1. Using EMDR to Address Unprocessed Memories

Transcription

1 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg Using EMDR to Address Unprocessed Memories A QuickStart Guide: The Power of EMDR to Treat Trauma: Identifying, Reprocessing, and Integrating Traumatic Memories by Ruth Buczynski, PhD with Francine Shapiro, PhD Traumatic experiences often become disturbing memories that get stuck in one's head. EMDR attempts to help the brain process the information associated with the memory so that it can be remembered in a different way. Dr. Shapiro: With EMDR, we're stating that pathology, whether it s posttraumatic stress disorder or across the board, is caused by unprocessed memories of an experience. We have an experience, and because it s too disturbing, it is being held in the brain in the form it was originally input. It holds the emotions, the physical sensations, the beliefs that were there at the time. If an individual comes in for therapy, we use different techniques in order to identify the current disturbances and the earlier memories that are the foundations of the problem. Then we prepare them in a certain way and ask them to hold (these disturbances and earlier memories) in mind while we do various procedures, including the eye movement and

2 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 2 allowing the information-processing system of the brain to take over so the appropriate connections are made. The person doesn t have to talk about it in detail; they don t have to do homework of any kind. EMDR is simply allowing the brain to pick up from where it got stuck. Because it was too disturbing, the information was not processed and it is held in a certain form of memory. In using EMDR, we access these memories, stimulate the information-processing system, and what you get are changes in images, thoughts, sounds, emotions, physical sensations, and beliefs. All of these will shift simultaneously as the processing occurs. (pp. 6-7 in your transcript) 2. Discovering the Traumatic Experience Not all problems have an obvious cause. While patients often seek treatment for a specific traumatic event, some may not know what event in their past is affecting them in the present. Dr. Shapiro discusses her approach to finding the experience that is troubling someone so they can address the problem.

3 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 3 Dr. Shapiro: We have a three-pronged approach; we would be targeting and processing the earlier memories that set the groundwork for the problem. We target and then process the kind of situations that are disturbing. Then we do the same for a future template what they ll need for enhanced behavior in the future. If the technique does not work to identify the earlier memory, we start targeting the current situations that are disturbing. Most often we find that these start going automatically into an association which takes them into the past experience. In those instances, where it hasn t been fully stored with an image, it still shifts and you can see it by the associations that then emerge the connections that emerge and ultimately the disturbance is no longer there. (pp. 8-9 in your transcript) 3. The Power of Reconsolidation EMDR attempts to change the perception of the original memory. If successful, this could prevent the occurrence of a relapse. Dr. Shapiro: In different war experiences with wounded and amputated limbs, there are a significant portion of people who have phantom

4 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 4 limb pain. We ve discovered that with EMDR processing of these trauma memories, not only do the trauma symptoms remit, but the pain does also. There are about five different articles that have been published, and the aggregate appears to be about an eighty percent success rate in either full elimination or substantial reduction of the pain through the processing alone. We believe although it hasn t been reported that with CBT therapies and the like, the original memory is still there and it s holding the pain sensation. If the memory is changed, it is not. We re finding the same thing with the treatment of child molesters. With a subset of child molesters, we have discovered they were themselves molested as children. We have discovered that if we process the memory of their own early molestation, not only does the denial get broken through and a sense of empathy and being able to put responsibility where it belongs on the person who molested them, but they re now able to take responsibility for what they have done. Again, that s because of the underlying basis of reconsolidation the memory itself has changed and those physical sensations that were part of these original memories are no longer there. They re no longer getting triggered in the present.

5 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 5 Now, when (former child molesters) look at a child, they don t get sexually aroused; they see the person as a person and not as a sexual object. (pp in your transcript) 4. Defining Trauma from the EMDR Point of View EMDR could potentially be useful in treating a wide range of traumas - some of which people may not even classify as trauma. Dr. Shapiro defines different categories of trauma and how EMDR might be able to address the problems associated with them. Dr. Shapiro: With PTSD you have criterion A there are certain standards that rape or molestation or a severe accident would meet. But we ve found over the past twenty-five years that that standard is too limiting, and what we view as a trauma is really anything that has a lasting negative effect upon self or psyche. This has been substantiated with research. In 2005, they did a survey and discovered that general life events can cause even more PTSD symptoms than a major trauma. A situation in which a child's parent leaves home would not be considered a major trauma or be defined as PTSD. But it s clear that it has a

6 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 6 major impact and can set the foundation for a lot of problems later on. So, you can call it big T trauma and small t trauma. We know that early humiliations and a variety of different types of mental assault that can occur during childhood have a negative effect. As a matter of fact, recent studies have even shown that bullying has set off psychotic symptoms in children. Now, we ve all been raised with Sticks and stones will break my bones but words will never harm me. But that is completely wrong. These negative experiences that children have all through childhood can set the foundation for a wide range of problems. It has been found that forty percent of those with panic disorder occurred because there was a separation from a parent in childhood. You wouldn t call that a major trauma according to PTSD criteria but, again, we see this negative, lasting effect. In EMDR therapy, we simply view it as an unprocessed memory that holds emotion, physical sensations, belief and can come out in a variety of different ways that form different diagnostic classes. (pp in your transcript)

7 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg The Phases of EMDR Knowing where to start to address someone's trauma can be tricky when you don't know what past issues are causing the trauma. Dr. Shapiro walks you through the phases of EMDR treatment to get you going in the right direction. Dr. Shapiro: We start off with a history-taking phase, and during that time, we re identifying: What are the earlier memories that set the foundation for the problem? What are the current situations that trigger disturbance? What is needed for a healthy, active future? For instance, if someone was molested multiple times during childhood, that anxiety would certainly have potentially caused an isolation and separation so that they didn t learn the appropriate social skills. Without those social skills, they wouldn t be able to establish good relationships or learn how to show appropriate behaviors. For example, how to stand up for yourself rather than being aggressive. That is overall what we identify during the history-taking phase. During the preparation phase, we teach a number of self-control techniques that allow the person to access the positive memory networks and identify whether these positive memory networks exist.

8 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 8 If someone hasn t had a good relationship in their life they haven t had good parental guidance or they haven t had a good significant other then we would be looking at what s necessary to inaugurate these positive memory networks within the therapeutic relationship. We need to have enough stabilization to allow the processing to occur. We need the person to feel in control and we need the person to feel stable during processing. We do the appropriate education during preparation. Then, we move into what we call the assessment phase where we re bringing up a past memory that needs to be processed. We have the person hold it in mind, identify the image the negative belief that they have, what they would prefer to think instead, what emotion they re feeling, where they re feeling it in their body and the level of disturbance, and how true that positive belief feels. During the assessment phase, we re getting information about the characteristics of the memory and measures that we ll be using. EMDR is a very accountable therapy. It lets the clinician know from one moment to the next, not only by what the person is saying, but with the measurements, how the progression has gone.

9 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 9 Then, we move into processing phases where insights come up, emotions change, physical sensations change We re guiding that by measuring from zero to ten - zero is neutral and ten is the worst feeling they can think of. If they start off at an eight level, we ll be processing and moving to that zero distress level. We look at that positive cognition and how strong that positive belief is. For example, the rape victim might be saying, I m a good person and not, I m a shameful person. We re testing how strong that is and we re moving to a seven level; from one (completely false) to seven (completely true), we want a firm foundation that they truly do believe the positive about themselves. What we re seeing in the processing is really a transformation of the event. It is not that it disappears it doesn t go away, but rather these early experiences become a source for resilience; they become, through selfunderstanding, a better understanding of their strengths and who they are now in relation to that event. We have another phase where we look at physical response. For instance, the rape victim, unhealed, may be in bed with a very loving partner, but he touches her in a certain way and

10 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 10 there s an automatic negative response that gets triggered. By the end of EMDR processing, that no longer occurs because those physical sensations that would come up at the touch no longer exist in the memory network. We move to a closure phase in order to make sure the person has complete equilibrium. Then the last phase is re-evaluation in order to check the earlier experience that was processed to see what else may need to be addressed. (pp in your transcript) 6. How to Use EMDR to Meet Your Needs EMDR can be applied to a wide variety of cases. Therefore, understanding how to use this technique might be beneficial to people in many professions. Dr. Shapiro gives examples of how specialists in different areas utilize EMDR. Dr. Shapiro: EMDR is structured therapy, but it s also creative. The person who starts with a psychodynamic background has certain training to be able to understand defenses, and that is not lost in EMDR. Folks from the Menninger Clinic said that they learned EMDR and found that it helped them

11 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 11 use what they knew that defense in EMDR terms would be caused by an earlier unprocessed memory of interactions that occurred in childhood. The EMDR treatment would be to access these earlier memories and process them. You would get that shift and a defensive reaction would no longer emerge. For those who were cognitively oriented, they can very easily recognize beliefs. From an EMDR vantage point, the belief is not the cause of the pathology; it is the symptom. The cause is the unprocessed memory that holds that belief. If they recognize that an individual has a negative belief, the EMDR procedures allow them to identify where the earlier memory is that set that in motion and then to process it. Someone who is somatically oriented could recognize different postural changes and the techniques in EMDR the procedures would allow them to identify the memories in which that got launched. For instance, if an adolescent is walking around hunched over all the time what are the earlier memories that set that in motion? In this one example, she was a very weak child when she was born; she was in the hospital for many months and her parents were very, very worried. Although she grew out of that, they were constantly worried for her if she ran,

12 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 12 they would stop her so that she wouldn t overtax herself. This constant over-attention, which came purely out of love, gave her the feeling of being a burden, not good enough, and insecure. So, that posture followed suit. By accessing and processing these earlier memories, the whole body changed and the hunching over was no longer there. For those who have a relational orientation, EMDR is very often used in family therapies when you re trying to teach and educate how to respond to each other, but you have earlier memories that are causing negative reactivity or causing anger or causing people to be pushed away. By identifying that within a relational context, once again you use EMDR procedures to identify the earlier memories that are causing clinging behavior, reactive behavior, anger and allow that to be processed. Because EMDR is an integrative therapy and complements different and other orientations, people are able to use their own strengths and be creative in terms of its use. What s important is the processing of those earlier memories that set the foundation. (pp in your transcript)

13 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg The "Safe Place" Technique Dr. Shapiro introduces a technique to give clients a feeling of safety. Dr. Shapiro: There are a variety of self-control techniques that we use, and one is the safe place or a calm place because many clients are not able to achieve a sense of safety. With this technique, you identify an emotion that they would need in order to feel in control of the situation to let go of anxiety or pain. It s simply asking them, for instance, for a sense/ place of safety or empowerment: where do they feel safe? It might be on a beach or it might be on a mountaintop, or it might be in a different location. You ask them to bring that up and hold it in mind. You can use guided imagery for them to identify and connect with what they re seeing, what they re feeling, and what they re hearing. You want to allow those emotions to come into them so that they are able to feel them. You then use key words to allow them to bring those emotions back when they need them. That is just one of a number of different techniques that an individual can use. (pp in your transcript)

14 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg The "Paint-Can" Technique With this technique, people can make their negative memories more manageable, until they eventually make the negative feelings associated with them disappear altogether. Dr. Shapiro: In order to get rid of the negative image that a person might continue to have they are upset about something coming up over and over again they can use a paint-can technique. Here they are imagining this image on top of the can of paint and just stirring it up. This disrupts working memory and allows it to dissipate; it becomes more handable. What we re looking at in EMDR are these different self-control techniques. Everyone can use these at different times, but we re looking at them as a bridge we re allowing a person to make life more manageable until the full processing takes place. Eventually, a person won t need these very often because what was getting triggered negative emotions, negative beliefs, negative feelings from an unprocessed memory, are no longer there. (p. 21 in your transcript)

15 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg EMDR and Humiliation There is sometimes an element of humiliation affiliated with trauma. Dr. Shapiro explains how to process memories of humiliation from the past to resolve problems that people are having in the present. Dr. Shapiro: The technique that we use very often, in order to allow people to see how they may be affected by their unprocessed memory, is to simply remember. Every time that I do a conference presentation, I ask people in the audience how many remember being humiliated sometime in grade school. They are invited to then go back and remember that experience, noticing what happens in their body and noticing the thoughts that emerge. If you bring up this old memory of humiliation and you feel your body shift, tighten, change, or you get the thoughts/ emotions that you were feeling at the time, this is an indication that the memory has not been processed. At that point, take a look at the different areas of your life in the present that you might have difficulty with: speaking to authority, being in groups, asserting yourself and notice if tentacles from that experience are wrapping themselves around your present.

16 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 16 Many of these earlier humiliation experiences are really the evolutionary equivalent of being cut out of the herd. Being humiliated in grade school is like being cut out of the herd. That fear can simply be holding this memory in place, unprocessed. Anything that happens in the present has to link up with your memory networks in order to make sense of it. If you walk into a room with a large group of people and you have an earlier childhood unprocessed memory of humiliation in that group, those feelings can come up right there. We re invited to take a look at how often we re being pushed and prodded by these earlier experiences. Now, some people may go back to that early childhood experience and they don t feel anything negative; the thing that comes up for them is, Boy, that teacher shouldn t have been teaching, or, Boy, I was really something. We would say that memory is processed because what you have is the integrated adult response to it. Why does that happen for one and not for another? It may simply have been that after the humiliation, a good friend came over and put an arm around you and said, It s going to be fine, and that was enough to allow it to integrate.

17 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 17 Another individual might have been awakened the night before by a car backfiring and was particularly tired so it would have a negative effect. Here s the bottom line it s basically the luck of the draw: we didn t ask for these experiences, but they re ubiquitous throughout childhood. The negative feelings we have about ourselves and about the world now can most often be traced back to these earlier unprocessed memories and happily they can be processed, which means liberation from this current suffering. (pp in your transcript) 10. How EMDR Heals Trauma in Nightmares People who suffer from PTSD often have disruptive REM sleep and nightmares. EMDR can be used to try to examine and process the disturbing dreams of trauma survivors. Dr. Shapiro: The earlier memory of the trauma in the PTSD is being held, unprocessed, with the emotions, physical sensation and belief. The brain is trying to process the trauma and that is what dreaming is about. REM researchers, dream researchers, say that during REM state, the brain is attempting to process

18 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 18 survival information into resolution. That s why all of us have had the experience of feeling disturbed at something, going to sleep, and getting up the next morning and feeling better about it having a better understanding of what to do. The brain has done what it s supposed to do it has processed the information and guided us appropriately in the future. When a trauma has occurred, the processing is disrupted. The brain is trying to process the trauma during a dream, but the person continues to wake up in the middle of the dream nightmare because it s too disturbing. With EMDR, we look at what the nightmare images are and what a person reports. For instance, if a person says that they continually wake up in the middle of a nightmare in which they re being chased by a monster through a cave, we target that dream image. The person is holding in mind being chased through a cave by the monster. We start the processing, and most often what happens is like a veil getting peeled back. The person sees what the actual experience is and reports, Oh, my god that s the person who molested me, chasing me through my childhood home.

19 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 19 The processing moves the trauma to resolution and the person, again, no longer has that dream image. Once fully processed, it s integrated with the larger memory networks and arrives at adaptive resolution. That nightmare-dream image does not come back again. Happily, that is one way that EMDR is able to function. You don t have to try to change the person s mind about it or talk about it; they don t have to describe it in detail at any time. It s simply identifying the image and their thoughts that go with it, and then processing it to complete resolution. (pp in your transcript) 11. The Importance of Self- Forgiveness Dr. Joan Borysenko describes steps to selfforgiveness in the process of overcoming feelings of shame. Dr. Borysenko: I found from my own observations that people who had a deepseated sense of shame, who really did not like themselves and who really blamed themselves and beat themselves up, were the people who did not heal.

20 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 20 So, I have had a long questioning in my mind: How, as a therapist, can I be most helpful to that pattern? It really comes down to self-forgiveness. This is very important. There is now a very robust literature on forgiveness forgiveness of others and forgiveness of self. There are steps to self-forgiveness. There are lots of different kinds of steps to forgiveness, but in general, what I help people do first of all is come to the recognition of how the shame is affecting their life so positively. It s not so much that something is coming from the outside world, but it s something that is coming from inside themselves that has become a roadblock for them. I want a person to really look at what ways that creates suffering, and then to begin the process of forgiveness. Turns out that what is critical in this process is changing the meaning of an event. There are lots of studies that have shown that if you do something wrong or somebody else does something wrong and you can find a benefit in it, then that completely changes the memory. For example, I learned something about myself I became more compassionate I really discovered what empathy was This got me on

21 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - QuickStart - pg. 21 the road to doing volunteer work or practicing meditation or I wouldn t be me if I hadn t any of these can change the memory. Francine talked a lot about this: how you actually don t just put in some new memory, but you transform the original memory. That is what self-forgiveness is all about it s the transformation of what you have done into a celebration of who you have become. (p. 6 in your TalkBack transcript)