Southside Counselling & Therapy Centre,
3 Carment Drive,
Glasgow G41 3PP

Trauma, PTSD and Complex PTSD & EMDR

What is trauma?

Trauma is the experience of severe psychological distress following any terrible or life-threatening event. Sufferers may develop emotional disturbances such as extreme anxiety, anger, sadness, survivor’s guilt or PTSD. They may experience ongoing problems with sleep or physical pain, encounter turbulence in their personal and professional relationships, and feel a diminished sense of self-worth due to the overwhelming amount of stress.

Although the instigating event may overpower coping resources available at the time, it is nevertheless possible to develop healthy ways of coping with the experience and diminishing its effects. Research on trauma identifies several healthy ways of coping, such as avoiding alcohol and drugs, seeing loved ones regularly, exercising, sleeping and paying attention to one’s self-care.

Traumatic experiences often arouse strong, disturbing feelings that may or may not abate on their own. In the immediate aftermath of a traumatic event, it is common to experience shock or denial. A person may undergo a range of emotional reactions, such as fear, anger, guilt, and shame. Feelings of helplessness and vulnerability are also common. Some may experience flashbacks and other signs of PTSD. Traumatic memories fade naturally with time. Persistence of symptoms is a signal that professional help is needed.

What is PTSD?

Today, PTSD is researched, understood and valued by many as a very real and impactful psychological condition. PTSD is used to describe a range of symptoms people may develop in response to experiencing events outside of their normal range of experiences, such as natural disasters, mass catastrophes or serious accidental injuries.

PTSD is a condition that may involve disturbances that threaten perception, sensitivity, self-image and emotional functioning. It can cause serious disruption in the ability to have healthy, satisfying relationships and tolerate life’s uncertainties, failures and rejections without excessive distress. It can also cause phobias, sleep disturbance, negative mood, anxiety and attention/concentration difficulties that interfere with academic or career success.

Complex PTSD?

PTSD is generally related to a single event, while complex PTSD is related to a series of events, or one prolonged event.

Symptoms of PTSD can arise after a traumatic episode, such as a car collision, an earthquake, or sexual assault.

Most frequently, complex PTSD trauma involves long-term physical, emotional, or sexual abuse. Symptoms may result from changes in some regions of the brain that deal with emotion, memory, and reasoning. Affected areas may include the amygdala, the hippocampus, and the prefrontal cortex.

The following are some examples of trauma that can cause complex PTSD:
  • Experiencing childhood neglect.
  • Experiencing other types of abuse early in life.
  • Experiencing domestic abuse.
  • Experiencing human trafficking.
  • Being a prisoner of war.
  • Living in a region affected by war.
PTSD symptoms develop due to dysfunction in two key regions:
  • The Amygdala and The Prefrontal Cortex.
  • This is a small almond-shaped structure located deep in the middle of the temporal lobe.
  • The amygdala is designed to detect threats in the environment and activate the “Fight or flight” response.
  • Activate the sympathetic nervous system to help you deal with the threat.
  • Help you store new emotional or threat-related memories.
  • The Prefrontal Cortex is in the frontal lobe just behind your forehead. The PFC is designed to regulate attention and awareness.
  • Make decisions about the best response to a situation.
  • Initiate conscious, voluntary behaviour.
  • Determine the meaning and emotional significance of events.
  • Regulate emotions.
  • Inhibit or correct dysfunctional reaction.

When your brain detects a threat, the amygdala initiates a quick, automatic defensive (“fight or flight”) response involving the release of adrenaline, norepinephrine, and glucose to rev up your brain and body. Should the threat continue, the amygdala communicates with the hypothalamus and pituitary gland to release cortisol. Meanwhile, the medial part of the prefrontal cortex consciously assesses the threat and either accentuates or calms down the “fight or flight” response.

Studies of response to threat in people with PTSD show:
  • A hyper reactive amygdala.
  • A less activated medial PFC.
  • In other words, the amygdala reacts too strongly to a potential threat while the medial PFC is impaired in its ability to regulate the threat response.
  • Consequences of Brain Dysfunctions in PTSD.
  • Hyperarousal.

Because the amygdala is overactive, more norepinephrine is released in response to threat and its release is not well-regulated by the PFC.

Effects of excess norepinephrine include:
  • Hyperarousal.
  • Hypervigilance.
  • Increased wakefulness and sleep disruption

As a result of hyperarousal, people with PTSD & CPTSD can get emotionally triggered by anything that resembles the original trauma (e.g. a sexual assault survivor telling her story on TV, a loud noise, or passing somebody who looks like their assailant). Symptoms of hypervigilance means they are frequently keyed up and on edge, while increased wakefulness means they may have difficulty sleeping or wake up in the middle of the night.

Reactive Anger and Impulsivity

A reactive amygdala keeps people with PTSD & CPTSD on the alert and ready for quick action when they face a threat, leading them to be more impulsive. The orbital PFC is a part of the PFC that can inhibit motor behaviour (physical action) when it is not appropriate or necessary. In people with PTSD & CPTSD, the orbital PFC has lower volume and is less activated. This means that people with PTSD CPTSD have less control over reactive anger and impulsive behaviours when they are emotionally triggered. Reactive anger can cause damage to career success and interfere with relationship functioning.

Increased Fear and Anger and Decreased Positive Emotionality

People with PTSD often report feeling an excess of negative emotion and little positive emotion. They may have difficulty enjoying their day-to-day activities and interactions. This could be the result of a hyperactive amygdala communicating with the insula, an area of the brain associated with introspection and emotional awareness. The amygdala-insula circuit also impacts the medial PFC, an area associated with assigning meaning to events and regulating emotions. Research shows overactivity of the amygdala-amygdala-insult circuit can suppress the medial PFC, thereby interfering with the ability to regulate negative emotions and assign more positive meaning to even.

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How can counselling help?

1. Delicately exploring your trauma in a safe place and recovering how your past experiences, have impacted on your feelings in the present.

2. Explore your emotional trauma at your own pace which provides an opportunity to get an understanding of your feelings, emotions, and responses.

3. Offers reflection on how we view our selves and what is needed to feel happier.

4. Enables a new sense of self and a new way of being.

5. In understanding the psychological impact of CPTSD & PTSD impact gives additional support to reducing symptoms.

6. In feeling understood can reduce possible alienation from the world, and help you understand what you feel is natural after a traumatic experience.

7. Identify what you can do. When we encounter stress, it is important to ask ourselves if we can do anything about it. If there is some action we can take, then taking that action will help reduce our anxiety.

8. Learn and discover healthier ways to manage intense emotions and learn new techniques.

9. PTSD & CPTSD undermine our fundamental beliefs that our lives are safe secure and manageable. Counselling offer space to reflect on and challenge irrational fears and phobias, by reducing anxiety we can start to feel safer in the word.

10. Offers an opportunity to gain a different relationship with the trauma and gain a new perceptive.

Today, the therapy is recommended by the National Institute of Health and Care Excellence (NICE) for the treatment of post-traumatic stress disorder (PTSD) is EMDR./p>

EMDR is option for counselling and is specific method/approach, clients may opt to have the more conventional approach.

What is EMDR? EMDR stands for 'eye movement desensitisation reprocessing'

Eye movement desensitisation reprocessing (more commonly known as EMDR), is a form of psychotherapy developed in the 1980s by American psychologist Francine Shapiro. While walking in a park, Shapiro made a chance observation that certain eye movements appeared to reduce the negative emotion associated with her own traumatic memories. When she experimented, she found that others also exhibited a similar response to eye movements. After further study and experimentation, EMDR was developed.

Complex PTSD?

PTSD is generally related to a single event, while complex PTSD is related to a series of events, or one prolonged event.

Symptoms of PTSD can arise after a traumatic episode, such as a car collision, an earthquake, or sexual assault.

Most frequently, complex PTSD trauma involves long-term physical, emotional, or sexual abuse. Symptoms may result from changes in some regions of the brain that deal with emotion, memory, and reasoning. Affected areas may include the amygdala, the hippocampus, and the prefrontal cortex.

EMDR therapy is increasingly being recommended for other issues too, including:
  • • PTSD.
  • • Trauma.
  • • Anxiety.
  • • Low self-esteem.
  • • Phobias and fears.
  • • Complex bereavement and loss.
  • • Death under traumatic circumstances.

This type of therapy is recommended by the National Institute of Health and Care Excellence Today (NICE) for the treatment of post-traumatic stress disorder (PTSD).

How EMDR can help your Symptoms

Of course, we are all different, and so what works for one person may not work for another. However, the common aims of EMDR therapy include:

  • • Reduce re-experiencing trauma memories.
  • • Help you feel more able to cope with and manage trauma memories without needing to avoid potential triggers..
  • • Help you feel more able to engage in and enjoy pleasurable activities and relationships.
  • • Reduce feelings of stress, anxiety, irritation, and hypervigilance - allowing you to rest well, address pressure and/or conflict, and go about your daily business without feeling fearful and prone to panic.
  • • Reduce feelings of isolation, hopelessness and depression.
  • • Boost self-confidence and self-esteem.
  • • Reduce or stop emotional flashbacks & visual flash backs.
  • • Reduce or stop the disturbance surrounding the trauma.
How does EMDR work?

When traumatic events happen, the body's natural coping mechanisms can be overwhelmed, and subsequently, the memory isn't always processed adequately.

EMDR therapy looks to help you properly process these traumatic memories, reducing their impact and helping you develop healthy coping mechanisms. This is done through an eight-phase approach to address the past, present, and future aspects of stored memory. This involves recalling distressing events while receiving 'bilateral sensory input', including side-to-side eye movements, hand tapping, and auditory tones.

What are the eight steps of EMDR?

During the initial phase, your therapist will ask you about your history, including what you are experiencing, whether you're taking any medication and what kind of support you're already receiving (if any). Getting to know you in this way will help your therapist determine whether EMDR is the best course of action for you.

Before EMDR treatment begins, your therapist will talk you through the theory, answering any questions you may have. At this point, your therapist will spend some time going through relaxation exercises (these may include guided meditations or breathing techniques) to utilise during the treatment and during times of stress outside of your sessions. Therapists refer to this second phase as preparation.

At this point, you will be led through phases three to six. You will now target specific distressing memories with eye movements or other forms of left-right stimulation such as taps or sounds. To start with you will be asked to select an image to represent the event and then to think about positive and negative thoughts, the amount of distress you feel and where you feel it in your body.

Your therapist will then use bilateral eye movements (or taps or sounds) in a series of 'sets' lasting around 25 seconds. After each set, you will be asked for feedback on your experience during the preceding set, before starting the eye movements again.

Your therapist may also ask you to recall the original memory and ask you how it seems to you now. This will continue until your feelings of distress have reduced and you're experiencing more positive thoughts and feelings.

The seventh phase is known as closure, and it offers you time to feel calm again using the relaxation exercises you learned at the beginning of the session. Finally, the eighth phase is called re-evaluation - and this is effectively the first step in your next session. This phase will see you and your therapist working together to consider how you are coping and whether you need to address the same memory as last time or if you are able to move on to something different.

EMDR can support you to reprocess these experiences, to move between stability and safety to dip into the painful, distressing material and to re-emerge. The process continues outside of sessions, so there is a value in adopting coping strategies to practise and use at times when experiences are a struggle.

EMDR is a remarkable, creative and powerful therapy.

How will I feel after my EMDR session?

The nature of EMDR means that after your session the treatment will continue to be active in your awareness. This means that you may find yourself thinking about the thoughts you focused on during your session and you may feel the same emotions you experienced during your session.

To help you through this process, allow yourself time and space to relax after an EMDR session and utilise the relaxation techniques you have learned. Be sure to discuss your feelings with your therapist in your next session. While everyone is different, over time these feelings will generally become less intense, and many people say they feel a strong sense of relief after their sessions.

How many EMDR sessions will I need?

This every much depends on the individual client, other factors include the depth, length and servery of the trauma. Also, how long it will take to do a full case history and prepare EMDR.

That every individual has the capacity to be fully functioning person if the power of the person is given recognition. Carl Rogers