EMDR: Eye Movement Desensitization Response Valerie Bryant, PhD [email protected] EMDR • Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is based on an information processing system designed to resolve symptoms resulting from disturbing life experience. • It is a structured approach addressing past, present, and future aspects of disturbing memories. EMDR • Short & long term treatment • For children and adults Addresses cognitive, emotional and physiological memories. Procedures are structured and follows sequential and step by step protocols. Resourcing • Empirically-tested for PTSD but also used for other anxiety disorders such as performance anxiety, panic attacks, stage fright, complex PTSD • Problem is identified by client Frontal Lobe • In humans, the frontal lobe reaches full maturity around age 25 marking cognitive maturity. • The frontal lobe contains most of the dopramine-sensitive neurons, which are associated with reward, attention, long-term memory, planning and drive. • A reduction of dopramine in the prefrontal cortex is related to poorer performance & inefficient functioning of working memories and slight increased risk for schizophrenia. • The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control, and social and sexual behavior. • • Frontal area is the most common region of injury following mild to moderate traumatic brain injury (Levin et al., 1987). Left Brain Cognitive Logical Objective Rational Analytic Language Synthesizing Looks at parts Right Brain Emotions Intuitive Subjective Random Holistic Non-verbal Looks at wholes TRAUMA MEMORY • In trauma, information is processed and stored differently in the brain. – Encoded, processed, stored and retrieved differently – Trauma memory is timeless and immutable vs. narrative memory – Reactivated by trigger stimuli vs. narrative memory upon intent – Activation of one element evokes all other elements automatically What is Post-Traumatic Stress Disorder? 309.81 PTSD is an anxiety disorder that can develop in some people after witnessing, participating or being exposed to a terrifying event or ordeal in which grave physical harm occurred or a threat has occurred. Numbing, avoidance, intrusive flashbacks, physiologic hyperarousal Other variables: age, gender, natural resilience, nature & number of trauma events COMPLEX PTSD • Classic PTSD including triad of: a. Dissociation & Reenactments b. Somatization c. Affect Dysregulation shown by difficulty modulating anger, chronic self-destructive & suicidal behaviors, difficulty moderating sexual involvement, impulsive risktaking behaviors & emergence of pathological self-care behaviors. CLIENT HISTORY • Risks: History of dissociation, eye problems, inability to tolerate stress during between sessions, medical problems (heart problems, high-risk pregnancy); poor therapist relationship, seizures, self-injurious behaviors, alcohol or substance abuse, severe life stressors. • Strengths • History of trauma • Maladaptive Coping Styles • Cognitive Schemas Therapy Process Client will focus simultaneously on the image, the negative cognition, and the disturbing emotion or body sensation. • BLS • After a set of eye movements, the client is asked to report briefly on what has come up; this may be a thought, a feeling, a physical sensation, an image, a memory, or a change in any one of the above. • Initially, a therapist asks to focus on this image, thought, and begins a new set of eye movements. • From time to time a therapist may ask the client about her or his SUDS. The desensitization phase ends when SUDS reaches 0 or 1. PREPARATION • Therapeutic alliance • Education about trauma—triggers hardwired by old & new experience :smell, taste, sound, place • Affect Tolerance: safe place, light stream, mindfulness, yoga… • Informed Consent PROTOCOL • Picture (IMAGE) What is the worst part of that incident now? • N/C• P/C • VOC-as you bring up that picture, how true does it feel to you now (1-7 is completely true) • Emotions • SUDS • Location of Body Sensations RESOURCE INSTALLATION • Imagine the kind of person or quality that would help you to respond differently. • What resources might others need to get through a distressful situation? • When you think about what it means to have this resource, what comes to mind? • What would it be like imagining that resource already in your body? • And if you felt more??, What would follow from that? • As you imagine being able to feel….do….notice where you experience it in your body? Notice your thinking.. • 4-12 sets • Psycho-educational: Apply resources for mildly daily challenging events, anniversaries, anticipating anxious situations, use daily to reinforce… Performance Enhancement • The first step in performance enhancement is to define your goals, and any limit or ceiling you are encountering. What are your strengths? • Where do you want to be, when? • What factors are slowing you in reaching your goals or what could speed your success? SAFE PLACE • Before beginning EMDR for the first time, it is recommended that a person identifies a safe calming place, an image or memory that elicits comfortable feelings and a positive sense of self. • Safe place applied later bringing closure to an incomplete session or to help a client tolerate an upsetting session.