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Psychiatric Nurse gives pointers for dealing with severe emotional disorders

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Hi Everyone,

This detailed and thoughtful article by Karen Grisham RN MN should be of particular interest to mental health professionals dealing with severe cases. It comes from many years of experience and outlines some important concepts. Note: My consistent urging to "Try EFT on Everything" must be blended with common sense. Clients with severe emotional disorders can likely be helped with EFT but should be left to those with the appropriate experience.

Hugs, Gary


By Karen Grisham RN MN  EFT ADV 

As we gather our experience in the use of EFT and its refinements, it occurs to me that one day we may be able to eliminate the need for psychotropic medications in the treatment of severe and persistent mental disorders like schizophrenia and bipolar disorder.

This is a very exciting and provocative thought, and I want to be open to the idea. For the time being, however, I am getting some classy results using EFT for a number of issues these people face.

I think it may be premature to take away all medications and expect to manage everything with EFT at this moment in time. But,  if we can erase past trauma, manage anxiety, empower clients and touch on spiritual foundations that may have been ignored, perhaps medication would not be necessary.

It makes logical sense that we can look forward to a day when powerful medications with their side effects and expense are a thing of the past. Now that is exciting!!

Here are some thoughts on making this transition responsibly and safely. 

Considerations in the use of EFT with severe and persistent mental disorders: 

1. Severe and persistent mental disorders are always multifaceted and complex.  There are physical, emotional, spiritual, social and psychological consequences of these disorders.  Treating the client without this holistic approach may result in decreased symptoms, but often does not improve the quality of life. Frequently, one problem is exchanged for another less troublesome one.  This explains why many clients do not follow prescribed treatment plans, or take prescribed medications.

2. They are usually long term, remitting and relapsing disorders. This is another consequence of treating one body system and ignoring others. One of the many gifts of EFT, simple techniques that can be used to treat whatever is troublesome at the time,  It may not cure the illness, however, empowering the client to manage symptoms effectively is really what makes life quality.

3. Typically have tried many therapies that promised relief only to fail in maintaining remission.  Again, not all providers view the problem from the perspective of the whole person and social system in which they live. EFT can systematically address each facet of the person’s life, including deficits in their social support systems.

4. Usually taking multiple psychotropic medications which, in addition to having individual side effects, have a variety of drug-drug interactions. Most of us who are experienced prescribers are used to the predictable impact of medications. Given the limitations of managed care, we know we can accomplish certain outcomes by the skillful and creative use of medication combinations.  I remain convinced that medications are a part of responsible care for this population, however, in some cases, I see patients able to decrease their medication dosages with the use of EFT.  Time will tell how much we can safely do and maintain the stability and quality of life that the client deserves.

5. Families have had hopes dashed repeatedly.  Often families are reluctant to try something new, only to find that this doesn’t work either. Again, EFT offers an opportunity to try something harmless and gentle without giving up the security of the existing treatment regimen.

6. Clients frequently perceive that they are responsible for their illness, and therefore blame themselves for its persistence, or when therapies fail. What a tappable issue!!

Providing relief from shame and blame is easily accomplished with EFT and makes a huge difference for the client, even if that is all they ever got from EFT!

7. Instability of provider-client history due to financial status, insurance changes, etc.

Rarely has the client been able to establish a long term stable relationship with a single provider.  Here again, EFT empowers the client to be less dependent on a provider.

It gives him control over day to day issues, and an ability to provide clear information of needs to new providers. This smoothes out the transition from one provider to the next.

8. Multiple losses accompany chronic mental disorders. Often people have lost friends, jobs, money, security, family members, and the list goes on. The loss of hope is foremost here, and when present, is a powerful factor in suicidal thinking and actions.  Grief responses, treated sensitively with EFT, can be healing and strengthening to the client.

9. Frequently, the client’s history includes trauma of some kind.  In my opinion, this is one of the most promising aspects of EFT.  Freed from the controlling power of traumatic experience, the past no longer need predict the future. One more barrier to a quality life is overcome.

10. Support system may be tapped out, consideration for client’s ability to self administer EFT, or to maintain consistent contact with mental health professional for supervision.  Creativity and skillful planning can prevent the client from getting lost in the shuffle.  Websites like my own and many other healing practitioners give access to help when professional assistance isn’t accessible. Gary’s www.emofree.com is an excellent resource for clients motivated to stay well.  Encouragement and hope are needed to keep clients motivated, and these websites can provide it.

11. Issues of trust must be respected, in terms of taking the time to develop a relationship where the client feels safe and has time to adjust to the therapist’s ways of doing things. Again, these people have been through many disappointments, and like all of us, have had their trust betrayed by trusted professionals and friends. We must earn their trust, and one way to accomplish that is by using EFT right from the start to deal with superficial issues. Our intentions are clear when we spend time relieving their suffering, no matter how insignificant it may seem.

12. The significance of change, financial, support system, family, to the individual’s   big picture’ must be considered.  This takes foresight in regards to necessary medical and psychiatric cooperation with any plan.

13.  Some knowledge of the effects of medication is necessary. Specifically, the effects of discontinuing or tapering off medication can be done safely, but the client must do this under the supervision of a qualified prescriber.  There is a tendency for clients to respond to initial effects without taking time to measure consistency. (i.e.: differentiate between remission and cure)  Someone may do fine off their medication for a month or so, and then find themselves relapsing, then needing more or different medication to accomplish the necessary results.

14. The practitioner needs to be familiar with beliefs surrounding spiritual issues such as demonic possession which are sometimes blamed for persistent mental illness. In these cases, care must be taken to assess the spiritual strength and resources of the individual, and the beliefs of those who comprise his support system.

15. Long term commitment may be required, both from the client and from the treating professionals.

Diagnosis of Bipolar Spectrum Disorders: 

DSM IV only really covers the classic Bipolar I and II and mixed disorders.

There are many variations in the field of psychiatry, lots of different ideas.

Diagnosis serves to narrow down the treatment options, but does not provide hard and fast rules for successful treatment.

In the absence of a firm diagnosis, symptoms suggestive of the bipolar spectrum of disorders may be treated with medications known to stabilize the individual symptoms.

How do we treat Bipolar Spectrum Disorders?

I take a sort of ‘Forest and Trees’ approach with medications as well, like hitting the major disabling symptom first and then seeing what remains.

Frequently, these disorders present to me when the family, community, primary care provider have exhausted all of their resources and decisive action needs to be taken.

When significant damage has been accumulated in the client’s life, it is important to carefully analyze how ‘rocking the boat’ might affect the stability of the illness.

It is important to do a risk-benefit analysis of any contemplated action in advance, and involve the client and family in the decision.

Therefore, if a client is severely manic, or imminently suicidal, she may need to be stabilized on medication prior to attempting other forms of therapy.

In this situation EFT could be attempted on an inpatient basis where the client’s safety could be guaranteed, but it would not be prudent to try on an outpatient basis.

Stability would also allow for the introduction of EFT to be the only ‘variable‘ in the person’s treatment regimen. This would further isolate the specific impact of EFT. 

Suggestions for symptom changes that could be measured for impact of EFT in Bipolar Spectrum Disorders: 

Some of the most troublesome symptoms on a daily basis and ideas for starting points are: 

1. Pervasive, unrelenting anxiety may be too general  a topic, so breaking it down as follows will isolate each ‘tree’. 

**It  is important to be sure that medical reasons for chest pain and shortness of breath have been ruled out before assuming the symptoms are anxiety. You don’t want to be taking it on yourself to treat a cardiac or asthmatic emergency!!

a) have the person write down all of the objective signs of anxiety he experiences.

 (This may vary from person to person, including having extreme,  tightness in the chest, hands shaking, skin clammy, dizzy, and tingling or numbness in hands or feet. Feeling like I am outside my body, nauseated, rapid or pounding heart rate, sense of doom,  hot flushes and cold chills, sweating. (Symptoms of a panic attack) and then describe what would constitute a 10 , 9 , 8, to 0.  (Like Gary says, “How do you know you are at an 8?”)     

Here is an example: for the symptom of shortness of breath:

10 = unable to get a breath, gasping 

5 = can breathe easier, but still struggling, cannot fill lungs fully .

0 = breathing easily and fully, chest open and relaxed

b) then do the same with the anxiety triggers i.e.: seeing,smelling, hearing,

 feeling , touching something or someone. 

You can then formulate an easy individualized monitoring system for the client’s recording. (Anxiety drives impatience, if it isn’t easy, it won’t get done). After treating all of the symptoms and all of the triggers, you will pretty much have the person in a comfortable space to manage day to day problems with ease.  Again, with a few major symptoms treated to 0, many of the others will collapse as well.

2.   Mood:

                 I have clients rate this on a 1-10 scale each visit, but further fleshing out of what constitutes each number rating would be more precise.  With mood swings, another important factor is the stability of the mood.  (i.e.: varies from 2-9, versus 5-7

3. Sleep onset:

                Time from lying down in bed to go to sleep, to falling asleep. For simplicity I categorize as follows: <30”,  30-45”, 45-60”, 1-2 hours, more than two hours.

4.      Sleep interruptions:

 

       Number of interruptions, reason and whether return to sleep is perceived as easy or difficult.

5.      Presence of dreams or nightmares:

 

       Theme (being pursued, attacked, ridiculed, etc), frequency and role changes over time, (i.e.: does the individual become stronger in each successive dream, how do they feel when they wake?)

6.      Waking condition:

      

       Does the client wake feeling rested, tired, exhausted, anxious or energized?

7.      Physical energy:

 This is affected by many factors, including level of anxiety, medications, amount        of quality sleep, activity level, use of substance like caffeine, and interest and        motivation levels. It can be measured by what the client can accomplish without        getting tired.

8.       Panic Attacks( may have already been addressed with the anxiety work, or you may have to do the tearless trauma  or telling the story techniques to bridge into core issues that are triggering the attacks.)

        Some measurements of panic attacks are frequency, intensity and duration.

       When panic attacks may appear to be similar. look for new triggers. As is peeling an onion, when one trigger is collapsed, another may emerge.

9.      Perception of quality of life.                       

       I currently use a good, fair, poor subjective rating, but again, more detail would            aid in precision of measurement.  Cognitive shifts are detected as clients work        through the various trees in their individual forests.

10.   Activities that are performed consistently: 

        Many families will measure a loved one’s wellness by the number of family functions they attend, whether they shower regularly,  find the individual’s specific information, and help to design a chart to use for monitoring.

I have a particular interest in the use of EFT in improving quality of life for persons who have been diagnosed with severe and persistent mental disorders and continue to use it in whatever way I can to relieve unnecessary discomfort.  I love to read the reports of those of you who are venturing into this challenging area. I hope this has been of some help as you carry on this very important work. I am forever grateful to all of you who have made this work available and accessible to so many.  The newsletter contributions are rich with your dedication and experience and enhance my ability to care responsibly and effectively for my clients.

Karen E Grisham RN MN  EFT ADV

 

 

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