With Eye Movement Desensitization Reprocessing (EMDR) therapy becoming popularized as a mental health treatment, I would like to spend some time with you today talking about the various mechanisms of trauma and how it affects our brain and its functioning.

A primary question I often receive centers on the question of "what is dissociation" and "will I dissociate during EMDR?". Dissociation is a survival oriented process. Dissociation is the way the brain has the ability to take something that is so overwhelming when a patient cannot escape a stressful event and/or is caught in the freeze response.

So for example, there might be a child being hurt by a caregiver. Children are often too small to run away or fight back. They are the victim of the grown up. What the brain does during this type of scenario is that it allows the child to be there and not be there at the same time. In other words, the dissociative process of the brain is protecting the child so they can survive the experience.

EMDR therapy helps patients move through the dissociative process, which is inherent in any kind of trauma. EMDR helps the patient move through the experience with a much reduced rate of emotional arousal.

For the previous thirty years when trauma and Post Traumatic Stress Disorder (PTSD) were added to the Diagnostic Statistical Manual (DSM), it only categorized trauma as specifically large or “Big T” events. However, adverse life experiences or “little traumas” can also have a major impact on social, emotional, psychological, and physiological functioning.

I personally choose not to define trauma by “little” or “big” events. What is significant to me in my professional opinion is how the smaller, more repetitive patterns of events become recorded in the nervous system and because of its repetition, these experiences gradually accumulate in the brain.

Where in the brain does this all get stored? Please allow me to introduce to you, if you have not already learned about the amygdala. The amygdala is within the right hemisphere of the brain, known for responding to a heightened sense of arousal. The amygdala translates information that it receives from the other parts of the brain into an emotional response. This type of response can manifest in a variety of ways within the body (e.g. heightened blood pressure, more rapid breathing, blood moving from the central part of the body to the peripheral, and the release of adrenaline). ​

In my next post, I will continue to discuss two key symptom behaviors that are congruent with trauma: avoidance and rumination. Stay tuned! 

I am so excited to share the news of this freshly released podcast episode with you! 
I recently sat down for a conversation with Jacksonville local, Kacie Main, who is both the author of her book "I Gave Up Men for Lent" and host of "The Better You" podcast. 
Kacie beams with joy and she is clearly passionate about learning and inspiring others. During our conversation, Kacie (with permission of course) picked my brain about my most favorite topics in mental health, including EMDR therapy, the neurobiology of trauma, and mindfulness! 
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Click here for the link to Episode 7 of my conversation with Kacie for Apple 
Click here for the link for Episode 7 of my conversation with Kacie for Stitcher

This community continues to surprise me in the most incredible ways and I am so thrilled to be here in Ponte Vedra Beach knowing people like Kacie are here shaping the world into a better place. I know I for sure look forward to hearing more from Kacie. Something leads me to believe she is on to something special with the work she is doing. 
If you have not done so yet, please give a follow to the incredible Kacie Main Instagram account @kaciemain_writes and of course, tune into and give a follow to the podcast @thebetteryoupodcast. 
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Read that one more time: YOUR BRAIN IS NOT WIRED TO MAKE YOU HAPPY. YOUR BRAIN IS WIRED TO SURVIVE.

Generally speaking, we are taught and conditioned from a very young age that being happy all the time is "normal" and represents a standard of "good health". What I am about to share with you right now may cause some cognitive dissonance, but please try to keep in an open mind: there is no survival value in being happy. You aren't more likely to be successful. From my experience and observation as a mental health professional, I notice fear and anxiety steering the wheel for my clients, driving him her to get things done. Having fear and anxiety driving the vehicle towards completing tasks and obligations is actually pretty normal and healthy. And really, it is not all that bad if we are looking at these motivating behaviors through an evolutionary lens. Why? Your brain is programmed to get things done under the assumption he or she may have to confront an unknown perceived danger or threat.

So you might be asking, how does this have to do with happiness and survival? As our human ancestors evolved over time, they began colonizing into groups, forming communities of hunters and gatherers. Humans who would have most likely hesitated when they saw something in the woods or came across unfamiliar terrain on a hunt, were more likely to survive. Over time, this specific trait began appearing more frequently in the genetic material passed down to future generations.

Over time, the need for a higher volume of food supplies, weaponry, shelter, and children increased as a result of our human ancestors focusing more on safety and its positive impacts such surpluses would provide, ultimately ensuring the continuation of passing on the strongest genetic material to future populations. The more successful these early humans were, the stronger the genetic material would be, ensuring the continuation of a species that would evolve and continue to evolve over time to survive and adapt to changing environments and climates.

Here we are today in the modern world. Being careful often hurt us, and "threats" are not typically life threatening. This is where anxiety tends to show up in our lives. Our brains are programmed with the unique ability to process information so that we can survive. Survival includes connection, communication, and community. Your unique genetic material does not have the data to compute beating yourself up emotionally for not being a happy person.

In the experiment of life, survival is the Independent Variable (IV). Happiness is the Dependent Variable (DV). The DV is assumed to be affected by the IV, hence the term 'dependent' (its value depends on the state of the IV).

I am a huge advocate for using a strengths-based perspective. So when I meet with someone for session, I am going to ask "what's strong in you?" rather than "what's wrong in you?" 

When I would have resident physicians shadow me as a therapist in Tallahassee, I would often get asked questions that focused on finding connection with adolescents and finding ways to get to the roots of presenting mental health issues.

 I will never forget a specific conversation I had with a resident one day. He told me that during his rotation in the emergency room, he said he had seen an adolescent patient who attempted suicide by slitting his/her wrists and didn't know where to begin or how to begin talking to the teenager. I encouraged him to start where the patient is. 

Through his lens, it would have been expected of the resident to look at the physical cuts to the wrists and begin treatment there. But I invited him to acknowledge that patient, that person's pain. Yes, physical pain is obvious, but clearly that person was in a kind of pain that modern medicine, no matter how advanced, could not directly touch. 

That kind of pain can be more significant than any physical pain you or I can experience considering we can find refuge in knowing a blood test, IV infusion, or over the counter prescription can locate the root of the issue and give us relief. 

Healing begins the moment we feel heard. So why are we not making greater efforts to listen? 

So excited to announce that after two years of intensive training, I have been approved for certification as a Certified EMDR therapist! 

What is the difference between EMDR trained and Certified? Clients will ask me, "what does it mean if I read that a therapist says he or she is Level 1 or Level 2 trained?".  Generally speaking, EMDR basic trainings require a minimum of six days and a majority of EMDR trainings will break up the six day requirement by hosting two-three day weekend training events held on different assigned weekends of a specific month. When a clinician will state that he or she is "LEVEL 1 EMDR Trained",  he or she has technically only completed the first three days of basic training. Subsequently, when a clinician states he or she is "LEVEL 2 EMDR Trained", he or she has completed the six days of basic training. Some therapists may find the basic training to be sufficient for what he or she is looking to add to his or her own practice. Once I completed basic training I immediately began applying the skills I learned and provided EMDR therapy in my sessions. I began to notice that my clients symptoms began to resolve almost immediately. How cool is that? People feeling better? I was hooked! 

After completing basic training I was presented the opportunity  to invest in furthering my knowledge of EMDR treatment even more and I went for it! I dedicated the next two years of my life utilizing EMDR and somatic processing in my sessions, attending monthly meetings with an EMDRIA approved consultant for case consultation, and learning even more about the history, mechanism of action, and function of EMDR. In my down time I spent hours studying the limbic system, neurobiology of trauma, and human anatomy so that I could truly understand the biology of stress on a cellular level. My training and certification was unique in that the founder of the Somatic Attachment Focused EMDR protocol (S.A.F.E) interweaved a concept of noticing and understanding how the body will tell us what the client needs and how a feeling, movement, or overall posture may be linked to the emotion(s) associated with a disturbing memory.  Being an EMDR provider requires a great depth of understanding and dedication to understanding how the human body reacts to stress, perceived danger, and how to work with a client when he or she may be beyond a window of tolerance to keep him or her safe. As a Certified EMDR therapist, part of my intensive training focused primarily on safety. This type of treatment necessitates a high level of competency and should not be used as a treatment unless the clinician has the qualifications, experience, and training to do so. I understand the necessity of keeping my clients safe and closely monitor each session, ensuring a person does not leave the session until he or she feels grounded enough to do so. 

So what's next? I look forward to continuing to utilize EMDR in my practice and would like to become an EMDRIA approved consultant. As a consultant, I would have the privilege of working with mental health professionals in the field who are interested in deepening his or her understanding of EMDR treatment. Regardless, the journey is far from over! If you have any questions regarding EMDR, Certification in EMDR, or would like to make an appointment, please feel free to give me a call:  904-280-8006

Today we will go a little deeper in trauma. Dr. Stephen Porges developed Polyvagal theory to expand our understanding of how the nervous system responds to threat and trauma. 

In our last post we briefly talked about the nervous system and it's role in trauma. Dr. Porges added a third factor: the vagus nerve. The vagal nerve plays a role in regulating the heart, face, stomach, and breath. The nerve also communicates with the brain. When talking about the nervous system, we will need to use some anatomical terms to orient ourselves: 

Ventral: towards the front of the torso. The navel (belly button) is on the ventral or anterior part of the body. 
Dorsal: towards the back of the torso. For example, the shoulder blades are dorsal or posterior to the ribs. 

The vagus nerve, or more specifically the ventral branch of the vagus nerve, controls the muscles of the face. The face, heart, and lungs are all used when we interact with others (e.g. smiling or making eye contact, feeling our heart beating faster, using our lungs to speak and breathe). This is what Dr. Porges calls "social engagement". In other words, it is through our face, heart, and brain connection that we learn to respond to interpersonal threats and challenges. Let's use a worst-case scenario as an example of how this works. Imagine this: you are walking down a dark alley alone and you see a dark shadow in the distance approaching you. Your face (eyes, nose, and ears) capture the image, hear the footsteps, and smell any scents or aromas in the air. Your brain takes in all the information your sensory organs are sending and tries to make sense of the shadowy figure. As this takes place, your heart begins pumping a lot harder to disperse blood flow to your muscles just in case you need to fight or make a run for it (flee/flight) from this unfamiliar and potentially dangerous shadowy figure. So what just happened? Your vagal nerve was working in overdrive, working hard as gatekeeper of your body's responses to the environment, moderating a conversation between your brain and body during a moment of possible danger.  Another branch of the vagus, the dorsal vagus, regulates organs below the diaphragm (e.g. stomach, intestines). The dorsal vagus activates what we call "shutting down" during overwhelming trauma. 

Polyvagal theory emphasizes that our nervous system has more than one defense strategy and whether we use fight-or-fight or shut down, is not a decision we actively decide to use. But if we are trapped, or feel unsafe, our nervous system reads those cues and makes a decision from there. I should note these responses were adaptive to the environment or situation that an event or trauma occurred at a moment in time. This is where Somatic and Attachment-focused EMDR (Eye Movement Desensitization Reprocessing) can really help clients identify these patterns and work WITH the vagal responses to process painful memories and heal. Somatic and Attachment-Focused EMDR or SAFE EMDR model is compatible in treating most psychiatric diagnoses including but not limited to PTSD, trauma, anxiety, and depression.

This concludes our discussion about the neurobiology of trauma. If you or a loved one have any questions, would like further information on EMDR, or would like to set up an appointment. Please feel free to give me a call at 904.404.1763. 

Trauma can leave you feeling overwhelmed, anxious, or possibly shut down and it is incredibly beneficial to develop an understanding of where these feelings and responses are coming from inside the body. 

You may be familiar with the body's acute stress response: fight-or-flight.. If you are not familiar with the terms, fight-or-flight are features of the body's built in protection mechanism that surface in the presence of something that is terrifying, either mentally or physically. There is an additional response to perceived threat to safety: Immobilization/Freeze/Submit. This occurs when fight-or-flight do not restore safety and can appear in various forms such as a high alert stillness,  freezing, or dissociation.

You can probably think of a time when you  experienced the fight-or-flight response. In the face of something that may have been frightening; perhaps encountering a growling dog during a walk or preparing to give a big presentation at school or work, your heartbeat began beating much faster, you could feel yourself breathing faster, and your entire body became tense. Maybe you felt a lump in your throat, felt dizzy, tired, you could feel your hands trembling, or felt serious urgency to use the restroom. Essentially, the physical symptoms you experienced were indicating that your body was gearing up to either fight or flee the threat (real or perceived). Your brain, and more specifically your nervous system, sent the signals to your body, preparing you to fight or flee, making it more likely that you would survive the danger. Cool, huh? Let's take a minute to discuss where and what this whole nervous system thing is about before going deeper into trauma. 

Your Nervous System 101
A basic way to describe the very intricate and delicate nervous system is to point out the two components of the nervous system. One that is conscious (e.g. actively thinking to move your fingers) and another that functions without awareness (e.g. regulating body temperature). The main actor in the human nervous system that functions without conscious awareness is the autonomic nervous system (ANS).  The ANS regulates organ functions such as heart rate, digestion and also responds to trauma or threat.
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Also, the ANS either deploys energy (e.g. cortisol) or conserves energy through two primary systems: the sympathetic nervous system and parasympathetic nervous system. Why is this important? Our autonomic nervous system plays a significant role in our emotional and physiological responses to stress (trauma included!). The sympathetic nervous system releases a stress chemical (cortisol) in the body (fight-or-flight). The parasympathetic nervous system pumps the breaks on the sympathetic nervous system and instead allows the body to shift towards relaxation, digestion, and recovery. When things are going well and you are feeling great, chances are your sympathetic and parasympathetic nervous systems are working in harmony and you would be less likely to have issues with digestion, sleep, and feeling "run down". This is where trauma comes back into the story...

Trauma interferes with the harmonious dance between the sympathetic and parasympathetic nervous systems. I should also point out that the parasympathetic nervous system is not only associated with recovery functions but is involved with dissociation and immobilization (freeze). 

Dissoci-what?
Dissociation is a biological protective mechanism deployed by the body when there is a perceived threat or danger. Dissociation separates you from conscious awareness particularly when frightening feelings or memories surface. I'm going to normalize dissociation here by saying we all do it or have done it at some point in our own lives. What does dissociation look like? Dissociation can appear in a variety of symptoms however, most frequently they may manifest as relatively mild sensations of fogginess, sleepiness, nauseous, or difficulty concentrating to feeling numb or cut off. In some of my more complex trauma cases, I have worked with clients who have reported experiences lapses of memory or feeling "lost in time". 

When a trauma occurs and goes unanswered, a survival mechanism, either fight-or-flight will become conditioned into the nervous system. So if a traumatic event, death, abuse, accident, rejection, abandonment, chronic illness, sports injury, and so forth occurred in childhood, chances are a triggering event may produce anxiety and high arousal if there was a missing experience during and after the event. This I feel to be especially true if that person experienced a pain that was unanswered with love, connection, or attachment, particularly when he or she needed it most.

With just a slight shift in the lens of therapy, it's become apparent that a lot of the psychopathologies I treat as a therapist have at some point or another functioned as adaptive coping mechanisms for my clients, and that they were most likely developed as a response to a significant change (e.g. threat, loss, trauma, etc.). Whatever it is that they needed to do to allow him or her to thrive also became a symptom and limitation keeping him or her stuck. But you don't have to stay stuck if you don't want to! We will get to more on that in a future post ;) Stay tuned.