Sunday 29 June
The brain has highly evolved functions which allow complex decision-making. It also has more primitive defence responses which are likely to be dominant at a time of intense threat – even if that threat is interpersonal or social rather than physical. The evolved functions are based in the neocortex; the more basic ones in the midbrain. It is likely that in PTSD there is a readiness for emotion or defence response generation from the midbrain – with very little conscious control. The resulting activation of the sympathetic nervous system maintains a high arousal, hypervigilant state which makes cortical processing difficult to achieve. The brain is reacting as if the threat is present and immediate. If a person is in a more relaxed state when working on the intrusive traumatic image it may be that the cortical functioning can be kept more on-line. The polyvagal theory of Porges suggested a way of allowing the client to reach a degree of relaxation capable of modifying the visceral feelings associated with the intense distress. The first component is activation of the social engagement system through the therapist’s presence. The second is to use a “parasympathetic” breathing pattern which down-regulates the arousal. Both reduce the high-adrenaline state characteristic of PTSD. The prefrontal cortex can then regulate the midbrain centres.
Revised Impact of Event Scale scores before and after treatment are presented to show the value of this modification of the standard protocol.
Fin Collins, RMN, BA, MPhil, had extensive experience in mental health nursing prior to his career as a university lecturer in psychology and mental health. He is the lead therapist with PETAL (people experiencing trauma and loss) an organisation for helping people who have been bereaved as a result of murder and suicide.
Frank Corrigan, MBChB, MD, FRCPsych, is a consultant psychiatrist currently working part-time in the NHS and in private practice. He trained in EMDR in 1999 and has been an accredited consultant since 2005.
Richardson, P; Williams SR; Hepenstall, S; Gregory, L., McKie, S., Corrigan, FM. (2009). A Single-Case fMRI Study: EMDR Treatment of a Patient With Posttraumatic Stress Disorder. Journal of EMDR Practice and Research, 3, 10-23.