EMDR: An Introduction Edited for Public Viewing

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1 EMDR: An Introduction Edited for Public Viewing NASW-NJ Annual Conference May 3, 2010 Kathy Heeg MSW, LCSW-Hillsborough NJ Lyn Siegel MSW, MPH, LCSW-Annandale, NJ

Dr. Daniel Amen s Spectroscopy 26 years old, violent rape, physical

drug use Symptoms: depression, anxiety, worrying and drug use.

attention), basal ganglia (anxiety) and limbic areas (depression and mood

2 Dr. Daniel Amen s Spectroscopy 26 years old, violent rape, physical abuse, grief (8 friends deaths) hx. drug use Symptoms: depression, anxiety, worrying and drug use. Before: marked overactivity in the cingulate (problems shifting attention), basal ganglia (anxiety) and limbic areas (depression and mood dyscontrol). Before treatment After treatment 4 psychotherapy sessions with EMDR (+1 month of St. John s Wort milligrams a day) 2

3 EMDR: An Empirically Supported Treatment American Psychiatric Association American Psychological Association Cochrane Colloboration National Institute for Mental Health International Society for Traumatic Stress Studies Department of Veterans Affairs Department of Defense

4 What is EMDR? (Eye movement Desensitization and Reprocessing) Psychological Approach Emotional difficulties Cause = disturbing life experiences Trauma is a neurophysiological freeze in the autonomic nervous system Offers rapid relief Can lead to behavioral change

5 EMDR is not a Technique. It is a Total Approach to Therapy EMDR is a complex method that brings together elements from well-established clinical theoretical orientations including psychodynamic, cognitive, behavioral, body centered and client-centered approaches.

6 How Was EMDR Discovered? In 1987, psychologist Francine Shapiro (accidentally) discovered that her voluntary eye movements reduced the intensity of negative, disturbing thoughts EMDR was originally developed with lateral eye movements later: alternate forms of bilateral stimulation (auditory and tactile) Research study (Shapiro, 1989) reduced symptoms of (PTSD) in traumatized Vietnam combat veterans and victims of sexual assault.

7 Normal Processing of Events and Experiences New experiences are assimilated by the IPS (information processing system) Corrective information is internally generated

8 Normal vs. Maladaptive Processing of Events and Experiences When a memory is accessed adaptively, it is linked with emotional, cognitive, somatosensory, and temporal systems When traumatic or fearful events are encoded maladaptively, experiences tend to be dysfunctionally linked to existing neural networks. (often fragmented, easily triggered) Consequently, experiences are inadequately processed and remain dysfunctionally linked susceptible to dysfunctional recall New information, positive experiences and affects are unable to functionally connect with the disturbing memory. Leading to a continuation of symptoms and to the development of new triggers.

9 Trauma/Disturbing Events Initial processing gets interrupted Due to high arousal or survival encoding The memory is dysfunctionally linked to neural networks Traumatic memories are susceptible to dysfunctional recall with respect to: Time Place Context Experience

10 The Experience of Trauma The experience of the trauma remains frozen, RESULTING IN persistent intrusive thoughts negative emotions self-referenced beliefs unpleasant body sensations.

11 EMDR Theory: Trauma Leads to Disruption Psychopathology is due to traumatic experiences or disturbing life events. Malfunction of the natural information processing system EMDR allows client s innate ability to process and integrate the experience(s) within the central nervous system. Unprocessed components of memory (image, thought/sound, emotions, physical sensation, beliefs) change/transmute to an adaptive resolution.

12 Theory: (AIP) Adaptive Information Processing Model Inadequately processed memories, inappropriately stored in the brain, are the basis of clinical pathology New info is unable to functionally connect with the disturbing memory Leading to continued symptoms, and new triggers Dysfunctional/pathological traits, behaviors, beliefs, affects, body sensations are manifestations of unprocessed memories. Physically stored memories need to be accessed and reprocessed

13 The Adaptive Information Processing (AIP) Model The AIP model describes the effects of trauma and how EMDR works to alleviate trauma. EMDR targets traumatic material and appears to restart this stalled information processing in a focused manner Facilitating the resolution of the traumatic memories by activating neurophysiological networks where appropriate and positive information is stored Forging new neural networks. Processing is viewed as the forging of adaptive associations between networks of information stored in the brain. Client Experiences: It s over, it s as if it happened to someone else, like watching it on TV (without the emotion) 13

14 Tenets of the AIP that Guide EMDR and Predict Outcomes EMDR procedures facilitate access to dysfunctionally linked experiential components, allowing them to be integrated/linked within appropriate emotional, cognitive, somatosensory and temporal systems. This facilitates effective processing of traumatic or disturbing life events and associated beliefs, to an adaptive resolution.

15 Tenets of the AIP that Guide EMDR and Predict Outcomes Previously impaired linkages in the information processing system are repaired facilitating real-time access to appropriately linked emotional, cognitive, and somatosensory information As a result the client can access adaptively linked information and respond appropriately

16 The Core of EMDR Treatment Involves Activating components of the traumatic memory or a disturbing life event (sensory, cognitive, emotional) Simultaneously pairing these memory components with alternating bilateral stimulation (eye movements, tones, taps). Facilitates normal information processing and integration of the memory.

17 Benefits of EMDR Treatment Symptom alleviation The target memory is no longer bothersome Improved view of self At peace Relief from bodily disturbance Resolution of triggers

18 What Happens in an EMDR Session? A structured 8 Phase protocol is followed The client focuses on a distressing memory (image, + associated negative cognition, emotions, and body sensations) EM or auditory or tactile stimulation. set with dual attention task= about 24 secs After each set the client reports Client is directed to focus on the invoked association

19 Examples of Applications of EMDR Mood disorders Depression Anxiety disorders: Panic disorder, fears, phobias Reaction to severe stress and adjustment disorders Somatoform disorders Attachment disorders (child/adult) Dissociative disorders Eating disorders Sexual dysfunction, Sleep disorders Psychological/behavioral factors associated with diseases/illness Personality Disorders-e.g. borderline Grief and Loss Disease Issues-Chronic, eczema, GI px, Chronic Fatigue Phantom limb PTSD, Trauma (sexual, physical, disasters), car accidents Excessive Anger Addictions, Eating Disorders, porn, internet, alcohol Performance Enhancement (targeted neg beliefs, failures - professional, sports, testing /exam anxiety) EMDR is not just for Trauma!

20 How Does EMDR Work? Many hypotheses, no definitive explanation EMDR may help in the treatment of PTSD by turning on memory processing systems normally activated during Rapid Eye Movement (REM) sleep but are dysfunctional in the PTSD patient. Two separate memory systems store information in the brain. One, located in the hippocampus, stores 'episodic' memories The second, located in the neocortex, stores general information and associations. Recovery from trauma depends on the processing of traumatic memories in their episodic form into general semantic memories. This normally occurs during REM sleep but is prevented from occurring for people who have PTSD due to the arousal. 1 Harvard Medical School sleep researcher Robert Stickgold, Journal of Clinical Psychology (2002)

21 Components for EMDR Processing The Encapsulated Memory: Events/ Experiences Images Negative cognition/belief Feelings Body sensations or other sensory information

22 Negative and Positive Cognitions Beliefs are not the cause they are symptoms The cause is the physiologically stored memory disturbing affects, sensations, perspectives stored a the time of the event Neg cognitions are processed w/emdr, Positive cognitions result Three categories of beliefs: Responsibility (shame/guilt) Safety/Vulnerability Choices/Control

23 Examples of Negative and Positive Cognitions Negative Cognitions I am a bad person. I am worthless (inadequate). I am shameful. I deserve only bad things. I cannot trust my judgment. I cannot succeed. I am not in control. I am powerless. I am weak. I cannot protect myself. I am stupid. I am Insignificant (unimportant). I am a disappointment. I deserve to die. I deserve to be miserable. I cannot get what I want. I am a failure (will fail). I have to be perfect (please everyone). I am permanently damaged. Positive Cognitions I am a good person. I am worthy; I am worthwhile. I am honorable. I deserve good things. I can trust my judgment. I can succeed. I am now In control. I now have choices. I am strong. I can (learn to) take care of myself. I have intelligence. I am significant (important). I am okay just the way I am. I deserve to live. I deserve to be happy. I can get what I want. I can succeed. I can be myself (make mistakes). I am (can be) healthy.

24 EMDR: Three Pronged Approach Addresses: 1) earlier life experiences 2) present-day related experiences/stressors 3) desired thoughts and actions for the future. (future template) EMDR treatment may last from 1-3 sessions to 1 year or longer for complex problems.

25 Goals of the 8 Phase Approach Specific psychotherapeutic procedures to: Ensure adequate stabilization throughout Tx Create states of dual attention Facilitate the client s innate ability to heal Access existing information Introduce new adaptive information (e.g. interweaves) Facilitate information processing Inhibit accessing of inappropriate information (e.g. avoid flooding)

26 8 Phases of the EMDR Protocol 1. Client History and Treatment Planning 2. Client Preparation 3. Assessment 4. Desensitization 5. Body Scan 6. Installation 7. Closure 8. Reevaluation

27 Description of the 8 Phases Phase I: identify presenting problem, targets, determine suitability (client and target px), treatment issues, treatment planning. Phase II: client education, stabilization/ affect regulation Phase III: Identification of the target/issue, neg and pos cog (tentative) and measure both (VoC*), SUD scale, elicited body sensations * Validity of Cognition

28 Phase I- Identifying EMDR Target Presenting problem/history taking Identify the Issue then the Target Ways to Identify Issues/Targets Loss timeline NCQ (Negative Cognition Questionnaire)

Negative Cognitions I don t deserve love I am a bad person I am in danger I do not deserve I am powerless I can not succeed Positive Cognitions I deserve love I am a good person It s over, I

29 Negative Cognitions I don t deserve love I am a bad person I am in danger I do not deserve I am powerless I can not succeed Positive Cognitions I deserve love I am a good person It s over, I am safe now I deserve, can have I now have choices I can succeed 4 types of cognitions: Responsibility, Inferiority, Safety/Vulnerability Control/ Choices Examples of Cognitions (Teen/Adult)

30 Phase II-Client Preparation Safe/Calm Place-Installation Container

31 Phase III Identification of the target/issue, neg and pos cog (tentative) and measure both (VoC*), SUD scale, elicited body sensations *VoC-validity of the cognition

32 The 8 Phases (con t) Phase IV: Desensitization- BLS *, client asked to notice what comes up (continues until SUD=0) *bilateral stimulation

33 Modalities for Bi-lateral Processing (BLS): Light, Sound, Tapping, Kinesthetic Audio, visual, and tactile Kids Tapping: knees/hands Drumsticks Magician s wand Puppets (eyemovement) Audio + Theratappers (tactile) 33

Phase-Client is asked to hold the positive cognition

34 The 8 Phases (con t) Phase V: Body Scan Phase: Identify residual tension and reprocess Phase VI: Installation Phase-Client is asked to hold the positive cognition together with the target memory while BLS (bilateral stimulation) is continued

35 The 8 Phases (con t) VII- Ensure client stability at end of session (e.g. container, relaxation, HeartMath, brief meditation) VIII- (next session) Reevaluation of previous processing of targets, emergence of new material or disturbance (SUD) /change in mood or behavior

36 Case Example: Future Template Kathy Heeg, LCSW Followed by Video Clip of EMDR

37 EMDR with Children

38 EMDR Institute Training WEEKEND 1 10 hours of didactic + 10 hours of supervised practice It is recommended that clinicians practice the skills learned in Weekend 1 with selected clients for a minimum of sessions before attending Weekend 2. WEEKEND 2 10 hours of didactic + 10 hours of supervised practice Certificate of Completion Requirements: Completion of Weekend 1 and Weekend 2 Trainings Reading the textbook, EMDR: Basic Principles, Protocols and Procedures (Shapiro 2001) 10 hours of case consultation with an EMDR Institute Approved Consultant 5 hours are required prior to Weekend 2; 5 hours after Weekend 2 LS

39 Training Levels I and II EMDRIA Certified Clinician-minimum of two years experience in their field. 50 clinical sessions in which EMDR was utilized, 20 hours of consultation in EMDR by an Approved Consultant. In addition they must complete twelve hours of continuing education in EMDR every two years.

40 HAP Training Upcoming- in Fall Call Lynn Enhorn (at St. Peters Hospital)- (732) x38 or (C) (973) Discounted for Soc Service Agencies employees ($300 +free consultation) Must work for non-profit minimum 30 hrs per week to qualify

41 EMDR Approved Consultant 3 years of experience with EMDR after completing an EMDRIA Approved Training Program 300 hundred clinical sessions in which EMDR was utilized twenty hours of consultation from an EMDRIA Approved Consultant They must complete twelve hours of continuing education in EMDR every two years

42 Information on Training List of Approved training programs /Basic%20Trainings%20Approved.pdf

43 Further Questions Lyn Siegel LCSW Kathy Heeg LCSW ext.18

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