Dr. Raymond Shred, Registered Psychologist

ADHD: Its not just for kids anymore

Mon, 24 Aug 2009 23:51:10 +0000

What do these people have in common -- Jim Carrey, Tom Cruise, and Terry Bradshaw? How about these people -- Malcolm Forbes, Henry Ford, and Benjamin Franklin?

While there are a number of characteristics that the men in each group have in common, it may surprise you to know that they are all suspected of having ADHD. Jim Carrey may not surprise many people but Ben Franklin?

Many people are aware of the symptoms and some of the treatment for Attention Deficit Hyperactivity Disorder or ADHD. Most people tend to think that this condition only affects children. The stereotypical person with ADHD is an eight-year-old boy who is bouncing off the furniture, unable to sit still, and unable to pay attention for very long. However, ADHD also affects girls and older boys. And, only ½ of the symptoms are related to hyperactivity.

What happens when children with ADHD grow up?

Research evidence has shown that 70% of people properly diagnosed as children will still have the symptoms of ADHD as adults. So, why don’t we see adults bouncing off the furniture? Okay, well except Jim Carrey. Adults with ADHD often choose to live and work in environments where they can manage their attention difficulties and wear off some of their excess energy.

There are four core symptoms that characterize ADHD: Inattention, Impulsivity, Hyperactivity, and Distractibility. The pattern of symptoms for any one person tends to be consistent but how they are shown may change over time. A child who is unable to remain seated at school may become an adult who feels a deep sense of internal restlessness.

Someone with a problem with inattention may be unable to stay focused on one task for very long. They become easily bored especially when learning a new task or doing something that requires close attention. They may be perceived as unconcerned or lazy. They are often disorganized and have great difficulty completing tasks. Many projects are started but many are not seen through to conclusion. In contrast, they may be able to give effortless, automatic attention to something they really enjoy.

Impulsive individuals often act before they have considered the consequences. They may have frequent angry outbursts or may engage in more high risk activities than is usual for their age group. They may be impatient with others and have difficulty noticing non-verbal cues that other people use during their interactions. One result is that they may have difficulty making friends or keeping friends.

Distractibility is another of the core symptoms. Much of our modern world, whether in school, at work, or at home, has multiple sources of information and stimulation often operating at the same time. Focusing on one thing requires being able to tune out all the distractors. This can be difficult for anyone. Distractibility is one of the major reasons that people with ADHD are often underachievers in school. Their intelligence and other abilities are often much higher than their achievement would suggest.

The need to move is often present to a higher degree in people with ADHD. One person described the feeling of staying still to that of holding your breath – you can only hold it in so long and then you have to breathe.

Adults with ADHD (especially when undiagnosed) have difficulty staying in one job. They are frequently depressed and may experience distress about their lack of achievement. Because ADHD does not affect intelligence, there are many bright capable people pursuing their dreams and becoming extremely frustrated because they are not getting there. I have had clients who know what to do on the job. They may be able to teach others. But, when they are faced with completing the necessary tasks, they find themselves unable to complete them. They start but then are distracted by something else or they are daydreaming or, what was I writing about?

Not all problems with attention or distraction are a result of ADHD. However, if you find yourself (or a friend, partner, or relative) unable to finish chores, being disorganized, forgetful, or distracted almost all the time then it may be helpful to consult with a qualified professional to discuss your options. Feeling compelled to talk, difficulty waiting your turn, and excessive impatience may be appropriate sometimes. Or, they may be symptoms of ADHD.

It is important to note that many of the difficulties that people with ADHD have could also be symptoms of other disorders. For example, depressed people often have difficulty maintaining their attention. Anxious people may respond inappropriately in social situations. Sometimes a person may be diagnosed with one condition but may have another. Some of the symptoms of ADHD are similar to the manic symptoms of Bipolar Disorder. Because someone with ADHD may also be depressed, a treating professional needs to exercise caution in making a diagnosis so that appropriate treatment is given.

There are effective treatments available for ADHD. Treatment may include medication but other therapeutic treatments are effective as well. Psychotherapy may be helpful to improve one’s self concept that may have been affected by ongoing attention problems. There are biofeedback therapies that can be used to increase a person’s degree of self-control. Neurofeedback helps a person learn to control and change the way their brain works.

An exciting new treatment is the Cogmed Working Memory Training program. It helps improve a person's working memory and reduces symptoms of impulsivity and inattention. Please click on the link to read more about it.

Some people with ADHD turn to personal or professional coaches to help them stay organized and on-task. A coach can help through regular contact and, for example, creating, maintaining, and reviewing "To do" lists and a person’s priorities. However, before treatment is implemented an accurate diagnosis should be made.

Compliance, Attachment, and Emotion Regulation

Wed, 19 Aug 2009 00:43:11 +0000

As part of my PhD program I wrote a paper called Compliance, Attachment, and Emotion Regulation.

The paper was written to demonstrate how parenting behaviour can have a highly postive impact on these three areas of child development. Similar parenting behaviour is implicated in all three areas of development. Specifically, parents who respond to their children, interact with them in a child-centered way, and help them to identify their emotional response to events help children develop in pro-social ways.

You can read the paper here. I would be pleased if you want to comment on the paper -- use the contact form on the contact page to send your comments.

Medication for ADHD?

Thu, 16 Jul 2009 20:00:57 +0000

What treatments are available for ADHD? There are a variety of options. Family therapy may help a family adjust to the stresses that are related to having a family member with ADHD. Social skills training may be useful for a child to get along better with his peers. Classroom management may help to reduce the impact of potential distractions for a child. Insight-oriented therapy (cognitive-behavioural, EMDR, etc.) may help repair damaged self-esteem.

One of the more effective ways of changing one's attention style is stimulant medication. This is also the most controversial. People are reluctant to consider medication for their children and there is much misinformation about how it works.

In this article, I will explain briefly how these medications work. This is not meant to be a comprehensive review of the medications available; I focus primarily on the mechanisms and effects of Ritalin or methylphenidate. However, most of this information will apply to all the stimulants currently used whether in quick release or slow release formulations.

I have found myself in a strange position because, as a psychologist, I do not prescribe medication. However, one of the treatment options available for children (and adults) is medication. Therefore, I have recommended that a parent to consult with their physician about a trial of stimulant medication. A trial is necessary because it does not work for everyone and there are side-effects.

What would I do if my child had ADHD? First, I would likely have him or her complete the Cogmed Working Memory Training program. After that, if problems remained, I would likely ask my physician to prescribe a trial of stimulant medication. In part, that is because I know that children with ADHD don’t fit in to many classrooms or other settings with their friends.

Once it has been tried, children themselves often remark about how much better they are able to attend, behave, etc. I would count up all the positive effects and carefully monitor for any negative side-effects. If there were no serious side effects, then I would want my child to have a happier, more productive life.

How does stimulant medication work? It seems kind of ironic to be prescribing a stimulant for a "hyperactive" child. However, once you know what it does then it’s not so strange. Ritalin or Dexedrine speed up the processing in the frontal lobes, thus making the child better able to decide not to pay attention to things that aren’t important.

Also, Ritalin is quite user friendly. Because of the way it works, all the medication taken one day has been eliminated from the body by the time a child takes their dose the next morning. The technical reasons for this are related to the pharmacokinetics and the half-life of Ritalin. It moves through the system quite quickly so that the user does not build up a tolerance. Unlike other medications it can be stopped at anytime, the only result would be that the user will not benefit from the positive effects.

The speed at which Ritalin works makes it difficult to determine the best dosage and timing of administration. Because different children’s bodies work differently, some children need a higher dose or need it sooner than the standard rules state. The appropriate dosage for each child is usually determined through a process called titration. The child is given a low dose initially and the dose may be increased until the most effective dosage is found. In all cases, the goal is to give no more of medication than is required to obtain the desired effect.

Further information can be obtained from the following documents published on the internet: Canadian Psychological Association ADHD Factsheet, the American Academy of Pediatrics -- Diagnosis and Evaluation of the Child with Attention Deficit Hyperactivity Disorder, the Canadian group Children and Adults with Attention Deficit Disorder or CHADD Canada, there is also CHADD in the US, and the ADD association.

Auditory Processing Disorder

Thu, 16 Jul 2009 19:59:43 +0000

One of the running jokes in my family is that whenever someone says something like, “Did you hear . . .?” the other person answers, “What?” We try and catch each other off guard and get them to repeat themselves. While this is fun for us, it is no fun having a hearing loss or a problem that interferes with understanding what is being said to you.

Auditory Processing Disorder (APD) is a listening problem rather than a hearing problem. To diagnose an APD, the first step is to rule out a hearing loss. An APD often manifests itself as difficulty in discriminating between different speech sounds. For example, some people (children or adults) hear “thing” when “sing” is spoken.

Auditory Processing problems may be the result of problems with the muscles involved with hearing. We need to stretch and relax the muscles that control the tympanic membrane (i.e., the eardrum) and other structures in our ears in order to discriminate between sounds. You can demonstrate this by tightening or loosening the top of a drum – you get sharper or duller sounds depending on how much the skin is stretched. The ear can be retrained to make the missing distinctions if given appropriate practice. This tends to work better with younger children.

To assess auditory processing, I use a test that takes about ½ hour to administer. It looks at several listening skills: 1) the ability to make discriminations between speech sounds when some of the lower frequencies are filtered out; 2) the ability to make discriminations between speech sounds when there is competing background noise; and 3) the ability to make discriminations between speech sounds when there are two competing sources of speech sounds.

An APD can be an underlying reason for reading or spelling problems. It would be very hard to learn how to spell words beginning with a “th” or an “s” if those sounds appear to be identical to you. Similarly, learning how to pronounce two words like sing and thing would be difficult for someone who cannot tell the difference between the sounds. It would be hard to figure out how to say or understand new words that begin with “th” and “s.”

When I have diagnosed an Auditory Processing Disorder and the child has received appropriate treatment, I have seen major gains in their reading levels, when the APD was the reason for the problem. In one case, the young boy went from a beginning Grade 1 reading level in late March of his Grade 3 year to being at the end of Grade 3 level in June. His teacher could not understand why he was having problems because he seemed very bright and he worked really hard. Everyone was pleased when the hard work paid off.

Auditory Processing problems can also lead to behaviours that look very much like Attention Deficit Hyperactivity Disorder (ADHD). A child who tries to listen in a classroom setting but who is not successful will quickly give up. Not being able to follow what the teacher is saying, the child may then be distractible and engage in “off-task” behaviours.

Caregivers (teachers, parents, and others) need to know to address the child with an APD directly (i.e., face to face). They need to ensure that the child has understood the intended message. The child should be asked to repeat what they were asked to do if there is any question about whether they understood. There are remedial programs available for Auditory Discrimination training that can be used with children. They are computer-based and relatively inexpensive.

It is important to distinguish between ADHD and APD because the treatment options are very different. As many people are aware, the symptoms of ADHD can often be improved or eliminated with a method such a Cogmed Working Memory Training. Stimulant medications such as methylphenidate may help as well. However, an APD is best treated with a combination of education and remediation. Of course, it is possible for a child to have both ADHD and APD and they may benefit from treatment for both.

There is an organization that can provide more information for parents, teachers, and health care providers: National Coalition on Auditory Processing Disorders. It can be accessed on the internet at: http://www.ncapd.org

Quitting Smoking

Thu, 16 Jul 2009 19:58:18 +0000

So, you want to quit smoking. Every smoker quits, eventually. In an old BC comic strip, one cave man asked the clerk at the Advice Rock, "What is the best way to quit smoking?" The answer: "Voluntarily."

There is much misunderstanding about smoking tobacco and how and why it is harmful. Most people understand that the main and most addictive ingredient in tobacco is nicotine. However, most people don’t know how it works or why it is so addictive.

According to medical sources, smoking is one of the major causes of preventable death. However, nicotine itself does not cause cancer. It is the ingredient that makes the smoking habit such a hard one to break. It keeps smokers inhaling the 100’s of toxic chemicals that make cigarette smoke so harmful.

Many people’s experience in quitting smoking is that they are only successful for a brief time and then they go back to their old habit. In fact, they often smoke more after they go back to it than before they quit. One of the important research findings about nicotine is that the smoker’s tolerance level for nicotine never goes down. When people start smoking (once they get past the throwing up and other symptoms of adjusting to taking in a poison) they find that they need to smoke more and more over time to get the same effect. People often end up smoking a pack or two packs (20 to 50 cigarettes) a day. However, the tolerance level does not change and even 25 years after they quit, a former smoker will feel compelled to smoke as much as they did when they quit, if they start again.

Nicotine is addictive because it mimics one of the main chemicals in our brains. Our brain communicates by using chemicals (called neurotransmitters) to send signals from one brain cell to the next. The neurotransmitter fits into receptor sites on the second cell and one of the more common receptor sites are called nicotinic receptors. When nicotine is ingested it fills up these receptor sites and our brains produce less acetycholine, the neurotransmitter that usually goes there. Part of the acute withdrawal pains that occur when we stop smoking are caused by the absence of both acetycholine and nicotine. It takes about three days for our brains to start producing sufficient acetycholine again. This is why the first three days are the hardest for smokers trying to quit and the withdrawal pains are most severe.

Another reason that quitting smoking is so difficult is that there is more than one habit that must be broken or replaced. There is: a) the physical addiction to nicotine, b) the psychological addiction to smoking as a stress relief tool, c) the social aspects, and d) the numerous environmental cues that smokers associate with the habit.

The physical addiction is at the same time the simplest and the most difficult aspect of quitting smoking. One simply needs to stop smoking for a period of time and the physical cravings will stop. However, cigarettes are a nefarious and efficient delivery system for nicotine. Nicotine is one of a few substances that cross the blood-brain barrier almost instantly. The smoke gets the nicotine into the lungs and then into the blood stream. Then, it is pumped almost directly into the brain. Although the physical addiction is strong, it can be effectively managed with a nicotine replacement product such as the patch.

Smokers frequently tell themselves and others that they need a cigarette to calm down because they are stressed. Smokers typically are more relaxed after going out for a cigarette. However, it is more likely that they relax because they take a break from what they were doing and are outside in the fresh air, breathing deeply – that part is a standard relaxation skill taught by most psychologists. But, nicotine is a stimulant. Having a cigarette to calm down is like having a cup of coffee to help you sleep.

Relationships based on smoking tend to be rather shallow. Most smokers respect those who want to quit and they will not smoke around the person quitting. Also, the longer a person stays away from smoking the more they will be repelled by the smell of rooms inhabited by smokers. In fact, being exposed to second hand smoke can create cravings in a former smoker, even 10 years after they have quit. If your still-smoking-friends don’t respect your need to have a non-smoking environment, they probably don’t have your best interests at heart. You should also note that second-hand smoke can cause cancer and heart disease as well as asthma and the recurrence of ear infections in children.

Finally, almost anything can be associated with the need to light up and have another smoke. Walking out of an office building or a movie theatre are potent cues to many smokers; the first cup of coffee or a beer after work are other cues. One of the ways to counter all of those cues is to work at changing your view of yourself. Making up a list of the reasons that you want to be a non-smoker is a very good starting point. Reminding yourself of the items on the list at least once a day will help you change your mind.

Overall, nicotine is one of the most addictive substances to which we are exposed. Understanding this and developing a plan to manage the factors that make it addicting is a way to break that habit. The issues addressed in this brief article can apply to almost any behaviour you want to change. Identify the factors that create the urge, understand how it really works and what you need to do to change it, seek support from family and friends (if you must, find new friends), and work at changing your self-image from smoker to non-smoker. While it may be difficult, you owe it to yourself and your family to be successful.

Victims of Suicide

Thu, 16 Jul 2009 19:57:35 +0000

When we hear about a death by suicide, our first thoughts are often about the person who died. We try to imagine why they killed themselves. Many people’s thoughts then turn to the other victims of suicide, the people left behind.

The most obvious victims are the family members, friends, and acquaintances of someone who has completed a suicide. Survivors are left to deal with the loss of a loved one. They may have very conflicting and conflicted feelings. Survivors may be sad at the loss of the person who died; they may be angry at the way he or she left; and/or they may feel guilt or remorse that they didn’t know how the person felt and couldn’t stop them. Survivors of suicide may need help to sort out all of their feelings. They might benefit from participation in either a survivors of suicide group or from professional therapy.

There can be other victims as well. A client of a colleague was injured physically and psychologically when he was involved in a head-on collision with someone who wanted to kill themselves by driving into another vehicle. It has been over four years since that accident but my colleague’s client is still affected by it.

One result is that he is in constant physical pain. This is a result of the injuries received in the accident. It has been exacerbated by the numerous surgeries that have attempted to fix the problem but have not done so. Any activity in which he engages causes an increase in pain. He finds himself sensitive to the weather and movement. So, cold days are bad. But, hot days can be bad too. He would like to go for a boat ride or participate in one of the sports he played prior to his injury but he can’t.

Typically, an increase in the intensity of his pain brings back memories of the accident. After some intense therapy, daily flashbacks and nightmares are no longer present. But being reminded of the accident is still disturbing.

There is an intense anger at the driver of the car who was attempting to kill himself. He is not comfortable with this feeling. He never had feelings like this before his accident.

He continues to have considerable anxiety about driving. He is very uncomfortable when anyone is near him on the road – either coming the other way, or behind him, or beside him. He is looking for the next vehicle that will do the unthinkable and drive into him. However, for him, this is no longer unthinkable.

He had to stop working for considerable periods of time because of the surgeries he has had and the various rehabilitation programs that he has taken. Consequently, he has suffered a considerable loss of income. He worries that he may lose his house and all that he has worked for over the years.

Ironically, one of the worst impacts for this client has been having his own thoughts of suicide. This was never an issue for him before. However, he often feels so overwhelmed by all that he now has to deal with that he finds himself thinking about suicide.

The primary message I hoped to convey in this short article is that suicide can have a profound effect on many people beyond the person who attempts to commit suicide. Sometimes, people feel that suicide may be a solution to their problems or pain but they forget that their suicide will affect a large number of other people. The survivors’ pain just begins when someone completes a suicide. Whatever is affecting someone can be solved; just reach out for help.

Psychological and Emotional Trauma

Thu, 16 Jul 2009 19:56:16 +0000

One of my favourite bumper stickers from the 1980’s stated that “One nuclear bomb can ruin your whole day.” Similarly, a major trauma can ruin much more than one day.

Psychological trauma affects many people. The formal definition of trauma and the type of experiences that are considered traumatic has changed over the years. The first definitions related to extreme experiences of soldiers on the battlefield. The condition has been called shellshock and battlefield psychosis among other things until the 1980’s when the name Posttraumatic Stress Disorder was first used. PTSD is the name that has come into common use.

The type of experiences that could create a traumatic response has been broadened to include: serious motor vehicle accidents, rape, physical assault, child sexual abuse, and witnessing a murder, among others. Most authorities agree that whether or not an incident is traumatic depends upon the reaction of the person who was affected. The same experience may be traumatic to one person and not another; it is even possible for something to be traumatic one time and not the next time for the same person.

An event may evoke a traumatic response when it overwhelms a person’s ability to cope. Usually the traumatic event was unexpected and it contained or implied the possibility of serious harm or death. Thus, a motor vehicle accident could create a traumatic response.

In assessing someone who has been affected by a traumatic incident, psychologists look for certain symptom patterns. These include the following:

Re-experiencing the trauma: A person may have frequent flashbacks to the event or nightmares about it. They may have a sudden flooding of emotions or even smells or other bodily sensations related to the traumatic event.
Emotional numbing and avoidance: Sometimes people forget an important part of a traumatic event or they may avoid people and situations that remind them of the event. They may experience depression, a sense of estrangement from people close to them, or an altered sense of time.
Increased arousal: Some people become jumpy or have an extreme sense of being "on guard." They may overreact emotionally to events such as having an extreme anger response. They may have difficulty sleeping.

As I implied above, exposure to trauma can have a long lasting impact on a person (and their family, friends, and coworkers as well). When a person is left on their own following a traumatic event they will often develop ways of coping with their reactions. While some coping responses are appropriate and effective, others are not. Remember that, by definition, something that is traumatic tends to overwhelm a person’s ability to cope effectively.

Some people develop problems with substance abuse. They may use alcohol or other drugs to numb or avoid their painful emotions. They may respond as if the rules of the world have changed and lose faith in previously held beliefs that helped them to cope. They may engage in self-destructive behaviour. They may feel permanently damaged.

Emotional and psychological trauma may result in a person’s inability to maintain close relationships or they may choose to associate with people who are not interested or able to help them recover. They may develop sexual problems. They may withdraw socially while at the same time have increased arguments with family members, employers, or co-workers.

It is important to remind you that different people are affected differently by events. Whether an event causes PTSD for any individual depends upon a number of factors. These include the person’s degree of control in the situation, their past history of exposure to trauma, the response of people close to them in the aftermath of the trauma, and the availability of appropriate coping responses.

It is even more important to state that being affected by a traumatic event, or even developing PTSD, is not a sign of personal weakness. Whether someone develops PTSD as a result of some event is similar to whether a person’s leg breaks in response to a physical trauma. Some pressures and forces will break bones; we would not think someone is bad because they have a broken leg. I believe it is important to think about psychological trauma in a similar way.

Subsequent articles in this series will provide information on treatments that we have found effective for the impact of experiencing a traumatic event.

Is Your Anxiety Something to Worry About?

Thu, 16 Jul 2009 19:53:08 +0000

What? Me worry?” That famous tag line from Alfred E. Neumann of Mad Magazine fame underlines our curious relationship with anxiety. On the one hand, we seem to think that we shouldn’t worry because that indicates we are not sure of ourselves. On the other hand, when we feel sure of ourselves, we worry that we’re missing something. Like many areas in life, it is important to find a balance in our anxiety.

What is anxiety anyway? Anxiety or worry is the feeling we get when we are faced with uncertainty. When we face a big challenge or find ourselves in an unfamiliar place, we may be anxious about what will happen. Notice that anxiety is the anticipation of a negative outcome. Anxiety may be accompanied by unpleasant physical sensations such as an increase in heart rate, sweaty palms or facial perspiration, or the feeling of butterflies in the stomach.

Anxiety is not always a bad thing, though. It makes us examine what and how we are doing. For example, if I worry about a presentation I plan to make, I am more likely to spend time preparing and rehearsing. That’s a good thing. So, if we can’t eliminate our anxiety, how can we manage it? Too much anxiety can affect our sleep, our eating, our social life, and our ability to concentrate. It can be debilitating.

How we respond to anxiety-provoking life events is affected by a number of factors. Each person has a characteristic way of responding to the world which tends to stay consistent – our temperament. Each person has their own history of dealing with anxiety-provoking events – our experience. Finally, each person has a circle of people who provide support or not when we need it – our social network.

Sometimes our anxiety may be mild. I might worry about whether it will be sunny and hot or just hot tomorrow for the picnic I’ve planned and worked hard to produce. At other times, our anxiety may be severe. If I have been in a motor vehicle accident, I may be highly anxious about driving and avoid even getting into a car.

Our brain reacts to our experience of anxiety and produces chemicals (i.e., hormones and other neurotransmitters) that may make the reaction even stronger. People affected by panic disorder can go quickly from having a small anxiety reaction to feeling as if they may die because they can’t breath or they feel their heart may stop. At other times, we only realize we are anxious because of the effect of a stress hormone, like that butterfly sensation.

People may experience traumatic events and have anxiety reactions that are triggered by things that remind them of the trauma. For example, someone who has been in a motor vehicle accident may have an anxiety reaction triggered by the sound of squealing tires. While most people would just be annoyed at the noise, someone with Posttraumatic Stress Disorder (an anxiety disorder) may experience a flashback where they feel that their motor vehicle accident is happening again.

Some people find themselves anxious in social settings. They are affected by social anxiety. Other people find themselves compelled to perform some ritual in order to calm down. They are affected by Obsessive-Compulsive Disorder (OCD) which may provoke strong feelings of anxiety (e.g., the danger of fire). Someone with OCD will cope with this by some ritualistic behaviour such as going back to check that all the elements on the stove are turned off five or more times, after they have already left the house. Again, turning off your stove to avoid a fire is a good thing; what makes this a disorder is the excessive checking that is unnecessary and does not increase safety.

Two of the words psychologists use in describing how people respond to stressful events are appraisal and coping. Appraisal is how we understand an event. Are we optimistic or pessimistic? Do we take events personally or feel they are random? How you understand something will determine how it affects you and how well you will be able to cope with it. Noticing our appraisal reactions and then looking for evidence to support them (or not) is a first step in managing our anxious reactions.

So, if you find yourself feeling anxious, don’t worry. If you can’t stop feeling anxious and you find yourself reacting strongly to what should be minor problems, it will help to talk to someone who can help. For some issues a good friend or your spouse may provide all the help you need. Sometimes, you may need to talk to a professional therapist. He or she will help you to reframe your understanding of events, to put things in perspective, and to reduce the impact of traumatic events with a cutting edge therapy method such as EMDR or Cognitive-Behavioural Therapy.

Eye Movements Alone Relieve Pain

Thu, 16 Jul 2009 19:51:40 +0000

Buffalo Springfield (I guess that dates me; they are a late sixties rock group) said it best in one of their songs, "Something’s happening here. What it is ain’t exactly clear . . . ."

EMDR has been a central part of my practice as a psychologist since the day after my Level 1 training. I feel quite confident in my ability to help clients resolve ("metabolize") traumatic memories and their cognitive sequelae. I’ve felt fairly confident about using Mark Grant’s Chronic Pain Protocol with modest success for clients with chronic pain. Until recently, I had never considered using only Eye Movements (EM’s) directly for pain.

It all started with a misunderstanding. Susan Rogers wrote to the EMDR Institute listserv with a case example and I read it but didn’t pay particular attention. Then, Dr. Rogers sent a follow-up message with a throw-away comment about a “one set” treatment for pain. Intrigued, I wrote to her directly for clarification and she described using EM's to reduce pain. Not a protocol, just EM's. I decided to check it out. This was at the beginning of March, 2003.

To the EMDR Institute listserv, I wrote, "I saw a client today (3rd session) who was recently diagnosed with Fibromyalgia. She had been in constant pain for at least 4 weeks. She has been in varying degrees of pain for about a year for other reasons.

"The constant pain was centred in her neck just below the skull and radiated into her head -- only on the right side. She has been in enough pain on several days that she has only been able to sit in a darkened room and cry. She described that as an 8 or 9 on a 0 to 10 scale of pain intensity (SUDS scale).

That is the highest it had been but she could imagine it going higher. In today's session, she reported that the pain intensity was at 6.

"After obtaining a rating, I asked her to focus on the pain and follow my fingers. After the first set, she reported a sensation like her face melted -- that is, the tension just dropped away. With each set of EM's after that the pain level dropped. As the pain level decreased to 2 out of 10, she was able to exert a greater range of motion than she had for weeks. I became emboldened. I hadn't had any particular expectations when I started. I felt maybe the pain intensity will go down a little, maybe it won’t. But, there was no harm in trying. Anyway, once it went down to a 2, I figured I better not stop until it went to 0.

"To make a short story even shorter, it did go to 0. I was left with a client sitting there amazed saying, "Wow, that's amazing," over and over. For the first time in 4 weeks she was totally pain free."

At the time of writing, it is now over two months since that session and the pain has not returned. The client reported that her husband asked her to thank me for giving him his wife back. She has been able to deal with other old stresses as well as present stresses more effectively and with less impact on her life. That is, she is more able to let things go now.

Since many of you may also subscribe to the EMDR Institute Listserv, the case above may not be news to you.

Recently, I have begun to use EM,s to help people with "bad" headaches relieve the pain. Two of the people I have used this with have been post-MVA clients. They have had headaches on a regular if not a daily basis for a considerable period.

Asking clients to rate the pain intensity, and then to “just notice that sensation and follow my fingers” has brought complete relief. In one case, the client was photosensitive as well. This had been very true after his MVA but continued and it was now 8 months later. When we started our session on a sunny morning (aren’t they all in Nanaimo), I needed to close the blinds in my office in order for him to be comfortable. By the end of our session, he was pain free and able to look outside without his sunglasses. This was a short session because of his schedule and we only had about 30 minutes in total.

There have been residual somatic sensations (i.e., pain) following the processing of some issues for other clients. Again, I have just asked them to focus on the feeling and follow my fingers. A few sets of EM’s have been sufficient to relieve the residual pain.

At the present time, I can only speculate about what is happening. The clients mentioned above have all been seen only a few times. So, it is unlikely that they would be expecting some miracle cure based on past success with EMDR. Prior to the session focused on their pain, they had between 0 and 2 sessions where I used the EMDR standard protocol.

As EMDR is purported to be an information processing therapy, it is most likely that the EM’s helped the brain to reprocess what is essentially dysfunctional and unneeded information. Headache in most cases, and especially chronic headache, is not a “good pain.” It may be that the Dual Attention Stimulation (i.e., the Eye Movements) is effectively metabolizing the unnecessary and ecologically invalid headache pain.

I'm still not sure what the active mechanism is regarding pain relief but, “Wow.” Dr. Rogers wrote in her email, "If you are impressed with what [EMDR] does for PTSD, wait till you see what it can do with pain."

I'm impressed.