EMDR

From what l have read (Pete Walker book) flashbacks with cptsd can centre around feelings rather than thoughts. l get the theory behind EMDR and thoughts, but how can the feelings in the absence of clear thoughts, be treated?

Is there a successful treatment beyond life long therapy?

I can't really answer your question but I am very intrigues by EMDR. I would like to try it if I could.

I believe the VA is working on methods of very intensive "relive the trauma and come to terms with it, or resolve it somehow."

I know hypnosis has been used for a long time as a similar method.

EMDR therapy is the only therapy (for any psychological disorder) that includes thoughts AND feelings, beliefs, and body sensations. So SoupDragon, the feelings (etc.) are essential parts of memories/thoughts of trauma(s) and are part of EMDR therapy. It's not a "life-long" therapy: research shows its efficacy in far less time than almost all therapies.

The World Health Organization has published Guidelines for the management of conditions that are specifically related to stress. Trauma-focused CBT and EMDR are the only psychotherapies recommended for children, adolescents and adults with PTSD. “Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Eye movement desensitization and reprocessing (EMDR): This therapy is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements. Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.” (p.1) (Geneva, WHO, 2013).

Many organizations, professional associations, and departments of health of many countries, the US Dept. of Defense, and the VA, all have given their "stamp of approval" to EMDR therapy:
American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Post-traumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines.
~EMDR therapy was determined to be an effective treatment of trauma.

Department of Veterans Affairs and Department of Defense (2004, 2010). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Washington, DC.
~EMDR therapy was placed in the "A" category as “strongly recommended” for the treatment of trauma.

Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press.
~EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR “A” rating for adult PTSD.

SAMHSA's National Registry of Evidence-based Programs and Practices (2011) Intervention Summary - Eye Movement Desensitization and Reprocessing. The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency of the US Department of Health and Human Services (HHS).
~This national registry (NREPP) cites EMDR as evidence-based practice for treatment of PTSD, anxiety and depression symptoms. Their review of the evidence also indicated that EMDR leads to an improvement in mental health functioning.

There are 35 randomized controlled (and 20 nonrandomized) studies that have been conducted on EMDR in the treatment of trauma. And more excellent research now on the role of eye movements, mechanism of action, and other RCS, not only on trauma and PTSD, but also on the use of EMDR therapy with generalized anxiety disorder, treatment of distressful experiences that fail to meet the criteria for PTSD, dental phobia, depression, body dysmorphic disorder, chronic phantom limb pain, panic disorder with agoraphobia, obsessive-compulsive disorder, and peer verbal abuse.

I use EMDR therapy as my primary psychotherapy treatment and I've also personally had EMDR therapy for anxiety, panic, grief, and “small t” trauma. As a client, EMDR worked extremely well and also really fast. As an EMDR therapist, and in my role as a facilitator who trains other therapists in EMDR therapy (certified by the EMDR International Association and trained by the EMDR Institute, both of which I strongly recommend in an EMDR therapist) I have used EMDR therapy successfully with panic disorders, PTSD, anxiety, depression, grief, body image, phobias, distressing memories, bad dreams, and many other problems. It's a very gentle method with no significant "down-side" so that in the hands of a professional EMDR therapist, there should be no freak-outs or worsening of day-to-day functioning.

One of the initial phases (Phase 2) in EMDR therapy involves preparing for memory processing or desensitization (memory processing or desensitization - phases 3-6 - is often what is referred to as "EMDR" which is actually an 8-phase method of psychotherapy). In this phase resources are "front-loaded" so that you have a "floor" or "container" to help with processing the really hard stuff, as well as creating strategies if you're triggered in everyday life. In Phase 2 you learn a lot of great coping strategies and self-soothing techniques which you can use during EMDR processing or anytime you feel the need.
In phase 2 you learn how to access a “Safe or Calm Place” which you can use at ANY TIME during EMDR processing (or on your own) if it feels scary, or too emotional, too intense. One of the key assets of EMDR therapy is that YOU, the client, are in control NOW, even though you weren’t in the past, during traumatic events. You NEVER need re-live an experience or go into great detail, ever! You NEVER need to go through the entire memory. YOU can decide to keep the lights (or the alternating sounds and/or tactile pulsars, or the waving hand, or any method of bilateral stimulation that feels okay to you) going, or stop them, whichever helps titrate – measure and adjust the balance or “dose“ of the processing. During EMDR processing there are regular “breaks” and you can control when and how many but the therapist should be stopping the bilateral stimulation every 25-50 passes of the lights to ask you to take a deep breath and say just a bit of what you’re noticing, anything different, any changes. (The stimulation should not be kept on continuously, because there are specific procedures that need to be followed to process the memory). The breaks help keep a “foot in the present” while you’re processing the past. Again, and I can’t say this enough, YOU ARE IN CHARGE so YOU can make the process tolerable. And your therapist should be experienced in the EMDR therapy techniques that help make it the gentlest and safest way to detoxify bad life experiences and build resources.

Grounding exercises are essential. You can use some of the techniques in Dr. Shapiro's new book "Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR." Dr. Shapiro is the founder/creator of EMDR but all the proceeds from the book go to two charities: the EMDR Humanitarian Assistance Program and the EMDR Research Foundation). The book is an easy read, helps you understand what's "pushing" your feelings and behavior, helps you connect the dots from past experiences to current life. Also gives lots of really helpful ways that are used during EMDR therapy to calm disturbing thoughts and feelings.

Pacing and dosing are critically important. So if you ever feel that EMDR processing is too intense then it might be time to go back over all the resources that should be used both IN session and BETWEEN sessions. Your therapist can use a variety of techniques to make painful processing less painful, like suggesting you turn the scene in your mind to black and white, lower the volume, or, erect a bullet-proof glass wall between you and the painful scene, or, imagine the abuser speaking in a Donald Duck voice... and so forth. There are a lot of these kinds of "interventions" that ease the processing. They are called "cognitive interweaves" that your therapist can use, and that also can help bring your adult self's perspective into the work (or even an imaginary Adult Perspective). Such interweaves are based around issues of Safety, Responsibility, and Choice. So therapist questions like "are you safe now?" or "who was responsible? and "do you have more choices now?" are all very helpful in moving the processing along.

You might want to take a look at a description of EMDR therapy: EMDR Network

Wow, thank you Pattijane, that's really comprehensive and helpful. l'll follow up some of those links.

I'm not sure l am ready to do that work, l think l still have some denial stuff to work through. But sounds like something to explore in the future.

Soup.

SoupDragon, thanks for starting this thread. I've had some similar questions in mind after reading that book!

Pattijane, that's really helpful - thank you. I'm having my second session with an EMDR therapist this week, so I'm trying to find out more before I see her next. I find it very encouraging about being in control - I'll hang on to that.


Bluegrey

Thanks Bluegrey. Hope EMDR is helpful for you.