EMDR

Post Traumatic Stress Disorder (PTSD) refers to psychological symptoms that may develop in the aftermath of traumatic events or distressing life experiences. According to the DSM-5, ‘the essential feature of post-traumatic stress disorder’ (PTSD) is the ‘development of characteristic symptoms following exposure to one or more traumatic events’. 

Psychological trauma is common in the general population. Trauma survivors, with or without a formal diagnosis of PTSD, often develop chronic symptoms. 

Typical PTSD symptoms include, but are not limited to, intrusive memories, distressing dreams, dissociative ‘flashbacks’, heightened physiological stress reactions to trauma related ‘triggers’, avoidance of trauma-related stimuli, memory deficits and changes in mood. In PTSD there is a considerable risk of co-morbid or other conditions, such as depression, anxiety and alcohol misuse. 

Post Traumatic Stress Disorder (PTSD) has a strong relationship with somatisation or body sensations and particularly with medically unexplained symptoms (MUS). Physical pain, body sensations and other somatic complaints have consistently been linked to traumatic experiences or exposure. 

EMDR Adaptive Information Processing 

The EMDR, Adaptive Information Processing (AIP) theoretical paradigm or model, views psychopathology or psychological disturbance, as based on memories of traumatic life events, that have been incompletely processed by the brain’s information processing system. 

Traumatic events and distressing experiences, may overwhelm the cognitive functions of the brain and are not processed properly, creating dysfunctional memory systems that reveal themselves as symptoms of psychological disturbance, including Post Traumatic Stress Disorder (PTSD). 

According to the AIP theory, incomplete processing of life experiences, means that a disturbing event has been stored in memory as it was originally experienced with the emotions, physical sensations and beliefs fundamentally unchanged. 

EMDR therapy is conducted in the context of a therapeutic alliance between the EMDR practitioner and the client/patient. EMDR is an eight-phase protocol treatment developed to access the dysfunctional experiences or memories, stored in the mind/brain. 

Research studies relating to efficacy, found that EMDR therapy significantly reduces the symptoms of PTSD, depression and anxiety. 

The eye movement component of EMDR adds to its effects in the processing of emotional memories. A core feature of EMDR therapy is that the patient is asked to hold a disturbing memory in mind while engaging in sets of eye movements or other dual attention, bilateral stimuli (BLS), including sounds or bilateral tapping. The EMDR process, involves focusing on a traumatic image, thought, emotion and bodily sensations. Research into the eye movement component of EMDR has found that eye movements promote changes in memory vividness and emotionality. 

The EMDR ‘desensitisation’ reprocessing procedure involves the client processing memories by shifting their awareness between the past and a safer present. The EMDR protocol also includes a structure to explore and process positive experiences. EMDR therapy aims to identify current situations that are triggering the disturbance, the experiences that have laid the groundwork for the dysfunction and positive experiences that are needed to overcome any lack of knowledge or build personal skills, resources and resilience. 

Shapiro, F., (2014) The role of Eye Movement Desensitisation and Reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal Winter 2014/Vol. 18 No. 1.

Phase 1.  Client History - Purpose - Obtain background information. Identify suitability for EMDR treatment. Identify processing targets from positive and negative events in the client’s life. Procedures – Standard history-taking questionnaires and diagnostic psychometrics. Review of criteria and resources. Questions regarding (1) past events that have laid the groundwork for pathology, (2) current triggers, (3) future needs. 

Phase 2.  Preparation - Purpose – Prepare appropriate clients for EMDR processing of targets. Stabalise mood and increase access to positive affects. Procedures – Education regarding the symptom picture. Metaphors and techniques that foster stabalisation and a sense of personal self-mastery and control. 

Phase 3.  Assessment - Purpose – Assess the target memory for EMDR processing by stimulating primary aspects of the memory. Procedures – Elicit the image, negative belief currently held, desired positive belief, current emotion, physical sensations and baseline measures. 

Phase 4.  Desensitisation - Purpose - Process experiences and triggers, toward an adaptive resolution (subjective units of distress SUD level 0). Fully process all channels of memory networks, to allow for a complete assimilation of memories. Incorporate templates for positive experiences. Procedures – Process past, present and future. Standardised EMDR processes that allow for the spontaneous emergence of insights, emotions, physical sensations and other memories. “Cognitive Interweave” to open blocked processing by elicitation of more adaptive information. 

Phase 5.  Installation - Purpose – Increase connections to positive cognitive networks. Increase generalisation effects within associated memories. Procedures – Identify the best positive cognition (initial or emergent). Enhance the validity of the desired positive belief to a validity of cognition VOC level 7. 

Phase 6.  Body Scan – Purpose - Complete processing of any residual disturbance associated with the target. Procedures – Concentration on and processing of any residual physical sensations. 

Phase 7.  Closure – Purpose - Ensure client stability at the completion of an EMDR session and between sessions. Procedures – use of guided imagery or self-control techniques if needed. Briefing regarding expectations and behavioural reports between sessions. 

Phase 8.  Re-evaluation – Purpose - Evaluation of treatment effects. Ensure comprehensive processing over time. Procedures – Explore what has happened since the last session. Re-access memory (target) from last session. Evaluation of integration within larger social system (Shapiro, 2005).