EMDR in Laymen’s terms – Introduction to EMDR therapy for PTSD, trauma and other anxiety concerns

Have you experienced something very frightening, were exposed to an accident or are a survivor of sexual abuse? Whatever traumatic past you have had, you know that in most cases counseling and therapy can help you feel better. But who to turn to and what to look for? While EMDR therapy is not as new as some people may think, it is receiving more and more attention through media, PTSD support groups, Veteran organizations, survivors of sexual abuse programs and many other mental health related platforms. So in today’s blog, I decided to give some layman information and facts on EMDR therapy, plus EMDR therapists and counselors.

EMDR's founder, Francine Shapiro, discovered the concept by chance in 1987. While walking in a park she realized on herself how eye movements had a calming effect on emotional distress. She then had other individuals experience and confirm her personal observations. However, Shapiro realized that only the eye movements themselves were not enough, so she added a cognitive treatment component and developed a standard protocol. In 1989 the first research studies about the effects of EMDR and the treatment of PTSD (Posttraumatic Stress Disorder) were published that showed significant treatment effects for a majority of clients. Shapiro continued to research the treatment effects and kept developing her therapy approach by implementing client and other therapist’s feedback. Until today various studies have been published that show the positive treatment effects of EMDR in trauma therapy. Overall EMDR is not effective with every mental health problem, but shows effectiveness with disorders that are due to a trauma related memory (www.EMDR.com).

So what is EMDR? EMDR, which is short for Eye Movement Desensitization and Reprocessing, presents a psychotherapy and counseling model that allows people to heal from the emotional distress and symptoms as a result of an upsetting or traumatic life experience. This therapy has proven to provide quicker relief than other previously applied counseling methods, which makes it become more and more popular. Generally, the brain has the power to heal itself after a psychological trauma. However, sometimes it gets blocked and this is when EMDR can help by removing this block and allowing healing to take place. You can compare it to the healing of a scrape cut on your knee. Usually it heals quickly unless something is stuck in the wound. Whenever the wound has been cleaned recovery can continue rapidly which is what EMDR tries to achieve.

The EMDR therapy protocol includes 8 phases starting with the history taking, (assessment of readiness). Phase 2 incorporates learning and practicing of distress tolerance skills (coping skills) to control strong emotions that are coming up in and outside of session while receiving EMDR therapy. Phases 3-6 include the following components: identifying the target(s) for processing, describing a visual image that represents the specific event, stating a negative believe connected to the event, identifying related emotions and body sensations, finding a positive thought to connect with the event and rating the current emotions plus feelings of truth of the positive thought. The goal of phases 3-6 is to decrease the intense negative emotions and body sensations through bilateral stimulations while holding the image and target in mind plus installing the positive thought. Phase seven is the closure stage by helping the client calm down and applying self-soothing strategies. Furthermore, the client will be instructed on using a personal journal to keep track of new material that may arises outside of session. The last phase, which usually is at the beginning of the following session, presents an evaluation of the previous week’s process and possible identifying of new materials that have to be addressed.

Side effects of EMDR can be upsetting and unresolved memories that come up. Some clients experience reactions during a session that neither they nor the therapist expected like very high levels of emotions and/or physical sensations. Also, after a session the processing of materials very likely continues and other dreams, memories and feelings can arise. Due to these possible side effects it is crucial that the client is ready to start EMDR therapy, has a good support system and a pallet of coping skills to choose from in order to self-regulate in and outside of the counseling session. Certain individuals who have been exposed to severe trauma may show high levels of dissociation, which in layman terms presents an altered level of awareness. In these instances, it is important to work with an EMDR therapist that is experienced in handling these issues because further unexpected emotions, and feelings may arise which need more attention.

 If you are considering EMDR therapy and want to look for a counselor who is providing these services, a good website to check is www.EMDRIA.org. You will have the choice to search for EMDR trained and certified therapists. Counselors and therapists who are EMDR trained have had the basic level 1 and 2 training, which includes internship and supervision hours. EMDR certified therapists have provided a certain amount of EMDR therapy after their level 1 and 2 training, completed continuing education hours and supervision through an EMDR consultant. Certified EMDR counselors are in most cases better equipped to help clients who are experiencing high levels of dissociation due to a traumatic event Since the term high levels of dissociation is very difficult to measure for a layperson, EMDR trained and certified therapists are able to use an assessment tool which can help determine the severity of dissociation. Overall, every individual experiences some level of dissociation throughout the day. One example of this experience would be driving in a car and making it home but then having forgotten how you got here or being surprised of how late it already is even though the car ride seemed to have gone by quickly. These instances of dissociation do not mean they are a problem, which has to be addressed by an EMDR counselor. Dissociation due to trauma can be much more severe with various types of memory loss or out of body experiences. In very tough cases they may include the development of various new identities to suppress the pain. If you are struggling with hyper-vigilance, muscle tension, anxiety which appears to come out of nowhere or in response to certain triggers, have trouble with your sleep, flashbacks, nightmares, anger or emotional outbursts and other symptoms that possibly could be related to one or many frightening past events, consider consulting a therapist who provides EMDR treatment. The counselor can determine through a thorough assessment if this type of therapy is appropriate for you. Feel free to contact me with any questions, leave a comment or contact me to schedule a consult if you are interested to see if EMDR is right for you.

Parenting tips that are simple and effective (tips 1-4)

First of all there is no wonder weapon to turn your child into the little sweet prince that cleans up after himself, says please and thank you and massages your feet every night. Being a parent means being able to stay calm, strong and on your toes. It is hard work but brings so much more than anything you could ever buy. It brings you unconditional love by a little person that needs you to survive and grow. In your child’s eyes you are a hero, a know it all, a superhuman being that can fix any hurt and destroyed toys.

But I do understand that life can be much easier when your child decides to cooperate with you more often than less. So here are the best ideas I could come up with that can help you to find more serene moments when your child actually listens. Please keep in mind that all of the parenting skills have to be adjusted to the age of your child. Also it is important to check with for example a doctor or counselor if your expectations are age appropriate. For example: I understand that sometimes we want our child to stay calm and take it like a “man” but in reality having a tantrum between the age range of 1-4 years old is a very age appropriate response to being told “no”. Yes, there are things you can do to decrease the number of tantrums, but if it happens, keep in mind it might be normal. So here are the first tips for positive parenting:

1.     Play and be silly.

If you want your child to respect you, listen and follow your instructions you better take time to play with him and also allow him to take the lead. Through play kids actually learn social skills, turn taking/sharing, language skills, practice their imagination, grow muscles, develop coordination, and so much more. When you make it a habit to play at least 5 minutes each day with your child (more is better), your kid will want to please you more often and feels bad when disappointing you. Play and at times following your kid’s lead are the fundamentals for building a positive parent-child relationship and trust. Just think about it. Wouldn’t you prefer to help the co-worker who keeps spending time with you at lunch over the one who is mostly distant?

2.     Parenting tip number two is praise. 

Praise anything that you want your child to do more often and keep doing. Most kids actually want to please their parents. By you making a big deal out of your son listening to you, you are giving him a hint of how he can make you happy. But there are cautions. Make your praise and compliments age appropriate. A young child for example for sure needs a specific praise while your teenager understands the usual “great job”. A young child needs to hear what they did great since they may have done 3 things at the same time (i.e. (1)putting the toy away, (2)kicking the cat while doing it and (3)complaining). Tell your toddler “great job putting your toys away, that was awesome.” And maybe even give him a high five or hug. When giving praise, make differences in the intensity of them. Remember when your child said the first time “mommy”? You probably were frantic about it. After a while you stopped celebrating him saying “mommy” but gave more attention to new words and only ones a while decided to praise him saying “mommy”. The same applies for everything else. When your child has never cleaned up before and just did, make a big deal out of it. This initially gets him hooked on the task plus increases his self-esteem. You can fade out the intensity of the praise when he keeps cleaning up more frequently after himself. Even though, I personally believe that a “thanks for cleaning up” is always appropriate to teach good manners.

3.      Tip number three is stating what you want.

This means instead of telling your child what he is doing wrong or should not be doing, you tell him what is expected. An example would be letting your child know to play with his toys gently and share rather than having to intervene and saying stop throwing your toys and taking your sister’s away. Keep in mind, most children want to follow our directions but they also hate being told what not to do. So try to get around the “No, Stop, Don’t” as much as possible by stating your expectations in a positive and clear way. Keep those harsh words for real dangers or cautions so they don’t loose their meaning. Imagine you are starting a new job and your instructor just criticizes what you are doing wrong or should not be doing. You probably would hate it and feel some resentment towards the person. The same happens with our kids when they keep hearing us use the negative words. So make it easy on your self and even consider using this little tip with your partner. It will get you what you want more often and at times even prevents arguments. In my counseling practice I often had partners and parents say: “But he should know it.” Guess, what, no one can read your mind. And while sometimes repetition allows people to assume what is expected, stating it clearly and positive makes it easier and does not leave room for misunderstandings.

4.     The last tip for today is Ignoring (but keep appropriate age expectations in mind).

Ignoring is a life safer and appropriate for minor behaviors that are not a danger to your child, others or property. Typical behaviors you could practice ignoring would be attention-seeking behaviors like whining, clinging, begging, and maybe even talking back. Ignoring means you are not giving your child any attention for the behavior you are trying to extinct. But in return you will have to give attention to the behavior that you want your child to do. For example: when your child keeps whining for chocolate, ignore but when your boy uses his words praise him. You may still decide to not give him the chocolate but you provide positive feedback for the appropriate behavior. Important is that whenever you are ignoring a behavior keep in mind it does get more annoying before subsiding. Stay strong. If you give in, you may send the message to your child that he just has to try harder. Also, for the toddlers, sometimes an indirect verbal hint can help. Meaning you want your child to stop whining and use his words you could say this while not giving him eye contact or other attention: “Whenever Johnny is able to use his big boy words than I can listen to him.” I am assuming your child (in this case Johnny) knows what big boy words are. If he does not know it, than you will have to practice it while he is calm.

These were my tips for today. Subscribe to my blog for more tips to come.

When anxiety gets the best of you … Part 2 of 2 (list of anxiety self-help skills)

So here are some things you can try the next time anxiety gets the best of you.

First and for most, when you know you get frightened easily, stop watching scary movies and the news. Nowadays the News are filled with too much detail about the cruelty on this planet. While it is nice to be up to date on the disasters and wars, sometimes not knowing is bliss and a vacation for your worried mind.

The next tip is to become aware of your bodies anxiety symptoms which are usually: an increase in heart rate, increase in breathing, maybe sweaty hands, tingling in your stomach, light headedness, and so on. Becoming aware of your bodies signals can help you to apply the upcoming listed calming strategies early and maybe prevent a full on anxiety attack.

Keep a journal in which you will write any triggers that cause you to feel anxious.  This usually takes some practice and personal insight. You will have to calm down first and revisit what maybe has caused you to feel anxious. When did it first start? Triggers can be anything: sounds, smells, visual cues, colors, thoughts, behaviors, feelings, etc. The more triggers you can identify, the easier it gets to be proactive about using calming strategies.

Start to recognize any anxiety provoking thoughts. And the best way at the beginning is to write them down again. After you identify the thoughts that cause you anxiety, revisit them and see if they are true? Can you find evidence that your mind might be tricking you? Challenge these thoughts and try to find more balanced ones.

Now, things to do when recognizing your body’s symptoms: first of all try to take deep breaths also called belly breaths. These help you to slow your heart rate down and keep you from hyperventilating. The breathing will also help your muscles to relax and allow your mind to think more clearly and balanced.

Create a safe place in your mind. This is something you should be doing while not being anxious. Either come up with a place in your imagination or take a vacation magazine and pick a place you could see yourself feeling safe. Try to imagine it as detailed as possible. After you have picked it, close your eyes and envision yourself there. See yourself being calm. Try to focus on what you smell, hear, taste and feel at this place. Please be aware that this exercise/technique is only helpful when there is no anxiety-provoking trigger at this place. To give an example, I ones did this exercise with a client and the person envisioned a place with children. When we went deeper into this situation by imagining smells, sounds, feelings, tastes and activities there, the person started crying and felt more anxious than prior because the children triggered frightening memories from the past. Anyway, after having established this safe place, keep practicing going there in your mind for a couple of minutes. It is important to keep practicing this so it becomes easier to apply when you actually do feel frightened.

The next techniques, you probably have already heard and read about in other articles. They are also often used for depression treatment. In the mental health field we like to call them coping skills which are for example: working out, reading, praying, taking a bath, listening to calming music, getting a massage, yoga, progressive muscle relaxation, etc. Anything that you can come up with that helps you to relax and be safe (no drugs, or alcohol). Often it helps a little bit when you can distract your self from the anxiety-provoking event and revisit it later in your mind to identify the earlier mentioned triggers.

In order to take control of your anxiety, it is also very beneficial to keep being in the here and now (being mindful). Often thinking too much about the future or past can put us in a situation that we cannot control at this point of time. This feeling of being out of control possible leads to more anxiety. If you want to make future goals or process the past, pick a certain time and place for it plus keep your anxiety fighting tools close. Someone ones told me that that they were able to mentally put the fear in a box when it came up uncontrolled and let it out in situations where it was appropriate plus safe to face them. How great is that! Here is a website that gives exercises and information on mindfulness: http://www.the-guided-meditation-site.com/mindfulness-exercises.html.

One more technique that I love and is for sure worth a try: creating a little anxiety emergency kit for yourself. You decide what goes in it but keep in mind the goal is to calm you down. Therefore, it could be a soothing music or sounds (youtube is great to find something like nature sounds, etc.), maybe sun glasses or a peaceful picture, a certain smell that calms you down, a taste that helps to relax (gum, mint, etc.), for the tactile people, having a stress ball handy, some fresh water or cooling pad, or a little soft fabric to relax, plus add a calming phrase like a slogan to remind you to relax. Here is an example of a slogan: “Feelings come and go like clouds in a windy sky. Conscious breathing is my anchor.” (Thich Nhat Hanh). For more examples of quotes about mindfulness have a look at this website: http://www.goodreads.com/quotes/tag/mindfulness.

Put all of your anxiety emergency tools into a little bag and keep it with you, ready to use when necessary to help you ground yourself and be in the moment.

My last suggestion is to seek professional help when anxiety is getting a hold of you and you feel like it is too difficult to control it. A good therapist can support you in identifying ways to stay present, breath, etc. Also, techniques like hypnosis, EMDR, Cognitive behavior therapy, and others are very helpful and promising treatments for anxiety disorders. You don’t have to suffer alone. A good counselor may also send you to a psychiatrist for medication evaluation when your symptoms are too intense to start working through them.

Ok, this will sum up all my suggestions at this point of time. If you have questions or requests for new blogs feel free to leave some feedback. I appreciate you taking the time and reading my blog. www.kathrinwinklertherapy.com

Have I been traumatized? Do I need help?

While starting my private practice, friends often asked me what I am going to specialize in. My idea was putting special focus on treating trauma victims, depressed and anxious clients.  The next question surprised and also confused me alike. Many asked: “What do you mean by trauma? What is that?” Turns out, most of them had no idea what falls under the category of psychological trauma.

So here we go. What is trauma? And have I been traumatized?

The Google online dictionary describes a psychological trauma as a deeply distressing or disturbing event.

How we know if we have been traumatized is by our emotional and physical reactions to the specific event. When I was 16 years old my father and I had been in a head collision car accident with another driver. Thankfully none of us had severe physical injuries, however, something changed that day. Lets say, for a couple years I became a terrible passenger. I was the person who would tell you to keep the distance, push my imaginary breaks, and hold on to the side handle whenever I thought there was danger ahead, which was pretty much always.

So what happened here? How did I become this annoying passenger who appeared to be very critical of everyone’s driving. The truth is, I did get hurt in that car accident, maybe not physically but mentally.

Years after I was still fearful driving in a car. Having gone through training in psychotherapy I know now what happened. I experienced a traumatic event, which is something that had me fear for my life, my father’s life, and fear of severe physical injury. Whenever I was exposed to triggers that reminded me consciously or unconsciously of this event, I was right back in the moment of that accident. Triggers can be stimuli like certain sounds, smells, feelings, tastes, pictures, etc. that are reminiscent of the experience.

 I have worked on my traumatic event by using EMDR (a trauma treatment), gradual exposure therapy and practicing relaxation skills, which at least allows me now to drive my own car without fear and have almost no emotional outbursts as a co-pilot. Therapy has helped me to process some of the distorted thoughts and feelings that I overgeneralized to situations while driving in a car.  

Traumatic events can be anything, starting with an accident, a fight, abuse, loss of someone or just observing something very scary. The severity of the trauma response reaction will depend on our personal genetics, environmental factors and psychological resources. An event that has a lasting effect on one may not have the same on another person.

Typical symptoms of having been traumatized can look different in children and adults. Here is a sample list of possible reactions to traumatic events: sleep difficulties, headaches and other physical pain, feeling isolated from others, flashbacks, changes in sex drive, nightmares, anxiety attacks, “spacing out” (going away in your mind), sadness, dizziness, angry outbursts, uncontrollable crying, memory problems, feeling guilt, having trouble breathing, thoughts of self-harm and more.

Will you need to see a therapist whenever you have experienced a traumatic event? The answer is no.  Some reactions are very normal, especially immediately after exposure, and will disappear over time. I would recommend seeing a mental health professional who specializes in this area, like me, when the symptoms interfere with the quality of your daily life.