EMDR Therapy for Trauma-Related Brain Injuries
EMDR Therapy for Trauma-Related Brain Injuries
A Conversation between Lauran Hahn, LMHC and Dr. Dusty Narducci
I am thrilled to share this article on how EMDR therapy can help people recovering from trauma-related head injuries. Over the past few months, mine and Dr. Narducci’s offices have been working together to offer patients holistic and comprehensive care as they recover from head injuries and trauma. Dr. Narducci has been providing top-notch medical care and my practice has been utilizing EMDR therapy to treat post-traumatic stress disorder (PTSD) and the emotional and mental needs of the patient as they recover from trauma related to a head injury. This powerful combination of treatment fosters resilience and renewed hope for patients in the face of adversity.
An example of Narducci’s commitment to providing holistic care was evident to me simply by way of how we met. I was a Facilitator-in-Training and she was a student in EMDR Basic Training. I was in awe of the fact that she cares so much about ensuring quality care for her patients that she was willing to take time out of her very busy schedule to become trained in EMDR Therapy.
As soon as I met Dr. Narducci, I was struck by the deep care she has for her patients. She goes above and beyond to ensure her patients get all of their needs met, physical, mental, and emotional. She connects with her patients on a human level which creates a trusting and safe environment. All that she offers provides her patients with hope and healing, which leads to resilience and empowerment for her patients during a time of adversity.
Dr. Narducci specializes in concussions, sports-related injuries, athletic performance, eating disorders, ADHD, and mood disorders, and offers LGBTQIA(+)-friendly healthcare. She is board-certified in Family and Sports Medicine and a Certified Eating Disorder Specialist. Her training and experience bring a wealth of knowledge to her practice.
Over the years, as I have advanced from an EMDR Therapist to an EMDR Consultant, and now to an EMDR Facilitator, I have had the great fortune to witness so many individuals overcome PTSD and trauma. Where they were once held prisoner by PTSD symptoms, they are now free from those symptoms and have been able to make a full recovery.
As of most recently, I have thoroughly enjoyed joining forces with Dr. Narducci to help individuals heal from trauma-related head injuries, offering patients the most comprehensive treatment so that they can recover and experience a renewed sense of empowerment.
As you are reading this, we hope that you share in our excitement as Dr. Narducci answers questions about the benefits of using EMDR in the recovery process from a head injury. Doctors and Therapists, we hope to offer you a new perspective on how EMDR Therapy can expedite recovery. Patients, we hope this article offers you hope and inspiration on your road to recovery.
(Note, the terms ‘patient’ and ‘client’ will be used interchangeably throughout this article).
What is the difference between a head injury, concussion, and traumatic brain injury?
I prefer thinking of a head injury as an event rather than a diagnosis. A concussion occurs when enough force is produced from a direct or indirect injury to the head, neck, or body creating a metabolic cascade of pathological events within the brain. Often, ‘head injuries’ aren’t evaluated by trained clinicians so many of these injuries have no clear diagnosis.
The terms traumatic brain injury mostly mild (mTBI) and concussion are used interchangeably in the literature. The Veteran Affairs & Department of Defense uses concussion when communicating with patients and caregivers because there is less stigma than the term TBI etc. By definition, a concussion has no abnormalities on neuroimaging whereas a TBI often has abnormalities such as subarachnoid hemorrhage, subdural hematomas, and cerebral contusions.
The most widely accepted definition of TBI is an injury that results in one or more of the following:
Loss of consciousness.
Loss of memory regarding events immediately before or after injury.
Altered mental status at the time of the injury.
Focal neurological deficit.
GCS less than 13.
Post-traumatic amnesia of more than 24 hours.
Glasgow Coma Scale aka GCS is a clinical score to classify TBI. Complicating things more, some of the tests used to determine if an athlete has a concussion on the sideline include the GCS but it’s only one of multiple test batteries.
The literature also likes to distinguish between sport-related concussions aka SRC versus non-sport related. This doesn’t reflect underlying pathophysiological differences and is very unnecessary in my opinion but possibly helpful in research when identifying mechanisms of injury.
What are the potential psychological effects of head injuries, and how does trauma play a role in this context?
There is no concrete test to determine if someone has a concussion. It’s a subjective diagnosis based on the mechanism of injury, negative neuroimaging, neurocognitive assessment, and physical exam but most symptoms are self-reported. The psychological component of concussions is important and under-appreciated.
Our prefrontal cortex (PFC) which stores all of our memories and interpretations is affected following a traumatic event regardless of whether there was an impact on this region of the head. When we are traumatized the spindle fibers communicating between the PFC and limbic-system are on overdrive. Whether it be a motor vehicle accident, sports injury, or falling that causes the concussion this event MUST be processed correctly to prevent PTSD.
If there is underlying psychological trauma the injury could trigger emotions, images, sensations, etc. Just the vulnerability alone could be a trigger. Personally, I think that the overloaded PFC already struggles to function given the traumatic event and since the entire brain is trying to heal it would make sense that it would be even more difficult for the brain to process the event appropriately (add in baseline PTSD and oh goodness it’s a recipe for disaster).
Attention, concentration, executive functioning as well as the speed at which someone processes information following a concussion can become impaired. Often leading to more brain overload and understandably irritability, frustration, and emotional disarray. I’d like to use the analogy that all the stop signs and traffic lights stop working and drivers aren’t sure which direction to go on the road system.
What should someone expect during recovery after a concussion?
When someone with a concussion doesn’t allow themselves time to heal or that they don’t realize they have a concussion they can become frustrated that they aren’t “functioning” per usual. Sleep is often affected by concussions, either people can’t fall asleep or have fragmented sleep. Impaired sleep and mood will certainly worsen someone’s cognitive abilities.
Treatment also affects mood. Completely removing an individual from work or school is sometimes needed but almost always should be temporary. We need to use our brains or we don’t heal well. Similar to a muscle, if you don’t use it you will lose it. When someone restricts their normal life following an injury their mood can crash quickly. They seem to focus on their discomfort and how they predicted their cognitive ability before the concussion (whether this perception was true or not is unknown).
It’s very important to find a balance between physical and cognitive rest while maintaining what I like to call active cognitive and physical recovery. Withholding a concussed individual from dangerous or symptom-exacerbating movement is necessary to prevent further brain injury or delayed recovery but almost always I have them do some physical movement. My recommendations are individualized based on safety, pre-concussion activity, and symptoms. I often have people walk, use a stable bike, or do another activity that doesn’t exacerbate their symptoms or put them at risk of another injury with slow progression to their baseline exercise.
I recommend single-tasking not multitasking, socializing but not in an overstimulating environment, and slowly adding variables back in as tolerated (e.g. lunch with a friend in a white environment, then in a restaurant then at a dinner party, etc.)
What is post-concussion syndrome?
We try to use the term persistent post-concussive symptoms (PPCS) rather than post-concussion syndrome (PCS) regardless, symptoms include headaches, memory problems, stress intolerance, personality changes, and irritability are common.
Recent studies suggested that these symptoms are not specific to brain injuries but occur for all types of trauma. Additionally, PTSD and PPCS have a shared causal component in which stress plays a key role. Therefore, it was suggested that EMDR Therapy not only alleviates PTSD symptoms but can also help treat PCS and promote faster and easier recovery from concussions. This is not a general consensus not because partitioners don’t agree, but because they don’t know EMDR to be an option.
How can EMDR help with sensations related to a concussion?
The somatic symptoms associated with concussions, such as photophobia (light intolerance) or phonophobia (sound intolerance), may very well have to do with the mechanism of injury and its associated trauma rather than a true pathophysiological change in the brain. Think about a motor vehicle accident. At the time just before, during, and after the collision, there are scary lights and loud sounds. Of course, somebody is going to be triggered by this after the fact.
Most of the time doctors tell people persistent post-concussive symptoms are the reason for a person’s continued medical concerns, indeed sometimes it is but often I challenge this diagnosis. It definitely has to do with the history that the patient gives us, some medical intuition, and going against the norm. When EMDR can lessen or subside these reactions, we are removing what sensations that are considered to be related to a “concussion. “
How does EMDR Therapy help with concussion-related sleep disturbances?
A traumatic psychological and physical experience often leads to dreams, nightmares, or fragmented sleep. New trauma can bring up old traumatic experiences which contribute to sleep disturbances. Processing the trauma through EMDR lessens the body’s need to re-experience these memories when awake and during sleep. Better sleep aids in concussion recovery.
How does EMDR help with mood and irritability after a concussion?
People may become very sad, anxious, or irritable after a concussion, so of course EMDR Therapy would be helpful with this. EMDR focused just on the event or their negative cognitions regarding recovery from a concussion provides ample opportunities to aid in symptom improvement. Many patients report flashbacks of the injury or prior injuries if they have experienced such. Resolving past negative cognitions from these past injuries is fundamental in the recovery of one’s current concussion.
How can EMDR Therapy help with trauma related to ER visits and doctor visits?
The emergency room (ER) can be a scary place and it might not be explained to a concussed person what’s going on or what to expect. I recently worked with a patient and the primary focus of EMDR Therapy was the negative experiences with medical professionals over the last eight months since the injury. She and so many others I see (especially individuals, with “post-concussive syndrome or persistent post-concussion symptoms” ) report medical gaslighting and never feeling like this process of recovery is going to end.
I am very careful to label people as having a persistent or post-concussion diagnosis. This is so disempowering, we don’t realize how much damage this type of communication can do. EMDR and a fantastic psychotherapist can change the entire experience for a patient going forward or resolving a past experience.
How can EMDR help with the stress of slowing down and allowing the brain to heal?
I see a lot of clients in particular who struggle to take a step back in life, for example, someone who is a parent competitive athlete, or scholar, in a high-functioning corporate or healthcare role often finds validation in their multiple roles and successes. EMDR could be very helpful cases, especially if there is a negative cognition such as, ‘I always have to be in control of the situation’, or ‘my worth is based on how successful I am at work’, etc.
What signs or symptoms might indicate the need for a referral to an EMDR therapist for a patient with a head injury?
Any client that has persistent post-concussion symptoms, significant physical, trauma, traumatic mechanism of injury, multiple concussions, history of PTSD, frustration with the recovery process, emotional symptoms associated with a concussion and so much more will likely benefit from consulting with an EMDR Therapist.
What information should concussion doctors and EMDR therapists share to ensure collaborative and informed care?
Clinicians should investigate the baseline physical, and cognitive abilities, and history of prior concussions of the client. If there’s a learning disability, short-term, memory impairment, or mental health condition this would be important to share, but not a contraindication.
If the client has ADHD, it will be important to understand baseline symptoms and take note if symptoms worsen after the head injury. If a client with ADHD has worsening of their symptoms, then faster eye movement or other modifications to bilateral stimulation might be helpful.
Informing the therapist of any changes or additions to medication(s) as well as sleep would also be important. It’s important to know If the client is doing any other treatments, such as vestibular therapy or neurofeedback. Again, most likely not a contraindication, but could be of use.
Always a touchy subject, but whether or not the client has personal gain from being “concussed,” such as being in a court case, a motor vehicle accident, or not wanting to go to work. This is not always intentional as the ‘sick’ or ‘injured’ role is a safe place for some. Indeed an uncomfortable situation but I do think it’s very important to consider.
Are there any known contraindications or risks associated with using EMDR therapy for patients with recent head trauma?
Normal EMDR contraindications are considered, such as limited internal/external resources, not with a trauma-informed therapist, or poor grounding-coping skills.
Someone who is not able to process, after dissociation is ruled out. For someone who is not able to tolerate eye movements, switching the DAS to butterfly taps, etc. is completely reasonable. Further evaluation including a cognitive and physical assessment, and possibly imaging may be useful if the client has a history of multiple concussions and is not progressing as expected with EMDR.
A seizure type of reaction can occur at the time of a head injury. This is something we see in concussions but they have a seizure disorder or they’re at risk of going into seizures with EMDR. Loss of consciousness, at the time of injury is not a contraindication for EMDR. If someone is concerned that there is an underlying seizure disorder or amnesic disorder, then further evaluation by a concussion-informed physician would be appropriate.
Regarding the space for which EMDR should be performed, I consider lighting and sound as someone normally not disturbed by bright lights or sounds following a concussion (also common in PTSD). Sometimes when I use remote technologies to perform telehealth EMDR I can’t use both sound and movements, they may be a bit more specific about the color of the screen as well as speed, etc.
Antipsychotics and benzodiazepines aren’t contraindications but processing with EMDR might be limited in someone using these medications
Amnesia is not a contraindication but therapists should be aware that patients become very distressed and sometimes fixate about not remembering what happened before, during, or after the injury. This should be considered as some patients may try to use EMDR as a means of recollecting memories from the event if not appropriately educated.
EMDR therapy is a powerful tool in helping individuals overcome the emotional and physical aspects of trauma following an injury. Adding EMDR therapy to the treatment plan allows providers to not only attend to the physical needs but also prioritize the psychological needs of the client. This comprehensive and collaborative approach empowers clients as they overcome adversity.
Thank you to Dr. Narducci for taking the time to share the breadth and depth of this very important topic, providing collaborative and comprehensive care to those recovering from a trauma-related head injury. We are very grateful for the care and compassion she has for her patients and the generosity of time and information in preparing this article.
Learn More About Dr. Narducci
If you are interested in learning more about Dr. Narducci and her compassionate approach to working with patients, visit her website here. To connect and schedule an appointment with Dr. Narducci call 813-821-8014.
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Additional Resources for EMDR Therapy
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How EMDR Therapy Can Heal Emotional and Somatic Flashbacks
EMDR Therapy Orlando for a Recent Trauma
Orlando Therapist Explains How EMDR Therapy Works
Orlando Therapist Explains What to Expect in EMDR Therapy
Orlando Therapist Answers the Question - What is EMDR Therapy?
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About the Owner of Mindful Living Counseling Orlando
I'm Lauran Hahn, LMHC, and I'm offering EMDR Intensives at Mindful Living Counseling Orlando. I discovered EMDR Therapy about six years ago and was completely blown away by the amazing results my clients saw. I became really passionate about EMDR Therapy and decided to pursue further certification. This therapy helped them heal from so much trauma, pain, and suffering that had been holding them back.
Lauran is the owner of Mindful Living Counseling, an EMDR-specific practice located in downtown Orlando. Lauran is a certified Sensorimotor psychotherapist, a certified EMDR therapist, as well as an EMDRIA-approved consultant and EMDR Facilitator at ConnectEMDR. Currently, Lauran is currently focusing on providing EMDR Intensives to clients who want to do the deep work without having to commit to weekly sessions.