Ep 46 - EMDR physical considerations
Hello everyone. Welcome to episode 46 of the EMDR Doctor podcast.
This week one of my lovely listeners has sent in a question for me about physical considerations, about who should not do EMDR…
Now of course you know me pretty well by now and my answer is usually ‘no-one!’ because I do believe that everyone can benefit from EMDR, but of course I am a little bit more considerate than that and there are a few things that need to be taken in to consideration. As a GP I tend to do my own informal assessment of the physical situation, so I tend to make sure that there are no indications in the health history that might flag a problem - what I am looking for there is maybe high BP, strokes, heart issues. If someone is on medication for their health, I suggest to continue taking their meds, usually this will make sure that the BP etc is kept stable enough to do EMDR. Having high BP is not a contraindication to doing EMDR, we just want to make sure that the BP is under control. So un-medicated health issues are a bit of a red flag, but if they are taking their meds and seeing a GP or cardiologist, then in my opinion, it is safe to proceed.
Sometimes people ask me about working with elderly clients, and so far in my practice, all good! I don’t think anyone is too old to deserve to have better mental health, so I work to facilitate this. I think the oldest person I have worked with was in their late 70’s, and did very well. Now I do need to mention, that this was in hospital, so we did have the extensive support of the nursing staff, which is very reassuring, so if this was in the community setting, then we may have worked a bit slower, chunked down the memories in to smaller bites and titrated it a bit, so as not to get too overwhelming. But I want to encourage all the EMDR therapists listening to not discriminate against clients due to their age, talk through the process and let the client decide, with all the information on board, if they want to go ahead, just the usual process of informed consent! And if you are a client who is worried about age, please do not be, talk to your therapist and maybe encourage them to listen to this podcast if they are worried about doing EMDR with you.
Now we do know that BP goes up with agitation, so if we are processing a difficult memory, and there is some agitation, then the BP may go up. This will eb temporary, and ti will come back down again. And we also know that ongoing stress and agitation from a history of trauma will push the BP up on a continuous basis, so in my opinion again, it is better to work on the stress and underlying agitation, and the better mental health that arises from trauma resolution will undoubtedly be better for the physical health than avoiding work ing on it at all.
Pregnancy I have talked about in a previous podcast so I won’t go in to it in detail, just to mention that EMDR is safe during pregnancy, and much easier to sort out the trauma before the birth, not wait until after, when there is a lot more to deal with in terms of sleep deprivation and lots of other family stresses. If we are considering EMDR postpartum, like for recent trauma as in medical trauma from the birth, then within reason, the sooner the better so the family can get on with the business of raising the baby without the trauma hanging around.
I will just talk briefly about epilepsy. In standard EMDR, we do use eye movements as the bilateral stimulation. So if you do have epilepsy, and your fits are provoked by visual stimuli, like flickering lights etc, then what we can do is change to a different mode of bilateral. The risk is very low, but we can happily change to use tapping, buzzies, or even auditory bilateral stimulation. So definitely speak to your EMDR therapist about adjusting the protocol, we won’t exclude you from EMDR, and we will make some small adjustments to keep you safe.
Eye disorders are a bit similar - if there is eye pain, or issues with maybe dry eyes, or irritation with contact lenses, then we can skip the eye movements and adjust to another form of bilateral stimulation instead.
Now what about surgery, how soon after surgery can we do EMDR. There really is no literature about this, but I think being sensible is step one. I would probably avoid EMDR for a couple of weeks after a general anaesthetic - just allowing the brain to recover form the sedation is a good idea. And to all owners any pain to settle so we are not causing an increase in pain from the EMDR. I do have clients who have been going through chemotherapy and radiotherapy, and have been keen and feeling physically able to do EMDR, so I do think it is a case by case basis - if you are going through some cancer treatments and want do EMDR, talk to your therapist and chat through the pros and cons. There is no hard and fast rule here, we want you to feel better as soon as possible, in all the ways, physically and emotionally, sometimes we need to wait, sometimes we need to act.
Chronic illness is a little bit the same - everyone is different. We may need to pace the EMDR therapy, it can be exhausting, may need to focus on smaller targets first, take things in a graduated manner, allow rest breaks, more time for integration. But it is also exhausting to carry a huge trauma load, and trauma can exacerbate chronic illness, so taking action to help is really necessary, and adjusting how we do it is the answer.
I also encourage the use of analgesics post session, to avoid a pain flare being precipitated by EMDR. As the EMDR therapy continues, and the trauma load gets smaller, the risk of a pain flare reduces, but in the short term, go carefully and anticipate to need to rest post session, may be more prolonged rest than applies to other, physically more fit individuals.
Alright, I hope that's been helpful. I will talk to you again next week. In the meantime, take good care. Bye for now.
