EYE MOVEMENT DESENSITiZATION & REPROCESSING
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CITY HALL
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CENTRAL CONSTRUCTS OF THE THEORY
The Eye Movement Desensitization and Reprocessing (EMDR) protocol:
- is a radical psychological approach that is well-known for its empirically based application for healing trauma symptoms (Siegel, 2018).
- was developed to treat intrusive thoughts and memories attached to different traumatic events (Tan, S.-Y., 2011).
- involves guiding clients to map out their trauma narrative through visual imagery in a strategic fashion and process by mimicking eye movements similar to that of an intense dream state (Tan, S.-Y., 2011).
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WHAT CAUSES DYSFUNCTION IN THE THEORY'S VIEW?
Classified as conditionally recommended, as opposed to strongly recommended, by the APA (2022)
Potential adverse effects exist that may re-traumatize the client
Considered a controversial therapy technique due to lack of long-term research
More consideration needs to be taken in assessing for stability to endure triggers and distress
It is not entirely clear as to the exact mechanism at work responsible for positive outcomes
Complexity and rigidity of the process may lead to inconsistent practice and poor training
Requires that the therapist have an advanced level of insight into brain processes
Critics state EMDR is only sustainable when combined with cognitive techniques
(Landin-Romero et al., 2018; Houben et al., 2018)
Often referred to as a pseudoscience, along with other energy techniques, that potentially causes false memories
Dr. Jamie Marich offers an example of how an aspect of EMDR, specifically the element of identifying a calm safe place, works against the therapeutic process (2020). In this EMDR demonstration, she explores the client’s intense and overwhelming anger response, and transitioned to a talk approach instead that was safer and more productive for the client’s trauma memory navigation (Dr. Jamie Marich, 2020).
Dr. Jamie Marich (2020). When "Calm Safe Place" Doesn't Seem to Work in EMDR Therapy. Retrieved November 25, 2022, from https://www.youtube.com/watch?v=8udaUIQ7QOw.
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the Nature of therapy for emdr model
adaptive processing model
- Focus on patient's own internal resources
The theoretical framework for EMDR is the adaptive information processing model (AIP). Some features of the AIP model relevant to informing EMDR theory include:
- Assumption that the brain can process and integrate stressful information
- If the processing system is impaired, the raw storage of the memory will have maladaptive effects
- Dysfunctional stored memories become the focus of EMDR protocols in order to activate the necessary processing system and reprocess the pathogenic memories
- Emphasis on pathogenic memories associated with intrusions stemming from stressful experiences lacking PTSD diagnosis criteria
- Conceptual expansion of trauma to focus on link between pathology from stressful events & success of processing memories outside the scope of "traumatic"
(Hase et al., 2017)
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Active assessment by the clinician is a vital part of EMDR throughout the process.
significant elementS & roles in emdr
ROLE OF ASSESSMENT
Initial assessment is conducted where the clinician and client will develop treatment goals and targets
A guided assessment of the client’s available coping skills in the “Safe/ Calm Place Exercise” is performed
When target memory is activated for the focus of the session, IMAGE, COGNITION, AFFECT & BODY SENSATION are assessed.
Self-reported scales measure changes in feelings or thoughts
Validity of Cognition (VOC) scale and Subject Units of Disturbance (SUD) scale are re-administered as needed
Body scan assessments utilized to assess self-reported physical responses
(American Psychiatric Association, 2022)
VOC & SUD SCALES
SUBMIT
CANCEL
(American Psychiatric Association, 2022)
COUNSELOR
Therapeutic relationship is one of the core elements of EMDR
Directive guidance through protocol
Must attune to client's experience
Assess often & focus on coping skills
Hase, 2021) (Hase & Brisch, 2022)
ROLE OF THE CLIENT & COUNSELOR
CLIENT
These qualities will help the client to find success with EMDR:
- Open-mindedness
- Readiness to change
- Vulnerability
- Emotional insight
- Coping resources
- Emotional regulation
We, as EMDR Therapists, are in relationship to our clients and their experience in real time; we perceive our clients’ signals, maintaining a mindful presence, while responding promptly and appropriately to what is needed.
The inherent processing demands of EMDR Therapy require a high level of safety and trust in the relationship as well as in the process itself, in order for most clients to be able to venture into the unchartered emotional territory of their past traumas
Hase, 2021, p.5
GOALS OF EMDR THERAPY
Change Memory Storage
Involves teaching the client to recall a distressing memory and avoid intense emotions and overwhelm. This is done through altering how a memory is stored.
WHAT IS EMDR TRYING TO ACCOMPLISH?
Deal With Past Trauma
Trauma is becoming more prevalent and causes consequences for physical and mental health. Through processing of the connected memories, pathology is reduced.
Deal With Future Trauma
Aims to identify present-day adverse events impeding functioning, and build on a client’s tools to deal with potential future trauma and increase sustainability of the therapeutic results.
Increase Positivity
Identification of a positive belief that is installed to reframe distressing events serves as a new focus and narrative that is associated with the memory.
Integration and Adaptability
The EMDR aims for no distress surrounding trauma as a final result, and many clinicians have found it to be extremely effective when used in conjunction with other interventions.
(Cerny, 2021)
WHAT ARE SOME EXAMPLE TECHNIQUES OF EMDR?
- Accessing and reprocessing subconscious connections to traumatic memories
- Installing new beliefs and narratives
- Visualization and memory retrieval
- Somatic techniques including rapid eye movement and body scans
- Utilization of coping resources when necessary
(Kullack & Laugharne, 2016)
WHAT IS THE EMDR THERAPEUTIC PROCESS?
The process of EMDR is very structured and uses an eight-phase protocol. The recommended treatment time is 10-12 sessions.
Over the course of therapy, a distressing memory is targeted and reprocessed until distress levels decrease. This process is repeated with multiple memories if needed.
(Hase et al., 2017; U.S. Department of Veterans Affairs, 2018)
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According to EMDR Institute (2020), the EMDR treatment approach has been empirically validated in over 30 studies with victims of trauma, with an additional 25 showing efficacy for the component of eye movement specifically.
CASE EXAMPLE #1
Buydens et al. (2014)
In this study, researchers exemplified the proven positive effects of EMDR for the addressing recent experiences involving traumatic elements in individuals diagnosed with acute stress disorder.
CASE EXAMPLE #2
KULLACK & LAUGHORNE (2016)
This study successfully showcased the efficacy of utilizing EMDR protocols for individuals with a dual diagnosis of PTSD and substance dependence, indicating improvements during a 12-month duration.
CASE EXAMPLES OF EMDR
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CRITiQUE OF EMDR THEORY
EMPIRICAL SUPPORT FOR EMDR MODEL
EMDR therapy is a recognized effective treatment for PTSD and endorsed by many organizations including:
- THE U.S. DEPARTMENT OF VETERANS AFFAIRS
- SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
- AMERICAN PSYCHIATRIC ASSOCIATION
- DEPARTMENT OF DEFENSE
- INTERNATIONAL SOCIETY FOR TRAUMATIC STRESS STUDIES
These treatment guidelines are based on reviews that evaluate research of established evidence-based mental health treatments.
EMDR therapy has demonstrated efficacy for both children and adults, and therapists are using it successfully to address challenges including:
- Personality disorders
- ·Post-Traumatic Stress Disorder (PTSD) and other trauma and stress-related issues
- ·Sexual assault
- ·Sleep disturbance
- ·Substance abuse and addiction
- Violence and abuse
(EMDRIA, 2022)
- ·Anxiety, panic attacks, and phobias
- ·Chronic Illness and medical issues
- ·Depression and bipolar disorders
- ·Dissociative disorders
- ·Eating disorders
- ·Grief and loss
- ·Pain
- Performance anxiety
FURTHER RESEARCH NEEDED
A significant aspect of the EMDR theory that require further research is the adaptation to the growing virtual experiences in our post-pandemic society. Some elements of this shift include:
- A resistance to virtual options existed in the mental health sector previous to the pandemic.
- This resistance was not evidence-based, but simply premised on a traditional belief of what constituted a real therapeutic relationship.
- There were many EMDR therapists at the time of the pandemic faced with the choice to abruptly stop an intensive therapy or attempt to provide the services virtually.
- Studies display a parallel global shift to acknowledging the benefits of accessibility, affordability, sustainability, and increased health equity in virtual delivery.
- Many therapy clients have chosen to continue virtual modalities due to convenience and time-saving aspects.
However, with EMDR being primarily somatic and energy-based, it brings up real questions as to whether the full benefit can be achieved with the mechanisms involved.
- There are some research studies done about the usage of EMDR in a virtual setting, but many providers and advocacy groups still disagree on its efficacy and benefit used this way.
- Due to necessity and forced by isolation conditions, guidelines that inform EMDR virtual treatment were adopted during the pandemic by mental health governing bodies.
- There is still a need to review EMDR as an evidence-based practice at it's initial adoption with in person primary usage as compared to a virtual use to gain clarity about best practice.
- A number of unique considerations arise in light of virtual therapy this way and attempting bilateral stimulation remotely
EMDR International Association seeks to bridge the gap for therapists forced into a virtual telehealth modality in order to ensure quality EMDR services are accessible to everyone in need. They offer resources including:
- General Telehealth Information
- Online EMDR Therapy Platforms or Apps that provide specific bilateral stimulation/ dual attention stimulus services
- Tips for maintaining the therapeutic relationship with EMDR online therapy (pictured below)
EMDRIA.ORG VIRTUAL BEST PRACTICE GUIDELINES FOR EMDR THERAPISTS
CLICK TO DOWNLOAD!
FAITH DIMENSIONS IN EDMR THEORY
Spiritual awareness has been growing rapidly in the mental health field, altering the context for trauma and the way it is approached.
Development of a fundamental spiritual consciousness and self offer pertinent opportunities within the EMDR protocol for the following facets:
- Positive resourcing
- Adaptive functioning
- Cognitive techniques and installations
- Emotional stabilization
- Coping resource reinforcement
- Giving spiritual meaning to adverse events
(EMDRIA, 2022)
According to siegel (2018), the following emdr theory concepts possess roots in spiritual institution & tradition:
- THE Concept of an interconnected energy field
- higher capacity of consciousness
- experience of interconnectedness to all worldly things
- plausibility of recognizing & sensing connection to a divine force
(EMDRIA, 2022)
CuLTURAL DIMENSIONS IN EDMR THEORY
According to Nickerson (2022), there are distinct ways in which EMDR techniques display cultural competence:
-Theories and principles that have adaptability across cultures
-Clinical model that involves assessing significance of cultural facTORS
-Client-centered model focused on client’s subjective experiences and values
-Increasing library of scholarly sources documenting effectiveness in application with variety of cultural groups
-Inherent capacity to address effects of culturally-based and generational traumA
Additionally, EMDR informed organizations are extending reach and efforts to culturally underserved populations around the world to offer accessible treatment options (Nickerson, 2022).
EMDR HUMANITARIAN ASSISTANCE PROGRAMS (HAP)
is one example of this shift, developed in 1995 to offer pro bono treatment for victims and first responders of large-scale disasters and crises.
This organization has evolved and grown to conduct international outreach for trauma healing with EMDR services, as well as provide free trainings, workshops, and conferences to practitioners (EMDR HAP, 2022).
"The heartfelt devotion to our ever important mission keeps the vision of our founder, Dr. Francine Shapiro, alive — a vision to bring hope and healing to those suffering from the effects of emotional trauma through EMDR therapy"
-Carol R. Martin
EMDR HAP Executive Director | (EMDR HAP, 2022)
click
to view the book on Amazon
Shopping
Eagle Wings Flapping EMDR Therapy is an example of the EMDR protocol adapted specifically for Native American and Indigenous communities with stabilization techniques to complement and attune to their beliefs and strengths.
Founder Shelley Pompana Spear Chief, Clinical MSW, published a book to provide an accessible source of education on the adapted treatment approach, where the characters learn how to manage big emotions with Phase 2 of the technique.
(EMDRIA, 2022)
Clients often identify connections, and this supports understanding and allowing clients to connect to their own cultural ways of knowing therefore internal abilities to let go and heal.
It is often presumed that one protocol, one way of practice will support all people the same regardless of values, norms, culture, race, and gender. This is not the case.
Shelley Pompana Spear Chief, Clinical MSW, Founder of Eagle Wings Flapping EMDR Adapted Protocol (EMDRIA, 2022).
CHRISTIAN WORLDVIEW COMPATABILITY
According to the Biblical Counseling Coalition (2021), in a
statement released about EMDR, they note that:
"Scripture helps us appreciate certain aspects of EMDR, while being neutral about other aspects of EMDR, while opposing still other aspects of EMDR."
Some problematic elements of EMDR:
- As EMDR is presented, God and Scripture find no place.
- Strong emphasis on self-healing and solutions found inside the person
- The self as the Savior substitute
- Personal experience trumps Scripture
- Lacking strong scientific methodology behind EMDR
Some CHRISTIAN aligned elements of EMDR:
- The basic intentions are compassionate in an attempt to help suffering people
- Extensive and organized methodologies with empirical backing
- Many aspects do not infringe upon or contradict the work of biblical counseling
- Body-sensitivity of EMDR therapy
(Biblical Counseling Coalition, 2021)
We see ourselves for who we truly are by measuring ourselves against the truth of Scripture.
DALE JOHNSON
The way that EMDR is carried out by the therapist would play a big role in improving compatibility with the Christian worldview.
Some modifications that the therapist can pay attention to are:
- Address negative beliefs associated with God and Christianity
- Assess the impact of trauma on self-love and worthiness of love by God
- Address how Complex PTSD can impede client's ability to see an authority figure as protective and loving
- Use the opportunity, as the client goes through EMDR phases, to encourage reintroduction of God as an ally
- Acknowledge how somatic emphasis allows Jesus to show up in a tangible way that is felt in the body
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KEY EDUCATIONAL RESOURCES
for learning EMDR approach
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American Psychological Association. (2022). Eye movement desensitization and reprocessing (EMDR) therapy. American Psychological Association. Retrieved November 25, 2022, from https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing
Biblical Counseling Coalition. (2021, December 16). BCC Statement on EMDR. Biblical Counseling Coalition. Retrieved November 30, 2022, from https://www.biblicalcounselingcoalition.org/wp-content/uploads/2021/12/Statement-on-EMDR-by-the-BCC.pdf.
Brown, H. (2020, July 6). Many patients are realizing they prefer remote therapy. After Trying Online Counseling, Some May Never Go Back to Real-Life Therapy. Retrieved November 24, 2022, from https://www.vice.com/en/article/y3zbmx/teletherapy-more-widely-accepted-covid-19-pandemic
Buydens, S. L., Wilensky, M., & Hensley, B. J. (2014). Effects of the EMDR protocol for recent traumatic events on acute stress disorder: A case series. Journal of EMDR Practice and Research, 8(1), 102-112.
Cerny, B. (2021, November 2). 5 goals of EMDR therapy. Applied Behavior Analysis Programs Guide. Retrieved November 29, 2022, from https://www.appliedbehavioranalysisprograms.com/lists/5-goals-of-emdr-therapy/
Dr. Jamie Marich (2020). When "Calm Safe Place" Doesn't Seem to Work in EMDR Therapy. Retrieved November 25, 2022, from https://www.youtube.com/watch?v=8udaUIQ7QOw.
EMDR HAP. (2022, September 16). Trauma recovery: EMDR humanitarian assistance programs. Trauma Recovery | EMDR Humanitarian Assistance Programs. Retrieved November 25, 2022, from https://www.emdrhap.org/
EMDRIA. (2022, November 15). EMDR International Association. Retrieved November 24, 2022, from https://www.emdria.org/
Fisher, N. (2021). Using EMDR therapy to treat clients remotely. Journal of EMDR Practice and Research, 73-84.
Francine Shapiro, Ph.D. (2022, May 17). EMDR Institute Inc. Retrieved November 24, 2022, from https://www.emdr.com/
REFERENCES
Goth, L. (2021). EMDR and Christianity. Retrieved November 25, 2022, from https://maibergerinstitute.com/emdr-christianity/.
Hase, M. (2021). The Structure of EMDR therapy: A guide for the therapist. Frontiers in Psychology, 12, 660753.
Hase, M., Balmaceda, U. M., Ostacoli, L., Liebermann, P., & Hofmann, A. (2017). The AIP model of EMDR therapy and pathogenic memories. Frontiers in psychology, 8, 1578.
Hase, M., & Brisch, K. H. (2022). The Therapeutic Relationship in EMDR Therapy. Frontiers in Psychology, 2729.
Houben, S. T. L., Otgaar, H., Roelofs, J., & Merckelbach, H. (2018). Lateral eye movements increase false memory rates. Clinical psychological science, 6(4), 610–616.
Kwik, J., & Bernstein, G. (2022). Understanding and Healing Trauma with Dr. Dawson Church. Gaia. Retrieved October 30, 2022, from https://www.gaia.com/video/understanding-and-healing-trauma-dawson-church?fullplayer=feature.
Kullack, C., & Laugharne, J.. (2016). Standard EMDR protocol for alcohol and substance dependence comorbid with posttraumatic stress disorder: Four cases with 12-month follow-Up. Journal of EMDR Practice and Research, 10(1), 33-46.
Landin-Romero, R., Moreno-Alcazar, A., Pagani, M., & Amann, B. L. (2018). How does eye movement desensitization and reprocessing therapy work? A systematic review on suggested mechanisms of action. Frontiers in psychology, 9, 1395.
Nickerson, M. I. (2022). Cultural competence and healing culturally based trauma with emdr therapy: innovative strategies and protocols (2nd ed.). Springer Publishing.
Nickerson, M. I. (2022). Cultural competence and healing culturally based trauma with emdr therapy: innovative strategies and protocols (2nd ed.). Springer Publishing.
Rydberg, J. A., & Machado, J. (2020). Integrative psychotherapy and psychotherapy integration: The case of EMDR. European Journal of Trauma & Dissociation, 4(3), 100165.
Maurice, S. (2020, October 22). Tried it all? An intro to energy psychology with Sabra Maurice, LCPC. The Mental Wellness Center - Bloomington IL Therapists. Retrieved November 27, 2022, from https://www.thementalwellnesscenter.com/new-blog/2020/10/22/tried-it-all-an-intro-into-energy-psychology-with-sabra-maurice
Siegel, I. (2018). EMDR as a transpersonal therapy: A trauma-focused approach to awakening consciousness. Journal of EMDR Practice and Research, 12(1), 24-43.
Tan, S.-Y. (2011). Counseling and psychotherapy: a Christian perspective. Baker Academic, a division of Baker Publishing Group.
Tarquinio, C., Brennstuhl, M. J., Rydberg, J. A., Bassan, F., Peter, L., Tarquinio, C. L., ... & Tarquinio, P. (2020). EMDR in telemental health counseling for healthcare workers caring for COVID-19 patients: a pilot study. Issues in Mental Health Nursing, 42(1), 3-14.
U.S. Department of Veterans Affairs. (2018, August 10). Eye Movement Desensitization and Reprocessing (EMDR) for PTSD. Retrieved November 24, 2022, from https://www.ptsd.va.gov/understand_tx/emdr.asp
VEN EMDR. (2016). How Emdr Works? Look at this animation. YouTube. Retrieved November 30, 2022, from https://www.youtube.com/watch?v=hKrfH43srg8.