A horrible accident, the brutality of war or childhood abuse can disrupt someone’s life years after the trauma.
Mental health providers can help people try to cope with trauma’s lingering effects, but counseling doesn’t always help people put events behind them.
Counselors at Lutheran Family Services of Nebraska and elsewhere are finding that a treatment regimen called EMDR, or Eye Movement Desensitization and Reprocessing, can help people move past the effects of trauma when other methods have failed. The method uses lights, tapping or alternating sounds to engage both sides of the brain while the patient thinks about a traumatic event.
Therapists with the Department of Veterans Affairs use EMDR to help servicemen and -women who have post-traumatic stress disorder, and treatment guidelines of the American Psychiatric Association designate the treatment as effective on post-traumatic stress.
Cyndi Muhlbauer and Ben Czyz, two Lutheran Family Services counselors in Omaha, have submitted a paper that they hope to have published in an EMDR journal, outlining their successes in using the method as a supplemental therapy.
A few years ago, Muhlbauer and Czyz started noticing that when they used EMDR with their patients — many of whom are homeless, and some who haven’t been able to hold jobs — clients “got not just better, they got lots better, and they stayed better,” Muhlbauer said.
During the treatment sessions, clients and counselors talk about issues that may be causing the person nightmares, flashbacks or anxiety, Czyz said.
“We start taking a look at some of those events in their life that may have caused high distress or disturbance, to help get rid of present-day issues,” he said. “There is, a lot of times, a negative thought attached to those events, like ‘I’m worthless,’ ‘I’m stupid’ or ‘I’m useless.’ ”
The treatment involves many phases, including assessing troubling memories, reviewing current situations that cause emotional distress and working on coping strategies.
In a phase that involves eye movement, clients are asked to think about — not talk about — a traumatic event and associated negative thoughts while their eyes follow scrolling lights on a light bar, or while they’re tapping both hands or drumsticks, or hearing tones in alternating ears.
They’re instructed to pay attention to the emotions they experience and where they feel tension in their bodies.
The bilateral stimulation is thought to help the person begin to process the memory — and the disturbing feelings — because both hemispheres of the brain are being engaged.
“The theory behind this is that information that’s associated with strong, negative or frightening emotions doesn’t get stored in the memory the way normal emotions do,” Muhlbauer said. “It gets stored in a place that isn’t easily accessed and processed during (rapid eye movement) sleep the way normal memories are.”
EMDR, Czyz said, “helps kick those memories, and store them, into the correct places in our brain.”
It doesn’t work for everyone, he said, but in a lot of cases, it does.
The process is intense, said Omahan Clare Marsh, who underwent the treatment after her adult daughter’s suicide. “It’s like being there again,” she said.
Marsh remembers screaming when she found her daughter’s body. “I didn’t experience any of that” during the treatment, she said. “I just felt it. ... You get really, really emotional because you’re seeing the same thing again.”
Before those sessions, Marsh said, Czyz helped her to develop coping skills to deal with the anticipated flood of feelings.
Marsh, who is 61, said that before the treatment, she felt guilty and blamed herself for her daughter’s death. Forty to 50 times a day, she said, she would flash back to when she found her daughter’s body. “I had gotten to where I had a hard time walking into a dark room,” she said. “I couldn’t go down in the basement.”
After her treatments, she said, “I realized the guilt was pretty much gone. It did not change the sadness, (but) I don’t have the guilt. It was her choice to end her life. I had nothing to do with it.”
Dr. Robert Langenfeld, a psychiatrist at the VA Medical Center in Omaha, said that when he first heard about EMDR in 2001, it sounded like voodoo to him. “I couldn’t believe it,” he said. “I was a healthy skeptic.”
But the more he read, he said, he found “it’s an accepted practice, it’s got good empirical evidence behind it. It’s a matter of finding the right fit for the patient.”
According to the EMDR International Association, about 20 controlled studies have investigated the treatment’s effects. The studies consistently have found that EMDR effectively decreases or eliminates the symptoms of post-traumatic stress for the majority of clients, the group says.
Langenfeld said he sees a significant reduction in symptoms in well over half the people who undergo EMDR.
It’s important to determine where the patient’s problem comes from, said Karen Bermel, a mental health practitioner with Alegent Creighton Clinic. Therapists “look for the negative cognition or the negative thought that is really hanging that person up. Once you look for that negative thought, you look for the event in that person’s life that may be attached to that thought, as well as the physical and emotional feelings attached to that situation.”
Sometimes, she said, people will say, ‘I can really feel it in my gut’ or ‘My neck is getting tense.’ So there can be a physical feeling attached to that memory.”
Therapists, Bermel said, try to replace the negative thought with a positive one.
A person who survives a tornado, Langenfeld said, may recall being trapped under debris. The thought he or she associates with that memory might be, “The world is not a safe place.”
Langenfeld asks the person what she would rather believe, and she might offer a positive statement along the lines of “It was a 1 in a million event, and the world is a safer place than I believe it is.”
Through the therapy, he said, he tries to move the person toward the positive idea and away from the negative. If successful, he said, “the memory is still there, but the memory in terms of how it affects that person changes. It no longer interferes with their day.”
The process is cathartic, Langenfeld said. “You’ll see some of these great, big burly guys crying at times during the session. ... Afterward, they say they really feel a positive benefit.”
After Muhlbauer and Czyz showed their results to Lutheran Family Services management, officials decided that EMDR could be a useful intervention for clients. The two have trained 12 other agency therapists from across Nebraska to use EMDR.
Muhlbauer, who also serves as an administrator, sees fewer clients than Czyz. Of the 11 clients referred to her so far this year for EMDR, two dropped out and one went back to a regular therapist because the person wasn’t yet ready for the treatment.
Of the eight people who completed EMDR, she said, all reported lower scores on a PTSD index after treatment than they had scored before the treatment. Seven reported needing lower dosages of anti-anxiety and antidepressant medication to maintain mental health stability. And of those, five also reported going from weekly therapy sessions to biweekly or monthly sessions.
The treatment is covered under mental health benefits, said a spokeswoman for Blue Cross Blue Shield of Nebraska. But Muhlbauer said it can be expensive. The training of therapists is costly, she said, and the treatment usually is provided by private caregivers, not agencies such as Lutheran Family. In order to undergo EMDR, she said, the person must be stable, which can take months of therapy.
“If you don’t have insurance, you can’t get in therapy long enough, usually, to get stable enough to have EMDR,” she said. “What we’re trying to do is make this affordable and easily doable for the agencies that do serve that population.”
Marsh, who was referred to Czyz by her regular therapist, said she was left with a strange — and welcome — side effect from her EMDR treatment. “I used to have a really, really bad, horrible snake phobia,” she said. “Now I wouldn’t say I like them — I still don’t like to be around them. But I’m not phobic anymore.”