EMDR Therapy and Concussion/ABI

Episode 18 April 28, 2022 00:53:45
EMDR Therapy and Concussion/ABI
TBI Therapist
EMDR Therapy and Concussion/ABI
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Show Notes

Bonus, a re-air from Hope After Head Injury! Have you wanted to learn about other therapies for concussion or acquired brain injury?

This week on the podcast I talk about EMDR and we have a re-air of a podcast from Cristabelle Braden’s podcast, Hope After Head Injury. I link the original episode on her podcast here:
https://hopeafterheadinjury.com/hopesurvives/

I thought you would get a ton of value from listening to her questions.

You can also hear me talking about EMDR here on a therapy focused podcast: https://thingsyoulearnintherapy.buzzsprout.com/

All the trauma things last week! Finally, I co-authored a blog…I will get it up on my site when I get some help with that!

Until then, check it out on Veronique's blog: https://www.weirdwonderfulbrain.com/post/emdr-processing-trauma

I also provide this therapy in my clinical practice in the state of Maine. Spend a week (or a couple days) with me in beautiful Freeport, Maine and heal from the trauma of your injury. www.newlifeofmaine.com.

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Episode Transcript

Speaker 0 00:00:01 Hello, survivor squad, Dr. Jen Blanchette here. It's been a minute since I've talked with you on the podcast, I have been going round around traveling, also dealing with sickness in my house. I had COVID last month. So dealing certainly with that and, um, sick children. So we took the masks off here in Maine, and I found my children have been pretty sick. So luckily everyone is relatively healthy and I think we're gonna be okay. And I know that's not the case for everyone. So my heart goes out to anyone who's struggling with law on COVID or struggling with or long lasting brain injury symptoms. I, my heart goes out to that as well. So I hope you're enjoying spring or whatever season it is in your country. I'm loving seeing daffodils here and this first signs of spring, which is great. So today on the podcast, I'll introduce, it's a different type of podcast because it's a re-air of a podcast that was heard of an interview of me on hope after head injury podcast. Speaker 0 00:01:17 And that podcast is with Christabel Braden. So let me just give a little intro from, for Christabel and her podcast. So the hope after head injury podcast was created by TBI survivor and advocate Christabel Braden on her podcast. She talks about the journey through head head trauma. And that is a road that when walked a loan can be very scary and lonely. She interviews people with lived experience of brain injury, caregivers and professionals weekly. So I was lucky enough to be one of those professionals who was featured on her podcast just recently. So this podcast today is her interview. It's a re-air of her podcast. So I really thought that'd be great for you guys to hear it on my podcast, because I talk a little bit about EMDR. So what is that? So EMDR and I talk more about this in the interview is I movement reprocesing in desen as a E M D R desensitization. Speaker 0 00:02:30 And reprocesing my brain reverses those two ladders almost every time, even though I've done this therapy for eight years. So just fun things that brains do, right? <laugh>. So anyway, that I'm gonna leave that blooper in there because I know you guys enjoy those. I talk a little bit about this therapy and why I think that I've noticed in my clinical practice, how I've seen changes for folks with EMDR therapy is that I don't think the trauma of your brain injury or of a brain injury is addressed most readily with therapists, doctors, really a lot of people. So I think I see a lot of my folks who come to me for psychotherapy and my clinical practice struggling with trauma related symptoms. And that makes a whole lot of sense. For many survivors, there was a felt sense of life or death with their brain injury. Speaker 0 00:03:31 So felt sense, or it was actually a life or death situation. So in that situation, you are in with your brain and injury, you might have potentially lost your life. And it doesn't even matter if you did, did have that threat or believed in your body that that threat was there. Trauma symptoms can still persist, even if you know, oh, well, it's not like I was hurt that bad. It was just a concussion. I, how many times I've heard that and still the body remembers and has trauma symptoms. So just because it was quote unquote, just a concussion does not mean that you won't have trauma from it. So I encourage you to think about what are those symptoms of trauma and do I need to receive trauma treatment? Is that something it's lingering after my brain injury? So, you know, I kind of fell into trauma treatment. Speaker 0 00:04:27 I was always interested, you know, coming through my training, but it's what I started working with survivors at neurore rehab. I, I had a felt sense that there was more than just C, B, T, or mindfulness or D B T. And I'll kind of unpackage what I'm talking about. So C B T is cognitive behavioral therapy. And in cognitive behavioral therapy, we look at the interaction between thoughts, situations, and emotions. And it's very helpful. It's a very helpful therapy for depression, anxiety, but it doesn't often look through the lens of the nervous system. And I think more and more therapies are looking at how do we have a whole body perspective, which would include body sensations, emotions, thoughts. So it prompted me to look at a different model for true reading, my clients who are in front of me. And I found that starting to do EMDR and I do it differently than a lot of clinicians do it because, you know, eye movements, you might think this sounds like vestibular therapy. Speaker 0 00:05:36 Well, I don't want the eye movements to induce symptoms. So for many of my clients with concussion, I won't use eye movements in EMDR. And some people are like, well, what is it then? So EMDR has a component to it called bilateral stimulation. So we're accessing both sides of the body, both sides of the brain. And some thinking in the trauma literature is that adding this bilateral tapping or movements can be helpful for staying present. So feeling like you're a one foot in the present moment and one foot in your traumatic experience. So it doesn't feel too overwhelming. That's one, that's one piece of it. So we wanna keep you more present, potentially both sides of the body, adding something tactile can be helpful. So I will use usually tactile stimulation. I haven't so much used auditory bilateral stimulation. So that would be like putting headphones on somebody and giving like tones on either side of their ear. Speaker 0 00:06:42 Most typically I will have someone hold what is called athero taper. And it just is like a light buzzing in the hands. And it'll buzz on at each side. Some of my brain injury clients couldn't even tolerate the buzzing. So I've had them do light tapping or even I had, I remember one person that would just kind of like rub each so shoulder as we went through the traumatic experience and that's what they needed. So I think there is license to be creative and think about what each client needs after a brain injury to help them process through the, at trauma. So that's a little bit of my thoughts on EMDR. I talk more in the interview with crystal bell. So I'll, I'll definitely link that her original airing of that podcast, I'll put that in there. I had another podcast come out the same week, which I didn't realize all this would happen. It's like tr it was like week for me. <laugh> so anyway, I had another podcast come out with Dr. Beth Tramel, who has a podcast called things you learn in therapy. And there I talk about EMDR and I talk a little bit more about my life too, about how I tennis and I'm pretty competitive sometimes. And I also teach Zumba classes. Speaker 0 00:08:07 Yeah. So we talk a little bit about that, but also deep dive into EMDR. And, uh, that podcast was meant for therapists. So if there's any professionals that listen to this podcast, that might be a great one for you to listen to. I love Krista bells because she's a survivor and she kind of asks those, those survivor specific questions. And the third thing that came out last week was a blog that I co-authored with a survivor of encephalitis. So the blog is the weird, wonderful brain, which is a wonderful topic for a head injury blog. And we talk about trauma EMDR, her own experience of trauma after ENCE encephalitis and her acquired brain injury. So she talks a little bit about what that experience was like for her in therapy. She was not my client. So I, I co-authored with this article with her based on her experience with a different therapist. And then I add in some information about the therapy. Speaker 0 00:09:18 So I hope you'll check one of those out. And I'm lucky enough that crystal ball was so gracious to have me re-air this episode, which will be coming up next. Certainly check out my interview with her, which was back in March. So let me know if, uh, you, you guys, what you thought about it. I wanna hear from you also, if you're interested in potentially coming to do EMDR therapy with me, you could do that. So if you have the ability to come to the us, or if you're in the us and you can come to the beautiful state of Maine, my practice is located in Freeport and I do EMDR intensive therapy with folks after a brain injury. So certainly reach out to me if that would be something you would enjoy and you thought think would be helpful in your brain injury recovery, then you can come see me in person actually. So check this podcast out from Christabel and I'll talk soon. Hi, everyone. Welcome to the TBI therapist podcast. I'm your host, Dr. Ly shot, where we explore the heart of brain injury Speaker 2 00:10:37 Today. I'm here with Dr. Jen Blache and she is the host of the TBI therapist podcast. She also has over 10 years of training and experience in brain injury therapy and neuropsychological testing. She is wonderful, and I am so thrilled to have her on today. Thank you for coming on here, Dr. Jen, Speaker 0 00:10:59 Thanks so much. It's great to be here and to meet you via zoom. Speaker 2 00:11:04 Yeah. Speaker 0 00:11:05 Somewhat live <laugh> Yes. Pandemic life here. Speaker 2 00:11:10 So do you wanna share a little bit about yourself and what you got you interested in brain injury recovery? Speaker 0 00:11:16 Yeah. My story is a little bit of a wonderer. I stumbled into it and I think it found me versus me finding it. So some people I know some professionals are like, yes, I wanted to work in brain injury, or they had maybe a family member who had gone through the experience, but I think it was serendipitous for me that it found me. So I was at a crossroads in my career. And, uh, I actually had about a year off where I was, I didn't have a placement for my postdoc because of the last economic downturn, as a longer story, we probably need to go into in here at any rate, I was cold calling a neuro rehab center and just hopeful that I could get this post-doctoral placement. And I was pumping Beyonce, you know, hoping that they would like me. And I think what they really wanted was a therapist. Speaker 0 00:12:07 So I had a lot of group experience and really, I had sat with a pain of people and a lot of the people coming into that program wanted to do neuropsychology primarily. So testing and working on memory and compensatory strategies and going crazy with that. But I was really focused on more of the therapy end of it. And that's what they wanted. And that's what I really did. I did neuropsychological testing too, but primarily therapy sitting with the pain of people that have gone through these difficult experiences. And I was just really shocked that I didn't know as much about the population from my training. So it was just a, so I, I had my doctoral degree at that time and I really didn't know a, uh, brain injury. Of course I studied it a little bit, but it was just an immersion really. And learning about what people go through, what it looks like, what it feels like, what families go through, which was a whole nother layer. Speaker 0 00:13:09 A lot of times I'd have family members in and I thought to myself, why aren't we treat them too, because they're struggling so much with what they're going through with their injured loved one. So that was a piece of it as well. I learned a lot from my supervisor. Of course, he was really, really helpful. Had been in brain injury work for about 30 years and also just learned a lot from other special, so speech therapist, I didn't know what they did either, honestly, not, not much at all in the brain injury world. So I learned what their role was OTs role was PTs role was, and we co treated together and I just loved that experience of different professionals and what they're seeing and tried to help them on the whole versus, okay, there's a memory issue. You do that. And physical issue. I do that. We're looking at the whole person, okay, all this stuff is going on in their life. How could we as a team come together and help them with this problem? So that was, that's a little overview. I don't know if there's any parts of that that you want you talk about or any directions. Speaker 2 00:14:21 Yeah. Well, I think it's great. And I would love to actually ask you a little bit about the difference that you would see between neuropsychology and therapy, because, you know, when you think about neuropsychology, there's neuropsychological testing, like you said, but I I'll just share a little bit of my personal experience. I've seen neuropsychologists for over 10 years. I have seen different. Um, I had one, then they retired, then I got another one kind of situation. And, you know, it was sort of like therapy, but they would talk to me a lot more about strategies for my brain injury and talk about things like that. And more recently, I had gone through some trauma in, in other ways. And my neuropsychologist actually said, I think you should get a trauma therapist that specializes in that because he didn't feel like he could really speak to that. Speaker 2 00:15:21 I, um, was in an abusive relationship a couple of years ago. I'm so sorry. I went through, um, some things like that. And so that would come up in my sessions, but I couldn't, you know, he, he, he, he kind of was directing me that, Hey, you might need someone else. So I started seeing another therapist and that specializes in trauma, but doesn't specialize in brain injury. <laugh> so, you know, um, a little tangent there, but I just wanted to ask you, what are your opinions on that? Or, or what do you see on the cross ver between neuropsychology and therapy and what's the difference? What should people be looking for? Speaker 0 00:15:57 Right. Right. So sometimes you will find a unicorn who, a person who is a neuropsychologist who has been trauma trained and has a trauma modality. And I'll define what those are because I'm people are like psycho B, what's happening. <laugh>. So sometimes that will happen while you have your neuropsychologist can do that. But primarily a neuropsychologist is a clinical psychologist like me who has undergone specific training and neuropsychology. So their internship and their PO post doctoral residencies and their schooling will be all specific to the brain and not just brain injury, but other types of issues that might occur in a brain. So I didn't do the two years post after, you know, to get that training and to get that certification. But I still do neuropsychological testing. So clinical psychologists can also do the testing, but I'm not called, I don't have the distinction of being a clinical neuro psychologist. Speaker 0 00:16:55 So those folks typically do testing. So they'll primarily do testing and they will work on strategies. They'll give you strategies for memory compensatory, you know, whatever school strategies going back to work, all kinds of different things. So they tend not from my experience to do as much therapy, although some of them enjoy it. And they do that. My supervisor was a clinical neuropsychologist and he did. So he provided maybe five hours of therapy a week or something like that because he enjoyed that piece. So for me, I went out after my post doc and then I just did therapy 100% of the time. And I found, I kind of stumbled upon, okay, what do these folks really need from me in therapy? They need trauma work. So I knew that I needed to be trauma trained. And so the Mo the modality or the type of therapy, that's another way of saying type of therapy. Speaker 0 00:17:50 Therapist will say modality is EMDR. And that's an evidence based trauma therapy that we use with folks who've been through something traumatic. What I've found with concussion and brain injury survivors is every single client has had a trauma, their brain injury event, or those, if that surrounding their brain injury has been traumatic for them. Do all of them have PTSD? No, but I think all of them have experienced some level of trauma. And I'm just gonna cite a little bit of research here. So about 10 to 20% of people with PCs postconcussion syndrome, you knows, sorry. Back up, back up. So about 10 to 20% of folks who have a concussion will develop PCs of that 8% or about half of folks will have PTSD. So potentially half of people who have post concussion syndrome really have trauma. Um, and that may be really what they're dealing with after their concussion, or it could be a piece of what they're dealing with after their concussion. And that when I saw that research study, and I'll give you that research study, you can link it in the show notes. It just really took me aback that I know people aren't receiving the trauma treatment they need, and it's impacting their, their symptoms of concussion and everything. Speaker 2 00:19:14 Yeah. Thank you for sharing that. And I think it's so valuable. So when you talk about, you know, they have some sort of trauma, can you define, like, what is trauma? Speaker 0 00:19:25 Sure, sure. So what, and I'll just, I'll make these into two distinct. So a trauma, if we're looking at a clinical diagnosis, we'd say something that's a life or death experience, something where you felt like your body felt like you could have died from that event. And I know your story. So that certainly qualifies <laugh> because your body at least knew or felt like you may not survive that event. It doesn't really matter if you were close to death or not close to death, it's what the body feels and what the body recognizes. So that would, that's what we call a big T trauma. So that would look like a car accident that could look like a, a domestic assault where you felt in danger, your life felt threatened. Speaker 0 00:20:18 That could look like, um, event of war, childhood trauma. So lots of different, I won't name all of them, but those are just some of the big T traumas that look at that potentially could have someone diagnosed with PTSD. Post-traumatic stress disorder. Now, these other traumas, what I call little tea traumas. They may not be a life or death event, but in the body, the body feels like I'm in danger. And oftentimes I encounter that with folks after concussion or brain injury. When they tell me I went to the store and my heart was racing, and I felt like I had to get out of there. And I said, yep, that definitely happens because your body doesn't know the difference between something that's dangerous and it feels very dangerous to you. And that's actually dangerous. So all those signals are mixed up. Yeah. Speaker 2 00:21:11 That's so good. Like the symptom overload can feel like trauma, you know, I definitely, I know like I've, I've been in, this has happened so many times where thankfully less recently, but I've been in public and I have gotten scared because I've gotten confused. I'm not sure where to go. I'm I'm by myself. I don't know where I am. I forgot what I was there for. You know, there's been times that I've been like, afraid, like genuinely scared. Like, you know, what, what do I do in this situation? Where to, why go, you know, or when I was younger after my brain injury, like if I was in a store and I couldn't see my mom, I didn't know where she was. I got scared. I would get scared. And, and, you know, I, I, I was 14 when my brain injury happened. So, you know, I'm like a teenager, a 15, 16 year old, you know, and store, nobody would be like, oh, that's a lost child, but I felt like a lost child. You know? So there's so many times that, you know, I, I love how you distinguish between like the big T trauma of like the incident or something really major that may have happened. But then there's also a lot of different types of trauma that maybe comes out of as a result of the injuries. Speaker 0 00:22:31 Right? Yes. And I see that all the time and I tell some people even say, well, it's not like I was in a car accident for folks. Who've maybe been concussed from a fall. Like you, I mean, yours was a type of fall. I remember you mm-hmm Speaker 2 00:22:47 <affirmative> yeah. I've had multiple. Um, yeah. Speaker 0 00:22:51 Okay. Yeah. So they might say, well, it wasn't like a trauma and I tell them, yes, it was, it was, it doesn't matter. It's whatever your body determines, if it felt like if it was life or death. And one of the, the best books that kind of explain this in the body is the body keeps the score by Bessel, Vander Coke. And that book really talks about that. Everything is stored in our body with regard to trauma. And if we're not working through the body, if we're just all up in here in our head, we're, we're not gonna get better. So doing all the strategies that help our body heal is really important. Speaker 2 00:23:31 Can you explain maybe what some of those might be? Speaker 0 00:23:33 Sure. Yeah. So I, so one way is doing trauma therapy. So I do a therapy called EMDR and I don't do eye movement. So if you're seeing this video, oftentimes when we do EMDR, when we're processing a trauma, I might, I have someone follow their, my hands with their eyes. So oftentimes I do tactile with my folks with concussion, because that's Speaker 2 00:23:55 A great idea. Cause Speaker 0 00:23:56 <laugh> Speaker 2 00:23:59 Yeah, yeah. That's like vision therapy all, and that that's gonna cause a, a little teach trauma right there. Speaker 0 00:24:05 <laugh> it might totally might do that. It might cause you to be symptomatic. Yeah. So I'll typically have them learn something like a butterfly hug where they're, you know, linking their fingers and then they're tapping on their collarbones. And most people can tolerate that. I find, and it's bilateral both sides of the body, both sides of the brain. And also we're, we're helping you have that memory and feel safe at the same time. So that's what needs to happen. You need to feel like I'm safe now, even though I didn't feel safe then, so that's kind of our goal in trauma therapy to have the body know it's over, it's not happening anymore. It's not happening right now. And there's could fusion with that. I think a lot of times early post-injury like, am I gonna hit my head again? And so the trauma reaction comes up because if you've had a re-injury or you've had a bump on the head, it's a trigger for trauma too, not only your symptoms, but your trauma symptoms, your concussion symptoms and your trauma symptoms. That was a little confusing there. Does that make sense? Speaker 2 00:25:06 Yeah. So when you say concussion symptoms and trauma symptoms, so we know we might know what brain injury symptoms are, as far as you know, we talk about that a lot on the podcast, as far as like headaches over stimulation, light sensitivity, vestibular mm-hmm, <affirmative> autonomic dysfunction. You know, there's a lot of, um, different types of brain injuries symptoms, but what is a trauma symptom? And what could that look like? Speaker 0 00:25:31 It looks pretty similar because we're talking about the autonomic nervous system. So in, in trauma therapy, I'm often talking about when you're feeling your heart is racing, when you've been triggered, when you see, okay, let's, let's like a, a real life example. It's much easier to think through that. Let's say it's a car accident. And every time you get back in your car, your heart starts racing. So your autonomic nervous system starts to go haywire. Your heart is racing. Your hands are sweating, you're clammy. And oftentimes with PTSD, we have increased sympathetic. We have all kinds of nervous system bells going off. So that's happening. Speaker 0 00:26:13 You have emotional numbing that we see a lot of times, which again happens with concussion. People have a numbing of emotion because things are very overwhelming. And so they tend to isolate and retreat. We often see that with PTSD, hyper vigilance and reexperience is also reexperiencing is one of the other hallmark symptoms of PTSD. So having flashbacks or having memories of your brain injury event for example, is a symptom of PTSD. And I can link, you know, if people want some information about PTSD and what that looks like, I can link that for you for folks. Speaker 2 00:26:51 Thank you. Yeah, that would be great. Speaker 0 00:26:54 But they, what I, I think what is important to know is there's a lot of overlap and I think it's a piece of the puzzle that a people aren't addressing and may really help in their concussion recovery. And there's a little graph that I can also include that I put up on Instagram of that overlays, PT, PCs, post concussion syndrome, and PTSD. And there's a lot of overlap in like a VIN diagram that I have. Speaker 2 00:27:24 Yeah. That's great to know. And you know, I think when you're in it and you're going through it and you have like a moment of overwhelm, it can be hard to determine like what's the cause of it or what's the root cause of it, you know, especially if you are having autonomic dysfunction from the brain injury. Sure. Is it purely physical or is it trauma related? You know, how, how do you, how do you work on that distinction with your patients? Speaker 0 00:27:55 I think you don't Speaker 2 00:27:56 Okay. Speaker 0 00:27:57 You don't because we don't know for sure. So if it looks the same, if it it's kind of like, if it walks like a duck, it talks like a duck, you just kind of treat it. So if you know that they're having memories of their concussion and that's disturbing, there's distress in the body, when you remember your concussion event, then we do the trauma work. So you don't no longer have that distress and that should help your concussion symptoms. Because when you go to the store, for example, if that's thing that's stressful, or when you go in the car, for example, then you're not gonna have that level of distress like you had before. So I think telling if it's concussion or PTSD is, is not really possible, it's just, okay. If I know I'm stressed out about this memory, there's probably reasons to go through trauma therapy to work on that memory. Speaker 2 00:28:50 So when you say PTSD, is every trauma trigger going to necessarily be PTSD D or is that like a different distinction or diagnosis? Speaker 0 00:29:02 Sure. Yeah. And again, if we're looking at that research study was saying that maybe half of ECS folks could have PTSD. That doesn't mean that everybody has that full clinical diagnosis. However, a lot, a lot of people could benefit from the trauma therapy, even if they don't meet like the full criteria for PTSD, you still have a traumatic reaction to your brain injury event or to a distressing event, then it could be helpful to work on that event. Does that make sense? Speaker 2 00:29:34 It does. Yeah. Okay. So when you say work on it or work in trauma therapy, like, what does that mean? How do do that? You know, it, it sounds overwhelming and maybe really hard <laugh> Speaker 0 00:29:47 Well, my goal is always to make it never feel hard, make it always feel manageable. So we're always making it manageable. And I wanna keep you, keep you in something called the window of tolerance. So if we have have a window and I'm making a window with my hands, I always want you to feel like you are fully present with me here. And then maybe you have one foot here and one foot there in the memory and one foot in the present. So if you get too far out of your window tolerance, then you feel overwhelmed. You feel like your head's spinning. Maybe your concussion symptoms are start. So I never want someone to feel like it's overwhelming. So the first part of trauma therapy is always about what are we basically, what are we gonna cover? And then working on resources to help you feel grounded, help you feel safe, help you feel present. So that's always the first part. And so I never say, let's talk about the worst thing that's ever happened to you never, ever do. I do that as a trauma therapist, I say, okay, we're gonna go about this in a very methodical way. And I'll be with you the whole time. It's like, you're riding on a train in first class and we can always pull like the stop pull. I'm thinking of like a train pool where you pull and you can just stop that train <affirmative> and we can go at your own pace. Speaker 2 00:31:07 That's good. Speaker 0 00:31:08 Yeah. So it often looks like, I mean, there's, there's eight phases of EMDR, so I really do the EMDR model. And again, that's a whole nother discussion. I could probably do a whole podcast with you on what, what that trauma therapy looks like, but essential way, what needs to happen is you need to learn the skills to basically regulate your nervous system. Things that a lot of people are learning in their concussion journey anyway. So mindfulness, deep breathing, having a practice of centering your body and yourself grounding skills. And I can define any of those. If you'd like me to define any of those, please Speaker 2 00:31:45 You go through and define them. I think that would be super helpful. Speaker 0 00:31:48 Sure. So a practice of mindfulness or deep breathing, so being able to engage your parasympathetic nervous system. So our autonomic nervous system is broken up into the sympathetic. That's the one that's a fight or flight. So that's, that's, what's activated when we're feeling, or basically when we're in a stressful situation in the grocery store. I always use the grocery store as an example with my concussion folks, because that's a really overwhelming place for them or with, with driving anxiety after an accident often I'll talk about the car, cuz that's a stressful place too. So that's when you wanna get out of the store or that when you want to run. And the parasympathetic nervous system is basically our calming piece of our nervous system. And I think in trauma recovery, I also have people think about the, the freeze response. So a lot of times our parasympathetic nervous system will shut everything down and just cut everything off. And I often hear that from concussion clients that say like, I just shut down. I just couldn't do anything for the rest of the day. I was like, yep. Your parasympathetic said we're done and it's nap time or we're done for the day. And that could be due to concussion or trauma or both, or the combination Speaker 2 00:33:06 Because the concussion, I I've been diagnosed with dysautonomia. So it's dysfunction of the autonomic nervous system. So the doctor said basically like the concussions, the brain injuries has caused me to my, to be like stuck in the fight or flight response all the time, basically. So it's like, you're, there's different. And I have another episode of my podcast previously Onno for anyone listening that wants to learn more. But, um, I'm not a doctor. I can't explain it as well as, as, um, somebody might, but when it to somebody who has autonomic dysfunction from their concussion, trying to, you know, this, this might be a really good way to cuz a lot of times they say like exercise helps with that. And that's a great medical tool to kind of help with that. Of course, that you can tolerate. Again, I did an episode on exercise tolerance, you know, sub symptom threshold exercise, but that can help with your autonomics. But you're talking about how mindfulness and breathing helps with your autonomics as well, because autonomics are also triggered by trauma. I'm just thinking out loud, I'm trying to like, yes, Speaker 0 00:34:16 You're, you're Speaker 2 00:34:17 Comprehend what you're saying. <laugh> Speaker 0 00:34:19 You are right on. Yeah, you're right on. So, and I just wanna, so I wanna it's both. And so okay. Speaker 0 00:34:25 With the moderate exercise, of course we are learning more and more how beneficial, moderate, cardio and exercise is for inflammation. So looking at that metabolic cascade that happens in concussion, we need that inflammation to move through. And so the exercise helps with, with that. So the moderate exercise, and also I think having some retraining with your parasympathetic nervous system for the mindfulness and the deep breathing can help. We never want our nervous system be to be stuck in one state. So we don't wanna be stuck in sympathetic. We don't wanna be stuck in parasympathetic. So it's not the goal to say, I just want you to chill and like breathe all day. <laugh> cause that's, that's not reality. That's not the life we live in. When I, when you're in the car, you need your sympathetic nervous system because you might need to jerk that wheel to make sure you make a good choice if someone's coming close to you. Speaker 0 00:35:21 But we wanna have that natural, a toggle where we're not stuck and sympathetic. If someone cuts us off in a car that we can kind of take some breaths and be like, okay, I'm safe now. And I find those words, I'm safe now, is it really helpful for the nervous system too, to realize this is over, I'm not in the car anymore. I'm not in the grocery store anymore. I'm in my car. I'm or I'm okay. I'm back home. I'm in a safe place. And I can relax because if we're not giving those messages to our body, our body is thinking we're in a dangerous place still. And DYS anomia adds another layer to what happens with PTSD. So I'm not gonna say that just breathing is going to be helpful for that. That's you're gonna need to see your doc and see what other therapies that they're gonna recommend for DYS anomia. Yeah, Speaker 2 00:36:13 That's a great answer. Thank you. So, uh, before we kind of went and to this tangent, you were talking about the different things that help in trauma therapy or EMDR. So you mentioned mindfulness breathing. Um, I forget what the next one was. Speaker 0 00:36:28 Oh sure. Yeah. So mindfulness and breathing can really help. There's been some really good evidence for yoga. So doing some yoga Nera, which is a relaxing type of yoga, it can be helpful. Um, body work. So having some kind of body work done. So whether that looks like massage or acupuncture, or even doing some, some self, like I know people have foam rollers and they'll do some foam rolling on their own. And that's usually been instructed from a physical therapist that they'll learn those, those skills in PT. And then they'll do that self body work on themselves. So I'll defer to my physical therapy experts for that kind of stuff. Uh, let me just think mindfulness yoga body work community is really important. So really trying. And I know that you're crystal ball, you really are a believer in community. You make community wherever you go. It seems like <laugh>. Speaker 0 00:37:38 So I, I do believe we heal and community and I always encourage anyone I work with to find the people that they can be seen by that they can be known by because that is so essential to healing. I think what's been one of the biggest issues with recovery from trauma or concussion in the pandemic is isolation. That's been a real struggle for a lot of the folks, including myself. I think we've all felt that that struggle with being more isolated and what that's meant to who we define ourselves as now. So I always encourage that way to stay connected to people, even if it's challenging, even if it's hard work, even if it's the last thing you want to do that week, it's so important. Speaker 2 00:38:29 Yeah. And that could look like attending your local brain injury support group, or if they're not meeting in person going on zoom, even if you don't feel like it. <laugh> Speaker 0 00:38:39 I know, you know, Speaker 2 00:38:40 I, I have my zoom group once a month and we have a number of people that come and keep their cameras off and listen. And I tell them, that's wonderful. I'm glad you're here. You know, we, I never expect people to participate, but even just coming and listening and being part of it, it reminds you that you're not alone. Speaker 0 00:38:58 Yeah. I've heard from a number of survivors. I'm not a survivor myself, but when they have been with other survivors, it's been so powerful because they feel so isolated. And when they come together, it's oh my gosh, they understand my emotion and my feeling and they get it. It's so hard, but I feel so much better that someone saw me and saw my struggle today. So I find that so, so important. I'm just thinking through some other things with trauma therapy that I think about right now, and you can ask me a question I Speaker 2 00:39:31 Ponder. Yeah. Well, I just wanna say one thing about the community. I think yes. Going to a brain injury support group is, were helpful, but also you need friends, whether they have a brain or not like, and sometimes it's really, really hard to find. Not sometimes it is hard to find good friends. <laugh>, it's hard to find good friends. Um, it's hard to find a good friend and you know, sometimes you don't know how do I, if you're lonely, you don't know where you go. Like, how do I find a friend? And then if you have friends, you know, it can be hard to invest in those relationships, especially with the pandemic and you know, being overwhelmed. And, you know, I just can't take another zoom meeting kind of, kind of thing, but it's, it's worth it to even have like short conversations to check in with people, um, to just continue to foster that relationship. Even if you don't have the energy for a long conversation, you know, just a short call or a text can go a long way in maintaining friendships. And, um, you know, because like you said, community it's so, so important. Speaker 0 00:40:43 It really is. Yeah. And I, I it's, it's this, this tension I often feel with, with the folks that I work with of that work that needs to go into those relationships and their ability to put that work in because yeah, they're recovering from a brain injury, so it's harder too, to do many things. And so that work often seems insurmountable. So I do like to bring it in, like, what can you do? What can you actually do this week? Can you send a text? Can you do maybe a 30 minute phone call, audio, whatever you can do to kind of start to make that connection and bridge and find the things that worked before, you know, who were the friends that you really connected with before this. And sometimes those work will continue to be your people and sometimes they won't. Unfortunately. Yeah. And that can be part of the grief journey. I think that happens with losing part of your circle after brain injury at times. Speaker 2 00:41:45 Yeah. That's so, so good and so important. And that's traumatic in itself too. Like losing a good friend, you know, that's that you, you thought was a good friend that Doesn't seem to understand or be there for you and learning how to let go of that. And it's, it's, that's challenging in itself. Speaker 0 00:42:06 It is. It is. And I think we don't have a social script for those types of losses, brain injury, or a loss of a friend, because you're so different from each other now. So the things they're interested in, perhaps aren't things you're interested in now, and that might be a result of the injury. And I think looking at that as sometimes we just have these relationships in life that are shorter. And I, I think if we can approach those relationships as that was good for me in that season, and that's not serving me well now in this season. And of course acknowledging the loss and acknowledging those emotions that you have about that relationship. But it's, it's things sometimes I, people don't understand in, in the brain injury world about people they're not in the brain Andre world rather. Yeah. About what happens. Speaker 2 00:42:59 Cause it's so multifaceted and so hard to understand and explain. And like you said, like that tension between like, I want this friendship, but I don't have the energy, you know, or the ability, even sometimes I don't have the cognitive ability to reply to a text. Like I don't have the words or there are times that my fingers, aren't like, it's hard for me to type my motor skills. Like, especially if I'm really tired. And so, you know, it's, it, it can be, it can be a challenge, but kind of going back into our, our conversation on trauma. So you said things that help was the mindfulness breath, work, yoga, some sort of movement community mm-hmm <affirmative>. Is there anything else that stands out to you that helps in the healing trauma healing space? Speaker 0 00:43:50 Yeah, I mean, and certainly going through the trauma therapy itself and, um, re do saying that overwhelm and the sympathetic reaction that's happening with that memory and that happens in the trauma therapy. And some people get through that naturally. So some people are able to process that through naturally. So whether that be through strategies, strategies that they've had, or they can go on like a grief walk and kind of hold that memory and they can process, process that stuff on their own and not everybody needs it, but I think it's there and it's an option for folks if they do need it. Speaker 2 00:44:29 So finding a therapist that specializes in trauma to help you go through it. Speaker 0 00:44:35 Yeah. I think finding a therapist that specializes in either an EMDR therapist or, um, a C P T therapist, these are two types of trauma therapy that are evidence based. What's Speaker 2 00:44:47 That second one, Speaker 0 00:44:49 Cognitive cognitive pro processing therapy. Speaker 2 00:44:52 Okay. And that's different than C BT cognitive behavioral, Speaker 0 00:44:56 Correct. Speaker 2 00:44:56 Different. Okay. I just wanna cuz we're audio podcast here. I just wanna make sure we're very clear about what we're talking about. CP. Speaker 0 00:45:05 I know there's there is like a psychological alphabet I'm giving you <laugh> Speaker 2 00:45:08 Yeah, no, that's fine. It's it's good. It's important to learn, especially for someone listening, who's going, Hey, maybe I need to find somebody, you know? And um, So yeah, so EMDR or CPT cognitive processing. Um, Speaker 0 00:45:25 Yeah. And I would say with the, I'm not trained in CPT, so, you know, I take this with a grain of salt, but I see, think that does tend to be more of a auditory processing and cognitive type of therapy. So you're kind of verbally talking about the trauma where EMDR, you're noticing your body, you're noticing your emotion. Okay. The negative thought and what you'd wanna think. And then you just kind of run seen. So I find that more of a experience or experiential or embodied therapy where we're moving through the body versus C P T again, I, I shouldn't really make the distinction if I'm not <laugh>, you know, train in the other model. Yeah. Speaker 2 00:46:07 That's super important cuz I mean, you've been explaining EMDR this whole time, but it helps to explain to people like that's actually a type of therapy that uses more body movements and things to help you work through it. So different things work for different people. Right? Speaker 0 00:46:25 Yeah. And I know a lot of people have done Ft, which is a tapping I'm not trained in that therapy, but a lot of people have found and that's been helpful. Okay. So Speaker 2 00:46:36 I've also done biofeedback, um, at, through my neuro the neuropsychology and uh, I remembered she, she would, you know, have me wear a, a, what do they call it? The thing on your finger that does your pulse and pulse socks. Um, yeah. And she would like monitor and I think she put on other things too on me, but basically like we would talk about certain things and she would have me like monitor how I felt and help me get to know my body's responses. Cause I was having a lot of anxiety and it kind of helped me to be, I only did it brief time. It wasn't something I did for a long time, but those months that I did it, it helped me to be more self aware of when my heart would start to raise when my body would start to feel certain ways when I would be, get, start to get anxious. And she taught me some techniques on how to calm myself down. So that's like the biofeedback, it it's different than neurofeedback too. Yes. Um, but I, I did the biofeedback and it's um, SIM similar, I guess in concept, as far as helping you understand how your body is reacting to trauma. Speaker 0 00:47:50 Right. Right. So from my understanding, I'm again, I'm not biofeedback trained. I don't believe they reprocessed trauma through biofeedback, but it's a, Speaker 2 00:47:58 We didn no, Speaker 0 00:47:59 It's a great tool for nervous system regulation. Yeah. You're learning. Okay. My heart and my, if I'm thinking about the grocery store, my heart's racing. So can I notice that and then watch my numbers go down, watch my heart rate come down. So once you can see those numbers and your ability for your body to do that, it's basically retraining the nervous system to be able to self-regulate. Speaker 2 00:48:21 Well, and for me, like I was so not self aware <laugh> cause like you're with the concussions of brain injury too. Like sometimes you have a hard time being self aware. And so it, it kind of helped me to actually realize that I was feeling this way when I wouldn't even before have been able to put into words that my heart was racing. I wouldn't have even noticed, honestly, they would, I would have all these symptoms, but I wouldn't notice them happening until it's too late and now I'm crashed and I don't know why. So <laugh>, you know, but when you're talking about EMDR therapy, you're, it's, it's specifically about processing through trauma specifically. Speaker 0 00:49:04 Right? So whatever memory it is, you would try to hold, let's say it's a car accident. We're gonna have that memory of the car. We're gonna hold that memory. And at the end of the therapy. So when you hold that memory, maybe you're like a seven outta 10 distress level at the end of the therapy, we want you to be zero. So you have that memory and there's zero distress in the body just gonna fix my earbud. So there's zero distress at the end, again, thinking of the memory than having you feel like you're in safety and that you're okay, basically it's over the trauma happened and it might be sad. It might be difficult, but there's no physiological distress in the body anymore. And I've, I've found it really helpful. I mean, something I've personally done for other things in my life. Um, when I first encountered it as a therapist, it was like, oh my gosh, why haven't I been doing this the whole time? And I found it after my training in, in, um, at the post doc, my at neuro rehab. So, but it's, it's kind of changed how I practiced for sure. Speaker 2 00:50:08 That's great. So is there, I kind of wanna start rounding this up. So mm-hmm <affirmative> what would you say to kind of bring it full circle related to healing from trauma after brain injury? You know, what are maybe some of your top things or top suggestions for our listeners? Speaker 0 00:50:31 Yeah, I would say you're not alone, so you're not alone that most of the people that I see that come through my door that have had a brain injury also have trauma. So I think a lot of people are not talking about what's happening. So number one, you're not alone. And number two, there's help. So there's very specialized and specific help that you can get for this. That it's not, it doesn't have to be super hard. It can be difficult to go through it. But if you're with someone who's trained in that therapy or trained how to do this, then you can get relief. And I find that so hopeful for people to know, oh, I don't have to deal with this feeling forever. No you don't. We can, we can help you through that. So I think knowing that there's hope knowing that there's, there's something that you can do about it's really important and also just, just doing what you can like if stop judging yourself so much, I guess. So it's part of me as a therapist. When I see my folks being like, oh, I had a bad day again and you know, is this always gonna happen? And I just, just be easy, just be more compassionate toward to yourself. You've been through a lot. And of course you have the feelings you have. It makes total sense to me. Speaker 2 00:51:49 Yeah. That's great. I, so my final question is always, this is hope survives podcast. So what are your final words of hope? I feel like you just already shared some, but I am gonna ask you it anyway. And, um, what would be your final words of hope today for our listeners? Speaker 0 00:52:05 Yes. There is help always help for you and just to continue to fight, continue to just seek it and don't give up. That's one of our big sayings in brain injury, never, ever, ever give up. Speaker 2 00:52:17 I love that. So how can our listeners get in touch with you? I highly recommend if you enjoyed this episode, check out her podcast called the TBI therapist so they can listen to that. And you're on Instagram, TBI therapist. Speaker 0 00:52:33 Yeah. I'm at [email protected] And so on the, on my podcast, we talk about all things, mental health and brain injury. And if you would like my grounding guide, I have a grounding guide. That's probably the best places to go to Instagram at TBI therapist. And there, my link tree is there and you can see on my things. So I hope to connect with you guys. Speaker 2 00:52:57 That's great. I'll put those just links in the show notes as well. So thank you so much for coming on today. This has been such a great conversation. I know I got a lot out of it and I'm sure our listeners have too. Speaker 0 00:53:11 I hope so. Speaker 3 00:53:15 Thank you for joining us today on the TBI therapist podcast, please visit TBI therapist.com for more information on brain injury, concussion and health. The information shared on today's podcast is intended to provide information awareness and discussion on the topic. It is not clinical or medical advice. If you need mental health or medical advice, please seek a professional.

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