Kim Howard  00:05

Welcome to the Let’s Talk EMDR podcast brought to you by the EMDR International Association or EMDRIA. I am your host, Kim Howard. In this episode, we are talking with EMDR, certified therapist, trainer and consultant, Carol Miles about EMDR therapy and panic attacks. Let’s get started. Today, we are speaking with EMDR certified therapist, consultant and trainer Carol Miles to discuss EMDR therapy and panic attacks. Thank you, Carol for being here today. We are so happy that you said yes.

 

Carol Miles  00:33

Oh cam, thank you so much for inviting me. I’m delighted.

 

Kim Howard  00:36

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

 

Carol Miles  00:40

Well, as much of my path has been it was not really a very strategic process, it was mostly a matter I think of really good luck. I’ve had very fortunate situations happen to me over the years, this one came because of my involvement with a younger colleague, I was by her graduate school in turn instructor and then later, her mentor, I guess, and friend. And so over the years, we would have conversations. So Hurricane Katrina came and went, thank goodness. And we were all having our own struggles at that point. And she suggested we should get trained in EMDR. And I said, Absolutely not. I don’t want to sit around like a monkey wave and my arm. I’ve had a lot of other trainings. So I don’t need to do that I had a little bit of an attitude problem. But she said or encouraged me as a younger person might with an older person to go look it up. So I went on and studied event and thought, okay, maybe. And I wrote to Bob Gelbach at the Humanitarian Assistance Program was the head of that at that time. And I said, you know, you guys have been doing free trainings over here since Katrina, it’s been a year and a half, would you be interested in doing another one? And he said, Oh, no, we’re finished. But I had a Tulane.edu account, which meant I was a adjunct professor in the School of Social Work. And his wife had his late wife, now, Kathy Davis, had graduated from Tulane in the School of Social Work. And so he was intrigued by the opportunity to come to two lanes, so I did logistics for them. And they came to New Orleans again, after they had finished doing their free trainings. And so I got a free training. And in that very first meeting in this really beautiful old but has a lot of, of aches and pains building that were in that too, and offered crammed in a lot of people and not your most perfect training, I’ll say now as a trainer from the standpoint of the space. And we did this training, and I was totally wowed from the beginning in the practicum. And then continued on my process over the years. But that was how I became an EMDR therapist kind of fell into it. And I really do want to credit my younger colleagues for not only do they get mentoring from us old folks, but they also help us stay abreast of new things and stay involved in new things. And I really appreciate that involvement. It’s a two way street when you work with folks.

 

Kim Howard  03:07

Yeah, that’s a great origin story. And you’re not the first podcast guest we’ve had, who was a little skeptical of the therapy or wasn’t exactly interested in the beginning. And so sort of had to be convinced by other colleagues. So we always like to know where people are coming from and how they got here. So thanks for sharing that, Carol. What’s your favorite part of working with EMDR therapy?

 

Carol Miles  03:34

Seeing people get well, certainly. Watching people grow and heal is what I got into this profession for and what I love to see with EMDR it’s probably the most exciting thing that can happen in work is to see folks who come in with such pain, grow and change. And I’ve worked with some folks where it took a lot of time and pacing in order to get them where they needed to go and other folks were it’s so immediate. It’s just unbelievable. I’ll walk out of those sessions just thinking How did that happen? This is amazing to watch people’s brains heal themselves.

 

Kim Howard  04:13

Yeah, that’s a great answer. Thank you. So let’s talk about why you’re here today talking about EMDR therapy and panic attacks. Can you tell the audience what a panic attack is?

 

Carol Miles  04:22

Well, I did a little research knowing that I was going to speak on panic attacks. And I found that panic attacks are actually much broader than I had been thinking of them in terms of but they’re defined as recurrent, unexpected fears, anxieties that have a surge of intense discomfort from this extreme fear and it gets high usually within minutes. Sometimes it lasts as much as five minutes. Sometimes it lasts, sort of cycling up and down for a much longer period of time. And I started thinking about all the different types of panic attacks and in my mind it came a continuum, all the way from my answer to the question, Carol, when you come on the podcast, and talk about panic, but I said, Okay, I’m panicking now, you know, common language. And we talked about getting a little anxious or nervous or worried about stuff, all the way up to the idea of much more extreme panic attacks. So it kind of developed this idea of a continuum, kind of from pre panic, which is like, I’m really worried about it, oh, no, what’s going to happen? Anxiety, we’re afraid we’re dreading things, we’re stressed up then to an actual panic attack, which is generally short lived very extreme, often, having had a real danger occur, sometimes coming up with no real danger, it just sort of out of the blue kind of hits us. And we have this fight flight freeze response. We have physical symptoms that often mimic heart attacks. One of the most common problems for folks in the emergency room is folks come in, clients come in with panic attacks, but it looks like a heart attack. So they run all these tests are trying to figure out what’s going on with them, and they send them home. Basically, it’s all in your head or a worry about what’s going on psychologically. And so it may be they kind of know what’s been going on that created the panic, or they have no idea. And then they begin worrying about having another panic attack, or they avoid circumstances that might create anxiety. And that’s really when the development of a panic disorder occurs, is when one of those two things happens. And then it may add to the problem, where people will begin to avoid going out so that they get so worried about whatever might happen to them, they develop agoraphobia, panic disorder can be with or without agoraphobia. Then on the far, far end of the continuum are folks who have very lengthy intense panic attacks. So the other ones were maybe five minutes up to an hour, these might last all day long on and off, kind of cycling up and cycling down a little bit, and then back up again, and the down and up again. And those folks tend to be folks who have see PTSD or that kind of developmental PTSD that occurs when people have a lot of trauma in childhood. And I have a number of those clients anywhere on that continuum at any given time.

 

Kim Howard  07:36

But it’s good that you mentioned it, I have a friend who had that experience. What he didn’t realize at the time was a panic attack about 15 years ago, he went to the emergency room thinking he was having a heart attack. No, I’m not suggesting that people don’t seek care if they think they’re having a heart attack or think, oh, it might be panic, I don’t need to go see a doctor. But he literally thought he was having a heart attack. And so the symptoms are very similar. And so I’m glad that you, you.

 

Carol Miles  08:02

Absolutely, Kim. One of the things that was in your list of questions that maybe we can just go ahead and segue to now is about an interesting case. So which reminds me of your friend and this fella came in, I’m offering now only for new clients, I only see folks for intensives. So we do longer sessions. We do all of it packed into a relatively short period of time, six to nine hours over a week or so. And so this fella came in. And he explained to me that he had had a whole series of panic attacks that were really secondary to a diagnosis of cardiac problems. So he had cardiac problems and panic simultaneously, which was really a kind of a complicated piece to sort out and figure out where to intervene for him. He had been to the ER I think he said 12 times over the past year, and eventually learned that it was a panic attack and what the signs were in that he wasn’t about to die of a heart attack or that we had a cardiac condition.

 

Kim Howard  09:09

Right. So let’s talk about the successes you’ve seen using EMDR therapy for panic attacks.

 

Carol Miles  09:15

This gentleman that I was talking about, it was about my age, so mid 60s, I guess that’s given me a little extra room there. Let’s say later, he came in and described this scenario to me. He was really unusual and interesting, and that as we began talking about it, his fear very clearly was I’m gonna die. The doctors deemed him extremely healthy with this cardiac condition that he had. He didn’t need to have a stent. His lifestyle was great. His exercise routine was great. He was otherwise a very healthy man. He was in a good relationship with his second wife things were really good for him strong spiritual component to his life at this point. And he said, I said, Well, when was the first time you were out? Were afraid of death. And he said he was a little boy, preschool maybe or kindergarten, very, very young, he couldn’t pinpoint the date. But he remembered really clearly a family member had died. And he didn’t know anything about death before that, and he was terrified. This is very, very young. So it fit the EMDR model of going back early and looking at that past target. Although there are a lot of modified protocols that we look at today, and working with folks with panic disorder, I chose kind of a traditional model with him to go back and work on that really early time with his mom, which his brain was incredible, listening to him, make the generalizations and move through stuff. And he created a whole safe place within his processing that was in addition to his other safe place. And he created this imaginary, actually afraid of himself dying and didn’t know what that meant. His mom’s answer was that we’re gonna go to heaven, which didn’t satisfy him very much. At that age, he was pretty much still terrified. And he remembered that really clearly. So we zoomed in on that, that target with Phase Three started there. And then he began doing this work. And things just were coming up for him just the way things do and EMDR. And suddenly, there was a cloud with his father standing on his father had indeed passed away, he had avoided being terrified of his father’s death by exiting stage, right, I guess you would say he had another event he had to go to. So he didn’t stay by his father’s bed, he had an excuse to go somewhere else. And he always felt guilty about that. So in the processing, he imagined his father on a cloud, I guess, in heaven, waving and smiling at him. And then soon another person appeared on the cloud was a friend of his who he had died. Well, I guess he also had avoided any of the triggers about death for also smiling and waving, not beckoning not calling him. But saying that they were happy, they were pleased with him. They were good. And he was good. And so we went on with this processing, he finished the processing, did all of the work, we also did some present triggers. And we did future template. When we completed all of that work. In nine hours total, over a number of days, he went on a trip to the beach, which he loved to do, and most of us around here love to do, went to the beach. And there’s a part of my intensive packet, you’re supposed to send back the end and send it back yet. It’s really curious. I wrote to him and I said, Oh, by the way, just a reminder, there is this component of the packet, really love for you to send it back. And he wrote back and he said, I’m doing great. I’m so happy. I haven’t felt anxious at all. And I thought, wow, that’s really cool. Yeah. So that was one of my successes, kind of an unusual route, because of that very early memory was so clearly identified by him. So connected to the fears that he was having presently. Some people it’s not like that it’s more complicated. Other folks who don’t have panic disorder, who are just having panic, it may be just in the moment, we’re going to do some resource work to help get them better, grounded and calmer. A lot of the work around panic disorder or having panic attacks, is around helping people have that ability to self soothe to emotionally regulate.

 

Kim Howard  13:29

Yeah, yeah, absolutely. And I, I saw so suspect, I mean, you and I both raised children, you know, when children are young, it’s so difficult for adults to explain complicated life events, especially a death and when they’re young, it’s, you know, their mind starts to go, Well, what if my parents die, or what if my grandparents are somebody that they’re really close to, and they love, and then they get worried about those kinds of things. And so I can see how that would happen, and how that would sort of manifests over the years to become a huge worry for him. So I’m so glad that he was able to find you and work that out.

 

Carol Miles  14:07

But what was fascinating about it to me was that he was so worried about those things, but he actually had done this incredible job of avoiding his fear for all those years, you know, 60 plus years, really avoided them beautifully, and avoid them anymore when he was faced with his own medical condition, right. And then it was right in his face. And he was terrified and over and over again, having those experiences that mimicked his actual illness. So it was really it was a great case I had a lot of fun seeing the results of that case and we can say it’s so much fun when you’re in the middle of it because you’re you know right there in the in the scenario with the client, but watching the results is the best.

 

Kim Howard  14:55

That’s great. Thank you for sharing that. Carol, are there any specific complexities which challenges with treatment for people with panic attacks?

 

Carol Miles  15:02

I do think you really have to identify carefully. And clearly whether or not this is somebody who is panic about something specific in their life. And it’s related to real circumstances, or is it something from the past that is coming up right here. And now, it’s generally irrational stuff. But there could be rational things, creating panic, if you’re in a domestic violence situation or other situations where there is impending danger, you got to make sure your client really is safe. On the other hand, the majority of the time when my experience has been folks who are panicking about things that are not immediate, dangerous to them, and then they really have to learn some skills of emotional regulation. And sometimes we have to titrate the process, take bite sized chunks of the feared things this gentleman didn’t have to do that. He dove right in, he was really ready to get rid of these feelings, really ready to do the work on it and had already learned a number of tools himself for emotional regulation. Sometimes folks who come in who experience panic, are at such a hypervigilant level, that’s very hard for them to achieve a sense of safety and trust with the therapist. So you have to work hard on that relationship, making sure that there is at least a moment of safety within the relationship with the therapist.

 

Kim Howard  16:27

That’s good advice. Thank you. Are there any myths that you would like to bust about working with EMDR therapy and panic attacks?

 

Carol Miles  16:34

So as I was thinking about the continuum idea, I reached out to a friend of mine who’s EMDR trained, but has used it very little, she’s really in the VA system in a management position. And I wrote to her and I said, what about this? And she said, Yeah, I think that makes sense. That’s good. Make sure that you did. And then she said, and then of course, exposure is what should be used. And I wrote back as the way she’s used to be writing back and said, Well, you know, EMDR, can also be effective for this. So I think that there are a lot of folks who are very well trained, very thoughtful, smart folks who just don’t know about the benefits of using EMDR. And I want to point to a study that was done, I think it’s by force in 2017. And it was a comparison study between EMDR and CBT. There aren’t very many studies that look at the use of EMDR. But that one showed it was equal to CBT. I think there may be more studies coming up, certainly in the Netherlands, Adi Jiang and Susie Mathias and have been doing a tremendous amount of work with very intensive types of treatment processes, they use a combination of exposure EMDR, and exercise in their treatment modalities, seems to be extremely effective, haven’t seen their work replicated in outpatient, like private practice settings are in the US. But they have done a tremendous amount of research on their work in the Netherlands. Very impressive. So I’d like to say to the folks who don’t know that EMDR can work with panic disorders, go for it, see what happens.

 

Kim Howard  18:14

I will post those studies that you mentioned in the description box so that people can directly click on them and go check them out. So thank you, Carol. How do you practice cultural humility as an EMDR therapist? You

 

Carol Miles  18:28

You know, that was such an interesting question. And I’ve had to really ponder that for a bit. I think the first piece is really personal reflection, I have made, I can’t even tell you how many mistakes in this category. Over the years, so many times teaching in graduate school or in interpersonal relationships, or even in when I worked on on the EMDRIA board, there were times where I made really mistakes. And what I really have to do is reflect on those mistakes. I’m okay with being called out being talked to about where there’s a microaggression or where I’ve misunderstood something, or I need to wake up to more information. And I’ve really liked to have that directly given to me so that I can respond well, I try to be open, I try to be teachable. I try to engage in settings where I’m going to learn more about other cultures, I try to be aware of the opportunities for that and also really look for opportunities to mentor folks who are of different cultures to help to launch them in part in solidarity with EMDRIA stance on that subject, but also because it’s important to me personally.

 

Kim Howard  19:43

Good answer. Thank you. Carol, do you have a favorite free EMDR related resource you would suggest either for the public or other EMDR therapists?

 

Carol Miles  19:52

Well, you know, I always point to emdria.org as the place to find out things. And one of the new hot things that It has just come out is the EMDRIA library, which is amazing. And it has some components that are only available to members and some components that are open source that are available to everybody. So that’s my new thing. And I love the EMDRIA videos, and the opportunities for folks to see those things. So I use a lot of of those pieces to try to help people find out more. And I’d like to when I talk to people about EMDR, the public or friends, I try to kind of vet what it is they’re going to look at and warn them when you do the Google search, stuff comes up, that doesn’t really hold water, it’s been disproven a number of times already. And here it is popping up again. So here try to look at this, which is where emdria.org comes in.

 

Kim Howard  20:48

Yep. Thank you. Thank you for the plug. We we agree, but we’re a little biased. So what would you like people outside of the EMDR community to know about EMDR therapy for panic attacks?

 

Carol Miles  20:58

I think it’s very important to work with a therapist who’s going to look carefully at the diagnostic components and make sure that they’re addressing the need of the client, and then go for it. I think standard protocol can be very effective as it was with this gentleman that I referenced earlier. I think using in some cases, flash forward, where you are really zooming in on what is the feared thing that might come up in the future? How are you going to address that? So I think go for it. There are a number of different ways to address panic in the client population, and you need to look for the right one.

 

Kim Howard  21:37

All right. If you weren’t an EMDR therapist, what would you be?

 

Carol Miles  21:42

That’s probably the hardest question.

 

21:45

There’s no wrong answer here.

 

Carol Miles  21:46

Yeah, I don’t know. I mean, I always wanted to be a blues singer, but didn’t have the voice for it. So I don’t know that that’s a that’s an option. I love what I do. I have no desire to retire as long. I always say my brain still works. I’m gonna keep doing it. I love teaching EMDR I love working with people and seeing them heal. I don’t have another career choice that really, to me.

 

Kim Howard  22:13

That’s the answer, too. I mean, not everybody who gets on here comes up with a different career path. We have had guests before, say, You know what, I would still do this work. And here’s why. So it’s a good answer. Thank you. Carol, is there anything else you’d like to add?

 

Carol Miles  22:28

I always perceive myself to be a bit of a hostess for my region. So come to New Orleans; come even to my small town of Covington. Come see what we have here. It’s it’s unique. It’s wonderful. Come visit. This

 

Kim Howard  22:43

has been the Let’s Talk EMDR Podcast with our guests Carol Miles. Visit www.emdri.org for more information about EMDR therapy, or to use our Find an EMDR Therapist Directory with more than 16,000 therapists available. Like what you hear, make sure you subscribe to this free podcast wherever you listen. Thanks for being here today.