Des | EMDR Therapy Sydney|Clinical Psychologist

What happens during EMDR sessions?

24/04/2020 By Des Leave a Comment

Your first session is history taking and assessing your readiness as well as demonstrating what EMDR feels like. The second session will involve selecting targets (distressing memories and related incidents). You will also be taught skills to help regulate distress during sessions. The aim is to produce rapid and effective change whilst you maintain as much emotional equilibrium as possible.

The processing phase (session 3 or 4) begins by getting you to focus on the most distressing image associated with the traumatic experience, plus the emotions accompanying the image, body sensations (tight throat, increased heart rate), and an associated negative belief about yourself (e.g., ‘I could not save him’ or ‘I’m unlovable.’). There is no need to describe the memory in detail, and you can focus on those aspects of the memory without having to say them out loud. I (the therapist) do not need to know the detail, which is advantageous if some of your memories make you feel shameful or guilty.

Whilst holding in mind the most distressing image/emotion/body sensation/cognition, and not speaking, you will track a moving object across your visual field, for 10 to 40 seconds. (Other, non-visual options are alternating sounds or tapping sensations.)

There is nothing for you to ‘do’ or get ‘right’. Basically, we trust your mind and brain to go where they need to go to allow unprocessed traumatic memories to be processed. I will only intervene if your emotions become overwhelming.

After each set of eye movements, you are asked, ‘What are you noticing?’ (which is briefly reported, although you may choose not to say anything), you will be directed to ‘notice that’ for another set of eye movements (whilst not talking), after which you are again asked, ‘what do you notice?’ This basic, repeated sequence is the core of an EMDR session.

If your memories go forward or backwards in time, to earlier or later parts of the traumatic event, or even to completely different past of future events, it is accepted as normal. There is nothing to get wrong or right, just to trust a proven process with an experienced trained EMDR professional.

Near the end of a processing phase, distressing images are recalled to see if they still have a significant ‘emotional punch’ together with disturbing body sensations. If they are no longer distressing a new positive belief is installed.

Instructions are given to deal with any dreams, thoughts, etc. and the session is closed.

EMDR therapy in Sydney

I am Clinical Psychologist an Accredited EMDR therapist in Crows Nest, Sydney.

Please call me on 9908 2950 to make an appointment or email me

EMDR therapy in Sydney

I am located at:

Centre for Clinical Therapy

119 Willoughby Rd, Crows Nest, Sydney

To contact me and find out more EMDR therapy Sydney

Kind regards,

Desne Doman

Clinical Psychologist MAPS

Medicare Rebates Available (with a current GP Mental Health Plan)

How does EMDR work? A neuroscience explanation.

30/01/2020 By Des Leave a Comment

Eye Movement Desensitisation and Reprocessing is now over 25 years old and is considered an evidence-based treatment. The question “Does it work?” has now been replaced by the bigger question “How does it work?”

There are a number of theories but the one that makes sense to me is in the article Eye Movement Desensitization and Reprocessing and Slow Wave Sleep which I will try and summarise as I understand it (all errors of interpretation are mine, email your corrections).

Essentially,

When we experience something overwhelming and relive the traumatic event there is reduced control of the pre-frontal cortex over the activated amygdala and hippocampus (the amygdala and hippocampus become overstimulated). In other words, when you are triggered, the rational thinking part of your brain can’t control the emotional part of your brain. This is why when you get triggered, you can’t think and you feel overwhelmed.

Traumatic memories are “stuck” in the amygdala-hippocampal complex and when triggered, they seem to occur in the present. “Stuck” memories are thought to be unprocessed memories.

During sleep, we process and consolidate memories from the hippocampus to the neocortex. Normal, less traumatic memories, don’t become “stuck”, because at night when we dream (Rapid Eye Movement or REM phase), these are moved out of the amygdala-hippocampal complex and processed by the rest of the brain. This is one of the reasons we feel so much better after a good night’s sleep.

Neuroscientists propose that what happens during REM (dream) sleep happens during EMDR.

During EMDR, therapists move your eyes from side to side whilst getting you to focus on a fragmented traumatic memory or emotion. Much like when your eyes move side to side when you dream.

EEG tracings show that the eye movements (much like in REM sleep) elicit a synchronisation of all cortical activity at a frequency in the delta range like slow-wave sleep. EMDR temporarily slows your over-stimulated amygdala down and synchronises your brain waves helping you process the traumatic memory.

This suggests that during EMDR therapy the traumatic memories are continuously “reactivated, replayed and encoded into existing memory networks”. In other words, EMDR helps traumatic memories become “unstuck” and processed like normal, less traumatic memories.

To quote the article:

“In fact, we posit that bilateral stimulation mimics the low-frequency stimulation typical of SWS (slow-wave sleep), inducing a depotentiation of the AMPA receptors of amygdalar synapses, which in turn lead to a weakening of the traumatic memory. This reduction of the over-potentiation of amygdalar synapses makes traumatic memory more accessible, and facilitates the connection between emotional memory and episodic memory, thus promoting a shift of memory to associative and neocortical areas.”

Essentially, the bilateral movements used in EMDR rapidly allows us to process stuck traumatic memories as we would normally do with less traumatic memories during sleep.

They have a great picture of an EEG tracing that show how the bilateral movements mimic slow-wave sleep. Click to see it in the original article.

EEG tracing upon eye movements during an eye movement desensitization and reprocessing (EMDR) session. Note the slow-wave sleep (SWS)-like frequency from the beginning to the end of bilateral stimulation.

EMDR bilateral stimulation (moving your eyes side to side) mimics slow-wave sleep, calming the amygdala and allowing it to synchronise with the rest of the brain. Thus allowing your brain to process a traumatic memory. What we do in therapy (move your eyes side to side), is what you do every night when you dream.

I probably have not done the article justice so if you enjoy knowing how stuff works like me, have a look at the article.

Remember research regularly overturns previous evidence, perhaps a better explanation will emerge soon. Stay curious.

I look forward to hearing from you.

Kind regards,

Desne Doman

Clinical Psychologist MAPS

EMDR Accredited Practitioner.

References:

Keywords: EMDR, mechanism of action, eye movements, sleep, slow-wave sleep, REM, orienting response, working memory

Pagani M, Amann BL, Landin-Romero R and Carletto S (2017) Eye Movement Desensitization and Reprocessing and Slow Wave Sleep: A Putative Mechanism of Action. Front. Psychol. 8:1935. doi: 10.3389/fpsyg.2017.01935

Pagani, M., Di Lorenzo, G., Verardo, A. R., Nicolais, G., Monaco, L., Lauretti, G., et al. (2012). Neurobiological correlates of EMDR monitoring – An EEG study. PLOS ONE 7:e45753. doi: 10.1371/journal.pone.0045753

How to stop worrying about what others think

26/03/2019 By Des Leave a Comment

I call this the “Stand Down Dino!” method.

For over 50,000 years our ancestors had to constantly monitor what was going on around them. Not only did they have to watch out for the sabre-tooth tiger and poison berries, their biggest threat – their own tribe members.

As resources were limited, groups (about 40-200 members) needed to roam large areas to survive. Anyone of us who met the disapproval of the tribe or was considered working against the common interests was abandoned.

Abandonment nearly always meant death.

A key survival mechanism in our brain was to constantly scan and monitor others to ensure we had their approval. For example, a dirty look or a rolling of the eyes meant you had to do some quick social repair work with Aunt Lucy.

Fast forward to the industrial revolution around the late 1700’s, we moved to cities which gave us access to many new tribes (other than our family or local farming community).

Then, around 20 years ago the internet allowed us access to an even greater number of national and global tribes. If my family or community shunned me because I was gay or vegan or liked long-haired goats, I could find a tribe who accepted me. Today, exclusion does not mean death, but it still may feel like it.

Our brains have not yet evolved to embrace this new reality. They still react as if a dirty look or being rejected after a first date could mean abandonment or death.

This outdated dinosaur part of our brain is alive, well and running the show.

So, how do we change this?

Simple. Use your Evolved Brain too talk back to it.

Use your evolved brain to stop worrying what other think

The next time you change outfits 5 times, tell yourself your outdated Dinosaur brain is running the show. No one notices the difference between 5 patterned t-shirts.

KEY FACT: people who you think are judging you, have a dinosaur brain that is making them more worried about what YOU and others will think about them….

We are self-focused and paranoid about what others will think of us.

Here are a couple of examples

Dinosaur brain: “That guy on Tinder, didn’t ask me out again, nobody likes me”

Evolved brain: “Stand down Dino, who knows what his reasons are, let me keep on looking for someone who I like, and who likes me back”

Dinosaur brain: “If I get up and dance, everyone will laugh”

Evolved brain: “Stand down Dino, they will be worrying about what I and others think of them, lets dance like nobody is watching”

Dinosaur brain: “Don’t know which of these 5 t-shirts to wear, what if she thinks I’m a dork”

Evolved brain: “Stand down Dino, she probably will be worried about what I think about her outfit, let me wear something I feel is appropriate and comfortable”

Now to assume other people’s opinions of you don’t matter at all, is going too far. You probably won’t get the job if you wear your pajamas to an interview. We still have social rules.

When someone doesn’t approve or love you (and not everyone will), you may feel like you will die….

You won’t. That’s just your Dinosaur Brain. Talk back to it.

For a more nuanced understanding see:

Evolution, Social Roles, and the Differences in Shame and Guilt by Paul Gilbert, Social Research Vol. 70, No. 4, Shame (winter 2003), pp. 1205-1230

Hierarchy in the Forest, The Evolution of Egalitarian Behavior by Christopher Boehm

Tim Urban neatly calls this our Social Survival Mammoth

How to find a good EMDR therapist Step by Step

06/01/2019 By Des Leave a Comment

I am often asked to refer family or client’s partners to another EMDR therapist that I would recommend (this is a conflict of interest for therapists).

This is how I as a Accredited EMDR Practitioner would check credentials when I need to find one for my family members. There are no gaurentees but at least this gives you a good chance of getting someone who has good experience.

In Australia, EMDR therapists are graded by the EMDR Association of Australia (EMDRAA) according to there training and experience.

Step 1 – Goto EMDRAA Find a Therapist and Accept Terms (Alternatively click on EMDRAA.org and close down any promotional popup, select it from the Menu (top ribbon) and accept their disclaimer)

Step 2 – Enter your post code

IF NO RESULT – TRY SAME SEARCH AGAIN! The Website has glitches occasionally – try at least twice more.

The resulting list will start with the Accredited Trainers/Consultants/Practitioners (most experienced) and then Members within the radius you specified (Look at the little blue labels ). Scroll down to find someone close to you. However….

Step 3 – Check for these three things (if possible)

Check 1. Availability

Are they Accepting new clients?

Check 2. Experience

Are they an Accredited Practitioner or an Accredited Consultant? If they are a Member – do some more research (see below) as there is no guarantee of experience.

3. Regulation/ Rebates

Do they offer a Medicare Rebate? This means that your practitioner is regulated by the Australian Health Practitioner Regulation Agency (AHPRA). You may be eligible to receive a rebate on some of your session fees that include Medicare acceptable strategies. Examples of 2020 rebates for a 50+ minute session are – Clinical Psychologist ($126.50), Psychologist ($86.15) or Occupational Therapist/Social Worker ($75.95) see MBS Online . Note that most therapists do not bulk bill (They charge more than the Medicare rebate).

To be eligible to receive psychological services under Medicare, a person must be referred by his or her GP and in some instances by another medical specialist.

Note that some EMDR Members are highly experienced, others do the training and rarely use it and its hard to know the difference.

To do more research to find a good EMDR therapist

Check their website.
Call them up and ask them what therapeutic modalities they mainly practice.
Ask them how often they use EMDR.

There are 3 grades.

1. EMDR Member

The person is a trained EMDR practitioner. They would have:

Completed the EMDR Basic training by a recognised EMDRAA Trainer (20 hours of Training),
10 hours of consultation with an EMDRAA Approved Consultant,
20 hours of practice.

If your therapist has obtained either of the next two Accreditation grades they will have gone through an additional rigorous evaluation program

2. EMDR Accredited Practitioner

The person is a Member AND has met additional requirements of supervision and experience. They would have

Completed the EMDR Basic training by a recognised EMDRAA Trainer (20 hours of Training),
20 hours of consultation with an EMDRAA Approved Consultant. Which includes witnessing the applicants EMDR clinical work either through DVD or in-vivo
They are members of the EMDRAA
The EMDRAA Consultant needs to have directly witnessed the applicant’s EMDR work either through the use of video/DVD or In Vivo
They would have completed at a minimum 50 EMDR Sessions (my personal experiences is that usually Accredited Practitioners have completed 200 plus hours if they use EMDR as their main therapy by the time they apply).
They would have treated with EMDR a minimum of 25 clients (my personal experiences is that usually Accredited Practitioners have treated 75 plus clients if they use EMDR as their main therapy by the time they apply).
They require two references, one from an EMDRAA Consultant and the second from a person who can comment upon their professional practice and standing.

3. Accredited Consultant

This means the person is an Accredited Practitioner AND has additional experience and skills to be approved by EMDR Australia to provide supervision to other therapists.

I look forward to hearing from you.

Kind regards,

Desne Doman

Clinical Psychologist MAPS

EMDR Accredited Practitioner.