Ep 123 Does EMDR therapy work for PTSD?

Recently, one of our online followers sent in a great question about PTSD. His name is Al Levin and he's the host of the podcast called The Depression Files. You can visit Al's podcast which also has a blog and other great resources by checking out his website www.TheDepressionFiles.com. He interviews people on his show and provides resources to help manage depression and mental health issues. It's definitely worth a listen. PTSD stands for posttraumatic stress disorder and it is triggered by trauma. The trauma comes in different types. Medically speaking, there are about 30 specific types of trauma that are linked with PTSD. There are many others, but these are the most common ones. For example, military experiences, war, sexual assault, domestic violence, death in the family, car accidents, and terrorist attacks can all trigger PTSD. People who survive natural disasters including fires, tornadoes, flooding, and earthquakes also suffer from PTSD symptoms. How common is PTSD? In the United States, about half of the population will go through 1 of those 30 types of trauma that we just mentioned - that's about 150 million Americans. Out of that number, about 10% of men and about 20% of women will develop PTSD symptoms for at least a part of their lifetime. It may not last the entire lifetime, but they will have symptoms for a portion of it. People who have PTSD have psychological symptoms as well as physical symptoms. Each person's experience will be different, but there are 4 common symptoms that almost everyone will have. These include reliving the event over and over again through flashbacks and nightmares. These are often triggered by things you see on TV or hearing fireworks. These can remind the person about gunshots or being back in a war zone. Another common theme is avoiding anything that reminds you of the event. For example, you may avoid people or places that have anything to do with that trauma. If a person was involved in a car accident on a specific highway, the person may go a long way around or avoid highways completely because they're afraid it's going to happen again. Often people have an increase in negative thoughts, guilt, or shame about the event itself. This is true even if they had no control over the event. For example, if someone died in a house fire and you just happened to be walking by at the time. There could have been firefighters and all types of medical personnel already on site trying to save the victims, but you feel guilty because you didn't run into the building to save them. There was nothing more that could have been done, but those people carry that heavy weight with them for a long time. Another common scenario is feeling on edge, hyperarousal, or hypervigilance. These people have a hard time sleeping or concentrating. They look almost paranoid and they're always looking for danger even in their own homes or in places that are safe. These people startle very easily and if you approach them in a threatening manner, they get overwhelmed. This also leads to being impulsive and can lead to alcohol abuse or drug abuse. What are the treatment options that are available? There are 2 pathways that people can follow and they do overlap. The 1st pathway involves medication, including antidepressants. The 2nd pathway includes psychotherapy which includes EMDR and cognitive behavioral therapy. Let's talk about the medication route first. There are different treatments for and psychological and physical symptoms that people have with PTSD. If someone is having trouble sleeping and have a lot of flashbacks or nightmares, there is a medication called Prazosin which is highly effective. This is an alpha-blocker and also used for certain types of blood pressure. Anxiety can lead to elevated heart rate and elevated blood pressure. Taking prazosin helps people sleep, which goes a long way for them to manage their PTSD symptoms. It's not addictive and there are no major side effects so it's used as a first-line agent. Secondly, there are antidepressants called SSRIs or SNRIs. Some of the common names include Prozac, Cymbalta, and Effexor. Some of the medications are generic which means they're very inexpensive. Others are brand-name only and are expensive. However, each work on the serotonin pathway. Serotonin is a chemical in the brain that helps regulate our moods. The medications in these categories work very slowly to stabilize the mood. The key is you have to stay on the medication for at least 6 months or longer to get the full benefit. It's not an immediate fix, but it does reduce a lot of the complications from PTSD. A lot of people say they don't want any type of medication because they are afraid of being addicted to it. These antidepressants are not addictive. It's much safer to be on the treatment. They can be prescribed by your family doctor or more a psychiatrist. If they have partial improvement, the doctor can increase the dose or add a second agent. It's interesting that adding 2 antidepressants together provides more benefit than 1 alone. The other pathway is psychotherapy. There are several types of psychotherapy, but they all involve talking with a professional such as a psychologist, a chaplain, or psychiatrist who guides people through very difficult emotions. CPT is cognitive processing therapy. This is a way to address all of the negative thoughts including things like guilt, paranoia, and anger at others. The therapist will work through specific steps and provide worksheets with coping strategies to manage your day-to-day interactions at home, school, and work. The other method is called EMDR or Eye Movement Desensitization and Reprocessing. This is the question that Al was focused on. With EMDR, the therapist will ask you to talk through and relive the full trauma. It's a little bit scary at first. Remember, we talked about how people don't want to think about the trauma and they don't want to relive those experiences because they're afraid it's going to make them weak or break down again. The therapist will use their fingers as a focal point to communicate with the patient's eyes. Let me explain a little bit more in detail. Let's say we have a patient who went through a very serious car accident. The accident happened 2 years ago, but they haven't been able to drive on a highway since that time because they're so afraid. They can only drive short distances in their neighborhood to and from work. This is causing a lot of issues with their family because they don't want to go to football games or concerts or on road trips anymore. The therapist might ask the patient to tell the event like a story. Perhaps the patient was driving home from work around 10 PM on a Friday night. There were listening to rock music on the radio. All of a sudden they see headlights coming down the highway in the wrong direction. The patient tried to turn their car to the right, but the other car smashed into the driver side. All of the airbags deployed. The patient had their seatbelt on, but the windshield was shattered. They look down at their hands and see bleeding. They try to get out of their car, but couldn't. They start to panic. After a few minutes, the police and fire department show up. They're able to remove the patient from the car, but they have to put them into a stretcher and strap them down while wearing a cervical collar around her neck. The person couldn't find their phone, so they couldn't notify their family. The ambulance takes them to a hospital and they go through CAT scans and get stitches and find out they broke their wrist. Finally, after 5 or 6 hours the patient's family members arrive at the hospital. Car accidents are a very common event, unfortunately. However, the way this person described it, you can see that there's a lot of emotion. During this conversation, while the patient is describing the accident, the therapist would tell the patient to focus both eyes on the fingers of the therapist. While they are talking about an upsetting part of the story (ie, the bleeding or the feeling of being very scared when they couldn't find their phone), the therapist will tell them to follow the fingers with their eyes. The therapist will ask specific questions about the patient. For example, they might say "What were you most afraid of when you saw the blood on your hand?" The person might say they thought they had amputated the fingers or "I thought I was going to die." That's when the therapist can step in and tell them some reassuring words. For example, they could tell them even though you broke your wrist, you healed completely, you have no pain and you're able to play basketball. Linking the eyes with a very difficult story actually creates a positive environment and it gives control back to the patient. The goal is that over time with EMDR, people can think about the event and realize they didn't die and are actually better now than they were in the past. EMDR requires multiple sessions, usually between 8 to 20 from most people. Why does it take so many sessions? Well, we have to remember the trauma was a one-time event, but the aftereffects, psychological scars, and the physical pain may have been developed over months or years. The goal of therapy is to step down the process slowly and help to prevent a flare-up of those symptoms. It is more likely the patient will be able to cope with those issues long term. One session isn't enough to cure PTSD. Another question that Al had was regarding early initiation of EMDR to prevent PTSD. I tried to find medical research regarding that aspect. Unfortunately, I couldn't find the answers to clearly explain it. As we talked about earlier, PTSD has so many variations. Some people have mild symptoms while others are completely disabled. The key is early intervention. Psychotherapy and medications work best when they're started early in the process. However, I don't have a specific timetable for EMDR or ways to prevent PTSD