Journal Two for Traumatology Class

Reflection Journal Two

           The first journal discussion focused on prolonged exposure therapy (PE) and how it applies to treat posttraumatic stress disorder (PTSD). In this second journal discussion, the focus will shift to the use of eye movement desensitization and reprocessing (EMDR) in treating PTSD. This paper will specifically highlight the therapeutic foundation of EMDR and how it relates to both PE and cognitive processing (CPT). Emphasis placed on how and when to use EMDR with special precautions accompanying its use. In the Christian worldview, section application is made in how to integrate EMDR with spirituality to ensure the opportunity for the client to heal holistically.

Three Key Points

      Point one. Posttraumatic Stress Disorder (PTSD) is a trauma stress-related disorder. It may be caused by an extremely traumatic event, which may include violent acts, dangerous activities, life-threatening illnesses, exposure to war, childhood sexual, physical or emotional abuse, and death of a friend or loved one (Stark, 2016). PTSD has four main cluster areas that include intrusion, avoidance and numbing, negative alterations, and arousal and reactivity. The three main parts of the brain affected by PTSD include the first part being the reptilian (brain stem and cerebellum) that is responsible for the flight, fight, freeze response, and basic survival (Stark, 2016).   The second part is the limbic or mammal (the limbic system that is responsible for emotions, memories, and habits) (Stark, 2016). The third part being the human brain (cerebrum and neocortex accountable for language, abstract thought, consciousness, and imagination) (Stark, 2016).

           Trauma stress may negatively affect the brain through a traumatic event so that the reptilian and mammalian brain centers take over and shut down higher brain function. The body’s flight or fight response becomes highly engaged so that the brain floods the body with adrenalin and cortisol (Stark, 2016). The brain’s primary function then becomes to anticipate, prevent, or protect someone from potential dangers. The brain bypasses the part of the brain that is involved with learning and making constant judgments and becomes focused within the survival brain (Stark, 2016). The mind becomes injured and unable to reset itself after a traumatic event; therefore, the brain becomes stuck and can no longer determine what is safe and unsafe and construes everything as dangerous (Stark, 2016). 

           Eye Movement Desensitization and Reprocessing (EMDR) is a holistic therapy that integrates parts of psychodynamic, cognitive-behavioral, interpersonal, experiential, and body-centered therapies (Shapiro, 2018). EMDR was originally designed to ease the distress of traumatic memories, though now used to treat other aspects of PTSD, such as negative cognitions and hypervigilance. EMDR based on the Adaptive Information Processing (AIP) model (Stark, 2016). This model proposes that a physiological processing system exists in the brain that stores new information. Adaptive processing occurs when forging further information in memory networks and when blended with older stored material (associated memories) results in learning and relief of emotional distress (Stark, 2016). If details of a traumatic event are not processed fully, the initial traumatic impressions will become fused with any distorted thoughts experienced at the time of the traumatic event (Shapiro, 2018). If these thoughts and feelings are not processed correctly, they will become the distorted thoughts and feelings seen in PTSD.

           Point two. EMDR uses bilateral eye movements like rapid eye movement (REM) sleep to stimulate both halves of the brain and reactivates the information processing networks that PTSD had turned off (Shapiro, 2018). The mind becomes desensitized to the distress associated with these memories; it becomes possible to reprocess the memories with positive and adaptive information stored within the brain’s memory network (Shapiro, 2018). EMDR establishes a link between one’s consciousness and the site where the data stored in the brain. One’s negative images, affect, and cognition becomes more diffuse and less valid, while positive images, affect, and cognition becomes more vivid and more valid (Shapiro, 2018). 

           The first step in applying EMDR to addressing traumatic memories is to ensure that he or she has the coping skills necessary to tolerate distressing feelings that may occur along with the activation of the memory network (Marich & Van Wyk, 2016). It is imperative to evaluate clients to determine if EMDR is safe, appropriate, and if the client is prepared to begin working on his or her traumatic memories. Clinicians assess the client’s physical health, support system, and any potential for at-risk mental health reactions (Stark, 2016).  EMDR teaches Clinicians to help clients create a safe place by using deep breathing relaxation techniques that bring the client to a place that he or she can go to if things become too stressful or overwhelming (Marich & Van Wyk, 2016). EMDR Clinician training includes instructional (20 hours), supervised practicum (20 hours), and consulting with trained therapists (10 hours) to ensure safety (Stark, 2016). Rollins, Hughes, Cordes, Cohen-Peck, & Watson-Wang (2020) state that EMDR should only be used under the direct supervision of a licensed therapist trained in administering EMDR.

          This writer went through EMDR phase one training, though still learning to apply the techniques to one’s practice. While researching EMDR recently on the internet, a web site (virtual EMDR) encourages potential clients to access EMDR services for a nominal fee of $69 per month. There were no licensed clinicians nor trained EMDR therapists present to help guide clients through the EMDR process. As stated earlier, when a person seeks to activate his or her past traumatic memories, he or she must have a safe place, along with appropriate supervision and guidance, to ensure safety for the person accessing this service. There are no safety protocols available, and complex trauma clients may experience dissociation and abreaction during EMDR therapy sessions. There is no way of knowing what a given target or anxiety is linked, and even seemingly innocuous disturbances can be rooted in disturbing childhood memories (Rollins et al., 2020).

           Point three. Best practice guidelines for the treatment of PTSD encourages clients to engage with traumatic material through exposure-based interventions as first-line treatments for PTSD (Kaminer & Eagle, 2016). Potential limitations with implementing trauma-focused (CBT) therapies are many. Service providers in everyday practice settings are likely to have the less ideal training and supervision, more extensive and more diverse caseloads, more client attendance issues, and barriers (Rubin, Parrish, & Washburn, 2016). Kaminer and Eagle (2016) discuss these three evidence-based, trauma-focused CBT (TF-CBT) treatments that include PE, CPT, and EMDR have similarities.  These include they are typically 8-12 sessions in length, contain elements of focused psychoeducation about trauma, exposure to traumatic memories, and cognitive reprocessing of the belief and meaning associated with these memories (Kaminer & Eagle, 2016). 

In journal one, PE was found to be the most substantial evidence of all the CBT treatments for PTSD. PE focuses on two primary elements that first requires the therapist to engage the client in repeated, step by step retelling of their most distressing traumatic memory and secondly to guide the client into in-vivo exposure to situations in the client’s life (Kaminer & Eagle, 2016). The second trauma-focused (CBT) treatment is CPI.  This treatment encourages the client to write a narrative of the trauma then reading it to the therapist, followed by identification and cognitive reprocessing of maladaptive trauma-related beliefs related to ‘stuck points’ in the trauma narrative (Kaminer & Eagle, 2016). The third trauma-focused (CBT) treatment EMDR combines core exposure and reprocessing with bilateral stimulation, which may enhance the processing of trauma-related memories, affects, and cognitions (Kaminer & Eagle, 2016). In all three of these trauma-supported treatments, clients create a new ending to their narrative story.  

Christian worldview. Traumatic events may distort many aspects of oneself, including his or her concept of God or one’s spirituality. Spiritually based cultures affirm that once someone has experienced profound trauma, they become spiritually wounded, affecting the survivor’s body, mind, heart, and spirit, causing despair and loss of meaning and impacting the entire sense of self (Tick, 2013). Cornine (2013) describes how trauma may affect one’s sense of self through cognition and the messages communicated to oneself after a traumatic experience. This writer has worked with many traumatized victims that internalized false messages such as being punished for not being good enough, of being permanently damaged, feeling guilt and shame for what had happened to them. How does one reconcile having done nothing wrong but have become victims of violence, or being forced to fight on a battlefield? 

Trauma-informed therapies focus on negative memories that become stuck and replay over and over in memories through flashbacks, nightmares, with negative messages and consequences. The way a person views God is influenced by parents, teachers, books, and formal or informal education (Cornine, 2013). PE helps to heal the mind by taking the client back to the traumatic event to help him or her process and desensitize his or her perception of the episode. While CPI helps to restructure distortions, and EMDR helps to address the physiological reactions to trauma. The spiritual intervention has predominantly focused on making meaning of the traumatic event. However, it is just as essential to reach out by asking for help and accept comfort from one’s faith community. Those who view their spirituality, faith community, and Higher Power as sources of support, validation, and acceptance are more able to make healthy meanings and recover than those who don’t (Harris et al., 2011). 

A couple of years ago, this writer was in a hospital room surrounded by family members awaiting the passing of a mother to some, a wife to others, and sister to still others. No matter how one tries to prepare for the death of a loved one, indeed, it is a process no one wishes to go through. This writer left early to meet one’s spouse in Asia and was not there at the end. It could be considered both a blessing and a curse because only a short goodbye was communicated but did not have to face the impending heaviness of a funeral. It has taken some time to unpack and process feelings of grief and loss. The verse that has meant the most in difficult times has been 2 Corinthians 4:8-10 “We are hard-pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed. We always carry around in our body the death of Jesus so that the life of Jesus may also be revealed in our body. These verses have brought comfort and peace amidst life’s most difficult trials. 

References

 Harris, J. I., Erbes, C. R., Engdahl, B. E., Thuras, P., Murray-Swank, N., Grace, D., … Le, T. (2011). The effectiveness of a trauma-focused spiritually integrated intervention for veterans exposed to trauma. Journal of Clinical Psychology, 67(4), 425–438. DOI: 10.1002/jclp.20777

Kaminer, D., & Eagle, G. T. (2017). Interventions for posttraumatic stress disorder: a review of the evidence base. South African Journal of Psychology, 47(1), 7–22. https://doi.org/10.1177/0081246316646950

Marich. J. & Van Wyk, R. (2016). Calm, safe place: EMDR Therapy preparation demonstration. [PowerPoint slides]. Retrieved from  https://www.youtube.com/watch?time_continue=789&v=Zbu4zjJ3uqM&feature=emb_title

Rollins, S., Hughes, T., Cordes, G., Cohen-Peck, M., & Watson-Wang, J. (2020). Guidelines for virtual EMDR Therapy. Retrieved April 19, 2020, from https://www.emdria.org/wp-content/uploads/2020/04/Virtual_TG_Report_for_Member.pdf

Rubin, A., Parrish, D. E., & Washburn, M. (2016). Outcome benchmarks for adaptations of research-supported treatments for adult traumatic stress. Research on Social Work Practice, 26(3), 243–259. https://doi.org/10.1177/1049731514547906

Shapiro, F. (2018). Eye movement desensitization and reprocessing (Emdr) therapy: basic principles, protocols, and procedures. New York: The Guilford Press.

Stark (2016). EMDR basics. [PowerPoint slides]. Retrieved from https://www.youtube.com/watch?time_continue=19&v=8aiS1Pa7QgY&feature=emb_title

Tick, E. (2013). PTSD: The sacred wound. Health Progress, 94(3), 14-22. Retrieved from https://ezproxy.liberty.edu/login?url=https://search-proquest-com.ezproxy.liberty.edu/docview/1415612742?accountid=12085