The real voyage of discovery consists not in seeing new landscapes, but in having new eyes… Marcel Proust

According to one of the foremost experts in healing trauma, Dr. Peter Levine,

“Trauma is a basic rupture – loss of connection to ourselves, our families, and the world.  The loss, although enormous, is difficult to appreciate because it happens gradually.  We adjust to these slight changes, sometimes without taking notice of them at all . . . although the source of tremendous distress and dysfunction, it (trauma) is not an ailment or a disease, but the by-product of an instinctively instigated, altered state of consciousness.  We enter this altered state, let us call it “survival mode” when we perceive that our lives are being threatened.  If we are overwhelmed by the threat and are unable to successfully defend ourselves, we can become stuck in survival mode.  This highly aroused state is designed solely to enable short-term defensive actions; but if left untreated over time, it begins to form the symptoms of trauma.  These symptoms can invade every aspect of our lives.”

Linda Curran, a trauma specialist who has trained thousands of mental health clinicians on trauma treatment across the country states “The most effective to evaluate whether or not you have been traumatized is to answer this simple question: when you remember the incident, is the memory exactly the same every time? If the answer is yes, then the memory is a traumatic one.  By no means does one traumatic memory constitute a diagnosis of PTSD; however it does indicate that the traumatic event has been dysfunctionally stored; remains inadequately processed; and continues to cause you distress” (Curran, Linda, BCPC,LPC,CACD,CCPD, Integrative Trauma Treatment , 2011).

Traumatizing experiences shake the foundations of our beliefs about safety, and shatter our assumptions of trust (Baldwin, David, PhD., Primitive Mechanisms of Trauma Response: An Evolutionary Perspective on Trauma-related Disorders, 2013).  Our response to trauma is specifically and precisely determined by whether we can control the event.  If we can control that experience by defense or escape, our brains will process it in a manner that adds to our accumulated important life experiences that were associated with heightened states of emotional arousal.  If we face a threat to our life in the face of absence of control – a state of perceived helplessness – our brains process the experience in quite another manner (Scaer, Robert C., Healing from Trauma, 2008).

Part of the key to understanding how we react to traumatic events is to look a little closer at how these memories are processed.  Traumatic memories are frightening and emotionally upsetting.  Before a traumatic event, a person probably had some preexisting beliefs about how the world works, such as: the world is basically a safe place, life is predictable, horrible things don’t happen to good people, or really bad things can happen to other people, not me.  The reason trauma memories are so difficult to deal with is that they are highly emotionally charged and they go against our beliefs about how the world works.  Traumatic memories may be stored in different parts of the brain and are coded differently than regular memories.  Some parts of a traumatic event are processed consciously and are verbally accessible. Verbally accessible information is information you easily remember about where you were, what you were doing, and how you reacted after a traumatic event.  There is also a portion of the event that is processed unconsciously – out of your awareness.  These emotionally charged memories are situationally accessible, meaning you have less control over when and how you remember them.  They are often triggered when something reminds you of the traumatic event.  People places, smells, sounds, and feelings can all remind you of these types of trauma memories.  These situationally accessible memories are often rich in detail; they were processed rapidly by the brain during the time of the actual traumatic event.  To tackle traumatic memories we need to get a handle on the situationally activated memories (usually these are what people experience as “flashbacks”) as well as find a way to integrate our shattered assumptions about the world into a new, coherent belief system (Raja, Sheela, PhD., Overcoming Trauma and PTSD, 2012).

Trauma results in a fundamental reorganization of the way the mind and brain manage perceptions.  It changes not only how we think and what we think about, but also our very capacity to think.  We have discovered that helping victims of trauma find the words to describe what has happened to them is profoundly meaningful but usually is not enough.  The act of telling the story doesn’t necessarily alter the automatic physical and hormonal responses of bodies that remain hypervigilant, prepared to be assaulted or violated at any time.  For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present (van der Kolk, Bessel, M.D., The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, 2014).

To heal from these effects, we must change the perception of our survival brain from a state of persistent helplessness to stable and ongoing control. We must change our trauma memory, and all of its triggers, from representing an ongoing threat to being only an old event in the past – an event admittedly emotional but now harmless, one that may contribute to who we are but no longer has control over us.  The body sensations and feelings that accompanied that event may be experienced from time to time but are no longer warning of impending danger.  They only tell us that our current level of life stress has brought up some of our old self-protective reflexes.  We are now able to use this recognition of body states as useful messages rather than indications of present threats.  By achieving all of this, we will have achieved wisdom – the integration of emotions, the feelings of the body, and our ongoing conscious awareness and thinking.  We will have progressed from the state of being a trauma victim to becoming a trauma survivor (Scaer, Robert C., Healing from Trauma, 2008).

The goal of the treatment of trauma is to help people live in the present, without feeling or behaving according to demands belonging to the past.  Psychologically, this means that traumatic experiences need to be located in time and place and distinguished from current reality (van der Kolk, Bessel., The Body Keeps The Score: Memory and the Evolving Psychobiology of Post Traumatic Stress, 1994).

There is a mistaken assumption that anyone experiencing a traumatic event will have PTSD.  This is far from true.  Studies vary, but confirm that only a fraction of those facing trauma will develop PTSD.  What distinguishes those who do not remains a hot topic of discussion, but there are many clues.  Factors mediating traumatic stress appear to include: preparation for expected stress (when possible), successful fight or flight responses, prior experience, internal resources, support from family, community, and social networks, debriefing, emotional release, and psychotherapy (Rothschild, Babette, Post-Traumatic Stress Disorder: Identification and Diagnosis, 1998).

Developed in the late 1980s by Francine Shapiro Ph. D., Eye Movement Desensitization and Reprocessing therapy (EMDR) currently has more scientific research as a treatment for trauma than any other non-pharmaceutical intervention.  While no one knows how any form of psychotherapy works neurobiologically or in the brain, EMDR appears to assist in processing traumatic information, resulting in enhanced integration – and a more adaptive perspective of the traumatic material.  However we do know that when a person is very upset making it impossible for their brain to process information as it does ordinarily, one moment becomes “frozen in time” and remembering a trauma may feel as bad as going through it for the first time because the images, sounds, smells, and feelings haven’t changed.  Such memories have a lasting negative affect that interferes with the way a person sees the world and the way they relate to other people.   So theoretically, EMDR is about integration – right/left brain integration, but practically, it is about convincing the mind and body that the traumatic event is over.  EMDR helps to put the past in the past, where it belongs, instead of staying stuck in it and feeling like it is happening all over again in the present – with the same thoughts, emotions, and body sensations –  that accompanied it in the past.  Normal information processing is resumed, so following a successful EMDR session, a person no longer relives the images, sounds, and feelings when the event is brought to mind.  EMDR is a physiologically based therapy that helps a person see disturbing material in a new and less distressing way (van der Kolk, Bessel, M.D., The Body Keeps the Score: Memory and the Evolving Psychobiology of Post-Traumatic Stress. 1994).

The general process of EMDR begins with the therapist and the client discussing what issues they would like to work on and taking a history of the client’s life, experiences, as well as determining what memories and situations will be targeted in the treatment plan.  This is also a time to assess whether or not the client is ready for EMDR and what skills may need to be developed or enhanced for self-soothing and/or coping for the future when disturbing memories and emotions are brought up.  The actual processing phase involves the therapist having the client bring up the targeted memory along with a negative belief about themselves and any emotions or body sensations.  While the client focuses on the image, emotions, and sensations, the therapist uses bilateral stimulation (such as a Theratapper) and the client is instructed to just notice anything that comes to them.  With each set of bilateral stimulation, the client is encouraged to just notice and the therapist will help guide or assist the client if distressed or whenever necessary. The end result is to replace the original, negative belief with a positive one along with the emotions and sensations.  While the procedure may seem a simple and straightforward one, the actual process looks different for each person and the length also varies.  It is important to note that EMDR is not a quick fix nor can it or should it replace traditional talk therapy.  EMDR should only be used after a solid therapeutic relationship has been formed and only if the client is ready. Sometimes it is necessary to spend time talking and resourcing before the reprocessing of target memories begins. This is all part of EMDR (Wallace, Rebecca, MSW, LCSW, What Does EMDR Look Like?, 2011).

It is widely assumed that severe emotional pain requires a long time to heal.  EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma.  Using the detailed protocols and procedures learned in EMDR training sessions, the clinician helps clients activate their natural healing process.  There has been much research on EMDR that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, The World Health Organization and the Department of Defense (EMDR Institute, What is EMDR?, 2011).    

Trauma and EMDR

► Jane Fitzpatrick time to read: 7 min