Facing Past Trauma, Part VII: Can PTSD Therapy Help Us Manage Our Bipolar?
This is the seventh in our conversation on past trauma. We left off with the proposition that the PTSD diagnosis is far too narrow to encourage us to seek treatment for traumas that emerged from surviving a miserable childhood or from various abusive relationships or horrific but “everyday” events. This despite the fact that past trauma looms large in bipolar, so much so that it begs the obvious question:
Shouldn’t standard treatment for bipolar also include treating the trauma that may be driving the illness?
Unfortunately, the bipolar experts do not seem to be talking to the trauma experts. In the seven multi-day psychiatric conferences devoted exclusively to bipolar that I have attended over the years, not one speaker, to my awareness, brought up treating trauma. The same is true regarding endless bipolar sessions I have sat through at psychiatric conferences.
My impression - judging from several PTSD sessions I have also attended - is that the PTSD experts share a similar isolationist point of view. Thus, Freudian-era talking therapy aside, we are flying in the dark about applying PTSD treatment to bipolar. You’ve been warned:
The flavor-of-the-month for treating PTSD is eye movement desensitization and reprocessing (EMDR), developed in 1987 by California psychologist Francine Shapiro. The treatment has been empirically validated in numerous studies, is recommended in numerous clinical guidelines for treating PTSD, and is supported by the military and VA in treating soldiers. Nevertheless, the discussion regarding its practice and theoretical underpinning is nowhere near settled.
In two NY Times blog pieces from March this year (The Evidence on EMDR and Expert Answers), Dr Shapiro sought to clear up some of the confusion. PTSD, she says, represents a failure of the brain processing information stemming from a disturbing experience. Instead of forgetting the event the way we might forget what we ate for dinner last night, the incident is stored intact, along with any negative emotions, easily revived and relived. Dr Shapiro believes that the event need not equate to combat. Hurtful childhood experiences will do the trick.
What distinguishes EMDR from other therapies such as desensitization therapy and exposure therapy is that the patient focuses on a negative experience while tracking a moving object with his or her eyes. As the session progresses, the patient transforms the stuck memory into a learning experience and an adaptive resolution. Thus:
For example, the feelings of shame and fear voiced by a rape victim at the beginning of an EMDR session may be replaced by the feeling that she is a strong and resilient woman.
According to Dr Shapiro, eye movement in EMDR appears to simulate the eye movement in REM sleep, the dream state where the brain processes survival information. Like REM sleep, the eye movements of EMDR may facilitate the transfer of the bad memory and its emotional and physiological baggage into mainstream semantic memory networks, free of negative associations.
Another theory is that the dual-tasking of EMDR taxes the working memory to the point where the bad memory becomes less vivid and emotional. A number of studies support both theories, but Dr Shapiro acknowledges that further research is needed.
For recent trauma, eight sessions of EMDR is standard, administered by a licensed therapist. But for childhood abuse and its manifold complications, about three times as many sessions are required to achieve the full benefit.
Okay, back to the warning: The measure of success for EMDR - or for that matter any trauma therapy - is in reducing PTSD symptoms. It stands to reason that resolving underlying trauma should make one’s bipolar a lot easier to manage, but we have no hard study evidence of that.
One more warning: One should not delve into potentially destabilizing bad memories - even with a qualified therapist - until one’s bipolar is fully under control.
Be smart. Do your homework. Live well ...