EMDR Therapy with Children: Applications for Trauma & Other Concerns Connecting the Pieces April 10, 2018 Alyssa Caldbeck, LISW, RPT

What is EMDR? EMDR is a is a psychotherapy approach developed by Dr. Francine Shapiro to help people heal from trauma or distressing life adversities. .Validated as an evidence-based approach and included in SAMHSA (the Substance Abuse and Mental Health Services Administration) and the National Registry of Evidence-based Programs and Practices. The California Evidence-Based Clearinghouse for Child Welfare accepts EMDR therapy as an evidence-based approach for children.

What is EMDR Continued EMDR therapy works on helping the brain reprocess these traumatic memories, and as a result alleviating the emotional and psychological disorders. Uses eye movements or other bilateral stimulation or BLS (right left back and forth) to help the brain examine a traumatic or distressing memories. .

Explanation of EMDR EMDR is base don AIP model which is based upon that there is an inherent information processing system in the brain that gets blocked when traumatic or adverse events occur, These events to get locked in the brain with the original picture, sounds, thoughts, feelings and body sensations. Whenever a reminder of the traumatic or adverse event comes up, those pictures, thoughts, feelings, and sensations can continue to be triggered. According to Dr. Shapiro, many emotional problems and disorders are manifestations of these unprocessed trauma memories that are stored in the brain.  

Origin of EMDR EMDR therapy was first developed by Francine Shapiro upon noticing that certain eye movements reduced the intensity of disturbing thought. She then conducted scientific studies with trauma victims in 1988 and the research was first published in 1989. Since then, EMDR has developed and evolved through the contributions of therapists and researchers all over the world. Today, EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches.

EMDR & AIP Theory When a traumatic or disturbing event takes place, the natural system for processing a memory is interrupted because of high arousal and/or encoded as survival information. Information that occurs at the time of the upsetting event is stuck or frozen in the memory. Present day triggers or experiences can activate the feelings and responses in the stored memory. Persistent, intrusive thoughts Negative emotions Negative perceptions of self Physical sensations

Describing EMDR When a disturbing event occurs, it can get locked or frozen in the brain with the original pictures, sounds, thoughts, feelings and body sensations. Present day experiences can activate those original feelings, thoughts, images, sensations. EMDR seems to stimulate that frozen information and allows the brain to process the experience by connecting that stuck memory with other information in your brain. Similar to what may be happening in REM (rapid eye movement) sleep when we dream. The eye movements or other forms of bilateral stimulation (tones, taps) may help to process the unconscious material.

Understanding EMDR EMDR does not take away the memory. Information is still remembered, but not as distressing. EMDR does not take away any information that is valid or that you need to hold on to for your well-being. Working through the memory in this manner allows the memory to get to a point where it can be stored in a calm form, properly kept in the past. Reprocessed memories are then stored as a ”rewritten story”- think of it as re-organizing the brain’s library of memories

EMDR is a Therapy Approach Eight Phases of Treatment Three Pronged Protocol (Past, Present, Future) Forms of BLS – Eye Movement, “Buzzies”, Tapping “Bottoms up approach” vs. TF-CBT “down” Incorporates elements of other theoretical orientations: - Psychodynamic, Cognitive, Behavioral, Client centered, Mindfulness

Therapy Modality Components Cognitive Behavioral Therapy (CBT) – Foundation of problem: Dysfunctional beliefs, behaviors Trauma Focused CBT (TF-CBT) *adds in trauma story for exposure to what happened EMDR Therapy – Foundation of problem: Unprocessed memories of disturbing events that are dysfunctionally stored in neural networks.

Process Targets: A Three-Pronged Approach 1. Process Past Event Identify Core Memories – earliest memories that laid the foundation for the presenting problems. Identify Clusters/Themes – single event to represent many similar incidents 2. Process Present Event Current Triggers, Stressors, Recent Event 3. Process Future Event Template of desired thoughts, emotions, actions for future events that typically have been avoided or uncomfortable.

Trauma Memories Regular memories are stored in the hippocampus part of the brain. The hippocampus is like the librarian of brain storage Traumatic memories are overwhelming when not processed which results in the hippocampus not being able to do its job. The hippocampus is a integral part of the limbic system which regulates emotions When traumatic memories are stored they are stored in the hippocampus in raw unprocessed form The trauma memories are easily triggered, causing distress over and again

Memory Storage

Information Stored in an Unprocessed Memory Trauma Memory Triggers Images, Sounds, Smells, Taste, Feel Emotions Body Sensations Thoughts Meaning of Event, Belief about Self (NC)

Why Bilateral Stimulation (BLS)? Unprocessed memories are stored in the right hemisphere of the brain where emotion is located. BLS gets memories moving across the midline (brain stem) and can help settle them in the left hemisphere of the brain, which is where reasoning takes place. BLS is also found to be calming and a grounding method when triggered. The act of using BLS can help solidify more positive feelings and beliefs to overcome the negative ones.

Information Processing “Bilateral stimulation” or “Dual Attention Stimulus” jump starts the limbic and physiological information processing systems.

Adaptations for Children There are specific EMDR protocols (different ways of doing EMDR) that are applicable for trauma, attachment concerns, and with children Reverse Protocol- Dr. Robbie Adler Tapia Early Trauma Protocol Attachment Focused EMDR- Dr. Laurel Parnell Use of narrative story Integrative Treatment

Play Therapy & EMDR Use of puppets - “Elizabeth, Mario, David, and Robbie” BLS with magic wands, hands, laser pens, drumming Bibliotherapy

Play Therapy & EMDR Continued Sand tray Photo Credit: Meredith Krugel, LCSW http://meredithkrugellcsw.com/

Negative Cognitions Core thought and perceptions that are triggered- drive behavior and actions “I’m not safe” “I can’t trust” (anyone or adults) “I have to be in control” “I am bad” “I am unlovable” (or not loved) “It’s my fault”

In utero and preverbal trauma Children experiencing in utero distress and/or preverbal attachment wounds as well as adverse childhood experiences, are vulnerable to ongoing reactivity impacting physical and mental health. The distress of adverse childhood experiences negatively impacts their physiology and does not spontaneously resolve. Their continual anxiety and reactivity suggests that the information processing system has stored this experience without a resolution. The child continues to hold hyper arousal and distress in the body that sets a foundation for ongoing life problems, with reactivity in beliefs about self (not safe/lovable/powerless), emotions (fear/anger/avoidance), and body sensations (elevated heart rate & fight/flight/freeze/play dead survival responses) impacting their ability to learn and function and resulting in ongoing developmental deficits.

Demonstration Colleen West • Small Miracles – EMDR with Children Short Demo

EMDR Applications Depression and Other Mood Disorders Generalized Anxiety Disorders, Panic Attacks, Phobias PTSD, Grief, Traumatic Bereavement Abuse and Neglect – Emotional, Physical, Sexual Accidents, Medical Treatments, Natural Disasters Addictions, Dissociative Disorders Somatic Problems – chronic pain, phantom limb pain, gastrointestinal, migraines, eating disorders, body image Vicarious Trauma Performance Enhancement (work, art, sports) Children, Couples, Veterans, Police Officers, Firefighters

Childhood Trauma Case Example TRIGGERS IMAGE SENSATIONS (BODY) EMOTIONS TRAUMATIC MEMORY COGNITIONS

Resources EMDR specific- http://www.emdr.com/ www.emdrhap.org www.emdria.org Other- Tapping In: A Step-by-Step Guide to Activating Your Healing Resources Through Bilateral Stimulation- Laurel Parnell

Resources Continued Early Trauma/Attachment Trauma Beacon House- UK - http://beaconhouse.org.uk/useful-resources/ Integrative Parenting: Strategies for Raising Children Affected by Attachment Trauma  by Wesselmann, Schweitzer, & Armstrong Trauma The Body Keeps the Score: Brain, Mind , and Body in the Healing of Trauma- Bessle van der Kolk Trauma Through a Child’s Eyes: Awakening the Ordinary Miracle of Healing-Peter Levine & Maggie Kline

References EMDR Therapy and Adjunct Approaches with Children: Complex Trauma - Ana M. Gomez, MC, LPC Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition: Basic Principles, Protocols, and Procedures- Dr. Francine Shapiro When There Are No Words: Repairing Early Trauma and Neglect From the Attachment Period With EMDR Therapy -Sandra Paulsen & Katie O’Shea What is EMDR retrieved from http://www.emdr.com/what-is-emdr/

Contact Email: alyssa@alyssacaldbeck.com Website: alysscaldbeck.com Facebook: www.facebook.com/acaldbeck

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