Posted by carrot on September 11, 1999, at 1:54:06
In reply to Re: EMDR - for DL and Elizabeth, posted by Toby on July 22, 1999, at 9:10:04
>I have a couple of questions about EMDR. I was seeing a generally awful psychiatrist (he mixed me up with other patients nearly every session and only realized it after 45 minutes)...but, he does EMDR, and regardless of how I feel about his effectiveness in psychotherapy, I'm interested in having some sessions.
I have had panic attacks and generalized anxiety for 20 years (I'm 32). My symptoms are similar to PTSD, but I don't have a particular trauma (that I'm aware of at least) which precipitated my overactive fight-or-flight response, terror, dread, and existential angst.
Given this scenario, how would I approach EMDR with this Dr? Do I need an episode, trauma or `picture' to focus on for the EMDR to be effective? In other words, if my anxiety is generalized, and I for example focus on fear of driving, will my generalized anxiety be affected, or just anxiety related to driving? How would you approach doing EMDR with this scenario...or is it not effective with generalized anxiety?
Thanks. Carrot
Accidentally submitted prematurely, so there is another blank message before this. Sorry.
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> To Elizabeth - There are now so many research papers on EMDR that it is difficult to list them all. For the best listing, go to the EMDR website, www.emdr.com, and see that fairly up to date list. Sadly, most of the review papers indicate that EMDR doesn't work. However, when the review papers are closely looked at, it is revealed that the reviewers are looking only at research papers done by researchers who aren't trained in EMDR and aren't really even doing proper EMDR. But those papers get lots of press and get quoted so they become "mythical fact."
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> When Francine did her early work, she was just a PhD candidate, but now she is fully credentialed and the folks that work with her are well credentialed and respected. As for the notion that it should be rejected because there is no theoretical basis for why it works: I rarely scoff, but I scoff at the idea that it should be rejected because we don't know how it works. After all, do we know why cognitive-behavioral therapy works for OCD or panic or depression as well as medications do? No. But we still use them. And double-blind studies of any talk therapy is nearly impossible to do, yet we accept many different types and focuses of therapy. What of hypnosis? Do we know how it works in the brain or why? But I digress. There actually is a theory as to how and why EMDR works. EMDR is based on REM of sleep which we know are involved in memory and learning. It appears that the bilateral stimulation of the brain (both the emotional and logical sides) during sleep helps process daily events, worries, fears, etc (hence we get daily residua incorporated into dreams, Freudian interpretations of snakes chasing us, repeated nightmares of recent trauma that fade over time, etc). Bilateral stimulation of the brain during conscious awareness stimulates the brain to make rapid associations between current events, past events, emotions, and deeply held convictions (cognitions) about each of those events and emotions that appear to perpetuate our self image and subsequent life decisions. Just as in regular talk therapy where the goal is to get the person to make those associations through repeatedly recalling to them their childhood and reinterpreting various events in their lives so that they can see where they got the idea that they were helpless, useless, in danger, or whatever, EMDR does this so quickly by virtue of the fact that the bilateral stimulation occurs rapidly and the various associations are called up quickly. My own personal theory about why the results seem to last is that once a proper association is made, the brain can't return to the old association because it doesn't make sense anymore and will reject it (and the personal theory is the analogy to having someone hum part of a song that you don't like, but then you can't get the song out of your head and there you go humming the song for the rest of the day. The brain just sucks up those kinds of associations). Anyway, I know my analogy is lame, but there it is; please don't associate it with real researchers who even now are doing work with PET scans to test the areas of the brain that are stimulated during EMDR and what structural and physiologic changes occur during and after EMDR and what changes are long lasting.
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> As for the wide variety of things it seems to work for that don't seem to be trauma associated; again, I think it is the fact that early on EMDR was used only for trauma and it got the reputation for being the trauma treatment and nobody looked at it as being for anything else. However, therapists got curious and started saying, "well, maybe it might work for this or that" if the problem was even remotely related to trauma or perhaps had some of the characteristics that respond well to EMDR such as panic, OCD, eating disorders, performance anxiety, pain, etc. Anything that would produce a negative thought about oneself and that one could get a distressing picture about. These elements form the basis of what responds to most therapies and EMDR is no different. Change the cognitions, change the physical/emotional response to the picture and the cognitions, and the problem diminishes, if not vanishes. I fully understand why people are skeptical of the fast action, as I was when I first heard about it ("what a great scam" I thought), but as I said above, there appears to be a real reason why it is fast. The rate of "fast" appears to be different for different people, and may have something to do with how long they've been carrying the problem around, how willing they are to give it up, how many positive resources they have to replace the bad stuff with, how long ago the trauma occurred, and other physiological stuff in the brain itself. For example, I have used EMDR for many people who have had really bad car accidents, where people died or were maimed for life, and the quickest recovery time was 17 minutes from first eye movement to last, and the longest was 8 sessions, with the usual recovery time being 1 to 2 sessions (1 1/2 to 2 hours long each). Now, why did the one person recover in only 17 minutes? I don't know. That's been 3 years ago and I see her from time to time because she went from being unemployed because she could not drive anymore and could hardly stand to be in a car with someone else driving and taking 40 mg Valium per day, to going back to school and becoming a social worker, driving everywhere; so I know the effects have lasted. But perhaps she had more resources to draw on, or she was smarter and could see the proper associations more quickly or her brain just needed a push. I don't know. The one who took 8 sessions did have more traumas in her life and she jumped from one to the other and had a hard time making a connection to being safe, but once she resolved some of the other traumas, she moved pretty quickly to resolving the car accident and feeling safe so that she, too, could start driving again and living her life.
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> Therapists in the Boston area who do EMDR include Carol Hartman on Hillis Rd, Bessel van der Kolk on Braddock Park (he's a well-respected board certified psychiatrist who specializes in PTSD and DID), in Brookline there's Merry Arnold on Garrison Rd, Dennis Balcom on Harvard Street, Nancy Cetlin on Pnd Ave, Martha Guastella on Kent Street and Karen Peterson on Addington Rd, in Cambridge there's Janina Fisher on Massachusetts Ave, Patti Levin on Concord Ave, Zonda Mercer on Cogswell Ave, Devin Ryder at Harvard, William Simpson on Broadway, Pat thatcher on Dudley St.
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> Now, to Dottie,
> I can tell a difference in your writing. You are more directed, self-assured. You've got less "I feel bad, always have, always will" feeling and more "I felt bad, still do sometimes, don't have to always" feeling to your writing. This is HEALTHY. This is the way so-called "normal" people cope with life and feelings. If you read all the stuff above, i want to make another analogy for you (I probably need to make less analogies, but that's just me). People who have strong resources most of their lives and then get a big trauma, may have a very difficult time recovering if they decide that every truism they ever knew is wrong as a result of this bad thing that has happened to them. if they go into therapy, EMDR or otherwise, and begin to utilize their strengths again and allow themselves to see the paradoxes of life, that good exists side by side with bad, black with white, etc, then they can crawl out of the pit they are in and stand on top again. But, although the pit felt really deep to them, reltvely speaking they weren't all that deep, they hd just never been in the pit before so they didn't know how to judge its depth. Now, a person who has been trampled on since childhood and who doesn't have much in the way of positive resources is in the pit too, but much lower down and then life comes along and throws in some rocks on their head just for good measure. So the person begins to duck and then finally never raises their head at all to avoid the rocks. So they never know how deep the pit is or how to get out of it. When they go into therapy, they too can get out of the pit, but it takes longer because they have farther to go and more rocks to dodge. Plus they need to acquire some positive resources in order to complete the journey (like you would need food and water and warmth and possibly a companion to complete a real journey). That is the basis for doing the Positive EMDR sessions. These help you access good parts of you, remember positive influences from your life, and provide something to fill the hole left by the bad stuff that has resolved. it is common for troubling issues to arise during a positive session because your brain doesn't know how to incorporate the good stuff since it has so many conflicting views from the past. When the troubling things arise, that is good because it lets you know there is a connection there that has kept you from feeling the positive stuff all this time. You just go with whatever comes up and resolve those issues and then the therapist will help you return to the positive thing you are trying to install and see if it makes more sense now. Some people visualize people who have the qualities they want and then visualize them touching their hand and the positive quality flowing into them. But you and your therapist will search out which technique works best for you.
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> Take care.
>
poster:carrot
thread:8171
URL: http://www.dr-bob.org/babble/19990829/msgs/11391.html