The Science and Art of Weaving DBT Therapy into EMDR

1. The Science and Art of Weaving DBT Therapy into EMDR As an EMDR and DBT Therapist, I’ve had ample opportunities to learn about the ways in which these two psychotherapies intersect. Both modalities have been widely known and accepted as evidence-based and effective therapeutic practices around the world. Initially, the efficiency of both EMDR and DBT was discussed around PTSD and complex trauma. More up to date research has revealed that EMDR Therapy can be utilized to treat any presenting concerns in addition to trauma (depression, anxiety, OCD, stress, addictions, eating disorders, personal development). DBT can be used to supplement EMDR Therapy and drastically help specifically with phase 2. Each of them has well established protocols and procedures in place to follow. Beyond the science of adhering to the methodology, there is also a fine art that’s required for the clinician to integrate and deliver them in an organic, highly personalized manner. DBT modules and skills can be weaved into EMDR during each of the EMDR treatment phases in ways that take into consideration a client’s unique needs and characteristics. The DBT skills are grouped in four modules: Mindfulness, Interpersonal Effectiveness, Emotion Regulation and Distress Tolerance. EMDR Psychotherapy has eight phases: History Taking, Preparation, Assessment, Desensitization, Installation, Body Scan, Closure and Re-evaluation.

2. In the History Taking and Preparation phases, DBT’s Biosocial Theory complements the Adaptive Information Processing (AIP) model to facilitate understanding that nature and nurture play a role in the development of problems, issues and diseases. Such challenges and issues are rooted in traumatic life circumstances, memories and/or development. Treatment, while still following specific procedures, focuses on changing maladaptive patterns and developing more adaptive ones. The Preparation phase in particular allows the clinician to orient the client to tangible skills from the four DBT modules in addition to the EMDR stabilization techniques. The purpose of all techniques taught during preparation centers around guiding the client to build basic affect tolerance and establish a sense of safety that are needed for the following more intense phases. In the Assessment phase, as we set up and activate a memory or part of a traumatic experience, the core mindfulness skills come in handy to sharpen our internal observer that can maintain dual attention and help us remain curious about what is about to unfold. The Radical Acceptance skill also invites clients to learn that life itself is activating and suffering is an unavoidable part of life, yet we have the choice to transform our pain rather than remaining locked in it. The Desensitization phase takes the client and clinician into an unpredictable and emotionally intense journey that facilitates reprocessing of traumatic material. Teaching clients to learn how to “ride the waves” of activation with the use of skills can enrich this process. Skills from all four modules will enhance effective reprocessing during this phase. During the Installation phase, which coincides with clients shifting dramatically from negative core beliefs to positive ones, DBT helps in identifying and reinforcing adaptive responses, also conveying to clients the importance of practicing them. As Deany Laliotis emphasizes, the absence of the negative doesn’t necessarily translate into the presence of the positive, so clinicians need to assist clients in learning adaptive ways of thinking and responding. The DBT skills may provide us with the bones of future templates we can help our clients rehearse and strengthen. The Body Scan phase in EMDR naturally integrates elements of mindful body scan that is being taught in DBT. Here is where the core mindfulness, distress tolerance and emotion regulation skills may enhance a deeper awareness of what our body holds and is ready to release. In the Closure phase, internal and external observation skills will assist client in containing remaining disturbance, grounding and reorienting in the here and now. DBT tools such as Diary Card and Chain-link Analysis may be utilized in the Re-Evaluation phase to explore what has generalized and worked for client versus what hasn’t. Interested in learning more about how EMDR and DBT can help you? We offer individualized EMDR and DBT treatment as well as DBT Group Therapy. Schedule a free 15 min consult to learn more! With offices in Gilbert & Phoenix Arizona, our therapists are ready to help you achieve your limitless potential.

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