Objectives Identify the current status of EMDR as an evidencedbased

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1 Linda J. Mabey, DNP, APRN, BC Assistant Teaching Professor Brigham Young University Objectives Identify the current status of EMDR as an evidencedbased treatment model for PTSD Discuss the EMDR protocol Summarize initial research findings on EMDR in psychiatric conditions other than PTSD Discuss the advantages and obstacles of including basic EMDR training in graduate psychiatric nursing program education *The speaker has no conflicts of interest to disclose DSM V Criteria Four symptom Clusters Re experiencing Avoidance Arousal Negative Cognitions and Mood (the new DSM 5 cluster) Mabey 1

2 PTSD Occurs in 7 12% of the general population in U. S. 14% in military veterans of Iraq and Afghanistan conflicts Medical, psychological and social sequelae One of the most costly of mental illnesses 3 billion in yearly productivity loss Kessler, R. C. (2000). Brunello, N., Davidson, J. R., Deahl, M., Kessler, R. C., Mendlewicz, J., Racagni, G. et al. (2001). Eisen, S. V. (2012). Background on EMDR Controversy Founder Francine Shapiro 1989 Concern about legitimacy of the model Was EMDR just another CBT or Exposure method? Rigor of the research questioned Dismantling research on the method? Exaggerated claims from enthusiasts CBT vs. EMDR: the big guys vs. the little guys IOM Report (2007, 2012) Evaluates the literature; does not derive practice guidelines. In 2008 said inadequate evidence to recommend PTSD Treatment Guidelines International Society for Traumatic Stress Studies (2010) A ratings for EMDR, Cognitive Processing Therapy, Cognitive Therapy, & Stress Inoculation Therapy VA/DoD Guidelines (2010) A ratings for EMDR, Cognitive and Exposure therapy, Stress Inoculation Cochrane Review (2009) Trauma Focused Individual and Group CBT Stress Management EMDR. Mabey 2

3 EMDR Process Gain distance from the event New thoughts/images often emerge Associations to other linked memories free association Psychological memories transformed to objective memories (Parnell, 2007) No emotion that is ecologically necessary is removed by EMDR (Shapiro, 2001) 7 Three Pronged Approach Past experiences Present triggers or situation Templates for appropriate future action EMDR addresses: the primary emotions associated with trauma the negative self referencing beliefs the somatic distress associated with memories 8 EMDR Essential Principles Innate physical and emotional healing process Client is in charge Safety is paramount Assessment is critical A formulation and treatment plan proceed the work Mabey 3

4 Readiness for Trauma Treatment Comfort with own body/physical experience Establishes distance from the traumatic event No current life crisis Accepts diagnosis, has working knowledge of trauma Mood is stable, even if depressed Two or more people to count on Knows & uses self soothing techniques Gives honest self reports Living situation is stable Readiness for Trauma Treatment Able to communicate Stable therapeutic relationship Adequate impulse control, no injurious behavior to self or others Stays grounded and oriented when distressed No major dissociation is present Can identify triggers Able to report significant symptoms Readiness for Trauma Treatment Can set limits and is able to leave dangerous situations if necessary Can tolerate positive and negative affect and shame Client with dissociative identity disorder is cooperative and has contractual agreement among parts Wheeler, K. (2008). Mabey 4

5 Eight Phases of EMDR 1. History and Evaluation Key life events Present situations 2. Preparation Assess strengths Resource Development Installation Safe Place 3. Assessment Image, beliefs, emotions Level of distress Body sensations 4. Desensitization Focus on all aspects of memory 5. Installation: Expression and Consolidation of Insights 6. Body Scan 7. Closure 8. Reevaluation 13 Case Study History and Evaluation Preparation Assessment Desensitization Installation Body Scan Closure Re evaluation What else does the Literature Tell Us? Medline Jan May 2013 retrieved 63 articles About how EMDR may work About brain effects About what other psychological conditions that may be treated with EMDR About EMDR in children & teens Stability of treatment Mabey 5

6 EMDR Training PESI (part of CMI Institute) EMDRIA and EMDR Institute EMDR HAP(public, non profits) EMDR Training for Psychiatric NP Students in Graduate Education Opportunities Students will encounter traumatized patients often EMDR offers a framework for understanding trauma AIP model Students will have beginning knowledge/skills of EB tool for treatment Challenges Difficulties of training in academic settings Credit hours how much can we cover in already crowded curriculum? Requires certified trainer Follow up practice and supervision required Where is EMDR going from here? Mabey 6

7 Questions? Mabey 7

9/3/2014. Which impairs the ability to integrate these experiences in an adaptive manner.

9/3/2014. Which impairs the ability to integrate these experiences in an adaptive manner. Presented by DaLene Forester Thacker, PhD Licensed Marriage and Family Therapist Licensed Professional Clinical Counselor Director and Trainer with AEI daleneforester@yahoo.com I was not able to use EMDR