An emergency is defined as a circumstance in which a devastating event of natural origin or caused by man, in an unexpected and sudden way, creates a climate of activation, of fear, of alert, of urgent need accompanied by immediate rescue attempts.
The emergency psychology is therefore the field of psychology that deals with clinical and social interventions in disasters, disasters and emergencies. It is the discipline that studies the behavior of individuals, groups and the entire community in crisis situations.
In recent decades there has been an increase in awareness of the impact of disasters on the population. Disasters are common and complex events, where everyday life and the aspects that up to that moment gave certainty and planning become unstable . Losing homes or family members, fearing for their own safety or being exposed to terrifying scenes are serious mental health risk factors. Both adults and children can easily develop Post Traumatic Stress Disorder .
The emergency at the time of the Coronavirus
Right now the whole world is facing an emergency situation . The impact of the Coronavirus has in fact turned into a real collective trauma where everyone becomes victims in different ways.
Who directly suffers the impact of the virus. Relatives and loved ones of the sick or deceased. Rescuers and health workers continuously and for a long time exposed to direct contact with acute suffering, a sense of helplessness, difficult choices. The whole community , severely limited in freedom, upset in the habits of life and in a constant state of uncertainty. Especially with respect to the evolution of the situation and the life and economic scenarios that we will have to face in the near future.
Individual reactions move from denial and underestimation of danger to anxiety. Fear is an absolutely normal and precious emotion to activate and orient us towards defensive behaviors. But when the alert becomes excessive, the behaviors lose their clarity, become disorganized and counterproductive.
Coronavirus and possible effects on mental health
Sometimes the fear can worsen into panic or take the form of generalized anxiety , for which a limited and contained danger of contagion is generalized. This leads to perceive each situation as risky and alarming. For someone it can take the form of hypochondria , understood as a tendency to excessive concern for one’s health , where every slightest symptom is interpreted as an unequivocal sign of Coronavirus infection.
In this particular historical moment, technology allows us to survive and inform ourselves. But it also exposes us to a continuous bombardment of information and images that can create a constant alarm response (hyper-arousal) with respect to the condition of vulnerability and uncertainty.
Why EMDR in an emergency
L ‘ EMDR (Eye Movement Desensitization and Reprocessing) is well integrated in emergency contexts to date a therapeutic approach. It is the primary tool within the WHO guidelines for the treatment of Post Traumatic Stress Disorder .
It is in fact used as a preventive tool in the development of possible psychological disorders that may arise following a critical event. It works on multiple dimensions: from the emotional stabilization of the person, to the installation of resources, to the adaptive reworking of the traumatic experience a. It brings relief and facilitates post traumatic growth.
These psychological interventions are adapted to the most varied contexts (from schools to hospitals, from barracks to Civil Protection centers). They allow you to work with people both individually and in groups when the possibility of sharing emotional experiences becomes a very precious tool for treatment and prevention. Today, no less is the possibility of making interventions (with due evaluations and precautions) even online.
EMDR treatment and Coronavirus emergency
The treatment with EMDR can be an integral part of the intervention in peri-traumatic phase and can be used in the target reworking (memories) from the first exposures to critical events.
The protocol for recent events, used specifically in emergency contexts , allows for rapid and effective intervention. Work on the points of disturbance triggered by the traumatic experience already from the first month, in order to favor integration and avoid the cumulative effect of the traumatic events to which people are exposed.
The fact that the critical event is characterized by persisting over time, therefore with a delay or absence of a post-traumatic period of safety (just as it is happening in this period of health emergency, both for operators and for the population) a further impediment to the processing of the original critical event. This is because exposure to continuous stressful events with similar information (same feelings or emotions) does not allow the traumatic memory to be integrated and consolidated in an adaptive way.
What are the mechanisms of operation of EMDR?
EMDR starts from the assumption that there is an innate information processing system in the brain that assimilates the new experiences that the person lives every day (with thoughts, emotions, images and sensations) within the memory networks already present. body to such related events).
When this system works normally, the new experiences are then processed, assimilated, contextualized. At the end of this process they lose their disturbing quality in case they are negative experiences.
However, when the person experiences a traumatic event this processing system can stop and find it difficult to adaptively process the information, leaving the experience of the trauma unresolved.
Particularly stressful events can in fact remain frozen in time in the neural network that has formed, unable to connect to the networks already present containing the more adaptive information.
Neurophysiology of EMDR
The main brain structures involved in this system are the prefrontal cortex, the amygdala, the hippocampus and the thalamus.
The amygdala is a deep core of the brain that has a primary role in the formation and preservation of memories associated with emotional events and is activated in all negative emotions but especially in fear.
There are extensive reciprocal connections between the amygdala and the prefrontal cortex which, under physiological conditions, inhibits the amygdala by actively causing the extinction of the threat response.
In the absence of this inhibitory input, the amygdala remains activated and continues to maintain a high level of adverse response. Inhibition of the prefrontal cortex on the amygdala is a necessary and fundamental aspect for the coding and processing of a traumatic event.
The hippocampus is the seat of episodic and autobiographical memories and is fundamental in identifying “safe” contexts. The hippocampus plays a central role in the consolidation of information from short-term to long-term memory and is very sensitive to the effects of stress .
The amygdala-hippocampus short circuit
The extreme stress of a traumatic event with a strong emotional value leads to an excess of stimulation of the neurons of the amygdala and hippocampus in a sort of short circuit.
The information derived from the traumatic experience is physically translated into neuronal networks called engrams which remain (due to the short circuit) confined to these nuclei. They cannot be transferred to the neocortex which is instead delegated to their adaptive contextualization through integration with other memories and learnings that are part of the person’s life.
Unprocessed memories (i.e. that do not return to the neocortex) can remain unchanged throughout life if there is not something that favors the removal of the engram from the amygdala and processing.
The engram moves from the amygdala and hippocampus to the cortex thanks to “slow” brain waves that we know are released during sleep and are fundamental for learning and memorization processes.
The utility of eye movements
During the EMDR session, eye movements (bilateral alternating stimulation) are used while the person focuses on traumatic memory. It is through this stimulation that the appearance of slow brain waves is elicited, which reproduce the phenomenon that normally occurs during sleep. That phenomenon that activates the transfer of memories of daily events to the neocortex.
Here a new neuronal network is formed relating to that event which replaces the previous one and cancels its effects. It therefore allows the more adaptive integration of the emotional aspects contained in the amygdala and of the episodic ones contained in the hippocampus, contextualizing the traumatic experience at a higher cognitive level.
This process results in the possibility of rethinking the traumatic event as something of the past. It becomes part of one’s life story without generating the sometimes overwhelming symptoms and emotions associated with that event. The person also sees himself in a new light of “growth”.
Effectiveness of EMDR
The mechanisms of functioning of EMDR have found empirical evidence in important recent research. The most important article is the one published by Baek and colleagues in “Nature” (2019).
The study reveals the mechanism of action of EMDR and its neuroanatomical path through an animal experiment. The authors reproduced with mice a similar situation to what happens during an EMDR session in case of PTSD. They found that bilateral alternating stimulation is the only condition that leads to a total extinction of fear.
The authors found that bilateral stimulation had also played a role in increasing the neuronal activity that activates the thalamus from which fundamental waves for long-term memorization start.
The engram representing fear in the mouse was removed by slow waves elicited by bilateral stimulation . The information was brought to the neocortex with the possibility of the latter to act its modulation function of the excitability of the neurons of the amygdala.
Relationship between natural sleep and EMDR
There is an almost absolute similarity between the slow waves that emerge during sleep and the slow waves that emerge during bilateral stimulation (EMDR). It is therefore very likely that what happens during sleep is replicated during therapy. With the difference that during sleep we have three periods in which we release slow waves and it is not said that the priority at that moment is the processing of the traumatic event .
Instead, during the EMDR psychotherapy session when bilateral stimulation is done, the person is asked to focus on that engram, not on other things or events that may exist.
This immediately moves the event to the top of the processing hierarchy. The fact that slow waves are formed about 900 times during the session dramatically increases the possibility that during that wave generation the engram will move and a new non-disturbing engram will form at the cortical level.
Growing up after trauma
Neuroscientific studies therefore show us today in a tangible way how our brain is equipped with the possibility of processing traumatic experiences and making them an integral part of our life baggage.
However, the same studies also show us how particularly stressful events lead to a short circuit in the system that can prevent the achievement of a new, good post-traumative balance, making the person vulnerable to psychological disorders and suffering.
In light of this, today more than ever it is important to understand and invest in psychoeducation, psychological support and targeted professional intervention. This is to ensure that the processing processes take place properly. When this happens, not only do such experiences no longer create emotional disturbance, they also become what we call post-traumatic growth .
When the negative emotional effects of the trauma are left in the past and the experience brought to the level of reflection of the cerebral cortex, the awareness of a new evaluation and an enriched feeling towards oneself opens.
Fear and helplessness leave room for the newfound confidence of those who know they have made it to face and overcome that difficult moment.
Their resources are recognized as stronger with a renewed sense of control and personal effectiveness . It is possible to rediscover the affections and feel that you are part of a human solidarity. We can accept not controlling what is not controllable but feel capable of choosing and managing our reactions to what life brings.
They can change their priorities and their own scale of values . Taking care of the psychological aspect of today’s trauma is of crucial importance for what the person’s experience will be tomorrow and in the long-term future.
