EMDR: An EAP tool for assessment, support and referralRoger M. Solomon, Ph.D.

HistoryEMDR - 1987 Francine’s walk in

the parkCurrent status – Evidence based

treatment for trauma3-6 sessions for single episode

PTSDMore needed for multiple

traumatization (e.g. studies show 12 session for veterans)

Part of an overall treatment plan for complex trauma and dissociative disorders

World Health Organization Guidelines (2013)

Trauma-focused CBT and EMDR therapy are recommended for children, adolescents and adults with PTSD.  “Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.”  

Neuroimaging studies(Pagani, et. al., 2013)Cortical activation of limbic areas during script reading

Emotional hyperarousal during trauma reliving

Neuroimaging studiesEMDR results in normalization of these

activations and can be understood as a neurobiological correlate of clinical recovery

A shift of emotive attention to cortical regions with a dominant cognitive and sensorial role.

Hence memory retention of the traumatic event can move from an implicit subcortical to an explicit cortical status where different regions participate in processing the experience!

Neuroimaging studiesComparing findings from EEG and CBF SPECT

scan studies, it was found that the same brain regions are implicated in response to EMDR therapy.

This cross-validates the two methodologies and implicates that EMDR therapy is associated with functional changes in the same topographic regions as those activated by a autobiographical script (fusiform gyri and occipital and frontal cortex)

EMDR the first psychotherapy with a proven neurobiological effect.

Adaptive Information Processing ModelPresent problems that result from

past memories “living in trauma time”, maladaptively stored

EMDR processing may facilitate memory networks containing adaptive information to link into memory networks containing maladaptively stored information, allowing integration to occur

EMDR - eight phasesHistoryPreparationAssessmentDesensitizationInstallationBody ScanClosureRe-evaluation

EMDR

Three ProngsPastPresentFuture

Development of EMDR/EAP model1990 Secret Service - peer support team

training1990 FBI - peer support team training Post Critical Incident Seminar1995 Oklahoma City, US Attorneys OfficeSeptember 11, 2001 New York City, US

Department of Justice2004 Department of State, Diplomatic

Security2010 US Senate EAP

Goals of EAP Model Enhances:the assessment, referral and

treatment process,motivates clients towards

treatmentEAP’s ability to address short-

term issues in-house,rates of client satisfaction and

successful outcomes.

EMDR as assessmentIf client responds positively to

EMDR and problem is resolved no further referral is needed

If more negative material becomes evident, then referrals are facilitated

Therefore EMDR can be used to assess the nature of the problem, and what support is needed

EAP ModelInitial EAP assessment to select

appropriate clientsPreparationEMDR utilizationFollow-up/referral

Model – Selection of clientsAppropriate selection of clients –

stable social environment, moderate to high integrative capacity, ability to lower level of physiological distress, agree to follow-up with outside counseling (referral)

Client has distressing events, past and recent, related to current problem

Model - PreparationExplanation of EMDRDiscussion how it may help to

improve current situationReading material

Model: PreparationAssessment by RogerInitial discussion of goal(s) of

sessionSafe/calm place or resource

installation, or other stabilization methods, if appropriate

Agreement for referral for follow-up, if needed

EMDR utilizationWork stress issuesCurrent crises Recent trauma Grief and loss issuesPast distressing events that are

currently being triggered

EMDR utilizationStabilization - safe/calm place

and resource installationDistressing memories linked to

present problemPresent triggersFuture template

Model: Follow-up and referralQuick follow-up (e.g. later the

same day, next day) Ongoing follow-up as appropriateReferral for follow-up treatment

as appropriateOngoing support/further sessions

as appropriate (can work with client’s current therapist)

Safe Place

1) Positive image of place with safety/calm

2) Close your eyes - notice feelings, sensations

3) Identify a word that would go with the feeling

Safe place

4) Close your eyes, bring up the image, notice the pleasant feelings, and say the word in your mind, and notice the feelings as you merge with the scene and repeat the word. Then after a moment or so, open your eyes5) If positive feelings came up, repeat closing eyes, bringing up the image, and the word to pair with it. Do this five times (about a minute each time)

Safe place

6) Test the effect – notice your body, and then bring up the image and the word

If positive, bring up something recent that mildly disturbed you, notice how your body reacts, and then bring up the positive image and word, and see if the good feeling comes back

Adding bilateral stimulationOnce you have the safe or calm

place, add bilateral stimulation - tapping with hands on thighs - butterfly hugBring up image of safe or calm place along with the positive word, and allow yourself to go into the state of safety/calmness. Then tap alternatively on your thighs or with butterfly hug 4-6 times

Adding bilateral stimulationIf positive repeat several timesIf negative, stop, and use safe

place without bilateral stimulation, or slow breathing to calm