ptsd

EMDR and Interhemispheric integration

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When I wrote a paper to become a specialist in clinical psychology, I focused on EMDR (eye movement desensitization and reprocessing) and the brain. When I woke up today I was inspired to learn even more, and maybe try to do more research the coming years. To summarize my paper, I tested a woman with neuropsychological test before and after treatment with EMDR to see if there were any changes in the test results. The result showed that her memory scores became better after EMDR. To educate myself further, I started to read an article today about trauma and the brain, where EMDR was one of the treatment methods mentioned. I want to share the most interesting part of the article, here.

Decades ago, Harry Harlow compared monkeys raised with their mothers to monkeys raised with wire or terrycloth “surrogate mothers.” Monkeys raised with the surrogates became socially deviant and highly aggressive adults. Building on this work, other scientists discovered that these consequences were less severe if the surrogate mother swung from side to side, a type of movement that may be conveyed to the cerebellum, particularly the part called the cerebellar vermis, located at the back of the brain, just above the brain stem. Like the hippocampus, this part of the brain develops gradually and continues to create new neurons after birth. It also has an extraordinarily high density of receptors for stress hormone, so exposure to such hormones can markedly affect its development. Something as seemingly inconsequential as five minutes of human handling during a rat’s infancy produced lifelong beneficial changes. New research suggests that abnormalities in the cerebellar vermis may be involved in psychiatric disorders including depression, manic-depressive illness, schizophrenia, autism, and attention deficit/ hyperactivity disorder. We have gone from thinking of the entire cerebellum as involved only in motor coordination to believing that it plays an important role in regulating attention and emotion. The cerebellar vermis, in particular, seems to be involved in the control of epilepsy or limbic activation. Couldn’t maltreating children produce abnormalities in the cerebellar vermis that contribute to later psychiatric symptoms? Testing this hypothesis, we found that the vermis seems to become activated to control— and quell—electrical irritability in the limbic system. It appears less able to do this in people who have been abused. If, indeed, the vermis is important not only for postural, attentional, and emotional balance, but in compensating for and regulating emotional instability, this latter capacity may be impaired by early trauma. By contrast, stimulation of the vermis through exercise, rocking, and movement may exert additional calming effects, helping to develop the vermis.

A powerful new tool for treating PTSD is eye-movement desensitization and reprocessing (EMDR), which seems to quell flashbacks and intrusive memories. A moving visual stimulus is used to produce side-to-side eye movements while a clinician guides the patient through recalling highly disturbing memories. For reasons we do not yet fully understand, patients seem able to tolerate recall during these eye movements and can more effectively integrate and process their disturbing memories. We suspect that this technique works by fostering hemispheric (Reprint from www.dana.org a non-profit dedicated to brain research) integration and activating the cerebellar vermis (which also coordinates eye movements), which in turn soothes the patient’s intense limbic response to the memories.

 

You find the rest of the article by following this link:

http://www.theresiliencezone.com/wp-content/uploads/2015/03/Neurobiology-of-Child-Abuse.pdf

 

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Protected: Conquering fear

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Protected: Listening to what your brain and mind tries to tell you

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Protected: The sound of cars crashing

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Protected: The sound of Stockholm 

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Who am I? The person in the mirror

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Right now I am ready “The body keeps the score” by Bessel van der Kolk. At one point, he talks about the problem trauma victims have with recognizing basic needs like if they are hungry or need to move their bodies to not be in pain.

What is dissociation?

Dissociation is a word that is used to describe the disconnection or lack of connection between things usually associated with each other. Dissociated experiences are not integrated into the usual sense of self, resulting in discontinuities in conscious awareness (Anderson & Alexander, 1996; Frey, 2001; International Society for the Study of Dissociation, 2002; Maldonado, Butler, & Spiegel, 2002; Pascuzzi & Weber, 1997; Rauschenberger & Lynn, 1995; Simeon et al., 2001; Spiegel & Cardeña, 1991; Steinberg et al., 1990, 1993).

When they dissociate, signals from the body are often disconnected from their experience, and he writes that sometimes they cannot even recognize themselves in the mirrors. He goes on to explain that brain scans have shown that this is not merely inattention, they really have problems with recognizing themselves.  

He also writes that the relationship and talk in therapy, might not be the most important healing force in therapy. What patients really need, he believes, is the “therapist’s attuned attention to the moods, physical sensations, and physical impulses within. The therapist must be the patient’s servant, helping him or her explore, befriend, and trust their inner felt experience.” Relationship therapy can seem like a kind of ersatz friendship, but “it doesn’t make you better friends with yourself.”

To underscore the shocking possibility that neither talk nor relationship may be necessary in trauma treatment, van der Kolk likes to tell the story of his training in Eye Movement Desensitization and Reprocessing (EMDR), an approach held in very low esteem by many of his research colleagues. Although he initially considered EMDR a fad, like est or transcendental meditation, he went for the training after seeing the dramatic effects it had on some of his own trauma patients. “They came back and told me how supportive our therapy relationship had been, but that EMDR had done more for them in a few sessions than therapy with me had done in four years,” he recalls. Van der Kolk decided to go see for himself what this weird new thing was all about, and took the training.

So, do you know who you are?

Sometimes we need others to be able to see who we are when we look into the mirror.

mirror kopi

Protected: Look at me

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Evidence-Based Treatments for Posttraumatic Stress Disorder: New Online Continuing Education (CE) Course from HealthForumOnline

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HealthForumOnline (HFO) adds a new online continuing education (CE) course, Evidence-Based Treatments for Adults with Posttraumatic Stress Disorder, to their library of over 100 online CE courses for mental health professionals and allied healthcare providers. This online CE course presents trauma treatment options for acute stress reactions, acute stress disorder, and PTSD with a focus on PET, CPT, EMDR, and SIT.

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PTSD is often a chronic condition, with symptoms persisting for over 10 or more years. Moreover, PTSD is frequently associated with significant comorbidities (e.g., depression, addiction) making it one of the most difficult conditions to treat.

Philadelphia, PA (PRWEB) March 30, 2015

HealthForumOnline (HFO) is pleased to announce a new online continuing education (CE) course entitled,Evidence-Based Treatments for Adults with Posttraumatic Stress Disorder, to its extensive library ofover 100 online CE courses for mental health professionals. Posttraumatic stress disorder (PTSD) is one of the most debilitating conditions resulting from exposure to trauma (e.g., child abuse, intimate partner violence, natural disasters, combat). While the lifetime prevalence rate for PTSD is only approximately 7% in the general population, a rate that appears steady for the past 30 years, PTSD is rising among military personnel and veterans (1, 2). Increased focus on PTSD has also been driven by the rape trauma and domestic violence movements, and military advocacy groups vocal about the deleterious impact of trauma on psychosocial and occupational functioning (e.g., 3). HFO, a nationally-approved (APA, ASWB, NBCC)provider of convenient, cost-effective online continuing education (CE), is pleased to offer this timely and important CE course for counselors, psychologists, social workers and allied healthcare providers, working in the trauma context.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), PTSD may emerge after exposure to an event that involves actual or threatened death, serious injury, or sexual violation (4). The symptoms that characterize PTSD are grouped into four separate clusters: 1) intrusion (e.g., intrusive memories, nightmares, flashbacks), 2) persistent avoidance of thoughts, feelings, and reminders associated with the trauma, 3) negative alterations in cognitions and mood that are associated with the traumatic event (e.g., negative beliefs about the self and others, persistent fear and anger), and 4) alterations in arousal and reactivity (e.g., exaggerated startle responses, difficulty sleeping). DSM-5 states that PTSD symptoms must last for at least one month in duration and cause clinically significant distress or impairment.

Looking beyond diagnostic guidelines, the clinical evidence suggests PTSD is often a chronic condition, with symptoms persisting for over 10 or more years (5). Moreover, PTSD is frequently associated with significant comorbidities (e.g., depression, addiction, suicidal ideation, health problems), making it one of the most difficult conditions to treat. Not surprisingly, a diagnosis of PTSD places an enormous burden on patients and their loved ones. Collectively, PTSD exacts significant costs on society as well, resulting in billions of dollars in health and mental health care expenditures and disability compensation (6).

This online CE course will present the three-stage model of trauma recovery, along with treatment options for acute stress reactions, acute stress disorder, and PTSD with a focus on the most widely used evidence-based psychological treatments (e.g., Prolonged Exposure Therapy; Cognitive Processing Therapy; Eye Movement Desensitization and Reprocessing; and Stress Inoculation Treatment). Sociocultural factors associated with response to trauma, as well as treatment, are reviewed to facilitate culturally sensitive approaches. Additionally, available pharmacological and alternative/complementary treatment options are explored. Lastly, common patient-based (e.g., impediments to trust in the therapeutic alliance), as well as provider-based (e.g., vicarious traumatization, self-care strategies), treatment-related issues are addressed.

More:

New Frontiers in the Neurobiology of Mental Illness

1. Norris, F.H., & Slone, L.B. (2013). Understanding research on the epidemiology of trauma and PTSD: Special double issue of the PTSD Research Quarterly. PTSD Research Quarterly, 24(2-3), 1-24.

2. Richardson, L.K., et al. (2010). Prevalence Estimates of Combat-Related PTSD: A Critical Review. The Australian and New Zealand Journal of Psychiatry, 44(1), 4–19.

3. Foa, E.B., et al. (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (2nd Ed). New York: The Guilford Press.

4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

5. Jonas, D.E., et al. (2013). Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD). (Comparative Effectiveness Reviews, No. 92). Rockville, MD: Agency for Healthcare Research and Quality (US).

6. Marciniak, M.D., et al. (2005). The cost of treating anxiety: the medical and demographic correlates that impact total medical costs. Depression and Anxiety, 21(4), 178-184.

Healing the trauma of war

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Trauma of war

This month I found an article on national geographic that I wanted to share with you. It is about war victims and their way to healing, and the therapy is using art to do so. I have worked together with an art therapist, and know its potential. Recently I also read a book by Norwegian art therapist working with eating disorder. Since trauma is what I work with the most, this article was very relevant. Not only relevant, but well-written with beautiful pictures. I have included parts of the article, but to get the full experience follow the link on the top.

Brain injuries caused by blast events change soldiers in ways many can’t articulate. Some use art therapy, creating painted masks to express how they feel

“I THOUGHT THIS WAS A JOKE,” recalled Staff Sgt. Perry Hopman, who served as a flight medic in Iraq. “I wanted no part of it because, number one, I’m a man, and I don’t like holding a dainty little paintbrush. Number two, I’m not an artist. And number three, I’m not in kindergarten. Well, I was ignorant, and I was wrong, because it’s great. I think this is what started me kind of opening up and talking about stuff and actually trying to get better.”

Hopman is one of many service members guided by art therapist Melissa Walker at the National Intrepid Center of Excellence (NICoE), which is part of Walter Reed National Military Medical Center, in Bethesda, Maryland. Images painted on their masks symbolize themes such as death, physical pain, and patriotism.

“I THOUGHT THIS WAS A JOKE,” recalled Staff Sgt. Perry Hopman, who served as a flight medic in Iraq. “I wanted no part of it because, number one, I’m a man, and I don’t like holding a dainty little paintbrush. Number two, I’m not an artist. And number three, I’m not in kindergarten. Well, I was ignorant, and I was wrong, because it’s great. I think this is what started me kind of opening up and talking about stuff and actually trying to get better.”

“I think he was one of the first patients I’d ever had to ask me to let him die.”

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The sound of a swinging pendelum

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History of dissociation

When a pendulum swings one way, there will often come a different reaction that ultimately leads to a shift in view. This means that theories will be created, updated and ultimately rejected if it does not explain the data collected in a good way. This is especially true for psychology, where theories and ideas have been proposed and opposed in a consistent fashion. When we had no other way than our minds to study the insides us, this was particularly true. The history of psychology is in some way a very recent one, but it is also an old one, since philosophers have tried to understand thought and behavior since we were able to. Plato, Aristoteles, Descartes and so on, all tried to construct models on how we could live a good life, and what determined it. Descares, for example, thought we had a body (matter) and a mind. He thought those were divided from each other, and this thought is still alive today when people discuss if a psychiatric condition is biological or psychological (most people now think its a combination of both). Locke, proposed that we were “tabula rasa”, which meant we were born ready to take in the world as we wanted, but that is not so. We are influenced by our genes and what we experience in the womb. We are “ready” for the world we come into, but the meaning we make of it is created along the way. We are probably the only species who need this, who has to have meaning in addition to just existing. For example we are born with a knowledge about what gives us pleasure: Milk, warm objects, a nice voice and so on. We automatically approach that, like the baby searching for the nipple. Baby`s automatically cry when they need something, this is also something they were born with.

Back to how something goes back and forth. I will demonstrate this principle with using examples from the history of psychology.

Mind over matter

I have already mentioned Descartes`s name. Many people know the name and maybe some of his theory. Descartes thought we where divided in soma/matter and in mind/consciousness. This was a popular thought, that in some ways relate to the idea of an eternal soul, that we meet in many religions. This dualism has shaped how our society is constructed and how we treat each other. If we believe there is a soul, that will go to heaven or hell after we die, we will want not to sin (we want pleasure in heaven, not pain). Descartes was sure about this division, and a lot of others, were, too. Then the princess of Bohemia comes along. She asks Descartes: If mind and matter really are divided, then how can they interact? Descared`s answer was that there must be a place in the brain where it happens, and proposed the pineal gland. This actually did nothing to strengthen his argument, since the pineal gland is itself biological tissue. When we got the methods to study the brain, we found out there is no “soul” in the pineal gland, so new theories tried to explain our thoughts and actions (the pendulum swung).

The uterus and the devil

One had a phenomena (for example, extreme mood swings in women) that had to be explained. In the start the one of the explanations could be that the uterus was too dry. For that reason, it had to “find” moisture in the body, and did so by “wandering” around in the body. When it wandered around, it explained why moody women “twisted” and seemed so agitated. In borderline PF-disorder some of the symptoms can be constant shifting moods, strong emotions, flashbacks and analgesia to pain (the same symptoms “hysteric” women had). The uterus theory was after a while challenged, since it couldn`t explan why men without an uterus could have the same symptoms. Another theory explaining some of these symptoms, was that our “nervous system” had literally been “shaken”. But that did not explain why people who hadn`t been “shaken” had the same symtoms. Another popular theory was phrenology, where different “bumps” in the brain were related to different personality characteristics.

When we didn`t know much about psychology, stress-symptoms could even be explained as manifestations of a devil possessing the “patient”. Exorcism was then the solution. After a while, people started to criticise the theory, and again the pendulum swung to new explanations that fit the data better. One of the new explanations was the theory of “hysterics”. Hysteria was a popular term when Freud was young, and he was very interested in the phenomena, and ultimately this led to his grand psychoanalytic theory.

All these examples, show how we make theories, clarify them, challenge them, or even discard them, if they don`t fit the knowledge we have collected by different means. We actually do this all the time, as children. We explore by putting things in our mouth, to see if it is edible (we learn some things are not) and must make another category for it (it is an animal, and they should not be eaten, at least not when they are alive). This way we learn and become who we are today. This means that through history, we have explained many of the same “symptoms” with different theories that also influence how we “treat”” those symptoms.

War-time and new theories

When the war came, the condition of PTSD was not particularly known. After the war, however, a lof of men got a variety of symptoms. It could be mood-swings, irrational behavior (anger over “nothing”) or flashbacks. This also had to be explained, and when we knew more about biology, we learnt that certain things happened in a stressful situation, like adrenaline being released in the body. When they came back from the war, this still happened even when there was no real threat around them.

The mind and body works together, and this ultimately lead to the theory about dissociation.

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