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EMDR for pain relief  – a brave new world

In the last few months I have started using EMDR  to assist clients with reduction in pain levels associated with chronic disease. I was prompted by a client who asked me one day “How come you don’t use EMDR for pain relief when you’re using it for so many other things?” I suppose there was a natural hesitation on my part even though some of the more recent research is really encouraging. To meddle in the area of pain management seemed to be a big step for me as I have always had a well developed sense of responsibility toward my clients and consistently advocate the reminder to ‘do no harm’ in therapy.

Eye to the world
EMDR

I proceeded with extreme caution, following the appropriate protocols and encouraged by this client who was all for giving this treatment a go. “After all, ” she chided “I’m in one hell of a lot of pain right now so what harm can it do?” Visualising convulsions, fainting spells or worse I  very cautiously and tentatively went ahead. Targeting the thoughts, feelings and bodily sensations associated with the day to day burden of living with pain was a starting point and the accompanying words to describe the picture provided the impetus for processing. My client had walked into my office that day complaining of severe pain in the back of her neck and was consistently trying to correct the angle of her neck in an attempt to provide some short lived relief, without success.

As the saccades rolled by she said things like “I can’t believe this is happening” and “I just don’t see how this can be working” as she experienced a distinct reduction in pain from 8-9 down to 2-3 at the end of the hour. Not only does she experience a reduction in pain but there seems to be the added benefit of “feeling chilled out” to use her own words. Now this is a very driven, energetic and hardworking person who finds it very difficult to take time out for herself. This therapy hour brings her some significant pain relief for up to two or three days as well as some peace of mind, without the need for taking prescription drugs. Most of us working as therapists in the addictions field encounter people who have been unwittingly seduced into addiction by the need to control serious pain and using EMDR could bring some welcome light relief for those who are willing to give this amazing therapy a try.

Building upon a solid therapeutic relationship founded on empathy, trust and unconditional positive regard,  utilising EMDR for pain relief as a step toward a new direction has proven to be both beneficial and rewarding for myself and my clients alike. Every day brings something new and fresh with EMDR as a powerful therapeutic tool. While I am not advising people to throw away their pills just yet, I, like many other EMDR therapists pose the question that perhaps there might be a way to reduce pain naturally using a neurologically based process such a EMDR. More research needed but we are off to a good start.!

RESTORE trial speculation

Last week Federal Minister for Veterans Affairs Dan Tehan launched the trial of a new intensive treatment program for current and former Australian Defence Force (ADF) members who have PTSD. It’s great to see the Australian Government trying to do something positive to help the men and women who serve our country, but it also raises some questions in the PTSD therapy field which currently seems to be experiencing something of a divide. In one corner the more traditional CBT exposure therapy proponents advocate the much researched cornerstone treatment methods and in the other there’s much ado about somatic therapies, body based approaches, and, the highly-claimed and researched EMDR (Eye Movement Desensitisation and Reprocessing). The Minister’s four year partnership project grant through the National Health and Medical Research Council (NHMRC) was awarded to DVA, Defence, and, the University of Melbourne to conduct the RESTORE (Rapid Exposure Supporting Trauma Recovery)  trial, and Phoenix Australia – Centre for Posttraumatic Mental Health is leading the project on behalf of the University. Interestingly Phoenix also endorses EMDR as an effective treatment for PTSD so its going to be interesting to see the trial results (this is a rapid and therefore shorter period of exposure) and to find out how they shape future directions in PTSD treatment.

Firing neurons
Neuron Stem Cells

While both exposure therapy and EMDR are evidence based therapies, trauma experts like Bessel van der Kolk give good reasons for moving  PTSD therapy away from cognitive therapies (Exposure Therapy is a form of CBT)  – and  ‘talking about the problem’ – towards therapies that focus on body awareness and processing and integrating traumatic material. His book, The Body Keeps the Score, has been praised by EMDR founder Francine Shapiro, as well as others trauma authorities like Peter Levine, Judith Herman and Jon Kabat-Zinn. He argues that traumatic stress has very little to do with cognition as it emanates from the emotional part of the brain that is rewired to constantly send out messages of danger and distress, with the result that it becomes difficult to feel fully alive in the present. While acknowledging that talk can enable the individual to gain a better perspective of what happens (especially in the first few days after a trauma) he points out the mistaken notion that trauma is primarily about memory or the story of what happened.

Van der Kolk is a big advocate of EMDR having experienced it in therapy himself and regularly using it in his work with people recovering from PTSD. Being part of the only NIMH-funded study on EMDR he states the results of  the 2014 study  were more positive than any published study of those who developed PTSD in reaction to a traumatic event as an adult. This incredibly successful EMDR trial revealed that the impact of trauma is in the somatosensory self – trauma changes the insula, the self awareness systems which is why traumatised people often become insensible to themselves and find it hard to experience pleasure and to feel engaged. He also argues the reason why many veterans drop out of prolonged exposure therapy (PET) is probably because they are being retraumatised. Perhaps the  briefer exposure therapy used in RESTORE will counteract this fallout but will it improve veterans’ ability to ‘feel’ and be present in the world as does EMDR?  Let’s just hope the trial and its findings will offer hope and restoration to people who really need it. As Bessel van der Kolk knows from his extensive research, EMDR really works for PTSD – let’s hope rapid exposure therapy does the same.