Tag: EMDR

EMDR and Interoception

Posted on by TriWellness in Blog, Uncategorized

Have you ever noticed that a certain thought, memory or experience can cause a physical reaction in your body? Our emotions are tied to this process. Noticing our body’s physical reaction is an important first step in learning emotion regulation. When you can identify it, you can begin to apply techniques to manage the distress  (See April’s blog, When “Just Breathe” Isn’t Enough). Awareness and sensitivity to the connection between cognitive activity, or negative cognitions as we refer to them in EMDR, and the body’s internal signals that accompany those thoughts or memories are an important part of the EMDR process.  

Interoception is the ability to identify physical sensation in the body, including the functioning of organs such as heartbeat, respiration and satiety, as well as the state of the autonomic nervous system (rest & digest, fight/flight or freeze). Take a moment and notice if your body feels pleasant, unpleasant, or neutral. How do you know? Have you felt some tension in your shoulders ever since that guy cut you off in traffic? Did you just come back from the gym and notice that your heart rate is faster? Maybe you just spent some time doing one of your favorite things and now you’ve noticed that the muscles in your face have relaxed.

For a little practice “noticing,” the Pendulation technique created by Dr. Peter Levine, is a good starter exercise. To “pendulate” is to shift back and forth from one thing to another. Give the following a try:

  1. Do a body scan from head to toes and try to identify a part of your body that is distress free/neutral and focus on that for a moment. Does your breathing become more regulated, or your heart rate slow down?
  2. Next identify a part of your body that is uncomfortable or perhaps painful and focus on that for a moment. You may notice your breath, heart rate change or perhaps an increase in intensity as you bring your attention to it.
  3. Now shift your attention from the neutral part back to the uncomfortable part a couple of times. The uncomfortable part will likely begin to change, lessen in intensity or go away completely.

Now that you’ve practiced interoception, let’s move on to how this is an integral part of EMDR treatment for trauma. In October’s blog, Uncovering the Mysteries of EMDR and Trauma, I explain in detail how a traumatic event and the negative cognition associated with that event (exp. “I should have done something.”) leaves an imprint in the nervous system. The result is a whole slew of bodily reactions and sensations that can be activated in the future. Perhaps a completely unrelated and non-traumatic situation generates that same cognition of “I should have done something.” Due to the imprint that the previous trauma left, that negative cognition can conjure all of those same physical reactions, even when there is no danger. During EMDR, in addition to treating the traumatic memory, it detaches the associated negative cognition and discharges all of those physical changes in the body. During treatment I will frequently ask the client to do a body scan and tell me what they are noticing. Then we focus on clearing out the sensations that the client is noticing in their body. It may be a heaviness in their chest, nausea or a lump in their throat. Part of preparing for EMDR (phase 2) is teaching the client how to identify even the slightest changes in their body. The skill of interoception is incredibly useful in day to day life. Paying attention to how your body responds as you move through your day, from environment to environment and from one encounter to another. Listen to those cues and use those as a roadmap to create change and a lifestyle that is healthy and happy for you. And of course, seek out a skilled EMDR therapist to help you with the big stuff.

Resources

To learn more about Dr. Peter Levine and his work on Somatic Experiencing visit: https://traumahealing.org/about-us/

To learn more about EMDR visit:  http://www.emdr.com/

To learn more about our practice or wanting to connect with an EMDR clinician? Please contact us to set up an appointment.

This post was written by Tonya Nowlin, MA, LPC, to learn more about her please see her bio.

When “Just Breathe” Isn’t Enough

Posted on by TriWellness in Blog

It seems almost everyone is struggling right now in some way. I think it is safe to assume the COVID-19 global pandemic has brought major change to pretty much everyone in one aspect or another. For some the disruption is mere inconvenience, but for many the changes represent a major trauma. Wherever you fall on this spectrum, conditions are ripe for mental health challenges. Some of those challenges may bring intense emotions, intrusive thoughts, bodily discomfort, and possibly traumatic memories.  We’ve all been told to “just breathe” at one point or another. It can come across as diminishing or making light of the distressing feelings, as if it is a magic eraser or cure-all. While diaphragmatic breathing with mindfulness and intention can be quite effective, for some kinds of distress, it is not enough. The following are some exercises that can address disturbing thoughts, feelings, memories and bodily sensations/discomfort.

ENERGY SWIRL (Shapiro 2012)

Here is a technique that anyone can use.  It is from Francine Shapiro’s book, Getting Past Your Past:  Take Control of Your Life with Self-Help Techniques from EMDR Therapy.  It is called the Spiral Technique (found on page 108).

 If you are experiencing upset or discomfort, try the following:

  1. Bring up an image that represents your discomfort.
  2. As you think of the image that represents it, notice where you feel the disturbance in your body.
  3. Now pretend that the feeling is “energy.”  If it was a spiral of energy, which direction is it moving in:  clockwise or counterclockwise?
  4. Now, with your mind, gently change the direction of the spiral in your body.  For instance, if it was originally moving clockwise, gently change it to counterclockwise.

Notice what happens to the feelings in your body.  For many people, their feelings will lessen as they change the direction of the spiral.  If one direction didn’t work, try the other direction and see if it lessens the disturbance.  If this has been helpful, practice this regularly so it becomes a stronger coping skill for you!

LIGHT STREAM (Shapiro 2012)

  1. Bring up some disturbing thought, feeling, memory or sensation and concentrate on the body sensations that accompany the disturbance. 
  2. Next bring a disturbing memory, situation, feeling, or sensation to mind and notice the resulting changes in the body sensations. 
  3. Now concentrate on the feeling in your body…. If the feeling had a shape what would it be? 
  4. And if it had a size, color, temperature, texture (exp. prickly), and sound (high or low pitch), what would it be?
  5. Which of your favorite colors might you associate with healing? 
  6. Imagine that this favorite colored light is coming in through the top of your head and directing itself at the shape in your body. Let’s pretend that the source of this light is the cosmos: The more you see, the more you have available. The light directs itself at the shape and penetrates it, resonating and vibrating in and around it. As it does, what happens to the shape, size, or color?
  7. As the light continues to direct itself to that area, you can allow the light to come in gently and easily fill your entire head. Now allow it to descend through your neck, into your shoulders, and down your arms into your hands and out your fingertips. Now allow it to come down your neck and into the trunk, fill your body, easily and gently. Now allow it to descend through your buttocks into your legs, streaming down your legs and flowing out through your heel. 
  8. Lastly, I’d like to ask you to become awake and aware on the count of five, four, three, two, one…

THE BASIC EXERCISE FOR VAGAL TONE AND NERVOUS SYSTEM RESET

The following is an exercise that can help regulate the nervous system, which can either become underactive (depression) or overactive (fight/flight/freeze) during times of distress. Toning the vagus nerve also activates the “social engagement” reward center in the brain, which we can all use right now.

  1. Lie down or sit upright comfortably in a chair with support.
  2. Gently roll your head and stretch your neck side to side, noticing and tension or pain.
  3. Interlock your fingers and cradle the back of your head at the base of your skull, supporting it as you remain facing forward.
  4. Moving only your eyes, look up and to the right as far as you can (may be some mild discomfort) and hold this position 30-60 seconds at a minimum, until you notice a sigh, yawn or swallow. This is a release of tension. You may feel a sensation of calm trickle down from your head like a waterfall.
  5. Once you notice this shift, come back to center.
  6. Repeat on the left side until you notice this same shift.
  7. Come back to center, take a deep cleansing breath. 
  8. Rotate your head and stretch your neck, noticing how it feels differently than it felt in the beginning.

(If you feel slightly dizzy, this is normal. It means you fully relaxed and your blood pressure dropped. Take a moment for this to subside before standing)

LEAVES ON A STREAM

This guided meditation script is a popular Acceptance and Commitment Therapy (ACT) exercise designed to diffuse negative thoughts. 

Leaves on a stream Guided Meditation Script

Imagine you are sitting or standing in the middle of a stream. 

The water is flowing away in front of you. 

Notice if there is any sound from the running water.

Notice if there are any trees, etc. on the banks of the stream.

Now see leaves floating down the stream away from you.

They can be any shape, color, or size. 

As the negative thoughts come into your mind, 

be aware of what the thought is, 

and then place it on a leaf.


Now watch it float away down the stream.

Do this with each thought as you notice it and for as long you like until you feel better.

As you acknowledge each of your thoughts,

you do not need to hang onto them. 

There is no need to become attached to the thought. 

Just acknowledge it and then place it on a leaf.
By watching it float away, it loses its hold on you and its intensity.

For more information on these techniques and others please check out:

  • Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR therapy. Emmaus, Pa: Rodale Books.
  • Rosenberg, S. (2017). Accessing the healing power of the Vagus Nerve. Berkeley, CA: North Atlantic Books.
  • Walser PhD, R. (2007). Acceptance and Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder and Trauma Related Problems. New Harbinger Publications.

If you find that your symptoms are unmanageable through these or other exercises, perhaps seeking the assistance of a licensed professional may be necessary. Most mental health professionals are offering telehealth services due to social distancing. TriWellness clinicians continue to offer services utilizing HIPAA compliant teletherapy services, contact us to schedule a free brief phone consultation today.


This article was written by Tonya Nowlin, MA, LPC. To learn more about Tonya please visit her bio.

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EMDR Preparation Phase

Posted on by TriWellness in Blog

Arguably the most important step in EMDR treatment is the preparation phase. Since the EMDR process involves recalling disturbing memories, feelings and sensations, it is of utmost importance for clients to have tools to manage those and stay within their “window of tolerance.” Window of tolerance, a term coined by Dr. Dan Siegel, is now commonly used to understand and describe the body’s autonomic nervous system response to stress and trauma. The “window” is the state of our nervous system that is neither under (hypo) or over (hyper) aroused, but in the state of “rest and digest.” For most clients, the preparation phase will take from 1-4 sessions. For others with more complex histories of trauma/adverse experiences, it can be much longer. The following are some tools an EMDR trained clinician will teach a client to manage their stress response and allow them to comfortably go about life as normal during the treatment.

Safe/Calm Space

In this exercise, the clinician will ask the client to think of a place, either real or imagined, where the client feels completely safe and calm. The clinician will ask the client to fully engage the senses and imagine the scene, including temperature, smells, sounds and other sensations. Once the safe/calm space is identified, the clinician will ask the client to notice how their body feels when thinking about this space. For this to be an effective tool when distressed, the client should feel no discomfort when bringing the image to mind and should notice a mental and physical shift that will clear the client’s mind of distressing thoughts, decrease heart rate, slow the client’s breathing and relax the body. The clinician will then have the client practice shifting “states” by thinking of something mildly disturbing and noticing how their body reacts, followed by imagining their space and noticing the mental and physical shift. The more the client uses this in and outside of session, the effect is strengthened and becomes easier to access when needed.

Container

This tool is used at the end of session to provide a mental holding space for whatever content is being processed to be placed until next session. It is also helpful when the client’s thoughts outside of session are such that they are too distressing for a client to manage at any given moment. The clinician will ask the client to imagine a container that is large enough to contain whatever the client needs to put inside and also comfortable enough so that whatever is placed inside will stay inside. The container should have a two-way system, in which big thoughts and feelings can be placed at once and small amounts can be accessed at a time. A client may choose a barrel with a spout at the bottom, or a jewelry box with a spinning mechanism to select one item at a time. Clients tend to get creative with this one! Just like the safe/calm space, the clinician will have the client practice using this tool in a similar way, noticing the physical and mental shift when placing thoughts and feelings inside. Clients will continue to “process” the material being targeted outside of session and it is essential that the client have this container to avoid undue distress in between sessions. Whatever the client chooses to place there will inevitably be retrieved and processed in session under the direction and care of the clinician.

There is no one size fits all resource. For whatever reason, a client may not find these two tools to be effective. There is no right or wrong here. The clinician and client can get creative and tailor the tools to fit each individual. Deep breathing exercises like Yogic Breathing, yoga stretching, aromatherapy and music can be just as effective. What is most important in EMDR treatment success is finding a clinician who will meet the client where they are and is willing to experiment with different tools and strategies to make the treatment process not only effective, but manageable.

If you are interested in learning more about EMDR or would like to schedule an appointment, reach out through the contact page or call our office.

This article was written by Tonya Nowlin, MA, LPC. To learn more about Tonya please visit her bio.

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EMDR & Bilateral Stimulation

Posted on by TriWellness in Blog

(It’s not just for trauma!)

Eye Movement Desensitization and Reprocessing (EMDR) has been best known for decades as an evidence based therapeutic intervention for treating trauma. In my previous post, Uncovering the Mysteries of EMDR, I explained the function and process of EMDR as it is used to treat traumatic memories/incidents. Since EMDR isolates and targets maladaptive neural networks, that process can be applied to other diagnosis, such as phobias/anxieties, grief and addictions. These maladaptive neural networks present as negative core beliefs, which carry over and negatively impact other areas of our lives.

Grief

Someone struggling with the loss of a loved one may develop the negative core belief, “I should have done something,” “I’m powerless,” or “I’m abandoned.” These are maladaptive thoughts that can carry over into relationships or work. If a person views their world through the lens that they have no power or control, they may not speak up for themselves at work, which can snowball into other problems. EMDR/Bilateral Stimulation can be used to desensitize that core belief, along with the strong emotions associated with it, and replace it with one that is more adaptive. As an example, a person who feels they “should have done something,” may be released from that and realize they did what they could, or maybe they can recognize what they can cannot control. These shifts in thought can enable individuals to grieve and process their loss in healthy ways.

Phobias/Anxiety

Someone with social anxiety may have the negative core belief, “I’m invisible” or “I’m not good enough.” In this example, an EMDR therapist can desensitize those maladaptive thoughts and reduce the unwanted emotions associated with those thoughts. Lastly, the therapist can help the client think of the situation adaptively and imagine themselves in future worst-case scenarios, feeling differently, while strengthening those positive neural networks with bilateral stimulation. Once treatment is complete, the client will no longer feel that anxiety in social situations.

Addiction

Someone who struggles with addiction may possess the core belief, “it’s not safe to feel,” or “I’m defective.” These thoughts would be treated in the same manner as my previous examples. What makes EMDR a stand-out treatment for addiction, is the ability to desensitize triggers that lead to using and reduce the urges. EMDR can also be used to strengthen adaptive, alternative behaviors and coping skills.

If you are interested in learning more about EMDR or would like to schedule an appointment, reach out through the contact page or call our office.

This article was written by Tonya Nowlin, MA, LPC. To learn more about Tonya please visit her bio.

Uncovering Mysteries of Trauma and EMDR

Posted on by TriWellness in Blog

Eye Movement Desensitization and Reprocessing (EMDR) is an 8-phase, evidence-based treatment for trauma. In order to understand the function of EMDR, it is helpful to understand what is trauma. The Substance Abuse and Mental Health Services Administration (SAMHSA) describes trauma as “events or circumstances experienced by an individual as physically or emotionally harmful or life threatening, which result in adverse effects on the individual’s functioning and well-being.” One of the simplest, working definitions of trauma I have come across is that trauma is any experience or event that is too much, too soon or too fast for our nervous system to handle, especially if we can’t reach a successful resolution. Trauma does not reside in a specific event or experience, but rather in the physiological response within the nervous system. Working within this definition of trauma, it is easy to see how trauma can put individuals  at a greater risk for health-risk behaviors and chronic health conditions later in life, though few people realize there is a connection.  Health-risk behaviors and how those impact our lives, as well as somatic symptoms associated with trauma are typically what brings people to therapy.

The EMDR approach to treatment of trauma believes past emotionally charged experiences and their impact on our central nervous system, are overly influencing your present emotions, sensations, and thoughts about yourself. EMDR processing helps to break through the emotional blocks that prevent people from living adaptive and emotionally healthy lives. Additionally, allowing our bodies and minds to retrieve and “reprocess” these events, which we were not able to do before, i.e., “too much, too soon, too fast,” Another way I like to explain this process is like retrieving an old misplaced file from the hard drive, editing and saving it in a new location.

So how on earth is that possible, you might ask? Well, our brains already possess the tools for this job. It’s called Rapid Eye Movement, otherwise known as REM. When we go to sleep, we (ideally) fall into what we call REM sleep. For someone with a sleep disorder, they are likely not getting much of this. This is the stage of sleep that allows our brains to process the input from the day. REM sleep is essential for our health. EMDR essentially replicates this rapid eye movement through a process called bi-lateral stimulation. This can be achieved by either tracking the clinicians’ fingers in a swift, left-right pattern for a certain number of “sets,” or it can be achieved through tactile stimulation by holding a small vibrating device, that we call “tappers”, in each hand. The tappers alternate in the same left-right sequence. A third option is auditory, which involves binaural tones heard through headphones. All methods are effective, and it is based on client preference as well as to which the clinician will use. Some clients who suffer from migraines may find that finger tracking causes strain on the eyes and can possibly trigger a headache. In cases such as this, one of the other methods would be best.

One thing that many clients like about EMDR, is that it is not necessary to talk about all the details of your experiences with the clinician for them to be processed. All that is required is for the client to think about the experience or event. This process essentially fires up the affected neural networks in the brain that we have triggered. Once processing is complete, the client’s recollection is NOT erased, but is experienced differently. Instead of reliving the experience, with all its intensity, it loses the emotional and physical charge. Our brains have essentially “digested” it.  I like to compare it to looking at the event out the window of a train and just watching it pass by without the mental or physical impact that use to accompany such recollection.

Helpful resources

http://www.emdria.org/

www.EMDRConsulting.com

www.EMDR.com

http://www.emdrnetwork.com/

If you are interested in learning more about EMDR or would like to schedule an appointment, reach out through the contact page or call our office.

This article was written by Tonya Nowlin, MA, LPC. To learn more about Tonya please visit her bio.