"The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma" is a groundbreaking work by Dr. Bessel van der Kolk, a leading expert in trauma. The book delves into the nature and impact of trauma on the body and brain and explores innovative treatments beyond traditional talk therapy.
Empathy is an emotional competency vital for fostering close connections with others, especially during challenging times. It requires the maturity to set aside one's own needs temporarily and resonate with another's emotions, making them feel genuinely understood in their struggles.
Finding acceptance, whether it's acceptance of oneself, of others, or of situations, is a fundamental aspect of personal growth and emotional well-being. It involves recognizing and coming to terms with realities that might be challenging or unpleasant without attempting to deny, resist, or change them. Here are some steps and considerations to help you cultivate acceptance:
Eye Movement Desensitization and Reprocessing
EMDR is a psychotherapeutic approach designed to help individuals process and integrate distressing memories, particularly traumatic ones. While the complete neurological underpinnings of EMDR are not yet fully understood, there are several theories and observed effects that explain how EMDR might help unlock and process troubling memories:
Bilateral Stimulation and Adaptive Information Processing Model:
EMDR typically involves bilateral stimulation, most commonly in the form of guided eye movements. According to Francine Shapiro, the developer of EMDR, the bilateral stimulation works in conjunction with the brain's inherent information processing system. The AIP model posits that our brains naturally move towards health and healing. When a trauma occurs, this natural processing can be disrupted, leading to the traumatic memory being stored in an isolated form with the original emotions, beliefs, and sensations. Bilateral stimulation, as used in EMDR, is believed to stimulate the brain's information processing system and facilitate the integration of these distressing memories.
Working Memory Hypothesis: Some researchers propose that the eye movements in EMDR may work by taxing one's working memory. As the client recalls a distressing memory while simultaneously following the therapist's fingers with their eyes, the dual attention competes for space in the working memory. This process might lead to the memory becoming less vivid and less distressing.
Neurobiological Changes: Preliminary neuroimaging studies have suggested that EMDR can produce changes in the brain's neural networks. After successful EMDR therapy, some studies have shown changes in the amygdala, hippocampus, and anterior cingulate cortex, which are areas involved in the fear response and memory processing.
Desensitization: By repeatedly recalling the distressing event in a safe environment (the therapist's office) while simultaneously undergoing bilateral stimulation, the individual becomes less and less emotionally aroused by the memory, leading to desensitization.
Reconsolidation of Memory: Recent theories in neuroscience suggest that when a memory is recalled, it becomes "labile" and can be modified before being stored again (or "reconsolidated"). During the EMDR process, when a distressing memory is recalled and processed, it might be stored again in a less distressing and more integrated manner.
Incorporation of Positive Beliefs: A critical aspect of EMDR is not just the processing of distressing memories, but also the incorporation of positive beliefs about oneself. This reframing can lead to the individual viewing the memory in a new light.
It's essential to note that while EMDR has been shown to be effective for many individuals with trauma and PTSD, it's not entirely clear which component(s) of the treatment are crucial for its efficacy. Research is ongoing, and our understanding of the mechanism of action in EMDR will likely continue to evolve.
EMDR – History taking
History-taking in EMDR is crucial. It allows the therapist to understand the breadth and depth of a client's traumatic experiences and their current manifestations in the client's life. The history-taking phase not only provides necessary information to guide the treatment but also aids in building rapport and trust between the therapist and the client.
Here's an approach to history-taking for EMDR:
Building Rapport: Establish a comfortable and safe environment for the client. Create a therapeutic relationship where the client feels understood and respected.
Gather Background Information: Collect basic demographic information, reasons for seeking therapy, and a general overview of the client's history.
Determine Previous Traumas: Ask about past traumatic experiences, starting from childhood and moving chronologically to the present. This can include experiences of abuse, accidents, surgeries, or any distressing and disruptive events.
Assess Current Symptoms: Understand the current symptoms and challenges the client is facing. This includes physical symptoms, mental health symptoms, emotions, beliefs, and behaviors.
Identify Triggers: Ask about situations, places, or people that exacerbate or trigger the symptoms. This will help in understanding the current impact of past traumas.
Establish a Target Memory List: Based on the traumatic events identified, create a list of specific memories to target in EMDR processing. This list provides a roadmap for therapy, though it can be adjusted as therapy progresses.
Evaluate Dissociative Symptoms: Determine if the client exhibits any signs of dissociation. Understanding this is essential as high levels of dissociation might necessitate modifications in the EMDR approach.
Check for Previous Therapies: Understand any previous therapeutic interventions the client has undergone, their experiences with those therapies, and the outcomes.
Assess Coping Mechanisms: Recognize the client's existing coping strategies, both adaptive and maladaptive. This can help tailor the preparation phase of EMDR.
Risk Assessment: It's crucial to evaluate any risk factors, such as suicidal ideation, self-harm tendencies, or any potential harm to others.
Evaluate Readiness for EMDR: Ensure the client is ready and stable enough for EMDR processing. Some clients might benefit from stabilization and grounding techniques before delving into traumatic memories.
Gather Information about Support Systems: Know about the client's support systems, such as family, friends, or community resources. This information helps the therapist understand the client's external resources.
The information collected during the history-taking phase provides the foundation for the EMDR treatment plan. It's essential to approach this phase with sensitivity, as discussing traumatic events can be distressing for clients. The therapist should prioritize the client's safety and well-being throughout the process.
EMDR - Preparation
Francine Shapiro's development of EMDR primarily focused on processing traumatic memories, but an essential component of this treatment involves ensuring that clients have tools to manage their emotional responses. Proper emotional regulation is crucial, especially during the early stages of EMDR therapy, to ensure that clients can handle distressing memories and emotions that may arise.
Here are some of the emotional regulation techniques and skills often utilized in EMDR therapy:
Safe or Calm Place Visualization: Clients are taught to visualize a place where they feel safe, calm, or peaceful. This can be a real or imagined place. This visualization can provide a respite during intense emotional processing.
Deep Breathing: Controlled breathing can help regulate the nervous system. Slow, deep breaths can activate the parasympathetic nervous system and promote relaxation.
Resource Development and Installation (RDI): This is a specific EMDR technique wherein a therapist helps the client develop internal resources. For example, a client might be guided to recall or imagine a time they felt strong, secure, or loved. The therapist then uses bilateral stimulation (like the eye movements in EMDR) to help "install" and strengthen this positive feeling.
Butterfly Hug: This is a self-soothing technique where a person wraps their arms around themselves, placing a hand on each upper arm. They then alternate tapping each arm, which provides bilateral stimulation, similar to the back-and-forth eye movements in EMDR.
Containment: A mental imagery technique where clients are taught to visualize placing distressing memories or emotions in a container, which can be sealed or locked. This technique provides a temporary way to set aside distressing material until they're in a safe place to process it.
Grounding Techniques: Grounding exercises help clients reconnect with the present moment, especially if they become overly distressed or dissociative. Examples include:
5-4-3-2-1: Naming five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste.
Feet on the Floor: Concentrating on feeling one's feet firmly planted on the ground.
Positive Interweaves: During processing, if a client becomes stuck in a negative belief or is overly distressed, a therapist may use a positive cognition or positive experience to help shift the processing.
Distraction Techniques: Simple tasks like counting, recalling neutral events, or engaging in a non-threatening conversation can help divert attention and decrease distress temporarily.
Body Awareness and Relaxation: Checking in with one's body and releasing tension, or using progressive muscle relaxation.
Bilateral Self-Stimulation: Encouraging clients to use alternating tapping on their legs or hands, or using audio tools that switch from ear to ear, can help mimic the bilateral stimulation used in EMDR.
Clients are often introduced to these techniques during the preparation phase of EMDR, ensuring that they have resources and tools to manage distress both within and outside of therapy sessions.
Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment designed to alleviate the distress associated with traumatic memories. Developed by Francine Shapiro in the late 1980s, EMDR is recognized as an effective treatment for trauma and post-traumatic stress disorder (PTSD).
The specific protocols for EMDR can vary based on the client's needs and the clinician's training, but the standard protocol involves the following eight phases:
History-taking and Treatment Planning
The therapist gathers information about the client's history and identifies potential target memories for EMDR processing.
The therapist explains the EMDR process to the client and ensures they have adequate coping mechanisms to manage potential distress. This may involve teaching the client various relaxation techniques.
The therapist and client select a specific target memory to process. They identify the associated negative belief about the self, the desired positive belief, the emotion linked to the memory, and the location of any physical sensations.
The therapist facilitates bilateral stimulation (typically using eye movements, but tactile or auditory stimuli can also be used) while the client focuses on the distressing memory. The goal is to reduce the distress level associated with the memory.
After the distress level has decreased, the therapist works with the client to strengthen the desired positive belief. Bilateral stimulation continues during this phase.
The client is asked to notice any residual tension or discomfort in their body related to the target memory. If any is detected, it's processed using bilateral stimulation until it's resolved.
If the processing of a target memory isn't completed in a session, the therapist ensures the client returns to a state of equilibrium before leaving. Techniques learned in the preparation phase might be used to achieve this.
At the beginning of subsequent sessions, the therapist checks to ensure that the positive effects of previous sessions have been maintained and that there are no new issues or concerns.
It's important to note that while the process might seem formulaic, EMDR is a flexible therapeutic approach. The therapist tailors the treatment based on the client's needs, and not every phase may be needed in every session.
If someone is considering EMDR therapy, they should consult with a trained and certified EMDR therapist who can provide more detailed and individualized information.
Mindfulness is a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. It's often used as a therapeutic technique and is rooted in Buddhist meditation practices, though it has been popularized in the West in a secular context, especially in the realms of psychology and wellness.
Here are some key points about mindfulness:
Benefits of gratitude lists are many
Research on gratitude, including the practice of keeping gratitude lists or journals, indicates numerous psychological, physical, and social benefits. Here are some findings based on various studies:
Improved Psychological Well-being: - Gratitude journaling has been associated with increased well-being and reduced symptoms of depression and distress. Individuals who maintain gratitude lists often report higher levels of positive emotions such as joy, love, and optimism.
Enhanced Sleep: Writing in a gratitude journal before bed can improve sleep quality and increase sleep duration. This may be due to the reduction in negative thought patterns and ruminations before sleep.
Reduced Physical Symptoms: Individuals who regularly practice gratitude report fewer physical symptoms, feel better about their health, and are more likely to engage in healthy behaviors, such as exercising regularly.
Increased Resilience: Gratitude can act as a buffer against stress and may enhance resilience against traumatic events. People who regularly express gratitude tend to recover more quickly from adversity and experience less trauma-related distress.
Improved Relationships: Expressing gratitude can increase feelings of connectedness and satisfaction in relationships. Couples who regularly express gratitude towards each other report higher levels of relationship satisfaction. Gratitude can also promote pro-social behavior, making individuals more likely to help others and build social bonds.
Enhanced Empathy and Reduced Aggression: People who are more grateful are less likely to retaliate against others, even when given negative feedback. They demonstrate a reduced desire to seek revenge and show increased empathy.
Positive Reinforcement: When individuals notice and jot down what they're grateful for, it serves as a form of positive reinforcement. Over time, they may begin to notice and appreciate positive events and moments more, amplifying the beneficial effects of gratitude.
Boosted Self-Esteem: Gratitude has been shown to increase self-esteem, potentially by reducing social comparisons. Instead of becoming resentful toward people who have more (a common reaction driven by envy), grateful people can appreciate others' accomplishments.
Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389.
Froh, J. J., Sefick, W. J., & Emmons, R. A. (2008). Counting blessings in early adolescents: An experimental study of gratitude and subjective well-being. Journal of School Psychology, 46(2), 213–233.
Lyubomirsky, S., Dickerhoof, R., Boehm, J. K., & Sheldon, K. M. (2011). Becoming happier takes both a will and a proper way: An experimental longitudinal intervention to boost well-being. Emotion, 11(2), 391–402.
Toepfer, S. M., Cichy, K., & Peters, P. (2012). Letters of Gratitude: Further Evidence for Author Benefits. Journal of Happiness Studies, 13(1), 187-201.
Watkins, P. C., Woodward, K., Stone, T., & Kolts, R. L. (2003). Gratitude and happiness: Development of a measure of gratitude and relationships with subjective well-being. Social Behavior and Personality: an international journal, 31(5), 431-451.
Algoe, S. B. (2012). Find, remind, and bind: The functions of gratitude in everyday relationships. Social and Personality Psychology Compass, 6(6), 455-469.
Wood, A. M., Maltby, J., Stewart, N., & Joseph, S. (2008). Conceptualizing gratitude and appreciation as a unitary personality trait. Personality and Individual Differences, 44(3), 621-632.
Seligman, M. E., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5), 410.
Emmons, R. A., & Mishra, A. (2011). Why gratitude enhances well-being: What we know, what we need to know. In Designing positive psychology (pp. 248-262). Oxford University Press.
This is a tool for those who are working through difficult memories and childhood experiences. It is a structured approach to surface the memories and to tap into the brains visual processing with the intent of lessoning the power of the trauma(s).
Uncovering Unconscious Beliefs Using The Trauma Egg
The Trauma Egg was developed by Marilyn Murray as part of her theoretical treatment model for treating emotional trauma called, The Murray Method, and later adapted by Patrick Carnes in his work with sexual addiction. It is a useful tool for processing various levels of trauma, from hurtful childhood experiences to big traumas, to help anyone understand the impact of their experiences on their lives. Traditionally, this exercise works best in a group format, with the support of others, but individual therapy works well too.
As homework, ask your client or congregant to spend about two hours drawing the trauma egg using the following directions and referring to the picture provided as a template on the last page. Pace your next session so that you can cover the whole Trauma Egg together in one session.
Drawing the Trauma Egg
The goal is to go through all of the Trauma Egg, identify key feelings and mission statement.
Ask your clients to describe each drawing briefly. Have them elaborate on feelings and have them make statements about the self.
• Ex. “What do you think you were saying to yourself about yourself at that moment/time?” and “What were you feeling then?”
After the client goes over all the drawings, encourage the client to reflect on the whole picture and ask him/her to fill in the blanks (without thinking too much) as you read the four elements of the mission statement:
Mindfulness, meditation and breathing