Using EMDR to process traumatic experiences and make them more manageable
By: Dr Aliza Bilman
Pesach 2016 was a chag I will not soon forget. I was in the third trimester of my first pregnancy. I had heard that first time mums are often overdue, so I expected that I would be too. I had packed a bag just in case, but I had no intention of using it. On the last day of Pesach, my husband and I joined a family for a lovely lunch and then went home to take an afternoon shluff. I woke up with strange uncomfortable sensations – contractions. After Yom Tov was over, my husband and I resumed Lamaze classes, which turned out to be imperative and helped me survive a lone labour and a messy delivery rife with medical negligence (a story for a different time).
When my son was born, he was placed on my shirt momentarily and then swiftly whisked off to the Neonatal ICU. The gynae stated that my newborn baby boy’s oxygen levels needed to be checked and he needed monitoring. Perhaps it was the lingering effects of the Pethadene, but I was okay with my son requiring observation in the NICU. I’ve had two nephews who required a few hours of monitoring in the NICU after their births and I was confident that my son would be fine.
A few hours of monitoring turned into a few days, which dragged on until he was ultimately discharged after 16 days. Throughout this time, although my son was hooked up to oxygen, connected to tubes, and required intensive chest physio, I was blissfully optimistic. In other words, I was in complete denial. Even after his discharge, when the paed called us in to his office to inform us that our son had contracted an antibiotic resistant infection while in the NICU, I was confident that everything would be okay. I was sure the new course of medication would be sufficient and he would not need another admission. Note that it was an antibiotic resistant infection; the infection by nature does not respond to the usual course of medication.
Thank G-d, the medication worked and my son did recover. At 29 days old, a day before his Pidyon Haben, we were grateful to be able to organise his bris and give him a name.
After his discharge from the hospital, life mostly returned to normal post-baby life. I often felt grateful for my son’s health and wanted him close to me, but I did not have any unusual symptoms. Even though it had been difficult not to leave the hospital with my son when I was discharged, I had fond memories of my experience with the NICU. Although I found nights the most difficult, not having my newborn with me, I was glad to be able to rest and recover from the birth.
As my son grew, I enjoyed each stage of his development. I loved his smiles and laughs. I treasured holding his little fingers and feeling them curling over my hand. I kept him close in a wrap most of the time and he seemed to love it. Although I was in denial about the severity of my son’s issues and the danger he faced in the NICU, I was acutely aware of the trauma of my labour and delivery. I thought about it often and had a strong emotional response when I accompanied my friend to the same hospital when she was pregnant. I knew that before I thought about trying for another pregnancy, I would need psychotherapy. I was still, however, in comfortable denial regarding the NICU and my son’s health issues.
That changed abruptly, when close to a year after my son was born, a friend’s 35-week newborn, who was small, but healthy, contracted an infection in a NICU and tragically passed away. Almost instantly, my world turned upside down. I was in a constant panic about my son’s health, worried about what could have happened, tearful at the drop of a hat, ruminating about those first 16 days, and experiencing recurring flashbacks.
At that point, I recognised that I needed psychological intervention. Being a psychologist myself and having had EMDR previously for a horrid dating experience, I decided that EMDR was my intervention of choice. EMDRIA.org, the EMDR International Association explains that Eye Movement Desensitisation and Reprocessing (EMDR) therapy is an extensively researched, effective psychotherapy method proven to help people recover from trauma and other distressing life experiences, including PTSD, anxiety, depression, and panic disorders. EMDR therapy does not require talking in detail about the distressing issue. Rather, it allows the brain to resume its natural healing process and resolve unprocessed traumatic memories.
EMDRIA.org explains that our brains have a natural way to recover from traumatic memories and events. This process involves communication between the amygdala (the alarm signal for stressful events), the hippocampus (which assists with learning, including memories about safety and danger), and the prefrontal cortex (which analyses and controls behaviour and emotion). While many times traumatic experiences can be managed and resolved spontaneously, they may not be processed without help. Stress responses are part of our natural fight, flight, or freeze instincts. When distress from a disturbing event remains, the upsetting images, thoughts, and emotions may create feelings of overwhelm, of being back in that moment, or of being “frozen in time”. EMDR therapy helps the brain process these memories, and allows normal healing to resume.
I met with my EMDR therapist and she guided me through the process. She had me identify images, thoughts, emotions, and body sensations associated with the experience as I thought about it then, nearly a year after it had occurred. The image that represented the worst part of the experience was seeing my baby in the incubator connected to tubes with the machine next to him flashing and beeping. The negative thought that was not rationally true, but felt true, and which I associated with this image was “I am helpless”. Emotionally, I felt fear and anxiety.
Initially, I rated the level of disturbance as a 10 on a scale from 0-10. Thinking about the experience felt overwhelming and horrifying, like it was happening right now. The therapist had me bring up the image with the “I am helpless” thought and had me notice where I felt it in my body. She asked me to follow her fingers with my eyes back and forth. After several repetitions, she stopped, had me take a breath, and asked what I was noticing. Images including my son being whisked away to the NICU, seeing him connected to tubes and staring at the numbers and listening to the beeps of the machines scrolled through my mind.
This process repeated. Memories and images from my son in the NICU were interspersed with sensations in my body – tension in my shoulders, tightness in my chest, a feeling of wanting to cry and vomit. Feelings of helplessness, fear, and anger emerged. Intense at first, but then fading and feeling more distant. There was a paradoxical sense of being immersed in the past and then recognising that it was over and that I am in the present. My son was in serious danger, but now he is okay. Gradually, the experience felt more distant and more manageable. It felt as if the memory was being released from my body and I could recall the experience more objectively – understanding the severity of the situation, but no longer overwhelmed or in denial.
Nearly nine and a half years later, I can recall the experience and describe it like I would any other memory. Having a newborn in the NICU is scary and sad and emotionally laden, but I no longer feel that emotional charge like I did back then. I can talk about it and I can hear other mothers describe their experiences with the NICU and be empathetic. As an EMDR therapist myself now, I can facilitate the EMDR process with my clients and be objective and sympathetic, helping them heal from their experiences.
There is ample research supporting the effectiveness of EMDR and it is endorsed by the World Health Organisation (2013) for the treatment of trauma. Locally, EMDR South Africa has recently been launched as an association dedicated to the dissemination of information related to EMDR, increasing the use of EMDR in South Africa, and the training and upskilling of EMDR therapists.
For more information about EMDR or to find a qualified EMDR practitioner, you may look at www.emdrsouthafrica.co.za.
To contact Aliza: www.alizabilman.com or email@example.com
IN A BOX
Each baby’s NICU experience is different and each parent’s experience is uniquely influenced by the individual circumstances surrounding their NICU stay as well as by their coping styles and personal life stories. There is ample attention focused on the baby and the baby’s well-being, but minimal intervention given to the parents – and I am newly committed to changing that.
Having a baby in the NICU often results in post-traumatic stress responses. In the past, I have tried to network with NICU teams and relevant doctors and offered EMDR. More recently, I have connected with a neurodevelopmental physiotherapist who works with babies in the NICU on a regular basis. She has offered to help me make additional connections in the NICU and think about more effective ways to offer support to parents of babies presently or previously in the NICU. I also hope to connect with medical aids and discuss the long-term medical and psychological benefits of providing support to these parents.
After a medically necessary termination and subsequent miscarriage, Samantha fell pregnant for the third time in just over a year. Samantha’s pregnancy was marked by extreme anxiety, but she looked forward to the birth of her daughter. After an emergency Caesar, Samantha’s baby turned blue and stopped breathing. The doctors did CPR, stabilised her, and took her to the NICU for observation. While Samantha’s newborn fought for her life, Samantha struggled to enter the NICU. Each time she approached the NICU, Samantha broke down in a rush of tears, unable to handle the reality that her daughter was so fragile and she was powerless. The nurses had to calm her and gently coerce her to approach her daughter, explaining that her daughter needed her to be there. Thank G-d, her daughter pulled through and was discharged just after a week.
Although grateful to have their daughter at home, Samantha and her husband were consumed with constant fear and worry. They were hypervigilant regarding everything their daughter was exposed to and constantly feared for her health. They regularly checked on her to make sure she was still breathing. Complicating matters, Samantha and her husband experienced a nasty home invasion around this time. Fortunately, the baby was not harmed, but Samantha and her husband were severely shaken and feared for their lives. The combination of the multiple traumas brought Samantha in for EMDR, where she has begun the process of healing and regaining her sense of normalcy.
Terri had an unremarkable pregnancy and she was looking forward to becoming a first time mum. Her baby was on the small side, but not unusually so. As her son was born, he flatlined, sending the gynae and nurses into action. They resuscitated the baby and sent him to the NICU for observation. The baby appeared to be stable, so he was returned to his mother. As Terri attempted to feed her newborn, she felt uneasy. Sensing something was wrong, she alerted the nurses, only to be told that she was just being a sensitive first time mum and that all was fine. Terri’s concerns persisted and a specialist paediatrician was notified. He came to check the baby and was not content with what he saw. He returned the newborn to the NICU and conducted a number of tests. The tests revealed that the baby had two holes in his heart and required surgery.
The baby underwent delicate open heart surgery as well as bowel surgery. Although Terri’s son survived the surgeries, his survival was constantly in question. His development was an uphill battle in a way that no one could have anticipated. The baby’s paed was on constant high alert and would frequently be found checking on him in the middle of the night, cancelling multiple family holidays in order to be available for the baby. Terri spent nearly a year in and out of the hospital with her son dealing with frequent medical crises, during which Terri’s gynae prescribed an antidepressant to help her cope with the unfathomable circumstances. Terri went into action mode and did what she needed to do to help her baby survive. It took her 8 years to get to the point where she could consider the possibility of having another child. Many years after her first child was born, Terri continues to wake up nightly to check that her kids are alive and breathing.