Using EMDR to support healthcare workers - with Dr Michael Paterson OBE

SPEAKERS

Michael Paterson, Paula Redmond

Paula Redmond: 00:04

Hi, I'm Dr Paula Redmond, a clinical psychologist, and you're listening to the When Work Hurts podcast. On this show, I want to explore the stories behind the statistics of the mental health crisis faced by health professionals today and provide hope for way out through compassion, connection and creativity. This season is brought to you by the Association of Clinical Psychologists, the representative professional body for clinical psychologists in the UK. Join me as I talk to inspiring clinical psychologists about their work in this field and learn how we can support ourselves and each other when work hurts. Eye Movement Desensitisation and Reprocessing or EMDR is a NICE recommended psychological treatment for post traumatic stress disorder, and it's also becoming more widely used in the prevention of PTSD in healthcare settings where staff are exposed to traumatic events in their work. Dr Michael Patterson OBE is a clinical psychologist and EMDR Europe Accredited Senior trainer. In this episode, he describes what EMDR is and how it can be used to support health professionals with both recent and past events, both big T and small t traumas. He also movingly talks about his own experiences of being involved in an explosion that led to life changing injuries while he was a serving police officer in Northern Ireland, and the difference EMDR has made to him personally and professionally. I began by asking Michael to explain what EMDR is.

Michael Paterson: 01:51

Okay, well, I suppose the best way to describe it is to explain it how it was discovered because it was discovered by accident. And the story goes that Dr Francine Shapiro, who's the originator of EMDR therapy, had been having some health issues back in the 1980s. She'd been walking through a park area and realised that the thoughts that she'd been having about her health, which were quite uncomfortable, quite disturbing emotionally, seemed to have lost their impact. Then she mentally retraced her steps and she realised that as she was walking along, she was moving her eyes from side to side, and she wondered, was this something to do with helping those thoughts sit more comfortably with her. So she brought up another thought which was uncomfortable to think about, and moved her eyes from side to side for those thoughts too, they lost their impact. And she realised then that seems to be something that may be peculiar to her, or maybe would it work with other people? She went on then to ask friends and colleagues to have a go at bringing up some thought about something that was uncomfortable, move their eyes from side to side, for them too these uncomfortable thoughts seem to lose their impact as well. She realised then at this stage that she may well be on to something and she was always a person who said, if somebody comes up with an idea, do the research, and sure enough, she did. So in 1989, she published her first two papers in the Journal of Traumatic Stress. And in those days, it was called Eye Movement Desensitisation because it seemed to be a desensitisation technique. She had worked with Vietnam veterans and rape survivors, and these were people who were suffering post traumatic stress disorder. And then the studies were published in this prestigious journal. Now you can imagine, it is a quirky idea, somebody's got Post Traumatic Stress Disorder, you wave your fingers in front of their eyes, then the disturbing memory seems to lose its impact. Now imagine that landing on the desks of the great and the good in the word of psychotraumatology back in 1989, some people looked at it and said this is ridiculous, is this the April the first edition? Somebody had taken the mickey. But others looked and thought hang on, this is a very prestigious journal, it's peer reviewed, it actually tells you how to do it. So those who looked at it and were open minded, and put it into practice. Now you can imagine Paula, that instead of them picking the most simple case that they had, they picked the ones who are treatment resistant to exposure based therapies, and then they found that they were getting great results. So that's when things started to take off and the word spread and things developed from there. But with EMDR therapy, what it does is, as you know, having treated it yourself, is to target the disturbing memories that create the symptoms for somebody in the here and now. So think of it this way, when somebody has a disturbing life experience and the brain doesn't reprocess it and store it away in time and space naturally, which sometimes it can happen, then it gets stored there and on processed form. It's stuck. It's a bit like an item of clothing that doesn't go through the laundry. That say a lad of 14, he's been wearing the same underpants for five days, then decides he wants to change them. And the sensible thing would be put them in the wash basket, but he doesn't, he throws them underneath his bed. You can imagine the strains of bacteria that have been breeding in the underpants for five days. Yep. So in the heat of the bedroom, underneath the bed, that bacteria continues to breed, and of course, it smells. So the smells wafting out from underneath the bed is filling the room, it's affecting that immediate environment, the then and there, if the door of the room was left open, the smell's wafting out and going in different directions, spreading out to affect that area, spreading out to affect that area, and spreading out to affect that area too. That's very similar to loose disturbing events that the brain has not been able to process because when they occur, it affects the then and there it impacts the person at that time, it gets stored in unprocessed form, becomes a reference point. And as we go through life we'll draw on what we believe about ourselves to make sense of a situation we're in. So colours, our perception of the situation later, it affects your attitude, then our behaviour. So just as those underpants lying unwashed and are impacting the here and now, but also spreading out to affect different areas, these disturbing memories that have occurred, affect the person at the time, but also impact them later on as well. Because what's stored there feeds into the present, causes that disturbance and affects how people see themselves in that particular situation. So they may well have developed a negative belief about themselves arising from that event, something to do with being defective in some way or being responsible. And as a result of that, what does that say about them as a person? There's something wrong with me. It could be to do with safety and vulnerability, it could be to do with lack of control or choices, or it could be to do with connectedness, and belonging. And all these experiences would fall within one of those four themes, and it can affect us in the here and now. So we might feel in a social situation, shy away from talking to strangers. Or as I remember, one time going to a networking event, signed in, got the glass of wine and walked in, and I saw a guy standing up in the corner of the room so nobody could sneak up on him. And I thought himself, he's lacking confidence, I'll go and talk to him. So I went over and start talking to me, he looked, he could see me coming towards him, I could see the look on his face. And then I broke the ice and started chatting to him, and as it turned out, it was his first time there and he lacked, I could tell from just the general chat that he did lack confidence in himself. Now those circumstances, I would know then from my clinical practice that he would have had experiences, without me asking him what they were, way back in childhood, that would have laid down that negative belief about himself. So into adulthood, he's drawing what he believes about himself based on those past experiences to colour his perception, affect his attitude, then his behaviour. So EMDR therapy, as you know, and you've practised this yourself Paula, is about targeting those particular experiences that have created that current learning that affects us in here and now, adding in the eye movements as the therapy requires, and allowing the client, the person to reprocess the experience to adaptive resolution. It's like taking the underpants, taking them and putting them in the washing machine so they can be washed, then they can be dried, ironed if you choose to, and then put it away neatly in the drawer. So that's basically how it works.

Paula Redmond: 08:43

And what, because I guess many people who I work with when I start to explain it, particularly health professionals who you know, can be quite sceptical about things, find the eye movement part particularly weird, that it's not something... it's quite unusual for people who are used to talking therapies and other ways of sort of psychological interventions. What is the theoretical underpinning of that bit? Why do the eye movements help make a difference?

Michael Paterson: 09:22

There's been a more recent study in 2019 it was published in Nature. And you being, having an academic background yourself Paula, you well know that anybody who gets a study published in Nature can dine out and out for the rest of their academic career. So this is a study published in Nature by Baek et al. And what it demonstrated was that eye movements and a fear inducing situation led to a deactivation of the amygdala. Now, for those people who don't know what the amygdala is, that is part of the brain, a structure in the brain, which acts like a sentry, it watches out for things that are threatening or potentially threatening and it will sound an alarm. Once the alarm is sounded other areas of the brain release stress hormones, whenever they're activated we go into a state of increased arousal preparing us for the fight flight or freeze response. So Baek's study demonstrated that the eye movements, albeit in mice, demonstrate that the amygdala then switched off, became de-aroused. And we learned from that, that this event is no longer a threat to us. So that was a groundbreaking study, but there'd be lots of other studies done prior to that. One, Pagani and colleagues and in Italy, and they demonstrated that the eye movements lead to calming off the hemispheres of the brain, leads to greater inter hemispheric synchronicity. So the EEG on one side of the brain is equivalent to the EEG on the other side, so it leads to greater calming. Going further back, then we had the thought of this was creating an orienting response. And if you think about the orienting response, moving your eyes from side to side, because we're scanning the environment for threat. And if the person who's listening just now, if you're listening, and a if you imagine there's something out in your peripheral vision, what would you do? You would look to the site to see what it is, is it a threat to your survival? So by continually scanning the environment, with the eyes going from side to side, we're learning that there's nothing threatening in the room where we are with this memory activated. Another thought, and it's been tested as well, is that by doing the eye movements, we tax the working memory. Now working memory has a limited capacity, from people from a psychological background, will remember it's a number of little boxes seven plus or minus two. And in that as seven plus or minus two little boxes is where we process things in, in our immediate environment. In the old days, for example, it was epitomised by looking up a telephone number in the telephone book, and then going over to the phone to dial it. And so you're repeating the number, repeating the number, but if somebody says something to you, it's gone. That was our working memory. And what happens is that whenever the disturbing memory is activated, it fills the working memory. And it can feel as if it's happening again, in the here and now, as if we are back in that situation. By doing the eye movements, what that does, it uses a part of the working memory to do that task. And by doing that task at the same time as linking into the disturbing memory, it reduces the space available for the disturbing memory to sit. By reducing that space available, it helps us learn this is old stuff that it's in the past and that it can get stored away in time and space. So once that little piece of information gets stored away in time and space, then another piece comes in off the memory to fill its spot. And then we continue to reprocess that, that goes into the long term store, another piece comes in. It's a bit like standing on a tennis court, the other side of the court, there's a serving machine firing a ball at us, then we hit the ball back, another one gets fired at us, we hit that back, another one, we hit that back too. And so it's continually getting pieces of that memory feeding into the present, being reprocessed, getting stored away in the long term store, then another piece comes in, and so on and so on until that disturbing memory is reprocessed and it's no longer disturbing.

Paula Redmond: 13:26

And I'm wondering if you could tell us about how EMDR has been, and is being used to support health professionals, frontline staff?

Michael Paterson: 13:36

Well I suppose a good example was during the pandemic, health professionals were at the front line, as we well know. And they were used to a certain number of people getting very ill, a certain number of people dying, and that was within the realms of things they coped with. But with an increased number of very ill people and then had the chance to practice, having to be covered in plastic, be hot themselves, be uncomfortable, putting their lives at risk, and then more people dying as well. It often taxed the resources that the health professionals had. And if it went unchecked or without any help being offered, then it could have been totally overwhelming and the resources that we had available would have been depleted. It's like soldiers on the front line. So what happens then, so we need them to fight the enemy and if there aren't enough soldiers to fight the enemy who's going to win? The enemy. So similarly, in the pandemic, then it was important then to support health professionals so that they could get back in to do the role that they were doing. And EMDR had a role to play very much in that. And when we think about, for example, a health professional in that setting, and people are dying more than what they were used to, taxing their capabilities, what would that say about them as a person? For some people, it could be I'm not in control. For others it could be I'm not good enough. But what they have learned about themselves in the past has fed into that situation to colour how they see it, it affects our attitude and then their behaviour. So as a result, some people may have been more resilient than others based on the past experiences that they had had in terms of maybe adaptive experiences, and unprocessed experiences. So EMDR can be used in the full standard protocol. But what can happen is, whenever we do, then there is a chance that the person linking into that more recent experience, could then connect way back to the childhood experiences, which for some people could be overwhelming. And we could think about all of us being on a continuum of complexity. If you could imagine your hands apart about maybe half a metre, and your left hand, these are the well adjusted people who have had very positive experiences during life and very few life disturbing experiences. And generally things have been processed for them, Where the right hand is, about 50 centimetres from that, these would be the most complex client presentations, some of whom have had horrendous experiences growing up, it could be abuse of different sorts, emotional abuse, physical abuse, sexual abuse, neglect, and in and out of the care system, and so all sorts of difficulties that they could have had then they cope with them as best they can, they could well be functioning as a health professional, because a part of them knows how to do the job and do it well. But if we were to use the standard protocol for those most complex clients where the right hand is, then they could be totally unzipped emotionally, and fall apart. So there's versions of EMDR designed for recent events, and for keeping people contained. And we can use different forms of restricted processing with EMDR therapy, ranging from the most restricted, which is going back to Shapiro's original model of EMD, eye movement desensitisation. So we can use that and it keeps the person contained, linking into say, the covid situation by focusing solely on that, and preventing them from going down those other channels that could lead to the earlier memories, then it keeps them contained so that they can process that and get back into the working environment again. There's less... slightly restricted reprocessing, where we can allow the reprocessing to go a bit further, but then keep the client contained, basically ring fencing the target memory that we want, but would depend on where the client would be on this continuum of complexity. The well adjusted clients, well you could certainly use the standard protocol with them and they could link back to earlier experiences and stay very much contained, staying within what we call the window of tolerance. A window of tolerance, it's like setting your hands, one, let's say the right hand down at the bottom, and the left hand up above that, there's a gap in between. So above the left hand, that's the hyper-aroused state, below the right hand, that's the hypo-aroused state. And if the person was into the hyper-aroused state, or the hypo-aroused state, then they're not connecting to the memory, and the therapist working with them has lost control of the situation. So the idea is to keep the person within this window of tolerance, not hyper-aroused and not hypo-aroused.

Paula Redmond: 18:32

I guess, I guess that's one of the challenging things, because I know when I trained in EMDR, and my understanding of it is around, you know, was around treating PTSD, I guess. And, you know the, we usually think about PTSD as a post traumatic stress response and the diagnostic criteria are that symptoms have to last for over a month. And I guess, you know, it's usually the idea that it's something that has happened in the past, you know, often a discrete event that is done with and then it's continuing to, you know, disturb people and be very distressing. And I guess with the pandemic, and I suppose, you know, that also wasn't even a discrete event, you know, the the fallout is still being experienced, that there is this really difficult situation of people being exposed to intensity and duration of trauma. And that being very difficult to live with, but also needing to go back to it, that it's not something that is in the past and you know, left behind, that there's continual exposure to that. And I guess I'm wondering if that is what's fitting in with some of these, these other ideas around the application of EMDR. That we're not needing to wait until a traumatic episode is finished in order to intervene helpfully.

Michael Paterson: 20:18

Absolutely. And there was a study done in 2008 with children in Palestine, Zaghrout-Hodali and colleagues. And what it found was children who'd been traumatised in Palestine, some of them were taken out of that, the area and treated with EMDR therapy, and it was found that once they returned to the area, then they were at greater resilience compared to the children who weren't treated with EMDR therapy. So whilst the experiences were still ongoing at that time, in 2008, then those who were treated with EMDR therapy had greater resilience to face challenges later on. Whereas the kids who didn't, weren't able to as well as those ones. So it is something that can be can be used to create greater resilience in situations where things are ongoing, such as the aftermath of the pandemic. So I would certainly see that as having a role to play there. We can use a recent events protocol, and there's different variations of that, and Francine Shapiro herself came up with recent traumatic events protocol, which is taught, I certainly taught in the EMDR Institute courses that I would teach. And it was discovered, apparently, after an earthquake in California. So Shapiro was trying to use the protocol that she had developed, but found it, if it was within three months of the incident occurring, that the way she had worked with longer term trauma, then it didn't seem to be working as effectively. She realised then there were a number of sub traumas which were occurring, which had occurred as a result of the experience of the earthquake, but they all connected together. But they were standalone in their own right. So each of them had to be treated as a separate target for reprocessing. Then once they'd all been reprocessed separately, then she was able to connect them together, run through a mental movie of handling this situation, and then noticing any disturbance and reprocessing that then. So that is one, and a few others is Elan Shapiro has come up with the recent traumatic events protocol, then a group traumatic events protocol. So the group traumatic events protocol, which I think you did the training in Paula, if I'm not mistaken? And you may recall, it is a bit cumbersome about having to fill in different forms and different colours and things like that. So imagine that in a war zone such as Ukraine, or a number of police officers in a situation, and they're working in past traumas, then it is a bit cumbersome, and so that you want something which is perhaps a bit more manageable. There's current research ongoing with one of my colleagues has been involved in that, and it's looking at a using a more abbreviated version of the group traumatic events protocol. And the results they've got so far are quite promising. So watch this space.

Paula Redmond: 23:31

So we've got EMDR, which is the kind of classic, you know, standard protocol. Then we have EMD, which is a much more contained version, as you said around, so that we're not opening up too much, we're being really focused. And I guess that's often I think, useful, especially if you've got a limited number of sessions, you know, you've got a shorter timescale. And then we've got the R-TEP, which is the recent traumatic events protocol. And then G-TEP, which is the group traumatic events protocol. So lots of acronyms and different formats, but they're all centred around this idea of the standard protocol. And I wonder if you could just tell us, you know, for those who don't know what we're talking about, what that is and how, you know, the importance of that?

Michael Paterson: 24:35

Very much so. Well, what we operate by using EMDR therapy is what's called the adaptive information processing model, which holds these past experiences that create that learning which feeds into the present, causes that disturbance for us and affects our attitude and then our behaviour. So we have the past events. We have also present triggers which are things in the here and now which connect where that information is stored, feeds into the present, and the past becomes present to affect our perception, our attitude and our behaviour. Then we have the client's desired outcomes for the future. So we have that three pronged approach of past, present, and future, and we'd have to work with that. There are also eight phases, I have to be careful how I say this because with a Northern Ireland accent, it sounds like eyt, so I have to say eight so people can understand me! So it's got eight phases and it starts with history taking and then moving on to stabilisation. So with the history taking, we have to understand what's the client presenting with, and then what experiences have they had in the past that feed into the present to create that disturbance for them. And it involves taking a very detailed history, from conception up to the present as well because the foetus in the womb isn't necessarily immune from ongoing trauma, such as could happen when you're there, because stress hormones can cross the placenta and affect the development of their central nervous system. So we've got the history taking, then we have stabilisation and preparation phase. So this is phase two, it can last from as short as maybe 10 minutes for somebody who's at the healthy end of the continuum of complexity, the well adjusted clients. to months and months and maybe even over a year, or longer for somebody who's at the most complex end. So if somebody says how long should you spend in it, well, it depends. How long is a piece of string? It depends on the client, it has to be client led. But once we have identified our targets for reprocessing, and our client is stable enough, we've got a wide enough window of tolerance, remember the window of tolerance with hyper-arousal, hypo-arousal, if the client is able to stay within that, then they're ready to start reprocessing. And then in phase three, we link into the target memory in a controlled way. It's a bit like, to think about it use a tree and as a metaphor. It's like loading up the train and with the passengers. So they're all on board, and the guard locks the doors, blows the wistle, waves the disk, so the train is ready to leave the station. That's phase three. Then of course, once it leaves the station, the client moves into phase four, which is what we call the desensitisation phase. And that's whenever the reprocessed experience to what we call adaptive resolution that we're looking to have the client be able to tell us it's no longer disturbing. It doesn't bother me, kinda neutral about it. So that way, it's like the train moving down the track from A to B. In Ireland we've got the train that moves from Dublin. So Dublin Connelly station heads north towards Belfast, going along the track through different stations through Drogheda, Dundalk, Newry, Portadown, arriving in Belfast. So similarly with our clients doing the reprocessing, it is a journey and there is a destination. And once the client is able to say, well, I'm in Belfast, I can see the sign that says Belfast, that's how we knew the train has arrived. Similarly with our clients reprocessing, we're able to say, no doesn't bother me. So that way we know they've arrived at that point. That's phase four. But remember, we've got eight phases. So Phase five is installing a positive belief the client has said they would like to have about themselves. We have identified this in advance and phase three, but we revisited and then strengthen at this stage to allow that to consolidate, more sort of generalise for the client too. Once we've got that to its highest level of belief for the client, then we can move on to checking the body. Bessel van der Kolk wrote a book and it was published in 2014, it's called The Body Keeps the Score. Superb book if the listeners are would be interested in reading it, it's an easy read published by Penguin circuit you can pick it up and read it with a cup of coffee, but superb information in it, great teaching too, so excellent book and the Body Keeps the Score. So the body does keep the score and it's often the last thing to shift. And so we check to see is the body clear of any residual disturbance related to the traumatic event. Or we also want to check is the body congruent with the past experience, but also the positive belief they would like to have about themselves. So once we've done that, that's phase six now. Phase seven is closure. So you have phase seven for every EMDR session, we close it down, we make sure the client is grounded at the end of each session. And then we've got phase eight. Phase eight is reevaluation because we need to check that the treatment gains are maintained whenever the client comes back, and we want to find about has the client been able to implement these changes that have occurred into their lives and also in the the systems in which they exist, such as a family system, such as the work system. So those eight phases and the three pronged approach all connect together to help us use this adaptive information processing model.

Paula Redmond: 30:05

And I think what really struck me in in learning and practising EMDR is that there is this very standard way, it is a protocol, you, you know, follow the steps. But I found it just remarkable what goes on within that in terms of, you know, you're really following a client's leads, you know, you're allowing them to go where they need to go and it can be just amazingly creative, and it always, you know, it's always surprising. And, yeah, I don't know if that's your experience as well that you've got these two things of kind of this very structured approach, but at the same time, it allows for some magic to happen somehow?

Michael Paterson: 30:53

It certainly does. And the beauty of it is that with the reprocessing, the client's reprocessing will go where it needs to go for the healing to occur. We used that train and metaphor of the train going from Dublin heading north to Belfast, but it might actually pull out of Dublin Connelly heading north, but then heads down southwest down to Limerick. Then it goes northwest up to Galway, up the west coast, across the north coast and down to Ballymoney, Ballymena, Antrim and then arriving in Belfast. So it does arrive at the destination, but might take a circuitous route. And by allowing the train to go where it needs to go, that means the client will link to what they need to for that healing to occur. And they could link to other memories, which they didn't think were linked to it. The reason being memories are stored by association. So similar memories will connect together. And as the client does the reprocessing, they can link to those memories, and then link to another memory, another and another and so on. And, but they will go where the need to for that healing to occur. And by us, as the therapist sitting back sometimes, keeping our mouths shut, which is maybe often the better thing to do, using two ears and one mouth in that ratio, then it allows the client then to connect, because if we jump in too soon, then it could interfere with the reprocessing. Think about the train and move it along the track, it could send it up a different track and into a dead end. By us staying out of the way, as long as new material keeps coming up for the client, we can go with that. But there will be times of course, and you were alluding to that Paula, is that whenever the train's moving along the track, it will come to a stop. And there are things that we can do as the therapist to get the train and moving again, we can use what we call the cognitive interweave to give the train a nudge to get it moving. And that's whenever our creativity can come in to help the client connect to the next piece of information that they're not linking to spontaneously. So we as the therapist will remain attuned to our client, and what I've seen so often is that whenever I would do the set of eye movements and say the client pause, have a breath, what do you know this now? In my mind, I know what they're going to say. And so often they tell me what I'm thinking that they're going to say, and then we go with that, do another set. So that's the beauty of the EMDR reprocessing being attuned to our client. So it's not a case of just following up step by step, like step one, step two, step three, step four, we are going on that journey with our client. A lovely quote I heard, it wasn't one of my clients, but it would've been nice if it had have been, 'my therapist is the bannister on the stairs that I climb'. And I thought, yeah, that's us, because we are there as that support. It's a client who's going on the journey, but we are there supporting the client as they do that, alongside them.

Paula Redmond: 33:43

Yes, and I think what, the other thing I've noticed working with health professionals in particular is that, you know, I think and I, you know, resonate this myself too, you know, I think health professionals, we spend a lot of time in our heads, you know, a lot of thinking. And I think that sometimes traditional talking therapies can be in danger of getting stuck in an intellectual process. And I think EMDR manages to cut through that and, you know, people can really get in touch with their bodies, you know, with imagery, with the sensory experience of those memories and of the distress in a way that maybe either isn't possible in other approaches or takes a very long time, and I've certainly found that with health professionals that it's, you know, a kind of... feels quite remarkable for people to be able to get in touch with those parts of themselves, which they're often not used to accessing.

Michael Paterson: 34:52

Exactly, and EMDR can be seen as an integrative psychotherapy, and what I would say to people on trainings with me Is that what you're already familiar with, you will see an EMDR therapy. So for example, somebody who comes from a cognitive behavioural background, they will see shifts in cognitions and emotions. Somebody from a schema therapy background will see shifts and schemas, somebody from a psychodynamic background will see free association, they're going to see catharsis, therapists from a bodily therapy background will see shifts in bodily sensations. But as they say, to the therapist training and EMDR therapy, if that, if all you're looking for is what you already know, that's all you're going to see. So do open your mind to the other things that are there, because it is integrative and people will see those similarities to what they already know.

Paula Redmond: 35:46

And I guess we've touched on the fact that EMDR is now being used and more as an early intervention type approach and some of the applications of that relevant to health professionals. What else do you think the future might hold for this, for this field?

Michael Paterson: 36:04

I think there's huge potential. Because in the workplace, so many things can occur from humiliation by a boss, and maybe even inadvertently, the person perceives it as being put down when actally others would say there wasn't an issue, the boss can be 'What? What what did I do?', and but again, it could be tapping into those early life experiences that the person has had, that colours their perception, affects their attitude, then their behaviour. What I see so often, in many different therapists as well, on the EMDR trainings, that they would, if they experience EMDR therapy themselves and on the training, and they can choose something which is an issue for them, maybe an excessive need to get things right or an excessive need to get things to be in control. But that can often tap back into experiences they have had earlier in life, which create the sense of there's, I'm not good enough. And put somebody in the workplace in for a team meeting, they have to speak to the group and they shy away from it. And once they're activated, feeling anxious, it impairs performance, as we well know. The hour just stops and no one tells us this, I learned that in the early days of psychology, which indicates that just a little bit of arousal, which is not not anxiety, but a little bit of arousal, a bit of excitement leads to enhanced performance on a well practiced task. But too much arousal, such as anxiety will lead to a decrement in performance on a well practiced task. So even the person in that work environment, who knows their stuff, who knows how to present, once they're anxious, it goes out the window. So EMDR can be used effectively in those circumstances, those are sort of the minor T the smaller T events. But where we have people in the workplace who are exposed to threat situations, such as being caught in a machine, a client who I saw one time had been caught in a machine at work, so they'd got severe injuries and burns. And as a result of that, then it was off work for a prolonged period of time, he came along, this was more than three months later, so it's using the standard protocol, having taken his history as well, and then targeting that particular experience, he was able to reprocess it so much so that he was able to get back into the workplace and doing similar type work, but not necessarily that same job. I see so often working with retired police officers and some serving police officers too, then there can be a buildup of experiences over time. It's a bit like children's building blocks, one on top of the other, they're stacked up, and up to a point that pile of building blocks is going to sit quite stable, add a few more blocks, it now gets a bit shaky, and then all you have to go is whoosh, and it all folds over, or add another block to it, it all folds over. And the block that you add to it doesn't have to be a particularly large one. It could be quite something quite small in the grand scheme of things. The the old saying the straw that broke the camel's back, it can tolerate a certain amount, and then just one tiny bit more, it all falls down, and has that impact. So in those circumstances, EMDR can be used very effectively. Now, where there's multiple traumas like that, will it get the person back into the workplace and doing the job they were doing before? Possibly, but it could be by that stage they've had too much. So if it can be used earlier in the experience, after each event, identifying which events are disturbing to the client that they're not able to reprocess and store away in time space, then picking up on them and helping them reprocess and at that time, then that will lead to as we know from Zaghrout-Hodali's study with the kids in Palestine, it leads to greater resilience when they're faced with later situations as well. So if we can create the greater resilience, all the better, they can face more situations, but then emptying the bucket of the dirty water after each time would be the important thing.

Paula Redmond: 40:17

Yes, that is so important, because I think people and particularly again, health professionals, you know, I think we kind of bind to this idea that, you know, something really bad, like, one really bad thing must have happened in order for you to be experiencing a trauma response. And I often am talking to people about exactly what you've described, although I'm going to, going to steal your metaphor there, it's lovely about, you know, being a build up, and you know, that maybe the thing that left you, you know, crying in your car that morning, not being able to get out of the car to go to your shift seems very minor, and so people then just struggle to make sense of why are they feeling so overwhelmed when, you know, something small and silly happened? But being able to see the bigger picture. But also like you were describing about those, you know, those, those other things that are very commonplace in, in an organisation like the NHS, of those, you know, the humiliations, and, you know, bullying, and you know, racism, sexism, all of the exposure to that, that can be hugely impactful, even when it's not recognised by other people. You know, if you are caught in a machine at work, everyone's going to, you know, know that that was a traumatic thing, but if you're going in every single day, being humiliated, when everyone tells you, you're just making a fuss, that's much harder to put together and to ask for help around.

Michael Paterson: 41:54

It certainly is, and I think if the the person who's in that situation can notice their body, that'd be the important thing. Now, listener, if you're just listening to this now, if you can, if you just pay attention now to the sensation of the floor beneath your feet. If you're noticing that now, were you noticing that before I asked you to pay attention to it? Probably not, most people don't. And the reason being, we tend not to notice our bodies, but if we would start noticing our bodies and being aware of how our body is responding in certain situations, it could be a great indicator, a good barometer about how that situation is affecting us. An example of that, a number of years ago, I worked at the police rehabilitation and retraining trust in Northern Ireland. This was with retired and retiring police officers. And I was using EMDR therapy, working on significant trauma, this is horrendous things that they'd seen and dealt with, through the course of the Northern Ireland Troubles. And it was exciting from an EMDR therapists point of view, because I was, I was making a difference, I was loving it, every minute of it. But I noticed one day as I was driving into work, I felt a knot in my stomach. So I thought, 'Oh-ho-ho, Michael, the body's talking here, what's this telling you?'. So there was, it was telling me that there was this buildup of experiences. So I was feeling I'm invincible, I'm brilliant at this, and I was getting good at it, I must say, but the body was telling me it's now having an impact. So much so that I went in and spoke to my boss at that stage, very experienced colleague, Desmond Pool, now deceased, unfortunately. But he was, Desmond was a great proponent of EMDR therapy in its early days. I said to Desmond, that I think there's difficulties for us working in this field, he totally agreed with me. So we then were got something in place for us to have EMDR therapy on what we were picking up, what the experiences were tapping into for us. So it led to me, not only dealing with the past experiences that I've had in terms of trauma myself as a police officer, but also, then the earlier life experiences that fed into it so much that now, I can say that I've dealt with my major traumas, but also the smaller T events as well. And very rarely wherever I ever find a trigger for that now, so I'm pretty chilled and comfortable in myself now thanks to EMDR therapy.

Paula Redmond: 41:54

So there's that thing about how useful that is for supporting us with vicarious trauma and the risk of that, that we hold.

Michael Paterson: 44:31

Very much so.

Paula Redmond: 44:33

And I wanted to ask you, Michael, as well, because I know that you, you know the title of this podcast is When Work Hurts, and you've had your own experiences of being hurt by work. And I wonder if you could tell us about that?

Michael Paterson: 44:52

Well, yes, I mentioned just a moment ago there that I served in the police in Northern Ireland, the Royal Ulster Constabulary and 1981, I was 24 years old and married for three weeks and two days. So beautiful, autumnal day, 20th of September, and out on patrol in West Belfast. And Alec Beck, who had trained six, started his training and policing six weeks before me, so I knew him from before that, and then in the back was another chap and a second vehicle behind us. We were on a two vehicle patrol in West Belfast, and there was an IRA attack on our patrol. A rocket propelled grenade, what thay call an RPG, was fired from an alleyway. And as we had, Alec had slowed down the vehicle to go over a ramp, and then the rocket hit. But there seemed to be a long time before anybody came to our aid, and I found out afterwards that we were being shot at. So the idea, it seems, was the IRA mounted this attack, fired the rocket to immobilise our vehicle, and then they'd wanted to shoot the police officers getting out of the second vehicle. But they had sat tight, something didn't seem right, and then the crew commander there said, sit tight, so they sat on until the immediate threat had passed. But I was taken to hospital, and then when I was in hospital in emergency treatment, and then up into surgery as well. So I had a period then of being unconscious, there's a lot of activity around me, and I was concerned that somebody would tell my wife, Hazel, and was saying will somebody tell my wife, somebody tell my wife, and people rushing about, and just life support was the main thing. But a nurse tuned and said, I'll tell her what's her number? So like, I should have known that my colleagues would have contacted her and said something's happened to me. But at that moment, it was the furthest thing from my mind that just somebody needs to tell her. But I remember waking up in the intensive care that night and sitting there or lying there, and I knew my arms were were amputated, but they didn't know that I knew. So there was a bit of a dance ongoing about do you, have you been speaking to the doctor? Oh yes, I was. And what did they say? They said you're a bit cut up, you're going to be okay. I said, they don't know, they don't know. Now it was kind of obvious, they could see it, but my mind the way it was at that stage, probably lots of morphine in my system, and they don't know, I have to tell them. I said, Well, do you know I've lost my arms? Yeah, we do. Oh, that's alright then. So then I started chatting. And it was pretty relaxed, just chilled. I think the morphine was high enough, it seems. So I had that experience, which I carried for a number of years. And every time I spoke about the experience I noticed a knot in my stomach. And when I did my EMDR part one training in 1998, we had to work on a trauma in those days, and it was a trauma with a maximum SUD, a subjective view and a disturbance of seven. So I said, yeah, well, that's probably a seven. But I never suffered PTSD, thankfully, but was able to work in that particular experience. And as I was reprocessing with EMDR therapy, the image faded, the feeling in the body, it was it was staying there and started feeling more distant but I could feel that sensation in my stomach, focused on that, kept moving in the eye movements. And then I felt something moving up through my body, from my stomach up, and next thing, tears start to gush down my cheeks. I had had tears of frustration, after it happened, and anger and everything else. But this was tears that I then remember the last time I cried those same tears, and thst was 17 years previously lying in hospital, my leg was strung up in the Thomas splint and traction, and the swelling had gone down, and my arms had been chopped off, we could see the extent of that. A nurse was doing the dressing on my leg, because there was an infection, there was a risk of losing it too. But as I saw the extent of my injuries, just something clicked, and I started to cry. But she in a very maternal way, put her arms around me and held me close to her. And a very soothing, again maternal way, like my mum would have done when I was a child. And in those days, my mum would have said to me, there there, big boys don't... Of course, Paula, you could finish the sentence, couldn't you? So Michael, as the wee boy then, wanting to be a big boy, stop crying. So that's what I'd learned then, whenever that nurse held me close in that maternal way, as my mum would have done, is a learned response, stop crying. So the tears got locked in, back in 1981. And they were released in 1998 with EMDR therapy. And it's fair to say that EMDR changed my life personally with that experience and other things as well that I reprocessed, but also it's changed my life professionally, because not only would I have been making that difference in people's lives, it gives me such pleasure now and training other mental health professionals to deliver EMDR therapy and deliver it well, so they can go out and make a difference in people's lives too.

Paula Redmond: 50:09

Thank you for listening. If you've enjoyed this episode, please support the podcast by sharing it with others, posting about it on social media, or leaving a rating or review. I'd love to connect with you, so do come find me on LinkedIn or at my website, and do check out ACP-UK and everything it has to offer. All the links are in the show notes. Thanks again and until next time, take good care.