Hello everyone, Its Dr Caroline Lloyd. Welcome back to the EMDR doctor podcast.
I hope you are having a great week - my week has been pretty busy with the Group EMDR program rolling out at Cabrini, we are trialling a bit of a new format so that is exciting and keeping us on our toes.
This week I had a lovely text from a listener who requested a specific topic, so thank you so much for that suggestion, today I am going to talk a little bit about the body and the physiological response to trauma and how EMDR affects the body. Which is such a fascinating subject, lots of brain chemistry involved, which i won't get too deep in to, but I hope I can cover the basics for you.
And this could start as a story that began way back in the beginning of time, as our brain reflexes do still contain some pretty primitive responses, and these have stood us well in terms of our survival, and trauma and survival go hand in hand, we can't really seperate them out, but I promise I won't get too anthropological on you!
So most people know about the fight or flight response- There are actually 5 'F's in this series of responses: Flight, Fight, Freeze, Fawn, and Flop.
In a nutshell, when we are faced with something scary, for example if we are walking in the bush and we nearly step on a snake, our brain reacts instantaneously, even before we have consciously registered that we see the snake, and we produce a whole host of chemicals that flood our brain and body - a lot of adrenalin and noradrenalin, cortisol and other stress hormones.
The effect of these on our body affects every system in the body, to make our chances of survival higher - blood goes to our big muscle groups, away from our digestive system as we don't need to digest in that moment, so we may feel nausea, we may need to empty our bowels or bladder so we are lighter to run away, our pupils dilate so we can see better, our blood pressure and heart rate go up so we have more energy, muscles tense, even hair follicles stand on end, probably to make us look bigger like a cat does when angry. Fascinatingly, even the muscles in our middle ears work differently - we become more attuned to both high pitched and low pitched noises, like noises related to survival, for example screaming, or growling or avalanche type noises, and we become less attuned to noises of safety like our conversational voices. So when we are in this state of high arousal or distress, we don't hear normal conversation so well.
In our brain, several changes happen including our reasoning and executive function goes a bit off line - we become less rational and less able to think and plan than when we are feeling safe.
So this is the fight or flight state - we are ready to run or attack, we are less able to talk and think.
The freeze state is the next one in the process - if running or fighting is not an option, then we freeze. A bit like a deer in the headlights, or a rabbit, our body is in a state of high distress, with all of the changes I mentioned above still happening, but the muscles are immobilised. This is probably to try and stay safe - the less movement we do, the less noticeable we are to predators - maybe freezing would save you in the example of a snake I used earlier. If we are not moving, maybe we are less threatening to some animals. The freeze state is one of suspended motion, readiness to move quickly, in preparation of running or fighting. This state, this freeze state, is also one of the shame inducing states - people often say to me that they wished they hadn't frozen, that they 'should have done something' or 'why didn't I run or scream or grab the offender' or something similar.
It is really important to know that these responses come from a very powerful, and primitive part of your brain - that they are instinctive, that we as individuals don't have any sort of control over the response in that moment. It can be really challenging when we think of ourselves as a competent strong person, then an event happens and we don't 'perform' heroically, like a superstar in the movies would, sprinting into effective targeted action, it can really shatter our self esteem and our concept of ourselves. And this is possibly even worse for people in the protective services, who, on the surface of it, are trained to respond in a calm and effective manner, but even then, if they are placed in a situation of high enough stress, even those first responders can freeze instead of fighting, which can be really difficult for them afterwards.
So we have talked a little bit about the flight or fight response, and the freeze response. There are a couple of other responses that the body will come up with in a traumatic situation. One of those, especially for children, who instinctually know, that in an event where they are obviously overpowered, running away (flight) won't help, fight won't help, freeze in ineffective, so they learn to cope with the threat with a fawn response. Now I'm not a big fan of this title, fawn, but it can also be referred to as Please and Appease, which is a much more descriptive and less judgemental title. So often, this response , which is a trauma response, is carried forward in to the adult life, and becomes problematic in that a person is then unable to enforce healthy boundaries, and wants and needs to please and help any perpetrator that comes along, and I have a great example of this, in the series 'Dead to me', the character played by Linda Cardellini is a perfect portrayal of a Please and Appease response.
Now the last response, the Flop response, is what happens if the threat of death is still there after the person has gone through flight, fight, freeze and fawn. It is a serious, pre-death state, of dissociation and absence. The brain goes offline, numb, absent, vacant, and the person dissociates. This response is usually learned during childhood - if a child has no way of running, fighting, freezing doesn't work to stop the trauma, pleasing is not an option, then the brain gets the bejesus out of there, goes elsewhere, and the body goes in to flop. What this may look like is like a faint - the body is floppy and unresponsive, the eyes may be open but staring and vacant, there is no voice, essentially no response. Sometimes no memories are available from the time the dissociation starts to when the brain comes back online, the brain has just simply gone offline and not taken in any of the event details.
So what happens in the brain when dissociation is in effect? The stress hormones of cortisol and adrenalin etc have short circuited the memory networks, consciousness has essentially been impaired, no information goes in, and no information gets laid down in memories. So it is actually possible for people to literally have no memory of an extremely traumatic event. It appears to the person as like a black hole in memory, they may remember the beginning of the event and then the end of the event, but no details are available. Which is frustrating for law enforcement, but just a fact that the brain was trying to survive in the best way it could, and part of that was dissociating for the time that was necessary to survive.
Importantly, we have no choice in whether we dissociate at a time of crisis or not. Dissociation is probably more common in those with a history of severe childhood trauma. And we can learn to manage it and moderate it in those day to day scenarios, but if there is a crisis, there is no managing what the brain needs instinctively to do.
So what happens to the memories that are created in those times of incredible stress? A great question. All those brain chemicals that are flooding the brain at times of stress impede the laying down of memories - acutely stressful events are more likely to be held in the amygdala, in the fear centre of the brain, together with the emotions that were present at the event. So the sights, sounds, smells, emotions and pictures of that memory will be held all tied up together in the amygdala , instead of being allowed to be processed by the hippocampus, in to the longer term memory bank.
So what about EMDR? It seems that EMDR helps the brain tome the memory out of the amygdala , be processed by the hippocampus and then laid down, without the emotions, in to the long term memory part of the brain. So it separates the emotion from the memory, then moves it along from the fear centre of the brain, the amygdala, in to long term memory. Quit show it does this we are still figuring out, but we do know that it does happen. We have some very elegant studies that have looked at functional pictures of where the brain lights up when accessing a traumatic memory, then redoing those imaging pictures after EMDR, and when asked to recall that memory, the brain lights up in a different area. There is a physiological change in the brain after EMDR, and the memories have been redistributed to be stored elsewhere, out of the fear centre, the amygdala. which is truly incredible and inspiring, for those of us who get interested in brain function.
And what about the body after EMDR therapy? Well as we process more of the trauma, people find that they have a lower level of stress as a baseline in their lives - they have less adrenalin coursing through their body, they are less in survival mode and more able to communicate and be present with loved ones, there is less muscle tension, they can think and plan more easily, they have more attention for small things, life feels not quite so serious, more fun is available, there is less startle response, triggers are less triggering, a flatmate putting a coffee cup on the table doesn't set off a fear response, a touch on the shoulder no longer means holding back a fight response, children's play noises no longer feel intolerable, offhand remarks no longer feel like shattering criticism, even a pain response say to a stubbed toe, is less acute and lasts a shorter time. And of course there is less need for the coping mechanisms - less need for smoking, drinking, overworking, online gaming and all the other addictions that help people cope with trauma. Those activities or habits can gently fade away in to the past.
So thanks for bearing with me on a bit of a scientific bent today, I've covered off on the body and the brains physiological response to trauma and how EMDR can help. It has been a bit of a bigger episode today, I hope its been helpful to you, thanks for listening, and if you have a topic that you are keen to hear about, please do reach out and let me know and I'll do my best.
I will talk to you again next week. In the meantime, take good care. Bye for now.
