Post on 24-Dec-2015
HistoryEMDR - 1987 Francine’s walk in
the parkCurrent status – Evidence based
treatment for trauma3-6 sessions for single episode
PTSDMore needed for multiple
traumatization (e.g. studies show 12 session for veterans)
Part of an overall treatment plan for complex trauma and dissociative disorders
World Health Organization Guidelines (2013)
Trauma-focused CBT and EMDR therapy are recommended for children, adolescents and adults with PTSD. “Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.”
Neuroimaging studies(Pagani, et. al., 2013)Cortical activation of limbic areas during script reading
Emotional hyperarousal during trauma reliving
Neuroimaging studiesEMDR results in normalization of these
activations and can be understood as a neurobiological correlate of clinical recovery
A shift of emotive attention to cortical regions with a dominant cognitive and sensorial role.
Hence memory retention of the traumatic event can move from an implicit subcortical to an explicit cortical status where different regions participate in processing the experience!
Neuroimaging studiesComparing findings from EEG and CBF SPECT
scan studies, it was found that the same brain regions are implicated in response to EMDR therapy.
This cross-validates the two methodologies and implicates that EMDR therapy is associated with functional changes in the same topographic regions as those activated by a autobiographical script (fusiform gyri and occipital and frontal cortex)
EMDR the first psychotherapy with a proven neurobiological effect.
Adaptive Information Processing ModelPresent problems that result from
past memories “living in trauma time”, maladaptively stored
EMDR processing may facilitate memory networks containing adaptive information to link into memory networks containing maladaptively stored information, allowing integration to occur
EMDR - eight phasesHistoryPreparationAssessmentDesensitizationInstallationBody ScanClosureRe-evaluation
Development of EMDR/EAP model1990 Secret Service - peer support team
training1990 FBI - peer support team training Post Critical Incident Seminar1995 Oklahoma City, US Attorneys OfficeSeptember 11, 2001 New York City, US
Department of Justice2004 Department of State, Diplomatic
Security2010 US Senate EAP
Goals of EAP Model Enhances:the assessment, referral and
treatment process,motivates clients towards
treatmentEAP’s ability to address short-
term issues in-house,rates of client satisfaction and
successful outcomes.
EMDR as assessmentIf client responds positively to
EMDR and problem is resolved no further referral is needed
If more negative material becomes evident, then referrals are facilitated
Therefore EMDR can be used to assess the nature of the problem, and what support is needed
EAP ModelInitial EAP assessment to select
appropriate clientsPreparationEMDR utilizationFollow-up/referral
Model – Selection of clientsAppropriate selection of clients –
stable social environment, moderate to high integrative capacity, ability to lower level of physiological distress, agree to follow-up with outside counseling (referral)
Client has distressing events, past and recent, related to current problem
Model - PreparationExplanation of EMDRDiscussion how it may help to
improve current situationReading material
Model: PreparationAssessment by RogerInitial discussion of goal(s) of
sessionSafe/calm place or resource
installation, or other stabilization methods, if appropriate
Agreement for referral for follow-up, if needed
EMDR utilizationWork stress issuesCurrent crises Recent trauma Grief and loss issuesPast distressing events that are
currently being triggered
EMDR utilizationStabilization - safe/calm place
and resource installationDistressing memories linked to
present problemPresent triggersFuture template
Model: Follow-up and referralQuick follow-up (e.g. later the
same day, next day) Ongoing follow-up as appropriateReferral for follow-up treatment
as appropriateOngoing support/further sessions
as appropriate (can work with client’s current therapist)
Safe Place
1) Positive image of place with safety/calm
2) Close your eyes - notice feelings, sensations
3) Identify a word that would go with the feeling
Safe place
4) Close your eyes, bring up the image, notice the pleasant feelings, and say the word in your mind, and notice the feelings as you merge with the scene and repeat the word. Then after a moment or so, open your eyes5) If positive feelings came up, repeat closing eyes, bringing up the image, and the word to pair with it. Do this five times (about a minute each time)
Safe place
6) Test the effect – notice your body, and then bring up the image and the word
If positive, bring up something recent that mildly disturbed you, notice how your body reacts, and then bring up the positive image and word, and see if the good feeling comes back
Adding bilateral stimulationOnce you have the safe or calm
place, add bilateral stimulation - tapping with hands on thighs - butterfly hugBring up image of safe or calm place along with the positive word, and allow yourself to go into the state of safety/calmness. Then tap alternatively on your thighs or with butterfly hug 4-6 times
Adding bilateral stimulationIf positive repeat several timesIf negative, stop, and use safe
place without bilateral stimulation, or slow breathing to calm