EMDR

 

What is EMDR?

Eye Movement Desensitisation and Reprocessing

 

Squirrels…?


 

Noticed that eye movements reduced the impact of some distressing personal problems she had been thinking about

Experimented with friends using eye movements – reported reduced distress.

Conducted clinical trial with people living with memories of abuse and war trauma

Now a significant body of research behind EMDR, probably more than any other single therapy

One foot in present, one in past – dual attention awareness to allow them to move between traumatic memories/events and the safety of the present

Not fully understood how it works, however, but it is not alone in this.

 

What it is Not…

 

http://www.emdrtherapistnetwork.com/emdr-videos.html

Multiple traumas – more likely to develop PTSD

Reconciling what you think/what you feel – hypnosis in my view does this in a different way, but both act to process material, in a way in which CBT maybe doesn’t

Use of lightbars etc

Anything else from that?

 

Big t Trauma vs small t trauma

Evidence for cumulative ‘small’ events causing problems especially in childhood, especially where these are linked or have common themes such as abandonment, betrayal, attachment issues

 

What’s the difference between experiencing trauma and

having post traumatic stress disorder?

 
 

depression, anxiety, substance misuse problems, dissociative disorder

 

 

Factors which increase the risk of developing PTSD are:

Symptoms of PTSD

Intrusive symptoms – reliving the experience

 

Avoidant symptoms – avoiding reminders of the events; numbing

 

Hyperarousal – a constant state of hypervigilance

May also get new fears – sleeping alone, going out of the house, going to the toilet

May also get new behavioural problems – regression to previous developmental stage, self-harm, eating problems.

Perry et al (1996) defined two continuums of behavioural adaptation in coping with trauma – the hyperarousal continuum (adrenergic) and the dissociative continuum (serotonergic)

Teichler (1997) found significant neurodevelopmental changes in abused children.

 

When do trauma(s) or Trauma(s) become PTSD or complex trauma?

Risk factors:

 

Attachment

Quality of attachment an important resilience/vulnerability factor in children, young people and adults

An infant needs to development an attachment relationship with at least one primary caregiver for ‘normal’ social and emotional development

Behaviours likely to have evolved as a survival mechanism – meeting needs for safety, security and protection

Strange Situation – 12-18 month olds – caregiver left; child’s reaction on separation and being re-united, as well as to a stranger, was studied

Young humans form attachments easily, even in less than ideal conditions

Infants in early months direct behaviour at anyone – then discriminate

May attach to more than one person but generally there is a primary attachment figure

As a child progresses in age through middle childhood to an adolescent, attachment becomes more about the care giver being available if needed, rather than in close proximity

Secure attachment

Caregiver sensitive, timely and responsive in interaction – quick, warm, coherent and predictable

Quality felt to be more important than quantity

Fathers, or others, may become primary attachment figure if they provide care and interaction

Adults who have made sense of and resolved their own trauma can provide secure attachment

Adaptive family structure.

Strange Situation: protests care-giver’s departure, comforted on return, may be comforted by the stranger but shows clear preference for care-giver

Insecure-avoidant attachment

Caregiver gives little or no response to distressed child, encourages independence, seeks to discourage crying

Disengaged family structure.

Strange Situation: Little or no distress on care-giver’s departure, little or no response to return or to stranger

Insecure-ambivalent-resistant attachment

Unable to use care-giver as a secure base

Care-giver inconsistent in approach – can be appropriate, can be rejecting or neglectful, may respond more with increased attachment behaviour from infant

Enmeshed family structure.

Strange Situation: distressed on separation with ambivalence or even anger on care-giver’s return

Not easily calmed by stranger

Seeking then resisting contact – anxiety due to care-giver’s inconsistent behaviours

Disorganised attachment – identified later

Care-giver’s behaviour is frightened or frightening, intrusive, negative, mis-communication, even maltreatment – correlation with abuse

Contradictory behaviours such as approaching caregiver but facing away

Incongruent family hierarchy structure – role reversals.

Strange Situation: on care-giver’s return, may show stereotypical behaviours such as freezing or rocking

 

Insecure patterns of attachment compromise exploration and mastery, which can adversely affect development, yet they are also an appropriate response to care-giver unresponsiveness.

 

65% of children in the general population have secure attachments; 35% are divided between the other attachment patterns.

 

Patterns of attachment can change from secure to insecure due to stress or life events, or vice versa.  However, an early secure attachment seems to have a protective function (Berlin et al, 2008) for later social interactions, stability and relationships.

 

Reactive Attachment Disorder – recognised diagnosis rather than an attachment style – controversial and thought to be rare though recognised by ICD-10 and DSM-IV.  Characterised by markedly developmentally inappropriate and disturbed ways of relating to others; a failure to develop appropriate attachment bonds to primary care-givers during early childhood.


Complex Trauma vs PTSD

Complex trauma

 

Borderline Personality Disorder vs Complex Trauma

 

Dissociation

 

How can EMDR help with PTSD and other problems?

 

Research evidence has also found EMDR effective for..

 

Use of EMDR

Part of therapy – not in isolation

Important client has coping strategies – resource building

Not generally a one session fix

 

Eye Movements/Bilateral Stimulation

 

EMDR Protocol

Important to use protocol but also understand where with training you may deviate from standard protocol e.g., with children, chronic pain

 

Goals of Treatment in Young Children

 

Goals of Treatment in Middle Childhood

 

Goals of treatment in Adolescence

Eight Phase, Three Pronged Treatment

To address the past present and future aspects of a disturbing memory which has not been processed, and thus has been stored in a maladaptive way, which means that it or the sensory experiences associated with it are frequently ‘triggered’.  When a distressing or traumatic event occurs, it may overwhelm the usual cognitive and neurological coping mechanisms, causing the brain to go into shock, and be ‘misfiled’.  EMDR acts to:

 

Phase 1 – History taking

 

Phase 2 – Resource Building

 

Phase 3 - Preparation

 

           For younger children – ‘how big is the upset?’  show with outstretched hands, use artwork, smileys

 

Phase 4 - Treatment

Experiential – no rights or wrongs

May be:

May change, may not

 

Client focuses simultaneously on:

 

Asked to ‘just notice’ what they experience.

EMs/hand taps for approx 15-30 seconds, looking out for changes which indicate processing – changes in breathing, facial expression etc.

 

Reassurance: ‘That’s it’ ‘You’re doing well’ ‘Just notice’ ‘It’s old stuff’ – can distract from experience.

Client to feed back what they noticed/experienced (younger children – can ask to draw it).

Don’t reflect on their experience: ‘Just notice that’ ‘Just go with that’.

 

Repeat process of EMs/hand taps then feedback

 

 

Incomplete Session

Common to not process everything – incomplete session – ask what the most positive thing to have come up during the session is and do short set of EMs/hand taps on this

Finish with safe place/lightstream/containment exercise – can do slow short EMs or hand taps of safe place to install

 

Phase 5 – Installation - when processing on target has been completed

 

Phase 6 – Body Scan

 

Phase 7 - Debriefing

 

Phase 8 – Re-evaluation

 

Children and Adolescents

Some young people 9+ can use standard protocol.

12-18 years:

Younger children/those at young developmental stage may struggle with NC and PC or eye movements as opposed to hand taps.

Can be used at age of 2-3 but very much adapted, never EMs, more creative, parent/carer involved much more, target memory given by parent.

Age-related protocols of 2-3, 4-5, 6-8, 9-12 years.

 

Use creative means of expressing feelings, e.g., drawing memories, experiences or feelings.

Where someone has a learning disability, or regresses back in age when thinking about the trauma, or is stuck at the developmental age where the trauma happened, you would need to consider using the protocol appropriate to their developmental stage.

Keep in treatment window (window of tolerance) – not dissociated or hyperaroused – may need to increase window of tolerance to enhance resilience/resources.

Be wary of them closing eyes – dissociation; however, hand taps can ground.

 

Neural damage/plasticity

 

Children (also adolescents at a younger developmental stage) are more concrete in their experiences and might generalise less across experiences

Children/young people are more likely to be retraumatised if a further trauma occurs

Re-integrating and developmental catch-up occurs after processing of complex trauma – grow physically

Egocentric view of world leads to more guilt, shame

Grieving for losses can only occur after trauma work and before forming new attachments

Involve parents much more – where parents have been traumatised, work with them first

 

Work with the family to:

 

Critique

 

Training

Advise EMDRIA approved training

Advise only going to a therapist who has this training and who is a mental health professional

‘Hybrids’ of EMDR or ‘EMDR’ are being taught to hypnotherapists and other therapists; I am concerned about the possibility of this being taught in this way and used potentially for very serious issues.

 

EMDRIA approved training:

Child and adolescent training