Download - EMDR West Midlands

EMDR with OCD
John Marr
Hello
• John Marr (EMDR Practitioner)
• Trained in
– Humanistic Therapy
– CBT
– EMDR
• Worked as
– Social Worker
– University and College Lecturer
– Therapist (Charity)
Today
•
•
•
•
•
Basic information
Confusion Ex/RP or CBT
My Research (a background)
Adapted Protocol 1
Adapted Protocol 2
In the Beginning
• World Health Organisation (WHO) has actually
ranked OCD in the top ten of the most disabling
illnesses of any kind, in terms of lost earnings and
diminished quality of life.
• Obsessive Compulsive Disorder (OCD) is the
4th most common mental health disorder.
In the Beginning
• There was confusion world wide during peer review.
• All clients reported receiving CBT therapy in the past
• Peer reviewers argued CBT is not a treatment for
OCD
• Had to agree to use term Ex/RP to publish
• Criticism of UK term CBT Generically
Most recommended
• Although Ex/RP Therapy can be highly
effective for around 50% of people who
complete Ex/RP treatment there are a
number of recognized drawbacks
(Psychological Medicine. 40. pp2013 – 2023)
• One of the biggest problems with Ex/RP
is the relapse rate which is high (57.3%)
and which hasn't improved in past 20
years.
•
World Health Organization; Global Burden of Disease 2000, Draft 21-08-06;
Maher et al. 2010
My experience
• 4 clients
– All Male
– Aged between 18 and 28
– Untreated OCD
– All referred for CBT in past
– All told CBT not appropriate within 2 sessions
– All left for years
What to Do?
• Continue with EX/RP therapy (CBT)
• Medicate
• Do Nothing
• Discover the causal link
• Be Innovative
Traumatic Phobia
•
•
•
•
•
•
The Clients
Background
Traumatic Phobia
OPTC (Recent thinking)
Obsessive Post-Traumatic Compulsions
Conventional Therapy had not worked
Innovation
• Use a combination of the Phobia Protocol and
Mental Video Playback
• A standard Phobia Protocol with exceptions
• Mental Video Playback replaces EX/RP
• EMDR reprocess the response to the mental
exposure
Adaptions
During the history taking identify the OCD Triggers
• Electric Plugs
• Taps
• Touching People
• Water
• Locking Doors
• Infection
• ETC
Practicum
• Break into pairs (30 min)
• Each Identify a safe OCD Issue
– Door locking
– Tap Checking
– Removing plugs
– Shaking Hands
– Hand washing
– etc.
Process
• Each Trigger is dealt with as a separate OCD event
• Process each Trigger
– Ensure client able to completer a full video
without experiencing anxiety before moving on
OCD Protocol
• In this OCD Protocol, targets are desensitized
in the following sequence,
– starting with the current triggers (OCD
compulsions and obsessions);
– followed by past related disturbing
memories (if any);
• and then by
– the future template (imagining successful future
action).
• In the OCD Video Playback Protocol, each current
target is fully processed using standard EMDR
procedures.
Phase one: Client History
• As with standard EMDR, a full client history is
taken, thus providing the therapist with
insight into the client’s issues.
Phase two: Preparation
•
The client is prepared as in the standard EMDR protocol with a calm place, and with the
addition of an imaginal nurturing figure, strength figure, or a protection figure if needed
•
The stop signal is taught; this inclusion should be understood as a necessity by both client
and therapist.
•
A dry run of the therapy is conducted, using a minor issue with little subjective distress.
The Subjective Units of Disturbance (SUD; Shapiro, 1995) scale is introduced at this point
to measure the subjective disturbance, where 0 is no disturbance or neutral and 10 is the
highest disturbance that they could imagine.
•
Triggers:
Phase Three:
Video playback procedure to identify triggers.
• The following procedure is used separately for each
trigger (i.e., each OCD event).
• The therapist says, “Play the mental videotape of the
circumstances of this OCD event. When you begin to
experience anxiety similar to the anxiety that you
experienced during the actual event, let me know. ”
Phase Three:
Video playback procedure to identify triggers.
• The standard EMDR protocol for phase 3 is then
applied, with the client asked to identify the various
components. These include: a representative image,
Emotion, the SUD score; and the body location of the
emotion.
Practicum
• Using History taking techniques Identify Triggers.
• Door locking.
– Close door, key in lock
• Count clicks key makes as it enters lock
– Turn Key
• Count clicks
– Check door handle 10 times each hand
Adaptions
SUD (Personal Choice)
VOC (Personal Choice)
PC (I Don’t Identify, will arise during processing)
NC (Personal Choice)
Touchstone (Will present during processing)
Practicum
• Play video until anxiety
• Ask about the
– Image
– Emotion
– Bodily Sensation
• Use EMDR to process
• Return to Video and continue playing.
Practicum
• Either use the case study provided or a case of your
own. Use the mental video playback technique with
the presenting triggers.
• 50 Minutes
Group feedback
• How did you find the mental video playback to use.
• Did any issues arise
• Did the client find it easy to visualise
Delayed Positive Cognition
40
35
30
25
20
15
10
5
0
Client 1
Client 2
Client 3
Client 4
40
35
30
25
20
15
10
5
0
Client 1
Client 2
Client 3
Client 4
40
35
30
25
20
15
10
5
0
40
35
30
25
20
15
10
5
0
1
2
3
4