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By Linda Ouellette, MA, LPC, Sierra Tucson
Traumatic incidents are stored differently in the brain than other memories. In typical memory processes, new experiences process through an information system that allows the current situation to link with adaptive memory networks that store similar past experiences. These adaptive memory networks function as a knowledge base with perceptions, attitudes, emotions, sensations, and action tendencies that will assimilate more similar experiences in the future.
However, traumatic memories are stored separately from regular memories such that they cannot link with memory networks that have more adaptive information. In addition, new information, or positive experiences, cannot connect with the disturbing memory, as it is now in its own memory network, separate from the adaptive memory networks. This means that when the traumatic memory is accessed, it is without an ability to resolve the disturbance caused.
In people with post-traumatic stress injury (PTSI), traumatic memories can be triggered by experiencing something similar, such as seeing something on TV or having a nightmare. As a result, the person might experience recall of sensory fragments from the traumatic event, such as images and smells, or a flood of stored emotions or body sensations. This can be extremely distressing for officers. However, traumatic memories that have been maladaptively encoded or incompletely processed in the brain can be “fixed.”
A popular and often effective treatment is Eye Movement Desensitization and Reprocessing (EMDR), which is an evidence-based psychotherapy. EMDR facilitates the resumption of normal information processing and integration. By activating both the right and left hemispheres of the brain simultaneously, EMDR stimulates the brain’s innate healing tendency. This allows the separately stored trauma memory to eventually link with positive memory networks so the disturbance surrounding the event is discharged. “I’m in danger” becomes “It is over. I am safe now.”
There are eight phases in EMDR treatment that occur over several sessions.
Phase 1: Client History and Treatment Planning
The therapist begins treatment by reviewing the client’s history, which often includes discussing the actual traumatic event(s). Treatment planning consists of developing a list of “targets,” which are memories and/or events to process. Every memory associated with a traumatic event will be identified and treated.
Phase 2: Preparation
The client will be oriented to EMDR definitions and processes, so they can give informed consent. The client is also taught self-soothing skills such as breathing exercises or using calming imagery. They also develop adaptive resources prior to dealing with the disturbing memories. This includes accessing strengths the officer already has and enhancing them so they can be used in the processing when needed.
Phase 3: Assessment
The therapist and client establish a particular memory to target. The officer’s current response to the intensity of that memory is established as a baseline to assess the client’s current feelings associated with that memory. The client is asked first to imagine a picture of the worst part of the experience. Then they reveal a negative, irrational belief they have about themselves that goes with that event. For example, first responders often have negative beliefs like, “I should have done something more,” or, “It’s my fault.” Clients are then asked about a positive belief they would like to have about themselves instead, such as, “I did everything I could,” or, “It is not my fault.” They rate how true the positive belief feels to them at the time (on a scale of zero to seven). They are then asked what emotions they feel, how disturbing the memory seems to them (on a scale of zero to 10), and what physical sensations they are noticing.
Phase 4: Desensitization
The memory is accessed and the client is asked to notice his or her experiences while the clinician uses equipment to provide alternating bilateral stimulation. For example, the client might be asked to visually follow lights that move back and forth across a bar, hold small paddles in each hand that vibrate back and forth, or wear headphones that play tones that alternate between the left and right ear. The client then reports what they experience. Alternately stimulating the right and left brain hemispheres accesses the brain’s innate healing mechanism. Just like your body knows how to heal from an injury, your brain does too.
Phase 5: Installation
Once the officer reports that the disturbance is at or near zero when recalling the traumatic event, he/she is prompted to mentally pair the desired positive belief with the disturbing event. This is processed until that belief feels completely true.
Phase 6: Mental Body Scan
The patient assesses how their body is feeling. They are trying to identify areas where there is tension or tightness. If any is found, the use of bilateral stimulation usually helps to relieve it.
Phase 7: Closure
The session is closed and patients are provided information about how they can get support between sessions. They are also reminded how to use some of the self-soothing skills they learned during the preparation phase.
Phase 8: Reevaluation
The patient and clinician start each new session by reevaluating any disturbances associated with the target memory processed during the previous session. If disturbances remain, they repeat the processing. If there are no further problems with that memory, they move onto the next disturbing event from the target list using EMDR protocol.
About the Author: Linda Ouellette, MA, LPC is a certified EMDR therapist at Sierra Tucson, a world-renowned treatment facility in Tucson, Arizona. She also works in private practice, where most of her clients come specifically for EMDR. As an approved consultant, she helps train other EMDR clinicians in her work for the Trauma Recovery Network. To contact the author, email IPSauthor@apus.edu. For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.