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Helping Patients Suffering from Trauma using Eye Movement Desensitization and Reprocessing

March 9th, 2015

Introduction to EMDR

The precise neural mechanism for how eye movements affect emotional status is unclear, but the fact is they do. It is almost as though a broad view of the horizon from left to right, and right to left also helps the mind to place events within the broader context, or for both hemispheres of the brain to work together.

Iemdr-eye-movementn some respects this is nothing new. We have all experienced the calming effects on a stressful day of going for a stroll in the countryside, enjoying the view from a hill-top or from looking out over the sea. However, in some instances such as child abuse, sexual assault, physical assault or other severe traumatic events the experience can become mentally ‘blocked’, and unless worked through – or ‘processed’ can become utterly debilitating.

EMDR now has an excellent evidence-base for demonstrating its effectiveness, in the right safe, therapeutic environment for treating patients who have suffered from these forms of trauma. Some senior psychologists have explained the therapeutic effect of eye movement in technical terms such as, “tasks, such as eye movements, that tax working memory during recollection of stressful memories attenuate their vividness and emotionality during subsequent recollection”. In plain English this means that EMDR therapists can help their patients to re-visit the situation without causing undue stress.

Is EMDR really different from CBT?

The World Health Organization (WHO) describes the difference between Cognitive Behavioural Therapy (CBT) and EMDR. As EMDR is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories, treatment involves focusing simultaneously on the following:

  • Spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and,
  • Bilateral eye stimulation.

In this way EMDR reduces distress whilst also strengthening positive attributes that are related to the traumatic event. However, unlike CBT, EMDR does not involve detailed descriptions of the event, direct challenging of beliefs or extended exposure, or even the need for homework. Read the rest of this entry »

Gifting Connectedness

December 2nd, 2014

First prize: Help those less fortunate

 

season-to-giveAn extraordinary Catholic priest in Australia, Father Bob Maguire, is running a competition with a top prize that ‘guarantees happiness.’ 

See: http://www.theguardian.com/australia-news/2014/nov/24/father-bob-offers-people-chance-to-win-happiness-guaranteed

He is is offering a third-placed prize of five nights in a chain of high-end hotels, with the second-placed prize being five flat-screen TVs. However, it’s the top prize that we applaud, and which resonates so strongly at this time of year:

The chance to work in one of the soup kitchens run via the Father Bob Foundation, which aims to feed and provide educational support to the homeless and disadvantaged.

 

Genius! Although the initiative is meant to draw attention to the serious homelessness problems in wealthy nations like Australia, there is also, within it, a timely acknowledgement of the value of getting out there and helping someone.

This is something we weave into the very essence and grammar of our work with our patients at PROMIS: meaningful, rewarding connection with others as the sunlight ready to break through the clouds of isolation and a sense of worthlessness.

 

Read the rest of this entry »

Movember shines a light to another worthy but unspoken cause

November 3rd, 2014

We are delighted to hear that the organiser’s behind the Movember movement are turning their focus this year to men’s Mental Health. See http://www.bbc.co.uk/news/health-29841063

It is our considerable experience that physical and mental health are not separate matters but two aspects of well-being and resilience that overlap and have a clear cause and effect relationship; they affect and contribute to each other.

In building resilience to mental health, and in treatment for Mental Disorders, we need to accept that both areas of our lives need focus and attention. Poor physical health increases the risk of people developing mental health problems, while poor mental health is associated with an increased risk of diseases such as cardiovascular disease, cancer and diabetes.

Hence our enthusiastic support of Movember’s excellent decision to include men’s mental health within the focus of a charity dedicated to men’s health. Read the rest of this entry »

“Nothing About Us Without Us!” – Moving Away From Criminalisation Of Addiction

October 30th, 2014

Addiction in the NewsIt has been impossible, today, to ignore the important findings of a recent Home Office report, which compared the UK’s approach to drug misuse with that of 13 other countries and concluded that there is no evidence that the criminalisation of drug use leads to a reduction in the problem. See, for example, http://www.bbc.co.uk/news/uk-29824764.

In simple terms, there is no evidence that punishing people for having a drug problem will actually stop them using. Those of us who work in this field have a responsibility to those who suffer from addiction, and their loved ones and our communities, to focus the debate on what does work.

Awareness, understanding, tackling the grass roots of addiction in our homes, schools and towns must not be derailed, and works, but, as we all know, so does treatment.

 

Read the rest of this entry »

Looking In From the Outside

January 19th, 2014

An experienced Recovery Coach from the States paid our Hay Farm clinic a visit and gave us an account of his observations that we are happy to share with you. We thank Dr. Ronald W. Hill for his kind and insightful thoughts.

ReHayFarmcently I had the privilege and pleasure of visiting the PROMIS residential treatment facility in rural Kent. As a counselor from New York City, I was curious about how drug and alcohol treatment was approached and carried out in the UK, as compared to treatment in the United States. I was delighted at what I witnessed at PROMIS for several reasons. However, before I go into the details of my experience at PROMIS, permit me to digress a little to give some idea of my background, working in treatment.

 

During my 20 year career I worked in a variety of treatment centers, with diverse patient populations. Those treatment centers included Hazelden and Cornerstone Medical Arts in Manhattan. Before moving to New York I worked in Portland, Oregon on the west coast at Lakeside-Milam, The Springbrook Institute and the DePaul Center. I also spent 3 years as a counselor at a treatment center located inside a prison, and 3 years as an Assessment Specialist for NADAP, also in Manhattan. I mention these treatment centers to indicate that I have had quite a variety of experiences working in treatment.

 

Read the rest of this entry »

Horticultural Therapy

March 26th, 2013

Orange tulipsSpring is hopefully just around the corner and so is a great prompt to introduce Horticultural Therapy to Hay Farm. We have such a beautiful setting here, with 12 acres of farm land, so it is perfect for those who feel that this therapy might help them.

Horticultural Therapy is an active process which engages individuals to connect with nature as a way of healing themselves. It is the use of gardening as a client-centred therapeutic tool to promote physical, cognitive, emotional and spiritual well-being.

Throughout time, gardens have always been revered as a place of tranquility and peace and also considered as aesthetic expressions of beauty through art and nature. Just as we feel refreshed when walking through a forest or a field of flowers and experience a sense of joy when spring blooms, it is not hard to imagine how helping things grow and transforming an empty pot, field or land to a place of beauty can be very rewarding.

Among the many listed benefits of Horticultural Therapy such as enhancing positive mental attitude, reducing stress, alleviating depression, enhancing self-confidence, promoting gratification, developing cognitive skills and improving decision making, you are sure to discover your own unique benefits. Read the rest of this entry »

The Power That Lies Within The Heart

January 2nd, 2013

The peace that passeth all understanding

The Heart is the messenger of Life, I discovered that with my spiritual partner Carmel in the summer of 2005 while working on the creation of a new spiritual workshop in a small cottage on the wild and beautiful Beara Peninsula in West Cork, Ireland. We had been earnestly working for several days on the different aspects of the workshop, when one day we seemed to move into a space of absolute confusion, which suddenly exploded within us in the form of resistance and anger. We found this shift so unbearable, that we both retired to our rooms to hopefully sleep it off. Little did we know that what was to happen, would change our understanding of Life completely. Read the rest of this entry »

Hope for Depressed Addicts

December 27th, 2012

Not so long ago Alcoholics Anonymous was regarded with condescension by many professionals working in the addiction field. A common view was that science-based techniques, like Cognitive Behaviour Therapy (CBT) had made the Anonymous Fellowships seem like a quaint and outmoded quasi-religious cult.

At the same time, there were encouraging signs of scientific method being employed in the evaluation of both AA’s effectiveness, and of the value of the 12-step based Minnesota Method as practised in many treatment centres (Cook, 1988; McCrady & Miller, 1993). But the critical event leading to greater respect from the scientific establishment for the practices of AA was the publication of the results of Project Match in the 1990’s. This large-scale definitive study found that teaching alcoholics the basic tenets of AA philosophy and practice and encouraging participation in AA was at least as effective in facilitating recovery as was CBT. Subsequently, research into how AA works has continued unabated, and I wish now to highlight in particular a recent study from the USA that has examined the role of 12-step attendance with respect to current concern with the problem of “co-morbidity” – that is, the presence in an individual of a psychiatric condition like major depression alongside that of drug/alcohol addiction.

It’s now generally recognised that addicts with a “co-morbid” diagnosis of major depression present a particular challenge in treatment. Participation in AA/NA was shown in 2003 to have a beneficial effect on abstinence, whether or nor co-morbid depression was evident (Kelly et al 2003). A very recently published study shows just how important attendance can be for clients with both diagnoses (Worley et al 2012). 12-step treatment of co-morbid substance use and major depression was investigated,
in comparison with use of CBT. This study shows that 12-step attendance in itself, regardless of strength of affiliation, mediated a significant reduction in depression. In turn, the lower depression mediated an improvement in substance use. The improvement in depression in those treated by 12-step facilitation (TSF) actually exceeded that in a CBT group. Moreover, the beneficial effects of 12-step attendance on depression were also evident in those clients in the CBT treatment group who chose to attend the 12-step meetings. In summary, major depressive disorder is not an exceptional problem for those attending 12-step groups because AA attendance itself has a beneficial effect on depression, and lower depression leads to successful recovery from addiction. Read the rest of this entry »

How it was, how it is now…

December 10th, 2012

This is a poem from one of our patients about her recovery for those that might not be able to see a way out; there is always hope and a different way of feeling, living and being.

How it was

The wall to the west is built of fears
The eastern one of unshed tears
The other two are made I know
Of loneliness that wont let go

Its cold in here, the light is thin
Its damp and silent, deep within
Locked in this place its seems I’ll be
From now through all eternity

This prison haunts my mind and soul
It fragments me, I don’t feel whole
It never seems to move away
It saddens me night and day Read the rest of this entry »

PROMIS Research in Progress: Some early findings

November 28th, 2012

Some 7 months ago, following the start of my work as Director of Research, PROMIS agreed to conduct an experimental trial of new interventions based on proven practices that have emerged within the broad framework of the Positive Psychology movement (Peterson, 2007). Our intervention programme has been carefully designed in consultation with the VIA Institute on Character (University of Pennsylvania, and will be introduced shortly when staff training has been completed.

In the meantime we have been gathering the information that will be required to conduct a controlled evaluation of the intervention following its incorporation into the PROMIS Programme. Some interesting findings have already emerged, and I would like briefly to give the flavour of the kind of things we are discovering, in relation to just two small aspects of our ‘benchmark’ studies of clients at PROMIS, prior to implementation of the experimental intervention.

Aspects of Well-being

Working effectively with clients is problematic if they are feeling angry, depressed, anxious or ashamed, or another state indicative of a negative mood. Our ‘benchmark’ findings indicate that although clients do generally arrive in a negative, neutral or only slightly positive mood, this does not persist for long. The mood of the vast majority of clients soon greatly improves, and remains at more or less the same significantly more positive level throughout treatment.

But a positive change in mood, whilst desirable and important, is only the start. It may facilitate progress in treatment, but it may or may not be linked to progress in the long term. We’ll have to wait and see. The evidence we now have, already shows that the pattern of change over time is very different for our measures of psychologically more important states of mind. Let’s take just one example: Satisfaction with Life (SWL) is an important judgement about how satisfied with life one generally is, and is independent of transient moods. We measure it by asking clients to judge in their own way, using their own criteria, how closely their lives are to what ideally they might wish was the case. Our findings so far indicate that SWL, like mood, also improves markedly. Most importantly, this increase in positive judgements increases over the time in treatment, whether that is one week, two, or three weeks. The longer a client stays, the more satisfied they become. Similar findings are emerging with respect to other aspects of positive psychological progress, but to varying degrees. ‘Insight’, for example, seems to be more resistant to change. The overall picture will be clarified in time; the research is still in its early stages.

Posttraumatic Growth

The Positive Psychology movement has embraced the finding that traumatic events may lead not only to post-traumatic stress disorders, but to posttraumatic growth, or what has been termed “Benefit-finding” or “Adversarial growth”. The idea is not new. Major religions and philosophies have pointed to the possibilities of character developing positively as a consequence of overcoming, even welcoming, adversities. Psychological studies have now shown that a large array of crises in people’s lives – e.g physical illnesses like cancer, divorce, bereavement, military combat, rape and sexual assault – lead to perception of positive changes in five different but related areas of personal and social functioning, as follows: 1. relating to others, 2. establishing new opportunities in life, 3. increases in personal strength, 4. spiritual change, and 5. appreciation of being alive. These studies have used standardised questionnaire measures of posttraumatic growth, and at PROMIS we have used one of these inventories to assess how clients feel they have benefited from the crisis in their lives that led them to seek treatment. This work is in its initial stages, and some important questions cannot yet be answered. However we do have data that indicates that clients at PROMIS, after only a comparatively short time in treatment, demonstrate at least the same level of positive changes commonly found in those who have faced the extreme physical and stressful crises listed above. Moreover, these changes show signs of being related to length of time in treatment. If substantiated, this will in time suggest new ways of encouraging the processes of personal growth that coping with traumatic events in themselves naturally facilitate.

The research we are conducting at PROMIS indicates the centre’s commitment to defining priority areas of improvement and to implementing practices that are soundly based in replicable research. The most important results will emerge when the experimental intervention has been implemented and evaluated. In the meantime, the examination of changes occurring prior to the intervention is already of some intrinsic interest, and suggestive of therapeutic potential.

Geoffrey Stephenson
(October 25th 2012)



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