Case study: PTSD from a car accident—resolved in 4 sessions
Panic attacks while you are driving. Nightmares every single night, or else insomnia. Crying at random times and you’re not sure why. Hypersensitivity to sounds. Could you live like that? (Do you?)
These are the classic symptoms of PTSD, Post-Traumatic Stress Disorder, and Tom (not his real name) told me this was how he felt every day following his car accident.
In just four therapy sessions, however, all these symptoms were gone. I’d like to tell you about the process we used, EMDR (Eye Movement Desensitization and Reprocessing), a method that speeds the reintegration after trauma.
Tom’s car crash
A young man in his 30s, Tom had been working hard on building a successful career in marketing. We started his EMDR therapy a few weeks after his car was totaled. He broke four ribs, his spleen was damaged and his face got hit pretty hard by the airbag. He still suffered from physical pain all over his body when he came to see me. Even worse, the accident left him with the life-impairing symptoms I mentioned up top. Anything that reminded him of the trauma brought on symptoms. It was his worst nightmare.
Tom felt like his life had been taken away from him. He felt like he couldn’t function anymore. His insomnia, nightmares, and lack of sleep made it hard for him to do his job—one that required a great deal of focus and creativity. The few weeks before he started therapy were horrible for him. He had never had to miss so many meetings, leave work early or call in sick. He was afraid that all his accomplishments, mostly his professional achievements, would be lost.
So Tom and I began his EMDR therapy. Here is how it went.
Starting with history
Therapy always starts with the therapist and the client getting to know each other and establishing trust. Tom and I began by talking about his past, his childhood, his college years and his professional life. He had been talking with his girlfriend about getting married. He loved his marketing job and enjoyed his work and social life. He had no addictions and his occasional pot habit (mostly on weekends) was not a concern.
After learning about his history and after getting the sense that Tom trusted me, we moved on to the preparation phase.
The EMDR preparation phase
At this point, I explained to Tom how EMDR works in the brain. When trauma happens, it is so disturbing that our brain tries to protect us from it and locks those experiences away where we can’t access them. The brain disconnects parts of itself that usually communicate with each other, and this causes problems.
Some elements from Tom’s experience of the accident had been isolated from other networks in his brain and, as a result, kept triggering him. It’s like when you try to hold a beach ball underwater and, when you slip, it pops up with force.
These memories that the brain had separated and pushed underwater popped up without him wanting them to. He would instantly go into a state of upset. As you can imagine, repeatedly doing this makes it difficult to have a normal life.
EMDR can help the brain recover from trauma. EMDR reconnects and integrates the traumatic memory with other memory networks. The result is typically a transformation of the traumatic memory into a regular memory, just a fact.
Our goal was for the accident to be stored in his brain as an ordinary event that happened in the past, instead of something that keeps popping up, unbidden and emotional, at any time and affecting the present.
EMDR preparation phase exercises
The EMDR preparation phase included teaching Tom exercises to help him calm down his nervous system. Sometimes, while reprocessing traumatic memories, we activate the nervous system. Whenever Tom feels overwhelmed, we want him to be able to create balance. The exercises allow him to do that.
In the preparation phase, we also tested the form of bilateral stimulation (BLS) we were going to use. EMDR speeds the process of neural integration by stimulating both sides of the brain. In order to stimulate both sides of the brain, bilateral stimulation involves some kind of gentle physical experience and we have a few options.
Tom, like many other clients, chose to use the “buzzers,” two gently vibrating small pulsators that the client holds in both hands. The vibration alternates from side to side, triggering both sides of the brain.
After finding the right settings for him, we next practiced the Calm Place and the Container exercises. Tom’s ability to successfully use these resources indicated that he was ready to start reprocessing. After answering any questions he had about the process, we began.
How EMDR works: finding the targets
Trauma “disintegrates” us. As I mentioned, trauma is so shocking that parts of our brain stop communicating with each other, leading to symptoms. Reprocessing re-integrates the brain.
It seems hard to find information online describing what the EMDR experience is like, so I’d like to walk you through the full basic process.
Tom and I started by identifying the elements of the trauma that we will use in the reprocessing.
The 7 elements necessary to reprocess an EMDR target
- Choose the worst image – It is important to target the worst image of the scene or the trauma. Tom chose the moment the other car hit the side of his car as the most disturbing picture of the whole scene.
- Identify a negative cognition (thought) – Most people have some negative thoughts about themselves that are associated with the trauma. Tom’s was: “I’m not safe.” He thought he was going to die.
- … And positive cognition – I asked Tom what he would like to believe about himself in that situation. The answer, not surprisingly, was “I am safe.”
- Evaluate the validity of cognitions – Next, I asked Tom to think about the worst picture he had described and, while holding it in his mind, to rate his chosen positive belief (“I am safe”) on a 1-7 scale. He told me that it was a 1. He did not at all feel safe in that scene.
- Find the emotion – Emotions are a big part of every traumatic event. I asked Tom to close his eyes, imagine the picture he described and the words “I’m not safe,” and tell me what emotions he was feeling. The emotion he recognized was “terrified.”
- Rate the level of disturbance – Next, I asked Tom to rate his level of disturbance on a 0-10 scale. 0 means no disturbance, and 10 is the highest disturbance he could feel. He reported a level of disturbance of 10.
- Identify trauma is stuck in the body – Oftentimes, trauma gets stuck in the body, in addition to the brain. Lastly, I asked Tom to identify where he was feeling the disturbance in his body. He reported feeling it in his chest.
Reprocessing: Where the magic happens in EMDR
With all these tools available to Tom, next, we began reprocessing. I asked Tom to focus on the worst image of the accident, the negative thought about himself and the emotions he felt, and to also focus on where he felt it in his body. I asked him to let whatever happens happen, without trying to change or control anything, and I turned on the pulsators for 25 sets of bilateral stimulation.
Tom began shaking. He was crying. The healing process had begun.
After a few sets, he gradually calmed down. At the end of every short set, I kept checking in with him, and he told me what he focused on when he reprocessed the accident.
Toward the end of our first reprocessing session, I asked Tom to rate his level of disturbance again. Instead of having a disturbance level of 10 out of 10, Tom reported a 6 out of 10. The stress was more manageable. We ended the session with the Calm Place exercise and Tom reported feeling better than when he came in.
Second reprocessing session
When Tom came in the next week, he reported a huge improvement in his symptoms. His nightmares were reduced by more than half, he said, and he was sleeping so much better. He was able to function better at work and enjoy social activities again. This was a great sign, but our work was not over yet.
It is not uncommon for a client to continue to improve between sessions. I asked Tom to check on what comes up when he goes back to the scene of the accident. He was much less stressed and reported a disturbance level of 4 out of 10. That was another great sign. Tom’s brain had kept processing.
Again, I handed Tom the pulsators and asked him to focus on the worst picture, the negative thought related to the scene, the emotions he was feeling and where he was feeling it in his body. He was visibly much calmer, not shaking at all. After several more sets, Tom reported feeling good. He was okay. The accident happened in the past. He wasn’t disturbed by it anymore.
When I asked Tom to rate his level of disturbance – he reported that it was a 0.
His traumatic memory was cleared and the memory of the accident transformed into a regular memory. A mere fact.
Got his life back
Our EMDR work continued for just two more sessions, in which Tom reported feeling like he was getting his life back—the life he had before the accident. He enjoyed his work again and was able to function and socialize. His sleep improved, his concentration and creativity were back, and he returned to planning his wedding.
EMDR is a powerful tool, and I was honored to help Tom journey back to happiness again.
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.