WEBVTT 00:00:10.562 --> 00:00:18.381 - My name's Ashley Collins, and I am here to tell you good morning, and thank you for joining this breakout 00:00:18.381 --> 00:00:25.905 - session. We're happy to have Kara Berch presenting today for the session of Not Just Smoking Mirrors, 00:00:25.905 --> 00:00:33.282 - The Science Behind the Magic of EMDR. And EMDR is an amazing tool to have in your toolkit. And even 00:00:33.282 --> 00:00:38.814 - if you're not a clinician, it's great to understand how it actually works. 00:00:38.946 --> 00:00:44.327 - A quick housekeeping item before we get started, if you're planning to receive continuing education 00:00:44.327 --> 00:00:49.708 - credits for this session, please make sure that you've signed in on the sign-in sheet. There should 00:00:49.708 --> 00:00:54.174 - be one at your table. I have an extra one if your table happens to be missing one. 00:00:54.274 --> 00:01:02.366 - and you need to mark the time in that you arrive. Make sure to also sign out at the end of the session 00:01:02.366 --> 00:01:10.378 - and please stay until the end to scan your QR code and get the six digit code at close of the session 00:01:10.378 --> 00:01:18.470 - to receive your CEUs. I'm gonna turn it over to Kara. Thank you Kara. Hey everybody, good morning. Can 00:01:18.470 --> 00:01:23.262 - you guys hear me okay in the back? Can you hear me too okay? 00:01:23.650 --> 00:01:29.623 - No, okay, great, let me know if you can hear me too, okay, also let me know if you can't hear me, okay, 00:01:29.623 --> 00:01:35.367 - enough. So welcome, so glad to be here talking to you today, and I always kinda like to get a sense 00:01:35.367 --> 00:01:41.111 - of who I'm talking to. So we're gonna do just like an informal little poll here. Can you raise your 00:01:41.111 --> 00:01:46.854 - hand if you're a direct service provider, such as a counselor, a licensed social worker, a marriage 00:01:46.854 --> 00:01:51.966 - and family therapist, like a direct service clinician? Okay, and how about peer support? 00:01:53.186 --> 00:02:04.517 - Educators? Medical? All right. And let's see, students. There we go. All right. Welcome, everybody. 00:02:04.517 --> 00:02:14.942 - Anyone that I missed? Legal. Legal. Legal. Wave your hand in the air. All right. Thank you. 00:02:15.522 --> 00:02:21.140 - Again, I'm here to talk about EMDR from the scientific perspective because I know that it's a little 00:02:21.140 --> 00:02:26.703 - bit out there for somebody to walk into their office and somebody to say, hey, I'm going to go like 00:02:26.703 --> 00:02:32.321 - this and wave my hand in front of your face and you're going to feel better. That seems a little bit 00:02:32.321 --> 00:02:38.218 - like woo-woo. And so I'm here to talk about the science behind it, what research has been done to support 00:02:38.218 --> 00:02:39.998 - it, what EMDR is actually like. 00:02:40.354 --> 00:02:46.551 - in practice and how it can help. Another quick round of, or show of hands, if you feel comfortable to, 00:02:46.551 --> 00:02:52.808 - if you've ever experienced EMDR, had a family member, friend, or colleague experience EMDR. Okay, yeah, 00:02:52.808 --> 00:02:59.004 - so it's getting around out there. All right, so what are we gonna do today? We're gonna talk about the 00:02:59.004 --> 00:03:05.081 - theory and research behind EMDR. We're gonna learn about the adaptive information processing system, 00:03:05.081 --> 00:03:08.510 - which is sort of the lens through which we look at EMDR. 00:03:08.706 --> 00:03:13.792 - We're going to understand what trauma is, talk about different types of trauma, understand how traumatic 00:03:13.792 --> 00:03:18.685 - events are processed by the brain, which is actually key in understanding EMDR, and just learn about 00:03:18.685 --> 00:03:24.062 - the basic structure and practice of EMDR. What does it look like? What can I expect when I walk into the room? 00:03:25.922 --> 00:03:32.761 - So what is EMDR? Eye movement desensitization and reprocessing therapy. It is an integrative psychotherapy 00:03:32.761 --> 00:03:39.472 - approach. It's been extensively researched. It's very highly evidence-based for the treatment of trauma. 00:03:39.472 --> 00:03:45.863 - EMDR therapy includes a set of standardized protocols that incorporate elements from many different 00:03:45.863 --> 00:03:52.318 - treatment approaches. So it is evidence-based. The person who developed EMDR, Francine Shapiro, was, 00:03:52.674 --> 00:03:59.513 - very dogged about getting EMDR evidence-based because again, it sounds a little bit crazy to say, I'm 00:03:59.513 --> 00:04:06.420 - gonna go like this and you're gonna feel better. And so her mission throughout her professional career 00:04:06.420 --> 00:04:13.326 - after developing EMDR was to get at research to the point that right now EMDR and CBT are the two most 00:04:13.326 --> 00:04:17.886 - highly researched forms of therapy out there. So why eye movements? 00:04:18.562 --> 00:04:24.140 - So eye movements are thought to mimic neural processes that happen in REM sleep. You guys are familiar 00:04:24.140 --> 00:04:29.718 - with REM sleep, REM, rapid eye movement. And if you've ever watched somebody in REM sleep, you can see 00:04:29.718 --> 00:04:35.567 - their eyelids twitching, their eyes are moving back and forth rapidly during that stage of sleep. Sometimes 00:04:35.567 --> 00:04:41.253 - their eyes are halfway open and it looks really creepy. But that's that rapid eye movement in REM sleep. 00:04:41.253 --> 00:04:44.990 - It seems to activate the brain's natural problem solving mechanisms. 00:04:46.594 --> 00:04:52.685 - The mechanism, again, I use the word seems to be based in bilateral cross-body stimulation or dual attention 00:04:52.685 --> 00:04:58.665 - stimulation, meaning a couple of things happening at the same time. And different forms in EMDR, different 00:04:58.665 --> 00:05:04.645 - forms of bilateral stimulation can be used. We call it EMDR because that's when Francine Shapiro developed 00:05:04.645 --> 00:05:10.401 - it. Her first form of bilateral stimulation was eye movements. She was actually quoted later on in her 00:05:10.401 --> 00:05:15.486 - career saying she wished she just called it reprocessing therapy because everybody's like, 00:05:15.586 --> 00:05:23.947 - what's this eye movement thing, especially as different forms of bilateral stimulation, including tactile 00:05:23.947 --> 00:05:32.387 - and audio, can be used. So, Francine Shapiro's initial research. This was published in 1989 in the Journal 00:05:32.387 --> 00:05:41.694 - of Traumatic Stress. And she started out with a population of 22 clients with symptoms related to traumatic memories. 00:05:41.922 --> 00:05:49.017 - The clients that were part of this study or the participants that were part of this study had traumatic 00:05:49.017 --> 00:05:55.839 - incidents including having served in the Vietnam War, having been victims of some type of sexual or 00:05:55.839 --> 00:06:02.730 - physical assault or emotional abuse, childhood sexual molestation. And so the presenting complaints, 00:06:02.730 --> 00:06:10.030 - the symptoms that were recorded were intrusive thoughts and flashbacks, kind of classic PTSD symptomology, 00:06:10.030 --> 00:06:11.326 - sleep disturbance, 00:06:11.650 --> 00:06:18.420 - And then low self-esteem slash relationship issues. Sometimes we think about this in the clinical world 00:06:18.420 --> 00:06:25.255 - as feelings of worthlessness, right? Low self-esteem relational relationship issues. So in this research 00:06:25.255 --> 00:06:31.960 - study, and the reason this is important is because the EMDR protocol is actually kind of based on this 00:06:31.960 --> 00:06:38.014 - primary research. In this research study, the following measurements were used. The level of 00:06:38.114 --> 00:06:43.908 - anxiety or we would say disturbance, subjective units of disturbance scale, it's a zero to 10 scale. 00:06:43.908 --> 00:06:49.644 - Just like when you go to the hospital and they ask you how intense is your pain, zero means there's 00:06:49.644 --> 00:06:55.495 - no pain, 10 is the absolute most excruciating pain possible, and then we have in between with our SUD 00:06:55.495 --> 00:07:01.346 - scale or subjective units of disturbance scale, zero is no disturbance or neutral, 10 is the absolute 00:07:01.346 --> 00:07:06.910 - worst that that anxiety or that disturbance, that panic could feel, and then we have in between. 00:07:07.778 --> 00:07:14.513 - The second measurement is what we call the VOC, this is gonna make more sense later on, but the validity 00:07:14.513 --> 00:07:21.376 - of cognition. And this is a modified Likert scale, so a typical Likert scale, one to five, right? Strongly 00:07:21.376 --> 00:07:27.919 - disagree, disagree, neither agree nor disagree, agree, strongly agree. So a modified Likert stretched 00:07:27.919 --> 00:07:34.846 - out to seven so that we could see a little bit more nuanced movement of the positive self-statement, right? 00:07:35.010 --> 00:07:42.996 - Positive self-statement being something that feels like an adaptive resolution to the trauma. I am worthwhile 00:07:42.996 --> 00:07:50.329 - regardless. I am safe. I survived. Those are just examples of a positive self-statement. Things that 00:07:50.329 --> 00:07:55.774 - don't feel very true when we are suffering from this type of symptomology. 00:07:56.866 --> 00:08:03.058 - So of course, she split her subjects into two groups, the EMD group, which was just calling it EMD at 00:08:03.058 --> 00:08:09.432 - that point, eye movement desensitization, hadn't really added the reprocessing part yet. And there would 00:08:09.432 --> 00:08:15.928 - be short sets of bilateral stimulation, which is just following somebody's hand as they move their fingers 00:08:15.928 --> 00:08:22.423 - back and forth like that, or their hand out back and forth like that. Blank it out, think of the incident, 00:08:22.423 --> 00:08:26.430 - how disturbing is it now, zero to 10. If other incidents came up, 00:08:26.530 --> 00:08:33.939 - that interfered with the original incident, they would just continue the same intervention using these 00:08:33.939 --> 00:08:41.131 - bilateral stimulation. When the disturbance level reached zero, the positive thought was installed, 00:08:41.131 --> 00:08:48.468 - again, using eye movements to sort of increase how true that positive thought felt. The control group 00:08:48.468 --> 00:08:54.366 - was told to just think about the incident. No bilateral stimulation, blanket out, 00:08:54.722 --> 00:09:02.860 - Now think of the incident how disturbing zero to 10. And occasionally, intermittently would measure 00:09:02.860 --> 00:09:11.243 - that VOC. So the results here are pretty interesting. You can see in column A here, right, this is our 00:09:11.243 --> 00:09:18.974 - EMD group. This is the subject of units of disturbance. We started with about seven and a half 00:09:19.266 --> 00:09:26.334 - Average for that group, by the end of the desensitization, it was down to a little over one. The control 00:09:26.334 --> 00:09:33.335 - group, again, they were asked to just think of the disturbing incident, think of the disturbance, think 00:09:33.335 --> 00:09:40.067 - of the memory, without adding any bilateral stimulation. And you can see their disturbance actually 00:09:40.067 --> 00:09:46.462 - went up. So started around the same place as our EMD group, actually increased to almost nine. 00:09:46.562 --> 00:09:52.858 - So then Francine Shapiro did something that researchers are like, this is a big no-no. But she didn't 00:09:52.858 --> 00:09:59.585 - really feel okay about this because she's also a humanitarian. She was involved in founding the Humanitarian 00:09:59.585 --> 00:10:05.758 - Assistance Program and did not feel okay with this. So she came back and she retreated the control, 00:10:05.758 --> 00:10:09.214 - or yeah, the control group. And you can see that there, 00:10:09.314 --> 00:10:14.161 - ending result for the control group was about the same as the experimental group. And again, she was 00:10:14.161 --> 00:10:18.960 - criticized for that because they're saying, well, you can't do longitudinal studies on that. That's 00:10:18.960 --> 00:10:23.856 - not pure research, blah, blah, blah. And she's like, well, I'm not going to leave people suffering if 00:10:23.856 --> 00:10:28.703 - I have a thing that I think is going to help them. So like, amen, sister. So now we're going to talk 00:10:28.703 --> 00:10:33.502 - about the flip side of the coin, the validity of the positive cognition pre and post EMD treatment. 00:10:34.274 --> 00:10:43.316 - So we can see, again, our experimental group A, when they started, their positive cognition, their adaptive 00:10:43.316 --> 00:10:51.939 - resolution statement, I am worthwhile, I survived, I'm okay now, whatever that positive statement was, 00:10:51.939 --> 00:11:00.478 - we say the felt truth of it, not like logically how much your thinking brain knows that you survived. 00:11:00.610 --> 00:11:08.079 - because our thinking brains are frequently not, almost never, what's really driving the disturbance, 00:11:08.079 --> 00:11:15.621 - right? It's our emotional brains, it's our nervous system that's driving the disturbance. And so what 00:11:15.621 --> 00:11:23.163 - she saw with the research is that, again, starting with a very low validity of cognition, of positive 00:11:23.163 --> 00:11:30.558 - cognition, so we ask somebody when you think about the positive belief, I am worthwhile regardless, 00:11:31.586 --> 00:11:37.893 - And we say if one is totally false, you don't believe that, that doesn't feel true to you at all right 00:11:37.893 --> 00:11:44.077 - now in this moment. And seven is totally true. How true does that feel? Started around one, went all 00:11:44.077 --> 00:11:50.445 - the way up to six, which is mostly true, right? Again, the control group had very little movement. When 00:11:50.445 --> 00:11:56.814 - she went back and retreated the control group, it also increased significantly. So that was the initial 00:11:56.814 --> 00:12:01.406 - research. So the outcome, the desensitization of a highly traumatic memory 00:12:01.570 --> 00:12:07.657 - type of memory that's causing sleep disturbance, nightmares, and flashbacks. Cognitive restructuring 00:12:07.657 --> 00:12:13.805 - of the verbalized self-statement, which is basically a way of saying thinking about it differently on 00:12:13.805 --> 00:12:19.892 - a deeper level. Better sleep, fewer nightmares, reduction of flashbacks, startle response, all those 00:12:19.892 --> 00:12:21.278 - classic PTSD symptoms. 00:12:22.018 --> 00:12:28.405 - So that was her first published research study. Since then, there's been, as I said, so much study on 00:12:28.405 --> 00:12:34.667 - EMDR encouraged by Francine and the Francine Shapiro Memorial Fund. And so there's lots of research 00:12:34.667 --> 00:12:41.117 - out there now, and there's research out there about using EMDR with other presenting issues other than 00:12:41.117 --> 00:12:47.879 - trauma. I say other than trauma, but we know that trauma's underlying almost everything that we're treating 00:12:47.879 --> 00:12:49.758 - when we walk into the office. 00:12:50.370 --> 00:12:57.063 - including research on how is this working? So research on REM sleep, research on orienting response, 00:12:57.063 --> 00:13:04.154 - which is how our minds and nervous systems orient between something that is considered a threat, something 00:13:04.154 --> 00:13:10.914 - that's not a threat, and are we able to sort of like calm when we recognize a potential threat is not 00:13:10.914 --> 00:13:18.270 - a threat, that's about orienting response. Working memory, taxing working memory, which EMDR does through dual 00:13:18.370 --> 00:13:25.019 - stimulation to things happening at the same time, research on texting working memory and how that can 00:13:25.019 --> 00:13:32.124 - help move things into long-term memory storage in a more processed way so that when that memory is recalled, 00:13:32.124 --> 00:13:37.534 - it is recalled as a memory, not as something that feels like it's happening again. 00:13:37.826 --> 00:13:46.446 - Lots of meta-analyses out there, comparing EMDR to exposure therapy, comparing EMDR to CBT, and finding 00:13:46.446 --> 00:13:55.149 - that they were, in many cases, equally effective. And then, of course, randomized clinical trials. There 00:13:55.149 --> 00:14:03.769 - are over 40 randomized clinical trials at this point. So, I'm not gonna go through all of this research 00:14:03.769 --> 00:14:07.582 - line by line, but again, mechanism of action. 00:14:07.810 --> 00:14:15.420 - How does it work? EMDR contains many procedures and elements that contribute to the effect. So we actually 00:14:15.420 --> 00:14:22.816 - don't think it's just one thing with EMDR. Again, we're looking at taxing working memory. We're looking 00:14:22.816 --> 00:14:29.999 - at orienting response. We're looking at the alternating brain waves, REM sleep patterns, things like 00:14:29.999 --> 00:14:33.342 - that. So looking at a lot of different aspects 00:14:33.474 --> 00:14:40.155 - of the mechanisms of action that seem to contribute to it being such a robust therapy. And again, research 00:14:40.155 --> 00:14:46.524 - on a lot of different client populations. The initial research, of course, was on trauma because that 00:14:46.524 --> 00:14:53.017 - is how, or what EMDR was initially developed to treat. But you can find research at this point on using 00:14:53.017 --> 00:14:59.761 - EMDR with almost any client population, including substance abuse. It's very, very effective with substance 00:14:59.761 --> 00:15:03.070 - abuse. So again, not gonna go through each of these. 00:15:03.426 --> 00:15:11.858 - This is why EMDR has such a high evidence-based endorsement rate. So the American Psychiatric Association, 00:15:11.858 --> 00:15:20.448 - the VA, Department of Defense, SAMHSA, World Health Organization. This one I think is particularly important 00:15:20.448 --> 00:15:25.886 - because this particular study focused on trauma-focused CBT in EMDR. 00:15:26.498 --> 00:15:33.506 - as well as a few others, but trauma-focused CBD and EMDR are the only psychotherapies that were recommended 00:15:33.506 --> 00:15:40.060 - for PTSD. And when we talk about, okay, well, if these are our options, you know, is one better than 00:15:40.060 --> 00:15:46.678 - the other? Not saying one is better than the other, but. Some benefits of EMDR. EMDR does not involve 00:15:46.678 --> 00:15:51.934 - detailed descriptions of the event. And why would that potentially be a benefit? 00:15:56.162 --> 00:16:04.764 - Less re-traumatization, absolutely. When we retell the story, sometimes there's a risk of re-traumatization. 00:16:04.764 --> 00:16:12.971 - What else? Yeah, as the provider, you're actually at much significantly less risk for traumatic, sorry, 00:16:12.971 --> 00:16:15.102 - precarious traumatization. 00:16:22.594 --> 00:16:30.405 - If you don't have a complete memory of the event, which happens a lot, there's not a sense of like, 00:16:30.405 --> 00:16:38.216 - I must be crazy, am I making this up, I can't do this, it's not gonna work for me, because we don't 00:16:38.216 --> 00:16:46.731 - need all of that. Any other thoughts about why it might be useful to not have to do the detailed description 00:16:46.731 --> 00:16:50.558 - of the event? I don't wanna talk about it, yeah. 00:16:52.962 --> 00:16:58.371 - I mean, how many of you have heard that? I don't want to talk about it from a child, from an adolescent, 00:16:58.371 --> 00:17:03.780 - from an adult. I get a lot of first responders that don't want to talk about it. I get a lot of military 00:17:03.780 --> 00:17:09.137 - that don't want to talk about it. So yeah, I get people saying I'm so tired of talking about it because 00:17:09.137 --> 00:17:14.494 - talking about it doesn't help me. It hurts me, right? It doesn't involve direct challenging of beliefs. 00:17:14.690 --> 00:17:21.414 - We do have cognitive restructuring of beliefs, but it doesn't involve direct challenging of beliefs 00:17:21.414 --> 00:17:28.138 - the way that CBT does. And why might that be helpful for some people? Yeah, why might it be helpful 00:17:28.138 --> 00:17:34.861 - for some people to not be engaging in direct challenging of beliefs? Like not saying, well, can you 00:17:34.861 --> 00:17:41.854 - see how this is a cognitive distortion and it's really irrational or using that kind of language? Yeah. 00:17:45.410 --> 00:17:52.061 - Could be, yeah, could be hard to admit maybe that we need to change something. Yeah. I feel like it 00:17:52.061 --> 00:17:59.178 - avoids invalidation. Yes, exactly. It avoids invalidation. If this is the way I feel, and it's irrational, 00:17:59.178 --> 00:18:06.029 - and it's actually not helping me in the adaptive present, and somebody says, oh, well, let me tell you 00:18:06.029 --> 00:18:12.414 - your problem. You're thinking about this all wrong. How is that actually going to make me feel? 00:18:12.674 --> 00:18:19.588 - Now, as I said, it's not that we're not doing the cognitive restructuring, but we are doing it in a 00:18:19.588 --> 00:18:26.985 - way that is coming from the client as opposed to from the clinician. It doesn't involve extended exposure. 00:18:26.985 --> 00:18:34.313 - It does involve exposure because we need to be able to be present with emotions that are coming up during 00:18:34.313 --> 00:18:40.190 - the processing, but it doesn't involve extended exposure. Why would that be helpful? 00:18:42.498 --> 00:18:49.868 - Anybody in here do exposure therapy? It's great, it's really useful. And how many of your clients drop 00:18:49.868 --> 00:18:57.023 - out? A lot of clients will drop out of exposure therapy because it's really, really hard. So it can 00:18:57.023 --> 00:19:04.178 - be helpful with EMDR to not have that kind of extended exposure with EMDR. Generally what comes up, 00:19:04.178 --> 00:19:11.476 - even if it's really disturbing for a certain period of time, it will come back down within the course 00:19:11.476 --> 00:19:12.478 - of a session. 00:19:13.698 --> 00:19:20.858 - And it doesn't involve homework. Why is that helpful? There you go. I always tell my clients EMDR homework 00:19:20.858 --> 00:19:27.683 - is amazing because it gets done and you don't have to do it. So yeah, clients are very unlikely to do 00:19:27.683 --> 00:19:33.438 - homework. I'm unlikely to do homework unless I know somebody is going to be checking. 00:19:33.730 --> 00:19:40.163 - And my clients are very unlikely to do homework. So some benefits here of EMDR when we're looking at 00:19:40.163 --> 00:19:46.661 - it as a comparison treatment with trauma-focused CVT. Additional evidence-based, yeah, EMDR is really 00:19:46.661 --> 00:19:53.158 - evidence-based endorsed. There you go, ta-da. Again, other complaints that it's frequently used with, 00:19:53.158 --> 00:19:59.846 - anxiety, panic disorder, OCD, phobias, dissociative disorders, depression, bipolar disorder, complicated 00:19:59.846 --> 00:20:01.566 - grief, stuck grief, right? 00:20:01.922 --> 00:20:08.269 - Body dysmorphia, substance use disorders, pain disorders, they're pain protocols with EMDR. So all of 00:20:08.269 --> 00:20:14.740 - these different presenting complaints can be addressed with EMDR. I don't have complex trauma up there, 00:20:14.740 --> 00:20:21.150 - that's interesting, complex trauma. So now we're gonna talk a little bit about the neurobiology behind 00:20:21.150 --> 00:20:27.621 - EMDR. And so if you like neurobiology, you're gonna love this. If you don't like neurobiology, it won't 00:20:27.621 --> 00:20:28.990 - take long, I promise. 00:20:30.434 --> 00:20:36.829 - All right, so we're gonna talk about parts of the brain. All right, first we got our prefrontal cortex, 00:20:36.829 --> 00:20:43.039 - right? Sometimes we call it the forebrain. It's the thinking part of the brain. It's responsible for 00:20:43.039 --> 00:20:49.250 - processing and reasoning. Language, our language, both receptive and expressive language centers are 00:20:49.250 --> 00:20:55.952 - found in the prefrontal cortex, our thinking brain. Then we have the amygdala. The amygdala is the emotional 00:20:55.952 --> 00:21:00.318 - center of the brain. And it's also responsible for survival instincts. 00:21:01.154 --> 00:21:07.440 - emotions and survival instinct, all right in the same place. Great plan, not really. For survival, we 00:21:07.440 --> 00:21:13.725 - understand why it's helpful. When it comes to thriving, that can be a little bit tricky. It holds the 00:21:13.725 --> 00:21:20.011 - emotional significance of events, but it can hold them in a life or death feeling kind of way. That's 00:21:20.011 --> 00:21:26.420 - why I say the design on that is a little, it's definitely skewed towards what we would call privileging 00:21:26.420 --> 00:21:28.638 - survival, not privileging thriving. 00:21:30.050 --> 00:21:36.182 - And then the hippocampus. The hippocampus is sort of a middle person, middle man, in terms of our memory 00:21:36.182 --> 00:21:42.314 - storage process. If something happens, it's in your short-term memory. It goes to the hippocampus, which 00:21:42.314 --> 00:21:48.446 - is kind of like the little clerk here that's going to decide. How many of you guys have seen Inside Out? 00:21:49.474 --> 00:21:56.146 - Great, okay, so you guys know how this works then, okay? Hippocampus, they're in the control room figuring 00:21:56.146 --> 00:22:02.569 - it out, where's this gonna go? Okay, it's gonna go here, it's gonna get connected to this core memory, 00:22:02.569 --> 00:22:09.366 - and away it goes through the pneumatic tube into long-term memory, right? That's the job of the hippocampus. 00:22:09.366 --> 00:22:11.486 - So, when we are forming a memory, 00:22:11.810 --> 00:22:18.689 - Something happens, right, an event occurs that draws attention. Sensory information is sent to the amygdala. 00:22:18.689 --> 00:22:25.064 - So what we can see, hear, smell, taste, touch, that sensory information comes to the amygdala, which 00:22:25.064 --> 00:22:31.501 - assigns an emotional significance to it. Then our sensory cortices begin forming perceptions based on 00:22:31.501 --> 00:22:37.875 - that sensory information. But notice that the amygdala decides how important it is before any of our 00:22:37.875 --> 00:22:39.390 - sensory cortices, well, 00:22:39.778 --> 00:22:45.062 - except for smell, smell starts almost immediately. But before the other sensory cortices begin their 00:22:45.062 --> 00:22:50.294 - interpretation or their perception, the amygdala has already decided how important this feels. Then 00:22:50.294 --> 00:22:54.270 - the prefrontal cortex and hippocampus begin to categorize their experience. 00:22:54.402 --> 00:23:00.231 - Right, gets consolidated into long-term storage, just like Inside Out shows us, it kind of goes into 00:23:00.231 --> 00:23:06.406 - what I would refer to as a neural network, where it can be retrieved by the hippocampus as needed, updated 00:23:06.406 --> 00:23:12.119 - with new information, before being reconsolidated into long-term storage. And that's how we learn. 00:23:12.119 --> 00:23:18.063 - So like, how many of you, this is the first conference you've ever been to in your life? Okay. If this 00:23:18.063 --> 00:23:22.622 - is the first conference that you've ever been to in your life, you might have, 00:23:22.818 --> 00:23:27.609 - kind of thought maybe you knew what to expect from maybe people that you've talked to, but it might 00:23:27.609 --> 00:23:32.592 - have been really like, I don't really know what this is gonna be like. How many of you is this the 10th 00:23:32.592 --> 00:23:37.383 - or more conference that you've attended in your entire life? Yep, okay. You guys know. You got your 00:23:37.383 --> 00:23:42.174 - cushions, you got your water, you've got your blanket, you've got your fidget toys, you've got your 00:23:42.174 --> 00:23:47.061 - aromatherapy, you've got your snack because they said they'd have gluten-free, but what if they don't 00:23:47.061 --> 00:23:50.942 - have gluten-free, right? You've got all of those things because you have learned 00:23:51.362 --> 00:23:58.055 - by going to conference after conference after conference, what to expect. And every time you go to a 00:23:58.055 --> 00:24:04.815 - conference, your hippocampus is pulling up and integrating the material from this new experience into 00:24:04.815 --> 00:24:11.641 - all of the material that you have from all of these past experiences. And that's how functional memory 00:24:11.641 --> 00:24:17.406 - is created. Again, it's like working with a Word document on a computer. We've got the 00:24:17.922 --> 00:24:24.351 - new document, if you will, then when experience is new, once it's completed, it's saved, consolidated, 00:24:24.351 --> 00:24:30.718 - and stored on the hard drive. That's done by the hippocampus. And then if we want to update it in any 00:24:30.718 --> 00:24:36.961 - way, if we want to add to it, if we want to edit it, if we want to do anything to it, then we would 00:24:36.961 --> 00:24:43.390 - reopen it on our desktop, right, working memory, and then resave it in the hard drive. So it's kind of 00:24:43.586 --> 00:24:49.969 - It's not a perfect metaphor. There's no such thing as a perfect metaphor for the way our minds work 00:24:49.969 --> 00:24:56.990 - because they're so amazingly magical. But that's kind of a good analogy if you can think about how functional 00:24:56.990 --> 00:25:03.373 - memory formation happens. And so this is again how we develop what we would call an adaptive neural 00:25:03.373 --> 00:25:08.798 - network. So adaptive meaning helpful. Adaptive meaning useful. An experience occurs. 00:25:09.410 --> 00:25:16.785 - We have these perceptions, attitudes, behaviors. We often will talk about the Hebsaxium, neurons that 00:25:16.785 --> 00:25:23.581 - fire together, wire together, and when that happens, that creates that sort of word document, 00:25:23.581 --> 00:25:31.028 - if you will, where we have all of the things that go under conference. And then the next time you have 00:25:31.028 --> 00:25:37.246 - a similar experience, it reactivates the previous learning, pulls it out of long-term 00:25:37.346 --> 00:25:43.672 - memory, past and present experiences link and consolidate to an updated neural network that has all 00:25:43.672 --> 00:25:50.250 - of that new information in it. And so when we talk about adaptive information processing, we're talking 00:25:50.250 --> 00:25:56.892 - about keeping what's helpful, discarding what's no longer needed, and preparing for the next occurrence. 00:25:56.892 --> 00:26:02.206 - That is how our AIP, our adaptive information processing system, works. And then as 00:26:02.306 --> 00:26:10.546 - We experience more and more. We have a more robust adaptive memory network. Remember, adaptive means 00:26:10.546 --> 00:26:18.786 - helpful. And that's just sort of like a kind of conceptualization of what this looks like. So again, 00:26:18.786 --> 00:26:27.760 - when we come to how is this important for the foundation of EMDR, we need to know that events are emotionally 00:26:27.760 --> 00:26:30.942 - encoded according to their importance. 00:26:31.234 --> 00:26:39.057 - And that means our positive experience, but also our negative experiences. The more emotional significance 00:26:39.057 --> 00:26:47.026 - something has, the more deeply it's encoded. So for instance, if I asked you guys what you had for breakfast 00:26:47.026 --> 00:26:54.556 - on Tuesday, October 3rd, 1989, well half of you wouldn't be alive yet, but you wouldn't know. Now, for 00:26:54.556 --> 00:27:00.990 - a certain age group in this room, if I were to ask you where you were on the morning of 00:27:01.314 --> 00:27:08.829 - September 11th, 2001, and what you had for breakfast, you probably remember, right? Because emotional 00:27:08.829 --> 00:27:16.786 - importance was assigned to that time. So it's really important to remember that. Past experiences influence 00:27:16.786 --> 00:27:24.596 - present situations, present perceptions. We are always looking through a lens based on what we've already 00:27:24.596 --> 00:27:31.006 - experienced or what we already know, right? Always looking through that lens. Beliefs. 00:27:31.234 --> 00:27:37.677 - once language is available are the verbalization of emotions and sensations. That's an important one. 00:27:37.677 --> 00:27:44.119 - In just a little bit, we're gonna understand why that's an important one, but I'm gonna say it again. 00:27:44.119 --> 00:27:50.119 - Beliefs once available, or sorry, once language is available are the verbalization of emotions 00:27:50.119 --> 00:27:56.499 - and sensations. So why is that important? When I say the words, I'm worthless, right? Thinking about 00:27:56.499 --> 00:28:00.478 - a negative belief. I'm worthless. When that resonates with me, 00:28:00.770 --> 00:28:07.877 - on a felt sense, when I hear those words and I feel it in my body, I feel it in my emotions, the emotions 00:28:07.877 --> 00:28:14.783 - that go with that, despair, shame, humiliation, unwantedness, the words I'm worthless become much more 00:28:14.783 --> 00:28:21.555 - powerful than just words on a page, right? So that's gonna be really important when we start to talk 00:28:21.555 --> 00:28:25.310 - about what actually happens in the office, so to speak. 00:28:26.050 --> 00:28:32.769 - And then neuroplasticity, neurological plasticity, the brain's ability to change and update is essential 00:28:32.769 --> 00:28:39.232 - when we're talking about the AIP approach to psychotherapy, which is the foundation of EMDR. So when 00:28:39.232 --> 00:28:45.823 - I was in elementary school, I learned, and I think probably a number of you in this room did too, that 00:28:45.823 --> 00:28:52.734 - our brain, once we become an adult, there's no more development, there's no more growth like what you have, 00:28:52.898 --> 00:28:59.216 - what you have right and then they would show us those like say no to drugs commercials because they 00:28:59.216 --> 00:29:05.597 - didn't want us to like burn out our brain because what you have is what you have and and now we know 00:29:05.597 --> 00:29:12.357 - that's not true we know that the neurological plasticity or neuroplasticity is something that is available 00:29:12.357 --> 00:29:17.854 - to us throughout our entire lifespan we see stroke victims who are able to recover and 00:29:18.306 --> 00:29:25.417 - you know, parts of their brain that actually shouldn't actually even be able to talk to one another 00:29:25.417 --> 00:29:33.239 - are able to, are able to, because the brain rewired, right? And so neurological plasticity or neuroplasticity 00:29:33.239 --> 00:29:40.421 - is also a very important concept when we're talking about the AIP, EMDR, and how it all works. Okay. 00:29:40.421 --> 00:29:45.470 - Now we're going to talk about what is trauma. And I do want to say, I, 00:29:45.602 --> 00:29:51.263 - I try to be very mindful of not using specific or explicit case examples that are triggering, but as 00:29:51.263 --> 00:29:56.981 - we're talking about trauma, if something happens where you feel like you need to take a break, if you 00:29:56.981 --> 00:30:02.418 - need to step out or something like that, please do what you need to do to take care of yourself. 00:30:02.418 --> 00:30:08.192 - And again, I am mindful of trying not to use examples that can be triggering, but if something happens 00:30:08.192 --> 00:30:14.526 - where you need to step out, step out. Okay, so what is trauma? I've been talking for a while, you guys talk now. 00:30:28.802 --> 00:30:35.821 - Yeah, extremely disturbing situation, but it's person specific. Something that feels traumatic to one 00:30:35.821 --> 00:30:43.390 - person may not feel traumatic to another. What else? What other thoughts come up when you think about trauma? 00:31:09.858 --> 00:31:20.831 - the reaction or what did you experience with people, places or things. So trauma being, this is so important, 00:31:20.831 --> 00:31:30.805 - trauma being a reaction, trauma being what happens in you related to these experiences, absolutely. 00:31:30.805 --> 00:31:36.990 - What else? Any other thoughts about trauma? Changes you, yes. 00:31:37.186 --> 00:31:44.962 - Exactly, something happens and it changes you. It changes you. So the word trauma comes from the Greek 00:31:44.962 --> 00:31:52.511 - word for wound and we know and when you hear trauma center, you're probably thinking an ER, a place 00:31:52.511 --> 00:32:00.438 - where acute wounds are taken. So the Greek word for wound is where trauma comes from. When we talk about 00:32:00.438 --> 00:32:07.006 - psychological trauma, we can think of it as a lasting emotional or psychological wound 00:32:07.842 --> 00:32:16.544 - meaning something is changed, there is a felt sense of change in you. It involves the perception of 00:32:16.544 --> 00:32:25.769 - life, health, or safety, something essential to your personhood being in danger. And when I say essential 00:32:25.769 --> 00:32:34.645 - to your personhood, that can be, again, a sense of worth, a sense of mattering. It doesn't have to be 00:32:34.645 --> 00:32:36.734 - someone has a weapon to 00:32:36.834 --> 00:32:44.095 - your body or you're in a plane that may be going down. It doesn't have to be that level of trauma or 00:32:44.095 --> 00:32:51.285 - that level of danger. Trauma is subjective. We had a few people that pointed that out, meaning that 00:32:51.285 --> 00:32:58.546 - what's traumatic to one person may not be traumatic to another person. So it's not the thing. I know 00:32:58.546 --> 00:33:06.526 - we talk about traumatic events, but it's not the thing. It's what it did to you, what reaction happened in you 00:33:06.786 --> 00:33:13.535 - has changed you in some way. Again, based in perception, not based in fact. So like I've actually had 00:33:13.535 --> 00:33:20.482 - somebody say to me that they were held up at gunpoint and later on they found out it was like a airsoft, 00:33:20.482 --> 00:33:27.430 - like something like it wasn't, it was not an actual firearm that could have done them in that situation, 00:33:27.430 --> 00:33:33.054 - in that range, lethal harm. And so they didn't understand why they were still having 00:33:33.218 --> 00:33:39.312 - these flashbacks and everything like that. I'm like, well, you didn't know at the time. So the way that 00:33:39.312 --> 00:33:45.230 - that was recorded was you're going to die. So it doesn't matter what the actual information is. It's 00:33:45.230 --> 00:33:51.266 - the perception. And it can be vicarious. We had one of our people pointed out that they are not having 00:33:51.266 --> 00:33:57.360 - to go through detailed stories and everything can help therapists reduce vicarious trauma. So vicarious 00:33:57.360 --> 00:34:03.102 - means it didn't have to happen to you. You didn't have to witness it, just even hearing about it. 00:34:03.650 --> 00:34:12.466 - create that, and we tend to see that more in service care providers that are, again, working with people 00:34:12.466 --> 00:34:21.199 - day in and day out that are highly traumatized. Types of trauma, acute trauma. Acute trauma is exposure 00:34:21.199 --> 00:34:30.183 - to a single overwhelming or dangerous event, some examples up there, an assault, a car accident, a natural 00:34:30.183 --> 00:34:33.374 - disaster, witnessing a violent event, 00:34:33.538 --> 00:34:41.776 - These are all examples of acute trauma. Then we have chronic trauma. Chronic trauma results from repeated 00:34:41.776 --> 00:34:50.247 - or prolonged exposure to highly stressful or dangerous events over a period of time. So undergoing treatment 00:34:50.247 --> 00:34:58.174 - for significant or major illnesses, exposure to war or combat situations, which could also be certain 00:34:58.174 --> 00:35:00.894 - neighborhoods that people live in. 00:35:01.666 --> 00:35:09.530 - domestic violence, prolonged exposure to bullying, prolonged exposure to a toxic workplace environment. 00:35:09.530 --> 00:35:17.092 - These are all examples of chronic trauma. So repeated or prolonged over a period of time, different 00:35:17.092 --> 00:35:24.654 - from acute. And then there's complex trauma. And the term complex trauma tends to get tossed around 00:35:24.654 --> 00:35:30.174 - quite a lot, sort of in this sense of like, oh, it's complicated trauma. 00:35:30.914 --> 00:35:38.447 - Complex trauma specifically, when we use the terms complex trauma, specifically results from exposure 00:35:38.447 --> 00:35:45.905 - to varied and multiple traumatic events or experiences from a young age. This is where the age comes 00:35:45.905 --> 00:35:52.478 - into play. And so nowadays, you'll frequently hear people refer to developmental trauma. 00:35:53.058 --> 00:35:59.538 - Right? Rather than the term complex trauma, to try to help people understand that when we're talking 00:35:59.538 --> 00:36:05.954 - about complex trauma, we are talking about things that happen from a young age, which means that it 00:36:05.954 --> 00:36:12.563 - is shaping our initial and early perceptions of the world that we live in. And, you know, I'll use the 00:36:12.563 --> 00:36:17.182 - terms or the words, sometimes I'll say what goes in early goes in deep. 00:36:17.858 --> 00:36:26.181 - Trauma therapists sometimes have a little sort of saying they use, which is the more hysterical, the 00:36:26.181 --> 00:36:34.751 - more historical, meaning the more desperate of the feeling that is evoked, likely the earlier the onset 00:36:34.751 --> 00:36:43.404 - of the trauma began. And this is also an essential part of complex trauma, frequently within the context 00:36:43.404 --> 00:36:46.206 - of an interpersonal relationship. 00:36:47.458 --> 00:36:54.237 - And we're talking almost entirely, really, we're talking attachment relationships. So extreme childhood 00:36:54.237 --> 00:37:01.212 - neglect, childhood abuse, repeated traumas perpetrated against a child, multiple ACEs, of course, probably 00:37:01.212 --> 00:37:08.121 - most of us, everyone raise your hand if you're familiar with ACEs studies. Yeah, mm-hmm, yep, so multiple 00:37:08.121 --> 00:37:10.142 - adverse childhood experiences. 00:37:10.274 --> 00:37:18.960 - A series of home removals, so we see this a lot with children whose families are involved with DCS, 00:37:18.960 --> 00:37:27.646 - even if they are reunited, if it happens multiple times, if there's a series of them, especially at 00:37:27.646 --> 00:37:36.158 - a younger age. All of these examples fall under complex trauma. And then finally vicarious, okay. 00:37:36.930 --> 00:37:44.960 - Vicarious trauma, I don't know where my second vicarious trauma slide went, but what's vicarious trauma? 00:37:44.960 --> 00:37:52.760 - Right, when listening to or hearing about, being exposed to other people's trauma, that you take that 00:37:52.760 --> 00:38:00.408 - on as your own. Frequently, like I said, frequently it's service providers and it kind of creeps up 00:38:00.408 --> 00:38:06.526 - and it can lead to compassion fatigue, burnout, and needing your own treatment. 00:38:08.258 --> 00:38:15.083 - So earlier we talked about how adaptive memories form. Now we're gonna talk about how traumatic memories 00:38:15.083 --> 00:38:22.168 - form and how it's different than your adaptive information processing. So event occurs that draws attention. 00:38:22.168 --> 00:38:28.798 - Remember how before I said the amygdala decides what's going on here before anything else happens? So 00:38:28.798 --> 00:38:35.493 - the amygdala perceives danger and floods the body with stress hormones to prepare for fight or flight, 00:38:35.493 --> 00:38:37.118 - to prepare for survival. 00:38:37.538 --> 00:38:44.759 - That intense emotional distress will say overloads the hippocampus or takes down the hippocampus, hijacks 00:38:44.759 --> 00:38:51.708 - the hippocampus, takes it offline, preventing functional memory storage and consolidation, okay? Now, 00:38:51.708 --> 00:38:58.929 - remember I said the hippocampus is sort of the middle person and plays a really important role in storage 00:38:58.929 --> 00:39:06.014 - of memories? One of the things the hippocampus does is stamp a date on this thing that happened, right? 00:39:06.626 --> 00:39:14.379 - meaning that it sort of places it in a temporal period, right? Oh, that happened and it's not happening 00:39:14.379 --> 00:39:21.834 - anymore, right? But that doesn't, if that doesn't happen, when the hippocampus gets knocked online, 00:39:21.834 --> 00:39:29.438 - the memory gets stored dysfunctionally by the amygdala in sensory fragments, right? So how our senses 00:39:29.438 --> 00:39:36.446 - experience the trauma as it happened, smells, tactile physical sensations, flashes of images, 00:39:36.642 --> 00:39:42.551 - you know, an impact, like kind of stores this memory kind of dysfunctionally in these sensory fragments. 00:39:42.551 --> 00:39:48.234 - And then when a trigger is encountered, the amygdala recognizes that as a sign of danger, produces a 00:39:48.234 --> 00:39:53.861 - stress reaction to prepare for survival. So it's like a fragment of that memory that gets triggered 00:39:53.861 --> 00:39:59.826 - and remembering becomes reliving. This is where the importance of what I was saying about the hippocampus 00:39:59.826 --> 00:40:05.566 - kind of putting a date stamp on it and we're remembering something. When that process doesn't happen, 00:40:05.666 --> 00:40:11.798 - and a trigger is encountered, we are no longer remembering. We are reliving the trauma when those present 00:40:11.798 --> 00:40:17.814 - triggers reactivate. And then over time, these repeated stress reactions in response to triggers causes 00:40:17.814 --> 00:40:23.599 - changes in our nervous system. It causes our nervous system to be more reactive. It makes it harder 00:40:23.599 --> 00:40:29.384 - for us to come, well, first of all, it makes our nervous system baseline a lot higher. A lot of the 00:40:29.384 --> 00:40:34.590 - time you'll hear people talking about living on fight or flight, living in a sympathetic, 00:40:34.818 --> 00:40:42.555 - part of their nervous system where they're always hypervigilant, they're always jumpy, they're never 00:40:42.555 --> 00:40:50.291 - relaxed. So it kind of increases our baseline. It makes it difficult for our nervous system to relax 00:40:50.291 --> 00:40:58.411 - into a more relaxed and adaptive state of being. And so it causes these changes over time and the nervous 00:40:58.411 --> 00:41:03.390 - system is just more reactive. So like all of us sitting in here, 00:41:04.290 --> 00:41:10.105 - In that area, if one of the catering staff were to drop a stack of dishes, we'd go, oh, right? We'd 00:41:10.105 --> 00:41:15.920 - all have this initial feeling of, ah, right? And then we'd be like, what's going on over there? And 00:41:15.920 --> 00:41:21.910 - then we'd be like, oh, okay, that's all right, they just dropped some dishes. And we'd kinda come back 00:41:21.910 --> 00:41:27.841 - and our nervous system would kinda settle back to wherever they are right about now. Except for those 00:41:27.841 --> 00:41:33.598 - of you whose nervous systems are carrying a lot of activation because of repeated trauma. For you, 00:41:34.114 --> 00:41:40.349 - It might take five, 10, 20 minutes for your heart to stop pounding and for you to feel like, okay, 00:41:40.349 --> 00:41:46.835 - I'm okay, to kind of come down from that activation. So these repeated activation and stress reactions 00:41:46.835 --> 00:41:53.196 - over time will cause the nervous system to become more reactive. And that's an important thing to be 00:41:53.196 --> 00:41:57.982 - aware of because I say trauma is formed by the mind but stored in the body. 00:42:02.498 --> 00:42:11.193 - So before we talked about acute trauma, single incident trauma, when somebody experiences a single incident 00:42:11.193 --> 00:42:18.680 - trauma, like a highly, highly disturbing single incident, what happens is the nervous system 00:42:18.680 --> 00:42:26.972 - gets overwhelmed, the amygdala fires the life or death emotions, that survival instinct, the intensity 00:42:26.972 --> 00:42:32.286 - of the emotions freeze the system. The hippocampus ain't working. 00:42:32.514 --> 00:42:40.757 - The amygdala limbic system encodes a fight, fight, freeze, numb, dissociate, collapse response. That's 00:42:40.757 --> 00:42:49.321 - part of the nervous system response when we perceive that we cannot fight and we cannot flee. And adaptive 00:42:49.321 --> 00:42:57.965 - neural networks are locked out. Adaptive meaning able to take in new information and update and consolidate 00:42:57.965 --> 00:43:01.246 - new information. What do I mean by that? 00:43:01.890 --> 00:43:08.696 - If I'm in a close call car accident, like if I'm in a situation where I'm in a car accident and I survive 00:43:08.696 --> 00:43:15.180 - and I'm maybe not even that injured, but in the moment the car accident was happening, I didn't know 00:43:15.180 --> 00:43:21.665 - that I was gonna survive and that I wasn't gonna be injured, I might have actually thought I'm going 00:43:21.665 --> 00:43:28.085 - to die. I might have actually felt I'm going to die. After that, because my adaptive neural network 00:43:28.085 --> 00:43:30.782 - was locked out, there may be a part of me 00:43:31.746 --> 00:43:38.469 - doesn't actually understand that I'm alive, that I survived, and that I'm not in danger anymore because 00:43:38.469 --> 00:43:44.998 - that adaptive recognition has been locked out. Frequently, sleep patterns are disrupted, which makes 00:43:44.998 --> 00:43:51.656 - things even worse because we, again, we do a lot of our natural problem solving, emotional processing, 00:43:51.656 --> 00:43:53.854 - and problem solving in our sleep. 00:43:54.434 --> 00:44:01.869 - And we get the nightmares of the actual event frequently because it's like the brain is trying to process 00:44:01.869 --> 00:44:09.024 - it but can't because the adaptive is locked out. So that is when we talk about a single incident PTSD 00:44:09.024 --> 00:44:16.038 - memory or a frozen memory. That's how those develop. Now, when we're talking about the more chronic 00:44:16.038 --> 00:44:21.790 - or complex forms of trauma, we're talking about something a little bit different. 00:44:22.146 --> 00:44:28.098 - So when we're talking about a single incident trauma, I love single incident traumas. I adore it. When 00:44:28.098 --> 00:44:34.282 - somebody walks into my office and they tell me that they had this, we do their biopsychosocial assessment, 00:44:34.282 --> 00:44:40.061 - and they had a pretty decent childhood, relatively speaking, and things are going pretty well, they 00:44:40.061 --> 00:44:45.840 - feel pretty good about their life, and then they had this one horrible thing happen. I love that. I 00:44:45.840 --> 00:44:51.966 - don't love that. I mean, I don't love that that happened to them. But as a provider, I love that because, 00:44:53.442 --> 00:45:01.263 - generally that kind of a presentation, one to three sessions of EMDR and they're good, they're fine, 00:45:01.263 --> 00:45:09.006 - they're ready to go. But how many of those clients do you think actually walk into my office? There 00:45:09.006 --> 00:45:17.214 - are very few people actually out there that have that experience of everything's good in life. They had a 00:45:17.538 --> 00:45:24.186 - parents that were appropriately emotionally responsive. They've got really robust, healthy adaptive 00:45:24.186 --> 00:45:30.900 - neural networks and this one thing happened to them and totally, totally threw them for a loop. More 00:45:30.900 --> 00:45:37.880 - frequently, much more frequently what we see is the development of what we would refer to as an isolated 00:45:37.880 --> 00:45:44.062 - neural network that happens over time, again, due to chronic or complex or vicarious trauma. 00:45:44.290 --> 00:45:51.859 - So what happens in these situations? Negative emotionally charged memories develop into a negatively 00:45:51.859 --> 00:45:59.352 - charged neural network. So again, disturbing events encoded. I'm worthless, like again, think about 00:45:59.352 --> 00:46:06.396 - that example of I'm worthless as a negative belief that is putting words to the feelings, the 00:46:06.396 --> 00:46:12.766 - body sensations, and the emotions that go with that. So in my weird little amorphous 00:46:12.866 --> 00:46:19.477 - A picture there, we have an adult chastising a small child, right? Shaming, humiliating, right? And 00:46:19.477 --> 00:46:26.087 - this child's felt sense is unworthless. They may not actually have that word yet, if they're three, 00:46:26.087 --> 00:46:33.095 - four, five years old, but the felt sense that they have is that of being worthless. And when that happens 00:46:33.095 --> 00:46:38.846 - again and again and again, especially in family of origin, especially before age five, 00:46:39.618 --> 00:46:49.242 - It builds into this negative neural network of all of these repeated memories of being treated in ways 00:46:49.242 --> 00:46:59.053 - that made that child feel worthless. Now, adaptive neural networks can form in other environments. Maybe 00:46:59.053 --> 00:47:07.742 - there's that teacher, that grandmother, that coach, somebody that made this kiddo feel good. 00:47:09.090 --> 00:47:16.702 - Which of these do you think is gonna be stronger? A girl goes in early, goes in deep. Which of these 00:47:16.702 --> 00:47:24.541 - is gonna be stronger? Yeah, the negative one. Yeah, yeah. But if there is some adaptive neural network, 00:47:24.541 --> 00:47:32.380 - which I believe that we can always find some, right, we need to be aware of its presence because what's 00:47:32.380 --> 00:47:38.334 - actually happening when present triggers activate past emotions or sensations, 00:47:39.490 --> 00:47:45.679 - it's triggering that feeling of I'm worthless. So now, you can see this example of here's a kiddo at 00:47:45.679 --> 00:47:51.930 - school, or no, actually that's not a kiddo at school, that's a guy working at a desk, and there's the 00:47:51.930 --> 00:47:58.181 - boss, right? And even if this is a person who's like, you know, 30, 35 years old, when the boss comes 00:47:58.181 --> 00:48:04.615 - up to check on what they're doing, what's triggered is I'm worthless, right? There's generally not gonna 00:48:04.615 --> 00:48:09.150 - be a triggering of that adaptive neural network of that one kind teacher, 00:48:09.378 --> 00:48:15.667 - who would come up and encourage them in class. That's generally not what's gonna be triggered here. 00:48:15.667 --> 00:48:21.955 - It's gonna be a triggered, I'm worthless. And so these emotionally charged networks become isolated 00:48:21.955 --> 00:48:28.496 - and they are, again, unable to link with the adaptive neural network. That is important because, again, 00:48:28.496 --> 00:48:34.973 - that means that when we're in a situation where that negative neural network is activated, the feeling 00:48:34.973 --> 00:48:36.734 - of I'm worthless because of 00:48:36.834 --> 00:48:44.680 - being shamed, humiliated, criticized again and again as a child, it's not possible to access this adaptive 00:48:44.680 --> 00:48:52.453 - I'm worthwhile that maybe a coach or a teacher or a mentor made this person feel. They get stuck, they're 00:48:52.453 --> 00:48:59.933 - frozen, they're stuck, they're isolated, they're unable to consolidate with adaptive neural networks. 00:48:59.933 --> 00:49:03.966 - And the reason that is important is because as I said, 00:49:04.098 --> 00:49:11.611 - I don't get that many people walking into my office that were like, yep, they might tell me everything's 00:49:11.611 --> 00:49:18.981 - fine, but when we actually do the biopsychosocial, it rarely turns out to be true that this person has 00:49:18.981 --> 00:49:26.494 - a really healthy self-awareness, that they had a secure attachment growing up, that they have a healthy, 00:49:26.494 --> 00:49:32.862 - appropriately healthy self-esteem, which is mirrored in their relationships with others. 00:49:33.346 --> 00:49:40.678 - We don't get that so much in the office. What we get are people who have these negative neural networks, 00:49:40.678 --> 00:49:48.290 - things that built up over time. Sometimes we call it like death by a thousand cuts. So you can conceptualize 00:49:48.290 --> 00:49:55.831 - psychological problems as negative emotional neural networks. They're unable to link, bind, and consolidate 00:49:55.831 --> 00:50:01.278 - with functional adaptive neural networks. And so what that means is that when 00:50:02.626 --> 00:50:10.641 - my boss makes a critical comment about my work, I feel like I'm worthless. And any sense of like, I'm 00:50:10.641 --> 00:50:18.656 - worthwhile regardless, I can't get to it. It is not reachable. So the main difference between CBT and 00:50:18.656 --> 00:50:26.592 - EMDR, and the reason I focus on CBT here is because there are some elements that sound very similar, 00:50:26.592 --> 00:50:28.478 - but the main difference 00:50:29.026 --> 00:50:37.615 - is that in the CBT approach to psychotherapy, the idea is, the concept is disturbing experiences create 00:50:37.615 --> 00:50:45.873 - thoughts, cognitions, which generate emotions and sensations. Something happens, we have a thought. 00:50:45.873 --> 00:50:54.627 - Sometimes we label it as a cognitive distortion or a thinking error or a maladaptive thought that creates 00:50:54.627 --> 00:50:57.022 - the emotions and sensations. 00:50:58.146 --> 00:51:05.027 - And then the clinical interventions are gonna challenge the cognitive distortions. We're gonna change 00:51:05.027 --> 00:51:12.043 - the thought to change the feeling, right? EMDR approach to psychotherapy. Disturbing experiences create 00:51:12.043 --> 00:51:19.059 - negatives, emotions, and sensations. The felt sense of I'm worthless. The felt sense of I don't matter. 00:51:19.059 --> 00:51:23.646 - The felt sense of I have to be perfect to be loved. The felt sense. 00:51:25.698 --> 00:51:32.560 - And so these emotions and sensations are identified with those words that come across as negative or 00:51:32.560 --> 00:51:39.559 - irrational beliefs. But it's really starting with the emotions and the sensations. And so in EMDR, our 00:51:39.559 --> 00:51:46.693 - intervention addresses the emotions or sensations, the distortions there, to help update to the adaptive 00:51:46.693 --> 00:51:53.963 - present. So we're changing the feelings to change the beliefs. And that is how the cognitive restructuring 00:51:53.963 --> 00:51:55.390 - occurs. Both models. 00:51:55.522 --> 00:52:04.818 - Do involve cognitive restructuring. CBT says change the thoughts to change the feelings. EMDR says change 00:52:04.818 --> 00:52:13.763 - the feelings to change the thoughts. That's it. Now there's a little more. Any questions about any of 00:52:13.763 --> 00:52:17.534 - that? Does it make sense? Okay. All right. 00:52:17.762 --> 00:52:24.421 - So I talked a little bit before about mechanism of action. Eye movements reduce image vividness and 00:52:24.421 --> 00:52:31.213 - emotionality. So eye movements are especially helpful in situations where people are having intrusive 00:52:31.213 --> 00:52:38.072 - images, flashbacks, nightmares with vivid imagery. There's also been research on the alternating brain 00:52:38.072 --> 00:52:44.798 - wave frequency between high wave REM sleep and low wave hippocampal activity. Taxing working memory. 00:52:45.058 --> 00:52:51.294 - Right, this is where we're kind of making the hippocampus, or I'm sorry, making the mind work a little 00:52:51.294 --> 00:52:57.591 - bit harder. It's kind of hard to focus on something highly distressing when somebody keeps interrupting 00:52:57.591 --> 00:53:03.766 - you and making you pay attention to something else. So that's taxing working memory and that can help 00:53:03.766 --> 00:53:10.063 - increase the hippocampus' ability to move memories into long-term memory storage in a more functionally 00:53:10.063 --> 00:53:14.846 - stored way. Orienting response. Orienting between experiencing and reflecting. 00:53:15.362 --> 00:53:21.172 - Right, I'm asking you to step into the memory and sort of have that felt sense of being in the memory 00:53:21.172 --> 00:53:26.868 - and now I'm asking you to step out of the memory and I'm asking you to tell me what you're noticing 00:53:26.868 --> 00:53:32.734 - now, back and forth, we're in, we're out, we're in, we're out, so orienting response. All of these are 00:53:32.734 --> 00:53:38.544 - mechanisms of action in EMDR, which again is why, I believe why it is such a robust form of treatment 00:53:38.544 --> 00:53:44.126 - because of a number of different mechanisms of action working together. I always laugh when like, 00:53:44.354 --> 00:53:49.446 - All the researchers are like, no, it's this one, no, it's this one. I'm like, I don't care. It works. 00:53:49.446 --> 00:53:54.588 - Because again, I'm a very pragmatic person. I'm a clinician. And I want something that works. And when 00:53:54.588 --> 00:53:59.629 - we talk about why it works, yeah, it's great to know why it works. But I don't really think fighting 00:53:59.629 --> 00:54:01.726 - over why it works is super helpful. Yeah. 00:54:13.698 --> 00:54:19.382 - That's a great question. Yeah, that's a great question. So are there times the EMDR does not work? What 00:54:19.382 --> 00:54:24.847 - would that look like? Who are those individuals? What I'm going to say, actually, if I promise that 00:54:24.847 --> 00:54:30.530 - I'm going to answer this, can I defer answering it to a little bit later on? Awesome. Okay. Cause it'll 00:54:30.530 --> 00:54:35.230 - make more sense once we get to the what actually happens in the EMDR part. All right. 00:54:35.874 --> 00:54:42.633 - Okay, how does this work again? Bilateral simulation mimics neural processing in REM sleep. Using this 00:54:42.633 --> 00:54:49.196 - process in an intentional and focused manner while conscious assists the brain in the process, even 00:54:49.196 --> 00:54:55.955 - when a trauma has interrupted the brain's natural processing. It enables the consolidation of isolated 00:54:55.955 --> 00:55:02.649 - neural networks into more adaptive networks and reprocessing of traumatic memories to the appropriate 00:55:02.649 --> 00:55:04.158 - location in the brain. 00:55:04.642 --> 00:55:10.002 - Okay, I put that in quotes because the neuroscientists have nosebleeds whenever I say that, 00:55:10.002 --> 00:55:15.886 - but it's really, it's an analogy, kind of getting it into where it belongs, meaning something in the 00:55:15.886 --> 00:55:21.945 - past, something that's no longer true, something that's no longer happening to me rather than something 00:55:21.945 --> 00:55:27.771 - I'm reliving every time that it gets activated. That's the neurological, or sorry, the neuroscience 00:55:27.771 --> 00:55:32.606 - basis of EMDR. Okay, most of you are still awake. Okay, those of you that are not, 00:55:33.090 --> 00:55:39.842 - We're gonna talk about practice now, so I promise, neurobiology is as over as it can be. What does EMDR 00:55:39.842 --> 00:55:46.464 - look like in practice? In trauma treatment in general, we think about a three-phase process. We think 00:55:46.464 --> 00:55:52.956 - about preparation. Pierre Genet actually came up with this model in the late 1800s. He called stage 00:55:52.956 --> 00:55:59.838 - one containment, stabilization, and symptom reduction. Containment, stabilization, and symptom reduction. 00:55:59.938 --> 00:56:06.050 - We kind of think about it as preparation in case conceptualization, sort of planning out what are we 00:56:06.050 --> 00:56:12.645 - going to do here, helping the person get the resources that they need to sort of have that symptom reduction 00:56:12.645 --> 00:56:18.999 - and some stabilization, getting ready to do the work. The second stage in trauma treatment, modification 00:56:18.999 --> 00:56:22.206 - of traumatic memories. We just call that processing. 00:56:22.466 --> 00:56:29.501 - Right, it's processing. And then the third stage of trauma treatment, Pierre Genet called it personality 00:56:29.501 --> 00:56:36.536 - integration and rehabilitation. We just call it integration, right? So what you can think about in terms 00:56:36.536 --> 00:56:43.637 - of this three stage process, stage one is somebody comes into your office, they're probably pretty highly 00:56:43.637 --> 00:56:50.605 - dysregulated, pretty highly distressed. We're gonna help them to be able to find a less disturbed, less 00:56:50.605 --> 00:56:52.414 - distressed state of being. 00:56:52.834 --> 00:56:59.376 - Right? Symptom reduction and stabilization. We're going to do whatever preparation is needed to have 00:56:59.376 --> 00:57:05.852 - them ready to do the processing. And that can be psychoeducation. That can be more, you know, using 00:57:05.852 --> 00:57:12.588 - skills for grounding and stabilization and nervous system calming. And we're going to sort of plan what 00:57:12.588 --> 00:57:16.798 - is it we even need to process here. Stage two is the processing. 00:57:18.178 --> 00:57:24.525 - And in EMDR, we sort of split that into four different parts, but I'll talk about that in a moment. 00:57:24.525 --> 00:57:30.110 - And stage three is integration. What are you noticing now that's different from before? 00:57:30.498 --> 00:57:36.674 - What has shifted for you? What has changed for you? How do you want to integrate this into your life? 00:57:36.674 --> 00:57:42.729 - What changes do you need to make based on the work that we did? A lot of the shifts and changes are 00:57:42.729 --> 00:57:48.783 - happening internally in this person, but we generally have to make some external shifts too, right, 00:57:48.783 --> 00:57:55.262 - to kind of accommodate that cognitive restructuring difference in the way that we're looking at the world. 00:57:55.362 --> 00:58:01.223 - A lot of the time my clients that I've worked with over time kind of start to have this sense of like, 00:58:01.223 --> 00:58:06.913 - oh, you know what, maybe I actually don't deserve to be in this relationship with this checked out, 00:58:06.913 --> 00:58:12.717 - emotionally abusive person. All right. But that's definitely positive change. But the realization and 00:58:12.717 --> 00:58:18.635 - the felt sense of I don't deserve this crap, we still need to actually work through behaviorally what's 00:58:18.635 --> 00:58:22.334 - going to happen next. So that's that stage three of integration. 00:58:24.514 --> 00:58:30.551 - We also talk about EMDRs being a three-pronged approach, past, present, and future. The bad stuff that 00:58:30.551 --> 00:58:34.302 - happened in the past, the current stuff that's triggering that. 00:58:34.402 --> 00:58:40.688 - and or the not ideal relational and occupational settings that we find ourselves in because of the past 00:58:40.688 --> 00:58:47.095 - trauma. And then the future. What do we want the future to look like? We can talk about a positive future 00:58:47.095 --> 00:58:53.139 - view. We can also look at what are the fears in the future? What are the things that we worry would 00:58:53.139 --> 00:58:59.244 - re-trigger some of those old feelings of I don't deserve to be alive or whatever the negative belief 00:58:59.244 --> 00:59:03.838 - is. So we kind of have that awareness as we're going through the treatment. 00:59:05.314 --> 00:59:12.097 - So I'm gonna talk you through the eight phase model. And can somebody remind me when lunch break is? 00:59:12.097 --> 00:59:18.813 - Oh, I don't have a person in here, do I? Great, thank you, 1150, that's what I thought. It was like 00:59:18.813 --> 00:59:25.730 - 40, 50, something like that, okay. Did they update you all that they changed the schedule, they pushed 00:59:25.730 --> 00:59:32.446 - the schedule back? Okay, they pushed the schedule back because Shelley Yoder got caught in traffic. 00:59:33.346 --> 00:59:42.772 - I'm just gonna haul it out and look at it, so I apologize if they didn't update you on that before. 00:59:42.772 --> 00:59:52.574 - Session two, 10-20 to 11-50, lunch 11-50 to 12-50, all right. Okay, so an eight phase model. Phase one, 00:59:52.574 --> 01:00:01.246 - history taking. Now in practice, we don't actually start with phase one, so thanks Francine 01:00:01.378 --> 01:00:07.736 - you know, confusing us all. But in practice, we don't actually start with phase one because a lot of 01:00:07.736 --> 01:00:14.282 - the time we need to do some good resourcing, some good preparation before we can get too deep into what 01:00:14.282 --> 01:00:20.640 - happened. We do, of course, always start with a biopsychosocial assessment, which is history taking, 01:00:20.640 --> 01:00:26.998 - right? But we try not to get too deep into the trauma, right? Why do we try not to get too deep into 01:00:26.998 --> 01:00:30.334 - the trauma during a biopsychosocial? Say that again? 01:00:31.202 --> 01:00:38.425 - Well, they might leave. It might be totally overwhelming to their system. They're like, I'm not coming 01:00:38.425 --> 01:00:45.718 - back. That was horrible. What else? Yeah, it defeats the purpose of, well, I mean, of EMDR, but I would 01:00:45.718 --> 01:00:52.730 - say that it really kind of can defeat the purpose of therapy in general, right? Because when we get 01:00:52.730 --> 01:00:54.974 - in too deep before we're ready, 01:00:55.714 --> 01:01:03.213 - We can have this system overwhelm and it can be re-traumatizing and it can turn people off and like, 01:01:03.213 --> 01:01:10.712 - nope, I'm not gonna do it. How long do you guys have for biopsychosocial assessments, you providers? 01:01:10.712 --> 01:01:18.434 - Any ideas? Really good agencies give you 90 minutes, most places give you 60 minutes. Do you think that 01:01:18.434 --> 01:01:24.894 - you can really sit with a person and listen to all the details of their trauma history 01:01:25.218 --> 01:01:31.852 - in 60 minutes with a, right, okay. So with a biopsychosocial, we don't get too deep into the trauma. 01:01:31.852 --> 01:01:38.683 - We have to complete our treatment plan, right? At this point, this is where generally we will move into 01:01:38.683 --> 01:01:45.514 - phase two and we'll do affect management skills. There's a reason I have these guys next to each other. 01:01:45.514 --> 01:01:50.046 - We'll do affect management skills, resources, calm place, breathing, 01:01:50.306 --> 01:01:57.189 - nurturing figure, you know, resources that clients can use, I'll say, to be able to bring themselves 01:01:57.189 --> 01:02:03.663 - from a more distressed, disturbed, preoccupied, anxious state to a less distressed, disturbed, 01:02:03.663 --> 01:02:10.818 - anxious state. So we teach these skills in phase two, all right? The more complex the trauma, the longer 01:02:10.818 --> 01:02:17.701 - phase two is likely to take. Does that make sense? Yeah, okay. The less resource the individual, the 01:02:17.701 --> 01:02:20.222 - longer this phase is likely to take. 01:02:20.738 --> 01:02:26.411 - also probably makes sense. So we've done phase one, we've done a biopsychosocial treatment plan, then 01:02:26.411 --> 01:02:31.528 - we're gonna bump over to phase two and we're gonna do the affect management, the grounding, 01:02:31.528 --> 01:02:37.312 - the stabilization. Then we're gonna come back and do psychoeducation about EMDR. And I always say don't 01:02:37.312 --> 01:02:42.874 - over explain it. Your client doesn't need to know everything that I just talked to you about in the 01:02:42.874 --> 01:02:46.878 - last hour. All they need to know is that when really bad things happen, 01:02:47.170 --> 01:02:53.882 - either individual bad things or things that feel bad over a period of time. Our minds don't really store 01:02:53.882 --> 01:03:00.849 - that information in the most adaptive or useful way, and the EMDR is something that can help these different 01:03:00.849 --> 01:03:07.497 - parts of our brain, thinking parts, the feeling parts, the body, nervous system aspect, can communicate 01:03:07.497 --> 01:03:14.337 - with each other better. That's basically it, and answering any questions. Part of phase one is, of course, 01:03:14.337 --> 01:03:16.574 - relationship and rapport building. 01:03:16.770 --> 01:03:23.691 - And then when we talk about a target sequence plan, that's just fancy words for saying, what is it that 01:03:23.691 --> 01:03:30.346 - we're identifying that we need to actually address here? So again, I think about phases one and two 01:03:30.346 --> 01:03:37.068 - as more of a sandwich than as something that happens one and then the next. But those two phases are 01:03:37.068 --> 01:03:41.726 - our preparation phases before we get into the main work. Phase three. 01:03:42.338 --> 01:03:48.555 - Phase three is the assessment phase. And phase three, I think about, and I actually got this from the 01:03:48.555 --> 01:03:54.773 - person that founded the training program that I work for, I think about it as a pre-flight checklist. 01:03:54.773 --> 01:04:00.441 - We are lighting up aspects of the memory in a way that is activating it and getting it ready 01:04:00.441 --> 01:04:06.780 - to be reprocessed. So we'll ask, what's the worst part of it? I'm gonna use car accident as an example. 01:04:06.780 --> 01:04:11.230 - Anybody find it horribly triggering if I use car accident as an example? 01:04:12.386 --> 01:04:18.319 - All right, so I asked my client, okay, when you're thinking about that car accident, what was the worst 01:04:18.319 --> 01:04:24.023 - part of it? And the client says, just the image of the headlights coming straight at me, and it was 01:04:24.023 --> 01:04:30.070 - raining, and I couldn't do it. There was nothing I could do. Okay, there we go. We've got a really strong 01:04:30.070 --> 01:04:36.117 - image, car lights coming straight at me. Doesn't have to be an image. In some cases, it might be a sound. 01:04:36.117 --> 01:04:41.822 - In some cases, it might be a smell. It might be a tactile feeling, but what's the worst part of it? 01:04:43.074 --> 01:04:50.252 - then we identify that negative belief. In the case of a car accident, we work with the client on figuring 01:04:50.252 --> 01:04:57.228 - this out. It might be I'm powerless. It might be I'm going to die. It might be I have no control. What 01:04:57.228 --> 01:05:04.338 - is the negative belief? The words that encapsulate that feeling in that moment. The positive or adaptive 01:05:04.338 --> 01:05:09.214 - belief, what would you rather be able to believe and feel the truth of? 01:05:10.082 --> 01:05:16.267 - when you let yourself step back into that memory. Instead of I'm powerless, what would you rather be 01:05:16.267 --> 01:05:22.268 - able to feel the truth of? I can control what I can, or I'm able to recognize the choices I have, 01:05:22.268 --> 01:05:28.697 - or whatever. If the negative belief was I was gonna die, what would you rather be able to feel the truth 01:05:28.697 --> 01:05:35.678 - of right now? I survived and everything's okay, great. So we're gonna identify the negative, the positive belief. 01:05:36.546 --> 01:05:43.622 - The validity of the positive cognition, right? This is where our scales come into play again. When you 01:05:43.622 --> 01:05:50.561 - think about being in that car accident, and you hear the words, I survived and I'm okay, how true do 01:05:50.561 --> 01:05:57.568 - those feel? Not how logically true do you know they are in your head. I mean, clearly you walked into 01:05:57.568 --> 01:06:04.576 - my office, you're probably not dead. I don't say that. But not how logically true do you know them to 01:06:04.576 --> 01:06:05.950 - me, but the feeling 01:06:06.146 --> 01:06:14.013 - and what people will almost tell me is one or two. Yeah, it doesn't really feel true. Then I'm gonna 01:06:14.013 --> 01:06:22.504 - ask them what the emotions are in this moment as you're thinking about I'm going to die and those headlights 01:06:22.504 --> 01:06:30.371 - coming at you, what emotions are you noticing? Helplessness, fear, terror, anger, panic. And then we 01:06:30.371 --> 01:06:32.318 - can ask from zero to 10, 01:06:32.546 --> 01:06:37.537 - How bad did those feelings feel? Zero is not really there. Ten is the worst they could feel. 01:06:37.537 --> 01:06:42.903 - It's an eight. And where do you feel that in your body? I actually flip-flopped those last two, but 01:06:42.903 --> 01:06:48.270 - technically this is where you're supposed to go in. Where do you feel that in your body? My stomach 01:06:48.270 --> 01:06:53.636 - has a pit in it and my chest is tight and I feel like I can't breathe. Okay. So we've now activated 01:06:53.636 --> 01:06:54.334 - this memory. 01:06:54.722 --> 01:07:02.511 - using all of the different components of memory. So we have in there sensory information, like an image 01:07:02.511 --> 01:07:10.001 - or sound, a sight. We have cognitive information, the words of the negative belief and the adaptive 01:07:10.001 --> 01:07:18.015 - belief. We have how bad it feels. We have how true the positive belief feels. We have how bad the distress 01:07:18.015 --> 01:07:24.606 - is. We have the emotions and we have the body sensations. That's all aspects of memory. 01:07:24.802 --> 01:07:32.895 - right there, and that process takes about two minutes or less, right? So that's why I call it a pre-flight 01:07:32.895 --> 01:07:40.458 - checklist. It's not, we don't talk about each of these things. We identify it, we move on, right? I 01:07:40.458 --> 01:07:47.038 - just toss this up here because I keep throwing out these examples of negative beliefs. 01:07:47.138 --> 01:07:53.801 - that people can have in different situations. And I think this can just be kind of a useful way to look 01:07:53.801 --> 01:08:00.336 - at these negative beliefs around developmental themes or plateaus, right? I was talking about sort of 01:08:00.336 --> 01:08:07.256 - a survival level of like I'm going to die, that sort of thing. But when you look at it from a developmental 01:08:07.256 --> 01:08:13.086 - stage, when we're looking at survival level, we're actually tend to be talking about young 01:08:13.474 --> 01:08:21.176 - things that happened to children when they were young, the sense of not deserving to exist. And all 01:08:21.176 --> 01:08:29.108 - the way up through, you can almost tell, depending on what people's negative core beliefs are, you can 01:08:29.108 --> 01:08:37.118 - almost tell when the developmental sort of plateau was that the bad situation or bad situation started. 01:08:37.442 --> 01:08:43.400 - All right, and these are just some different examples of negative cognitions and then the adaptive or 01:08:43.400 --> 01:08:49.241 - preferred or positive. And it's certainly not an exhaustive list. But these are different ones that 01:08:49.241 --> 01:08:55.199 - you might come across. All right, so phase three is the pre-flight checklist. We're not talking about 01:08:55.199 --> 01:09:01.390 - it. We're just identifying it, boom, boom, boom, flipping the switches, getting ready to take off, right? 01:09:01.390 --> 01:09:06.238 - Phase four is where we start desensitization. This is the back and forth movement. 01:09:07.042 --> 01:09:13.949 - For eye movements, it's either, most clinicians use their hand, you can have a light bar. Teenagers 01:09:13.949 --> 01:09:21.063 - love the light bar because you can change the color on it. Of course, it could be purple, why wouldn't 01:09:21.063 --> 01:09:28.798 - you? If we're using tactile, people can use self-administered tapping like this. We have tappers where you hold 01:09:28.866 --> 01:09:35.210 - some paddles and they just vibrate back and forth. Audio tones that go back and forth. You probably 01:09:35.210 --> 01:09:41.618 - see a lot of ads for calm nowadays. It's like based on EMDR inspired bilateral stimulation, but that 01:09:41.618 --> 01:09:48.153 - back and forth side to side audio. These are all forms of bilateral that are used for desensitization. 01:09:48.153 --> 01:09:54.751 - And what actually happens here, because this is what people are always like, we actually do. The client 01:09:54.751 --> 01:09:58.558 - is instructed to notice without trying to control anything. 01:09:59.106 --> 01:10:04.273 - Notice their inner experience during the bilateral stimulation, meaning just notice what comes up. It 01:10:04.273 --> 01:10:09.389 - could be thoughts. It could be emotions. It could be body sensations. It could be memories. It could 01:10:09.389 --> 01:10:14.557 - be images. It could be inner dialogues. I had one client that processed almost entirely in color, and 01:10:14.557 --> 01:10:19.876 - I'm like, oh, this is interesting. I don't really know what's happening, but it worked. So just noticing 01:10:19.876 --> 01:10:20.990 - what comes up inside. 01:10:22.754 --> 01:10:28.754 - And over the course of the reprocessing, the client may notice, well, they will notice a shifting of 01:10:28.754 --> 01:10:35.230 - these different components of inner experience. Clients generally will experience higher levels of emotional 01:10:35.230 --> 01:10:41.231 - and sensorial or sensation arousal because they're really allowing themselves to access the material 01:10:41.231 --> 01:10:47.528 - on a deeper level than talking about it. It may take multiple sessions. And generally what's gonna happen 01:10:47.528 --> 01:10:50.142 - is that the disturbance is gonna be really, 01:10:50.274 --> 01:10:56.318 - reduced to zero, or as low as it will go, what we call ecologically appropriate. Meaning that maybe 01:10:56.318 --> 01:11:02.543 - somebody started out with a set of eight when they were remembering a really painful memory from their 01:11:02.543 --> 01:11:08.888 - childhood, and maybe it comes down to one, and they're like, I just don't think it's gonna go any lower, 01:11:08.888 --> 01:11:14.932 - and it makes sense to them. I'm just always gonna carry that. My dad died when I was eight. There's 01:11:14.932 --> 01:11:19.102 - always gonna be some upset around that. It's like, yeah, absolutely. 01:11:19.746 --> 01:11:28.488 - But something that's in that one area is something that we generally can say handle, but can make sense 01:11:28.488 --> 01:11:37.146 - of, can understand, can incorporate into sort of our narrative of who we are as a person. Whereas that 01:11:37.146 --> 01:11:45.804 - eight before kind of had us frozen there, had us stuck, had us not able to get past it. So we see this 01:11:45.804 --> 01:11:49.502 - reduction in disturbance during phase four. 01:11:50.594 --> 01:11:56.550 - And then phase five we call installation. This is where we're gonna, when I'm processing through the 01:11:56.550 --> 01:12:02.565 - client and that disturbance is coming down and down and down, at some point, generally when we get to 01:12:02.565 --> 01:12:08.521 - that sud, that disturbance to zero or pretty darn low, I'm gonna come back and I'm gonna check in on 01:12:08.521 --> 01:12:13.534 - the validity of cognition again. How true does that adaptive belief feel now, right? 01:12:13.730 --> 01:12:20.281 - And then we use the bilateral stimulation again to strengthen the positive belief until it's at a seven 01:12:20.281 --> 01:12:26.832 - or as high as it will go. Now, that's how the textbook describes it. Like, okay, yucky stuff, sud, goes 01:12:26.832 --> 01:12:33.950 - down and down and down and down and down and down and then it's gone. And good stuff, access to adaptive belief. 01:12:34.114 --> 01:12:39.271 - then starts to go up. That's not actually how it happens. These two things are actually happening at 01:12:39.271 --> 01:12:44.275 - the same time. And I like to use this analogy. Imagine you're looking in like a flooded basement, 01:12:44.275 --> 01:12:49.432 - all right? Unfinished basement of a house. You know, a lot of the time they have like the beams that 01:12:49.432 --> 01:12:54.539 - support the floor. The ceiling is the floor of the house above, right? So imagine that this support 01:12:54.539 --> 01:12:59.747 - beam is the adaptive belief, right? I'm gonna go back to my favorite, I am worthwhile regardless. Now 01:12:59.747 --> 01:13:03.934 - I want you to imagine that basement is flooded with gross yuck mucky murky water. 01:13:04.194 --> 01:13:10.607 - And that gross yuckiness, so to speak, is the disturbance, the negative emotions related to the idea 01:13:10.607 --> 01:13:17.083 - of I'm worthless. As we're processing, as the yuck is processing and the floodwaters are coming down, 01:13:17.083 --> 01:13:23.432 - we're getting more and more access to that adaptive neural network that says I'm worthwhile. And so 01:13:23.432 --> 01:13:29.909 - generally when I've completed phase four with a client and then I move into phase five and I ask them 01:13:29.909 --> 01:13:32.766 - where their SUD is, it's already quite high. 01:13:33.890 --> 01:13:41.761 - Not necessarily always seven, but already quite high. And then we'll do a few more sets to strengthen 01:13:41.761 --> 01:13:49.556 - the positive belief. And then phase six, body scan. We're checking for sensory memories, implicit or 01:13:49.556 --> 01:13:57.659 - sensory memories. So now think about the car accident and this adaptive belief, I survived and I'm okay. 01:13:57.659 --> 01:14:03.678 - Hold those together, scan through your body. Just notice what you find there. 01:14:04.034 --> 01:14:11.294 - And if there are any uncomfortable, any negative, uncomfortable, unpleasant body sensations, we bring 01:14:11.294 --> 01:14:18.697 - in the bilateral stimulation until the body releases that, which it does. I know it sounds kind of ooh, 01:14:18.697 --> 01:14:26.028 - but it does. And we have a neutral body scan. So that is the processing piece of EMDR. And again, that 01:14:26.028 --> 01:14:30.014 - can take multiple sessions for really disturbing or big 01:14:30.306 --> 01:14:37.557 - painful memories, or it might just take one session for this memory, one session for this memory, so 01:14:37.557 --> 01:14:44.736 - it can look a few different ways. All right. Phase seven. Phase seven is closure. When we're coming 01:14:44.736 --> 01:14:50.910 - to the end of a session, whether or not we consider the memory having been completely 01:14:51.042 --> 01:14:57.408 - processed, we're always going to make sure and stop in plenty of time to provide any stabilization that's 01:14:57.408 --> 01:15:03.834 - needed because again big feelings can come up during EMDR processing and we want to make sure that there's 01:15:03.834 --> 01:15:10.261 - time to kind of get them back to a good baseline. We remind the client the processing may continue because 01:15:10.261 --> 01:15:16.447 - we've kind of jump started a natural process and encourage our use of resourcing skills and then phase 01:15:16.447 --> 01:15:19.870 - eight reevaluation when your client comes back. We check 01:15:20.002 --> 01:15:25.522 - Previous processing outcomes, what's new, what's different since the last time we met? New insights, 01:15:25.522 --> 01:15:31.151 - new changes, any changes in symptoms. We continue processing the target if it feels like there's still 01:15:31.151 --> 01:15:36.671 - more there, but if it feels like the target's been completed, meaning that when they think about it, 01:15:36.671 --> 01:15:42.191 - they're like, yeah, it's not really activating me anymore. Yeah, that adaptive positive belief feels 01:15:42.191 --> 01:15:48.094 - true. Even when I think about that, then we can move on and we can identify another memory if there's some, 01:15:48.290 --> 01:15:56.210 - Almost always there's more than one that needs to be processed. Or we may be talking more about integration 01:15:56.210 --> 01:16:03.617 - of behavior change and things like that. So it really depends. So that is our eight phase model. And 01:16:03.617 --> 01:16:10.951 - I'm going to come back to that question of population. Does EMDR not work in populations it doesn't 01:16:10.951 --> 01:16:17.918 - work with? What I will say about that is that EMDR, because it is a full eight phase protocol, 01:16:18.018 --> 01:16:27.930 - including history taking, including resourcing, including the recognition of how these things that happened 01:16:27.930 --> 01:16:37.566 - to me shaped my self view, right? Because it includes all of that, I conceptually think of EMDR as being 01:16:37.566 --> 01:16:47.294 - a lot more than just the processing. So I will say that those aspects of EMDR I would do with any client, 01:16:47.394 --> 01:16:54.517 - regardless of whether I thought we were going to get into the processing part or not, which sometimes, 01:16:54.517 --> 01:17:01.917 - depending on time limitations, doesn't happen. But are there situations where processing, EMDR processing, 01:17:01.917 --> 01:17:08.972 - is not effective? I'm gonna say probably more that the clinician maybe doesn't have the competence or 01:17:08.972 --> 01:17:14.366 - skills that they need because when you've got a very highly protected system, 01:17:14.530 --> 01:17:21.086 - Lots of defense mechanisms and things like that. Processing really needs to slow down and we need to 01:17:21.086 --> 01:17:27.642 - be able to use processing adaptations to sort of help the client through. Also in the case of window 01:17:27.642 --> 01:17:34.198 - of tolerance issues. If you think about the window of tolerance, it's like a place where you're able 01:17:34.198 --> 01:17:41.143 - to engage with your memories, able to engage with what's happened to you, able to engage with an emotional 01:17:41.143 --> 01:17:43.934 - experience without becoming hyper aroused, 01:17:44.098 --> 01:17:50.354 - too activated or hypo aroused, like dissociation. Maintaining a window of tolerance is a skill in art 01:17:50.354 --> 01:17:56.733 - form in itself. Most people that tell me that they had a bad time with EMDR and they tell me about what 01:17:56.733 --> 01:18:03.296 - happened, it was because they exceeded their window of tolerance and either the clinician didn't recognize 01:18:03.296 --> 01:18:08.510 - it or didn't know what to do about it, and then it did end up being re-traumatizing. 01:18:09.410 --> 01:18:15.930 - Other situations where EMDR is contraindicated, not gonna do EMDR with somebody who's an active manic 01:18:15.930 --> 01:18:22.513 - episode, not gonna do EMDR with somebody who's in a psychotic episode. We wanna make sure that there's 01:18:22.513 --> 01:18:29.161 - a level of stabilization before we start engaging in processing, because again, we're generally looking 01:18:29.161 --> 01:18:35.808 - at some pretty painful stuff, so we wanna make sure that the person has what I refer to as the internal 01:18:35.808 --> 01:18:37.342 - and external stability. 01:18:37.538 --> 01:18:44.635 - Internal stability, meaning I'm not manic, I'm not psychotic. I have enough of a window of tolerance 01:18:44.635 --> 01:18:52.014 - that I can talk about this stuff without becoming entirely dysregulated. External stability being what's 01:18:52.014 --> 01:18:59.111 - the support system look like? What's going on in their social emotional world? Are they up for a big 01:18:59.111 --> 01:19:00.446 - promotion at work? 01:19:00.546 --> 01:19:06.833 - probably not time to dig up the childhood trauma, right? So there's sort of that external stability 01:19:06.833 --> 01:19:13.184 - and internal stability that we look at. All right, other questions? I wanted to make sure I hit that 01:19:13.184 --> 01:19:15.070 - one since I promised I would. 01:19:23.202 --> 01:19:29.106 - Good question. So a local provider that says they won't do EMDR with a client until they're 30 days 01:19:29.106 --> 01:19:35.010 - sober, there have been a few iterations of this idea. Back in the day, they were like, you can't do 01:19:35.010 --> 01:19:41.091 - EMDR until somebody's been 90 days sober. Okay, well, for a lot of people, that means that they're not 01:19:41.091 --> 01:19:45.342 - gonna get to do EMDR, right, because they're gonna relapse before that. 01:19:46.818 --> 01:19:54.122 - What I will say again, and again, I come to the provider, their level of skill and competence and what 01:19:54.122 --> 01:20:01.213 - type of EMDR they're providing. For people who are struggling with substance abuse issues, they are 01:20:01.213 --> 01:20:08.446 - chronically under resourced. That's what the substance is for, right? The substance is not a problem, 01:20:08.446 --> 01:20:12.062 - it's a solution to a problem that they had, right? 01:20:12.770 --> 01:20:19.369 - not trying to say substance abuse isn't a problem, but when you think about this conceptually, the substance 01:20:19.369 --> 01:20:25.908 - is the solution to the feelings of dysregulation, the feelings of emptiness, the feelings of disconnection, 01:20:25.908 --> 01:20:32.023 - the pain, right? And so they're gonna need a significant amount of resourcing. So in my model, we're 01:20:32.023 --> 01:20:36.382 - probably not gonna be doing any processing in the first 30 days anyway. 01:20:36.546 --> 01:20:43.058 - because we're still focusing a lot on resourcing. That being said, I will use a crisis intervention 01:20:43.058 --> 01:20:49.701 - with somebody, whether they are, you know, 130, 60, however day's sober, because then the other piece 01:20:49.701 --> 01:20:56.409 - of it becomes like, what are we focusing on and how are we focusing on it? Like I said, we're probably 01:20:56.409 --> 01:20:58.558 - not going to open up the big bad 01:20:58.658 --> 01:21:05.375 - of painful childhood trauma at the beginning. There are a lot of different ways, and this is where again 01:21:05.375 --> 01:21:06.910 - I kind of look at like, 01:21:07.106 --> 01:21:13.203 - you know, the training of the provider, EMDR providers, they all have like what we would call a basic 01:21:13.203 --> 01:21:19.240 - training. But then from there, do they have training in managing window of tolerance issues? Do they 01:21:19.240 --> 01:21:25.277 - have training in dissociation? Do they have training with substance abuse? Because it's really about 01:21:25.277 --> 01:21:31.613 - titrating the experience and making sure that it's not more that the client can handle. So I don't myself 01:21:31.613 --> 01:21:36.574 - find like arbitrary timelines to be so helpful as more like, what am I doing when? 01:21:37.410 --> 01:21:48.436 - I'll desensitize a trigger or an urge anytime because that's going to help them stay sober. Yeah. Yeah. 01:21:48.436 --> 01:21:59.038 - Great question. If I'm looking for an EMDR therapist, how do I know if they're basic or advanced or 01:21:59.038 --> 01:22:00.734 - where they are? 01:22:01.602 --> 01:22:09.082 - So you can go to, there's a website, MDRIA, E-M-D-R-I-A, which just stands for EMDR International 01:22:09.082 --> 01:22:15.646 - Association. Oh, look, there it is, MDRIA.org, and they have a find a therapist tool. 01:22:15.842 --> 01:22:21.184 - And if you use the Find a Therapist tool on imdria.org, they can show you, does this person 01:22:21.184 --> 01:22:27.513 - have certification? Now certification is advanced training, advanced training and consultation. It generally 01:22:27.513 --> 01:22:33.609 - takes one to two years for people to get their certification. And so it'll tell you, are they certified? 01:22:33.609 --> 01:22:39.473 - It'll tell you if they're a consultant or a trainer, which means that they've done even more work in 01:22:39.473 --> 01:22:41.854 - there. So you can kind of get that idea. 01:22:42.114 --> 01:22:48.569 - There are clinicians who are very good EMDR providers who are not certified though. I just wanna say 01:22:48.569 --> 01:22:55.089 - that because I know many of them. Because certification is a pretty big investment in time and money. 01:22:55.089 --> 01:23:01.799 - And so there are really good EMDR clinicians who aren't certified. So I'm gonna ask questions. I'm gonna 01:23:01.799 --> 01:23:08.830 - say, how long have you been doing EMDR? What are your areas of specialty? What extra trainings have you done? 01:23:08.930 --> 01:23:17.622 - And you know, I mean, if you have a decent BS meter, you can kind of get a sense of that. But I always 01:23:17.622 --> 01:23:26.483 - say no matter what we're talking about in terms of like the type of modality or whatever, ask questions. 01:23:26.483 --> 01:23:33.150 - When you call, make an appointment. Yeah. Yeah. I would say for me personally, 01:23:33.378 --> 01:23:40.519 - I don't wanna waste my time, I don't wanna waste my money. And also, when you think about how difficult 01:23:40.519 --> 01:23:47.523 - it is to access services, how difficult it can be to access services, to get yourself there, to start 01:23:47.523 --> 01:23:54.664 - the process, I don't think it's fair to expect somebody to get started and then find out like, oh, this 01:23:54.664 --> 01:23:57.822 - provider doesn't have the skills that I need. 01:24:17.506 --> 01:24:43.954 - Great question. So when it comes to people pleasing, I'm going to move this along to your QR code because 01:24:43.954 --> 01:24:47.198 - we are about 01:24:47.362 --> 01:24:53.773 - five minutes ago. When it comes to people pleasing, there's a few different ways we can handle it. One 01:24:53.773 --> 01:25:00.309 - of the considerations for me is does this person have the insight to understand their tendency to people 01:25:00.309 --> 01:25:06.783 - please? If so, we can talk about it. And I really emphasize curiosity and openness. I tell them there's 01:25:06.783 --> 01:25:13.132 - nothing that is supposed to happen, that anything that they tell me is just information, and that I'm 01:25:13.132 --> 01:25:14.750 - not looking for anything. 01:25:15.298 --> 01:25:21.556 - Which is actually true, I'm not looking for anything. And I'll use the words like accurate. Like this 01:25:21.556 --> 01:25:27.752 - is gonna be the most helpful for you if you can be as accurate as you can be. I don't use words like 01:25:27.752 --> 01:25:34.132 - honest or transparent because they're so value laden and people pleasing isn't about lying, right? It's 01:25:34.132 --> 01:25:40.389 - about a survival response. So I'll use the word accurate. And sometimes I just leave the numbers out. 01:25:40.389 --> 01:25:42.782 - Sometimes I just leave the numbers out 01:25:43.234 --> 01:25:48.801 - I tend to be really circumspect in how much I even come back to the numbers at all because it can create 01:25:48.801 --> 01:25:54.103 - feelings of pressure. Or it can kind of knock people out of their emotional processing because they 01:25:54.103 --> 01:25:59.617 - get really focused on like, well, I don't know, is this a four or a five? I don't know, how do I figure 01:25:59.617 --> 01:26:04.919 - that out? And it's like, well, okay, there we go, totally out of the emotional processing of it. So 01:26:04.919 --> 01:26:10.327 - there are definitely different ways like that because when it really comes to the EMDR, when it comes 01:26:10.327 --> 01:26:12.766 - to the numbers, when it comes to all of that, 01:26:12.866 --> 01:26:21.208 - When you have a felt sense, and I'm very big on what I call right brain to right brain communication, 01:26:21.208 --> 01:26:29.632 - when you have a felt sense of what's happening in your client's nervous system, you kinda know anyway. 01:26:29.632 --> 01:26:38.056 - Yeah, great question. Probably have time for one to two more. Alrighty, well, I think we're gonna turn 01:26:38.056 --> 01:26:42.718 - it over to Ashley for whatever's supposed to happen now. 01:26:45.314 --> 01:26:48.510 - Yeah, so thank you, Kara, for being here. That was great.