Beyond Trauma: Proven and Effective Applications of EMDR

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2 Earth, Wind, Water, Fire

3 Earth, Wind, Water, Fire The Opening Say, Let s take a current reading of your stress level where 10 = the most stress and 0 no stress at all, where are you now with stress with our 0-10 scale?

4 Earth, Wind, Water, Fire EARTH : GROUNDING, SAFETY in the PRESENT /REALITY Say, Take a minute or 2 to land to be here now. Place both feet on the ground, feel the chair supporting you. Direct your attention outwards. Look around and notice 3 new things. What do you see? What do you hear? (notice 3 things) (Don t ask this if it draws attention to on-going dangers e.g. if there are explosions still going on)

5 Earth, Wind, Water, Fire WIND: BREATHING for STRENGTH, BALANCE and CENTERING (Anxiety = excitement without oxygen and you stop breathing. When you start breathing your anxiety reduces). Say, As you continue feeling the SECURITY NOW of your feet on the GROUND, take 3 or 4 deeper slower breaths from your stomach, making sure to breathe all the way out to make room for fresh energizing air. As you breathe out, imagine that you are letting go of some of the stress and breathing it out. Direct your attention inwards to your center.

6 Earth, Wind, Water, Fire WATER : CALM and CONTROLLED -switch on the RELAXATION RESPONSE Say, As you continue feeling the SECURITY NOW of your feet on the GROUND and feel CENTERED as you BREATHE in and out, notice if you have saliva in your mouth? Make more saliva because when you are anxious, or stressed your mouth often dries because part of the stress emergency response (which has to do with the Sympathetic Nervous System) is to shut off the digestive system. When you start making saliva, you switch on the digestive system again (or the parasympathetic nervous system) and the relaxation response. This is the reason why people are offered water or tea or chew gum after a difficult experience. A Spanish surgeon uses this production of saliva to train his patients to ignore pain while he performs surgery without anesthetics. When you make saliva, your mind can optimally control your thoughts and your body. Direct your attention up to making saliva.

7 Earth, Wind, Water, Fire FIRE: LIGHT/FIRE up the path of your IMAGINATION Say, As you continue feeling the SECURITY NOW of your feet on the GROUND and feel CENTERED as you BREATHE in and out and feel CALM and in CONTROL as you produce more and more SALIVA, bring up the image of your SAFE PLACE (or some other RESOURCE). Where do you feel it in your body? Install with brief slow BLS / butterfly hugs. Direct your attention to feeling good in your body. Say, As you continue feeling the SECURITY NOW of your feet on the GROUND; and feel CENTERED as you BREATHE in and out; and feel CALM and in CONTROL as you produce more and more SALIVA; you can let the FIRE LIGHT the path to your IMAGINATION to bring up an IMAGE of a place where you feel SAFE /or a memory in which you felt good about yourself. Go with that (using BLS). Now touch your bracelet (or sticker, etc), thinking about earth, air, water and fire and go with that (to install your bracelet). Now, let s take a current reading of your stress level where 10= the most stress and 0 no stress at all, where are you now with stress with our 0-10 scale? Repeat 3 to 4 times or as needed until the SUDS level decreases to 0 or a tolerable amount. Option: this can be a way of introducing the Safe Place exercise as the 4th element, especially

8 EMDR Basics

9 EMDR Defined EMDR Adaptive Information Processing Model EMDR Treatment Approach Case Examples & Other Applications Origin and Hypothesized Mechanisms Research on Effectiveness

10 Eye Movement Desensitization and Reprocessing (EMDR) is an integrative psychotherapy approach 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 with the use of bilateral stimulation using eye movements, tons and/or tapping. To date, EMDR therapy has helped millions of people of all ages relieve many types of psychological stress.

11 EMDR is an evidence-based psychotherapy for Posttraumatic Stress Disorder (PTSD). In addition, successful outcomes are well-documented in the literature for EMDR treatment of other psychiatric disorders, mental health problems, and somatic symptoms. It is a client centered approach that allows the clinician to facilitate the mobilization of the client s own healing mechanism which stimulates an innate information processing system in the brain.

12 In 1987, psychologist Dr. Francine Shapiro made the chance observation that eye movements can reduce the intensity of disturbing thoughts, under certain conditions. Dr. Shapiro studied this effect scientifically and, in 1989, she reported success using EMDR to treat victims of trauma in the Journal of Traumatic Stress. 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.

13 The model on which EMDR is based, Adaptive Information Processing (AIP), posits that much of psychopathology is due to the maladaptive encoding of and/or incomplete processing of traumatic or disturbing adverse life experiences. This impairs the client s ability to integrate these experiences in an adaptive manner.

14 EMDR is a psychotherapy approach that is guided by the Adaptive Information Processing Model and composed of integrative protocols and procedures which include the use of bilateral stimulation (BLS). Eight Phases of Treatment Three Pronged Protocol (Past, Present, Future) Forms of BLS Eye Movement, Tones, Taps Incorporates elements of other theoretical orientations: - Psychodynamic, Cognitive, Behavioral, Client centered, Mindfulness

15 Psychodynamic Therapy - Foundation of problem: Intrapsychic conflicts Cognitive Behavioral Therapy Foundation of problem: Dysfunctional beliefs, behaviors EMDR Therapy Foundation of problem: Unprocessed memories of disturbing events that are dysfunctionally stored in neural networks.

16 When a traumatic or disturbing event happened, the natural system for processing a memory was interrupted because of high arousal and/or encoded as survival information. Information that occurred at the time of the upsetting event is stuck or frozen in the memory. Present day triggers or experiences can activate the feelings and responses in the stored memory. Persistent, intrusive thoughts Negative emotions Negative perceptions of self Physical sensations

17 Generally in individuals who are healthy and have a more secure sense of self, new experiences are taken in, sorted through in terms of what useful information is learned, linked to the appropriate emotions and is accessible for the person to utilize in the future. For individuals who may not be as healthy, new experiences are taken in and sorted through with a more elevated limbic or emotional response not allowing adequate processing to complete to an adaptive resolution.

18 Traumatization has been described as the disruption of the inherent processing system that normally leads to integration and adaptive resolution following upsetting experiences. (van der Kolk, Fisler, 1995) Under normal circumstances, this information processing may occur during thinking, talking, expressive/artistic activities, and/or dreaming. In trauma, however, a malfunction of this natural information processing system occurs such that the experience of the trauma remains frozen, manifesting in persistent intrusive thoughts, negative emotions and self-referenced beliefs, and unpleasant body sensations. 18

19 When a disturbing event occurs, it can get locked or frozen in the brain with the original pictures, sounds, thoughts, feelings and body sensations. Present day experiences can activate those original feelings, thoughts, images, sensations. EMDR seems to stimulate that frozen information and allows the brain to process the experience by connecting that stuck memory with other information in your brain. Similar to what may be happening in REM (rapid eye movement) sleep when we dream. The eye movements or other forms of bilateral stimulation (tones, taps) may help to process the unconscious material.

20 Access the dysfunctionally stored information. Stimulate the information processing system and maintain it in a dynamic form. Move the information by monitoring the free association process and initiate procedures to facilitate adaptive (appropriate, positive, functional) resolution. Desensitize: Reduce the Subjective Unit of Distress (SUD) to 0. Reprocess: Learning takes place so client adapts their understanding of the event and shifts negative cognitions to positive cognitions.

21 Client internally generates corrective information about the event rather than that information being externally generated through discussion with therapist. Therapist does not reflect, interpret, reframe or intervene in other traditional ways Client Centered - Follow the client s processing Mindfulness Just notice, Go with that Cognitive Interweaves ask questions that link statements made by client and only when needed to move processing forward

22 8 Phase Protocol 1. Client History and Treatment Planning 2. Client Preparation 3. Assessment 4. Desensitization (Processing) 5. Installation (Processing) 6. Body Scan (Processing) 7. Closure 8. Reevaluation

23 Three Pronged Approach - Process Past Event Identify Core Memories earliest memories that laid the foundation for the presenting problems. Identify Clusters/Themes single event to represent many similar incidents - Process Present Event Current Triggers, Stressors, Recent Event - Process Future Event Template of desired thoughts, emotions, actions for future events that typically have been avoided or uncomfortable

24 Typically 90 minute sessions for processing. A targeted memory can require more than one 90 minute session for processing to adaptive resolution. Number of processing sessions needed varies based on client, issues, trauma history 1-4 processing sessions for a single traumatic event Processing may or may not continue after session Target Past, Present, Future to get full resolution

25 Client: A 40-year old man who was laid off during the economic restructuring of his company. Presenting Problems: Sleep-onset insomnia, loss of appetite, selfmedicating with alcohol, irritable, worried about the future, paralyzed in efforts to seek other work, fighting with his children and sometimes his wife. Negative Cognitions: I m not good enough to retain at my company so they let me go. I m worthless. Positive Cognitions: I have value to offer and can find an organization that recognizes this about me and is a good fit with my skills and who I am.

26 Picture: The Human Resources Director comes into my cubicle and tells me that I have 15 minutes to clear out my desk and download my computer files before my exit interview. Negative Cognition: I m worthless. Positive Cognition: I have value. Validity of Positive Cognition (VOC) = 3 out of 7 Emotions/Feelings: Irritable, worried SUD Now = 7 out of 10 Body Sensation: Nausea, tightness in chest, tingling in arms

27 Responsibility: Client considers whether he is at fault, for being on the list for layoffs. Client considers history of performance reviews and that all were average or above average. Client comes to understand that he is not at fault. He recognizes that this layoff had more to do with the company s economic pressures than his worth. The client acknowledges that he has performed well, as evidenced by his written reviews, but nevertheless, he has been let go.

28 Safety: Client explores, Will I be okay? He assesses his strengths and, he arrives at the idea. I will find another position because of the skills and work experiences I have accumulated. I do have the financial resources to last 6 months while I search for another position. I can borrow money from my brother if I have to.

29 He questions whether he must remain in the same industry and concludes that he can look at other industries hiring people with his skill set. He assesses the time and costs needed to change careers and decides that he will stay in the same line of work but search within several different industries. He feels more encouraged for having arrived at this greater sense of choice

30 EMDR is not a cure all or magic bullet. Studies report positive therapeutic results for a wide range of populations and issues: Depression and Other Mood Disorders Generalized Anxiety Disorders, Panic Attacks, Phobias PTSD, Grief, Traumatic Bereavement Abuse and Neglect Emotional, Physical, Sexual Accidents, Medical Treatments, Natural Disasters Addictions, Dissociative Disorders Somatic Problems chronic pain, phantom limb pain, gastrointestinal, migraines, eating disorders, body image Vicarious Trauma Performance Enhancement (work, art, sports) Children, Couples, Veterans, Police Officers, Firefighters

31 20 controlled studies have consistently found EMDR effectively decreases / eliminates symptoms of PTSD for the majority of clients in studies. EMDR designated effective for PTSD by: American Psychiatric Association Substance Abuse and Mental Health Services Administration (SAMHSA) International Society for Traumatic Stress Studies U.S. Department of Veteran Affairs, U.S. Department of Defense Many international health and government agencies Other studies on many other symptoms, disorders For research summaries, visit and

32 Feeling-State Addiction Protocol

33 EMDR Augmented by Mindfulness as a Treatment for Trauma MBCT Created by Teasdale, Segal and Williams (1991); based on MBSR created by Jon Kabat-Zinn Specifically designed for treatment of recurrent depression Combines CBT methods with mindfulness

34 EMDR Augmented by Mindfulness as a Treatment for Trauma MBCT Functions on theory that depressed individuals, when stressed, return to automatic cognitive processes that trigger a depressive episode

35 EMDR Augmented by Mindfulness as a Treatment for Trauma MBCT Negative mood and negative thinking form a connection during depression Recurrence of negative mood triggers negative cognition

36 Feeling-State Addiction Protocol Predicated on addictions being created when a desired feeling and a given behavior become associated together. Or Intense Desired Feeling + Positive Event = Addictive Fixation or Feeling State

37 Feeling-State Addiction Protocol Addiction can be triggered by an internal or external stimulus yielding Addictive Fixation (Feeling State) + Trigger Event (External or Internal) = Addictive Behavior

38 Feeling-State Addiction Protocol Feeling-State Theory 1) Positive feelings linked with specific objects or behavior form a state-dependent memory 2) The state-dependent memory, composed of feelings and the event, form a feeling-state 3) Feelings are defined as the totality of sensations, emotions and thoughts 4) The creation of a feeling state is theorized to be similar to the way traumatic memories become fixated

39 Feeling-State Addiction Protocol Beliefs and the Impulse-Control Disorder Preexisting negative beliefs I m a failure Positive feelings generated by the feeling-state I m the life of the party Negative beliefs generated by the out-of-control behavior I mess up everything

40 Feeling-State Addiction Protocol Resolving a Feeling-State Cognitive change once the fixated FS is reprocessed the rationalizations and justifications to support the out-of-control behavior are no longer needed and begin to subside Behavioral change as the FS is processed, destructive behaviors subside and the person automatically begins to seek appropriate ways to obtain the desired feeling

41 Feeling-State Addiction Protocol First session History of compulsive behavior. What part of the compulsive behavior has greatest emotional intensity What compulsive behavior is linked with that positive feeling rate it on the PFS. As with standard EMDR, locate and identify physical sensations created by the positive feelings. Have client combine image of behavior, the positive feeling, and the physical sensations. Eye movement sets are performed while the client focuses on material (e.g., memory, feeling, image, sensation, thought) that was elicited during the prior set. When the PFS is 1, identify the related NC and use the PC, SUDS, emotions, VOC, and body location according to the standard EMDR protocol (unlike the standard protocol, no specific memory is identified and no visual image is used).

42 Feeling-State Addiction Protocol Homework Assign homework to experience the behavior and judge progress. When applied to substances, many have the client picture doing activities other than the substance use to achieve the same positive feelings.

43 Feeling-State Addiction Protocol Second session As in standard EMDR, reevaluate behavior for both the feeling identified in the first session as well as identifying other positive feelings related to the ICD. Repeat 2-8 again if necessary. Continue reevaluation and processing in further sessions until the person s drive toward the compulsive behavior has been eliminated and the behavior has changed. When all FS processed, determine the negative belief that was created as a result of the compulsive behavior. Use the standard EMDR protocol for processing. Note: PFS=Positive Feelings Scale; NC=negative cognition; PC=positive cognition; SUDS=Subjective units of Disturbance Scale; VOC=Validity of Cognition Scale; EMDR = eye movement desensitization and reprocessing; ICD = impulsive-control disorder; FS = feeling-state

44 Beyond Trauma: Proven and Effective Dysfunctional Positive Effect

45 Beyond Trauma: Proven and Effective Dysfunctional Positive Effect Theory Designed to work with an ambivalent client ( I want to work on the issue but I m too afraid. Most effective way to address this issue may be to target the feeling of relief associated With avoiding that problem. NOT used to force a client to work an issue they don t want to work IS used with clients who have an unwanted avoidance impulse

46 Beyond Trauma: Proven and Effective Dysfunctional Positive Effect Theory Partially derived from Popky s Desensitization of Triggers and Urge Reprocessing (DeTUR) Theorizes avoidant behaviors tend to be maintained and reinforced by the stress relief associated with avoiding Scaling done 1-10 on the Level of Urge to Avoid (LoUA) Extends Popky s approach to substance abuse to those habitually using mental tactics to avoid disturbing material. Exact knowledge of the disturbing material not required; just the client report of changes to the urge to avoid

47 Beyond Trauma: Proven and Effective Dysfunctional Positive Effect Protocol Make an image of what is to be avoided Scale the image 1-10 as to how much the client wants to avoid the issue Determine where the urge to avoid is in the body Perform BLS while client holds image and stays with the feeling of wanting to avoid the image As the LoUA goes down, client usually spontaneously begins to directly address the incident and standard EMDR protocols are then used

48 Beyond Trauma: Proven and Effective Phobia Protocol Single Traumatic Event Phobia Specific Phobia person is fearful or anxious about or avoidant of circumscribed objects or situations Specific cognitive ideation not featured in this disorder as it is in other anxiety disorders The fear, anxiety or avoidance is almost always immediately induced by the phobic situation Intensity of reaction is to a degree that is persistent and out of proportion to the actual risk posed

49 Beyond Trauma: Proven and Effective Phobia Protocol Single Traumatic Event Types of Phobia Animal type spiders, insects, dogs, cats, snakes, etc. Natural Environment heights, water, storms, etc. Situational type enclosed spaces, driving, flying, elevators, bridges Blood, injury, injection type getting an injection, seeing blood, watching surgery, etc. Other types choking, vomiting, contracting an illness, etc.

50 Beyond Trauma: Proven and Effective Phobia Protocol Single Traumatic Event Treatment of Phobia In Vivo exposure is proven treatment of choice Uncontrolled and controlled case reports indicate EMDR efficacy in treating fears and phobias with improvement in a limited number of sessions EMDR may be particularly useful in high-anxiety phobias with a traumatic origin or clear beginning (target memory)

51 Beyond Trauma: Proven and Effective Phobia Protocol Single Traumatic Event Phobia Specific Phobia person is fearful or anxious about or avoidant of circumscribed objects or situations Specific cognitive ideation not featured in this disorder as it is in other anxiety disorders The fear, anxiety or avoidance is almost always immediately induced by the phobic situation Intensity of reaction is to a degree that is persistent and out of proportion to the actual risk posed

52 Group Traumatic Events Protocol (GTEP)

53 Integrating EMDR into Couples Therapy

54 Integrating EMDR into Couples Therapy Theoretical Underpinnings Connects a trauma model of relationships with Bowen s concept of differentiation Trauma impacts relational assumptions Couples where one or both have experienced trauma are likely to be highly reactive

55 Integrating EMDR into Couples Therapy Theoretical Underpinnings Bowenian Differentiation Families and other social groups tremendously affect how people think, feel, and act, but individuals vary in their susceptibility to a group think and groups vary in the amount of pressure they exert for conformity. These differences between individuals and between groups reflect differences in people s levels of differentiation of self. The less developed a person s self, the more impact others have on his functioning and the more he tries to control, actively or passively, the functioning of others. The basic building blocks of a self are inborn, but an individual s family relationships during childhood and adolescence primarily determine how much self he develops. Once established, the level of self rarely changes unless a person makes a structured and long-term effort to change it.

56 Integrating EMDR into Couples Therapy Theoretical Underpinnings Reactivity in couples usually includes: Rapid escalation in negative emotion Escalation in overt conflict Withdrawal-pursuit Conflict Avoidance Dominance-submission EMDR can reduce negative reactivity and phobic response to emotional engagement

57 Integrating EMDR into Couples Therapy Application of EMDR In trauma - EMDR clinicians look for change specific to the trauma and it s PTSD symptoms In couples therapy EMDR clinicians look for generalized effects; lowered state of arousal and less reactivity Multiple scripts including conjoint and individual scripts, processing and future template scripts

58 EMDR Scripted Protocols edited by Marilyn Luber Topics by Section EMDR with Children and Adolescents EMDR and Couples EMDR, Dissociative Disorders, and Complex Post-Traumatic Stress Disorder EMDR and Clients with Addictive Behaviors EMDR and Clients with Pain EMDR and Specific Fears EMDR and Clinician Self-Care

59 Recent Traumatic Events Protocol (RTEP) Comprehensive current trauma focused protocol Extends existing EMD and Recent Event protocols Usually requires 2-4 sessions, optionally conducted on successive days

60 Recent Traumatic Events Protocol (RTEP) Glossary of key terms Traumatic Episode (T-episode) the original traumatic episode with it s aftermath that is comprised of multiple Points of Disturbance (PoDs) from the original incident until today Episode Narrative + continuous BLS (Bilateral stimulation) telling the story out loud with continuous BLS. This integrates the fragments of the story. Recounting details is discouraged Google search (G-search) mechanism to identify the various PoDs by nonsequential scanning of the T-episode, without talking, together with BLS Focused processing. EMD strategy is narrow focused processing of the PoDs by limiting association to the PoDs. This is a good brief strategy. EMDr2 is a wider focused processing of the PoD by going with the AIP chains of associations relating to the T-episode. This is the main strategy.

61 Recent Traumatic Events Protocol (RTEP) Adapted 8 Phases Phase I: History/Intake brief history taking, evaluate readiness Phase II: Preparation, attention to safety and containment Points of Disturbance (PoD) level: Identification, assessment, and Focused Processing of target fragments (PoDs) within the Traumatic Episode

62 Recent Traumatic Events Protocol (RTEP) Point of Disturbance cont d 1. Traumatic Episode Narrative = continuous BLS telling the story (as on a TV) out loud with BLS 2. Episode Google search = BLS identifying Points of Disturbance relating to the T-episode from the original incident to today 3. Assessment (Phase III of each PoD) identified from the Google search Focused processing (Desensitization Phase IV) EMD and EMDR2

63 Recent Traumatic Events Protocol (RTEP) Point of Disturbance cont d 5. Installation (Phase V) of PC if SUD is ecological 6. Repeat steps 2-5 to identify and process remaining PoDs, until none are found 7. Body scan (Phase VI) 8. Strong closure (Phase VII) at the end of each session Follow-up (Phase VIII)

64 Recent Traumatic Events Protocol (RTEP) Contrasting EMDR and RTEP Phase I (History) EMDR full Intake, 3 pronged orientation (past, present, future) Targets identified for Treatment Plan RTEP Briefer intake history to assess SMS (Severity/Motivation/Strengths, current trauma focused priority, concept of T-episode, only general information about T-episode (details only requested later during episode Narrative + BLS)

65 Recent Traumatic Events Protocol (RTEP) Contrasting EMDR and RTEP Phase II (Preparation) EMDR safe place (more if needed) Extended preparation (4 elements, includes safe place and resource connection)

66 Recent Traumatic Events Protocol (RTEP) Contrasting EMDR and RTEP Phase III (Assessment) Target: event image; negative cognitions, positive cognitions, Validity of Cognition (VOC), emotion, Subjective Units of Distress (SUD) A) episode narrative +BLS; b) G-search with BLS to identify target fragments/points od disturbance (PoD); c) for each PoD, image, NC, PC, VoC, emotion, SUD, body

67 Recent Traumatic Events Protocol (RTEP) Contrasting EMDR and RTEP Phase IV (Desensitization) EMDR Processing with BLS, no limitations of association as long as there is change RTEP focused processing (EMD and EMDr) EMD for processing intrusive fragments; EMD is narrow focus on associations relating to PoD; EMDr is wider focus processing associative chains relating to the T-episode

68 Recent Traumatic Events Protocol (RTEP) Contrasting EMDR and RTEP Phase V (Installation) EMDR Install PC when SUD = 0/1 RTEP Install PC (for each target when SUD is ecological)

69 Recent Traumatic Events Protocol (RTEP) Contrasting EMDR and RTEP Phase VI (Body Scan) EMDR Body Scan RTEP no body scan until all the targets of the T-episode are processed

70 Recent Traumatic Events Protocol (RTEP) Contrasting EMDR and RTEP Phase VII (Closure) EMDR Closure RTEP Strong closure at the end of each session (Usually requires several sessions)

71 Recent Traumatic Events Protocol (RTEP) Contrasting EMDR and RTEP Phase VIII (Reevaluation) EMDR next session RTEP Check for remaining PoDs using G-search at next session; follow-up at end

72 Group Traumatic Events Protocol (GTEP) Group format (6 people) with no narrative Resource install first (Use EAWF) and date today Draw a picture (Date then) Resource connection envelope (Draws out positive resources) Desired future Positive Cognition

73 Group Traumatic Events Protocol (GTEP) worksheet

74 Group Traumatic Events Protocol (GTEP) Cont d Google search while tapping worksheet with one hand and following that hand with the eyes (double BLS) Client gets PoD and draws or writes it in PoD 1 3 sets of BLS (hand and eye) Refocus on PoD 1, get SUD score If not 0, then repeat for another 3 sets of double BLS

75 Group Traumatic Events Protocol (GTEP) worksheet

76 Beyond Trauma: Proven and Effective REFERENCES Van den Hout, M., Engelhard, I., Beetsma, D., Slofstra, C., Hornsveld, H., Houtveen, J., Leer, A. (2011), EMDR and mindfulness. Eye movements and attentional breathing tax working memory and reduce vividness and emotionality of aversive ideation: Journal of Behavior Therapy and Experiential Psychiatry, 42, Sun, T-F, M.D., Wu, C-K, M.D., Chiu, N-M, M.D. (2004), Mindfulness Meditation Training Combined with Eye Movement Desensitization and Reprocessing in Psychotherapy of an Elderly Patient: Chang Gung Med J, 27, Kabat-Zinn, J. Mindfulness meditation: what it is, what it isn t and it s role in health care and medicine. In: Haruki, Y., Suzuki, M., eds. Comparative and Psychological Study on Meditation. Delft, Netherlands: Eburton, 1996; Shapiro, F. Efficacy of the eye movement and desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress 1989;2: Shapiro, F. March 2, The Evidence on E.M.D.R. Consults New York Times Blog. Retrieved February 28, From Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York. Dell Publishing Shapiro F. EMDR 12 years after its introduction: past and future research. Journal of Clinical Psychology. 58:1:1-22.

77 Beyond Trauma: Proven and Effective Segal ZV, Mark J, Williams G, Teasdale D. Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. New York. The Guilford Press, Mindfulness-Based Cognitive Therapy. Retrieved February 28, From University of Massachusetts Medical Center. Stress Reduction Program. Center for Mindfulness. Retrieved February 28, From Bullis JR, Boe HJ, Asnanni A, Hofmann SG. The benefits of being mindful: Trait mindfulness predicts less stress reactivity to suppression. Journal of Behavior Therapy and Experimental Psychiatry. 45: Live Mindfully. Mindful Breathing and EMDR. Integrative Health Partners. Retrieved February 28, From Zangwill WM, PhD, Kosminsky, P, PhD. The Need to Strengthen the Mindfulness Component of EMDR. Retrieved February 28, From EMDRandMeditation.com. Scientific American. Can Eye Movements Treat Trauma? Retrieved February 28, From Weil. Spirit and Inspiration. Retrieved February 28, From Luber, M., PhD, ed. (2009). Eye Movement Desensitization and Reprocessing (EMDR) Scripted Protocols (1). New York, New York: Springer Publishing Company.

78 Beyond Trauma: Proven and Effective? s Gary D. Hees MA. LPC Decision Point Center ghees@decisionpointcenter.com