EMDR: The Hidden Gem of PTSD Treatment
October 10 is World Mental Health Day, a day encouraging increased awareness of mental health through education.
In the community of first responders, mental health issues are an unfortunately ever-present reality. Encountering tragic incidents on a regular basis can take a cumulative toll. While issues like post-traumatic stress and high suicide rates among the first responder population are pervasive, an open dialogue about treatment for these issues remains disregarded by many.
However, evidence-based treatment for trauma does exist. It’s little known in the EMS community, but its success rates demand its name to be known—it’s called eye movement desensitization reprocessing (EMDR).
A widely accepted form of psychotherapy practiced by 80,000 clinicians worldwide, EMDR is one of only three therapies recommended by the Department of Defense and the Veterans’ Administration for PTSD treatment. One of those practicing clinicians is Jim Marshall, MA, director of the 911 Training Institute, an organization that provides resilience training to 9-1-1 telecommunicators and other EMS professionals.
“Essentially, EMDR helps to reprocess traumatic information,” says Marshall, who has 25 years of experience as a trauma therapist. “We can apply EMDR and the pictures would fade, the emotions would melt off and the thoughts would change so they would truly be able to believe that it’s over. We are reprocessing that information and desensitizing the emotions connected with the event.”
Clinicians trained in EMDR implement a technique modeled after the neuromechanism of rapid eye movement (REM) stages of sleep, referred to as saccadic eye movements, which entail moving the eyes from one fixed point to the next.
The REM stages of sleep are “very important for us to be able to process life, restore our energy… and are vital to human health,” says Marshall. Researchers believe applying saccadic eye movements while a client focuses on the traumatic experience helps to accelerate the processing of traumatic information, as it activates bilateral stimulation of the brain’s left and right hemispheres, playing a key role in EMDR’s healing effect.
Krista Haugen, RN, MN, CEN, cofounder of the Survivors Network for the Air Medical Community, experienced the healing power of EMDR nearly 11 years following a harrowing helicopter crash she survived. Haugen was a flight nurse for Airlift 3 outside of Seattle. In 2005, while taking off to transport a patient, a loss of engine power sent the helicopter plummeting to the ground. While the crew and patient survived, the experience did not leave Haugen unaffected.
“You feel like you’re going out of your head, which is a very distressing feeling for people who are normally very much in control, very much used to being the ones who bring calm to the chaos and being the rescuers,” Haugen says. She recalls her drastic shift from being highly motivated and dedicated to her job to being “reduced to somebody who was really struggling.”
Haugen says this emotional toil impacts many aspects of an individual’s life, like income, relationships and quality of work output.
“Your sympathetic nervous system is essentially on overload, and the memories from the crash get stuck and they aren’t processed well,” Haugen says. “You continue to re-experience the fight-or-flight symptoms, which are dreadfully uncomfortable. You feel like you want to run from the saber-toothed tiger but there’s no saber-toothed tiger.”
Marshall says the unpleasant physical sensations of PTSD Haugen experienced can also be resolved by EMDR. He says this is particularly beneficial for EMS professionals who are triggered by circumstances that remind them of a traumatic call, like arriving on scene for a pediatric patient after experiencing the recent death of another pediatric patient. However, these intense emotions can be diminished or even eliminated through EMDR.
After realizing her 25 years working in emergency and critical care units, combined with her flight crash experience, was wearing down on her, Haugen discovered a local EMDR clinician through a Google search for psychologists.
“When I went to EMDR, I noticed an immediate change. It’s just releasing this mass of emotion and then it’s gone. It’s so strange. The discomfort is gone,” says Haugen, who decided to offload both the helicopter crash and all the other ghosts of patients past.
Haugen says other therapies she tried in the past weren’t remotely as helpful as EMDR. “EMDR brings more of an analytical perspective to the trauma and it kind of strips the emotions so when you think of it, it doesn’t produce a physiologic response of fight-or-flight.”
The immediate relief Haugen felt is not unusual. Marshall says many clients often “feel the healing happening in real time.” He adds, “As a clinician who has practiced this—30,000 hours of therapy, probably—I strongly believe EMDR is the most thoroughly healing… It’s just incredible. It gives people their life back.”
Before beginning EMDR, clinicians ensure the client is properly prepared to handle the initial stress of the process. They give clients the skills to safely manage their progress during, after and between sessions.
“Basically, they’re emotional grounding skills,” Marshall says. “We’re not putting them in an altered state of consciousness where they lose volition or choice. They are fully alert, fully attuned and fully in charge of the choices they make to go from A to B to C in the healing process.”
Haugen advises to allow an EMDR clinician to determine how and when EMDR should be used depending on each individual’s circumstances.
“Be open-minded, because it does sound hokey at first glance, quite frankly, but also realize that there are decades of solid research behind it and we know it’s effective,” says Haugen, who knows multiple crash survivors who found EMDR to be “extraordinarily effective.”
Marshall acknowledges that recalling traumatic memories in the process of EMDR is difficult, but it’s temporary and the alternative is a lifetime of experiencing unexpected flashbacks and other PTSD-related symptoms without any help.
“Our first responders need two things,” says Marshall. “There are two big Cs here: confidence that therapy can help heal them, and the courage to go seek it.”
Both Haugen and Marshall believe one of the best ways to instill these two values in the EMS community is for leadership to take initiative to educate and assist employees.
“I think that preparedness is really key for organizations and for leadership to really look at the trained peer support programs,” says Haugen. “Establish relationships with professional clinicians who have EMDR in their toolbox ahead of time before you actually feel like you need them.”
Haugen believes one of the biggest goals for the EMS community is to implement more education about mental health issues so providers know the issues are both preventable and treatable. Establishing “streamlined access to affordable, quality clinicians early in the process” is also an important step in taking care of first responders.
Marshall urges EMS providers not to wait until they are completely broken down by PTSD to seek help. The earlier the treatment, the better the healing.
“We really have an epidemic and there needs to be a stop sign right in the middle of the EMS industry that every leader and every front-line EMS professional can see,” says Marshall. “Stop, do not pass go, learn about EMDR, go get the help.”
Marshall discusses how the emotional code in the EMS industry implies that its providers must silently deal with their trauma or otherwise experience criticism for seeking help, further perpetuating the crisis at hand.
“The bottom line in this industry is that people seem to think we are supposed to carry this burden of what we’ve seen and experienced,” Haugen says. “I would suggest there’s no reason we should carry that around when there are very effective tools out there like EMDR. Trauma impacts us personally and professionally and it’s okay to have joy in your life.”
How to find an EMDR therapist near you:
- Visit EMDR International Association’s website.
- Click “Find a Therapist” on the upper right hand corner of the page.
- Click “Radius Search.” Select a radius of 25 miles.
- Under Specialty Areas, select ‘PTSD.’
- Under Populations Served, select ‘First Responders.’
- Under Certified Therapist, select ‘Yes.’
See below for additional resources on mental health treatment and prevention in EMS:
- Survivors Network for the Air Medical Community: https://www.survivorsnetwork-airmedical.org/
- The 911 Training Institute: https://www.911training.net/. Keep an eye out for Jim Marshall’s upcoming book, The Resilient 911 Professional, a handbook on optimizing first responders’ mental health, performance and retention.
Valerie Amato is an assistant editor for EMS World. Contact her at email@example.com.