Webinar presenter Duane Bowers answered a number of your questions after his presentation, Managing Trauma Triggers. Here are just a few of his responses.
Audience Question: So, we had a number of people that were asking about EMDR, which stands for Eye Movement Desensitization and Reprocessing. Can you kind of talk about how that helps with memories of trauma and PTSD?
Duane Bowers: Yes. So, if we understand the brain, the way the information is processed in the brain as it actually is processed across the corpus callosum that fishhook thing that I showed you. It processes both hemispheres of the brain back and forth, back and forth until it can be filed away until it finds the places where each thing needs to be filed away. And that’s a very rudimentary kind of description. But what happens, like I said, in a traumatic response, very often is we get frozen in the right brain so, we don’t process across. Or the event is so intense, that we can’t file it away, and so it stays in the process. One of the things that EMDR does, and the eye movement is very much I know you can’t see me. But if you were to hold your index finger up in front of your nose, and you look at it, and then move it back and forth, so that your eyes follow it, that’s kind of the movement of EMDR. And what that does, it’s bilateral. And so, when you shift the eyes to the left, it actually activates the right brain. When you shift the finger to the right, it activates the left brain. So, it actually helps your brain to process across the corpus callosum. It’s a very complex process. In other words, do not have someone do it who has not been certified. And certification in EMDR takes a long time. I mean, it’s a year’s process. They have to practice for a year. Train for a year. It’s a long process. So, you really want to have someone who knows what they’re doing with EMDR. But it is bilateral processing and I talk about that when I talk about interventions for trauma. When you use your body bilaterally, it helps your brain to process running, spinning, and walking, those kinds of things help your brain to actually process better. EMDR is a very intense way of getting the brain to process across the corpus callosum into the right brain-left brain, back and forth. And so, it really helps to process those things that have not yet been processed in the trauma or in the traumatic event.
Audience Question: What is your suggestion when you’re dealing with someone that is in the middle of a trigger, you’ve just met them, and you don’t have the rapport with them to try some of the options that you suggested?
Duane Bowers: I think, well, you have to understand me. But I would actually start doing that. I would actually start suggesting that. I would say, “I’ll tell you what. Why don’t you breathe with me? Let’s breathe together, inhale with me, exhale with me. Now, watch me, watch me,” and see by saying that by telling them to watch me, I’m having them come back from the event. Watch me and breathe with me and as they start to reconnect, as they start to come back out of that, then doing the other things, like maybe play Patty Cake with them, maybe do some physical activity to help them ground into the present moment and get them out, of wherever that response has taken them. But I think the first thing is to get them to focus. The very first thing that we get them to focus on is something and if I’m there, I’m going to have them focus on me. “Look at me. Focus on me. Watch me, breathe with me,” and start in that kind of way. I think the first step is absolutely to bring them back into the present moment. And if I’m there and able to talk to them, then use me as the focus.
Audience Question: How are the terms, PTSD, and trauma-related to each other? Can we use them interchangeably?
Duane Bowers: That’s a really good question, Isn’t it. Actually, technically, no, we can’t. Post-traumatic stress disorder is a mental health disorder. It has criteria that must be met in order to be used, in order for that term to be used appropriately. But when we refer to trauma, we refer to situations that cause a traumatic response within the body, which is not necessarily PTSD. And so, we look at the increase in the amount of cortisol. We look at the increased heart rate, increased respiration, what’s happening in the body, that sort of thing. But it may not meet the criteria for post-traumatic stress disorder. So, no. And that’s kind of an interesting question because the word trauma can actually have whatever definition you want to give it, where PTSD can’t have. It has to have a criteria of being met, but trauma. So, a lot of people can say, oh my god, my, my mother-in-law is coming to stay the weekend. That’s trauma. You know, we use trauma, unfortunately, in very loose terms, so no, you cannot really use them interchangeably. I tend to use the term trauma when there is a traumatic response within the body and brain, but it’s not causing the conditions necessary to make the diagnosis of post-traumatic stress disorder.
Audience Question: How can we ground someone if they’re being triggered while on a phone call and they can’t see you? Does everything that you talked about still apply like breathing with them and so on and so forth?
Duane Bowers: You can but you really have to get there. I’m assuming Lilian means that we are on the phone call with them, right? And that they can’t see it. So, if they’re on the phone call, they probably can’t see it like in a Zoom thing or whatever. So, we really have to get them to participate. And by that, I wouldn’t do the breathing in that one. I would actually do the connection to the environment. I would say, “Tell me three things that you see in your room. Tell me three things you see. Now, tell me two things that you hear, and, not me, but what other things can you hear? What can you hear outside of your house? Tell me two things you see.” See what I’m doing is actually getting them to focus on their environment. They’re still focusing on the hearing now, but it’s not their body, because it’s easier for them to tell me what they see, hear, taste, touch, and smell. So, I probably focus on the environment and focus on the phone call and get them to focus there. And then I would say, okay, “I want you to do something with me, I want you to slap your knees with your hand.” They’re holding the phone that may not be able to happen. So, if they’re sitting on a chair, “I want you to stomp your feet on the floor, let’s stomp together 1, 2, 3, 4,” and do that with them for a while to get them grounded. We’ve gotten them back, now, we want to get them grounded, and “Now let’s do opposite feet. So, left, right. Left, right?” And so, we can do those things, but constantly checking. “Are you doing it? How does it feel, you know? Now, let’s bounce in our chair bounce, bounce.” That kind of thing, so that you can still do it. But you have to get them to participate in a way that they are giving you feedback on the fact that they are doing it. And then talk about, “All right, let’s talk about what was the thing that triggered you, what was it? And keep the stomping on the floor if you need to stay here,” that sort of thing.
Audience Question: If trauma occurs when a person is a teen, but the PTSD symptoms don’t occur until the person is an adult, can that possibly still be PTSD?
Duane Bowers: Oh, absolutely. Yeah. There is written information on delayed reaction, and delayed symptoms, absolutely. That can happen. You know, your brain does have the ability to kind of repress things, and it does that to protect you. And if you’ve repressed a lot of that memory, and then it starts to come up, Yes, you can have those symptoms of post-traumatic stress disorder. And it may take you a while to figure out why is this stuff happening? What does this? And then you start to realize, oh, it’s associated with its associated with the trauma I had as a teenager. This is not uncommon. This does happen, particularly with sexual abuse or sexual exploitation, at least in the work that I’ve done. Absolutely. Where the person shut it down to the point that they didn’t think about it, they didn’t react to it, and then, later in life, it came up. And usually, because of a trigger. For example, I know several cases where a young woman may have been raped earlier in her early teens and whatever shut it down. Didn’t have therapy. It didn’t process. It shut it down. And then her first significant intimate relationship. All that stuff came up, and it just flooded her. And I’ve seen that happen, or I’ve had situations cases where that has been the case. Yes. My answer is yes.
Audience Question: Martina is wondering about trauma and triggers in a situation involving date rape where the person, maybe doesn’t even know what happened to them?
Duane Bowers: And that’s kind of what we were talking about, with the subconscious and the unconscious. It could be if they were unconscious while they were raped they will not, they won’t cognitively remember the event. But their body will remember aspects of it, and they will trigger and not know why they’re triggering. And one of the things we as supporters or therapists or whatever need to do is help them to be able to tolerate those triggers without ever knowing what it is but being prepared for it. As I said, we talked about coping with triggers, in that case, we’re never going to go be able to go back and resolve the unprocessed trauma because we can’t, it’s not in the memory. So, we’re going to have to cope with that. We were going to have to come up with coping skills. What happens if you’re triggered? How do you prevent, or how do you prepare for a situation? So, as I said before, if in my intimacy now, this stuff is starting to come up, start to look at, “Okay, when does it come up? At what point, and what can I do at that point to not have this traumatic response?” And that’s a lot of work. That’s not easy work, but it can you can do that work.
Audience Question: Is it true that EMDR should not be used if people are actively experiencing trauma?
Duane Bowers: I’m going to defer on that. I’m not trained. I have not been trained in EMDR and I refer out whenever I have a client that needs EMDR. I would suggest that you’re probably correct. There are some situations where EMDR doesn’t work. But I do want to say this, the American Psychological Association does recommend EMDR as a very valuable treatment for trauma and for PTSD, so it’s not just me saying it. It actually is recommended by APA. One of the reasons to use EMDR is to allow access to the subconscious to remember things that you may not be remembering. So, if I’m still going through the trauma, I don’t need to access that. I’m still going through it. So, I think it’s trauma work that needs to be done there, not so much the processing of it, but of unprocessed stuff. But how to cope with the trauma that’s happening now. So, I think you’re probably right on that, but I would have to do more research on that to get a correct answer.
Click Here to Watch a Recording of Managing Trauma Triggers.