S.A.D. or Depression: The result of impaired communication between brain cells.

Seasonal Affective Disorder (SAD) – Topic Overview

What is seasonal affective disorder (SAD)?

Seasonal affective disorder, or SAD, is a type of depression that affects a person during the same season each year. If you get depressed in the winter but feel much better in spring and summer, you may have SAD.

Anyone can get SAD, but it is more common in:

• People who live in areas where winter days are very short or there are big changes in the amount of daylight in different seasons.
• Women.
• People between the ages of 15 and 55. The risk of getting SAD for the first time goes down as you age.
• People who have a close relative with SAD.

What causes SAD?

Experts are not sure what causes SAD, but they think it may be caused by a lack of sunlight. Lack of light may upset your sleep-wake cycle and other circadian rhythms. And it may cause problems with a brain chemical called serotonin that affects mood.

What are the symptoms?

If you have SAD, you may:

• Feel sad, grumpy, moody, or anxious.
• Lose interest in your usual activities.
• Eat more and crave carbohydrates, such as bread and pasta.
• Gain weight.
• Sleep more and feel drowsy during the daytime.

Symptoms come and go at about the same time each year. For most people with SAD, symptoms start in September or October and end in April or May.

How is SAD diagnosed?

It can sometimes be hard to tell the difference between nonseasonal depression and SAD, because many of the symptoms are the same. To diagnose SAD, your health professional will want to know if:

• You have been depressed during the same season and have gotten better when the seasons changed for at least 2 years in a row.
• You have symptoms that often occur with SAD, such as being very hungry (especially craving carbohydrates), gaining weight, and sleeping more than usual.
• A close relative-a parent, brother, or sister-has had SAD.

How is it treated?

Doctors often prescribe light therapy to treat SAD. There are two types of light therapy:

• Bright light treatment. For this treatment, you sit in front of a “light box” for half an hour or longer, usually in the morning.
• Dawn simulation. For this treatment, a dim light goes on in the morning while you sleep, and it gets brighter over time, like a sunrise.

Light therapy works well for most people with SAD, and it is easy to use. You may start to feel better within a week or so after you start light therapy. But you need to stick with it and use it every day until the season changes. If you don’t, your depression could come back.

Other treatments that may help include:

• Antidepressants. These medicines can improve the balance of brain chemicals that affect mood.
• Counseling. Some types of counseling, such as cognitive-behavioral therapy, can help you learn more about SAD and how to manage your symptoms.

If you need help deciding if you are depressed and what you should do about it, then make an appointment for an initial consultation with me today.  Just click here to be redirected:  Riorancho-counseling.com  Appointments can be made in person or through skype/facetime.

Angela Zaffer, MA, NCC, LPC

What Happy People Do Differently

By Robert Biswas-Diener, Todd B. Kashdan,

The Real Rewards Of Risk: When anxiety is an optimal state

Truly happy people seem to have an intuitive grasp of the fact that sustained happiness is not just about doing things that you like. It also requires growth and adventuring beyond the boundaries of your comfort zone. Happy people, are, simply put, curious. In a 2007 study found that those who frequently felt curious on a given day also experienced the most satisfaction with their life—and engaged in the highest number of happiness-inducing activities, such as expressing gratitude to a colleague or volunteering to help others.

Curiosity, it seems, is largely about exploration—often at the price of momentary happiness. Curious people generally accept the notion that while being uncomfortable and vulnerable is not an easy path, it is the most direct route to becoming stronger and wiser. In fact, a closer look at the study by Kashdan and Steger suggests that curious people invest in activities that cause them discomfort as a springboard to higher psychological peaks.

Of course, there are plenty of instances in life where the best way to increase your satisfaction is to simply do what you know feels good, whether it’s putting your favorite song on the jukebox or making plans to see your best friend. But from time to time, it’s worth seeking out an experience that is novel, complicated, uncertain, or even upsetting—whether that means finally taking the leap and doing karaoke for the first time or hosting a screening of your college friend’s art-house film. The happiest people opt for both so that they can benefit, at various times, from each.

A Blind Eye To Life’s Vicissitudes:The benefit of seeing the forest but not the trees

A standard criticism of happy people is that they’re not realistic—they sail through life blissfully unaware of the world’s ills and problems. Satisfied people are less likely to be analytical and detail-oriented. A study led by University of New South Wales  found that dispositionally happy people—those who have a general leaning toward the positive—are less skeptical than others. They tend to be uncritically open toward strangers and thus can be particularly gullible to lies and deceit. Think of the happy granny who is overcharged at the car dealership by the smiling salesperson compared with more discerning, slightly less upbeat consumers.

Certainly having an eye for the finer points can be helpful when navigating the complicated social world of colleagues, acquaintances, and dates—and it’s something the less sunny among us bring to bear.  Depressed people are more likely than others to reflect on and process their experiences—and thereby gain insight into themselves or the human condition—albeit at an emotional price.

Yet too much attention to detail can interfere with basic day-to-day functioning, as evidenced by research from Queen’s University psychologist Kate Harkness, who found that people in a depressed mood were more likely to notice minute changes in facial expressions. Meanwhile, happy people tend to overlook such second-to-second alterations—a flash of annoyance, a sarcastic grin. You probably recognize this phenomenon from interactions you’ve had with your partner. While in a bad mood we tend to notice the tiniest shifts and often can’t seem to disengage from a fight (“I saw you roll your eyes at me! Why did you do that!?!”), whereas when we’re in a good mood, we tend to brush off tiny sleights (“You tease me, but I know you love being around me”). The happiest people have a natural emotional protection against getting sucked in by the intense gravitational pull of little details.

Similarly, the happiest people possess a devil-may-care attitude about performance. In a review of the research literature by Oishi and his colleagues, the happiest people—those who scored a 9 or 10 out of 10 on measures of life satisfaction—tended to perform less well than moderately happy people in accomplishments such as grades, class attendance, or work salaries. In short, they were less conscientious about their performance; to them, sacrificing some degree of achievement seems to be a small price to pay for not having to sweat the small stuff.

This is not to say that we should take a laissez-faire attitude to all our responsibilities; paying attention to detail is helpful. But too much focus on minutiae can be exhausting and paralyzing. The happiest among us (cheerfully) accept that striving for perfection—and a perfectly smooth interaction with everyone at all times—is a loser’s bet.

The Unjealous Friend: We’re buoyed by others’ good fortune

The happiest people are the ones who are present when things go right for others—and whose own wins are regularly celebrated by their friends as well.

Support for this idea comes from psychologist Shelly Gable, of the University of California, Santa Barbara, and her colleagues, whose research revealed that when romantic partners fail to make a big deal out of each other’s success, the couple is more likely to break up. On the flipside, when partners celebrate each other’s accomplishments, they’re more likely to be satisfied and committed to their relationship, enjoying greater love and happiness.

The process of discussing a positive experience with a responsive listener actually changes the memory of the event—so after telling you about it, your friend will remember that night with the model as even more positive than it was, and the encounter will be easier for him to recall a few years down the line when he’s been dumped. But equally important, you’ll get to “piggyback” on your friend’s positivity. Just as we feel happier when we spend money on gifts or charitable contributions rather than on ourselves, we feel happier after spending valuable time listening to the accomplishments of friends.

In life, it seems, there are an abundance of Florence Nightingales waiting to show their heroism. What’s precious and scarce are those people who can truly share in others’ joy and gains without envy. So while it might be kind to send flowers to your friend when she’s in the hospital for surgery, you’ll both derive more satisfaction out of the bouquet you send her when she finishes medical school or gets engaged.

A Time For Every Feeling: The upside of negative emotions

The most psychologically healthy people might inherently grasp the importance of letting some things roll off their backs, yet that doesn’t mean that they deny their own feelings or routinely sweep problems under the rug. Rather, they have an innate understanding that emotions serve as feedback—an internal radar system providing information about what’s happening (and about to happen) in our social world.

Happy, flourishing people don’t hide from negative emotions. They acknowledge that life is full of disappointments and confront them head on, often using feelings of anger effectively to stick up for themselves or those of guilt as motivation to change their own behavior. This nimble mental shifting between pleasure and pain, the ability to modify behavior to match a situation’s demands, is known as psychological flexibility.

For example, instead of letting quietly simmering jealousy over your girlfriend’s new buddy erode your satisfaction with your relationship, accept your feelings as a signal, which allows you to employ other strategies of reacting that are likely to offer greater dividends. These include compassion (recognizing that your girlfriend has unmet needs to be validated) and mindful listening (being curious about what interests her).

The ability to shift mental states as circumstances demand turns out to be a fundamental aspect of well-being. Columbia University psychologist George Bonanno found, for instance, that in the aftermath of 9/11, the most flexible people living in New York City during the attacks—those who were angry at times but could also conceal their emotions when necessary—bounced back more quickly and enjoyed greater psychological and physical health than their less adaptable counterparts.

Opportunities for flexible responding are everywhere: A newlywed who has just learned that she is infertile may hide her sense of hopelessness from her mother but come clean to her best friend; people who have experienced a trauma might express their anger around others who share similar sentiments but conceal it from friends who abide by an attitude of forgiveness. The ability to tolerate the discomfort that comes from switching mind-sets depending on whom we’re with and what we’re doing allows us to get optimal results in every situation.

Similar to training for a triathlon, learning the skill of emotional discomfort is a task best taken on in increasing increments. For example, instead of immediately distracting yourself with an episode of The Walking Dead or pouring yourself a whiskey the next time you have a heated disagreement with your teenage son, try simply tolerating the emotion for a few minutes. Over time, your ability to withstand day-to-day negative emotions will expand.

The Well-Being Balancing Act

Pleasure and purpose work together

Even the most ardent strivers will agree that a life of purpose that is devoid of pleasures is, frankly, no fun. Happy people know that allowing yourself to enjoy easy momentary indulgences that are personally rewarding—taking a long, leisurely bath, vegging out with your daughter’s copy of The Hunger Games, or occasionally skipping your Saturday workout in favor of catching the soccer match on TV—is a crucial aspect of living a satisfying life. Still, if you’re primarily focused on activities that feel good in the moment, you may miss out on the benefits of developing a clear purpose. Purpose is what drives us to take risks and make changes—even in the face of hardship and when sacrificing short-term happiness.

Working to uncover how happy people balance pleasure and purpose, Colorado State’s Steger and his colleagues have shown that the act of trying to comprehend and navigate our world generally causes us to deviate from happiness. After all, this mission is fraught with tension, uncertainty, complexity, short bursts of intrigue and excitement, and conflicts between the desire to feel good and the desire to make progress toward what we care about most. Yet overall, people who are the happiest tend to be superior at sacrificing short-term pleasures when there is a good opportunity to make progress toward what they aspire to become in life.

If you want to envision a happy person’s stance, imagine one foot rooted in the present with mindful appreciation of what one has—and the other foot reaching toward the future for yet-to-be-uncovered sources of meaning. Indeed, research by neuroscientist Richard Davidson of the University of Wisconsin at Madison has revealed that making advances toward achievement of our goals not only causes us to feel more engaged, it actually helps us tolerate any negative feelings that arise during the journey.

Nobody would pretend that finding purpose is easy or that it can be done in a simple exercise, but thinking about which activities you found most rewarding and meaningful in the past week, what you’re good at and often recognized for, what experiences you’d be unwilling to give up, and which ones you crave more time for can help. Also, notice whether your answers reflect something you feel that you ought to say as opposed to what you truly love. For example, being a parent doesn’t necessarily mean that spending time with your children is the most energizing, meaningful part of your life—and it’s important to accept that. Lying to yourself is one of the biggest barriers to creating purpose. The happiest people have a knack for being honest about what does and does not energize them—and in addition to building in time for sensory pleasures each day, they are able to integrate the activities they most care about into a life of purpose and satisfaction.

There’s More To Life Than Being Happy

Critics argue that the pursuit of happiness is a misguided goal—it’s fleeting, superficial, and hedonistic.

Research backs up some of these claims. People actually pay an emotional price for intensely positive events because later ones—even moderately pleasant ones—seem less shiny by contrast. (Sure, getting a raise feels terrific, but it might mean you fail to fully appreciate your son’s performance in the school play that afternoon.)

Perhaps more damning is a series of studies led by University of California, which revealed that people who place a premium on being happy report feeling more lonely. Yes, being happy might be healthy—but craving happiness is a slippery slope.

A well-lived life is more than just one in which you feel “up.” The good life is best construed as a matrix that includes happiness, occasional sadness, a sense of purpose, playfulness, and psychological flexibility, as well autonomy, mastery, and belonging.

While some people will rank high in happiness and social belonging, others will find they’ve attained a sense of mastery and achievement. This approach appreciates that not only do people differ in their happiness matrices—but they can shift in their own respective matrices from moment to moment.

By Robert Biswas-Diener, Todd B. Kashdan, published on July 02, 2013 – last reviewed on July 08, 2013

For the entire article go to PsychologyToday.com

Re-posted by Angela Zaffer:  Riorancho-counseling.com

The Queen B: Folate/ B vitamin tied in multiple ways to brain function. Impaired intake is linked to severe mental disorders, including Autism, Schizophreinia and Bi-polar Disorder.

The Queen B:  Folate is a B vitamin tied in multiple ways to brain function. Impaired intake is linked to severe mental disorders, including autism.

By Melinda Wenner Moyer, published on July 02, 2013 – last reviewed on September 02, 2013 Psychology Today

What, exactly, does folate do? “Believe it or not, we still don’t fully know why and how it works,” says Rebecca Schmidt, a public health scientist who studies folate at the University of California at Davis. One of the vitamin’s most important jobs is orchestrating the way DNA is read. Folate delivers molecular tags known as methyl groups to genes, thereby regulating the amount of protein the body makes from them. “What makes your ear your ear and your nose your nose—even though they have the exact same genetic code—is DNA methylation,” Schmidt explains.

Scientists are still working to solve many of folate’s molecular mysteries, but here are some insights gleaned from recent studies.

Stamp of Starvation

If nutrient deficiency in utero affects the way DNA is methylated, then people conceived during the Dutch Hunger Winter should have abnormal DNA methylation patterns even as adults. Studying 60 people who were conceived during the Hunger Winter and 60 of their same-sex siblings who were not, researchers analyzed methylation patterns of an oft-methylated gene, insulin-like growth factor 2 (IGF2), which regulates growth. Methylation of the gene indeed averaged 5.2 percent lower among those conceived during the famine.

Minding Methylation

Do people suffering from mental illness have DNA methylation abnormalities? UK and Danish researchers compared DNA methylation patterns in 22 sets of identical twins, one of whom had schizophrenia or bipolar disorder. They found significant differences between the healthy twins and those with mental problems. Affected sibs had lower methylation levels in certain genetic regions than healthy sibs. Since folate abets methylation, the findings suggest that prenatal folate deficiency may affect brain development by impairing gene regulation.

Autism Protection

Over 85,000 Norwegian women who took folic acid supplements from four weeks before conception through the first eight weeks of pregnancy were 40 percent less likely to have autistic children than mothers not taking folate. A U.S. study finds that the autism link is strongest among mothers or babies who have common variations in genes that impair folate metabolism. It may be extra important for the nearly 50 percent of women said to have genetic variations in folate metabolism to consume adequate amounts of the vitamin during pregnancy.

Brain Boost-Autism and increased Folate 

Autism has been tied to low prenatal folate exposure, but it also may result from the presence of antibodies that keep folate from doing its job. U.S. researchers recently analyzed the blood of 93 autistic children and found that three-quarters of them had antibodies in their blood blocking folate from crossing the blood-brain barrier and entering brain cells. When the researchers treated the children with a chemical form of folate that the so-called “auto-antibodies” spare, folate could enter the brain cells and autism symptoms diminished.

Depression Cure

Depressed adults often have low folate blood levels. But is folate deficiency causing their symptoms? A group of depressed adults who were not responding to treatment with a selective serotonin reuptake inhibitor (SSRI) were additionally given 15 mg a day of L-methylfolate, an active form of the nutrient. A similar group was given a placebo. Those who took the folate were more than twice as likely to report improvements in symptoms. Researchers speculate that folate alleviates depression by boosting a chemical precursor of serotonin and dopamine.

Appetite Link

Rodents exposed to low levels of folate in the womb are more likely to become obese later in life. For yet-unknown reasons, the folate-deficient animals consume more fat. The low-folate, high-fat mix does a double whammy on animals’ brains. It lowers levels of DNA-repair enzymes. Folate-deficient rats also suffer more oxidative damage to the brain, which can destroy tissue and set the stage for DNA mutations. The findings suggest that a low-folate diet predisposes animals to poor dietary decisions that ultimately put their brains at multiple risk.

Getting Your Folate Fix

In addition to its contribution to brain function, folate acts as an antioxidant, helping the body eliminate the dangerous byproducts of metabolism known as free radicals, which damage body tissues and degrade DNA, setting the stage for new mutations and disease. The vitamin also helps to synthesize DNA and repair genetic damage, which could reverse disease-causing mutations that arise in the womb.

Adults should aim to consume 400 micrograms of folate every day, but pregnant or breastfeeding women should consume slightly more (600 micrograms and 500 micrograms daily, respectively). So where, exactly, can you get your folate fix?

Dark leafy greens like spinach, collard and turnip greens, brussels sprouts and broccoli are rich with the vitamin—spinach contains a whopping 263 micrograms of folate per cup and asparagus is close behind—because the vitamin is essential for plants’ growth and metabolism, just as it’s important for our own. (But unlike humans, plants can make their own folate.) There’s good reason to eat a folate-rich diet even if you’re not pregnant: Some research suggests that the vitamin reduces cancer risk by facilitating DNA repair.

Beans—garbanzo, black-eyed, pinto, black, and navy—are also packed with folate; beans are plant seeds, where nutrients tend to be concentrated. Doctors frequently recommend beans as a way to boost heart health, and folate could have something to do with their benefits: A 2012 meta-analysis of 14 studies found that for every 200 extra micrograms of folate consumed per day—a cup’s worth of cooked beans—a person’s risk of developing heart disease drops by 12 percent.

On the sweeter side, some fruits—specifically, oranges, papayas, bananas, and cantaloupes—also contain moderate amounts of folate. When European researchers compared the blood levels of folate in more than 5,500 adults with what they ate, they found that those who consumed the most fruit had folate levels twice as high as those who consumed the least.

Since 1996, flour and grains have been fortified with folate. Bran flakes typically provide more than 600 micrograms per cup. Long-grain white rice delivers 716 micrograms per cup.

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People like me don’t cry; we just carry on. Don’t be ashamed of not being happy.

This is a partial article that I found fascinating.  Follow this link if you would like to read the full article.

…I didn’t feel as though I could complain – People like me don’t cry: we cover our emotions and carry on.On the surface things looked fine, but I was ignoring a rising panic within….

Mellody House, in Arizona…..A new generation of psychological therapies [are] being pioneered… I learned that conditions we have traditionally called “mental health” problems, such as anxiety and depression, are now beginning to be understood differently.

Increasingly, they are seen as being rooted in the neurobiology of our nervous systems, and in this respect all mammals are almost identical. When faced with stress, the body does what it needs to respond and ensure survival. However, when there is no chance to allow stressful experiences to resolve themselves naturally, many of us are unable to turn off our “neuroception” of threat long after the threat itself has been survived. This means we get stuck in a frozen state that our system struggles to resolve, resulting in a biological meltdown (aka “trauma”).

Outwardly, this can manifest itself as many symptoms including anxiety (when the system overreacts to perceived threat); depression (when it under reacts); OCD (obsessive compulsive disorder); ADHD (attention deficit hyperactivity disorder); and “medically unexplained symptoms”. These almost always arise from a failure of the nervous system to regulate itself.

Many people unknowingly make things worse by medicating the symptoms with drugs and alcohol as they try to bring themselves back to a balanced “normal”.

At the Arizona center..[treatment involves] ..working with the body from the “bottom up” (upwards through the brainstem) rather than from the “mind down”, and…so‑called mental health problems [are] restored by a new generation of therapies, such as sensorimotor psychotherapy, somatic experiencing and EMDR (eye movement desensitisation and reprocessing).

The difference between these and other therapies is that the therapist tries to engage with the mammal part of the brain and biology, not the human thinking or “mind”. The instruction to patients is often to engage with “sensation” rather than “thought” and in doing so the therapists are helping us to resolve problems in our mammalian brain rather than in the human neocortex. This is radically new because it puts the primal, animal instinct before the brilliant, overdeveloped human in the chain of solving this particular problem. And it works.

Anxiety; depression; bipolar: in my clinic we no longer think solely in terms of these recognised conditions. We think of “incomplete stress cycles”. Our patients are overwhelmed, responding to life as if it is a constant threat, and they cannot cope.

*How I F—– Up My Life and Made It Mean Something by Benjamin Fry is published this month. See khironhouse.com; getstable.org for more information

 

 

When the body heals the mind: Two alternative methods address PTSD symptoms.

When the body heals the mind: Two alternative methods address PTSD symptoms..

When Should I see an EMDR Certified therapist for Counseling?

What kind of problems can EMDR treat?

Scientific research has established EMDR as effective for post traumatic stress.  However, clinicians also have reported success using EMDR in treatment of the following conditions:

• Panic attacks
• Complicated grief
• Dissociative disorders
• Disturbing memories
• Phobias
• Pain disorders
• Performance anxiety
• Stress reduction
• Addictions
• Sexual and/or Physical abuse
• Body dysmorphic disorders
• Personality Disorders

EMDR

What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) is an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches. To date, EMDR therapy has helped millions of people of all ages relieve many types of psychological stress.

How does EMDR work?

No one knows how any form of psychotherapy works neurobiologically or in the brain. However, we do know that when a person is very upset, their brain cannot process information as it does ordinarily. One moment becomes “frozen in time,” and remembering a trauma may feel as bad as going through it the first time because the images, sounds, smells, and feelings haven’t changed. Such memories have a lasting negative effect that interferes with the way a person sees the world and the way they relate to other people.

EMDR seems to have a direct effect on the way that the brain processes information. Normal information processing is resumed, so following a successful EMDR session, a person no longer relives the images, sounds, and feelings when the event is brought to mind. You still remember what happened, but it is less upsetting. Many types of therapy have similar goals. However, EMDR appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. Therefore, EMDR can be thought of as a physiologically based therapy that helps a person see disturbing material in a new and less distressing way.

Does EMDR really work?

Approximately 20 controlled studies have investigated the effects of EMDR. These studies have consistently found that EMDR effectively decreases/eliminates the symptoms of post traumatic stress for the majority of clients. Clients often report improvement in other associated symptoms such as anxiety. The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for post traumatic stress. EMDR was also found effective by the U.S. Department of Veterans Affairs and Department of Defense, the United Kingdom Department of Health, the Israeli National Council for Mental Health, and many other international health and governmental agencies. Research has also shown that EMDR can be an efficient and rapid treatment.

How long does EMDR take?

One or more sessions are required for the therapist to understand the nature of the problem and to decide whether EMDR is an appropriate treatment. The therapist will also discuss EMDR more fully and provide an opportunity to answer questions about the method. Once therapist and client have agreed that EMDR is appropriate for a specific problem, the actual EMDR therapy may begin.

A typical EMDR session lasts from 60 to 90 minutes. The type of problem, life circumstances, and the amount of previous trauma will determine how many treatment sessions are necessary. EMDR may be used within a standard “talking” therapy, as an adjunctive therapy with a separate therapist, or as a treatment all by itself.

What is the actual EMDR session like?

Eye Movement Desensitization and Reprocessing (EMDR) is an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches. To date, EMDR therapy has helped millions of people of all ages relieve many types of psychological stress. Below is a Brief Description of EMDR Therapy.

8 Phases of Treatment

The amount of time the complete treatment will take depends upon the history of the client. Complete treatment of the targets involves a three pronged protocol (1-past memories, 2-present disturbance, 3-future actions), and are needed to alleviate the symptoms and address the complete clinical picture. The goal of EMDR therapy is to process completely the experiences that are causing problems, and to include new ones that are needed for full health. “Processing” does not mean talking about it. “Processing” means setting up a learning state that will allow experiences that are causing problems to be “digested” and stored appropriately in your brain. That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded. Negative emotions, feelings and behaviors are generally caused by unresolved earlier experiences that are pushing you in the wrong directions. The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.

Phase 1: History and Treatment Planning

Generally takes 1-2 sessions at the beginning of therapy, and can continue throughout the therapy, especially if new problems are revealed. In the first phase of EMDR treatment, the therapist takes a thorough history of the client and develops a treatment plan. This phase will include a discussion of the specific problem that has brought him into therapy, his behaviors stemming from that problem, and his symptoms. With this information, the therapist will develop a treatment plan that defines the specific targets on which to use EMDR. These targets include the event(s) from the past that created the problem, the present situations that cause distress, and the key skills or behaviors the client needs to learn for his future well-being. One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of his disturbing memories in detail. So while some individuals are comfortable, and even prefer, giving specifics, other people may present more of a general picture or outline. When the therapist asks, for example, “What event do you remember that made you feel worthless and useless?” the person may say, “It was something my brother did to me.” That is all the information the therapist needs to identify and target the event with EMDR.

Phase 2: Preparation

For most clients this will take only 1-4 sessions. For others, with a very traumatized background, or with certain diagnoses, a longer time may be necessary. Basically, your clinician will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you are generally able to proceed to the next phase. One of the primary goals of the preparation phase is to establish a relationship of trust between the client and the therapist. While the person does not have to go into great detail about his disturbing memories, if the EMDR client does not trust his clinician, he may not accurately report what he feels and what changes he is (or isn’t) experiencing during the eye movements. If he just wants to please the clinician and says he feels better when he doesn’t, no therapy in the world will resolve his trauma. In any form of therapy it is best to look at the clinician as a facilitator, or guide, who needs to hear of any hurt, need, or disappointments in order to help achieve the common goal. EMDR is a great deal more than just eye movements, and the clinician needs to know when to employ any of the needed procedures to keep the processing going. During the Preparation Phase, the clinician will explain the theory of EMDR, how it is done, and what the person can expect during and after treatment. Finally, the clinician will teach the client a variety of relaxation techniques for calming himself in the face of any emotional disturbance that may arise during or after a session. Learning these tools is an important aid for anyone. The happiest people on the planet have ways of relaxing themselves and decompressing from life’s inevitable, and often unsuspected, stress. One goal of EMDR therapy is to make sure that the client can take care of himself.

Phase 3: Assessment

Used to access each target in a controlled and standardized way so it can be effectively processed. Processing does not mean talking about it. See the Reprocessing sections below. The clinician identifies the aspects of the target to be processed. The first step is for the person to select a specific picture or scene from the target event (which was identified during Phase One) that best represents the memory. Then he chooses a statement that expresses a negative self-belief associated with the event. Even if he intellectually knows that the statement is false, it is important that he focus on it. These negative beliefs are actually verbalizations of the disturbing emotions that still exist. Common negative cognitions include statements such as “I am helpless,” ” I am worthless,” ” I am unlovable,” ” I am dirty,” ” I am bad,” etc. The client then picks a positive self-statement that he would rather believe. This statement should incorporate an internal sense of control such as “I am worthwhile/ lovable/ a good person/ in control” or “I can succeed.” Sometimes, when the primary emotion is fear, such as in the aftermath of a natural disaster, the negative cognition can be, “I am in danger” and the positive cognition can be, “I am safe now.” “I am in danger” can be considered a negative cognition, because the fear is inappropriate — it is locked in the nervous system, but the danger is actually past. The positive cognition should reflect what is actually appropriate in the present. At this point, the therapist will ask the person to estimate how true he feels his positive belief is using the 1-to-7 Validity of Cognition (VOC) scale. “1” equals “completely false,” and ” 7″ equals “completely true.” It is important to give a score that reflects how the person “feels,” not ” thinks.” We may logically ” know” that something is wrong, but we are most driven by how it ” feels.” Also, during the Assessment Phase, the person identifies the negative emotions (fear, anger) and physical sensations (tightness in the stomach, cold hands) he associates with the target. The client also rates the disturbance using the 0 (no disturbance)-to-10 (the worst feeling you? ve ever had) Subjective Units of Disturbance (SUD) scale. Reprocessing For a single trauma reprocessing is generally accomplished within 3 sessions. If it takes longer, you should see some improvement within that amount of time. Phases One through Three lay the groundwork for the comprehensive treatment and reprocessing of the specific targeted events. Although the eye movements (or taps, or tones) are used during the following three phases, they are only one component of a complex therapy. The use of the step-by-step eight-phase approach allows the experienced, trained EMDR clinician to maximize the treatment effects for the client in a logical and standardized fashion. It also allows both the client and the clinician to monitor the progress during every treatment session.

Phase 4: Desensitization

This phase focuses on the client’s disturbing emotions and sensations as they are measured by the SUDs rating. This phase deals with all of the person’s responses (including other memories, insights and associations that may arise) as the targeted event changes and its disturbing elements are resolved. This phase gives the opportunity to identify and resolve similar events that may have occurred and are associated with the target. That way, a client can actually surpass her initial goals and heal beyond her expectations. During desensitization, the therapist leads the person in sets of eye movement (or other forms of stimulation) with appropriate shifts and changes of focus until his SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). Starting with the main target, the different associations to the memory are followed. For instance, a person may start with a horrific event and soon have other associations to it. The clinician will guide the client to a complete resolution of the target. Examples of sessions and a three-session transcript of a complete treatment can be found in F. Shapiro & M.S. Forrest (2004) EMDR. New York: BasicBooks. http://www.perseusbooksgroup.com/perseus-cgi-bin/display/0-465-04301-1

Phase 5: Installation

The goal is to concentrate on and increase the strength of the positive belief that the person has identified to replace his original negative belief. For example, the client might begin with a mental image of being beaten up by his father and a negative belief of “I am powerless.” During the Desensitization Phase he will have reprocessed the terror of that childhood event and fully realized that as an adult he now has strength and choices he didn’t have when he was young. During this fifth phase of treatment, his positive cognition, “I am now in control,” will be strengthened and installed. How deeply the person believes his positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal is for the person to accept the full truth of his positive self-statement at a level of 7 (completely true). Fortunately, just as EMDR cannot make anyone shed appropriate negative feelings, it cannot make the person believe anything positive that is not appropriate either. So if the person is aware that he actually needs to learn some new skill, such as self-defense training, in order to be truly in control of the situation, the validity of his positive belief will rise only to the corresponding level, such as a 5 or 6 on the VOC scale.

Phase 6: Body scan

After the positive cognition has been strengthened and installed, the therapist will ask the person to bring the original target event to mind and see if he notices any residual tension in his body. If so, these physical sensations are then targeted for reprocessing. Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in motoric (or body systems) memory, rather than narrative memory, and retains the negative emotions and physical sensations of the original event. When that information is processed, however, it can then move to narrative (or verbalizable) memory and the body sensations and negative feelings associated with it disappear. Therefore, an EMDR session is not considered successful until the client can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.

Phase 7: Closure

Ends every treatment session The Closure ensures that the person leaves at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the person in using a variety of self-calming techniques in order to regain a sense of equilibrium. Throughout the EMDR session, the client has been in control (for instance, he is instructed that it is okay to raise his hand in the “stop” gesture at anytime) and it is important that the client continue to feel in control outside the therapist’s office. He is also briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and which techniques he might use on his own to help him feel more calm.

Phase 8: Reevaluation

Opens every new session At the beginning of subsequent sessions, the therapist checks to make sure that the positive results (low SUDs, high VOC, no body tension) have been maintained, identifies any new areas that need treatment, and continues reprocessing the additional targets. The Reevaluation Phase guides the clinician through the treatment plans that are needed in order to deal with the client’s problems. As with any form of good therapy, the Reevaluation Phase is vital in order to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment, as it is to complete an entire course of treatment with antibiotics.

Past, Present and Future

Although EMDR may produce results more rapidly than previous forms of therapy, speed is not the issue and it is important to remember that every client has different needs. For instance, one client may take weeks to establish sufficient feelings of trust (Phase Two), while another may proceed quickly through the first six phases of treatment only to reveal, then, something even more important that needs treatment. Also, treatment is not complete until EMDR therapy has focused on the past memories that are contributing to the problem, the present situations that are disturbing, and what skills the client may need for the future. Excerpts from: F. Shapiro & M.S. Forrest (2004) EMDR: The Breakthrough Therapy for Anxiety, Stress and Trauma. New York: BasicBooks. http://www.perseusbooksgroup.com/perseus-cgi-bin/display/0-465-04301-1

For another description, see Therapy Advisor funded by NIMH. This website promotes scientifically based psychotherapy: http://www.therapyadvisor.com/LocalContent/adult/consumer-shapiro-EMDR-PTSD.PDF.

Angela Zaffer Web Site

Quote: Be the change

“Be the change that you wish to see in the world.”
― Mahatma Gandhi

Creative and Expressive Therapy

There are many types of Creative or Expressive Therapy that a therapist can use.  Expressive therapy, also known  creative arts therapy, is the use of the creative arts as a form of therapy. Unlike traditional art expression, the process of creation is emphasized rather than the final product. Expressive therapy is predicated on the assumption that people can heal through use of imagination and the various forms of creative expression (http://en.wikipedia.org/wiki/Expressive_therapy).

There are a few Creative Therapy activities that I like to use with new children and teenagers that help us to get to know each other better.  The one below can also be used for assessment and treatment planning.  The activity below can also be done with adults and with group therapy.  When using creative art therapy, always provide different types of mediums: pens, pencils,  colored markers, colored pencils, crayons, colored paper and white paper.

The Star:

Materials: colored paper, colored pencils, colored markers.

Draw a big star in the middle of a piece of paper, big enough to almost fill up the page.  Inside the star, write words that describe your strengths and the good parts of your personality, words that describe to someone who you are: Funny, Rare, Dreamer, Wild, Incandescent, Smart, Blessed, etc.  (You may need to provide a list of words for the person to refer to).  On the outside of the Star, write the things you would like to change about your personality:  Outgoing, Confident, Truthful, etc.  This helps the therapist discover how the person views themselves and what strengths they would like to have.

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