Implicit Threats

Posted by Tim Mullins, MA, LCPC Therapist at Entrada on April 13, 2017

A loud noise happens on a crowded street. Many people are startled for a moment and then, after recognizing that it was a car backfiring, they go on with their day. But there is a teenaged girl and a forty-year-old man who are having very different experiences. The loud noise initiated a startle response and then the re-experiencing of vivid memories. These two are transported to entirely different places and times that have become defining characteristics of their lives. They are trauma survivors, one of whom is remembering a gunshot and the other the slamming of a door.

In one case, there was a critical incident where the firing of a single gunshot meant the end of a loved one’s life. In the other case, the slamming of a door was a repeated event that is associated with an upcoming physical assault. In both cases, the individuals having traumatic memories are disconnected from the here and now. Physiologically, it feels like one has been transported to another place and they are experiencing the same stress as when the memory occurred. The triggering event can be any kind of a memory with any kind of sensory associations like sounds, sights, smells, orientations in space or internal feelings of pressure, pain, or discomfort.

A year ago, I was going to go scuba diving in Hawaii. It was a beautiful day; the surf was gentle and I was with two friends. While snorkeling out to the drop, I was suddenly overcome by an irrational fear of choking to death. I could not catch my breath and began coughing uncontrollably. This was not a good situation going out into deeper water. Apparently, I had aspirated some sea water, but I had done this before and simply coughed it up and kept swimming. This was different. I was having a very different kind of experience and it was terribly frightening. I made it back to shore, eventually went to the emergency room and a month later found myself in an EMDR (Eye Movement Desensitization and Reprocessing) training for trauma treatment.

Though I knew of EMDR from other clinicians, I was skeptical about the protocol. Waving fingers in front of someone’s face while they followed the movement of someone’s hand seemed like kind of a parlor trick. It was very different from the exposure therapy or the somatic based trauma treatments that I was taught about in grad school. I was not a fan of the exposure therapy because clients told me that they had sometimes become re-traumatized more than desensitized. The somatic approaches seemed much more effective for most of my clients and I incorporated these concepts into treating anxiety and substance abuse, but I did not feel confident in treating trauma per se.

A part of the EMDR training I was to experience the protocol first hand as a client. When it came to my turn, I decided to process the scary diving experience since the memory was still vividly in my mind. I was very anxious about going into deeper water and wanted to return to my comfortable adventurous self. First we went through the introductory process where I had identified the memory, how disturbing it still was to me, and a way that I would rather feel about myself because of the experience. Then we began the bilateral stimulation (this is the eye movement tracking the pendulum of someone’s hand, but it could be any kind of bilateral stimulation like tapping on someone’s knees or having sounds move from one ear to the other).

After a few sessions, there was a very noticeable shift in my perspective. The facilitator recognized that I was not responding as my mature older self. Rather I sounded like a child. My sentences were short and emotionally charged. My facial expression and body language changed, and I felt like a child. What happened over the next half an hour was surprising and disorienting. The trainer continued the EMDR protocol as I returned to being a six-year-old boy who was afraid of choking to death. I had a vivid recollection of lying in bed alone, having difficulty breathing due to severe allergies and choking on phlegm. This was an experience that plagued my youth, but I hadn’t really thought of it in years. Suddenly, it flooded back into my memory and it felt as though I was experiencing two separate time sequences simultaneously. I was six, alone and frightened of dying, and I was also sixty sitting in a training session.

When we concluded the session and I could return fully to the present, I had an epiphany of interconnected memories and associations about my child-self, my fear of choking, and the panic attack that I had experienced in the ocean. Now, these disparate elements began to fit together into a fabric of unresolved trauma finding resolution. Over the next few months, I continued in my personal EMDR work as a client until was having no more psychological distress. Curiously, what appears to have brought on the panic attack was a respiratory problem that I had not even been aware of when I went diving.

Since then, I have continued to study and receive EMDR training. It is a method that I use with clients who are struggling with a variety of issues from substance abuse and anxiety, to unresolved grief and specific traumatic events. Like the composite characters at the top of the page, trauma comes in many varieties. There are the obvious traumatic incidents and there are also the repeated “small ‘t’ traumas” as are often seen with bullying, verbal and physical abuse, or substance use disorders.

Years ago, someone told me that substance abuse was like a trauma to the brain oftentimes inflicted repeatedly to solve some other difficulty. Having worked with a lot of substance abuse clients, this seemed not only plausible but likely. Imagine developing a habit using alcohol to destress and it works well. Then one begins having hangovers, that don’t feel so good, but the individual puts up with the discomfort because there is a strong habitual upside. The hangovers turn into daytime drinking to alleviate the pain and now the substance has become the problem. Neurologically, the pleasure pathways have become compromised, there are strong memory associations with both satisfaction and relief as well as pain and shame. The repeated behavior becomes a cumulative trauma.

EMDR is based on a theoretical model called Adaptive Information Processing (AIP). The idea is that “dysfunctionally stored memories” (Solomon & Shapiro, 2008) become stuck in memory networks that result in maladaptive responses. Consider my six-year-old memory of choking to death. Unresolved, this memory became associated with not being able to breathe and has been triggered by stimuli like sickness and respiratory problems or aspirating sea water. The associations in various memory channels become entangled in subliminal networks. In addition to the fear of death, I had the definitive six-year-old idea that I was being punished because I was a bad boy. AIP is a way of being able to unstick problematic memories and process them. Note that some of these memories are nonverbal and thus the reprocessing is a physiological experience. This is very much akin to the somatic, bottom-up, trauma approaches of Somatic Experiencing (Levine, 2010), or Sensorimotor Psychotherapy (Ogden, 2008).

Frank Capatch, LCSW, one of my EMDR trainers, says that EMDR is right in the middle of bottom-up somatic approaches and top-down exposure therapies that work on trauma through extinction. There are aspects of both in EMDR with the somatic procedure of bilateral stimulation and the direct accessing of emotional triggers as in exposure therapy. The most striking thing for me about EMDR is that the therapist does not need to know the context, the story, or anything else about the traumatic experiences. It is not important to the reprocessing. The therapist’s job is to provide safety and guidance to the client while they are in EMDR therapy.

In conclusion, EMDR is an evidence-based practice that I have only touched upon. There is considerably more information on the web and through the EMDRIA website. Mostly, I wanted to introduce the basic concepts and offer this as a possible therapeutic avenue for those suffering from acute stress or trauma. As with all therapeutic interventions, it is important for the practitioner to have practical experience and from my viewpoint, it is equally important to have the experience from both the client and facilitator sides of the equation. I’m continuing my training and supervision with EMDR and hope that this blog has been informative and helpful.

Namaste

Tim

References

Levine, P. (2010) In an unspoken voice: How the body releases trauma and restores goodness. Berkeley, California: North Atlantic Books.

Ogden, P., Pain, C., & Minton, K. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: W.W. Norton.

Solomon, R., & Shapiro, F. (2008) EMDR and the Adaptive Information Processing Model. Journal of EMDR Practice and Research, Volume 2, Number 4. Springer Publishing. Excerpted from http://www.ingentaconnect.com/content/springer/emdr.