Earlier in my career, I felt something missing from the treatment I was able to provide some of my adolescent girl clients. Many of these clients had experienced traumatic events that often manifested in the field. Therapy sometimes was particularly complicated because those incidents tend to be deeply intertwined with other treatment issues (identity, interpersonal relationships, emotional regulation and communication issues, depression and anxiety, substance use, promiscuity, self-harm or suicidality, personality disorders, etc). It was frequently reminiscent of the “whack-a-mole” arcade game.
At that time, I was aware of therapeutic modalities that facilitated trauma healing but had no training of my own. Accordingly, I steered clear of directly addressing such work. As girls’ past traumatic events surfaced in the field, I would help them by teaching coping skills, validating their painful experiences, challenging their belief systems about what occurred (e.g., personal responsibility and self-worth), and laying a foundation for future trauma work – all very necessary and beneficial. But we could never actually resolve the trauma itself. I was often left thinking I could better serve our girls … if only….
I decided to pursue training in Eye Movement Desensitization and Reprocessing, or EMDR therapy. In a nutshell, EMDR utilizes bilateral stimulation (left-right patterns of sensory input) as a way to reprocess traumatic experiences and develop adaptive core beliefs, providing relief from “frozen” neural pathways. In other words, this treatment modality allows us to move a stuck memory through the brain so that we can process it, resulting in decreased sensitivity to that memory. EMDR is a proven treatment that has been used to address trauma and a wide variety of other clinical issues, as well as the underlying negative core beliefs about oneself.
Traumatic experiences, by definition, are very subjective. Essentially, trauma is any event or situation that overwhelms one’s ability to cope or manage. With this definition, it is easy to imagine how something might be traumatic for one person but not for another. It has more to do with the brain’s response to those events and the person’s resources to properly cope with the situation. It does not have to be a massive incident. While such significant events are traumatic for many, less substantive experiences can be traumatic for others. Trauma can range from natural disasters, abuse, and terrorist attacks, to grief, accidents, or chronic pain, and anything in-between.
The History of EMDR
A psychologist named Francine Shapiro “discovered” this type of treatment by accident. One day, while walking, she was thinking about something distressing. After her walk, she realized that she didn’t feel as distressed as earlier. She tried to identify what occurred that might have decreased her distress and eventually recognized that her eyes were moving quickly left-right-left-right during her walk. She took that theory and applied it to her clients, trying to determine if they would receive the same benefits from this eye movement.
There was already research that showed eye movement therapy was effective, so she coupled that research with her own experiences and clinical practice. She began having her clients think and talk about stressful events while following her finger back and forth in front of their eyes, which appeared to be very effective. From there, she started a research study in 1987 to track the efficacy of this treatment method as a potential healing modality. The study proved that Eye Movement Desensitization, as it was originally called, was quite successful. Shapiro later added the Reprocessing piece, as she more clearly understood how bilateral stimulation helped the brain process the traumatic event. Today, EMDR has grown beyond eye movement and EMDR practitioners often use other forms of bilateral stimulation, such as tapping on one’s knees or utilizing electronic devices that provide the bilateral stimulation. In addition to specifically addressing past traumatic experiences, EMDR has also broadened its scope to treat other clinical issues including anxiety, phobias, grief, depression, chronic pain, etc.
Understanding Trauma and the Brain
So, what exactly does this bilateral stimulation do, and how does it help?
Neurologically, the events we experience are stored in our implicit and explicit memory. Implicit memory is considered unconscious and it uses past experiences to remember things automatically (e.g., days of the week, parallel parking the car, or tying our shoelaces). It retains the specific smells, sounds, and other sensations associated with events – and if events were overwhelming (traumatic), those sensations might not be fully processed, leaving us feeling stuck in the past. For example, let’s say you remember being teased in the school cafeteria when you were younger. Later in life, certain sensations linked to those memories might trigger a trauma response: the cafeteria smell, sights of lunch lines at your child’s school, the buzz of kids talking and laughing in a crowded room. Suddenly, you might feel frozen and stuck as your body responds to those cues.
Explicit memory requires conscious effort to recall past events (e.g., remembering which day of the week we scheduled a doctor appointment, remembering where we parked the car, or learning to tie our shoelaces). With traumatic experiences that are fully processed, our explicit memory allows us to recall such events cognitively without becoming hyperactivated emotionally or physically (i.e., trauma responses). It’s essential to fully process and integrate the implicit and explicit memories. Otherwise, our stuck implicit memory causes greater distress and sensitivity to its triggers, and a greater difficulty coping with other life situations.
EMDR also helps people change negative beliefs they have internalized as a result of an overwhelming traumatic event. As humans, we sometimes make false meaning out of experiences. Over time, this false meaning becomes ingrained in how we walk through the world, which can be detrimental. For example, someone might believe, “It was my fault that event happened,” or, “I’m not capable of succeeding,” or, “I’m not worthy of love.” Without addressing and reversing these negative core beliefs, a person begins to act in ways that actually reinforce the negative beliefs, becoming cyclical over time. Processing and desensitizing our negative experiences enable us to shift the associated negative beliefs.
Using EMDR at Open Sky
At Open Sky, we can help our clients begin to work through past negative experiences, shift maladaptive personal beliefs, understand their clinical issues, create motivation to change, improve interpersonal relationships, and develop healthy ways of tolerating emotional distress. Much of this work involves increasing internal awareness – somatically, cognitively, and emotionally. And, sometimes doing this internally focused work can be triggering to clients with past traumatic experiences. Adding EMDR therapy with certain clients allows them to begin processing through these hyper- and hypo-aroused states and desensitizing the triggers.
Wilderness is a powerful setting for EMDR therapy because of the numerous ways that hyperarousal and desensitization occur in Nature. Part of my excitement about EMDR is that it integrates so well with my work at Open Sky and enhances what I already do in supporting our clients to develop emotional resilience, identity strength, shift negative self-perceptions, recognize their unhealthy patterns, and enhance connections.
As an example, one of our adolescent girls refused to hike in her first week here, appearing oppositional and defiant. She broke down in tears whenever she put on her backpack to hike. She became flooded emotionally, shutting down and shutting out everyone who tried to understand and help her because she was so overwhelmed.
She was later able to share that she had experienced an assault prior to enrolling here in which somebody had grabbed her from behind. Every time she put on her backpack, she experienced a similar physical sensation with the weight on her back, wrapped around her shoulders and waist. This present sensation triggered and overwhelmed her emotionally and physically because of the unprocessed past event. Specific grounding and centering practices helped her settle internally enough to begin hiking, but the actual memory remained incompletely processed. EMDR was useful for her to further reprocess the assault, and therefore decrease sensitization to the feeling of putting on her backpack.
Wilderness therapy provided an emotionally safe setting in which to experience the hyper-arousal, and thus we could respond with the appropriate treatment to process the past event. She was able to get to a place where she could remember what happened without it overwhelming her in the moment. This allowed her to engage and benefit more from this program and future therapeutic treatment. There are numerous other examples of how EMDR can be helpful in the field.
Final Considerations and Limitations
The primary goals of wilderness therapy are assessment, stabilization, treatment, and long-term planning. Just because someone experienced something traumatic, does not mean now is the right time to address it. Often, we have to stabilize the co-occurring treatment issues before considering EMDR therapy. Typically, we start with the most recent or prominent challenges, such as substance use, self-harm, disordered eating, suicidal ideation, or emotional regulation issues. We then work backward to identify and address the earlier events in one’s life that led to these more recent difficulties, which sometimes takes the majority of a client’s Open Sky stay. In some cases, students don’t identify a past traumatic event until later in the program. Once we complete assessment and stabilization and help build some emotional resilience and identity strength, we can consider the appropriateness of beginning EMDR here. However, in some cases, the client might have experienced too many traumatic events, the trauma is too complex, or the event(s) occurred too early in one’s life to appropriately begin EMDR reprocessing therapy in this short-term treatment setting. In any of those situations, we stick to the work of assessment and stabilization and lay the foundation for the trauma work ahead.
In those cases, I might simply introduce the concept of EMDR to any clients for whom I believe it might be beneficial to help them create hope or increase openness to long-term treatment beyond Open Sky. With other girls, I might help them develop some basic EMDR skills to effectively manage trauma symptoms, called “resourcing,” which they can later use in EMDR therapy. I might even introduce the bilateral stimulation methods to some girls to deepen the integration of effective emotional regulation skills or powerful moments in Nature or with oneself. I always help our girls identify negative core beliefs to target and the positive beliefs they want to instill, something they will build upon in EMDR. We help them recognize unhealthy behavioral patterns that might actually be re-traumatizing them to help increase motivation for change and therapeutic engagement. For clients who have a specific, single-incident, recent traumatic experience, which might take only a few sessions to finish resolve, we might start the EMDR reprocessing work together. They have tremendous support from field staff to manage inevitable memory resurfacing and potential symptom exacerbation between therapy sessions. And for some girls, I have even begun EMDR reprocessing work at Open Sky knowing we won’t complete it here, depending on the particulars of their aftercare plan.
As amazing as this treatment modality sounds and can be, it needs to also be said it is not a miracle alone, and typically there are many other therapeutic interventions that must co-occur. However, by using EMDR when it’s appropriate for a client’s treatment, they can realize their traumas do not control them. They become empowered by the ability to work through challenges and continue healing, shifting to positive core beliefs, and self-efficacy in managing emotions.
For more on this topic, listen to Kirsten’s SKYlights podcast episode on EMDR therapy in wilderness.
Resources
Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1): 71–77. doi: 10.7812/TPP/13-098
Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D. , Cedrón, C., Colom, F., Pérez, V. & Amann, B.L. (2017). EMDR beyond PTSD: A systematic literature review. Frontiers in Psychology, 8, 1668. doi: 10.3389/fpsyg.2017.01668
October 7th, 2020