and deciding what memories are stored where. This part of your mind also alerts you to danger and stimulates the flight or fight response.
Memories are usually passed from here to your ‘hippocampus’, which converts short-term memory to long-term memory and encodes our memories with relevant information relating to date, time, location and context. However, if the amygdala is ‘activated’ due to high levels of stress, the hippocampus shuts down, and the natural process of memory conversion is blocked. This means that traumatic memories may be stored without full context, and this explains why the recollection of traumatic memory is often sketchy, blurred and indistinct. We may not even be sure if the memory is real or not.
Triggers are there to help us, to warn us about what was dangerous in the past. Triggers are vital pieces of information relating to past experiences. The amygdala is the ‘emotional alarm system’ of the brain. It scans incoming data from our environment for threat or danger. This happens outside of conscious thought. If the amygdala senses a threat it initiates the body’s fight or flight system. The amygdala is a basic bit of kit, which functions at speed. It acts as a ‘smoke alarm’ and responds to what it perceives to be danger. The more traumatic experiences we have, the more sensitive the amygdala is to assuming the worst – it becomes hypervigilant, like a faulty car alarm that goes off every time the wind blows.
When we are triggered, a simple but powerful process happens: the front brain switches off so we can’t think, and the back brain switches on, so all we want to do is act. The back brain is responsible for automatic responses and survival. It happens outside of conscious thought and within the blink of an eye. Being triggered by an automatic body-brain response can make us feel helpless.
Helplessness is that feeling of being overwhelmed and powerless to stop what is happening to us. If we have experienced repeated trauma and intense helplessness, our brains grow and develop in response to this experience. So, without a sense of choice, we develop a learned sense of ‘helplessness’ which can become the ‘default’ state when we are triggered into, or reminded of the original trauma.
Importantly, it is not the content of the trauma that keeps the memory alive. The learnings and uncomfortable felt sense that developed in response to what happened influence our perception, attitude and behaviours in the future. The body ‘remembers’ feelings that relate to traumatic incidents. It creates ‘somatic markers’ linking feelings to events, which may act as triggers for flashbacks in the future.
The result of this is that you may feel as though, at times, the trauma is still happening, even if it was several years ago. Examples of powerful negative cognitions that develop in relation to trauma are I’m not good enough, I’m not safe, I’m worthless, I’m powerless – there are many more. These cognitions are often in the form of a ‘felt sense’ stored deep within the body.
We may know logically that the belief isn’t true, but there is a mismatch between what we ‘think’ and what we ‘feel’.
Negative cognitions are self-limiting beliefs that result in the development of protective mechanisms, which serve to exile the wounded part of us. These protectors generally do their job really well, but to the detriment of living a fulfilled, healthy and meaningful life. So, for as long as we hold onto the negative beliefs, the trauma remains.
EMDR is a kind and gentle way of treating trauma. It does not require you to talk about what happened in any detail; you can choose to keep your memories private if you wish.
Memory is a reconstructive process. Every time we access a memory, we can add to it, delete from it, rearrange and update the information it contains – either positively or negatively. So, if we access traumatic or disturbing memory in a way that is disconfirming to the body and brain, we are sending a message to that neural network indicating that the threat is no longer current.
EMDR uses some form of bilateral stimulation (traditionally eye movements), which is believed to tax the working memory by activating all hemispheres of the brain, including those areas that were ‘off-line’ at the time of trauma. This process facilitates the brain’s natural healing process and integration of adaptive information that has been learned since the event happened. EMDR is an 8-phase protocol that takes place over several sessions. It can be interspersed with sessions of talking therapy if this is what the client prefers.
The first phase of EMDR is to assess, and where necessary, strengthen and develop resiliency of the autonomic nervous system to ensure that it has the foundational skills needed for successful of reprocessing of traumatic memories. This preparatory work also deepens connection to inner resources and healthy, adaptive memory networks.
During the preparatory phase of EMDR we do not work directly with the trauma. You will be encouraged to practice the techniques learned in-between sessions to create a sense of mastery, reinforce therapeutic gains and integrate progress more fully into everyday life. For various reasons, not all clients transition to the phase of memory reprocessing. However, through regular and consistent practice of neural exercises their autonomic nervous system can still build the capacity and flexibility to accurately appraise cues of danger or safety, and inhibit or mobilise states as appropriate.
Subsequent phases of EMDR identify and target specific memory networks for reprocessing. This step of the process aims to reduce the emotional charge or distress a 'memory' carries to as low as is ecologically possible and replace the negative beliefs we may have developed about ourselves and others with healthy, adaptive information which accurately reflects our here and now position.
I will fully explain and guide you through this step of the process – you are always fully awake and are not under hypnosis. I will ask you a series of questions to activate the memory, then you will simply allow your mind and body to interact with this content and notice whatever comes. We’re not trying to process the memory in a sequential or cognitive way. We’re not trying to intentionally ‘figure things out’ or ‘make sense of what happened’. We don’t push anything, pull anything, calm anything or actively seek anything. We simply notice. It is through this introspective noticing that deep healing comes.
The reprocessing of traumatic memory can reduce or alleviate symptoms in the here and now. When we take the emotional distress out of a memory and integrate adaptive information held by other neural networks, we are far less likely to be triggered by day to day experiences. We are also less likely to have the same overpowering negative beliefs, so our mind and body is free to start relating to the 'self' differently, with more compassion and curiosity without been critical or punishing.
EMDR aims to reprocess the memory with information from the whole of our system, so that it can sit peacefully in the long-term memory bank and fade with time. We can choose to recall the event by choice, not via triggers.
I use an internal family systems (IFS) informed approach to EMDR, which introduces a greater element of relational depth to the EMDR process. It means that we pay attention to unwanted parts of self (which you may describe as symptoms) in a way that they have not experienced before. It’s really tempting to want to get rid of, suppress, or ignore the parts that cause emotional distress or unwanted behaviours. But doing this just causes more tension and conflict within our ‘system’. Parts often feel calmer when they are seen, heard and understood. It is easier to work with symptoms (parts) if there is curious and compassionate observation.
During the process of EMDR, we will better get to know and understand the different parts of ‘self’. We will realise the intended positive intentions of behaviours, thoughts and feelings and learn how to communicate effectively with these parts and respond to difficult situations from a place of true self and not a defence stance.
As with any form of counselling, it’s hard to say how many sessions will be needed to resolve your issues. I recommend EMDR sessions are taken on a weekly basis for a minimum of 8 - 12 weeks initially, as this period of time will give a good feel as to if the technique is working for you.
This is a rough guide only, and more complex presentations may require EMDR interspersed with talking therapy on a regular and ongoing basis to ensure a full resolution of all issues.
I offer EMDR sessions from 60 mins to 2 hours in duration. You may wish to work more intensively for faster progress and reduction of symptoms, and therefore it is possible to engage in more than one session per week.
Counselling and EMDR is a collaborative process; I work with my clients to find a treatment plan that suits individual requirements and has the capacity to meet your goals for therapy. If you are unsure about whether or not EMDR will suit your needs, then please read 'Is EMDR Therapy right for me? for a more detailed explanation of what you can expect from sessions. This article also outlines some of the differences in how you may experience EMDR therapy in comparison to talking therapy.
You can also find out more information about EMDR by visiting:
https://emdrassociation.org.uk/a-unique-and-powerful-therapy/emdr-the-basics/
