Treatments for PTSD may include EMDR eye movement desensitization and reprocessing

Dr. Jeff Hersh
·4 min read
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Q: Is there some kind of eye movement treatment for PTSD?

A: Being exposed (directly or indirectly) to a traumatic event may stimulate adrenalin and other hormones/chemicals to trigger the "flight or fight" response. Once the event has passed the body releases certain other hormones/chemicals (for example cortisol) to return to baseline. One way to think about post-traumatic stress disorder (PTSD) is that it may, in part, be due to by an abnormal, prolonged and/or inappropriate stimulation of the fight or flight response, in addition to many other possible factors.

PTSD is quite common, affecting 5% to 10% or more of the population in their lifetimes. It is more prevalent in women. The diagnosis of PTSD requires:

Dr. Jeff Hersh
Dr. Jeff Hersh

  • The patient having experienced a traumatic event (directly or indirectly) typically with an initial response of intense fear, helplessness or horror.

  • The affected person having symptoms which persist for over one month that cause significant distress or impair day to day functioning which may include:

    • Intrusion symptoms such as:

    • Re-experiencing the event in specific ways (such as recollections, flashbacks and/or distressing dreams),

    • Frequently feeling anxious, afraid or in danger again, even to the point of having panic attacks,

    • Having marked physiological reactions (for example palpitations, sweating, others) from the intrusive episodes, and/or others.

  • Negative changes in thinking/mood:

    • Feeling guilty about having survived when others did not

    • Having symptoms similar to those of depression, which may even include suicidal thoughts,

    • Persistent avoidance of stimuli that may be perceived as similar to the traumatic event, and/or others.

  • Marked changes in reactivity to certain situations:

    • Such as increased arousal, hypervigilance, being "on edge" or being irritable, especially to cues that remind the patient of the traumatic event (for example reacting to a loud car backfire if the traumatic event involved a loud gunshot),

    • Having concentration and/or memory problems, difficulty focusing or difficulty making decisions, and/or others.

The formal diagnosis of PTSD is often made by evaluating the patient’s symptom score on a standardized assessment tool called the Clinician Administered PTSD Scale for DSM-5 (CAPS-5).

There are many possible treatments for PTSD.  Usually, a form of psychotherapy is utilized as a first round treatment, including:

Cognitive-behavioral therapy (CBT) where the therapist works with the patient to help them identify and understand their PTSD and uses thought exercises/real experiences to develop symptom reduction techniques, coping skills, stress management, etc. This may be done one on one with the therapist, or in group sessions.

Exposure therapy: here the therapist works with the patient to expose them to (always in a safe manner/environment) memories/situations reminiscent of their traumatic event.  The exposures may be by having the patient imagine the events, virtually exposing them to similar events, and even actual exposure to similar events.

Eye movement desensitization and reprocessing (EMDR) therapy: this involves having the patient imagining the traumatic event (similar in some respects to one of the exposure therapies just noted) to help them focus on the symptoms that this provokes, and then stimulating eye movement from the patient (for example by the therapist moving their fingers to have the patient track this movement across their field of vision) to stimulate certain areas of the brain and help the patient build an adaptive association between this movement and anxiety reduction/relaxation. There are many subtleties to this, but the goal is to build an adaptive response to address the PTSD symptoms.

Some patients may require medications in addition to the psychotherapy. There have even been some recent controlled trials showing benefit for appropriately selected patients using 3,4-methylenedioxymethamphetamine (MDMA, a chemical found in certain street drugs such as ecstasy/molly, but contained in a properly controlled and dispensed medication, similar to how THC, a substance in marijuana, may be given as a medication to some cancer patients to stimulate appetite).

Treatments for patients with PTSD are actively being investigated, and the available treatments continue to significantly improve. If you think you may be suffering from PTSD, or any other psychiatric illness, you should see your health care provider to be evaluated so you can begin your journey to better health.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.

This article originally appeared on MetroWest Daily News: Treatments for PTSD can include EMDR desensitization therapy