Eye Movement Therapy for PTSD

The story of eye movement therapy begins in 1987 with a walk in the park. Psychologist Dr. Francine Shapiro was preoccupied with a number of troubling thoughts. At some point during her walk she became aware that these thoughts had simply disappeared. Moreover, when she recalled them, they appeared far less of an issue than they had previously been. Applying her knowledge of psychology to the task, Dr. Shapiro noted that rumination continues unless some action is taken, yet her own experience suggested troubling thoughts had gone away without effort. However, when worrying, she recalled that her eyes had been moving from side to side, a factor she considered had enabled her to process troubling thoughts.

The aim of eye movement desensitization and reprocessing therapy (EMDR) is to desensitize the individual to images, thoughts and negative emotions following trauma, and to replace these with more adaptive coping mechanisms. The basic therapeutic procedure requires the client to hold in mind their traumatic thoughts whilst following the therapist’s finger, usually from left to right. Sets of approximately 30 movements at a time are used. A particular set of images and thoughts will be repeated until the client feels no emotional or physical response. One complete session may last for up to 90 minutes, with several sessions required overall.

Shapiro suggests that traumatic memories are stored in the way they were captured. Effectively they become linked with previously stored material and become stuck in memory. Shapiro originally pointed out the similarities between rapid eye movement (REM) sleep and EMDR. Memories of events tend to be processed during REM sleep and this helps integrate them into memory. Therefore, all the sensory events such as the sounds, smells, pain and emotional distress associated with trauma become frozen within a neural mesh involving different areas of the brain. This, she says, explains why PTSD sufferers relive the moment by just one sensation being triggered.

Dr. Shapiro claims that the alternating eye movements of EMDR simulate REM sleep. She believes this has the effect of stimulating similar processes that help store memories and this allows the therapist to access and unpick the processes that lead to the client revisiting their trauma. Whether eye movements actually do this is a matter of some debate. Several studies acknowledge the efficacy of EMDR but have failed to establish the necessity of eye movements, preferring to see it as little more than a variation on imagery, a well known therapeutic method.

Although there appears to be evidence for and against the effectiveness of EMDR, well designed randomized controlled studies have reported rather disappointing results. Some have attacked EMDR as little more than a pseudoscience. Others have said that EMDR is nothing new, but is being presented as though it is. Overall, despite the fact that well over 25,000 practitioners now use EMDR, it is probably the lack of a theoretical basis that has undermined its credibility within the wider scientific community.

If you would like to know more about EMDR, please visit the EMDR Institute Website.

Sources:

EMDR Institute http://www.emdr.com

Barlow, D.H. (2002) Anxiety and its Disorders (2^nd ed.). New York: Guildford Press.

Herbert, J., Lilienfeld, S., Lohr, J., Montgomery, R., O’Donohue, W., Rosen, G., & Tolin, D. (2000). Science and Pseudo-science in the Development of EMDR. Clinical Psychology Review, 20, 945-971.

Depressed Men: Causes and Signs

Depression has previously, if wrongly, been thought of as a problem only really affecting women and something to do their hormones. In fact rates of depression between males and females are roughly similar during childhood and differences begin to emerge more strongly during adolescence and into adulthood. Whilst it may be tempting to identify puberty as the reason for the gender differences in depression, significant hormonal fluctuations in women are actually quite brief and clearly associated with an event, such as depression following childbirth.

The male stereotype is very often rooted in issues of power and control. It follows that the more negative emotions associated with these are anger, pride, jealousy and aggression. Emotional expression of say, sadness, grief and depression are considered female qualities and therefore not something a real man needs to deal with. Very often the men who are most strongly socialized into the male stereotype find the greatest difficulty in acknowledging, articulating or coping with depression.

Depression in men is slowly becoming more recognized, but is often difficult to spot the symptoms even by long-term partners or health professionals. Men exhibit depression differently and the way they cope can often camouflage their state of mind.  So, whilst there is no strong evidence for a different type of depression in men, some symptoms of depression are much more marked. In particular irritability, anger, loss of control, risk-taking and aggression.  Other gender differences in depression are:

·      On average, the onset of depression is often later in men.

·      Men have less chance of recurrent depression.

·      Men seem to experience shorter bouts of depression and are less likely to suffer from chronic depression.

The onset, course and nature of depression in men may also differ in terms of whether they are adolescent, middle-aged or elderly and the life circumstances that affect them at various ages.

Depression is a significant risk factor for suicide and whilst women attempt suicide more often, men are more successful at their first attempt. Men in the age range of 16-24 and 39-54 appear most likely to commit suicide but the reasons why are not really understood. Depression is also a risk factor for heart disease, heart attacks and strokes.

What Places Men at Risk?

The precise cause of depression is not really known but current thinking points towards a likely combination of genetic predisposition and environmental factors. For men, the most commonly reported risk factors relate to:

• Work stress: especially role ambiguity, night shifts, holding down more than one job.
• Relationship breakdown: Divorced men are most likely to commit suicide.
• Fatherhood: Men also experience depression after the birth of a baby.
• Unemployment: the role of men can dramatically shift from that of breadwinner to dependent. This can similarly affect retired men.
• Bereavement: which can lead to diversions such as work and an escalation of risky activities, drinking, anger and frustration.

Signs and Symptoms

There are a number of potential markers to indicate that a man may be depressed.  Men are

more likely to externalise their depression and may fixate on activities like work. They are prone to turn to alcohol or drugs, which can lead to dangerous or risky activities. Relationships start to suffer as men prefer to ignore questions about their behavior or mental state. As the partner becomes more concerned, the situation becomes more tense and men begin to withdraw more and more.

Sexual drive in depressed men tends to decrease although in some cases sexual activity increases in an attempt to feel better. Some of the symptoms of depression will be exactly the same as women, but the nature of depressive symptoms in men does differ. For example:

• Feeling down, worthless, and tired.
• Easily irritated, frustrated and wanting to hit out.
• Loss of weight.
• Lack of interest in friends, family, relationships.
• Increase in risky activities like affairs, fast driving.
• Misuse of alcohol and/or drugs.
• Headaches, digestive problems.