Download File - Sarah M. Brothwell

Effective Use of EMDR
Sarah Brothwell, Rachel Pickel, Ashley Walczak
What is EMDR?
Eye Movement Desensitization and Reprocessing is a
therapeutic treatment that uses eye movements, sounds
or pulsations to stimulate the brain.
Using theses sensory experiences in conjunction with
focusing on a traumatic memory can create changes in
the brain that help a client overcome symptoms of
depression, anger and anxiety among other conditions.
EMDR combines aspects of behavioral, psychodynamic
and cognitive therapy.
History of
EMDR
In 1987, Francine Shapiro was
walking in the park when she realized
that eye movements appeared to
decrease the negative emotions
associated with her own distressing
memories, leading her to believe that
eye movements have a desensitizing
effect.
In her first controlled study to test
effectiveness, participants in the
EMDR conditions reported larger
changes than those in the imagery
condition.
Evolution of EMDR
In 1989, studies investigating the treatment of PTSD
were becoming more popular. During this time
Shapiro published two studies demonstrating the
efficacy of EMDR.
Shapiro, F (1989). Eye Movement Desensitization: A new
treatment for Post-traumatic Stress Disorder. Journal of
Behavior Therapy in Experimental Psychology, 20,211-217.
Shapiro, F (1989). Efficacy of the Eye Movement
Desensitization Procedure in the Treatment of Traumatic
Memories. Journal of Traumatic Stress, 2, 199-223.
Theoretical Model
According to Shapiro, the Information Processing System
incorporates the multiple elements of our experiences and
stores memories in an accessible and useful form.
When a traumatic or very negative event occurs,
information processing may be incomplete leaving the
memory dysfunctionally stored without appropriate
associative connections and elements still unprocessed.
When an individual thinks about a traumatic experience or
a memory is triggered, he or she may feel that they are
reliving it.
Shapiro proposed that EMDR can alleviate emotions
associated with the trauma by processing the components of
the distressing memories and linking them with more
adaptive information.
Goals of Treatment
To completely process traumatic experiences that are
creating problems in the present.
To leave the client with emotions, understandings and
perspectives that will lead to healthy functioning.
Treatment is not complete until EMDR therapy has
focused on the past memories that are contributing to
the problem the present situations that are disturbing
and what skills the client may need for the future
Stages of Therapy
http://www.youtube.com/watch?v=bqbFIj5vwmA
Stage 1: History Taking
Usually takes place during
the first two sessions of
therapy
Entails the development
of a treatment plan,
discussion of the specific
problem, and behaviors
and symptoms stemming
from the problem
Specific targets are
defined to use EMDR on
Stage 2: Client
Preparation
1-4 sessions
Primary goal of
preparation is to establish
a relationship of trust
Relaxation techniques are
taught to clients to rapidly
deal with emotional
disturbances when they
arise
Stages of Therapy Cont.
Stage 3: Assessment:
Person selects a specific scene from the target experience
that best represents the memory.
The client chooses a statement that expresses a negative
self-belief associated with the memory.
The person identifies negative emotions and physical
sensations associated with the memory and then rates
that disturbance using Subjective Unites of Disturbance.
Stages of Therapy Cont.
Stage 4: Desensitization
Focuses on the clients disturbing emotions and
sensations.
The therapist leads the person in sets of eye
movements or other forms of stimulation with
appropriate shifts and changes of focus until the SUD
scale levels are to zero.
This phase deals with all of the persons responses as
the targeted event changes and its disturbing elements
are dissolved.
Stages of Therapy Cont.
Stage 5: Installation
The goal is to concentrate on and increase the
strengths of the positive belief that the person has
identified to replace the person’s original negative
belief.
Stage 6: Body Scan
The therapist asks client to bring the targeted event to
mind and see if he or she has any physical sensations in
response to the event.
If so, then those sensations are targeted to be
reprocessed.
Stages of Therapy Cont.
Stage 7: Closure
The therapist assures that the client leaves feeling
better than at the beginning of the session.
If not the therapist will assist the person in using
relaxation techniques to regain a sense of equilibrium
before leaving.
Stage 8: Re-evaluation
Is done at the beginning of subsequent sessions
The therapist makes sure that positive results have been
maintained, identifies any new areas that need
treatment and continues reprocessing additional
targets.
Overview of Trauma
Causes of trauma: human action, such as domestic
violence, abuse, neglect, assault or war.
Noninterpersonal traumas including life threatening
illness, accidents, and natural disasters.
Types of trauma: An experience of a single traumatic
event are said to be a Type I trauma. The experience
multiple/enduring traumatic events, are said to be
Type II trauma.
Reactions to trauma: Acute stress disorder, Posttraumatic stress disorder, depression, generalized
anxiety disorder, childhood traumatic grief, specific
phobias, and separation anxiety.
Research
Silver, S.M., Rogers, S., Knipe, J., & Colleli, G. (2005).
EMDR therapy following the 9/11 terrorist attacks: A
community-based intervention project in New York City.
International Journal of Stress Management, 12 (1), 29-42.
This article addresses questions regarding the effectiveness
of EMDR as a treatment for individuals traumatized by mass
terror attacks and the effectives of EMDR in regard to the
time elapsed between traumatic event and treatment.
Results indicated a 50-61% decrease in scores on measures
of PTSD symptoms and even greater improvements on selfreport based measures after 4-5 treatment sessions.
Results also indicate that the sooner treatment begins after
a traumatic event the more effective treatment will be.
Research
Van der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. W., Hopper, E. K., Korn,
D. L., & Simpson, W. B. (2007). A randomized clinical trial of eye movement
desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment
of posttraumatic stress disorder: Treatment effects and long-term maintenance. Journal
Of Clinical Psychiatry, 68(1), 37-46. doi:10.4088/JCP.v68n0105.
This study indicates that the short-term use of EMDR may
not be sufficient on its own to treat clients who have
experience prolonged childhood trauma. Clients who
experienced childhood trauma may need more intensive,
longer-term EMDR treatment to experience permanent
symptom remission.
This study also identifies the benefits of pharmacological
intervention, which may be helpful for those who have
experienced significant childhood trauma.
EMDR may not be as effective in treating adults who have
experienced childhood trauma, because of the time that has
elapsed since the trauma occurred.
Research
Davidson, P.R., & Parker, K.C.H. (2001). Eye movement
desensitization and reprocessing (EMDR): A meta-analysis.
Journal of Consulting and Clinical Psychology, 69 (2), 305–
316.
Results from a meta-analysis of 34 studies indicated that
EMDR is effective when compared to no therapy at all and
non-specific therapies (e.g. applied relaxation, biofeedback,
active listening, rapid induction).
Results also indicate that EMDR was no more effective than
other exposure based treatments (e.g. in vivo exposure,
CBT).
Also, the authors did not support the necessity of the eye
movement component, nor for the training of therapists by
the EMDR Institute.
Research
Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active
ingredient in EMDR: Is it traditional exposure or dual focus of
attention? Clinical Psychology and Psychotherapy, 13 (2), 97-107.
This study investigated whether EMDR is another form of
exposure based therapy or if its effectiveness is related to dualfocus of attention.
Dual-focus is being able to maintain an optimal balance between
a focus on the traumatic material and a sense of not being part of
the trauma.
This article rejects the idea that EMDR is simply another exposure
based therapy.
Additional Uses of EMDR
Treatment of Migraines
Konuk, E., Epözdemir, H., Atçeken, Ş., Aydin, Y., &
Yurtsever, A. (2011). EMDR Treatment of Migraine. Journal
Of EMDR Practice & Research, 5(4), 167-176.
Treatment of Chronic Pain
Mazzola, A., Calcagno, M., Goicochea, M., Pueyrredòn, H.,
Leston, J., & Salvat, F. (2009). EMDR in the Treatment of
Chronic Pain. Journal Of EMDR Practice & Research, 3(2),
66-79. doi:10.1891/1933-3196.3.2.66
Treatment of Phantom Limb Pain
Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2008).
EMDR in the Treatment of Chronic Phantom Limb Pain.
Pain Medicine, 9(1), 76-82. doi:10.1111/j.15264637.2007.00299.x
Additional Uses of EMDR
Improvements in Attachment Style:
Wesselmann, D., & Potter, A. E. (2009). Change in Adult
Attachment Status Following Treatment With EMDR: Three
Case Studies. Journal Of EMDR Practice & Research, 3(3),
178-191. doi:10.1891/1933-3196.3.3.178
Treating Eating Disorders:
Bloomgarden, A., & Calogero, R. M. (2008). A Randomized
Experimental Test of the Efficacy of EMDR Treatment on
Negative Body Image in Eating Disorder Inpatients. Eating
Disorders, 16(5), 418-427. doi:10.1080/10640260802370598
Additional Information
EMDR.com
EMDRnetwork.org
EMDRinaction.com
THE END