Emotional Trauma and Phobias in Infertility Patients

by

Sherry Dale

Summer 2008

 

People experiencing infertility encounter many painful emotions. Most of these feelings make sense in the context of the uncertainty and sadness of waiting for a baby and bitter disappointment when treatments are not successful. Some people, however, experience very strong emotions that seem extreme or out of context. These feelings of extreme fear or distress may be associated with emotional trauma.

 

When we think of “emotional trauma,” what comes to mind is usually “Big-T Trauma” such as that experienced by combat veterans, hurricane survivors, or victims of physical or sexual violence. However, trauma exists on a continuum. On one end is catastrophic emotional trauma, often involving the threat of death. The other end of the trauma scale is the “Small-T Trauma.” perhaps more appropriately called “triggers,” with symptoms far less severe. Few of us reach adulthood without acquiring some type of trigger or “button” that when pushed, causes a predictable emotional response. A trigger can be as innocuous as feeling irritated every time you think of a cruel comment someone made to you, even if it was a long time ago.

 

There is much we don’t yet understand about emotional trauma. We don’t know, for instance, why certain things are coded in the brain as “traumatic events” and other experiences are coded simply as the memory of a painful or unpleasant event. If two people are together in a car that crashes, and both walk away unhurt from the accident, one of them may recall the event as simply a frightening experience that they are glad to have survived. The other may not be able to get back in a car again even months or years later, and may have recurring nightmares and flashbacks of the crash. Clearly, one of these people’s brains coded the car accident as a trauma and the other’s did not. When entire communities experience the same disaster, not all of the people affected will develop post-traumatic symptoms.

 

What we do know is that when the brain codes an event as trauma, the memory of that event is experienced differently than non-traumatic memories. Trauma memories appear to be coded in a different part of the brain than “normal” memories. Studies have indicated traumatic memories are active in the limbic system of the brain, which is not where long-term memories are typically stored.¹ Trauma seems to cause inappropriate and looping reactivation of the fight-or-flight response, long after the actual threat is gone.²

 

I think of traumatic memories as similar to having a virus on your computer. You may have no idea where that virus came from, but once it’s there, it interferes with normal functioning of your computer. The virus will knock you off track every time you try to accomplish something. People dealing with emotional trauma symptoms find themselves “defaulting” to certain reactions even when they wish to respond in a different way.

 

When working with clients to determine whether their memories are trauma-based, four criteria help us classify them. Firstly, if something is coded in the brain as trauma, when you talk about it or think about it, you get a physical reaction in your body. For instance, you may feel a knot in your stomach, a racing heart, clammy hands, flushing, dizziness, shortness of breath, or tearfulness. Secondly, that physical sensation is accompanied by a consistent emotional reaction – it is the same every time. Thirdly, the brain and the gut are not talking to one another on this topic. Your brain can be telling you all the logical reasons you shouldn’t be reacting the way you are, but the gut is not listening, and may be panicking and overreacting. Fourthly, trauma tends not to fade over time, but loops and persists.

 

Time does not seem to heal all traumatic wounds. Indeed, emotional trauma symptoms can worsen over time, as the person feels discouraged and self-blaming that they can’t just “get over it.” Other people may be impatient with their continued distress. People with emotional trauma feel stuck in their emotions and reactions, and indeed, they are – that’s the nature of trauma.

 

Wherever the person’s posttraumatic responses lie on the continuum, the common feature is “looping” and inability to move past or come to terms with the upsetting event. One trauma researcher states, “The core issue is the inability to integrate the reality of particular experiences, and the resulting repetitive replaying of the trauma in images, behaviours, feelings, physiological states, and interpersonal relationships.”3

 

The American Psychiatric Society classes trauma responses under “anxiety disorders.” These include Posttraumatic Stress Disorder (PTSD), which is relatively uncommon, affecting less than 10% of the population.⁴ There are many other post-trauma diagnoses, including panic attacks and phobias.⁵ Symptoms of the various post-trauma responses can include nightmares, flashbacks, intrusive thoughts, dissociation, substance abuse, bodily disturbances (pain, paralysis, preoccupation with body function), emotional numbing, panic, and depression.²

 

Most people who experience post-traumatic symptoms will not be diagnosed with a psychiatric diagnosis, but many, many people experience triggers. Emotional triggers can be anything we see, hear, smell, taste, touch or feel that evokes an intense emotional response that may not make sense in the present situation.

 

If a negative life event has been coded in your brain as a “trauma,” the healing process can be immensely difficult. Fertility testing and treatment can trigger pre-existing traumas. For instance, women who have sexual trauma in their past can find vaginal ultrasounds and IVF egg retrievals trigger their trauma responses. Grief that is hooked into trauma tends to loop with the trauma and it is far more difficult to heal. Many women who have had miscarriages experience post-traumatic symptoms of the pregnancy loss afterward. They may have very vivid recurrent images of the miscarriage or of the ultrasound scan that failed to reveal a heartbeat in their baby.

 

Many people experience fear regarding their infertility treatments. Most fears are normal and healthy – fear is a tool your self-protective instinct uses to tell you that something may be a threat. But when fears are exaggerated, inexplicable or illogical, they may be classed as phobias.⁶ Phobias fulfil the same criteria as post-traumatic responses, and are more common than most people think. Some estimates place the incidence of those experiencing some sort of phobia as high as 25% of the population.⁷ And there are a lot of phobias - one source lists more than 500!⁸ Some seem odd indeed, such as the fear of flowers, books, knees, and stars. People who suffer from these phobias may be aware that they are irrational, but the fear is very real.

 

Sometimes, the phobia has a clear cause (for example, if you were bitten by a dog, you may have developed a dog phobia), but often, there appears to be no real reason for the intense fear. People who are terrified of spiders, for instance, have probably never been attacked by one. Nobody knows just what causes phobias, though it is thought that genetic, social, and psychological factors can be influences.⁹

 

In the fertility clinic, because treatments almost always include regular blood draws and often injections as well, the most common phobia is fear of needles (trypanophobia). About one in ten people experience needle phobia to the point that it interferes with medical treatment.¹⁰ People can also have phobic reactions to blood (hemophobia), surgical procedures (tomophobia), pain (algophobia), or medical settings (Nosocomephobia). These phobias affect not only women undergoing medical procedures, but also their partners who witness or hear about them.

 

There are a number of treatments therapists find helpful to treat post-trauma and phobic symptoms, but the main one I use with clients is Eye Movement Desensitization and Reprocessing (EMDR). This treatment involves focusing one’s thoughts on the traumatic or phobic subject while administering bilateral (left-right) brain stimulation. The person also attends to emotions and body sensations experienced when thinking about the distressing memory or event. When EMDR was discovered in the 1980s, it was thought that the technique required the client to move their eyes back and forth while thinking of the trauma target. Now it is clear that any bilateral brain stimulation accomplishes the same result. I use headphones with a beep left and right or discs that the client holds that pulse back and forth. As the client focuses on multiple aspects of the disturbing memory during the bilateral brain stimulation, the distress fades. The technique’s originator, Francine Shapiro, says, “…the negative images, negative beliefs, and negative emotions become less vivid, and less valid. They appear to become linked with more appropriate information: The client learns what is necessary and useful from the disturbing past experience and the event is restored into memory in an adaptive, healthy, non-distressing form.”¹¹

 

Often, phobias can be released in one or two sessions. EMDR has been extremely effective in treatment of needle phobia in the fertility clinic setting.¹² Deep-seated, long-standing traumas such as childhood abuse can take longer. EMDR does not make the distressed person forget the event; it simply seems to take away the block to their natural processing. One author explains the effects of EMDR as follows: “Much of what we consider to be mental disorder is the result of the way information is stored in the brain. Healing begins when we unlock this information and allow it to emerge. I regard this healing process as an activation of the person’s innate ability to heal himself psychologically, just as his body heals itself when he is physically wounded…We are all biologically and emotionally geared for survival and mental equilibrium.”¹³

 

EMDR is effective not only with extreme post-traumatic stress such as PTSD, but can also “unhook” phobias and other milder kinds of triggered, automatic responses. If you are interested in finding an EMDR therapist, consult the professional association EMDR Canada for a practitioner near you.1⁴

 

If you have been having difficulty getting pregnant or staying pregnant, the emotional toll of that experience demands much from you. If trauma-based triggers or phobias also impact you in the infertility clinic setting, your upset may well be compounded. Working with a counsellor to specifically target trauma, triggers, and phobias can help alleviate the older, looping trauma-related distress so you can focus your energy on the emotional demands of the here and now.

 

Sherry Dale (formerly Sherry Franz) specializes in counselling for infertility and pregnancy loss. She works full-time at the LifeQuest Centre for Reproductive Medicine. Clients can see her at LifeQuest even if they are not patients there (e-mail sdale@lifequestivf.com or call 416-506-0804). Sherry also has a private counselling practice, where she can be reached at sherry.dale@pathcom.com or 416-410-8904. Sherry lives in Toronto with her two sons, both conceived through assisted reproductive technologies.

[1]. Villarreal, G. & King, C.Y. (2004). Neuroimaging studies reveal brain changes in posttraumatic stress disorder. Psychiatric Annals, 34, 845-856.

2. Briere, J. & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks, California: Sage Publications.

3. Van der Kolk, B.A., McFarlane, A.C., & Weisaeth,L. (Eds.). (1996). Traumatic stress: The effect of overwhelming experience on mind, body, and society. New York: Guilford Press.

4. Elkin, G.D. (Ed.). (1999). Introduction to clinical psychiatry. New York: McGraw-Hill

5. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

6. World Health Organization (2004). International statistical classification of diseases and related health problems: Tenth Revision. Geneva, Switzerland: World Health Organization.

7. Sadock, B.J. & Sadock, V.A. (2007) Kaplan and Sadock’s synopsis of psychiatry: Behavioral. New York: Lippincott Williams & Wilkins.

8. The phobia list. Retrieved March 23, 2008, from: http://www.phobialist.com.

9. Mayer, D.P. (2005). The everything health guide to controlling anxiety. Avon, Massachesetts: Adams Media.

10. Levenson, J.L. (2006). Essentials of psychosomatic medicine. Washington: American Psychiatric Publishing, Inc.

11. Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedure (2nd ed.).New York: Guilford Press.

12. Dale, S. & Laskin, C. (2007, September). EMDR successfully treats needle phobia in the ART setting.

Poster presented at the annual meeting of the Canadian Fertility and Andrology Society, Halifax, NS.

13. Shapiro, F. & Forrest, M.S. (1997). The breakthrough therapy for overcoming anxiety, stress, and trauma. New York: Basic Books.

14. EMDR Canada. Retrieved March 23, 2008, from http://www.emdrcanada.org.