EMDR for Eating Disorders

EMDR and Eating Disorders [close up of an eye]
Photo by Amanda Dalbjörn on Unsplash

By Runjhun Pandit, LPCC

EMDR….Sounds scary.

EMDR therapy, these acronyms make it sound like a scary treatment intervention. And oftentimes, when I mention this to my clients, they feel scared or confused. They do have questions about how it works and how it is different from hypnosis.

Eye Movement Desensitization and Reprocessing (EMDR) is a treatment specifically created to help people deal with a traumatic situation. It was initially developed for veterans who suffered flashbacks and nightmares upon return from war and were trying to readjust back to life with their families. Soldiers experienced reenactment of the wars in their dreams, emotional outbursts leading to frequent conflicts with their families, inability to maintain steady relationships, and dissociation from reality. EMDR hence was developed by Francine Shapiro, Ph.D. with the assumption that eye movements could assist in desensitizing to a traumatic situation. 

The limbic system in our brain is responsible for our behavioral and emotional responses while the brainstem and cortex are the areas that help in relaying the message from the spinal cord to the brain and store the verbal story of the events in our daily lives. When a person experiences a traumatic situation–like an accident or exposure to prolonged emotional distress like abuse or neglect– the usual coping mechanism that would help the person effectively “process” the situation, goes into overdrive. And the limbic system isolates this memory and stores it in the form of an emotional and physical sensation. Due to this isolation, the cerebral cortex doesn’t remember the “story” but the limbic system sends out an emotional response when some events in the present trigger some areas of the traumatic event. Hence, even if the memory is forgotten, the emotions attached to the memory– like pain, anxiety, or body sensations– continue to trigger the person in the present. This prevents a person from experiencing new situations or from living in the moment since oftentimes some parts of the present emotionally burden the limbic system. 

During EMDR sessions, the therapist creates a treatment plan and simulates eye movements similar to the ones that occur during REM sleep by asking the client to follow their fingers. Our brain has the natural capacity to heal itself. During the session, the therapist might also use a light bar to help you track the light across the visual field. These movements last for a minute and the therapist will ask you to report any experience–such as a change in emotions,, memories, or thoughts–after each set of eye movements. By repeating this process, the traumatic memory eventually loses its emotional charge and gets stored in the mind instead as a neutral memory. Frequently, people also have smaller memories associated with the actual traumatic memory which also may get resolved along the way. It has been noted that the “healing” of these smaller memories also creates a noticeable change in a person’s life. 

Although EMDR was developed for Post Traumatic Stress Disorder (PTSD), growing evidence shows that it may also be helpful for the resolution of panic attacks, anxiety, depression, eating disorders, and negative body image. EMDR helps clients process the traumatic memory and assimilate it in a healthier way without an emotional charge. Studies have shown that EMDR can be used in conjunction with Family-Based Treatment (FBT) or Cognitive-Behavioral Treatment (CBT) since these treatments focus on the here and now of the eating behavior while EMDR focuses on the past experiences around body image or food that maintain the disordered eating behaviors. Research has shown that EMDR generates a connection between body, emotions, and cognitions by allowing the elaboration of traumatic events and simultaneously resolving the emotional blocks attached to the traumatic memories. 

A complete EMDR treatment helps the person to “walk through” previously considered traumatic events with greater emotional and impulse control which eventually leads to an increase in feelings of self-worth and self-esteem. 

Runjhun Pandit, LPCC is available to see adolescents for EMDR via telehealth. EMDR can be helpful for food-related traumas and other traumas that might perpetuate eating disorder symptoms such as bullying, body shame, and other invalidating experiences.  To make an appointment with Runjhun Pandit, complete this form

Sources

Bloomgarden A, Calogero RM. A randomized experimental test of the efficacy of EMDR treatment on negative body image in eating disorder inpatients. Eating Disorders: The Journal of Treatment and Prevention. 2008; 16(5): 418–427.

Maria Zaccagnino, Cristina Civilotti, Martina Cussino, Chiara Callerame and Isabel Fernandez (February 1st 2017). EMDR in Anorexia Nervosa: From a Theoretical Framework to the Treatment Guidelines, Eating Disorders – A Paradigm of the Biopsychosocial Model of Illness, Ignacio Jauregui-Lobera, IntechOpen, DOI: 10.5772/65695. Available from: https://www.intechopen.com/books/eating-disorders-a-paradigm-of-the-biopsychosocial-model-of-illness/emdr-in-anorexia-nervosa-from-a-theoretical-framework-to-the-treatment-guidelines

Verardo A, Zaccagnino M, Lauretti G. Clinical applications in the context of attachment: the role of EMDR. Clinical applications in the context of attachment: the role of EMDR. Infanzia e Adolescenza. 2014; 13: 172–184

Phobia Exposure Therapy

Phobia Exposure Therapy [image description: man using virtual reality goggles]

We are excited to announce that we are now providing virtual reality phobia exposure therapy –partnering with Psious. Psious is one of the pioneering companies in the development of Virtual Reality for therapeutc purposes. The Spanish company offers immersive 3D simulations designed to treat a variety of mental disorders. A multidisciplinary team of psychologists, 3D artists and engineers worked together to create the first online platform for mental health practitioners, which makes the treatment readily accessible to patients.

Exposure is a critical component for the successful treatment of phobias and anxiety disorders. Standard therapy for phobias typically includes imaginal exposure (using the client’s ability to imagine him or herself in different scenarios such as on an airplane or in an elevator) done in session and in vivo exposure (real-life exposure) assigned as homework. Virtual reality therapy offers a powerful alternative, in that exposure scenarios that feel vivid can be faced with your therapist in session. This provides many benefits including privacy and cost-effectiveness (versus, for example, taking multiple actual plane flights). Virtual reality exposure therapy is effective and it allows the therapist to customize and titrate exposures specifically for each patient.

In VR, the patient wears a headset, which creates a completely 3-dimensional, immersive virtual environment.

Below is a demonstration of virtual reality and augmented reality exposure treatment for spider phobia.

Some of the issues we are able to treat using VR include:

  • Fear of flying
  • Fear of heights
  • Fear of enclosed spaces
  • Fear of driving
  • Fear of insects

Exposure therapy is a component of cognitive-behavioral therapy (CBT) which is the leading treatment for anxiety disorders. You will receive a complete assessment and treatment plan. CBT is a time-limited treatment. Phobias can often be successfully treated in 5 to 15 sessions of psychotherapy. In addition to exposure practice, treatment also includes psychoeducation, cognitive restructuring, and relaxation training.

If you are looking for phobia exposure therapy in Los Angeles, call (323-473-2112) or email us (lmuhlheim@eatingdisordertherapyla.com) today to learn more.

How to Communicate With Your Psychiatrist About Medication

How to Communicate with Your Psychiatrist [image description: doctor holding bottle of medication and writing on clipboard]

In my work with patients who have anxiety and/or depression, I often recommend a consultation with a psychiatrist regarding medication. I believe in the value of psychotherapy; that’s why I became a (non-prescribing) psychologist. However, I find the careful use of psychiatric medications as a helpful aid to psychotherapy. For best results, you must communicate closely and assertively with your psychiatrist about your experience as you try new medications.

It is important to note that I am not a psychiatrist and do not prescribe medication, but I have worked closely alongside psychiatrists in many different settings. I continue to work with patients during the intervals between psychiatry visits. I am intimately familiar with the experiences they have when starting medication. I frequently coach my patients to communicate more with their psychiatrists.

Psychiatric Medicine: an Inexact Science

The selection of an appropriate psychiatric medication is a less exact science than is the choice of medications for other problems. If you have a particular bacterial infection, the specific antibiotic indicated for that infection should work for most people – for example, penicillin for strep throat. However, a medication that works well for one person’s depression may not work for another’s. Unfortunately, we don’t know why that is. Today, there is luckily a large arsenal of medication options from which to choose.  Because some medications work for some and not others, often it takes trial and error to determine which medication works for a particular patient.

Furthermore, the classes of psychiatric medications that are most commonly used for anxiety and mood disorders do not take full effect immediately but rather build up to a therapeutic dose in one’s brain over time. There can be side effects that many people experience before the curative effects kick in. Often patients are started on a lower dose of medication to determine the lowest effective dose as well as to minimize the severity of potential side effects caused by the medication. Further complicating the process, some patients require a higher dosage than others to experience a therapeutic effect.  For example, some may get a benefit from 20 mg of Prozac while others may need 60 mg.

When choosing specific medications, psychiatrists rely on information from drug manufacturers and research trials as well as their own clinical experience of how clients with diagnostic similarities responded to different medications.  These doctors often try to match medication and its side effects with specific symptoms. For example, someone with depression who is very tired may be prescribed an antidepressant that is more energizing, while someone with depression who is more agitated may be prescribed an antidepressant that has a side effect of calming. The side effects often also determine at what time of day the medication should be taken. More activating agents are generally taken in the morning and more sedating medications at night.

Because of the trial-and-error process of matching patients to medications and the lag time it can take to build up to a therapeutic dose, it can take several months to find the right psychiatric medication for a patient. Unfortunately, I too often see clients stop taking medications before they reach a beneficial effect due to some annoying but mild side effect that would have gone away over time.  I have seen patients giving up on medication altogether if the starting dosage of the first medication tried doesn’t help. It is disappointing when this happens because it might have worked.

If a client does not seem to respond to medication, psychiatrists will often first try increasing the dosage to see if a larger dosage produces a positive effect once it has built up, which can take another few weeks. Then if this seems to have no effect, they will usually recommend patients stop or taper the first medication and switch to a different medication, which will take several weeks to ramp up. And then, if necessary, raise that dosage… and so on. Sometimes patients require combinations of different medications, which multiplies the combinations that must be tested.

As you can see, this can be a slow and frustrating process.  Due to the period of time it takes to test the effectiveness of each medication, this can be unavoidable.

What this Means for Patients

When moving to a new medication, it is critical to follow through with the medication plan and communicate closely with your psychiatrist about both the therapeutic effects and any side effects you experience. Your psychiatrist is not a mind-reader.  I have seen many clients who notice no benefit from their medications, wait until the next appointment, which is sometimes months away, to report on a lack of progress. In doing so, they can waste precious time.

Here are some suggestions for working with your psychiatrist and maximizing your chance at more quickly finding the medications(s) and dosages that work for you.

  • Take the medication exactly as your psychiatrist recommends.
  • Keep to the regular appointments requested by your psychiatrist. They typically time these to coincide with the opportune times to gauge whether your medication is working. However, do not hesitate to call them sooner.
  • Take notes on your symptoms and any side effects so you can remember details.
  • Report any severe side effects or suicidal thoughts to your psychiatrist right away (do not wait until the next appointment).
  • Watch for signs of serotonin syndrome, a rare but potentially life-threatening side effect that can occur in response to psychiatric medications. If you experience these symptoms, call your doctor right away or go to the emergency room.
  • Make note of mild side effects (headache, nausea, dry mouth) and try to wait it out. See if the side effects subside after a few days. If not, report to your psychiatrist.
  • Understand how long your psychiatrist has told you it will take to notice a therapeutic effect from the medication. If it takes longer, report to them even if your appointment is still several weeks away. Psychiatrists can sometimes alter a prescription by phone before seeing you again, or they may suggest you come in sooner.

I hope that this information and tips have felt helpful to you. If you are considering medication, it may not be a cure-all, but it can be an incredibly helpful recovery tool. Key is communication!