You might think of war veterans when you hear, or see, the words post-traumatic stress disorder – an anxiety disorder recognized after the Vietnam War, when soldiers returned home with symptoms of mental illness. You might also think of victims of tragic accidents, rape victims, or those who have endured any kind of abuse. What about health care workers, such as nurses? We tend to think of nurses as in control, emotionally strong, even in the face of gore and death. Still, nurses often hear others ask them, “How do you do what you do? How do you manage watching people die all the time?” But nurses suffer from PTSD too, also referred to as compassion fatigue, vicarious trauma, or empathic strain. PTSD is an occupational hazard for nurses. Fourteen percent of nurses experience PTSD symptoms – compare that statistic to the 3.5 percent of the general adult population.

Critical care, emergency room, and labor and delivery nurses are particularly at risk for PTSD, as well as those who work on rescue transport teams. For long shifts – twelve, sixteen, hours they witness an unending stream of trauma: shooting and stabbing victims, an attempted suicide victim, the deaths of newborns – the list goes one. Nurses cannot simply walk away from patients who are bleeding or not breathing. Their duty is to be wholly present – physical and emotionally – at patients’ bedsides. And since nurses are perfectionists (I’m a nurse, so I know the feeling), they might view their own PTSD as a sign of weakness. It’s easier for them to see symptoms of PTSD in others, because that’s what nurses are supposed to do – assess patients, then intervene on their behalf. Nurses, unfortunately, don’t take care of themselves.

Treatment is simpler than you might think: stretches and meditation. Researchers at the National Institutes of Health followed 22 nurses with PTSD symptoms. Led by someone trained in exercise science and martial arts, the nurses participated in a twice a week mind-body class that involved stretching, deep breathing, meditation, and balancing techniques. After eight weeks, half of the nurses experienced a 41 percent decrease in symptoms; the other half experienced only a four percent decrease. The exercises were simplified so that the nurses could easily engage in them anywhere at anytime, even during a quick bathroom break.

For more information see The Endocrine Society’s Journal of Endocrinology and Metabolism, Volume 98 Issue 7 – July 1, 2013.

http://nursing.advanceweb.com/Features/Articles/PTSD-in-Nurses.aspx

http://www.uic.edu/orgs/convening/vicariou.htm

http://psychcentral.com/news/2013/05/30/mind-body-techniques-reduce-ptsd-in-nurses/55418.html

http://press.endocrine.org/doi/full/10.1210/jc.2012-3742

Neuropsychologists are not medical physicians; they are psychologists who study the relationship between behavior and the brain. They first interview the individual: work and medical history, family dynamics, and school performance. The neuropsychologist gathers this information in order to compare level of functioning prior to a traumatic brain injury with post-injury functioning. The testing covers a broad range of areas: concentration, attention span, basic and abstract thinking, memory, mathematical reasoning, motor skills, problem-solving skills, judgment, and emotional character.

In May 2006, when I believed there had to be more than PTSD to blame for my difficulties in the workplace, I saw a neuropsychologist. I spent eight hours filling out self-evaluation forms and undergoing testing. Separately, my husband and I scored (one being the best, ten the worst) my level of irritability and depression, and my ability to remember things, concentrate, multitask, recall words, and think quickly. Our scores were nearly identical, with most of them ranging between five and eight. I spent the remainder of the day filling in dots on questionnaires, naming faces in photos, sticking pegs in tiny holes in less than fifty seconds, drawing figures from memory, naming as many items as I could think of that started with the letter T in less than one minute.

A few weeks later, the results came in the mail: the tests suggested I had sustained a traumatic brain injury when I was hit by a car three years earlier.

Finally, I had answers as to why I had trouble following conversations, learning new information, or performing most tasks in a timely manner. Finally, I had a reason as to why I could not retrieve the word from my brain when the neuropsychologist asked me to name the photo of two vertically connected glass bulbs with sand trickling from the top bulb to the bottom bulb.

Hourglass.

Emblematic of the passage of time, the hourglass also marks new beginnings.

My EMDR treatments for PTSD  included Cognitive Feedback Therapy, which focuses on the individual’s thought processes and how they affect behavior and beliefs. For example, it did not take much for my mind to swirl with negative thoughts when my husband traveled out of town for music gigs. I imagined him sprawled on the side of the road after being hit by a car. At night, I would wake and watch my husband’s chest for movement. In the dark, it was difficult to see if it was rising and falling, so I’d gently lay my hand on his chest, feeling for life. Or I’d snuggle close to him, waiting for him to exhale. These negative thoughts would lead to other negative thoughts or images: sometimes I’d see myself in a hospital bed struggling to breathe, with doctors hovering over me, sticking needles into my arms.

Like any successful project, cognitive therapy involves homework. My therapist instructed me to keep a log of events that triggered negative thoughts, sensations, and emotions. One day, I felt weak and feverish, as if I had the flu. Even though I did not have a fever, I thought something was wrong: I should go to the hospital, because I might have an infection. What if I need antibiotics? What if I don’t go to the hospital? I might die. As a nurse, it was easy for me to scoot down this irrational path. And since my spleen – an organ that destroys bacteria and is part of the immune system – had ruptured in the farmers’ Market accident, I couldn’t help but be anxious about dying from an overwhelming infection. But an uncountable number of people live productive and healthy lives without a spleen. By categorizing my thoughts into what my therapist labeled “faulty thinking patterns,” such as drawing conclusions or exaggerating the meaning of an event, then forming positive ways of thinking, I learned to halt the unraveling of irrational thoughts. I no longer keep a log, though I’m not completely free of negative thoughts and images. Instead, when they intrude on my sleep, or my daytime routine, I envision a huge stop sign. Sometimes I hold my hand up and say, “Stop!” And just like that, I’m unburdened by blackness, screams, and blood.

How exactly does EMDR work? Francis Shapiro, who discovered the treatment, explains it through the theory of the “Adaptive Information Processing Model.” The theory sounds metaphysical, but it’s not. The assumption is that all individuals have an information processing system, which takes our experiences and stores them in a section of our memories that is easily accessible. These experiences are connected to particular images, emotions, sensations, and beliefs.

Think of a computer. If you’re like me, you might have several folders filled with documents dotting your desktop, because you need the information to be readily available – at the click of the mouse. One of those folders might hold information that reminds you of something that evokes negative feelings. For instance, a folder has photos of your deceased parents. Every time you turn on the computer, you see the folder, and images of your parents fighting in front of you when you were a child return. You hear them screaming at one another, one of them saying, “I wish I never had children.” Each time you drag the folder into another one, so you won’t see it, the folder bounces back onto the desktop. Your computer is malfunctioning, so you need to take it to a computer geek.

Of course, we are not computers; we are human beings. Yet, our brains are very much like computers. In PTSD, the trauma – the negative images, emotions, and thoughts – are stuck in the easily accessible part of the brain. The processing system in our brains is working ineffectively, so each time something triggers memories of the trauma, like a car backfiring, you exhibit PTSD symptoms, such as panic. EMDR helps transfer the trauma and related images from your brain’s desktop into the part of the brain, or folder, that effectively processes the event.

When I speak to others about EMDR, they shirk from me, as if suspicious – maybe I’m looking to recruit them into a cult. But EMDR is not a cult at all, I promise.

There are 8 phases to EMDR: First, the therapist gathers background information about the client and discusses possible targets, or memories, on which the client may focus during treatment. In phase 2, the therapist ensures that the client is prepared to cope with potential distressing feelings. This may involve imagery or other stress reduction techniques. During phases 3 through 6, the EMDR procedure takes place. In phase 7, the client keeps a log noting any thoughts or emotions that arise. Finally, in phase 8, the client and therapist evaluate the progress made.

When I first learned about EMDR, I imagined walking out of the therapist’s office magically cured of all my PTSD symptoms. Maybe that’s what I wanted to hear when my original therapist told me about the treatment. But that’s not how EMDR works. EMDR is not a panacea – it assuages the anxiety related to the trauma, but does not necessarily eliminate PTSD symptoms all together. It wasn’t until I completed my first 90-minute session with the therapist when I learned that she could not give me an answer as to how long it would take before I noticed a reduction in anxiety.

Some people experience reduced symptoms of PTSD after a few sessions, but those who have suffered multiple traumas, or a complex history may require prolonged treatment. Once the therapist explained this to me, it made sense that I did not leave even the fifth or sixth session feeling marked relief. I grew up in a household where I endured both physical and emotional abuse. The emotional abuse continued into my twenties and early thirties when I became involved with men who treated me poorly.

As I shared my history with the therapist, I realized, for the first time, that other traumas I had experienced made my treatment complex: I was in a car accident with my father when I was ten, and another one with my step-mother when I was eleven. I nearly  drowned in the Colorado River when I was fifteen, and rammed into a tree while backcountry skiing when I was thirty. I completed twice-a-month EMDR treatments a year after my first session. Six years later, I returned for what I call a “tune up.”

For more information on EMDR, click on the video below:

https://www.emdr.com/client-session.html