PTSD and me part 3: EMDR therapy. St Emlyn’s

Editor’s note: This blog is third in a series from Rusty Carroll talking about his personal experiences of working in health care, the psychological sequelae and his recovery. This blog’s goal is to give some insight into the process, demands and outcomes of Eye Movement Desensitisation Reprocessing (EMDR). It utilises a personal account with the aspiration to give a sense of hope to anyone who finds themselves identifying with any or all of the elements of darkness described here or in previous blogs.

A couple of years ago I was very unwell. You may not have noticed, I had developed expertise in coping, compensating and covering up. My immediate family and colleagues were less lucky. They had to deal with a surly (on a good day), dysfunctional, hyper vigilant person who hardly slept, and comfort ate his way through shifts. On a bad day came the rage. Most days were bad days. I had had a diagnosis of Post Traumatic Stress Disorder (PTSD) for nearly a year, and I was awaiting the appointment to start Eye Movement Desensitisation Reprocessing 1(EMDR) therapy. A friend had expressed surprise and concern that I was to undertake EMDR. I was left with the impression that it was no bed of roses. I was right.

The descent into illness had come from the dissonance between self image and the outcomes for a particular group of patients. Repeated exposure to these patients over a decade, had insidiously eroded my ability to function. Early stages of the descent had seen a strategy of “cracking on” until the acute stress response of the exposure to the psychological trauma had passed. This acute phase may be familiar to you: intrusive thoughts, mood swings, affected sleep and appetite changes. The chronic phase’s coping strategies started out positively: yoga, meditation, exercise, optimising time with family, and even eating clean. As these strategies failed, other strategies were implemented: distraction through electronic entertainment and Social Media, comfort eating and withdrawal from all but the barest minimum of personal social interaction.

The diagnosis had come from my brilliant primary care (family) physician. He had recognised the problem immediately and made a referral to the local Mental Health service. A triage interview by the service had followed shortly thereafter. On reflection, this was the service undertaking a risk assessment for suicide. At the time, I wasn’t able to be honest about my suicidal thoughts, and so was triaged in such a way that the therapy appointment took nearly ten months to arrive.

Serendipitously, at about the point I went into full blown mental ill-health crisis, I was invited to start the therapy. Appointment one of EMDR therapy saw me in the waiting room of a community healthcare facility. Little did I know that I was about to start the most amazing and positive catharsis. Little did I know that I would come to trust my therapist utterly, and little did I know that the process would leave me with more resilience and positive wellbeing than at any other point in my adult life.

At first sight, EMDR appeared to me to be about as likely to work as homeopathy. Eye movements facilitating a re-programming of neurophysiological responses? Oh please. Yeah, I was wrong about that. EMDR is reported to have been discovered by accident by a therapist out for a walk whilst trying to re-frame a negative experience, who noticed a change in her mental framing as she rapidly moved her eyes between things she could see. She then developed this process, and it has subsequently been through evaluation and is now the therapy indicated by the NHS’ NICE PTSD treatment guidance.

For me, EMDR came in three phases. First came the resilience building. Not unusually, I needed therapy to be well enough to start EMDR itself. A few sessions later, the EMDR started. We had discovered that the eye movement for me worked less well than alternate taps on the forefingers of each hand. Whist this stimulus was taking place, my therapist guided my thoughts back to the psychological trauma and elicited my emotional response to the memories. We then attempted to understand what was the cause of the distress – in my case it was from failure to successfully resuscitate a patient, the subsequent self doubt and feelings of inadequacy. Those feelings were then explored in further sessions and re-framed. We went back to the first memory I had of those feelings and re-framed that memory as well.

There were tears, many tears. I felt fear, sadness and shame in overwhelming waves. Have you ever been caught in the breakers of the sea – where you barely get your head above water before the next wave crashes down up on you? It’s that. It’s horrible, and it’s necessary. In some weeks, I was even less even functional than before starting therapy. Doing the school run and the washing up was a good day. Entire box sets were consumed whilst the sofa mimicked a black hole.

Slowly, the worst passed. The final phase of the EMDR is future modelling. Using the most powerful sim tool known to human kind (the one between your ears), you enter a series of increasingly challenging scenarios and frame your response based on your new view of self. In parallel, the positive habits of mediation, yoga, exercise, clean eating, sleeping and being kind became a part of life. Some eighteen months post therapy and I continue to grow in wellbeing. Yes, some of this is the therapy continuing to shift my own self frame, and yes, some of it is as a result of multitude of life decisions made as wellbeing is now prioritised above much else in life. I don’t care. Wellbeing is wellbeing, I will take it any which way I can.

EMDR is tough, but its a bed of roses compared to living with PTSD.

Yours

Rusty

Posted by Rusty Carroll

Rusty Carroll PgC, DipIMC (RCS Ed), MCoP is a paramedic working in primary care in Manchester and a trainee Advanced Clinical Practitioner. You can find him on twitter as @paramedrusty.

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