A Collaboration By Michelle Maidenberg, Ph.D., MPH, LCSW-R, CGP & Dana Carretta-Stein, MS, LPC, LMHC owner & founder of Peaceful Living Mental Health Counseling in Scarsdale, NY. Both of us are committed and advanced trained EMDR therapist and are active in the EMDR community.
When we hear about trauma, we usually think about all the disasters we unfortunately keep hearing about. Mass shootings, school shootings, terror attacks, among other traumatic events buzz across our airwaves way too often these days. These are just some of the traumas we hear about or experience. There are many more that we just overlook because they are considered the “little” traumas and seem relatively inconsequential. All types of trauma are noteworthy and in almost all cases treatment and support is indicated.
We may be victims of trauma and not even know it. Trauma can be defined as anything that causes our parasympathetic nervous system to react, whether it’s a “big T” trauma, or a “little T” trauma. When an individual experiences a traumatic event or cumulative trauma overtime, it can create a change in functioning such as difficulty concentrating, trouble sleeping, headaches, stomach pains, etc.
Children can experience various types of trauma including natural disasters, physical, sexual, verbal, and emotional abuse, domestic violence, medical injury illness, or procedures, community violence, neglect and/or deprivation, traumatic grief/loss, being a victim of a crime, experiencing an accident(s), school violence, bullying, etc.
The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego. More than 17,000 Health Maintenance Organization (HMO) members who underwent a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction.
The study uses the ACE score, which is a total count of the number of adverse childhood experiences reported by respondents to assess the total amount of stress during childhood. The greater the number of ACE’s the greater the risk for the following problems later in life including alcoholism, depression, suicide attempts, smoking and liver disease, among other negative health related issues. Calculate your own ACE score. In her TED Talk, Nadine Burke Harris eloquently discusses “How childhood trauma affects health across a lifetime” based on her work and the ACE’s study.
The Impact On A Child
New research shows that witnessing traumatic events, like domestic violence, shootings, or even fighting, can impact the physical development of a child’s brain, potentially leading to lifelong health, mental health, and social issues. They may have problems thinking clearly, reasoning, or problem solving. It may be challenging to plan ahead and anticipate the future, which can be perceived as threatening or hopeless.
When children grow up under conditions of constant threat, all their internal resources go toward survival. When their bodies and minds have learned to be in chronic stress response mode, they may have trouble thinking a problem through calmly and considering multiple alternatives. They may find it hard to acquire new skills or take in new information. They may struggle with sustaining attention or curiosity or be distracted by reactions to trauma reminders. They may also show deficits in language development and abstract reasoning skills.
Children who have experienced complex cumulative trauma often have difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states. They often internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger. They may also develop ways of coping that allow them to survive and function day to day. For instance, they may be overly sensitive to the moods of others, always watching to figure out what the adults around them are feeling and how they will behave. They may withhold their own emotions from others, never letting them see when they are afraid, sad, or angry because these feelings weren’t responded to well, or weren’t responded to at all. These kinds of learned adaptations make sense when physical and/or emotional threats are ever-present. As a child grows up and encounters situations and relationships that are safe, these adaptations are no longer helpful, and may in fact be counterproductive and interfere with the capacity to live, love, and be loved.
General Trauma Treatment
Acute treatment can be highly effective in the aftermath of traumatic events. There are several different treatment approaches to trauma, which include Prolonged Exposure, Trauma Focused Cognitive Behavioral Therapy (TF-CBT) & Eye Movement Desensitization & Reprocessing (EMDR), which will be the focus of this article. Some research suggests that neuronal plasticity is enhanced in the very early days following a traumatic event. This would suggest that early interventions would have a high efficacy rate due to the brain’s ability to grow, adapt and change with incoming information. Generally, trauma informed counselling helps one to focus and heal from “what happened to them”, rather than “what is wrong with them” which are feelings often expressed and experienced.
What unfortunately happens, particularly during incidents of trauma, is that there is tremendous support for survivors in the days and months following an event. Eventually, things settle down, and everyone goes back to their daily lives. In the aftermath, survivors are left alone, still dealing with their unprocessed trauma, and often feeling isolated and misunderstood. While having support when the trauma first happens is helpful, it is often not enough. For survivors, it seems that the world has moved on, but they are still stuck in trauma time.
Post-Traumatic Stress Disorder (PTSD) is, by definition, a lack of time orientation. This means that there is a part of us that is constantly reliving the trauma, not realizing that the danger is over, and the time that the trauma occurred has passed. Many survivors struggle with this on a daily basis and become depressed and anxious, thinking, “there must be something wrong with me” because they simply cannot go back to the level of functioning that they were able to maintain before the trauma took place. Trauma is stored incorrectly in the brain, which is why it makes functioning so difficult for survivors of trauma. We know that with PTSD, the area that controls memory, the hippocampus, becomes smaller, and reactions come directly from the amygdala. Without sufficiently processing the traumatic material, an individual can continue to get activated day in and day out, years after the trauma has taken place.
Regarding the long-term costs of traumatic stress, McFarlane comments, “PTSD is part of a complex psychobiological process that leads to the emergence of the disorder in the weeks, months or years following the event.” Left untreated, this PTSD can morph into symptoms such as depression, chronic anxiety and panic attacks, disturbed sleep, inability to focus, among others. Overtime, this will affect the quality of an individual’s relationships and ability to function at work or school.
There may be distress related to acclimating back into mainstream society after an incident of trauma. Survivors often feel like they are stuck in an abyss. They may be experiencing lingering survivors’ guilt, feeling “different” than others, because others can’t possibly understand what they went through and are currently experiencing, or feeling so vulnerable and on the brink of breaking down emotionally so they avoid being around others who they “don’t want to make uncomfortable”, “will pity them”, “will spread their personal business around”, or “won’t know how to effectively support them.”
How EMDR Can Help
EMDR helps your brain to heal in the same way that your body heals from an injury. Your brain naturally works toward mental health, but when an injury takes place, i.e., a traumatic event, a block occurs that prevents the brain’s natural healing processes. This is why individuals with trauma often report feeling “stuck.” The traumatic material is stuck between the prefrontal cortex and amygdala. Once the block is removed (with EMDR therapy) then the healing can resume.
Wondering how EMDR actually works? Traumatic incidents are stored differently in the brain than regular, every-day life experiences. The emotions, thoughts and sensory perceptions, which were appropriate at the time of the trauma, can be triggered throughout the person’s life at times when trauma is not present. This results in symptoms such as anxiety, chronic pain, difficulty sleeping, etc. Most individuals who have experienced a traumatic event report feeling “stuck.”
During an EMDR session, the therapist will have you bring up the memory of the trauma and then move your eyes from left to right for a number of sets. Some therapists may use tapping instead of eye movement, it depends on your preference. By moving your eyes from left to right, you actually light up both areas of your brain, thus allowing you to use your whole brain to actually relearn the event with information that helps you digest it.
EMDR assists clients in reprocessing (revisiting and relearning) traumatic incidents that have contributed to their present-day symptoms. Doing so allows these trauma memories to be stored correctly in the brain so that emotions, thoughts and sensory perceptions are no longer triggered. EMDR also assists clients in working through the beliefs that developed as a result of traumatic experiences and helps them to remove these negative beliefs. This could include beliefs such as “I’m not safe”, “I should have done something”, etc. The EMDR therapist assists the client in replacing the negative beliefs with positive, adaptive beliefs about themselves.
It’s important for all survivors of trauma to make sure they know about all of the options available to support them, not just directly after an experience, but in the months and years following. Consistent support, including valuable, evidence-based treatment methods such as EMDR, leads to healing, growth, and overall wellness.