Kim Howard  00:05

Welcome to the Let’s Talk EMDR podcast brought to you by the EMDR International Association, or EMDR. I’m your host, Kim Howard, in this episode, we are talking with EMDR therapist, Dr Jaan Reitav and psychiatrist and sleep medicine specialist, Dr. Celeste Thirwell about discussing the role of sleep in treating trauma and how EMDR therapy can help. Let’s get started. Today. We are speaking with EMDR therapist Dr. Jann Reitav and psychiatrist and sleep medicine specialist Dr. Celeste Thirwell to discuss the role of insomnia and restless nights in treating trauma. Thank you both for being here today. We are so happy that you said yes.

 

Jaan Reitav  00:43

Lovely to be here.

 

Celeste Thirwell  00:44

Thanks, Kim, it’s great to be here with you.

 

Kim Howard  00:46

Jaan, can you tell us about your path to becoming an EMDR therapist?

 

Jaan Reitav  00:51

For sure. Yeah. So my path to becoming an EMDR therapist came out of the need to find more effective treatments for complex sleep disorders. So I undertook my training as an EMDR therapist in order to treat medical trauma. This rounded out my earlier career training in behavioral sleep medicine and health psychology, so putting trauma to sleep, the book that Celeste and I wrote integrates our clinical experiences with treating complex clinical cases with both medical and sleep issues. So let me say a little bit more about my background in each of these areas, which led me to becoming an EMDR therapist. So I’ve been treating sleep problems for 40 years now. I am first and foremost a clinician, and putting trauma to sleep is written for trauma therapists. So trauma therapists who know their patients have significant sleep problems, who understand that these sleep problems stand in the way of full resolution of their trauma, and are ready to deal with these problems. So all they are missing is a manual to guide them in this work, and putting trauma to sleep fills that gap. So first, I’m going to say a little bit about my training in behavioral sleep medicine. Like many therapists, my fascination with sleep began as an undergraduate reading the interpretation of dreams. This led me to do my PhD in Clinical Psychology. That was 40 years ago now, and my topic was dreaming and psychological defenses. Since graduation, I’ve been treating clients with sleep disorders all the way through. I continue to update my credentials and sleep medicine as the developments in the sleep field have been massive in the past 20 years, especially, I’m trained in CBT for insomnia or CBTI. I’m a certified behavioral sleep medicine specialist, a founding member of the Society of behavioral sleep medicine and a diplomate in behavioral sleep medicine from the American Psychological Association. So that’s my training in behavioral sleep medicine. Second, my experience is in treating chronic medical conditions. So about 20 years ago, I decided someone had to tackle treating the sleep disorders of chronic medical patients. So I took a position at Toronto’s University Health Network, which is apparently Canada’s number one hospital, and I began working with cardiac patients. So these are people who had heart attacks or surgery and helping them in their recovery from life threatening medical crises. So I’m still doing this work, but now expanded from treating cardiac patients to treating patients with cancer, diabetes, arthritis and stroke, serious health crises like these initiate really severe disruptions in physical, emotional and cognitive functions, and I was increasingly curious about how disturbed sleep set barriers to full health recovery for those patients, many have had heart attacks or had survived cancer treatments strokes or were living with diabetes, so really profound changes in their lives. At UHN, I began an innovative group program to tackle the two parallel barriers before these patients that included both chronic stress issues as well as compromised sleep. And this program, which I called a better you, integrated trust management training with CBTI, and on the basis of my clinical work, I contributed to the Canadian guidelines for cardiac rehab programs. So that was published in 2009 and those guidelines were the first in the world to identify sleep disturbances as essential targets. Is to reduce the clinical risks of cardiac patients in their recovery. So third I’m getting now to the EMDR path is treating medical trauma. So I began to realize that treating these patients led me to understanding that they were struggling, many of them with medical trauma, and at the time I read vessel van der cooks book The Body Keeps the Score, reading his account of EMDR, led to a light bulb going off in my head. I was stunned. I had completely missed the connection between bilateral movements of I of EMDR and REM sleep while I had understood REM itself as fundamental to establishing and maintaining our emotional health, I’d not made the link that Francine Shapiro had. So if I went to complete basic training in EMDR along with Celeste, I finished my certification, and I found that EMDR therapy was remarkably effective in resolving the medical trauma of my patients. So the results were amazing, and I was moving towards becoming an EMDR consultant in training when Celeste and I got sidetracked with writing our book. So my path to EMDR therapy came from realizing that CBTI and Mind Body techniques were just not enough by themselves to overcome the trauma that these patients had experienced. So putting trauma to sleep integrates these three clinical themes, trauma, body symptoms and sleep, to which we also added attachment. So attachment is a core issue in complex PTSD. So our model, as outlined in our book, integrates these four treatment targets, which are traumatic events, that’s a T, the attachment wounds, that’s the A, bodily symptoms, that’s the B, and sleep, that’s the s. So together, they spell out tabs, or the tabs model of trauma treatment, which integrates sleep into all of the other skills that EMDR therapists are using currently.

 

Kim Howard  07:28

That’s a great story, Jaan. Thank you for sharing that, and thank you for making the connection. So I’ve said this before on this podcast podcast; I don’t think it’s news. I am, well at this point, I’m post menopausal, and insomnia, that thing that happens when you hit menopause and you have trouble sleeping, trouble going to sleep or shuffle, trouble staying asleep if you wake up in the middle of the night, is a legitimate issue. And I cannot imagine people who have, you know, I consider my experiences fairly mild, although on days that I can’t sleep, I feel like they were, you know, the world’s ending. But people who have more chronic sleep issues, I cannot imagine having to try to function and deal with the things in your lives, and your body’s not rested, your mind’s not rested, you know, and having to go throughout your day without getting the good sleep that you need to re energize yourself, basically. So thank you for making that connection. I appreciate that.

 

Celeste Thirwell 08:21

Yeah, we really talk to the family members of our patients, you know, to really understand your your trauma. Family Member try not to sleep for three nights straight, and then you’ll understand what they’re trying to function through. That’s, that’s what it that’s what it is.

 

Kim Howard  08:37

Yeah, there’s, you know, there’s this whole thing. And I don’t know what the numbers are, but you know, you can go so many nights without so many days without food, so many days without water, but only, like, three or four days without sleep, and your body just starts to shut down. It’s not having sleep is torture.  Yes,. Yes.

 

Celeste Thirwell  08:54

You don’t physically torture anybody you you sleep deprived. And that actually is a technique that’s, yeah, yeah. And then birthing babies too, right? Another time when a mother’s sleep gets very, very disturbed with postpartum depression or reactivation of trauma that was there from earlier.

 

Kim Howard  09:13

Yeah, yeah. I remember those sleepless nights. I have two adult children, and I don’t know how we, well me, but mostly me. I don’t know how we got through that, you know, and you just put one foot in front of the other. But, yeah, it’s pretty intense. So, Celeste, how did you become involved in sleep medicine that focuses on trauma?

 

Celeste Thirwell 09:29

Well, you know, that’s an interesting question. It really goes back to my dad, who was studying at Baylor in Houston, Texas, came home from the hospital one day and gave me a mock up of the brain when I was four. And so that sparked my lifelong fascination with the brain and consciousness. And I told myself I was going to become a neurosurgeon or an astronaut or something really far out. And so I followed the holy grail of consciousness. So, you know, studying Western philosophy, psychology, psychiatry and and also ancient eastern Wisdom Teachings that really are about the body and the brain and connecting with consciousness. And then that led me to go ahead and study in neuroscience. And from there, medical school, and then my first elective in medical school was a psychiatry elective, because I wanted to understand psychiatry. I wanted to understand trauma. My grandmother had been in an internment camp in Hong Kong, pregnant with my dad, when the Japanese storm Hong Kong and I was exposed to immigrant immigrants from around the world very, very early in my medical career. So I spent 30 years doing immigration work for traumatized people from around the world, and I went looking for an elective in trauma, and University of Toronto told me, Well, that’s all fine and dandy, but you don’t have the right Peppa work to do an elective with us. So I kept on hearing everywhere I went, about Dr. Harvey Moldofsky, who’s one of the grandfathers of sleep in Canada, in the world. And I gave him a call, and I said, Dr. Moldofsky, I’d really like to learn more about trauma and sleep. He said, Well, show up on Friday. And I met him on Friday, and he said, start your elective Monday morning on sleep. And so he had a wrap around approach to sleep that was fully comprehensive, because his background was in psychiatry. So most sleep medicine specialists are respirologists, but he happened to be one of the few was a psychiatrist. So we looked at everything from chronic pain. He was the first researcher in 1975 on fibromyalsitis, which is now Fibromyalgia. So I developed a real specialty in sleep medicine and fibromyalgia. And then, as I work with the fibromyalgia patients, we found the trauma underneath that had sparked that that Fibromyalgia developing because fibromyalgia, first and foremost is a disorder of sleep, where people start having poor quality of sleep that goes on for weeks, months, years, and when you don’t sleep deeply, it actually affects the packaging on the cell membrane of your cell and if the cell membrane is not working properly, then the cell factory itself can function properly. So from there, when I was at Dr having modofsky lab, Dr Yan ratab walked in, and we were looking at doing some behavioral medicine programs for trauma and anxiety. And so the rest is history. We’ve been collaborating for over a decade now, presenting in international conferences around the world, from psychosomatic medicine to EMDR conferences, and it’s just been this fascinating journey. But really, what the most fulfilling for me is is I get a lot of Sleep Medicine patients who have been to two or three other sleep medicine clinics trying to understand what their sleep problem is, and trying to understand, make sense of their trauma or piece it together. And so when I do a sleep study with them, and I can show the objective data of their their mind, their brain at night, and show them look, this is where the sympathetic fight and flight system is waking you up from REM is waking you up from deep sleep, they go, Oh, my God, it’s not just in my head. I said, no, it’s actually in your brain waves. It’s in your circuitry. And that is such a liberating feeling for so many patients. And to me, if I hear someone’s not sleeping, I immediately think, okay, where’s the trauma, where’s the stressor, and how far back do we go for that? Because it can go as far back as in utero, yeah.

 

Kim Howard  13:44

And I’m glad you mentioned that, and you mentioned your grandmother, who you said, who was an internment camp and pregnant with your father, I believe. And so we have talked on the podcast before, and obviously we’ve done blog articles, and we’ve had speakers and magazine articles, etc, on this about how pregnant women experience trauma. It is passed through their body into the baby. And so the generational trauma starts can start in the womb, if woman happens to be pregnant by chance, and so that then carries on the DNA of that child. And so that’s pretty significant. And I’m glad you mentioned the sleep studies and how you can show the brain activity. My husband has sleep apnea, and for a few years before he was diagnosed with that, I said, you know, I think you have sleep apnea, you really need to go. And he finally went and got it done, because he had another medical issue happen, and he was waking up 38 times a night. And we were like, Holy mackerel. And people were like, Well, no wonder you can’t function properly. Because, you know, because he would say to me, he goes, Yeah, I was driving. And then all of a sudden, I was driving on my way to appointment. All of a sudden, I didn’t know where I was. Now, I got there, and I was like, holy cow, what are you talking about? You have to go take care of this. This is really important. So let me tell you, he does not sleep without that seat back machine now, and that’s been 10 years. Ago when he was diagnosed. So yeah….

 

Celeste Thirwell  15:02

Yeah. With sleep apnea, every time you block your airway partially or completely, your oxygen goes down, and that’s like a trigger for the fight and flight response, trigger wake up and breathe as an emergency. So you’re re triggering all night long. So we’re not treating the trauma at night. You’re undermining actually your trauma treatment during the day. And that’s what the book putting trauma to sleep is really about. Is like, Okay, time for trauma therapist to focus on nighttime. You can actually use EMDR, and I’ll talk a bit about that later, to to help treat the sleep so that you can fast forward and optimize your daytime trauma treatment.

 

Kim Howard  15:39

Great. Thank you.

 

Jaan Reitav  15:40

And the thing that I would add is that I went for sleep test myself to my clinic, and believe it or not, I have sleep apnea. And I thought, wait a minute, I’m asleep. Specialist, dramatic immunity from this. Apparently, not so. But the story, it’s because all of us are are subject to it, and for those that have been through trauma, they are vulnerable to sleep apnea, and it’s often missed by their therapists, and it does create barriers in their treatment.

 

Kim Howard  16:13

Yeah, absolutely. Jaan, what are the specific complexities or challenges of using EMDR therapy when treating sleep disturbances?

 

Jaan Reitav  16:22

Oh, that is such a critically important question. The reason we wrote putting trauma to sleep is that none of the current trauma treatment therapies directly address sleep. So all these therapists have to go, have to get their heads around is the idea of asking about sleep. So that’s the important thing. Is for therapists to ask about sleep in their evaluation and in the work they’re doing. And that is kind of the beginning place. But the first important complexity to understand is that sleep is not just a single problem. There are a variety of sleep disturbances that potentially could go on. So you mentioned sleep apnea as one the other important ones are insomnia and nightmares. But there are others over and above that as well, including night terrors, sleep walking, confusional arousals. Francine Shapiro herself wrote a lovely essay in one of her books on night terrors, so in a young child, so you need a strategy to be able to triage and evaluate sleep problems that are under the surface, and that’s what our book provides. So our book, our book highlights a number of key themes for EMDR therapists. The book is aimed at giving EMDR therapists, and really all trauma therapists, tools to be able to include sleep in their treatment planning. So I think there’s four important themes that we can kind of go over and these are elaborated fully in the book. The first important theme is empowerment. So all of the sleep disturbances reflect dysregulation at the brain stem level, and this dysregulation at the lowest level of the brain has neuro modulatory impact on all of the areas above, so it impacts the limbic system and it impacts the cognitive functions of the cortex. So it’s critical for trauma therapy and trauma therapist to understand that every trauma therapist is a sleep therapist, they have to kind of get their heads around that idea, whether they know it or not, because their patients are showing up with sleep problems, and they should pay attention to those. The second important theme in the book is education. So we need to teach trauma therapists about how to navigate these issues, and what we do provide is a whole section on what is restorative sleep? What is it that happens when our sleep is good, and that’s important for them to understand so they can talk to their patients about why they need to work honestly as a as an important part of their trauma therapy. The third important skill or theme is sleep triage, right? So we’re aiming at giving EMDR therapist tools that help them to understand the power of restful sleep, the variety of underlying sleep problems, and then strategies for approaching these quickly and effectively, and these things can be done in very brief and effective ways. And Celeste will talk a little bit more about that, hopefully a little bit later. So we devote many. Chapters to each of these elements. And then the last theme that I wanted to underline is the idea that there’s really four enemies for sleep and treatment. Requires an understanding of these root causes we document in the book. These four different enemies of sleep are, first of all, an untrained or disrupted circadian sleep wake rhythm. So this you can find in many adolescents these days who are on their phones in the middle of the night, they’re just not training the sleep system to function for them. A second enemy of sleep is hyper arousal of the sympathetic activity that’s activated by external survival threats. So these are the classic trauma situations in which you’re in a car crash or you’re mugged or raped, something has happened that has given your sympathetic system this huge surge, which does not let up. The third enemy of sleep is hyper arousal of sympathetic activity that is caused by asphyxia, hypoxia, not having enough oxygen, nothing is going to get your stress systems attention quicker than your oxygen levels going down, as it does in sleep apnea. And it’s important for people to understand that sleep apnea is a bit like a predator coming into your bedroom and putting his hands around your throat and choking you, you know, 2030, times every hour. And then finally, the fourth enemy of sleep is bodily sensations of distress. So this can include chronic pain, tinnitus, fever, all kinds of physical sensations in the body also can disrupt sleep. So once you get your head around that it’s not just one thing that we’re looking for and that you’re open to, what is it that I can do for my patients, then you know the book is going to provide you with most of the background that you need to actually function as a good sleep therapist in terms of understanding insomnia. One of the most important things that has happened in the last few years is an important paper written by a Dutch researcher. His name is use Van samarrin, and he published a monograph on insomnia. And the interesting thing that he concluded was that insomnia is actually not a sleep disorder at all. All the sleep centers in the brain are fine. Insomnia is actually a disorder of autonomic and emotional dysregulation, meaning it is a trauma-related diagnosis.

 

Kim Howard  22:51

That makes sense to me as somebody who suffers just a small bit in that because if I can’t go to sleep, or if I wake up at the middle of night and I can’t go back to sleep, it’s my mind that keeps me awake. Usually, do I have some aches and pains along way? Yeah, sure. But not, usually not enough to keep me awake. So it’s my mind starts thinking about all of the things. It won’t shut down. One of the tricks that I use is I try to count backwards from 100 and I try some yoga, deep breathing exercises. Sometimes that works, sometimes it doesn’t glad you pointed that out, because I think most of us don’t connect it that way.

 

Jaan Reitav  23:25

Yeah. I like your mentioning breathing, because that’s something that we go into in the book in great detail. It’s hugely important in kind of calming down the nervous system, activating, boosting your parasympathetic system, yeah, that’s what will get you to sleep.

 

Kim Howard  23:41

Yeah, first learned about all that in yoga, and then didn’t make any of those connections until later, and then I started working for EMDRIA, and I’m like, Oh, yeah. That makes a really big difference to your physical, your physical being. So thanks for mentioning that. So now that we talked about some things that are wrong, let’s talk about some things that that have gone right. So, Jaan, what senses have you seen using EMDR therapy for this population?

 

Jaan Reitav  24:05

Good question. So across the past decade, so I’ve been working as a EMDR therapist now for about a decade, and I want to highlight a couple of different patient scenarios that I’ve treated that that have been really important in terms of my own awareness of the power of EMDR in working with medical trauma. One of the first patients I treated was a woman who’s she was about 60 years old. I’ll call her Sarah. Her husband had a heart attack, called the ambulance. The ambulance came. She sat in the back with her husband. They left the driveway. He had another heart attack right up front of her eyes. She was watching as the paramedics tried to revive him. They got him revived. They went on about 100 yards before they got to the hospital. He had a third heart attack, so she witnessed three. Three heart attacks, one after the other. And luckily, the paramedics were able to revive him, and he was fine, but she was absolutely terrified that he was going to have another one at any moment. And so basically, I used EMDR, and I think it was six sessions, and everything cleared up, the nightmares, the sense of of, you know, lack of control over what’s going to happen, all of those things that we’re haunting are kind of just completely eliminated, which, you know, that was, for me, a real turning point. I said, wow, this really is important for all, all people that work with medical patients. You know, there’s so many medical situations where you know, patients or family members are traumatized by what’s going on. There’s also in the book we we highlight a couple of different scenarios. An important one is something in cardiology they call the Takotsubo heart attack. And Takotsubo is, is a really interesting phenomenon. It seems to be that more women than men are subject to Takotsubo heart attack. It’s about 80/20, women versus men, and it’s always triggered by some kind of emotional or physical crisis. And so a lady that I treated at the cardiac center that I work at, I’ll call her Angela, she had a young niece, Clarissa, who came over to visit Christmas Day. Clarissa had had about a 10 year battle with schizophrenia and just really, really difficult, hospitalized many times. Anyway, on that particular day, her niece lost hope of ever living a normal life, and went to the balcony and threw herself off the 19th floor and died. And my patient was kind of frantic, where is Clarissa looking around, and then went over, looked, peered over the edge of the balcony to see her niece lying on the ground, 19 floors below. She rushed down to see if anything could be done. When she got there, couldn’t get to where her niece was, and she had a Takotsubo heart attack. She was brought to the ironically, brought to the same hospital that her niece was. Her niece died, she lived, but she had persistent angina, all of the symptoms that go with Takotsubo. And again, I treated her with EMDR. And I think it was something like 14/15, sessions, and it cleared up completely. She went for cardiac assessment. They did all kind of imaging, and she said, they’re saying my heart looks normal, like nothing has happened at all. Wow. So we talk about that in the book, and then there’s a couple of other important clinical conditions. Another one that we include in the book is a patient who had persistent post concussive syndrome. So in this case, Mike was in an accident, a car accident, pretty much a car pulled right in front of him, and he could see the car, and had about two seconds before he hit it, and he was kind of, you know, bracing and reacting and hit the car. He was unconscious for about 5-10 minutes. So all of the symptoms of persistent post concussive syndrome, he had headaches that were kind of non stop sensitivities to noise, no sleep, like he tracked asleep literally from the moment of the accident for the following two years. And so included in the book are the actual changes in his sleep pattern as I treated him with EMDR. And from that, you know, he recovered his sleep back to his normal, which was about six hours of sleep a night.

 

Kim Howard  29:08

Those stories are so compelling and tragic. I’m so sorry that it happened to those people, but I’m so glad that they found some healing through you and EMDR therapy so that they can be healthy again. That’…that’s wonderful. Thank you. Thank you very much for sharing this. Jaan, can you talk about a little bit about the AIP model, just explain a little bit about what it is, and then how Francine Shapiro’s AIP model teaches you, and how you built on that.

 

Jaan Reitav  29:38

Okay, glad to do that. So basically, Francine’s introduction of EMDR therapy to trauma treatment, I would say, revolutionized our understanding of trauma and how it can be treated. So her AIP model shifted the focus of treatment from. Uh, the top down cognitive and cortical model that you have in in many trauma treatments to a bottom up AIP model. And so her thesis was that that the brain was kind of stuck in terms of how it was remembering, the kind of memory traces that had been created in the person who had experienced the trauma. So in the attached diagram, there’s a link to it from Alan Shore’s book. You can see the way in which memory itself is consolidated. And what Alan points out is that the left and the right hemispheres have to be talking to each other. And in trauma, the experience of the trauma is so impactful and so intense that the left hemisphere, which is where our sense of who we are as people, kind of sits our autobiographical self, it is threatened by the intensity of those experiences. So the right hemisphere holds on to those traumatic experiences without, in a sense, being able to move over to and be integrated into autobiographical memory. And so you can see in the diagram that the left hemisphere depends on the experiences of the right hemisphere in order for it to create any kind of real memory of what happened. So your narrative memory of your life and what it’s all about is really rooted in the right hemisphere experience, and the right hemisphere experience is rooted in the limbic system. So the ways in which your emotional system gets activated and triggered is critical to whatever the right hemisphere holds. So it holds the actual moment to moment experience as it unfolded in those critical moments. And so that is what Francine discovered, is that when you do the eye movements that it first of all seems to desensitize those right hemisphere memories the intensity of them, and as the intensity begins to drop down, you know, after a series of bilateral movements, the left hemisphere can begin to reprocess and integrate What happened in a different way. And once it’s integrated in a narrative, then you know that the original event is over. But until you’ve integrated it, that experience, that right hemisphere, memory of the trauma, is active and it’s current, it continues to drive what’s going on. So what Francine showed us is that eye movements are actually using the same mechanism that our brains use every single night during REM sleep, where the eyes are darting back and forth and back and forth, which itself was a puzzle to us sleep researchers in particular, because why should the eyes be moving if you’re not awake to see anything? So this is not a visual phenomenon. This is a neurophysiological way that the brain is healing itself. It’s integrating what you know about yourself with what you’ve felt and what you’ve experienced. So so her contribution to the field of trauma was a deeper understanding of how the limbic system and the right hemisphere need to be integrated into our autobiographical memory. Now, the area that Francine and others in the trauma field kind of overlooked is that they’ve, most people have kind of viewed the limbic system and the autonomic system, which sits below it, as being essentially tied to each other. And so if you reprocess limbic reactions of fear that you’ve automatically turned off autonomic sequela, or autonomic aspects of that fear response as well. And I think the one thing that neuroscience research in the last decade has shown is that, in fact, they are not working in parallel. They are two separate areas, and what our book talks more about is that the autonomic system has to be itself targeted, so not just the limbic system. And our emotional responses, but the pre affective shock reactions that are housed more in the brain stem and not in the midbrain hypothalamus.

 

Kim Howard  35:13

Thank you, Jaan. Celeste, can you talk briefly about the neuroscience behind why disruptive sleep can often be traced back to trauma?

 

Celeste Thirwell  35:22

I think the first thing that we have to start realizing is that sleep and trauma is a bit of a chicken the egg which came first. And as a neuroscientist and neuro electrophysiologist, my leaning is towards disrupted sleep came before trauma, and that bears out with some of the research that actually Harvey Moldofsky did, our mentor with the military. They did a 14 year retrospective study of veterans, and the one predisposing factor for developing PTSD was poor sleep prior to entering the military. So regardless of whether they saw combat or not, the ones who were poor sleepers entering the military were more likely to develop PTSD. And so that brings us back into utero again is imagine a mother fully stressed out in trauma, releasing a tsunami of stress hormones through her placenta, through the umbilical cord, into this baby, and this brain is then bathing and stress hormones so that already is prepping that baby’s nervous system to be on high alert, so increased sympathetic nervous system tone, which is the fight and flight system of the brain. Flight, fight and freeze, and then low parasympathetic nervous system tone, because that baby’s not getting any relaxed and restore hormones. So low parasympathetic nervous tone, setting that brain up for autonomic nervous system dysregulation and dysregulation of the brain stem a priori, even before exiting the uterus. And you have to look at it in a terms of a lifelong process, in terms of every little stressor, every little trauma becomes this activation of this sympathetic nervous system, tone that gets higher and higher and higher until you reach the straw that breaks the camel’s back, and then people have a PTSD, lasting neuronal circuitry response. Because what we’re learning now is trauma is what you make of it, not what the actual trauma is. So why could one person have trauma just walking across the street and someone honking at them, and another one not is because their underlying autonomic nervous system is primed with increased Sympathetic Nervous tone to have the PTSD response and have that circuitry ingrained, not only in their brain stem and their limbic system and then the cortical world is set up in the way they tell their narrative is like, oh, there’s danger everywhere. So really, when you come back to it, and what Jaan was mentioned with Van Someren, which is so fascinating, he talks about dysregulated REM. The term he uses is restless REM sleep. So when we’re sleeping at night, we start with Wake, then we go into deep sleep, and then we go into REM activity. And REM, the brain is actually as active as we are during the day, but the body is paralyzed, except for the hardest beating, and the diaphragm is moving so you can breathe, and the eyes are moving. Why is the body paralyzed so that you don’t act out your dreams? But you’re actually you’re in REM. Yes, you don’t go flying like Superman.

 

Kim Howard  38:43

Yeah, that might be very bad, acting out your dreams.

 

Speaker 1  38:45

It is. It is very dangerous, yeah, restless. REM means that the person doesn’t stay in their in REM state. They go in and out of REM state because the sympathetic bursts in the nervous system fragment the REM state. So without that re without proper consolidated REM, then we go through four REM periods a night, on average of 15 to 20 minutes throughout the night. Without that consolidated REM, the traumatic brain doesn’t have a chance to recover and reframe and do everything it needs to do to heal and process the memory, and so you get these traumatic kind of responses built up on top of another one, on top of the other one, on top of the ever rekindling the trauma circuit. So how I see EMDR working? I look at the brain more as like a mainframe of a computer, right? And what we’re doing with EMDR, or when people get to sleep in deep REM at night is we, we’re defragging the computer from viral circuits. So we let’s go in and defrag your computer with the bilateral stimulation, and then your main frame can start to work properly. But neuroscience research is bearing out even deeper. Going looking into the brain stem, and psychiatrist, Dr Frank Kerrigan, with deep brain reorientation, which is taking a step further, is looking at the non verbal shock that’s held within the body. And using deep brain reorientating, you can discharge, discharge the shock that’s in the body, and then come to the effective and cognitive narrative without that shock in and it becomes much easier to reframe and digest. So we’re saying, don’t start therapy with a highly, highly disrupted autonomic nervous system. Let’s first stabilize the autonomic nervous system by discharging the shock in the body. And animals do this, by the way, they shake things off. So let’s go do that, and then let’s see what’s left, what comes to the surface in terms of the effective and the cognitive piece. So really that bottom back up to the top of the brain. And I just find it so fascinating, and really the clinical vignettes we have with using the deep brain, reorientating when EMDR didn’t take us quite far enough in the example with Jan’s patient, who had concussion, he had a reactivation on an anniversary, which is common in PTSD, then he went in with the DBR, and then no more reactivation since then. Great, yeah, so that’s where I see it. And you know, there are many sleep disorders that are really important to look at like we were talking about. So I don’t know if you know, the people who are listening to this. Realize our trauma therapists realize that if you have PTSD, you’re up to 30 times more likely to develop obstructive sleep apnea, and part of that is at night, when you’re trying to sleep and you’re getting these sympathetic bursts that are fragmenting your deep sleep, fragmenting your REM you get these cortisol surges, which basically tell the brain, oh, there’s danger. We have to hold on to energy supply, because we don’t know when we might get energy again. So then that increases weight, and then the weight increases. And when you’re lying horizontally at night, you get a fluid shift up into the neck, which further constricts the airway. Also with the weight, the diaphragm can’t breathe nearly as properly, so it’s compressed, so you’re not getting the full breasts in so like Jan was saying, multiple strangulations throughout the night, triggering the brain to wake up and breathe, which is a stress, stress response. And these patients, we can actually help by focusing on we can use EMDR for nightmares. We can use EMDR to help them desensitize around wearing the mask. So what’s what’s a big challenge with trauma patients is they can’t stand anything on their face because they might have been attacked and they, you know, their mouth covered or something. So I have 123 year old patient who had been attacked and gagged, and we worked on with the EMDR, getting desensitized around that sensation, around that memory, and then she was able to finally wear the CPAP mask. The same thing with insomnia, it’s the brain waking up, you know, not letting you go to sleep like you were saying, waking you up in the middle of the night and waking you up too early. But there’s also something called non restorative sleep. So if anybody has patients who say, you know, I sleep eight to 10 hours and I’m still not rested. You know that they’re having non restorative sleep. They’re not getting into deep sleep and staying there. They’re not getting into the REM and staying there. They have this fragmentation throughout the night with these sympathetic bursts. And then finally, what we were at, we were at a conference recently, I guess, about three years ago, in sleep medicine, and one of the sleep medicine researchers, world renowned and restless leg syndrome, says, Well, you know, we used to think it was only dopamine, but now we realize it might be a trauma response to using the fight and flight muscles of your legs to run away from danger at night.

 

Kim Howard  44:13

Wow, that makes that makes sense, yeah. And it’s interesting that I think you said it was the Dutch researcher who did the veteran research and PTSD, because, you know, I think there’s a misunderstanding out there among the general public that everybody who served in the military has PTSD, or everybody who saw combat has PTSD. And that’s not necessarily the case. But if someone has had some kind of underlying pre trauma before they served in the military, that is exacerbated by their experience that may be traumatic in the military, depending on what they serve and what they do, and then that triggers the PTSD, that makes a lot of sense to me.

 

Speaker 1  44:51

And, that’s what’s sad about many of the military personnel that I’ve treated. I’ve been treating military personnel for over 15 years now, and, they come from poorly attached, traumatic backgrounds, and they’re just recreating it in another situation. And, you know, we’ve seen that over and over again, which is why, in our the book, we really focus on attachment and healthy attachment. It’s like such a big piece of setting the groundwork for autonomic nervous system regulation,

 

Kim Howard  45:22

yeah, thank you, Celeste. Celeste, how can EMDR therapist better recognize when sleep disturbances are interfering with our clients? Efforts to heal you. You may have touched on this earlier, but in case you want to add anything else, well, I just want to go and refer back to Jan and I came up with a table really kind of helping is like a thumbnail sketch of what disordered sleep looks like, and what therapists can actually quickly use in terms of questions to identify what’s going on. So the first question would be onslaught of sleep problems. So when did you first start having sleep problems. Was it as a baby? Was it in grade school, high school, college, university, work, when your own baby was born? Menopause? And then you’ll get an idea of how far back the autonomic nervous system dysregulation goes. Like someone who tells me my mom could never give me up for school and grade school, I know there was autonomic dysregulation and a high, high, high suspicion of trauma. Then you look at, you know, problems, like I said, falling asleep, staying asleep, waking up too early, non restorative sleep. Do you wake up feeling refreshed? That’s a great question. When’s the last time you woke up feeling refreshed? That’s really important. That’ll tell you so much, and then it’s important to differentiate a between sleepiness and fatigue. Like people say, Oh, I’m so tired. And you say, well, sleepiness? Is that an uncontrollable urge to fall asleep during the day, or, like your husband when he was driving the car, that would make me suspicious of sleep apnea. And then, you know, we need to go have a sleep test and check that out. Or is it fatigue? I’m so exhausted, but I’m wired, and I can’t turn my brain off. And you know, sleep problems underlie a lot of ADHD in kids, and that needs to be looked at as well. Then the next piece is the cognitive impairment. Do you have problems with memory, concentration, multitasking, and sometimes that gets lumped under depression, and someone has treatment resistant depression, when, in fact, there’s an underlying sleep issue. And then maybe trauma, latent trauma, that hasn’t been identified. And then we look at psychological problems, irritability, mood, anxiety, problems prone to accidents. And then the big piece that Jan is focused on is his work is chronic illness. If there’s an underlying chronic illness, there’s a high likelihood of sleep issues and pain and sleep are like that, chicken and egg too. Pain causes poor sleep. Poor sleep perpetuates pain, because when you don’t sleep well, you get increased inflammatory factors that accentuate pain, even worse. And then we’ve talked about in utero. So I always ask my patients, like, how was your mother’s pregnancy? And they said, I don’t know. I said, go back and ask her. You know, what were you like as a baby? Were there any delivery complications, lack of oxygen on delivery? I can’t tell you how many people told me that their umbilical cord was wrapped around their neck at delivery. So this is all predisposing issues, and then early development and attachment. We just can’t emphasize that enough. What was your relationship like with your mother, your father? Attachment figures. What was it like going to school for you? And finally, environment, you know, was there something in the environment at a young age or throughout your life that you felt unsafe with. Did you have other sleeping issues, and do you actually get enough adequate sleep? Do you feel refreshed in the morning? What’s your sleep pattern? Like some people, they just have a running pattern that just is a free fall pattern, right? Because they just was never that grounding, attunement and attachment to set a regular pattern for them. So those are basically like a little thumbnail that we talk about when we teach about sleep informed trauma therapy. Those are all great, great points and questions. And we will be happy to include a link to wherever you want to send our listeners to so they can take a look at that.  Oh, that’d be amazing.  That resource. Yeah, that’d be awesome. So I have one more question for Celeste before we move back to Jaan. How can EMDR help trauma patients with their sleep issues?

 

Speaker 1  49:37

Well, I think we touched a bit about that when we’re talking about sleep apnea, we can definitely help those trauma patients in terms of tolerating the CPAP mask. We can help insomnia patients, you know, the people who don’t sleep well at night or have nightmares at night, they’re actually dread going to sleep. So that’s a beautiful target for EMDR. Then. As I said to the restless leg piece. I mean, do they have these awakenings with night terrors or nightmares? We can also target that with EMDR therapy, and now also using DBR. So these are amazing ways to start to do trauma therapy, not only during the day, but with the night symptoms, and then you just get optimization of treatment and and, you know, I was really surprised when I started doing my military work, you know, I’d ask them, what are your top three symptoms? And they’d go, insomnia. It wasn’t the nightmares, it wasn’t the hyper vigilance, like 95% of the patients was insomnia.

 

Kim Howard  50:39

Yeah, yeah. I mean….I mean, I have not served in military and I but I could tell you, as a menopausal, post menopausal woman, sleep is the top three. It’s either one or two. I think the weight gain is, I think they go kind of hand in hand, right? You know, good sleep, you have a tendency to gain weight too, right? So it’s all connected. But you know, those are the top two issues, the lack of good sleep and the weight gain. You know, I can deal with the hot flashes. I’ve got that pretty much under control.

 

Speaker 1  51:04

And interestingly enough, the other elephant in the room is the hormones, and it hasn’t been properly researched, because hormones are like a dirty thing to follow. But Dr. Mark Gordon, who’s in the states treating many of the military people for PTSD, he’s using precursors to hormones to treat both concussion and PTSD.

 

Kim Howard  51:27

Interesting. That’s fantastic. Jaan can un detective sleep disturbances undermine the outcome of EMDR therapy?

 

Jaan Reitav  51:36

Absolutely it can. I think if you think about the autonomic dysregulation that’s going on. It’s not just a 16 hour daytime phenomenon that somehow disappears in the eight hours of the nighttime sleep. It’s a ongoing background dysregulation that disturbs both daytime and nighttime sleep. So in terms of sleep apnea, it can undermine your treatment results, because no matter how good your training as a trauma therapist, and you can go over many trauma triggers and desensitize and reprocess them, but at night, the person’s throat is continuing to constrict, and it’s like there’s somebody choking them and suffocating them every night, and if that isn’t picked up, and the person sent for a sleep test and treatment, which is actually very effective. I don’t know if I mentioned earlier, but I went for a sleep test and I have apnea. I’ve used my CPAP for the last eight years now, and it makes a difference. It allows the brain to actually go through that sequence of deep sleep and REM that Celeste was talking about earlier, and your trauma treatment alone isn’t going to correct that problem. It will not normalize that issue. So that’s one example of where trauma therapists need to be more aware of some of these background issues currently, maybe aren’t being picked up, but it’s very easy to do a screening for apnea. We have information on that in our book, and we’re also going to set up a website putting trauma to sleep.com which is going to have resources for clinicians to do triage work to find conditions that were previously not suspected or were not picked up, and for them to do a better job with all their patients, and so that’s kind of the best example I can give you of where sleep disorders can totally undermine the outcome that you’re going to get, and you can be doing treatment for the next 20 years, but if you haven’t treated the apnea, you’re not going anywhere.

 

Kim Howard  54:00

Thank you. That’s very true. Thank you. Part of our listener community is not just EMDR therapists or potential EMDR therapists, but also the public. So Jaan, what would you like people outside of the EMDR community to know about EMDR therapy and sleep disturbances?

 

Jaan Reitav  54:15

I’m so glad that you’re doing this podcast. I think it’s fabulous to get information out to people. And I think trauma therapists, both within the EMDR community and outside it, have the same difficult situation. And the difficult situation is that no one has been trained to recognize how sleep disturbances can undermine the success of their treatments. And this ignorance, if I can call it, that, extends not just to the therapist themselves, but also to the people who have have been drafting the guidelines for trauma treatment. So there are, you know, very prominent guidelines for how to treat trauma in in Britain, in Australia. Australia, in Canada, in the US, none of them mentioned sleep, which to me is appalling, but that’s the case. So in terms of first step, I think it’s to put sleep in front of everyone as let’s see what you can do with your patients, and that’s what we hope our book is is going to provide people. It’s a manual. It provides kind of information on how to go about understanding your patient’s sleep, what you can do to help them identify what my what kinds of sleep problems they may be having, and then taking steps to do the proper assessment and evaluation, and including sleep as an important target in the trauma treatment that you’re doing. So all of that, I think, is very doable, and that’s what our book is aiming to do, is to give people the tools that they haven’t had up until this point.

 

Kim Howard  56:02

Thank you, Jaan. How do you both practice cultural humility?

 

Celeste Thirwell  56:07

Being Canadian, we come from multiple cultural backgrounds, so we got no choice. But I’ll let young kick eat the can at that, and then I’ll, I’ll pipe in.

 

Jaan Reitav  56:16

Yeah. My mom and dad arrived in Toronto in 1951 I was born some six months later, so I was smuggled into the country, but we grew up in a small apartment complex where everyone was Estonian. So my parents background was Estonian, so I grew up with other kids who spoke Estonian. I went to school for kindergarten not knowing a single word of English and talk about trauma. I mean, I still have memories of sitting in my kindergarten teacher’s lap crying because I couldn’t communicate with the other kids. I couldn’t understand what they were saying. It was very, very upsetting, and I think affected me immensely. Maybe one of the reasons why I came became a trauma therapist is I understand what it’s like when people can’t understand you and people don’t know what you want to say, and you can’t understand them. So I think my personal experience has guided me a little bit that way, but I do think the key is really understanding and seeking to understand the other person’s lived experience, what they are experiencing at a deep level, that includes their emotional reactions, their beliefs, what’s important to them, and respecting and meeting them where they’re at, and being open to their telling you about what’s important to them in the work that you do,

 

Kim Howard  57:51

Sounds like you’re a good listener Jaan.

 

Jaan Reitav  57:56

it’s taken me about 40 years to get here, but yeah,

 

Celeste Thirwell  58:00

Your wife’s training.

 

Jaan Reitav  58:04

She’s a big part of it, for sure.

 

Celeste Thirwell  58:06

We say she’s the third author in the book, because this book definitely wouldn’t have gotten done without an um, wife. She’s a school teacher, and you know how the lesson plan is all organized. So, yeah, just organized over the last five years. Oh, losing computers and accidents and COVID. She’s the one constant that kept us through our did we do? Finished grade school? Maybe grade school…by the fifth grade we made it to.

 

Kim Howard  58:33

Love it.

 

Jaan Reitav  58:34

Maybe it was attractive to her. She was a grade one teacher. Yes, right.

 

Celeste Thirwell  58:41

So you know, for my part, my father was a Chinese, Portuguese immigrant from Hong Kong who came over on the boat all alone at 17 and a decade, became a doctor, married my mom, who was a United Empire loyalist, Scottish background Canadian, and had me in 1969 and really, as my parents, who set the stage for cultural humility, my mom, while my dad was studying at Baylor, you know, worked as a nurse for the Red Cross. She would take us to the ghettos with her when she taught, you know, the baby courses. And in our home, you know, anyone was always welcome, irrespective of religion, skin color, cultural background, everyone was always welcome. And the ethos was, how can I serve best serve, and for me, really doing my years of immigration work, meeting traumatized people from around the world, of all ages. You know, the core, they all have a similar need for safety, for human understanding, bearing witness to their suffering, and giving back human kindness, like, that’s, that’s my trick. That’s the secret sauce. Is human kindness and really bearing witness. To stories that they probably told no one you know, or never repeated before or would never repeat again, and a deep, deep, I agree with you on a deep, deep, deep respect for their journeys.

 

Kim Howard  1:00:10

We’ve talked about this before on the podcast. I interviewed Liliana Baylon few weeks back, and I I can’t remember when the podcast is coming out, because I work so far ahead. But the podcast is about EMDR therapy and, oh, I can’t remember the official title, migration. Maybe migration is a title, I think. But she talked about that and, and we talked about, you know, it’s for any for somebody to pick up and move out of their country. It doesn’t matter if you’re immigrating to an English speaking country or somewhere else in the world, but for you to leave what you know, what you’ve grown up with, what you’re comfortable with, and move somewhere where your language is not spoken, you don’t understand the culture, you don’t understand the society. And for you to do that and have to navigate and create a whole new life, is so unbelievably brave. You know, I mean, my grandparents immigrated from Italy, and they moved to California, and they had a grocery store in Long Beach, and they came directly from Sicily. I’m pretty sure neither one of them knew how to speak any English. You know, we never talked about that when I was growing up. But that’s for people who do that. That’s incredibly brave. And so we should give people high marks for being able to step out in some sort of faith that they’re going to a better life somewhere else than where they come from, for whatever the reason that they are that they decide to move. And so we should give people some grace for that. And so thank you for bringing that up.

 

Celeste Thirwell  1:01:36

It’s really a testament to the human spirit. And I, both Jan and I, you know, when we start with a patient, we have no idea where it’s gonna go, but we are so in awe of how well EMDR and deep brain reorientating And just this unconditional regard does this magic where a patient winds up in a completely different space from where they started that we never could have imagined, and they never could have imagined. It’s just so humbling. It’s such a humbling and experience. And I’m just grateful.

 

Kim Howard  1:02:07

We’re grateful for you guys as well. You guys help heal humanity. So that’s that’s a beautiful calling. Do either of you have a favorite free EMDR related resource you would suggest, either for the public or other EMDR therapists?

 

Jaan Reitav  1:02:21

Well, yeah, there’s many. I think a great start for any trauma therapist is Francine Shapiro’s short case report of Davey that’s 14 month old experiencing night terrors. So she wrote about this in 1997 the case was titled, When terror stalks the night sleep disorders and childhood trauma, and that’s written up in her book EMDR, the breakthrough therapy for overcoming anxiety, stress and trauma. So I think what the case report demonstrates is not just an example of how street sleep disorders are important in trauma work, but also demonstrates Francine’s understanding that EMDR therapy is accessing the neurophysiological mechanisms that support adaptive information processing, and that she was very aware of sleep as an important element of healing and recovery as well. I would direct people to our website putting trauma to sleep.com. So people can go there, and that’ll include many resources, tools and tips and strategies and so forth, to help EMDR therapists, trauma therapists and the public to find information that helps them understand and heal from trauma and what they can do about sleep issues.  Celeste, do you have anything you’d like to recommend?

 

Celeste Thirwell  1:03:49

Well, the American Association for Sleep Medicine and the Foundation for Sleep they have some very good sleep resources that quick, easy Google that people can get to. So that’s what I would suggest for now, but we will have a lot of resources on the putting trauma to sleep.com, website as well.

 

Kim Howard  1:04:11

I’ll list all those websites in the podcast description so people can go back and and click on it and get to it easily. Thank you both. Jaan, if you weren’t an EMDR therapist, what would you be?

 

Jaan Reitav  1:04:22

There’s a good question, and imagine doing anything other than what I’m doing. Well, I went, and when I was in university, I went through a period where I wasn’t sure what I wanted to do, and so I went to Europe with my best friend, and we bought bicycles, and we cycled through Europe, and I was drawing and painting, so I was just really mesmerized by just visiting different places and seeing things through my eyes. Of course, in Europe, there’s amazing art galleries, so going into those and looking at what artists have done and how they’ve shown us how. How to look at the world. So I was lucky enough to have that experience. I came back to Toronto and submitted my my drawings and sketches to the art program at the University, and they accepted me as a student, and I did sculpting and painting and and I really loved it. I actually applied for architecture at Columbia and was on the wait list. So I think I’d probably be doing something in terms of art or architecture.

 

Kim Howard  1:05:30

Yeah, that’s awesome. Were you able to go back to Estonia?

 

Jaan Reitav  1:05:34

I have been back. I went back with my dad in ’92 he would have been 84 at the time, and that was an incredible experience, because we were able to visit the places where he grew up, where he went to school. None of his friends were still alive, but he did meet somebody. We went over to have dinner with, somebody who grew up in his village. He grew up on a farm, and we had dinner with them, and they were reminiscing about, you know, the experiences that they had had in their lives. So my dad was born in Czarist Russia. He was born in 1908 he went to school speaking Russian. And then, of course, in 1920 the Estonians were able to create an independent country free of Russia, and he had to change, or the country changed to teaching in Estonian and being independent. And he was fiercely proud of being Estonian. So I’ve gone back after I went with him, and I’ve truly enjoyed it. One of my memorable trips was we put on some Baltic psychologists conferences in both Estonia and Latvia and Lithuania. And at the one we did in Estonia, Jaak Panksepp came and did a talk, and I had him autograph his book when I was there, and that was also another really memorable moment for me. I really treasure what Jaak has has provided to all of us as therapists.

 

Kim Howard  1:07:10

That’s good that you were able to do that with your dad and have been back and then also meet your your rock star. It was nothing like meeting somebody you really admire getting a photo or getting them to sign a book or something. Yeah, that’s cool. What about you, Celeste, if you were not a psychiatrist and a sleep medicine specialist, what would you be?

 

Celeste Thirwell  1:07:32

Well, that question brings me back to being in doing my mood disorders training during residency, and my preceptor asked me, well, you know what kind of psychiatry you’re going to focus on? I said, Well, I really see myself as a neuro electrophysiologist. He goes, what is that? It’s the connections in the brain, and knowing that the nervous system is actually an electromagnetic entity that really fascinates me. And quite frankly, I think that’s the future of healing and medicine too. We got to get on just beyond the body the physical we got to start looking at the electromagnetic frequencies around things and quantum physics, because the electromagnetic frequency around the heart is 40 to 100 times stronger than around the brain. And in Eastern philosophies that I studied, we always talk about the brain bowing to the heart. And with the veterans I work with one of the communities, they often say PTSD is a sort of the mind that you heal with the heart. And so recently, I just got a new degree as a doctor of humanitarian services through the World Organization of Natural Medicine. And I really just see myself as a humanist. I say to all the patients and people, you got to learn to talk to yourself. So tenderness, acceptance, loving kindness, before you can talk to anybody else, you got to talk to yourself. I really believe this healing, this journey, is really a healing journey of love, first, loving ourselves, loving others, and that’s the good, bad, ugly and wonder of who we are, and then trauma just gets in the way of that. So our book and the work of many others right now in the sleep and trauma fields are changing this. I’m just going to continue being a humanist.

 

Kim Howard  1:09:15

That’s an awesome that’s awesome answer. Thank you. Is there anything else either of you would like to add?

 

Jaan Reitav  1:09:20

I’m really appreciative that you’ve taken an interest in what we’ve written and our journeys, and we love what EMDR does, so thank you for all of what you do.

 

Kim Howard  1:09:31

Yeah, well, we’re happy to have you because we have not discussed this topic at all on the podcast. So this is completely new, and so we were thrilled to be able to make those connections. Because let me tell you, if we are a society that has bad sleep issues, we are going to be a bad society. And that’s just the way it’s going to be, because that impacts so much of what we do and think and act on and how we behave. And so you got to get that right, or nothing else is going to work.

 

Jaan Reitav  1:09:57

So, yeah, and the important message. Is, no matter how bad your sleep might be, anybody, anybody listening to this, that it’s fixable, that these things can be changed. They’re not permanent, but it does require a little bit of know how, and a little bit of time, but the brain can heal. And we hope that the book is is one part of helping people to see that and to to be able to get to that the outcome.

 

Celeste Thirwell  1:10:25

Yeah, I would just say that we’re very grateful to talk about our passion sleep and consciousness and that, just like Jaan was saying, the brain is and its circuity is flexible. It’s just like going to the gym. If you want a big muscle group, you’re going to have to work continuously on that. If you want to boost the off system of your brain, the person is sympathetic nervous system, then you’re going to go, have to go to the brain gym. You’re going to have to go to the gym to heal your heart and do it repeatedly. We can’t continue to live in a society that’s a quick fix pill or YouTube video to distract me, we gotta start taking responsibility for grounding our nervous system, coming back into our hearts, and realizing that we need to talk to ourselves, because the self talk of people who don’t sleep is usually, generally very, very negative, and that self talk then gets fueled out to others. So first, take responsibility for grounding and healing our hearts, and then move forward into a world that is one where there is humanity. My clinic’s tagline is we do this work to keep humanity humane. And I think we’re at a tipping point now where we have no choice but to start to be more humane with each other, or else the world won’t be extinct.

 

Kim Howard  1:11:48

Correct. That’s a great way to end the podcast. Thank you both.

 

Celeste Thirwell  1:11:52

Thank you.

 

Jaan Reitav  1:11:53

Thank you.

 

Kim Howard  1:11:53

This has been the Let’s Talk EMDR podcast with our guests, Dr. Jaan Reitav and Dr. Celeste Thirwell. Visit www.emdria.org for more information about EMDR therapy, or to use our Find an EMDR Therapist Directory with more than 17,000 therapists available. If you like what you hear, please subscribe to this free podcast wherever you listen. Thanks for being here today. You