Can art be used in the treatment of schizophrenia? What about martial arts? Yoga? Horses?
Therapy options like music therapy and sand play therapy are not meant to be main forms of treatment for schizophrenia. But, they are add-on therapies, also known as adjunctive therapies, that can be incorporated as a part of your treatment strategy.
One of these therapies that has become more popular in recent years is eye movement desensitization and reprocessing (EMDR) for post-traumatic stress disorder. Dr. Deborah Korn, a clinical psychologist and coauthor of “Every Memory Deserves Respect: EMDR, the Proven Trauma Therapy with the Power to Heal,” joins to explain how EMDR is being used to help people with schizophrenia.
Host Rachel Star Withers, a diagnosed schizophrenic, and co-host Gabe Howard explore different add-on therapies and discuss which ones are shown to help schizophrenia in this episode.
Deborah L. Korn, PsyD, a clinical psychologist with a private practice in Cambridge, Massachusetts, is on the faculties of the EMDR Institute in California and the Trauma Research Foundation in Boston. She is an EMDR International Association-approved consultant and presents and consults internationally on the treatment of adult survivors of childhood abuse and neglect.
She is the Coauthor of “Every Memory Deserves Respect: EMDR, the Proven Trauma Therapy with the Power to Heal.” Learn more at www.everymemorydeservesrespect.com
Rachel Star Withers creates videos documenting her schizophrenia, ways to manage and let others like her know they are not alone and can still live an amazing life. She has written Lil Broken Star: Understanding Schizophrenia for Kids and a tool for schizophrenics, To See in the Dark: Hallucination and Delusion Journal. Fun Fact: She has wrestled alligators.
To learn more about Rachel, please visit her website, RachelStarLive.com.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To learn more about Gabe, please visit his website, gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Schizophrenia. Hosted by Rachel Star Withers, an advocate who lives openly with Schizophrenia. We’re talking to experts about all aspects of life with this condition. Welcome to the show!
Rachel Star Withers: Welcome to Inside Schizophrenia, a Healthline Media podcast. I’m your host, Rachel Star Withers, here with my amazing co-host Gabe Howard. Today’s topic is add-on therapies or adjunctive therapies in the treatment of schizophrenia. Now, these therapies are not supposed to be your only and main form of treatment when it comes to schizophrenia, but they can be beneficial when incorporated as part of your treatment strategy.
Gabe Howard: We always like to add these on because people are reading about them online. And one of the things that we often hear about is, oh, you have mental illness, you have mental health issues, you have schizophrenia? Do yoga. And of course, everybody rolls their eyes and says, well, yoga is not a treatment for schizophrenia. That is absolutely correct. Yoga is not a treatment for schizophrenia, but it can help. Right? Physical movement, getting out in public, having a routine. All of those things do show great benefits. So please do not stop any therapy in order to do one of these. Remember it is add-on. It is okay to do multiple things. It’s like having a garden with more than one vegetable.
Rachel Star Withers: One of these therapies that has become popular in recent years is eye movement desensitization and reprocessing. It has been something that I’ve been asked about recently quite a few times, and I’m like, I have no idea what that is. It sounds really technical. Thankfully, later in the episode, Dr. Deborah Korn is going to be joining us, and she is a clinical psychologist and co-author of the book “Every Memory Deserves Respect: EMDR, the Proven Trauma Therapy with the Power to Heal.”
Rachel Star Withers: When we talk about add-on therapies, I think one of the most common that comes to people’s mind is art therapy. Just that general term of art therapy. Whenever you see in movies, a lot of times they’ll show mental institutions and they’ll have like somebody’s painting. Like, that’s always kind of going on somewhere in the movie. Art therapy is when you engage in artistic activities that encourage you to express your innermost feelings in a creative way. And this has actually been practiced since the 1940s. Not art. Meaning art therapy has been practiced,
Gabe Howard: You’re telling me that art was invented in the 1940s? We learned so much on this show.
Rachel Star Withers: No. Using art as a form of therapy. So this has been around a really long time. And if you go back to some of our episodes where we talk about how treatment of schizophrenia has progressed over the years, 1940 is that that’s actually before antipsychotic medications. When you combine the creative process with talk therapy, it often leads to positive outcomes. Usually, the person becomes more self-aware and self-compassionate. And one of the main benefits of art therapy is that you don’t have to be artistic to have success. So if you’re like listening, like, Rachel, I am terrible at painting. I’m terrible at drawing. I know I am, too. So it isn’t about being good. All right. You could make the ugliest little blob, but it’s about expressing yourself.
Gabe Howard: And remember, art therapy encompasses a whole lot of things. We always tend to think about it in terms of drawing or painting, but there’s writing therapy, music therapy, dance and movement therapy, drama therapy. The arts are a big, big bucket, and I really like to explain it like this. Schizophrenia is very scary. Treating mental illness is very scary. Creating isn’t scary. Many of us in fact, I would I would argue that all of us have some sort of creative hobby or add creativity to our hobbies to enjoy it more. So this is something that we are naturally drawn to. So if you’re thinking about it in terms of treating schizophrenia, what’s more difficult? Tell me your deepest, darkest fears. Everything that’s bothering you. Trust me. Explain it. And I’m going to prescribe you medicine or give you coping skills. That sounds very scary versus sit down and create something. Show me what you like, tell me what you want. And then in that creative process, more information will come out that allows the people that you’re working with to better treat you. And you can, of course, feel better about the process because you’re just doing something that you would naturally be drawn to or love anyways. And side note, personal story. When I was in the psychiatric hospital, I went to art therapy and I made a leather keychain.
Rachel Star Withers: That’s what I was going to bring up is that I didn’t realize art therapy could also be working with fabrics.
Gabe Howard: Yes. Somewhere that keychain still exists. I gave it to somebody on the way out and they told me they have it in their memory box now. They have not produced it in a great many years. So memory box may be in air quotes and still have it maybe in their hearts. But listen, we do still talk about it. And I can tell you that it worked for me. I do not live with schizophrenia, but I live with bipolar disorder, with psychotic features. And it was a disarming thing, especially considering I was I was in a psychiatric hospital. That’s a very scary place. And I’m speaking so fondly of this leather keychain that I made.
Rachel Star Withers: Well, it shows that that’s something that obviously made an impression on you.
Gabe Howard: Correct.
Rachel Star Withers: And when you think about all the different therapy that you’ve been through, all the different medications, I would say that’s something that that keychain comes to your mind.
Gabe Howard: It does, and it’s a positive memory in an otherwise negative space. And I think it’s okay to say that, you know, so often we say, well, being committed to a psychiatric hospital is negative. Well, but it’s for your own good. It helps you, it’s your benefit. Yeah. And it sucked, right? Something in your best interest can still be a negative experience. So to be able to pull something so positive is good. But, Rachel, does art therapy work for schizophrenia? There is this idea that people are just like, okay, what do you do in, you know, my loved one is severely mentally ill. I’m struggling with mental illness and you’re telling me to do art. What’s wrong with you people? What kind of podcast is this? Rachel, the facts.
Rachel Star Withers: Well, unfortunately, the majority of evidence that we have out really isn’t clear as far as can it treat symptoms of schizophrenia-like psychosis, hallucinations. However, art therapy has been seen to help people with schizophrenia with their overall mood and outlook on life. So yeah, obviously painting is not going to make your hallucinations, your voices, go away, but it could help you overall. The good thing about art therapy is that it’s low risk and high benefit. So it’s an easy thing to add to a patient’s treatment plan. You know, try it out, try a few different types of this art. And if it doesn’t work, hey, you know, there really isn’t going to be a major setback. However, the best art therapy for people with schizophrenia should be delivered in group sessions, and that kind of has to go with us not isolating and getting us more social. It’s just better if we do it in a group versus you hanging around at home, alone in the dark, painting the walls.
Gabe Howard: I really like how you phrase that it’s not going to treat anything by itself. Remember, the topic of this podcast is add-on therapies. We’re talking about an overall treatment plan that encompasses many, many things.
Rachel Star Withers: Some of these will not work for you. One of the art therapies is writing therapy, and a form of it is journaling. I despise journaling and this is probably the one that has come up so much in my life. Even my current therapist, she sends me a copy of my treatment plan, which is updated every three months. And one of the things that it had down was journaling. Rachel is going to journal every day and have me read it and I’m thinking, No, I’m not. Like I looked at, I’m not doing that. I’m like, I’m absolutely not.
Gabe Howard: [Laughter]
Rachel Star Withers: Because I’ve done it in the past. I don’t like it. I personally don’t see the benefits and it brings my overall mood down because I feel like I’m having, I’m being forced to do it. I’m not writing about my day. I’m having to write something down for the therapist to read. So, yeah, not all of these are going to click with you, but you have an open mind.
Gabe Howard: Rachel, still on the subject of art therapy. Is there an art therapy that works the best for people with schizophrenia?
Rachel Star Withers: It has been shown that music therapy and music therapy can be where you’re making music or singing, or it could also be just listening and responding to music or analyzing the lyrics. So yeah, it’s kind of a big umbrella because when I first hear music therapy, I’m like, Oh, I’m terrible at music. I can’t sing. But yeah, the listening and responding is another area of it too. It’s been found that for people with schizophrenia who are hospitalized, adding music therapy to their standard care leads to greater improvements in their symptoms than compared to just their standard care alone. Now, this does make me think, Gabe, because I feel this is one that would not connect with me because I feel like they would be like, tell us your favorite song and let’s analyze the lyrics. And I’d be like, Grillz by Nelly. You know.
Gabe Howard: That’s that’s that’s that’s that’s a.
Rachel Star Withers: Yeah. Yeah, I got a grill I call Penny Candy. You know what that means? It means, like now and laters, gumdrops, jelly and beans. Be like Rachel. How do you feel about that? I’m like, I feel that he has a grill that’s very colorful.
Gabe Howard: [Laughter] But it speaks to you
Rachel Star Withers: Yes.
Gabe Howard: And that’s the important thing.
Rachel Star Withers: Yes, even though a lot of these therapies may not help schizophrenia positive and negative symptoms, they can help other aspects. For instance, many of us like me, have tardive dyskinesia as a result of antipsychotics. So that’s where you’re shaking and having to do like motor skills practicing can help improve that. It has been shown that it’s good to keep using your hands and stuff in little things. That would be good for painting since, you know, some, some paintbrushes are huge. I could see that being like, okay, yeah, that’s a good one for me to do. Whereas writing I have a hard time holding normal pens.
Gabe Howard: So, there are all the art therapy things you can try, but we’re talking about all add-on therapies. What’s the next type of add-on therapy that we want to talk about today?
Rachel Star Withers: Yes. And these are some that are kind of outside the box. The most common one of these outside-the-box therapies is going to be animal-assisted therapy. I also feel that would be the most fun. And it tends to be a farm animals mostly. But you could also do dogs, cats, birds. And there’s just different types when it comes to working with animals. Some where you actually work on like a farm.
Gabe Howard: Really?
Rachel Star Withers: Yes. Oh, yes. Others with horse-assisted therapy, you learn how to groom and care for and ride the horses and go on like trail rides together as a group. Learn to connect with the animal. Obviously, again, the animals probably aren’t going to make your voices go away, but I can see this overall being a really good thing for mood. I know me having a dog has been one of the best forms of treatment I’ve ever had. Just having like that little friend who’s always there and so many of my dogs can tell when I’m having a hallucination and they really ground me.
Gabe Howard: There are so many things to consider here. And one of those is that people with schizophrenia often feel that they have a caregiver, they have a loved one who’s taking care of them. There’s a lot of talk in the community about people living with schizophrenia not having full control over their surroundings, their life, and even being able to care for themselves. And that can be a bitter pill to swallow if you’re a grown person trying to make your own way. Animal therapy provides you the opportunity to care for another living thing, to bond with another living thing, to be in charge of another living thing. And this can be very cathartic. This can be very powerful. It can be a great routine. It provides many, many, many external benefits. It can help somebody with schizophrenia show a sense of pride, responsibility. And finally, you ever hugged a horse, right? Have you ever you ever hugged a dog? I mean, just forget about schizophrenia for a moment. If you are somebody who is not living with schizophrenia and you think, okay, well, but how does this help? Everybody loves their animals. People with schizophrenia, they’re people. People living with mental illness are people. They love taking care of their animals, too. What’s the data show? Does this help people with schizophrenia?
Rachel Star Withers: The animal-assisted therapies are one of the most helpful. Again, it’s going to be overall mood. And something interesting that you just pointed out with the pets. So animal-assisted therapy is not exactly just what Rachel, I already have a cat at home. The one good thing about it is it can be animals that you don’t have regular contact with. Unfortunately, I did grow up on like a farming community, so the farm animals are pretty normal to me. Would you say, Rachel, would you like to hug a horse? No,
Gabe Howard: No? I’m afraid of horses personally, but.
Rachel Star Withers: I have two horses right now. No. No.
Gabe Howard: It is kind of amazing, though. They’re giant.
Rachel Star Withers: Yes. Yes, they are. And if you’ve never had those experiences, if you’ve never petted a cow or pigs, it is different than having a cat or dog at home. Definitely the different animals and even just going on trail rides, it can put you in a different mental space. Now, this next therapy I’d never heard of, Gabe, and I kind of. I don’t know. I like it. I would one day, like if I go to a new counselor, I would like if they suddenly pulled out a box of sand and it’s called sand play therapy. It’s nonverbal. And what you do is you have a little box of sand and toy figures, sometimes water, and you create miniature worlds that reflect your inner thoughts and struggles and concerns. And the therapist just watches. They’re not allowed to talk, like, why are you using that one? But it’s for you to kind of think about your own life and reflect after it’s done. You talk with a therapist and they can be like, Okay, let’s talk about what you made here. Why did like Godzilla come through and smash your town? What is some of the symbolic meanings in your little town? And then you can talk about making changes to your little world that you’ve created. So you kind of make them in the little sand world before you go out into the real world. I don’t know. I liked it. At first, I thought that was going to be a kids’ thing. But then when I read like how deep it got, I was like, Oh my, this is this is not just like building sandcastles. This is intense.
Gabe Howard: It’s very popular. So popular, in fact, it’s worked its way into mainstream therapy. There’s a type of sand called kinetic sand. It’s just a weird type of sand. The sand feels differently and it becomes very tactile and people suffering from depression, anxiety, people who are overwhelmed, people who are fidget are often playing with this. We’ve all seen those Zen gardens that executives have on their desk where you take the little rake. So once again, sometimes when we talk about things in terms of schizophrenia, people just tend to dismiss it immediately, like, oh, well, that’s not going to help schizophrenia. That’s not good for somebody living with schizophrenia. That’s ridiculous. And in reality, we have to keep in mind people living with schizophrenia are people. So, things that are trendy, popular, unique or that are talked about also appeal to us. It appeals to them. And that’s super important and it creates a sense of normal. If we can add that on to a fully functioning schizophrenia treatment plan, we can really do so much more.
Rachel Star Withers: Now, let’s take it a little bit of a turn here, Gabe. Because we talked about that, we talked about that creative side. Let’s talk about physical therapies. And I don’t mean like rehabbing a bum knee. Physical therapies as in using your body. And this is, you know, kind of unfortunate because nobody wants to hear this. But, yes, exercise has long been shown to improve positive and negative symptoms. Also, cognition and memory in people with schizophrenia. Like this is over and over they see, yes, exercise actually does help you treat schizophrenia. Now when they say, exercise just going for a run, and exercise therapy, two different things. So, exercise therapy is when you go to like a class and you do something together, certain types of physical activities together, these sessions are usually supervised. For people with schizophrenia, these are most beneficial for increasing motivation. So many of us don’t want to leave the house, we want to isolate. But if we have like a kind of a group, especially if you see the same people and they can kind of hold you accountable. We mentioned it earlier, yoga falls into this. Now, I got to say, I’m on the fence with the yoga.
Rachel Star Withers: I do agree that it’s good. I tend to do a lot at night when I’m watching my American Dad and my other adult cartoon shows. I don’t do well in yoga classes. A lot of the yoga classes like to, I don’t want to say get spiritual, but they’ll be like, feel Mother Earth below your hands. And I’m like, okay, we’re on the second story of, you know, a strip mall lady. Like, there is no earth under our hands, you know, come on. The other problem is that I can’t meditate. This isn’t all people with schizophrenia. But for those of us who suffer a lot of the positive symptoms, hallucinations and delusions, sometimes meditation can exacerbate those. So I’ve unfortunately learned many times that I can’t be a part of meditation type things. For me, basically, any time they say, Close your eyes. No. I cannot close my eyes because I will start to kind of get lost in my mind. So just something to think about for my people out there who do struggle with a lot of the hallucinations. Now, Gabe, are you ready for my most favorite therapy form?
Gabe Howard: You sound super excited. I’m a little bit worried about how excited you sound.
Rachel Star Withers: I’m so excited because I just found out recently. This counts.
Gabe Howard: This counts. All right.
Rachel Star Withers: This counts.
Gabe Howard: What is Rachel Star Withers’ most favorite add-on therapy for treating schizophrenia?
Rachel Star Withers: Martial arts therapy.
Gabe Howard: Martial arts therapy?
Rachel Star Withers: Yes. Now, when I say that there’s a there’s a big difference in just taking a boxing class, going and to your local UFC gym and beating people up. Martial arts therapy, it’s usually the traditional martial arts. That have to have a lesson integrated that is either philosophical or involving like societal issues and how you fit into society. So, if you’ve ever taken like karate, taekwondo, kung fu, they make you bow, they make you do certain things. My boxing class that I go to three times a week, we don’t do any of that. We go in there and we punch things and people. At no point is there any reflecting. It’s punch, punch, punch, punch, punch for an hour. I leave sweaty. So that is not martial arts therapy. But this year I have been taking kung fu and jeet kune do. And yes, I would say that definitely falls under that. It’s very philosophical. It opens with this like having to think. You open with working your mind before your body. I’m a big fan of this one. Does it really help people with schizophrenia? That’s going to be a toss up. It kind of falls back with our creative arts. Yes, it improves overall mood. But as far as helping different positive or negative symptoms, it’s going to be a maybe. With the exception of that it is exercise. So it would help in that way. One one thing I do want to point out, and this wasn’t a study. This was just something that a psychiatrist did. He was doing judo with some of his hospitalized patients. And he found that the judo principles were found to be applicable in conflict solving, particularly with the regressed and violent psychotic patients. And I just thought that was kind of an interesting thing because especially with violent people, you would think, well, I don’t want them learning how to fight. That seems the opposite of what I want to teach the violent people. But they found that, no, the judo actually helped them become calmer and cognitive skills as far as problem solving.
Gabe Howard: It really seems to be a form of meditation or mindfulness or centering. There’s lots of techniques out there that, again, people use coping skills to get out of your head and ground yourself in the real world and they don’t work for everybody. I am not a big fan of mindfulness or quiet. Any sort of sitting quietly is not for Gabe. But that’s okay. It’s for many, many people. And while we’re on that subject, what does help for me is reciting the alphabet out loud. That is something, I don’t use it often, but it’s just it keeps me focused on something or numbering or some people do the state capitals. Those people are much smarter than me. So I really, really like that because I can see where having something to focus on outside of your body.
Rachel Star Withers: And we’re back talking about add-on therapies in the treatment of schizophrenia.
Gabe Howard: Rachel, you got to interview someone. EMDR is one of the most popular, nontraditional therapies. If an add-on therapy for anything has gone viral, it’s EMDR. We’ve seen it all over social media. We get a lot of email in our email box. EMDR was originally founded or is founded the right word, Rachel? Started? Created? For post-traumatic stress disorder, and it’s shown great, great results in that area. And it’s slowly moved over to other severe and persistent mental illnesses, other issues. And now, of course, it’s been talked about in terms of for schizophrenia. And we are so lucky to have a psychologist who really understands EMDR talk to us to explain it at a much deeper level than Rachel and I are capable of. Rachel, you want to go ahead and play that interview now?
Rachel Star Withers: Yes. Let’s play that.
Gabe Howard: Here we go.
Rachel Star Withers: Excited today to be speaking with Dr. Deborah Korn, who is a clinical psychologist and coauthor of “Every Memory Deserves Respect: EMDR, the Proven Trauma Therapy with the Power to Heal.” Thank you so much for joining us today on the podcast.
Dr. Deborah Korn: Thank you, Rachel. It’s great to be here with you.
Rachel Star Withers: Now. Tell us right away what attracted you to the field of psychology?
Dr. Deborah Korn: Well, I was one of those kids that everyone talked to. Everyone confided in. I was a good listener. I studied people. I also grew up in a family that was quite committed to social justice. I loved studying psychology in high school, majored in psychology from day one in college, went straight to a doctoral program in psychology a year after college. And in terms of my interest in trauma treatment, in graduate school, it seemed that every client I saw reported significant traumas in childhood or throughout their lives. I worked with several rape and domestic violence survivors, and I was profoundly affected by seeing how they transitioned from seeing themselves first as victims, then as survivors, and then as people capable of truly thriving. And my graduate school supervisor, Andy Sweet, introduced me to EMDR in 1991, a few years after I had graduated, and I will never forget his words, he said, Debbie, there’s this new trauma therapy called the EMDR Eye Movement Desensitization and Reprocessing. And it sounds kind of wacky, but I think that it’s something very powerful and unique and you need to go and get trained in it. I started my training with Dr. Francine Shapiro, the developer of EMDR, that year. And two years after that, I joined the faculty of the EMDR Institute, her training institute, and the rest is history.
Rachel Star Withers: What do we know from research about the connection between trauma and schizophrenia or psychosis?
Dr. Deborah Korn: Well, we know that as a group, clients with psychotic disorders more often report having been exposed to traumatic events in their lives than individuals in the general population. Once an individual is suffering from psychosis, he or she is at increased risk of exposure to new traumatic events. And the person may develop post-traumatic stress disorder as a consequence of experiencing an episode of psychosis. Those who struggle with both PTSD and psychosis seem to experience more positive psychotic symptoms, more general psychiatric issues, and more difficulties with neurocognitive functioning. They experience more neurocognitive impairment. Also, they’re at a greater risk for victimization and typically have poorer general functioning and quality of life.
Rachel Star Withers: I’ve heard of EMDR, kind of just recently, actually. I’ve heard it kind of being brought up a few times in conversations, but I still do not fully understand what it is. So if you can help us here, what exactly is eye movement desensitization and reprocessing?
Dr. Deborah Korn: Okay. So maybe let me begin with the name. EMDR stands for, as you said, Eye Movement Desensitization and Reprocessing. It’s a mouthful. It’s an earful. Desensitization refers to the focus on reducing fear, anxiety and distress. Reprocessing refers to the reevaluation or the restructuring of thoughts and beliefs and the transformation of one’s sense of self relative to past traumatic experiences. Reprocessing leads to resolution and healing. It allows people to move the past into the past so they can live more fully and carry on in the present. Now, EMDR was developed by psychologist Francine Shapiro in the late 1980s. She would ask clients to focus on a relevant traumatic memory and then instruct them to follow her fingers with their eyes as she moved them horizontally back and forth in front of their face. Hence the name Eye Movement Desensitization and Reprocessing. Now, over the years, we’ve learned that in addition to eye movements, many other forms of back-and-forth stimulation, what we call bilateral stimulation, are also effective. Having the client listen to alternating tones, tapping back and forth on a client’s hands as they rest them in their lap.
Dr. Deborah Korn: These forms also work as well. EMDR is it’s best known as an evidence-based treatment for post-traumatic stress disorder, but it is in fact being used to effectively treat a wide range of disorders, symptoms and issues. In EMDR therapy, we focus on past traumatic memories underlying current symptoms or difficulties. We also focus on present triggers for distress and goals for the future. And by the way, it’s a therapy that can be helpful even when someone doesn’t self-identify as a trauma survivor.
Rachel Star Withers: Okay. How can this be used in the treatment of schizophrenia?
Dr. Deborah Korn: EMDR is actively being used with clients diagnosed with schizophrenia. It’s actually, it’s only been in the last decade that trauma-focused treatments have been studied in clients with psychotic disorders. It used to be believed that trauma-focused treatment was contraindicated for schizophrenic clients. Clinicians and researchers simply assumed that the risk of exacerbation of symptoms was too high. With EMDR therapy, we’ve gotten better and better over time at adapting our protocols to meet the needs and the complex presentations of our clients. And research has clearly demonstrated that EMDR is both effective and safe in working with schizophrenia and other disorders that involve psychosis.
Rachel Star Withers: What would it look like to add EMDR to someone’s current schizophrenia treatment plan?
Dr. Deborah Korn: When someone with a schizophrenia diagnosis is referred to me for EMDR therapy, assuming that they are stable enough to begin trauma-focused processing, I begin by taking a trauma history and evaluating the person for PTSD and dissociative symptoms that may be comorbid with their schizophrenia, that may co-exist with their schizophrenia. And I just want to note, I’m often amazed to hear from our clients that no one had ever asked them about past traumatic experiences in previous therapies. It’s quite stunning. These traumas may include childhood, physical, sexual or emotional abuse, neglect or abandonment, witnessing violence, traumatic loss, traumatic medical procedures or hospitalizations, adult domestic violence or experiences related to having schizophrenia. Involuntary admissions, experiences with seclusion, loss of relationships, sense of losing control, dealing with stigma, encounters with hallucinations or delusional thinking, or perhaps stressful life events leading to a psychotic break. Once a target memory is identified, I activate the memory through a series of questions and then introduce sets, usually 30 to 60 seconds. I introduce sets of eye movements or bilateral back and forth stimulation to jumpstart and support the brain’s stalled information processing system. I might have clients track my fingers with their eyes as the fingers move back and forth, or track a light that moves back and forth.
Dr. Deborah Korn: With every set of bilateral stimulation, the client is simply asked to notice what changes and to report thoughts, feelings, sensations, impulses, insights. Whatever emerges, I encourage them to just notice. To be a passenger on a train just watching the scenery go by. We work to maintain what we call dual attention, focusing on the memory being held in mind while also following the bilateral stimulation or focusing on whatever emerges once the processing begins while focusing on the dual attention stimulation or the bilateral stimulation with processing. A client’s distress eventually decreases and relevant adaptive bits of information located in other parts of the brain, relevant present-day perspectives get integrated. It’s over. I’m safe now. I was only a kid doing the best that I could. It wasn’t actually my fault. There are shifts spontaneously in thoughts, feelings, behaviors and physical sensations. Comprehensive treatment addresses past traumatic events, current triggers and symptoms, and future behavioral goals.
Rachel Star Withers: Is this a like a one-time therapy session or would I go to you every week? Like, how often would I undergo EMDR?
Dr. Deborah Korn: Mm hmm. Great question. EMDR is a psychotherapy. Just like other psychotherapies. Most people come for EMDR treatment once a week. Sessions are often a little bit longer than your average 45 or 50 or 60 minute session. Often, it’s helpful to schedule 80 or 90 minute sessions, so we really have time to check in and then move in to the trauma focused work. And then there’s time as well at the end to kind of reflect and debrief and reorient completely to heading back out into the world. There’s also a lot of work being done these days with consecutive day treatment, more intensive EMDR treatment where a client might come for consecutive days of treatment,
Rachel Star Withers: What kind of improvements would someone who has schizophrenia expect to see as a result of undergoing EMDR therapy?
Dr. Deborah Korn: Mm-hmm. Well, according to the research on EMDR and schizophrenia or psychosis, EMDR therapy can lead to a significant reduction in PTSD symptoms, depression, anxiety, avoidant behavior, auditory hallucinations, and other positive psychotic symptoms. It can also lead to improved self-esteem and quality of life, as well as increased access to positive emotions and effective coping. Clinically, I see all of this as well as significant shifts in clients’ sense of worth, their sense of safety and control of the world. And by the end of treatment, folks are less vulnerable to stress and triggers and more hopeful about relationships and about and about their ability to set and achieve goals for themselves.
Rachel Star Withers: Can you share with us any real-world examples of EMDR in practice?
Dr. Deborah Korn: Yes, I’d be happy to. I worked with a young woman in her thirties who was diagnosed with schizophrenia maybe two years before she came to treatment with me. And she was actually doing relatively well in her life. Her psychotic symptoms were relatively under control with medication, but she was really struggling with PTSD symptoms related to her childhood sexual abuse. And we began our work together and identified a range of targets from her childhood trauma history to address in our work together. And over the course of treatment, we address the childhood trauma history. She wound up reporting several other significant traumas in her life of rape when she was in college and a traumatic loss of a friend to suicide. And we also addressed those issues in treatment, and she did extremely well. She experienced a dramatic reduction in her PTSD symptoms. Actually, by the end of treatment, she was no longer diagnosed with PTSD. And also interestingly, reported that the frequency of some of her, her hallucinatory experiences decreased over the course of our EMDR work. We also did quite a bit of work around her sense of self, the sense that she was broken or that she was damaged goods. She really struggled with the stigma around schizophrenia, and so we did a lot of work around her sense that she wasn’t good enough and by the end of treatment she really had a different perspective with regard to that and was really feeling like she was indeed good enough and had a lot to offer the world. And out of our work came a real intention to get more involved in mental health activism. And so she followed up her work with me with some pursuits in that direction.
Rachel Star Withers: Wow. That’s incredible. Thank you so much for sharing that.
Dr. Deborah Korn: Absolutely. It was a very, very rewarding experience for me, and I learned a lot from her along the way as well.
Rachel Star Withers: Now, you also have a new book out called “Every Memory Deserves Respect.” Can you tell us a little about that?
Dr. Deborah Korn: So first the title “Every Memory Deserves Respect” stands for EMDR. Every memory deserves respect. It’s a way for people to remember our initials. It’s a book about the impact of trauma, the challenges and steps of recovery and EMDR therapy. I co-wrote the book with Michael Baldwin, a childhood trauma survivor who believes that his two years in the EMDR therapy with one of my colleagues literally saved his life. “Every Memory Deserves Respect” is written in both of our voices. Michael shares his personal story, his child abuse and neglect, adult struggles, his failures in talk therapy, and ultimately his triumphant experiences in EMDR therapy. And I provide the education about trauma, post-traumatic symptoms, recovery, and EMDR therapy. Interestingly, Michael saw eight different therapists over the course of 22 years with very, very little progress and very, very little relief from his symptoms. And not a single therapist asked him about trauma. Not a single therapist suggested that any of his symptoms might be related to experiences that he had in his childhood. I also in the book try to convey the wonder of this therapy approach and the profound nature of the transformations that we get to witness with the EMDR therapy. I continue to be amazed the EMDR has been around for 30 years, that it’s considered an evidence-based treatment for PTSD and is being used actively with many, many different disorders. And people still don’t know about it or there’s a lot of misinformation about it. So I felt very strongly about getting a book out there that is user-friendly and accessible and offers information for readers that will help them to really get their head around what EMDR has to offer.
Rachel Star Withers: How can our listeners learn more about EMDR therapy and where can they connect with you in the future?
Dr. Deborah Korn: We have a beautiful website. It’s www.EveryMemoryDeservesRespect.com. So, it’s the name of our book. And on the website, you’ll find articles and essays about EMDR. Some written by me, some by others. You’ll find articles and information about trauma and trauma-informed care, links to podcasts and interviews and presentations. And we’re in the middle of a four-month book publicity campaign right now, so there will be a lot more posted in the upcoming months. There’s also a section on the website about upcoming events where anything that we have scheduled that is open to the public and/or mental health professionals. Our book is available on Amazon and from many other online booksellers, and the links to these booksellers can also be found on our website. And of course, the book can be found in brick and mortar bookstores, and it’s also available on Audible. So, you can listen to it if you’d prefer, and you can also reach me or my coauthor, Michael Baldwin, through our website.
Rachel Star Withers: Amazing and again that website is www.EveryMemoryDeservesRespect.com. Thank you so much, Dr. Korn, for being with us today and really breaking down what EMDR therapy is.
Dr. Deborah Korn: Yes. It’s been a pleasure. Thank you so much for having me.
Gabe Howard: Rachel, excellent interview. After speaking with Dr. Korn, do you have any thoughts on PTSD therapy for schizophrenia?
Rachel Star Withers: I do think it’s an interesting concept. Obviously, a lot of people with schizophrenia have trauma. Just think, in the past episodes, we’ve dealt with homelessness, we’ve dealt with incarceration, we’ve dealt, you know, all these major issues that are very trauma-inducing. So, I can easily see that people with schizophrenia could use PTSD therapies. Also, I think just having a hallucination in general can be kind of trauma-inducing. You know, growing up, listening to voices talking that aren’t really there, that can be trauma-inducing also. So, I could see where, yes, this is something to look into. I was a little bit worried where a few times, I think, it was brought up that maybe trauma caused the schizophrenia. And that’s not really how it works. So I would say that don’t think you’re going into a PTSD thinking, Oh, I’m going to find out the cause of my schizophrenia. No, you’re learning how to deal with past trauma, which can help you deal with your schizophrenia. Don’t go into this like, yes, this is going to cure my hallucinations that I have from schizophrenia.
Gabe Howard: We know that you have opinions, but what does the research say is the best add-on treatment for schizophrenia?
Rachel Star Withers: I can’t say it’s the absolute best, but it is up there. And the reason it’s my favorite is that it’s easy to learn and you can do it anywhere. It’s called progressive muscle relaxation therapy, and it has been proven to decrease anxiety, improve well-being and social functioning in adults diagnosed with schizophrenia. And all it is, it’s a very simple practice of tensing, kind of like flexing a muscle group and then relaxing and then picking another muscle group to flex. And this technique has been around since the 1930s. And what we’re going to do, Gabe, I thought we could do it together. And if you’re listening, obviously, you’re in your car, you’re at home, you’re at work. This is an easy one to do. And you can even do it like low key. No one will notice. All right. So, Gabe, are you ready to do it with me?
Gabe Howard: Yes. I love I love interactive podcasts. We should probably tell our listeners that you don’t have to close your eyes. But if you are driving, please be careful.
Rachel Star Withers: Yes. You do not have to close your eyes. One reason I like it is that, yeah, you can do this at any point. Someone can be talking to you, and if you’re having problems with hallucinations and you need to ground yourself, you could easily do these without looking weird. So, the first muscle group we’re going to do thighs, some
Gabe Howard: All right.
Rachel Star Withers: Nice, big, strong thighs.
Gabe Howard: Mine are muscular.
Rachel Star Withers: Yes. Yes. Big. Muscular.
Gabe Howard: I just wanted the listeners to know that. I don’t want them to think I’m flabby.
Rachel Star Withers: No, no. Thunder thighs. Bring that thunder.
Gabe Howard: [Laughter]
Rachel Star Withers: What we’re going to do is you’re going to contract them and it’s kind of like you’re flexing your thigh muscles.
Gabe Howard: Like, squeeze them.
Rachel Star Withers: Yes. You’re just focusing on the thighs right now. Don’t try and do your whole body and look like you’re about to pop or something. All
Gabe Howard: Gotcha.
Rachel Star Withers: Right. So together first, we’re going to inhale. Hold that and squeeze your thighs. We’re going to do it for 5 seconds. Five, four, three, two, one. Relax and exhale.
Gabe Howard: [Exhale]
Rachel Star Withers: All right. So, then you’re going to move on to the next muscle group. And I thought because it’s a podcast and we’re having fun here, let’s do our butt.
Gabe Howard: [Laughter]
Rachel Star Withers: So, I want you to really squeeze your buttocks. All right? Okay. So, I should
Gabe Howard: Yep.
Rachel Star Withers: Be able to tell when. Yeah, you’re doing it if you’re
Gabe Howard: Yeah.
Rachel Star Withers: Doing it right or not. Okay, so inhale. Squeeze that buttocks muscle. Five, four, three, two, one. Exhale. Let it go.
Gabe Howard: [Exhale]
Rachel Star Withers: If you’re like that, that was really weird, Rachel. It’s kind of a grounding exercise. It’s to help you relax, but it also grounds you. And that’s one thing I like is especially if you’re having hallucinations, delusions. It is a very simple, easy technique. You’re out in public, you’re experiencing an attack or something. It can even be as simple as I’m going to flex my hand. I’m going to like kind of just flex this one arm to kind of help ground you back. In reality, progressive muscle relaxation can be learned by anyone, and it really only requires a few minutes a day to practice it. Thank you so much for listening to this episode of Inside Schizophrenia. Please like share, subscribe and rate our podcast and we’ll see you next time here on Inside Schizophrenia, a Healthline media podcast.
Announcer: You’ve been listening to Inside Schizophrenia, a podcast from Psych Central and Healthline Media. Previous episodes can be found at psychcentral.com/is or on your favorite podcast player. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. Thank you and we’ll see you next time.