INERGETIX-EMDR. Eye Movement Desensitization and Reprocessing (EMDR)

Transcription

1 INERGETIX-EMDR Eye Movement Desensitization and Reprocessing (EMDR) Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories. After successful treatment with EMDR, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced. In 1987, psychologist Dr. Francine Shapiro made the observation that eye movements can reduce the intensity of disturbing thoughts. Dr. Shapiro studied this effect scientifically and, in 1989, she reported, in the Journal of Traumatic Stress, success using EMDR to treat victims of trauma. Since then, EMDR has developed and evolved through the contributions of therapists and researchers all over the world. Today, EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches. During EMDR the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Therapist directed lateral eye movements are the most commonly used external stimulus but a variety of other stimuli including hand-tapping and audio stimulation are often used. Shapiro hypothesizes that EMDR facilitates the accessing of the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights. EMDR uses a three pronged protocol: the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information; the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized; imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning. No one knows how any form of psychotherapy works neurobiologically or in the brain. However, we do know that when a person is very upset, their brain cannot process information as it does ordinarily. One moment becomes "frozen in time," and remembering a trauma may feel as bad as going through it the first time because the images, sounds, smells, and feelings haven t changed. Such memories have a lasting negative effect that interferes with the way a person sees the world and the way they

2 relate to other people. EMDR seems to have a direct effect on the way that the brain processes information. Normal information processing is resumed, so following a successful EMDR session, a person no longer relives the images, sounds, and feelings when the event is brought to mind. You still remember what happened, but it is less upsetting. Many types of therapy have similar goals. However, EMDR appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. Therefore, EMDR can be thought of as a physiologically based therapy that helps a person see disturbing material in a new and less distressing way. Scientific research has established EMDR as effective for post traumatic stress (PSTD). However, clinicians also have reported success using EMDR in treatment of panic attacks, complicated grief, dissociative disorders, disturbing memories, phobias, pain disorders, eating disorders, performance anxiety, stress reduction, addictions, sexual and/or physical abuse, body dysmorphic disorders, personality disorders. Dr Shapiro developed the Accelerated Information Processing model to describe and predict EMDR s effect. More recently, she expanded this into the Adaptive Information Processing (AIP) model to broaden its applicability. She hypothesizes that humans have an inherent information processing system that generally processes the multiple elements of experiences to an adaptive state where learning takes place. She conceptualizes memory as being stored in linked networks that are organized around the earliest related event and its associated effect. Memory networks are understood to contain related thoughts, images, emotions, and sensations. The AIP model hypothesizes that if the information related to a distressing or traumatic experience is not fully processed, the initial perceptions, emotions, and distorted thoughts will be stored as they were experienced at the time of the event. Shapiro argues that such unprocessed experiences become the basis of current dysfunctional reactions and are the cause of many mental disorders. She proposes that EMDR successfully alleviates mental disorders by processing the components of the distressing memory. These effects are thought to occur when the targeted memory is linked with other more adaptive information. When this occurs, learning takes place, and the experience is stored with appropriate emotions able to guide the person in the future. Shapiro s Adaptive Information Processing model posits that EMDR facilitates the accessing and processing of traumatic memories to bring these to an adaptive resolution. EMDR International Association (EMDRIA) - Eye Movement Desensitization and Reprocessing (EMDR) is a method of psychotherapy that has been extensively researched and proven effective for the treatment of trauma. EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches. To date, EMDR has helped an estimated two million people of all ages relieve many types of psychological stress. For EMDRIA's clinical definition of EMDR, click here. Additional information about EMDR is available to the public in the What is EMDR?

3 brochure and to mental health professionals in EMDR: Information for Professionals brochure. Copies may be purchased at the EMDRIA Store. EMDR Institute, Inc. A Brief Description of EMDR see below (Eight Phases of Treatment) Frequently Asked Questions - EMDR was developed as a treatment for traumatic memories and research has demonstrated its effectiveness in the treatment of PTSD. Dr Shapiro states that it should be helpful in reducing or eliminating other disorders that originate following a distressing experience. In addition to studies assessing the effectiveness of EMDR in the treatment of PTSD, phobias, and panic disorders, some preliminary investigations have indicated that EMDR might be helpful with other disorders. Applications of EMDR are described for complaints such as depression, attachment disorder, social phobia, anger dyscontrol, generalized anxiety disorder, distress related to infertility, body image disturbance, marital discord, and existential angst. Eight Phases of Treatment from A Brief Description of EMDR - Eye Movement Desensitization and Reprocessing (EMDR) 1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies 2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR 1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if

4 available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the selfcalming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures. 1 Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York: Guilford Press. 2 Shapiro, F. (2002). EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism. Washington, DC: American Psychological Association Books.

5 Other links emdr/index.asp www. emdr.org.uk www. emdr-europe.org/ emdr-refs.php emdr.html Further Reading EMDR Casebook (Manfield, case studies) Transforming Trauma: EMDR (Parnell) EMDR (Shapiro and Forrest) Eye Movement Desensitization and Reprocessing (Shapiro, on protocols and procedures) EMDR: The Breakthrough "Eye Movement" Therapy for Overcoming Anxiety, Stress, and Trauma (Francine Shapiro and Margot Silk Forrest) EMDR Solutions: Pathways to Healing (Robin Shapiro) Small Wonders: Healing Childhood Trauma with EMDR (Joan Lovett M.D.) Emotional Healing at Warp Speed: The Power of EMDR (David Grand)