“Permanent Damage”

Following my first EMDR session over a week ago, it seems I have regressed to having high anxiety and flashbacks nearly all day. I’ve been needing naps during the day because of my inability to fall back asleep after nighttime feedings. I have not been this exhausted since I was pregnant. I even had a brand new flashback, one that has sent me into hours of researching the cult one side of my family was raised under. However, I know I have not completely regressed because I had a doctor’s appointment two days ago; my fourth in five months for the same problem. I was not triggered during the exam like I typically am. He told me I have “permanent damage” from giving birth and that I’d most likely have mild pain for the rest of my life… unless however, I had more children, then it would worsen. He gave no recommendations, just a professional “suck it up” and was out the door. I was more bothered by the news than the exam itself. It wasn’t until several hours later that I began to spiral because of where his hands were touching me.

I spoke with the EMDR therapist on the phone yesterday and she’s sending me back to my regular therapist for more CBT until both my containment skills are improved and the baby starts sleeping longer. It was so disappointing; I had a glimpse of healing and relief. I am ready to move on with my life.

I have not fully regressed. I still have yet to yell at my son due to his overwhelming urge to exacerbate my symptoms when I only want to be left alone. I even had enough patience to teach him to read three letter words.

My First EMDR Session

Eye movement desensitization and reprocessing (EMDR) research success rates make the treatment appear somewhat magical. If I recall correctly, EMDR is one of the most scientifically based therapies. However, it seems that no matter the level of research I did to prepare myself for the therapy, I had no paradigm for the process until I was the client.

I anxiously sat on the couch and looked around the room as I answered her questions. At the end of the questioning, she told me I was not ready for treatment. She said I need to work on my coping and containment skills; I need to learn to shut my emotions down and not let them spiral; I need to be able to manage my triggers before I reach a 10. She would talk to me in several weeks to determine if I would be ready then.

The therapist noticed my dejected expression and said she’d show me what EMDR was like. I watched her remove the “tappers” from the chest across the room. She handed me a tapper for each hand and calmly stated, “Tell me when you’re in your safe place,” as she returned to her seat. I did, and she told me to describe my safe place, including how I felt and where I felt it, what I heard and what I saw. Then, she turned on the tappers and I felt my hands vibrate alternately for a few seconds each.

EMDR

After about 15 seconds, she asked me how I felt. I explained that it was difficult to concentrate on my safe place with my hands vibrating. She said we would try one more time. After I had found my safe place, she turned the tappers on once more. “What did you think?” she asked once this set was complete.

“I don’t like these,” I replied.

“Are you okay?”

After what felt like an eternity, I was able to speak. “The tingles from the vibration are the same thing I feel right before I dissociate.” Session was over, but the therapist decided to do the lightsource grounding technique on me. This is where you imagine a light coming in from above and flowing through every inch of your body. Instead of grounding me, I felt myself slipping farther away as it spiraled me into flashbacks.

At some point after I left her office, I dissociated completely. When I was once again cognizant, I nearly panicked because I was driving and had no idea where I was. I was about to pull over when I saw a sign that indicated I was less than five minutes from home. I had never dissociated while driving before, and the flashbacks I had the remainder of the night were stronger than usual.

Art Therapy

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An example of art therapy when the prefrontal cortex is functioning

When a person experiences trauma, the brain may shut down the prefrontal cortex, which is responsible for higher functioning such as language and reasoning. The brain then uses its basic brain, which is where the limbic system is located. The limbic system is responsible for, amongst many other things, the storing of memory and emotion. It stores memory in fragments, so anything from a smell or a sound can trigger memory of the trauma. Because the brain views the trigger of a traumatic memory as a threat, it shuts down higher functioning and once again, the brain is storing the trigger as trauma.

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An example of art therapy during basic brain functioning (during a trauma response)

When I process trauma with clients, I find that the means of processing largely depends on where they are at in their own journey. For instance, if they can recall the trauma without their brain shutting down, we can process the trauma using language. If they are highly sensitive and begin shutting down when they are triggered, at times they can write, but it may come out in rudimentary words like “scared” and “help.” Their handwriting is often basic as well. However, if I provide the same clients with colored pencils and a blank paper, they can draw but in much the same form that a child would- with stick figures, and coloring very hard when very stressed. If they are willing, they can begin to process the memory through these drawings. If they are very creative people, however, they will attempt to shut this process down. This is because, I have noticed, when I hand creative people art supplies, they feel the need to perfect the art. While art therapy is useful for very artistic people, this is not usually what I use art therapy for in either my personal (I am not artistically inclined) or professional life. I use it as a means of communication and emotion regulation during a strong trauma response.

Ideas for art therapy:

Colors, how hard the colors are applied, objects, size of objects, objects in relation to one another, and placement of art onto the paper are all symbolic. The more a person is able to take these things into account, the greater they will be able to communicate through art. Keep in mind that conscious symbolism requires higher brain functioning. However, the unconscious brain often uses the same symbolism in art therapy; this is the means therapists use to interpret client art… particularly when treating a child.

The Battlefield

I have always been highly anxious and highly dissociative, but I have only met the full criteria for posttraumatic stress disorder (PTSD) for about a year and a half. A therapist friend shared with me that it is common for women in their late twenties to develop PTSD because:

  1. The brain is fully mature and has the ability to understand past trauma
  2. Many at this age are married and beginning to have children, and either (or both) of these things could cause the brain to recall trauma that has been stored away
  3. They are safely removed from their trauma and their brains have deemed their new environment as “safe”

Whatever the reason (and possibly all three), within a period of about six months, my memories manifested themselves into visual, tactile, and auditory flashbacks. For a year straight, the only time I was not immersed in this battlefield was when I was actively working with my clients. The battlefield wreaked havoc on my marriage, destroyed two of my closest friendships, deeply injured my faith, and I nearly lost my sanity and my job. With my clinician brain, I constantly questioned my flashbacks as truth, but always returned to the conclusion that everything I was experiencing was in fact a product of real trauma I had experienced. I have only had three flashbacks that were not a part of my conscious memories, and I have one memory that is slightly different than the flashback it turned into. I find flashbacks very interesting, and I find the unfolding of flashbacks to be even more interesting… from a clinical standpoint, not from a victim standpoint.

I was in therapy at the time for general support, but I quickly found a new therapist. I spent a year working endlessly to decrease the intensity of my flashbacks and decrease my emotional reactions using CBT and DBT, but art therapy and writing became my refuges. My flashbacks and spirals decreased to a couple days a week, which I found to be far more manageable than the constant flood of feeling from my past. This is when I sought EMDR, hoping it would further reduce my anxiety and flashbacks, and would improve my current anxious-avoidant attachment style.

About PTSD

At a training recently, I heard that trauma is so common that we must assume that everyone we come in contact with has experienced it in some degree- this is part of having a trauma informed perspective. We must have empathy for the negative attitudes or behavior a person may show towards us because we do not know whether these are symptoms of trauma. Normal, processed memories are stored in the cortex of the brain in language form. However, when a person experiences significant trauma, the brain may be altered. This alteration is more serious if the trauma occurs in childhood while the brain is still developing. A significant or unprocessed trauma is stored in the limbic system, or the part of the brain responsible for emotion (including fear). Therefore, each time the person experiences an overwhelming emotion, the brain is triggered and the person reacts with an emotional trauma response.

Because posttraumatic stress disorder (PTSD) involves measurable changes in the brain, PTSD infiltrates every aspect of a person’s life, regardless of how hard that person strives to keep it at bay. Faith, relationships, work, parenthood, marriage, and friendships may suffer, and everyday tasks can become difficult and overwhelming. Many people with PTSD do not sleep well, and may go through periods where they do not sleep at all. There are, of course, varying degrees of this disorder that may depend upon length of time since the trauma, the nature of the trauma itself, support system, environment, ability to cope with symptoms, and whether the trauma has begun to be processed.

There are several different types of trauma therapy, and one of the most common is trauma-focused cognitive behavioral therapy (TF-CBT). This type of therapy works to change a person’s thought process regarding the trauma, and often involves talking about the trauma in depth and coming to an acceptance. CBT in general is heavily present-focused, so a therapist will assist the client in making small, reachable goals regarding moving forward from the trauma. Dialectical behavior therapy (DBT) is also often used. DBT focuses on emotion regulation, especially accepting and controlling overwhelming emotions so that no damage ensues during strong trauma responses. Another common type of therapy is eye movement desensitization and reprocessing (EMDR). This involves the therapist assisting the client in processing the memory through various forms of bilateral stimulation, so the brain can re-store the memory in the cortex. EMDR does not require the client to talk about the trauma in depth, and is short-term because it only focuses on the brain’s ability to heal itself through bilateral stimulation. The best natural example of this is rapid eye movement during sleep, where the brain is able to process what has taken place throughout the day.