License #MFT 32021

EMDR

Article Links:

Eye Movement Desensitization and Reprocessing, or EMDR, Is an effective treatment for Survivors of trauma or loss.

Trauma may include:

Victim or witness of violence, assault.
Mugging, rape, or sexual assault.
Accident, injury or hospitalization.
Loss or injury of a loved one.
Childhood abuse or molestation.
Fires, floods, and earthquakes.
Or other disasters.

Symptoms may include:

Complicated grief.
Disturbing memories.
Stress, brooding, or worrying.
Fears or phobias, panic, or anxiety.
Nightmares or trouble sleeping.
Bad temper or "feeling negative."
Depression, shame, or guilt.
Not caring anymore.
Relationship problems.
Poor self-image.

The Problem
When someone has a frightening or painful experience, it's normal to be upset afterwards. Usually, we get over it, but sometimes, we get stuck. A memory may keep coming back. Or we may find troublesome changes in how we act, feel, or think. We might not even realize the changes are related to the experience, until we remember how things were different before the incident.

The Solution
How do you get "unstuck" and get back to your old self? For many people, "the only way out is through" --Facing and working through the disturbing memories, to achieve resolution. Psychotherapists are trained to facilitate this process.

EMDR
EMDR is an intensive procedure for working through upsetting material, while reducing stress and discomfort. The process of EMDR is safe, when provided by a trained mental health professional. It does not involve hypnosis or drugs; the client is awake and alert throughout the process. Research has shown that EMDR can help to make treatment both fast and effective.

Eye movement Desensitization and Reprocessing (EMDR) is an innovative therapeutic method for quickly and effectively relieving PTSD (the aftereffects of traumatic experiences) as well as resolving phobias, panic, and anxiety. It has also been found to be effective in treating addictions and resolving grief reactions.

_________________________________________________________________________

More and More, Favored Psychotherapy Lets Bygones be Bygones

Excerpt a from the New York Times, on Advances of cognitive behavioral therapy Published: February 14, 2006

Insurance companies likewise often prefer consumers to select cognitive behavioral therapists, rather than psychodynamically oriented practitioners. In the companies' view, scientific studies have shown that cognitive therapy can produce results in less than half the time of traditional therapies.

But is it really the case that understanding the past is not necessary to healing? Could thousands of people have saved time and money by skipping over conversations about parents and cutting straight to retraining their thoughts and behaviors?

Richard J McNally, a professor of psychology at Harvard, said reviewing the past could be therapeutically important because it could help patients construct narratives of cause and effect.

He pointed to cases of panic disorder. Many people have panic attacks, but a small percentage develop a full-blown panic disorder, he said. Those do not can usually find a rational explanation for their disturbing experience.

"They say, 'That because I am about to take a midterm exam or I had too much coffee this morning, 'explanations that decatastrophize the bodily symptoms," Professor McNally said.

The rationalizations are effective, he said, even when the explanation is not correct. Merely asserting a logical sequence of cause and effect lets people feel that they have some control, that they are not victims of unexplained forces.

In the same way, people who experience depression can benefit from an explanation for their feelings, an interpretation that allows them to feel that they are able, based on their understanding of the cause, to predict and control their emotions. This is a function of therapies that on the past, Professor McNally said.

"Detailed narratives about the past can be assumed under a larger rubric of trying to find meaning or trying to impose order, and thereby controlling one's world and experience," he said. "People say, 'At least I know why I'm unhappy in my life.' "

New research suggests that psychodynamic therapy exploring the past can be as effective as cognitive work. In the last three years, psychodynamic therapists have started to subject their approach to some rigorous research as that used for cognitive therapy. The studies show similarly good results.

The basic assertion that it is not absolutely necessary to review the past is now generally accepted. Even Professor Norcross, who says he regularly guides patients to the past when it is warranted, acknowledges that the data are not entirely solid.

"At the moment," he said. "There is no evidence that understanding the origins of your problems is necessary for effective psychotherapy. And there is some evidence that a preoccupation with the past can actually interfere with making changes in the present.

"Obsessive rumination about past events can trap patients in a self-defeating cycle from which they cannot extricate themselves. It can actually retard healing."

_________________________________________________________________________

What EA Professionals Need to Know About EMDR

The protocol in EMDR has relevance for EA professionals who perform assessments, referrals, and/or brief treatment. When an EA professional discovers that a client has suffered a severe trauma, either at work or in the community, the EA professional has the option of briefly treating this client or referring him or her to an appropriately trained, licensed clinician. The use of EMDR by the EA professional or community clinician offers a highly effective form of treatment for specific clients.

EMDR has been found to be effective in the following instances:

(A) When a critical incident happens at work (Roger Solomon, Ph.D., is a trainer for the EMDR Institute and is considered a leading expert on critical incident stress debriefing [CISD] and EMDR.);
(B) When there has been a traumatic injury, for example, in a transportation accident associated with work;
(C) When job performance is negatively affected by a traumatic event outside the workplace;
(D)When a company downsizes and an employee loses a job he or she has held for many years.

The study results conclusively proved the effectiveness of EMDR.

The managed care industry has shown an interest in including EMDR as a method of treating post-traumatic stress disorder. As this article was going to press, Kaiser HMO of Santa Clara had just concluded a controlled study of EMDR versus "standard treatment" for PTSD. Kaiser concluded that patients in the EMDR group could be treated more effectively in half the time and with fewer medication management sessions.References for this article are available from the author.

About the Authors: Mark Dworkin, CSW, teaches at the Mt. Sinai School of Medicine in the Departments of Psychiatry and Community Medicine and is a Fellow of the Nassau County Chapter of the New York State Society of Clinical Social Work Psychotherapists.

Maurie Cullen, MSW, BCD, has been a clinical social worker in private practice in Encino, CA for 20 years. A member of EAPA since 1986, she has been a clinical provider of services to many EAPs and managed care companies. She can be reached at 318-788-2610.

________________________________________________________________________

Eye Movement Desensitization and Reprocessing & EAP

Eve movement desensitization and reprocessing (EMDR] is a recently developed, eight-phase treatment procedure that is showing positive and rapid results in the treatment of post-traumatic syndrome disorder (PTSD), "the most severe and incapacitating form of stress reaction," according to Focus on Federal Employee Health and Assistance Programs, published by the U.S. Office of Personnel Management.

In 1987, Francine Shapiro, Ph.D., discovered that rapid eye movement decreased negative arousal, that is any dysphoric or negative beliefs a person may hold. She has developed the most effective treatment for PTSD and trained more than 14,000 therapists worldwide.

In EMDR treatment, the client first brings a picture to mind that represents the traumatic event and then identifies a negative belief about him or herself that has linked up with the picture (i.e., "I'm a bad person"). The therapist then asks the client what he or she would rather believe (i.e., "I survived and I'm okay"). Then linking the picture with the negative thought (that is, "I'm a bad person"), a degree of distress is evaluated, along with the specific emotional states aroused. The therapist enables the client to link the picture with the distressing thought and then elicits the painful emotion sparked by the picture and/or the negative belief or thought. While the client focuses on a picture, thought, and sensation, the therapist helps the client generate sets of rapid eye movements; after every set, the therapist asks the client for new information and the client dispatches another set of eye movements. This process continues until the client's emotions and negative beliefs have been desensitized. The therapist then helps the client install the desired belief (positive cognition) through more eye movements.

Shapiro states that EMDR works from an accelerated information processing model of the brain. According to Shapiro, there appears to be a distinct part of the brain that facilitates the flow of information. Non-conflictual information normally gels processed easily and automatically to a state of "adaptive resolution." In the process of adaptive resolution, a person thinks and experiences feelings about an event (which becomes a memory), makes appropriate connections about that memory, and then stores that information in a way that is accessible.

When someone is traumatized, however, it seems that a neurophysiological and neurochemical imbalance is created. In this state, the information gathered remains in the person's memory in the state in which it happened, cognitively and affectively. This state causes the PTSD symptoms of hyper-arousal, avoidance, and a general numbing or lack or responsiveness.

One central hypothesis has been tested over and over again and has been validated. This hypothesis states that "the eye movements used in EMDR (or alternative stimulus) trigger a physiological mechanism that activates the information processing system (and processes dysfunctional state specific memory to a state of adaptive resolution)." There is another hypothesis that when a client brings up a picture, thought, and sensation of the trauma, he or she may also be accessing, with his or her consciousness, the neural network where the information is stored. One of EMDR's main beliefs is that this action of activation and processing will naturally move the memory to the stage of adaptive resolution.

EMDR treatment consists of eight essential phases:

1. Taking a client history and planning the treatment:

2. The preparation phase in which the clinician introduces the client to EMDR procedures and theory, establishes expectations about treatment effects, and prepares the client for possible between-session disturbance;

3. Assessment includes determining the target and baseline response using Wolpe's Subjective Units of Disturbance and Shapiro's Validity of Cognition scales;

4. Desensitization addresses the client's disturbing emotions;

5. Installation focuses on the cognitive restructuring;

6. The body scan evaluates and addresses residual body tension;

7. Closure includes debriefing and is essential for maintaining client equilibrium between sessions;

8. Re-evaluation.