In 2015, I began working with refugees. I thought I’ve heard everything about trauma, but during the first few weeks of my work with refugees, I began having nightmares myself. As a therapist, I’d heard descriptions of emotional, physical, and sexual abuse, in addition to many stories that involved violence and humiliation. “I’ve heard it all,” I thought.
I was wrong.
In listening for the first time to stories of kidnapping and torture, something moved deep inside me, in my limbic (emotional) system.
You can’t compare one person’s trauma to another. One person’s trauma is never worse or easier than another person’s trauma. Every trauma is bad. Horrific. Thankfully, I can use EMDR therapy to help clear trauma more quickly than one might assume. Here is one such story.
Severe Trauma Can Be Healed
When I first met Teddy* (not his real name), a 47-year-old* refugee from Ethiopia,* he told me what happened to him at the refugee camp. He had been kidnapped along with his teenage daughter and then had been forced to watch her being tortured. I will save you the details, but you can only imagine how horrible this experience had been for him.
The trauma and shock of what he was forced to watch did something to Teddy’s brain. Now, everything triggered Teddy. Sounds, people from his country, his daughter, the president.
Teddy was almost constantly triggered into an extreme emotional state. It made him irritable all the time, which frustrated his wife and kids, who found him difficult to be around. Worse, he started seeing himself as defective. He used to be a calm, loving dad and now he was constantly angry with everything, including his kids.
In some cultures, what we call symptoms of PTSD is considered a bad moral character. In Teddy’s culture, you don’t get any help for mental health unless you are really sick––that is, people who receive mental health services bring shame to themselves and their families.
I told Teddy the truth: that he wasn’t crazy. He wasn’t a bad person. And he was right to seek help.
Then I explained why he wasn’t crazy or bad. Many books and websites describe the effects of trauma on the brain. Some of them are very complicated and technical. I will make it as short and simple as I can.
Trauma Gets Stuck in the Brain
When Teddy was tortured, his brain’s limbic system was active for a very long time. This is the part of the brain where we store trauma. It’s also an emotional place that does not operate in terms of language or logic. Interestingly, it responds faster than the “smart,” logical brain. It’s designed to help us react in very dangerous situations.
Traumatic memories, however, are stored differently than regular memories:
- Regular memories are stored as events that happened in the past. Trauma keeps living in the present.
- Regular memories are stored as a coherent narrative with a beginning, a middle and an end. Traumatic memories are stored as fragments, snapshots, or pieces.
- Regular memories communicate with other networks in the brain. Traumatic memories are isolated in the brain. (This isolation is supposed to be protective.)
- Regular memories can be difficult. We can learn about the death of an aged relative, be very sad, but not feel traumatized. A memory becomes trauma not according to the severity of what happened, but because it gets stuck or mis-filed in the brain. Regular memories and traumatic memories are stored in different areas of the brain.
When a memory turns into trauma and is stuck in the limbic system, it keeps being triggered. All the time. Traumatized vets can be triggered by loud sounds similar to a rifle or a bomb. It takes them a fraction of a second to become hypervigilant, with their fight-or-flight system going from 0 to 100 before they are consciously aware of it. These are symptoms of Post-Traumatic Stress Disorder, or PTSD.
Teddy was no different. To help him understand why he was experiencing nightmares, flashbacks, irritability, sleep problems, uncontrollable crying and sensitivity to certain sounds, I explained to him two things.
1. What happened in his brain during the trauma, and
2. how we were going to help him to transform his traumatic memories to regular memories.
When he was tortured, Teddy was immobilized, unable to help himself and his daughter get to a safe place. Teddy’s visual memory of his daughter being sexually abused, his hopeless thoughts (“we are going to die”), his feeling of anger and the tension he felt in his chest and head were isolated in his brain.
To recap, these four elements were isolated from other networks in his brain:
- Negative thought about himself
- Body sensation
Without communicating with other networks in the brain, these four elements of the trauma were not getting the message, “this is not happening now; it only happened in the past.” They were separated from the parts of the brain in charge of seeing the big picture and having thoughts about thoughts.
[WORDPRESS CAPTION] Images, thought, feeling and body sensation get stuck in the limbic system during trauma
I explained to Teddy that his reactions were the result of an overactivated limbic system that has been rewired during the trauma. With EMDR therapy, I explained, we can create changes in the brain. His brain and the way these memories are stored will be rewired.
How EMDR Therapy Processes Traumatic Memories
After doing some preparation exercises, we targeted the four elements that I mentioned earlier: the stored picture (the worst part of it), the negative thought about self, the emotion he experienced, and the body feeling he had while he was traumatized.
Once we identified these, I asked Teddy to hold these four elements in his mind, reminding him that he was safe with me in my office. Then I started EMDR’s bilateral stimulation – gently activating both sides of the brain for about 30 seconds.
Initially, as often happens at first, it was very hard for him. Up until now, he had always tried to avoid these memories. He didn’t want to think about what happened at the refugee camp. It made him feel horrible, so bringing up the worst picture was extremely difficult. But he did it.
He focused on the picture, the thought, the feeling and the body sensation that were stuck in his brain. I told him to let whatever happens, happen. “Don’t try to control or change anything” is how EMDR therapists instruct clients when they do sets of EMDR. Allowing what happens to happen allows reprocessing to proceed.
This point is crucial for both therapists and clients. You have to trust the process. (More about the process in a minute). It can be very hard, but you have to go through the worst part in order to allow healing to occur. EMDR helps you get over that hill quickly. Healing happens during desensitization and reprocessing (the D and the R in “EMDR”).
So we trusted the process. After a few very difficult sets, in which I had to instruct Teddy to focus on his breath, we started seeing the effects of EMDR. The hopeless thoughts and feelings of anger started to feel less immediate. The traumatic memory didn’t disappear, but it started integrating with the rest of Teddy’s brain. He felt a physical relief in his chest.
He told me that he felt, for the first time in a long time, that he was breathing.
[WORDPRESS CAPTION] In EMDR, we use bilateral stimulation to activate neural networks and integrate the traumatic memory networks with the rest of the brain.
To Improve Success with EMDR,
Understand How the Brain Heals: AIP
I find that clients who understand how Adaptive Information Processing (AIP) happens in the brain have a better reprocessing experience with EMDR. I’m not sure why an understanding of the AIP model makes EMDR processing easier, but it does. If you’re thinking about starting EMDR therapy, make an effort to understand the AIP model before your start. I’ll outline a bit here.
AIP is a process that happens naturally and allows the brain to heal from difficult situations. It’s like when you cut yourself and your body sends white blood cells to repair the damaged tissue. A similar repair process happens in the brain. When you experience an emotionally difficult (but not traumatic) event, your brain puts in play its natural healing mechanism (AIP) to process this memory.
The same process happens when you dream. The “EM” in “REM sleep” and in “EMDR” are the same: Eye Movement. When you dream, your eyes move, and the AIP leads to adaptive resolution. With adaptive resolution, your brain is able to process again.
In EMDR, we help when the AIP process is not functioning during the time of trauma. When memories are not processed – they remain in their raw form and keep leading to symptoms of trauma.
Done and Feeling Like His Old Self Again
In EMDR, when the trauma resolves and becomes simply a regular memory, a fact in the past, we are done. When Teddy was done with his therapy, he felt like himself again. He had almost forgotten his old self. He became the person he was before the trauma, and able to be a loving, patient dad and husband. He had never stopped loving his wife and kids, of course, he just wasn’t able to be patient with them in his damaged state.
Teddy was tremendously relieved and thankful after spending so much time with the hopeless thoughts that so many traumatized people experience, especially thinking “I will never get better.”
Teddy did get better. His life is not easy. He’s still a refugee in the U.S. in 2019, but life is manageable. He works hard, but he is able to enjoy life’s little moments. Most importantly, he is able to enjoy his relationships with his family.
When you treat trauma properly, it can and should get better. Now that you understand how trauma is stored in the brain, I hope it’s easier for you to make an informed choice when you decide how to treat your trauma.
Rotem Brayer is a certified EMDR therapist and an EMDR consultant in training practicing in Denver, Colorado. He divides his time between helping refugees to improve their mental health and maintaining a private practice.
* Details have been altered to protect client’s confidentiality