THROUGH THE EYE OF THE TRAUMA STORM: EMDR in the treatment of trauma

1. THROUGH THE EYE OF THE TRAUMA STORM:EMDR in the treatment of trauma Alexandra (Sandi) Richman sandi@alexandrarichman.com www.emdr-training.com

2. WHAT IS EMDR? • Eye Movement Desensitization & Reprocessing • Innovative clinical treatment for trauma • Also effective in treating anxiety-related disorders • EMDR is a complex method of psychotherapy incorporating a range of therapeutic approaches in combination with alternative dual attention stimulation • EMDR activates the information processing system of the brain

3. WHAT IS EMDR? • During EMDR treatment the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus • Traumatic memories stay “stuck” in the non-verbal, non-conscious subcortical regions and are not accessible to the frontal lobes

5. WHAT IS EMDR? • When the client recalls a traumatic memory or sensation, the therapist encourages them to notice what is coming up whilst tracking the therapist’s fingers • Information is adaptively processed with new associations being made between the disturbing memory and more adaptive memories or information • Leads to more complete information processing, alleviation of emotional and physiological distress and development of cognitive insights

6. HOW WAS EMDR DEVELOPED? Discovered and Developed by Francine Shapiro 1987 She noticed that : Disturbing Anxious Thoughts Changed with spontaneous eye movements to: LESS DISTURBING THOUGHTS LEADING TO ADAPTIVE RESOLUTION (ie. The negative charge was greatly reduced)

7. 1987 EMD : EYE MOVEMENT DESENSITIZATION 1990 EMDR : EYE MOVEMENT DESENSITIZATION & REPROCESSING ( processed traumatic memories into something more adaptive and functional)

8. EIGHT PHASES OF TREATMENT • PHASE 1 : CLIENT HISTORY • PHASE 2 : PREPARATION • PHASE 3 : ASSESSMENT • Image • Negative Cognition • Positive Cognition • Validity of Cognition (VOC) • Emotions • Subjective Units of Disturbance (SUDs) • Body Sensation

9. ASSESSMENT • Worst Part: ‘Him locking the door, hearing the lock turn’ • NC : ‘I’m Completely helpless’ • PC : ‘It’s in the past, I’m safe now’ or ‘I can take care of myself’ or ‘I can make better choices’ • VOC: 2 • Emotions: ‘fear, horror’ • SUD: 9 • Body Sensation: ‘in the throat’

10. EIGHT PHASES OF TREATMENT cont… • PHASE 4 : DESENSITIZATION - Worst moment : image, sound or smell - Negative cognition - Where felt in body • PHASE 5 : INSTALLATION • PHASE 6 : BODY SCAN • PHASE 7 : CLOSURE • PHASE 8 : RE-EVALUATION • EMDR is a PAST, PRESENT AND FUTURE model

11. WHAT HAPPENS DURING EMDR? • TRAUMATIC MEMORY EMDR MEMORY Associated with disturbing Image, Cognitions, Affect, Physical Sensations (fragmented, not integrated) Less disturbing Image, a Positive Cognition, Appropriate Affect without disturbing Physical Sensations STATE-SPECIFIC FORM IN IMPLICIT MEMORY (Right Hemisphere) FUNCTIONAL FORM IN EXPLICIT MEMORY (Left Hemisphere) RE-EXPERIENCING Timeless REMEMBERING Sense of time

12. ADAPTIVE INFORMATION PROCESSING • Pathology results when unprocessed experiences are stored in one neural network, unable to link up naturally with more adaptive information in another neural network/s • Implicit memories from past events are not processed • These unprocessed memories are at the root of a variety of psycho-social issues in the present • The past is the present • Present situation produces distress as it is a trigger for past, unprocessed incident/s

13. ADAPTIVE INFORMATION PROCESSING • Stored implicit memories in unprocessed neuro-networks are responsible for current dysfunctional behaviours, feelings, thoughts • EMDR processing involves working with unprocessed memories of earlier experiences • EMDR separates memory networks that don’t go together • EMDR encourages making adaptive connections to function more appropriately in the present

14. HOW DOES EMDR WORK? • Not entirely clear! • EMDR induces changes in regional brain activation similar to REM sleep • EMDR increases prefrontal lobe activation leading to more appropriate responses to triggers • The Eye Movements or other dual attention stimuli elicit an Orienting Response which disrupts the traumatic memory network, interrupting previous links to negative emotions and allows integration of new information

15. HOW DOES EMDR WORK? • EMDR has evolved into a synthesis of traditional orientations: • Aspects of CBT • Brief /Interrupted exposure • Free Association : • Directed and Non-directed • Focus on physical sensations • Dual attention stimulation

16. Processing torture memories

17. CLIENT • 20 year old woman from Sierra Leone • 12 yrs. Abducted by ‘rebels’ and systematically raped; witnessed killing of sister • 14 yrs. Witnessed mother’s violent murder and abducted with 2 brothers; made to carry arms and trained to kill • Systematically and continuously raped and branded • Extreme physical re-experiencing of rape/branding • Overriding sense of self as damaged & disgusting

18. CLIENT • Re-experienced the physical pain • Boundary transgressing body experiences threw her back to speechlessness • Rejected her body • Dissociated to protect herself from the shame • Somatoform pain states

19. PREPARATION • Able to create a ‘safe place’ in her imagination, i.e. being inside a church she knew with smells, colours, warmth, sound of priest’s voice. BLS used to install pleasant, relaxed body sensations whilst being in this place. • Installed with BLS internal resources – time when she had achieved praise from teacher for successful test results; time when she had been kind to a friend

20. Treatment • Focus on body sensations • Saccadic eye movements while just noticing the uncomfortable body sensations without judging them or allowing thoughts or feelings connected with them to intrude • More able to be in her body

21. Treatment • Processing of trauma – rape, branding, murder of mother • Profound questioning of her existence : ‘I am nothing’ • With processing found more adaptive framework within which to store what had happened to her

22. CASE MATERIAL ADRIAN 39 year old man Involved in a RTA (wife and 5 year old son in car) Son has severe gash on right cheek Wife also injured with back pain History : Mother had 2 breakdowns Parents divorced when 6 years old First EMDR Session Image of son bleeding from wound and saying ‘Oh no, Oh no, I’m sorry Daddy’ NC: ‘I am powerless’ Feelings: angry and sad Body tension in chest

23. CASE MATERIAL (cont) Second EMDR Session Image : Scar on son’s face Negative Cog : ‘My hands are tied I’m helpless’ Positive Cog : ‘I can take good care of my family’ VOC : 2 Emotions : Frustration & Anger SUDS : 10 (Highest Level of Disturbance) Physical Sensation : Felt in chest

24. CASE MATERIAL (cont) Third EMDR Session Same focus as last session Disturbance resolved PC :‘I can take good care of my family’

25. RESEARCH EVIDENCE FOR EMDR • More RCTs on PTSD and EMDR than all other approaches • Generally found to be as effective as exposure and CBT approaches • But more efficient • Fewer drop-outs • EMDR shows more positive changes on intrusion measures • NICE, 2005 : EMDR & Trauma-focused CBT treatments of choice for tx of PTSD

26. CONCLUSION • Supervised training essential • Basic, Intermediate and Advanced EMDR trainings • EMDR sounds deceptively simple but is a complex and immensely powerful therapy

27. RESILIENCE “I still weep sometimes and I feel pain but I can tell the story of my life. I had not words for my sorrows but I could share some moments with you and you heard and you saw my pain. Maybe I could tell my story before, but I was unable to feel anything. I had to find out how I feel. That was painful but somehow my burden was easier to carry and more distant instead of right inside me. My body is more mine now and I know what I feel. There are moments when sometimes I even try to think about the future ………”