Mount Carmel employs eye-movement therapy to treat trauma

August 1, 2016


Sari Winerman, a therapist at Mount Carmel Health System's Crime and Trauma Assistance Program in Columbus, Ohio, supports recovery for people suffering from effects of severe traumatic events. Her preferred method involves moving two raised fingers back and forth across a client's field of vision, instructing the client to visually follow her fingers in their back-and-forth movement while bringing trauma-related images to mind.

This widely hailed method has become known as eye-movement desensitization and reprocessing.

At intervals, Winerman will stop to ask the client how distressful the remembered images are on a scale of 1 to 10. Winerman will also encourage the client to verbalize feelings and thoughts. At first, these may be overwhelming, particularly when memories have long been repressed. Feelings and reactions may range from sadness to anger, fear to nausea. Thoughts are likely to take the form of "'I am not good enough,' or 'It was my fault,'" Winerman said.

Carly Mesnick, program manager of the Crime and Trauma Assistance Program at Mount Carmel Health System, teaches clients about the physiological aspects of the fight-or-flight response, which is triggered by an attack or the perception of threat.

After several such sessions — or in complicated cases, perhaps many — the trauma-related images and memories may become less intense, the feelings and thoughts more positive. The goal, she explained, is dramatically reduced emotional and physiological arousal and negative thought patterns associated with the memories, and newfound or strengthened personal confidence for survivors.

Removing treatment barriers
Winerman understands that the process with the tongue-twisting name seems unlikely and strange to some. But the therapy has caught on worldwide for its success in treating victims of many types of trauma, whether recent or in the past.

Winerman, who holds a master's in social work, has been using the eye-movement process for more than six years as a therapist in Mount Carmel's central Ohio-based program, where clients are survivors of crimes of violence including robberies, sexual assaults, human trafficking; of serious automobile crashes, possibly involving a DUI; or simply of the overwhelming toxic stress that can result from living in neighborhoods riddled with poverty, crime and fear. Most are diagnosed with noncombat-related post-traumatic stress disorder.

The therapy is entirely free to clients, thanks to support from donors, the Mount Carmel Foundation and a variety of state and federal grants.

There is no income test, no questions about insurance. "We don't even ask for an ID," said Carly Mesnick, program manager. The goal is to remove all barriers to treatment, she said. Clients who need them may even receive bus or taxi fares and interpretive services.

The majority of clients are under or near the poverty line, putting private therapy out of reach, and high-quality public programs are scarce. In fact, the Mount Carmel program, which began in 1997, is the only program of its kind in populous central Ohio.

Heightened vigilance
Mesnick oversees 11 therapists. Licensed as social workers and clinical counselors, they are trained in a variety of treatment modalities, including the longer-established cognitive behavior training, a form of talk therapy aimed at modifying problematic behaviors, emotions and thoughts. (See sidebar.) But in recent years, the program's therapists have begun favoring the newer eye-movement method, which has been shown through numerous clinical studies to be highly effective and often faster in treating trauma victims than the better-known cognitive behavior therapy. They are using it with about 80 percent of the program's clients, Mesnick said.

At Mount Carmel, clients present with a variety of trauma-related symptoms, which may include mood swings, nightmares, flashbacks, intrusive thoughts and feelings, sleep disorders, work and relationship problems and even suicidal ideation, said Mesnick, who came to the program in 2014 with a 10-year history of clinical work and management of trauma treatment programs.

The traumatic event or events may have occurred recently or in the past. "Those who suffer from traumatic experiences that happened long ago have usually had a recent trigger," Mesnick said. "Maybe they heard a song that reminded them of being violated, or found themselves in a place that reminded them of a previous assault" or face an upcoming court case involving the perpetrator. Usually it is some event that has "put them in a heightened vigilant state," she said.

"We see a high number of people who have been sexually abused as children. Some may have had a recent sexual assault, and it becomes way too much to manage." New immigrants and refugees represent a growing population in Ohio, Mesnick said, and most dramatically, the program is currently treating 13 victims of human trafficking — women and sometimes men who are often the most difficult to treat, she said.

Safety and comfort
Winerman said the first step for any kind of therapy is "safety, safety, safety." Building blocks to beginning the eye-movement therapy include freedom from present trauma and from perpetrators, and the ability to engage in coping mechanisms that help them get from hour to hour or day to day.

The stabilization period can take up to a month, she said. During this time, she offers information on available treatment modalities, including eye-movement desensitization, her preferred method because of the way it can fast-forward recovery time.

Receptivity among clients varies, she said. "Some have heard about it and ask for it. Some say, 'that sounds weird.' I tell them I know it sounds 'wonky,' but it's really effective." Shoring up their comfort level is critical because things may get uncovered during therapy that will temporarily increase their stress.

Sari Winerman, a clinical social worker, uses eye-movement desensitization and reprocessing as a therapeutic tool with clients recovering from post-traumatic stress and the effects of violence. Here, she listens to a client during a session at Mount Carmel Health System's Crime and Trauma Assistance Program.

Bilateral focus
During the eye-movement therapy sessions, a patient is prompted to recall a traumatic event while moving their eyes back and forth. This bilateral stimulation is thought by some experts to aid in quelling the patient's feelings of fear, threat and anxiety. Therapists may substitute tappers that vibrate back and forth between the client's hands or some form of right and left sound, such as alternating beep tones. Although the process is not completely understood, brain scans have shown changes in the brain following the therapy.

Winerman prefers the eye-movement method over using tappers or beeps because it provides for a closer engagement between client and therapist and has been shown in studies to be the most effective. Once the treatment begins, the intervals of bilateral stimulation and brief conversation may consume 40 to 45 minutes of an hour-long session.

In addition to individual therapy, the program provides group therapy, where clients learn more about the negative effects of trauma on their lives and the common bodily reactions that may cross over to other situations, such as the "fight, flight or freeze" response.

Ministering to the vulnerable
At Mount Carmel, the Crime and Trauma Assistance Program is one of six programs for vulnerable populations under the health system's community outreach umbrella. Mary Jo Dickinson, Mount Carmel's director of operations and community outreach, said the program is widely recognized statewide and receives referrals from numerous government and community service organizations.

The Crime and Trauma Assistance Program has strong ties to the prosecuting attorney's office, with Ohio State University's offices of student life and student advocacy, with LGBT groups in the state and with agencies that serve human trafficking victims, Dickinson said. Clients may also be referred into the program through Mount Carmel's own community outreach, which includes a street medicine program for homeless people who do not live in shelters; a mobile coach that provides health services to people living in shelters and a church partnership program.

Recently, the program added a case manager to its staff. "We learned, especially in working with trafficking victims, that wraparound services are the starting point for successful treatment. In addition to being safe from contact with perpetrators, "housing, food, medical care and job training skills are really important to stabilize clients," Dickinson said.

Cognitive behavioral vs. eye-movement therapy

Cognitive behavioral therapy is a widely accepted form of psychotherapy based on helping clients address and modify thoughts and feelings that lead to maladaptive or unproductive behaviors. It employs a talk-based approach, but unlike traditional psychoanalysis, it focuses on exploring the relationships between thoughts, emotions and behavior to address current problems rather than unconscious motives. It aims to replace self-defeating coping skills, thoughts, emotions and behaviors with beneficial ones by challenging the way an individual thinks and reacts in certain life situations. Cognitive behavioral therapy is considered a useful tool in treating depression and anxiety, addictions, and variety of mental disorders, including post-traumatic stress disorder.

Eye-movement desensitization and reprocessing is a newer method of therapy, developed in the late 1980s by an American psychologist Francine Shapiro. Shapiro discovered while walking in the woods one day and reflecting on a painful memory that her back and forth eye movements seemed to reduce its negative emotional impact. She experimented with the technique on others and found their experience was similar. Subsequent controlled studies confirmed the therapeutic effectiveness of rhythmic, bilateral stimulation, such as directed back-and-forth eye movements, in desensitizing clients to the effects of painful, unprocessed memories, and at a faster rate than any other method studied to date. The therapy caught on quickly and has been approved by the American Psychiatric Association and the World Health Organization for use in treating PTSD and other trauma-related behavioral and mental disorders.

The bilateral stimulation is thought to assist the brain in processing overwhelming emotions tied to memories, much as the eye movements during REM sleep help the brain process less dramatic events. Research employing brain imaging has demonstrated changes in the brain following eye-movement desensitization therapy.



Copyright © 2016 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.


Copyright © 2016 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2016 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.