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Seeing relief from post-traumatic stress

Therapists trained in eye movement desensitization and reprocessing at Landstuhl

Mideast edition, Tuesday, August 7, 2007

LANDSTUHL, Germany — Mental health care providers are reporting positive results using a relatively new and non-traditional treatment for post-traumatic stress disorder at Landstuhl Regional Medical Center.

During the past few weeks, about a dozen social workers, psychologists and other mental health professionals at Landstuhl have been trained to perform a treatment called eye movement desensitization and reprocessing.

Developed in the late 1980s by psychologist Francine Shapiro, eye movement desensitization and reprocessing, or EMDR, deals with stimulating the brain’s right and left hemispheres through bilateral movement. That bilateral movement usually comes in the form of patients following a therapist’s fingers back and forth with their eyes.

With patients told to recall a painful memory while moving their eyes back and forth, EMDR may seem like some mumbo-jumbo, hypnotic cure. But the Department of Defense and the Department of Veterans Affairs strongly recommend EMDR as one of four treatments for post- traumatic stress disorder in military and non-military populations. The treatment is one of several standard therapies being used by counselors at Walter Reed Army Medical Center in Washington, D.C.

The treatment — during which patients are fully awake and alert — produces positive results that can be demonstrated, said Dr. John Hartung, a trainer with EMDR Institute who is conducting the training at Landstuhl with a colleague. The institute is based in Watsonville, Calif.

“It’s much more than moving your eyes while thinking of a disturbing thought,” he said.

Researchers cannot explain exactly how or why EMDR works, but it does work, they say.

Brain scans of patients recalling a traumatic memory show a lopsided image, Hartung explained. The parts of the brain responsible for negative emotions and protecting us from danger in emergencies are highly active. The portions of the brain that control positive emotions, language and common sense are basically shut down, Hartung said.

“You put that all together and you’ve got a person under trauma overreacting to innocuous stimuli,” he said. “Now here’s the really good news. We can’t tell you exactly how we get here, but we know where we get.

“Four and a half hours later with EMDR treatment, we take a picture of that person’s brain. As the person thinks of that trauma now, it’s no longer traumatic. The brain is flashing on both sides, nicely balanced.”

The 4½ hours comes from three 90-minute sessions typical with EMDR treatment. Despite evidence, research and journal articles that EMDR works, some people still do not use the technique, Hartung said.

Landstuhl paid $15,000 for the training, according to hospital officials.

“The question is, ‘Why isn’t it being used more?’” he asked. “This is the best we have for helping people recover from the wounds of combat and move back to civilian life.”

As a treatment, EMDR has been somewhat controversial due to a variety of reasons including the unique proprietary nature of the technique (training is solely marketed through a company vs. being available through universities and medical schools as is the case with most other treatment modalities) and the purported relative speed and efficiency of EMDR compared to other techniques, according to VA/DOD clinical practice guidelines.

The same document stated that controlled studies show sufficient methodological integrity to judge EMDR as effective treatment for PTSD.

“Hopefully, EMDR will be a form of treatment that folks won’t be afraid of, won’t overwhelm them and is, I dare say, for some relatively quicker than some of the other forms of treatment out there,” said Air Force Maj. David Reynolds, chief of clinical health psychology at Landstuhl. “It’s another tool — a very powerful tool — in the therapists’ toolbox.”

Part of EMDR is explaining the process and going as slow or as fast as the individual wants, Reynolds said.

“It’s very user friendly,” he said. “The individual is in a lot of control. They’re going to know if it’s having an impact — the distress level will come down, positive beliefs go up. It’s different than some therapist saying, ‘Oh yeah, you’re getting better, but you just don’t know it.’

“We don’t do any of that. They’re going to know it.”


Center might add staff for increase in PTSD patients

Landstuhl Regional Medical Center is considering increasing the number of mental health care providers and associated staff as a result of more troops arriving with such ailments.

“What we’re looking at is expanding our capability here to make sure that we’ve got an ability to perhaps see more here and return more to theater rather than treating them here and moving them on to the States,” said Col. Brian Lein, Landstuhl commander.

The uptick in patients coming to the facility with post-traumatic stress disorder and mild traumatic brain injury is a result of an increased emphasis on education and identification, Lein said.

“The Army’s had a very, very strong push in post-traumatic stress disorder and mild traumatic brain injury,” he said. “Teaching and training has gotten out to the individual unit at the platoon level.

“We expect that we’re going to see a lot more of those people coming in because we want the people to identify their soldiers that have got this so that we start treating it early so that we can get them better and be able to either return them to their unit or return them functioning to society.”

Lein characterized the increase in patients requiring mental health care as “maybe a little more” but “not a phenomenal number.”

—Steve Mraz

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