Francine Shapiro Library - EMDR Bibliography Links
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1. van der Kolk, B. A. (1999, November). Assessment and treatment of complex PTSD. Specialty training course presented at the annual meeting of the International Society for Traumatic Stress Studies, Miami, FL.
Language: English
Format: Conference
Abstract:
While most research on PTSD has studied subjects exposed to single
trauma, in clinical practice the vast majority of treatment seeking
patients have histories of multiple traumas, usually interpersonal,
abuse. This gives rise to complex clinical pictures, of which
PTSD is just one dimension. The Trauma Center in Boston is a
large, multidisciplinary, developmentally focused Clinic which specializes
in the treatment of traumatized children and adults. Our
clinic uses a developmentally based assessment tool which helps in
the staging of appropriate treatment interventions. Special emphasis
is placed on providing patients with skills to deal with complex
trauma-based symptoms, such as dissociation, by teaching stablization with DBT techniques, psychoeducational groups, resource
installation, SIT, and body-oriented methods, in which patients are
taught skills to increase their internal locus of control. We will
review the rationale for various psychopharmacological interventions
and the role of groups to enhance the capacity for mutual
relationships. All treatment occurs on the foundation of continuity
of care with one individual therapist who follows the patient’s
progress,explores life issues, helps deal with re-enactment behaviors,
and does trauma-specific treatment, such as EMDR or CBT
for alleviation of trauma-specific symptoms. This conference will
explore these issues in depth and discuss in detail the staging and
applications of various treatment techniques in clinical practice.
Keywords: Complex Posttraumatic Stress Disorder Complex PTSD C-PSTD
Accuracy Verified: Yes
2. Cook-Vienot, R., & Taylor, R. J. (2012). Comparison of eye movement desensitization and reprocessing and biofeedback/stress inoculation training in treating test anxiety. Journal of EMDR Practice and Research, 6(2), 62-72. doi:10.1891/1933-3196.6.2.62 .
Language: English
Format: Journal
Abstract:
Eye movement desensitization and reprocessing (EMDR) and Biofeedback/Stress Inoculation Training (B/SIT)
treatment and no treatment (NT) were compared in reducing test anxiety. Thirty college students with high
test anxiety were randomly assigned to each condition. Pre-post assessments were conducted using the
Test Anxiety Inventory (TAI), State-Trait Anxiety Inventory (STAI), Rational Behavior Inventory (RBI), and
Autonomic Perception Questionnaire (APQ). Treatment therapists were licensed professionals with at least
2 years experience in their respective modality. Statistical analysis using a two-way analysis of variance with
repeated measures found significant interactions between time (pre-post) and treatment conditions for all
measures except the RBI. Post hoc Newman–Keuls analyses were conducted on the change scores, indicating
that both EMDR and B/SIT significantly reduced test anxiety. EMDR generally outperformed B/SIT.
Keywords: Biofeedback Stress Inoculation Test Anxiety
Accuracy Verified: Yes
3. Vienot, R. C. (1998, July). A comparison of eye movement desensitization and reprocessing and biofeedback/stress inoculation training in treating test anxiety. Union Institute and University, Cincinnati, OH. AAT 9822000.
Language: English
Format: Dissertation/Thesis
Abstract:
Eye Movement Desensitization and Reprocessing (EMDR) treatment, Biofeedback/Stress Inoculation Training (B/SIT) treatment, and no treatment (NT) were compared in treating test anxiety. Subjects (30) reporting test anxiety were randomly assigned to EMDR, B/SIT or NT. Treatment consisted of three 90 minute sessions using B/SIT and one 45 minute session/three 75 minute sessions using EMDR. Treatment therapists were licensed psychologists, counselors or social workers with two to twenty years experience using EMDR or B/SIT. Subjects in the NT group were offered treatment following the study. Six dependent variables were measured pre/post: trait and state anxiety (State Trait Anxiety Inventory, STAI-T.S.), test anxiety (Test Anxiety Inventory, TAI-T.W.E.), rationality of personal beliefs (Rational Behavior Inventory, RBI), negative self statements (TAI-W) and self report of physiological response (Autonomic Perception Inventory, APQ) using.05 level. ANOVAs were performed followed by a Newman-Keuls Multiple Comparison. There was a significant interaction between pre-post tests and type of group on all dependent measures except the RBI. EMDR showed a tendency toward greater improvement from pre to post test than B/SIT and NT. There were no significant differences between groups on the pre test. Post group means indicated: (a) STAI-S, there was no difference between the groups; (b) STAI-T and APQ, EMDR and B/SIT had a greater reduction than NT; (c) TAI-E, EMDR showed more reduction than B/SIT and NT; (d) TAI-T and W, there were differences between all three groups with EMDR showing the most reduction. A meta-analysis was performed to determine clinical significance. Prior to treatment all three groups were above the normative effect size of 1 SD. The NT group showed no change on post tests. The EMDR group showed a larger reduction in effect size than B/SIT. Based on the data both EMDR and B/SIT reduced test anxiety with EMDR generally outperforming B/SIT. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
Dissertation Abstracts International: Section B: The Sciences and Engineering. 59(1-B), Jul 1998, pp. 0430.
Keywords: Biofeedback/Stress Biofeedback Training Empirical Study Inoculation Training Stress Management Test Anxiety Treatment Outcome/Clinical Trial
Accuracy Verified: Yes
4. Jaberghaderi, N., Dolatabadi, S., & Zand, S. O. (2002, Winter). A comparison of eye movement desensitzation and reprocessing and stress inoculation training (SIT) for sexually abused girls. Advances in Cognitive Science, 3(4), 16-26.
Language: English
Format: Journal
Abstract:
Fourteen sexually abused girls aged 12-13, were randomly assigned to receive either EMDR or SIT. Participants and their parents completed Child Report of Post Traumatic Symptoms (CROPS), and Parent Report of Post Traumatic Symptoms (PROPS), pre and post treatment.
Results indicated that there was significant influence only on the PROPS. But there was a significant impact on both these instrument (CROPS & PROPS), with EMDR. In evaluating CROPS and PROPS, factor analysis with SIT illustrated that, externalizing and internalizing symptoms in PROPS and avoidance thoughts and behaviors in CROPS were treated. Further the results gathered from factor analysis with EMDR, showed that internalizing and somatic symptoms in PROPS and self harm, depression feelings and also somatic symptoms in CROPS improved as well. Clinical findings also suggested that EMDR and SIT did not have any significant differences in treating posttraumatic symptoms. Factor analysis found that, EMDR was more effective than SIT in treating somatic symptoms of sexually abused girls.
Keywords: Iran Sexual Abuse SIT Stress Inocculation Training
Accuracy Verified: Yes
5. Chard, K. M., & Gilman, R. (2005, August). Counseling trauma victims: 4 brief therapies meet the test. Current Psychiatry, 4(8). 50, 55-58, 61-62, 64.
Language: English
Format: Magazine
Abstract:
Therapists once believed trauma survivors required years of treatment, yet we now know that relatively brief cognitive-behavioral interventions can yield long-term gains in psychosocial and psychological function. Many psychiatric patients meet diagnostic criteria for PTSD, including: 33% of women experiencing sexual assault, 30% of male war veterans, and 30% of the 5 million U.S. children exposed to trauma each year. The authors offer recommendations on how to prepare traumatized adults and children for cognitive-behavioral therapy (CBT) and discuss four tested models -- prolonged exposure (PE), cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and stress inoculation training (SIT) -- that psychiatrists may find effective when treating PTSD. [Adapted from Text] [Pilots]
Keywords: Brief Psychotherapy Cognitive Therapy Exposure Therapy Posttraumatic Stress Disorder PTSD Treatment
Accuracy Verified: Yes
6. Peterson, G. (2002). EMDR for women who experience traumatic events. Journal of Clinical Psychiatry, 63(11), 1047-1048. Author reply 1048..
Language: English
Format: Journal
Abstract:
Comments on an article by E. B. Foa and G. P. Street,"Women and Traumatic Events, Journal of Clinical Psychiatry, Vol 62(Suppl 17), 2001. Special issue: Understanding posttraumatic stress disorder, pp. 29-34 regarding psychotherapeutic interventions for women with PTSD. It is noted that Foa and Street describe other psychotherapy procedures, but do not mention eye movement desensitization and reprocessing (EMDR). Peterson cites that in Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies [ISTSS] , 2 psychotherapy treatments for PTSD are listed as having been shown to be effective: exposure therapy and EMDR. SIT is reported to have had 2 well-controlled studies published on the treatment of PTSD. Both SIT studies were with female sexual assault victims. It is concluded that given that EMDR has been established as effective in the ISTSS guidelines, it may be important for the reader to know that this form of therapy may be applied when confronting the issues addressed in this article. A comment by Foa follows. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Keywords: Females Letter Posttraumatic Stress Disorder PTSD Rape
Accuracy Verified: Yes
7. Peterson, G. & Foa, A. (2002, November). EMDR for women who experience traumatic events [4] (multiple letters). Journal of Clinical Psychiatry, 63(11), 1047-1048.
Language: English
Format: Journal
Abstract:
It is noted that Foa and Street describe other psychotherapy procedures, but do not mention eye movement desensitization and reprocessing #EMDR#. Peterson cites that in Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies [ISTSS] , 2 psychotherapy treatments for PTSD are listed as having been shown to be effective: exposure therapy and EMDR. SIT is reported to have had 2 well-controlled studies published on the treatment of PTSD. Both SIT studies were with female sexual assault victims. It is concluded that given that EMDR has been established as effective in the ISTSS guidelines, it may be important for the reader to know that this form of therapy may be applied when confronting the issues addressed in this article. A comment by Foa follows. #PsycINFO Database Record (c) 2010 APA, all rights reserved)
Keywords: Females Letter Posttraumatic Stress Disorder PTSD Rape Reply
Accuracy Verified: Yes
8. Darker-Smith, S. (2007, June). EMDR installation for facilitating emotional identification in the treatment of attachment disorders. Poster presented at the annual meeting of the EMDR Europe Association, Paris, France.
Language: English
Format: Conference
Abstract:
The accessibility of emotions in children with attachment disorders is known to be complex at best. This presentation looks at a new method of enabling a child dissociating from emotions with severs attachment disorder and complex, traumatic histories to access emotions using the installation phase of EMDR.
For teaching purposes, this presentation will use real-life cases of 4 attachment disordered children where EMDR has been used successfully. All the children had been taught safe space (or similar containment methods) to enable them to self regulate their emotions – however, prior to the installation they did not experience emotions to self regulate.
In all four cases, none of the children were able to access emotions and were severe attachment disordered. The children aged between 12 to 13 years of age and all had a diagnosis of attachment disorder, comorbid with post traumatic stress disorder. Most of the children did not experience emotions directly and when asked where they “felt emotions,” would state that they experienced emotion because they were told that they were experiencing emotion.
An example is one child who mentioned that she had been angry – she only knew this, because an adult had told her she was angry. Some4times, her hands were mottled when she was angry – but there appeared to be no internal awareness of emotional feelings. The three other children reported similar lack of awareness of internal emotions.
Using the installation phase of EMDR within the context of a one-to-one therapy session, each child was asked to focused on a particular emotion and focus where in their body they experienced any feelings which may be associated with emotion.
The children began to describe complex emotions, which they had never previously been able to. Many of these children had never cried or expressed emotions “normally” prior to this. An example of one child’s experience follows. “I feel sad in my heart. It feels cold – as if someone has smashed it into a thousand bits. It’s blue and very lonely. It feels empty.” (This was a child who had never experienced any internal emotion since the age of t when he remembered feeling angry at being taken away from his parents by a social worker. This was the last time he remembered every experiencing any kind of emotion).
Following this, all the children were also encourage to sit with their new emotions and not to be afraid of them.
One child reported: “I never knew how god it could feel to finally be allowed to cry and my throat doesn’t feel so stuck no more.”
Another child stated, “It feels good to be sad. When I cry – that stops my heart hurting so much and the treats make the glue to fix my broken heart.”
Another child experienced: “It’s okay to be angry. Anger isn’t scary – it’s just a feeling – just because I feel it doesn’t mean I have to kick off – and it feels strong to e angry – I have a right to be angry and that’s okay.” So far, we have not experienced an unsuccessful outcome; however, this method is still in the early stages of being developed.
Keywords: Attachment Disorders Emotional Identification Poster
Accuracy Verified: Yes
9. Yoeli, F. R. ([2002])). The EMDR Practitioner special reports: Report from the Crete retreat. The EMDR Practitioner. Retrieved from http://www.emdr-practitioner.net on 12/27/2008.
Language: English
Format: Other
Abstract:
Finally, I am able to sit down and tell you a bit about the wonderful learning experience at the
Crete seminar.
Iwill not go into details of the lessons as you all will have the opportunity to attend similar
seminars - of course, not in such a beautiful location as Crete.
Accuracy Verified: Yes
10. Withers, D. (2000, Spring). EMDR therapy in the group setting. EMDR Group Therapy for kids with ADHD, The Children's Group Association Newsletter, 21(1), 4.
Language: English
Format: Newsletter
Abstract:
For kids with ADHD, movement is medicine. They often are asked to sit still and pay attention when their natural impulse is to move. What if they were validated and encouraged to trust this instinct and to use it creatively? [Author]
Keywords: ADHD Attention Deficit Hyperactivity Disorder Children
Accuracy Verified: Yes
11. Shapiro, F. (1999). EMDR: Working with grief. Phoenix, AZ: Zeig Tucker and Co.
Language: English
Format: Video
Abstract:
Sit in on therapy with the masters! This video is part of the innovative "Brief Therapy Inside Out" series - a unique series that puts you directly in the therapy room to watch as leading therapists demonstrate their approaches in 45-minute, unrehearsed clinical sessions with real clients (not actors).
EMDR founder Francine Shapiro has trained over 30,000 clinicians worldwide in her unique approach to the treatment of trauma. Known formally as Eye Movement Desensitization and Reprocessing, EMDR has been used successfully in critical incident work with victims of such tragedies as the Oklahoma City bombing, with both single-incident rape and incest survivors, with survivors of chronic abuse, even with treatment-resistant Vietnam vets.
Here, Shapiro illustrates her eight-phase EMDR protocol with Angie, a recovering addict struggling with the sudden loss of her lover. While the exact neural mechanisms underlying EMDR are still not precisely understood, what is clear is that with skilled use of this potent reprocessing treatment, painful experiences that used to take months or years to treat have been resolved in as few as one to three 90-minute sessions. The videotape provides a singular introduction to this powerful approach as demonstrated by its extremely skilled founder.
The clinical session is preceded by an introductory interview with series hosts Drs. Jon Carlson and Diane Kjos in which Shapiro explains basic principles underlying her approach. The video closes with a Q&A segment in which key interactions from the eight-phase treatment protocol are replayed and discussed. 95 minutes.
Keywords: Grief
Accuracy Verified: Yes
12. Browning, C. (1999). Flotar hacia atrás y flotar hacia delante: Técnicas para ligar el pasado, Presente y futuro [Floatback and Float Forward: Techniques for the Tie Past, Present and Future]. Presentation at EMDRIA Latinoamericana.
Language: Spanish
Format: Conference
Abstract:
El protocolo estándar de EMDR requiere enfocar los orígenes de la perturbación, los gatillos del presente y crear un patrón de conductas adecuadas para el futuro (Shapiro). Algunos pacientes, sin embargo pueden tener dificultades para conectar su problema actual con acontecimientos del pasado. Así también, otros pacientes pueden tener dificultades para crear patrones positivos para el futuro, especialmente si ensayar conductas nuevas los pone ansiosos. Para estos problemas las técnicas de "Flotar hacia atrás" y "Flotar hacia delante" desarrolladas por William Zangwill Ph. D., entrenador del Instituto EMDR, son métodos efectivos para ligar el pasado, presente y futuro en un ámbito terapéutico y proveen al terapeuta de instrumentos para abordar eficientemente ambos temas.
LA TÉCNICA DE FLOTAR HACIA ATRÁS
Abordar recuerdos tempranos asociados con el material perturbador es fundamental para EMDR. Shapiro dice que ayudar al paciente a encontrar un recuerdo temprano "debe ser una de las primeras opciones que debe considerar al terapeuta..." (Shapiro, 1995). La Técnica de Flotar hacia atrás es un camino eficiente y poderoso para llegar a esta meta, permitiendo al terapeuta asistir al paciente a llevar a cabo sus propias asociaciones con acontecimientos del pasado. Su uso es muy apropiado cuando el terapeuta sospecha que una perturbación que el paciente experimenta en el presente, tiene sus raíces en experiencias del pasado; especialmente cuando preguntas como "Cuál es su recuerdo más temprano en relación a lo que se siente ahora? no ha tenido éxito en ayudar al paciente a conectar con eventos del pasado. También cuando un paciente presenta un tema o experiencia recurrente, la Técnica de Flotar hacia Atrás es ideal para ayudar al paciente a identificar un target para el reprocesamiento. Muchos pacientes se ponen en contacto con los problemas actuales con relativa facilidad. Por ejemplo, una paciente que se queja que se siente abandonada cuando su marido se va de viaje de negocios, probablemente pueda recordar sus problemas actuales con facilidad. Entonces el terapeuta puede aplicar la Técnica de Flotar hacia Atrás para ayudarle a la paciente a recordar un acontecimiento del pasado con rapidez y eficiencia.
Para usar la Técnica de Flotar hacia Atrás, arme el protocolo con el problema actual, utilizando los pasos que figuran en el Manual de Entrenamiento del Nivel I y del Nivel II (Shapiro, 1994) incluyendo la imagen, la cognición negativa (CN), la cognición positiva (CP), la validación de la cognición (VoC), emociones, Unidad Subjetiva de Perturbación (SUD) y sensación corporal. Sin embargo, no incide todavía el procesamiento (es decir, movimientos oculares u otra estimulación). En vez de eso, diga a su paciente: "Fíjese en la imagen de... y esas palabras (repita la imagen perturbadora del paciente y su cognición negativa), fíjese que emociones le vienen y donde las siente en el cuerpo. Ahora cierre los ojos y deje que su mente flote hacia atrás a un período anterior en su vida, no busque, simplemente deje que su mente flote a una época donde usted pensaba cosas similares... (repita las emociones que dijo el paciente) en ...(repita los lugares del cuerpo donde el paciente sintió las sensaciones). Cuando esté listo abra los ojos y dígame lo primero que le viene a la mente".
Utilice esta experiencia más temprana como target, completando todos los items del protocolo: imagen, CN, CP, VoC, emociones, SUD y ubicación de las sensaciones corporales y comience a procesar con movimientos oculares u otro estímulo bilateral. Una vez que se ha procesado este material, vuelva al target original del material actual. Muy a menudo se generaliza el trabajo realizado sobre el material más temprano y ya no hace falta procesar el material actual.
Es importante usar términos generales cuando se le dan al paciente las instrucciones de la Técnica de Flotar hacia Atrás, es decir, pedir un recuerdo temprano y no el más temprano. Hay varias razones que avalan esto. Primero, muchas veces es el peor recuerdo y no el primero que funciona como el mejor target para el reprocesamiento,. Además, usar términos generales es una ayuda para los pacientes más compulsivos y perfeccionistas que de otra manera estarían demasiado preocupados en no equivocarse y encontrar exactamente la primera asociación. Finalmente, la flexibilidad que permite la utilización de términos generales más que términos específicos aumenta la posibilidad de éxito del paciente de conectarse con el pasado que es la meta de esta técnica.
El rasgo esencial de la Técnica de Flotar hacia Atrás es usar las preguntas del protocolo para conectar los problemas del presente con eventos del pasado. Pasar las preguntas como fueron desarrolladas por Shapiro es un potente método para ayudar a los pacientes a sintonizar con todos los aspectos de su experiencia del problema. El material perturbador se vuelve más vívido y actual para el paciente y posibilita recordar experiencias similares. Se supone, como hipótesis, que al haber desarrollado el protocolo con todas las preguntas sobre el problema actual, estimula la red neuronal de asociaciones y posibilita casi sin esfuerzo el "flotar hacia atrás" a asociaciones tempranas.
Además, el vínculo paciente-terapeuta es realzado porque el terapeuta valida la experiencia del paciente (la perturbación actual) al empezar el trabajo desde el punto en el que se encuentra el paciente. Las asociaciones son del paciente, eliminando el tema de la resistencia a cualquier idea o interpretación introducida por el terapeuta. El paciente se da cuenta vivencialmente de la conexión del presente con el pasado usando la Técnica de Flotar hacia Atrás, pudiendo esquivar la evitación y otras defensas.
LA TÉCNICA DE FLOTAR HACIA DELANTE
Mientras que la Técnica de Flotar hacia Atrás posibilita muy a menudo que los pacientes vean y sientan la conexión entre el problema actual y los eventos pasados, la Técnica de Flotar hacia delante permite que el paciente identifique y reprocese la ansiedad anticipatoria y desarrolle patrones positivos para el futuro. Es un método que puede ser utilizado en cualquier momento del proceso terapéutico para solucionar bloqueos, renuencias y en algunos casos, resistencias o temas de beneficios secundarios o pérdidas. Es especialmente útil para trabajar con el miedo del paciente a hacer EMDR.
Para ponerlo en práctica, primero pida al paciente que imagine lo peor que le puede pasar si hace "X" (por ej. probar una nueva conducta, testear una nueva habilidad, empezar una experiencia nueva). ¿Qué es lo peor que le puede pasar si hace EMDR? Que es lo peor que le puede pasar si soluciona este problema? ¿Qué es lo peor que le puede pasar si le pone límites a su jefe respecto a la cantidad de trabajo que espera que usted haga? El paciente puede necesitar ayuda para identificar la peor escena. Algunas sugerencias incluyen el miedo a perder el control de sus emociones, el miedo a perder el control de sus funciones corporales como el control de esfínteres, miedo a tener un ataque de pánico, y no poder manejar su vida emocional entre las sesiones.
Una vez que el paciente ha identificado el incidente, pregunte por la peor parte de esa escena y utilícelo como el target de EMDR, armando el protocolo con las preguntas estándar, pero con una leve modificación: pregunte por la imagen que representa la peor parte del peor incidente, por ej. "Cuando usted ve una imagen de si mismo/a haciendo......, que es lo peor que puede pasar?"
Después siga con el resto de las preguntas estándar, es decir, CN, CP, VoC, emociones, SUD, y ubicación de la sensación corporal. Estimule el procesamiento del paciente con movimientos oculares u otro estímulo bilateral.
Si el desarrollo de la peor escena del paciente le provoca un miedo racional, puede que se tengan que tomar medidas prácticas para solucionar estas preocupaciones. Por ejemplo, usando la técnica de flotar hacia delante con un chico de 13 años que estaba en un hogar adoptivo transitorio, la peor escena evocada por él fue: "Me van a devolver al Hogar si esta adopción no resulta". Durante el procesamiento, el SUD se redujo de 8 a 3 con bastante rapidez pero de ahí no bajaba. El paciente comentó que no bajaba porque esta "peor escena" podría sucederle realmente y le había sucedido en el pasado. Paramos los movimientos oculares, charlamos un rato y elaboramos un plan para: a) una sesión con sus padres adoptivos para hablar sobre la permanencia de la adopción y b) una llamada en conferencia a su asesor legal para clarificar sus derechos y opciones. Volviendo al target después de esto, le fue posible reducir el SUD a 1 con unos pocos sets de movimientos oculares.
Al utilizar la Técnica de Flotar hacia delante para reprocesar la peor escena, el paciente tiene una oportunidad para resolver la ansiedad anticipatoria. Durante la instalación de la cognición positiva, el paciente está creando patrones positivos para acciones en el futuro. Una mujer cuyo hermano fue verbalmente abusivo con ella en la infancia y en la actualidad la intimidaba, armó una "peor escena" con: "Va a ser igualmente abusivo cuando lo vea la próxima vez". La paciente había hecho mucho EMDR, reprocesando incidentes de la infancia relacionados con el abuso verbal del hermano. Sin embargo, sin un referente positivo vivencial, seguía ansiosa cada vez que interactuaba con él. Pidiéndole que "flote hacia delante" y usando EMDR sobre una de las peores escenas, alivió su ansiedad respecto a una fiesta familiar que tenía pendiente. Instalando una CP de "Ahora estoy más fuerte" le permitió crear una imagen de si misma manejando a su hermano con humor y sintiéndose segura.
A aplicar las Técnicas de Flotar hacia Atrás y hacia Delante y ocuparse así del pasado, presente y futuro, el terapeuta de EMDR puede sanar mejor a su paciente. Es más, las Técnicas de Flotar hacia Atrás y hacia Delante están basadas en EMDR. Las dos incorporan las preguntas del protocolo standard y le dan al terapeuta y al paciente la oportunidad de manejarse más fluidamente con dicho protocolo.
EMDR standard protocol requires a focus of the origins of the disturbance, the triggers of this and create a pattern of behaviors appropriate to the future (Shapiro). Some patients, however, may have difficulty connecting the current problem with past events. Also, other patients may have difficulty creating positive patterns for the future, especially if you try new behaviors makes them anxious. For these problems the techniques of "float back" and "Float forward" developed by William Zangwill Ph.D., EMDR Institute trainer, are effective methods to link the past, present and future in a therapeutic area and provide the therapist tools to effectively address both issues.
THE ART OF FLOATING BACK
Addressing early memories associated with foreign material is essential to EMDR. Shapiro said that helping the patient to find early memory "must be one of the first options to consider when therapist ..." (Shapiro, 1995). Floating Technique back is a powerful and efficient way to reach this goal, allowing the therapist to assist the patient to carry out their own associations with past events. Its use is most appropriate when the clinician suspects that a disturbance that the patient is experiencing at present, is rooted in past experiences, especially when questions like "What is your earliest memory in relation to what you feel now? Not been successful in helping patients to connect with past events. Also when a patient has a recurrent theme or experience, the Backward Floating Technique is ideal for helping the patient to identify a target for reprocessing. Many patients come into contact with the current problems with relative ease. For example, a patient who complains that she feels abandoned when her husband goes on a business trip, you can probably recall their current problems with ease. Then the therapist can apply the technique Float Backwards to help the patient to remember a past event quickly and efficiently.
To use the technique to back float, arm the protocol to the current problem, using the steps listed in the Training Manual Level I and Level II (Shapiro, 1994) including the image, negative cognition (NC) positive cognition (PC), validation of cognition (VoC), emotions, Subjective Unit of Disturbance (SUD) and bodily sensation. However, it still affects the processing (ie, eye movements or other stimulation). Instead, tell your patient: "Look at the picture ... and those words (repetition of the disturbing image of the patient and negative cognition), note that emotions come from and where you sit on the body. Now close eyes and let your mind float back to an earlier period in your life, look no further, just let your mind float to a time when you thought things like ... (repeat the emotions that said the patient) .. . (repeat parts of the body where the patient felt the sensation). When you are ready open your eyes and tell me the first thing that comes to mind. "
Use this early experience as a target, completing all protocol items: image, CN, CP, VoC, emotions, SUD and location of bodily sensations and begin processing with eye movements or other bilateral stimulation. Once this material has been processed, return to the original target of the current material. Very often we generalize the work done on the earlier material and no longer have to render the current material.
It is important to use general terms when the patient is given instructions Technique Float Backwards, ie a memory request early and not earlier. There are several reasons that support this. First, it is often the worst memory and not the first that works as the best target for reprocessing. In addition, using general terms is an aid for compulsive and perfectionistic patients who otherwise would be too concerned with avoiding failure and find exactly the first association. Finally, the flexibility that allows the use of general rather than specific terms increases the likelihood of success of the patient to connect with the past that is the goal of this technique.
The essential feature of the technique is to use Float Backwards questions of protocol to connect the problems of the present with past events. Skip the questions and were developed by Shapiro is a powerful method to help patients to tune into all aspects of their experience of the problem. The foreign material becomes more vivid and present to the patient and possible recall similar experiences. It is assumed, arguendo, that having developed the protocol with all the questions about the current problem, the neural network encourages and facilitates partnerships almost effortlessly "float back" early associations.
In addition, the patient-therapist relationship is enhanced because the therapist validates the patient's experience (current disruption) to start work from the point where the patient is. Partnerships are the patient, eliminating the issue of resistance to any idea or interpretation introduced by the therapist. The patient realizes experientially connecting the present with the past by using the technique Float Backwards, can avoid the avoidance and other defenses.
THE ART OF FLOATING FORWARD
While technology enables Float Backwards often patients to see and feel the connection between the current problem and past events, the forward float technique allows the patient to identify and reprocess anticipatory anxiety and develop positive patterns the future. It is a method that can be used at any time of the therapeutic process to troubleshoot crashes, reluctance and in some cases, resistance or topics of ancillary benefits or losses. It is especially useful for working with the patient's fear to do EMDR.
To put this into practice, first ask the patient to imagine the worst that can happen if you "X" (eg. Try a new behavior, test a new skill, start a new experience.) What's the worst that can happen if you EMDR? That's the worst that can happen if you solve this problem? What's the worst that can happen if you put your head limits on the amount of work expected to do? The patient may need help to identify the worst scene. Some suggestions include fear of losing control of his emotions, fear of losing control of their bodily functions such as bowel and bladder control, fear of having a panic attack and can not manage their emotional life between sessions.
Once the patient has identified the incident, ask for the worst part of that scene and use it as the target of EMDR, setting up the protocol with the standard questions, but with a slight modification: ask for the image that represents the worst of worst incident, eg. "When you see a picture of him / herself by ......, it's the worst that can happen?"
Then follow with the rest of the standard questions, ie, CN, CP, VoC, emotions, SUD, and location of bodily sensation. Stimulate the processing of patients with eye movements or other bilateral stimulation.
If the development of the patient's worst scene provokes a rational fear, you may have to take practical steps to address these concerns. For example, using the technique of floating forward with a boy of 13 who was in a temporary foster home, the worst scene evoked for him was: "I will return home if this adoption is not." During processing, the LDS was reduced from 8 to 3 fairly quickly but it does not down. The patient said he did not go down because the "worst scene" could really happen and had happened in the past. Eye movements stopped, we chatted a while and developed a plan for: a) a meeting with her adoptive parents to discuss the permanence of the adoption and b) a conference call to his legal adviser to clarify your rights and options. Returning to the target after that, it was possible to reduce the LDS-1 with a few sets of eye movements.
Using Floating Technique forward to reprocess the worst scenario, the patient has an opportunity to resolve the anticipatory anxiety. During the installation of the positive cognition, the patient is creating positive patterns for future action. A woman whose brother was verbally abusive to her children and now intimidated, put together a "worst stage" with: "It will be equally unfair when I see him next time." The patient had done much EMDR reprocessing childhood incidents related to verbal abuse of his brother. However, without a positive reference experiential, still anxious every time I interacted with him. Asking him to "float forward" and using EMDR on one of the worst scenes, relieved her anxiety about a family party that was pending. Installing a CP of "I'm stronger now allowed him to create an image of herself driving her brother with humor and feeling safe.
To apply the techniques to float back and forth and deal well past, present and future, the EMDR therapist can heal your patient better. Moreover, techniques to float back and forth are based on EMDR. Both incorporate the standard protocol questions and give the therapist and the patient the opportunity to be managed more smoothly with this protocol.
Keywords: Floatback Technique Float Foward Technique
Accuracy Verified: Yes
13. Spindler, C. (2007, June). Gentle EMDR: A precursor to standard EMDR protocol. Poster presented at the annual meeting of the EMDR Europe Association, Paris, France.
Language: English
Format: Conference
Abstract:
In the last few years several EMDR clinicians have introduced new approaches which have expanded on EMDR. Two examples are Ricky Greenwald's techniques for 'running a movie' and David Grand's performance enhancement techniques using visualization. GENTLE EMDR is a similar expansion of standard protocol. GENTLE EMDR follows basic EMDR protocol with additional emphasis on the emotions and body sensations connected to the target. Visualilzation is then tuilized to release these emotions and sensations one at a time until the target shows a SUDS of 0. At this point, positive cognitions are installed. The advantage of visualization is that it buffers the emotions with associated with the target, thus reducing abreactions, dissociations and resistance to further EMDR treatment. One advantage of Gentle EMDR is that a client does not need to face the target directly because emotions and body sensations are broken down into management segments. Thus, Gentle EMDR works well with clients who are too fragile to tolerate the standard protocol. One example of the use of visualization would be if the target is "being physically attacked." Clients are first asked what they feel when they think of the attack and where they feel it in their body. Next, clients are asked to visualize a river passing them, while they sit in a protective (safe) place. Finally, clients are asked how the water would appear if it was the identified emotion (such as a particular color) and to let the water flow past until the appearance of the emotional reaction dissipates. Once this is done, clients are asked to name the next emotion that eminates when thinking about the physical attack, allowing the water to 'clear' that emotion as well. When the emotions are approached in this way, the target typically becomes neutralized. The entire process is done using bilateral stimulation. Gentile EMDR is easily taught and has been well received by clinicians at Univerities and Clinical Practices in the United States.
Accuracy Verified: Yes
14. Brivio, R., & Bergamaschi, L. (2008, January). Human and organizational aspects affecting the wellbeing in rescue-working activity: EMDR (Eye movement desensitization and reprocessing), Mirror Neuron and Stress Inoculation: The role of training methods, practice and simulation for psychological risks prevention and management in emergency workers.. International Workshop Reinforce Rescuers' Resilience by Empowering a well-being Demension Workshop, Turin, Italy .
Language: English
Format: Conference
Abstract:
The wellbeing of rescuers: Relational, organizational and technical aspects that can affect rescuers' wellbeing during
rescue activities: Stress inoculation, role playing and the role of mirror neurons in training, also through the use of
video recordings. Relaxation techniques, psychological debriefing and EMDR in trainings.
Focus of our intervention is the wellbeing of the rescuer. The study and research
on this matter came and were carried out thanks to the activity done both during
trainings and simulations of the Civil Protection than real emergencies.
Our team work received contribution by some psychologists of OPP (Parma’s
Psychologists’ Observatory: A.Sozzi, E.Pedrelli, F.Frati, A. Bocelli, T. Serra). Wellbeing, defined as a subjective and positive emotional state together with a
global life satisfaction (Diener, 1984), is strongly at risk during rescuer’s
emergency activities and can affect the rescuer both physically and
psychologically. The rescuer's capabilities, that we think are technical “know how” and thorough
knowledge, are essential to give the best performance according to the complexity
and urgency of the intervention. These skills can really contribute to the rescuer's
wellbeing, because they can improve the self-efficiency perception.
To effectively manage and train rescuers, it is furthermore important to consider
and acknowledge the influence of interpersonal relationships on technical
performances. It is, in fact, particularly important to recognize and support the
typical relationships that can be created in a team with the same task and
specialization, as well as in multidisciplinary teams, or teams belonging to
different Institutions but operating in the same scenario.
In recent years increasing attention has been given to training activities, even through the use of the role play for interventions in artificial emergency
scenarios. To recreate scenarios of massive emergencies, different Civil Protection
Associations, as well as First Aid volunteer associations and the local
Institutions have been involved. In these simulations, most cases focus on improving technical performances.
Lately psychologists have been asked to join the rescuers team.
During these simulations, the role-play of emotional and psychological problems
occurs thanks to the cooperation between emergency psychologists and the
medical team. The introduction of the role and expertise of psychologists allowed to extend and
strengthen the attention to cross support and care aspects for the psychological
wellbeing of both victims and rescuers.
The psychologist must therefore consider the “wellbeing” in all the emergency
scenarios and contexts, as a sum of all the components that we talked about here
and the ones we will describe during our intervention.
He must first of all be aware of the complexity of each intervention in the field,
and adopt a kind of approach aimed at creating and recovering wellbeing
strategies, that can be used by himself as well.
Strategies on how to build, recover and maintain the wellbeing identify stress as
the first danger source the rescuer has to face in his training and emergency
activity.
When external events or stimuli are perceived as difficult to face compared with
resources available at that moment, the individual gets stressed.
When the person's efforts are not adaptive to the external requests and/or
coherent with his performance expectations, he becomes vulnerable to emotional,
behavioural, cognitive and physical reactions, which can be even very difficult to
manage both in the short and/or in the medium-long term.
This can happen when the sources of stress depend on the rescuer’s
performance, and it can also happen in case of post traumatic stress, visible in
different stages after the event.
From the psychologist's specialist background and from the integration of this
with the result of field experiences, the demand for a range of different tools to
manage the different kinds of stress emerges, and these tools must be applicable
both to the individual and to the group.
This range is still improving, and the results of our observational activity from
past and present experiences lead us to see the opportunity to carry on our
research of tools of efficacy.
During this speech we would like to underline that approaches like Stress
Inoculation Training (SIT, Michenbaum, 1983) and the use of role playing allow
the technical appraisal and let the rescuers improve their stress management
skills, and all that can lead to a decrease in the risk of PTSD.
In past simulations of emergencies, we found out that the use of videotapes for
the role plays is a tool that should be taken more into account. We think it is
important to evaluate its potential for the rescuers' benefit, because it seems to
be not only “a record of technical performances”, but also an observation and
learning tool about the rescuer's own defence and adaptive strategies.
In fact, during these simulations we found out that the rescuers' psychological
and emotional vulnerability emerged in several situations. The fact that even in these artificial situations there were acute stress episodes and O codes urged us
to focus more on the matter of mutual influence between technical performance
and internal experience of stress.
We understand that such acute stress episodes may occur during real life critical
events but we can see how role playing and video recordings show that such
acute stress episodes affected the simulators themselves even during the
simulation. The videos show that even apparently “high immunity” simulators,
who are considered 'immune' thanks to their comprehensive and strong
experience, experienced acute stress, perhaps because of an incorrect selfevaluation
of their own stress management skills.
The interest in the use of videos as a training and reprocessing tool for rescuers
led some of us to specialize in role playing recording, so as to carry out a more
accurate and comprehensive study on those same videos and use them as a
mirror of reality and better educational tool through a vicar experience or through
“seeing oneself from within the experience” and in the interpersonal dynamics
that took place in the scenario.
Videotapes are a very known and widely used tool in other kinds of trainings,
disciplines and therapies (i.e. Family Therapy and CBT).
The discovery of mirror neurons by Rizzolati, Gallese et Al., provides the evidence
that when someone observes the same action performed by another person, the
neurons "mirrors" the behaviour of that person, as though the observer were itself
acting. Thanks to these researchers it is now proven that this can happen
thanks to the motor neurons in the pre-motor cortex.
Therefore, we would like to underline the role of videos as very useful and
versatile training tools, since they expose a situation in an unexpected realistic
manner “as if” it were true and “as if” we were really experiencing that situation,
with the consequent learning movements at the emotional, cognitive and
behavioural level, at the stress management level, as well as at the level of team
work dynamics.
Visual imagination activates the same brain regions that are active during visual
perception and motor imagination activates the same brain regions activated the
movement is really happening.
More importantly, it was possible for us to verify that the videos recorded by other
operators were not focused on showing the important psychological aspects we
mentioned for the goal of the trainings, thing that happened instead with the
videos recorded by psychologists. We think therefore that the use of videotapes
recorded by psychologists should be given more consideration in the trainings of
rescuers. During this intervention we will devote part of the time to broadcasting
two short videos; the first one shows the role playing of an intervention in an
emergency context, and the second one shows a part of an EMDR session (Eye
Movement Desensitization Reprocessing). We think it is important to recreate and
protect rescuers wellbeing in the post-role playing and post emergency stages
too. For years EMDR has been proven effective in improving the individual's
coping skills and in reprocessing, wherever necessary, the post traumatic
aspects resulting from critical events to whom not only the victims, but also the rescuers too, are exposed during emergencies.
Keywords: Emergency Workers Mirror Neuron and Stress Inoculation Rescue-Working Activity Risk Prevention and Management
Accuracy Verified: Yes
15. Darker-Smith, S. (2008, June). Integrating emotion for attached-disordered and dissociated children. Presentation at the annual meeting of the EMDR Europe Association, London, England .
Language: English
Format: Conference
Abstract:
The accessibility of emotions in children with attachment disorders is known to be complex at best. This
presentation looks at a new method of enabling children disassociating from emotions with severe attachment
disorder and complex, traumatic histories to access emotions using the installation phase of EMDR. For teaching
purposes, this presentation will use real-life cases of 4 attachment disordered children where none of the
children were able to access emotions and were attachment disordered. The children were aged between 12 to
13 years of age and all had a diagnosis of attachment disorder, co-morbid with post traumatic stress disorder.
Most of the children did not experience emotions directly. Using the installation phase of EMDR within the context of a one-to-one therapy session, each child was asked to focus on a particular emotion and focus on
where in their body they experienced any feelings, which may be associated to that emotion. The children began
to describe complex emotions, which they had never previously expressed, prior to this. An example of one
child�s experience follows: �I feel sad in my heart. It feels cold � as if someone has smashed it into a thousand
bits��. Following on this, all the children were also encouraged to sit with their new emotions and not to be
afraid of them. One child stated: �It feels good to be sad. When I cry � that stops my heart hurting so much and
the tears make the glue to fix my broken heart.� So far, we have not experienced an unsuccessful outcome;
however, this method is still in the early stages of being developed.
Keywords: Attachment Disorders Dissociation Children
Accuracy Verified: Yes
16. Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010, August). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635-641. doi:10.1016/j.cpr.2010.04.007.
Language: English
Format: Journal
Abstract:
Two decades of research demonstrate the efficacy of exposure therapy for posttraumatic stress disorder (PTSD). The efficacy of prolonged exposure (PE), a specific exposure therapy program for PTSD that has been disseminated throughout the world, has been established in many controlled studies using different trauma populations. However, a meta-analysis of the effectiveness of PE for PTSD has not been conducted to date. The purpose of the current paper is to estimate the overall efficacy of PE for PTSD relative to adequate controls. We included all published randomized controlled trials of PE vs. control (wait-list or psychological placebo) for the treatment of PTSD in adolescents or adults. Treatments were classified as PE if they included multiple sessions of imaginal and in vivo exposure and were based on the manualized treatment developed by Foa, Rothbaum, Riggs, and Murdock (1991). Thirteen studies with a total sample size of 675 participants met the final inclusion criteria. The primary analyses showed a large effect for PE versus control on both primary (Hedges's g = 1.08) and secondary (Hedges's g = 0.77) outcome measures. Analyses also revealed medium to large effect sizes for PE at follow-up, both for primary (Hedges's g = 0.68) and secondary (Hedges's g = 0.41) outcome measures. There was no significant difference between PE and other active treatments (CPT, EMDR, CT, and SIT). Effect sizes were not moderated by time since trauma, publication year, dose, study quality, or type of trauma. The average PE-treated patient fared better than 86% of patients in control conditions at post-treatment on PTSD measures. PE is a highly effective treatment for PTSD, resulting in substantial treatment gains that are maintained over time.
Keywords: CBT Cognitive Behavioral Therapy PE Prolonged Exposure Exposure Meta-Analysis Review Posttraumatic Stress Disorder PTSD
Accuracy Verified: Yes
17. Crnobaric, C. O., Milovanovic, S., & Simic, S. (2002 ). Psihoterapija post-traumatskog stresnog poremećaja [Psychotherapy of post traumatic stress disorders]. Engrami - časopis za kliničku psihijatriju, psihologiju i granične discipline, 24(3-4), 123-133.
Language: Croatian
Format: Journal
Abstract:
Tokom prethodne dve decenije dolazi do novih podataka u vezi efikasnosti psihoterapijskih tehnika u tretmani posttraumatskog stresnog poremećaja. Najveći broj ispitivanja na ovu temu se bavi kognitivno bihejvioralnim tehnikama kao i metodom desenzitizacije i reprocesiranja pokretima očiju, dok je manji broj psihodinamskih i psihoanalitičkih ispitivanja. Aktuelne studije se razlikuju po metodologiji (nedostatak kontrolne grupe, nejasno definisanje simptomatologije i nepouzdani dijagnostički instrumenti, mali uzorak, itd). U radu se diskutuje o kompleksnosti kako pristupa tako i primena terapijskih tehnika.
The past two decades have produced increased knowledge about the efficacy of psychological treatment for post-traumatic stress disorder (PTSD). The majority of existing studies examined the usefulness of cognitive-behavioural treatments and eye-movement desensitization and reprocessing, whereas the efficacy of psychodynamic treatments has been the object of only few studies. Existing studies vary considerably in methodology and often are present with methodological limitations (e.g. lack of control group, of clear description of the participants' symptoms, and reliable diagnostic instruments, use of mixture of therapeutic approaches, small sample size, etc) that preclude definitive conclusions. Benefits from cognitive and behavior therapies have been reported in many studies, but methodological shortcomings in some of these studies pose problems in drawing conclusions. Treatments such as SIT EMDR and CBT have several therapeutic components, and it is difficult to tell which elements led to improvement and which are redundant. Another matter of concern is the ease of dissemination of treatment among nonexpert clinicians. Some treatments (psychodynamic psychotherapy, cognitive therapy and SIT) are relatively complex, as they comprise multiple components. Other treatments (exposure) may be less complex and more easily accessible to clinicians outsized of specialized settings. Such treatments may be more useful both in routine clinical practice and in emergency situations where larger number of trauma-survivors require help (e.g. in the aftermath of natural disaster or in war torn countries).[Author abstract]
Keywords: Posttraumatic Stress Disorder Psychotherapy PTSD
Accuracy Verified: Yes
18. Goldberg, A. (2010, October). Relational affect regulation: An integrative protocol for complex trauma surviviors. Presentation at the 27th Annual Meeting of the International Society for the Study of Trauma and Dissociation, Atlanta, GA.
Language: English
Format: Conference
Abstract:
Attachment theory and interpersonal neurobiology
demonstrate the importance of the therapeutic relationship as a primary change mechanism. With survivors of childhood relational trauma, betrayal of trust and attachment
issues create obstacles to developing a secure therapeutic alliance. Even when the therapeutic relationship feels more secure, these clients often experience separation between
sessions as attachment loss. This can feel burdensome to the therapist, who may receive multiple crisis phone calls throughout the week. In this presentation, the relational affect regulation protocol will be explained and case
examples will illustrate how it is put into practice. Drawing upon concepts from Stress Inoculation Training (SIT), Accelerated Experiential Dynamic Psychotherapy (AEDP)
and Eye Movement Desensitization and Reprocessing
(EMDR), the protocol helps facilitate dyadic affect regulation and object constancy during the stabilization phase of treatment with complex trauma survivors. The elements of an SIT script will be described and creative
adaptations will be proposed. AEDP microprocessing of the client’s experience of the therapist reading the script to the client will be explained and illustrated. The EMDR
procedure for installation of the therapist as a resource will be taught and strategies for utilizing this as a selfsoothing method between sessions will be delineated.
Participants will be able to:
discuss two problems clients ♦♦ with Complex PTSD
have with attachment and fear of attachment
loss in therapy, and will be able to identify
three strategies to address this issue.
♦♦ explain AEDP microprocessing of interactions
between client and therapist, and how this
technique can help survivors of childhood relational trauma to develop trust in the therapist.
♦♦ list the four essential elements of an SIT script and utilize the steps involved in the relational affect regulation protocol with their clients.
Keywords: Complex Trauma Relational Affect Regulation
Accuracy Verified: Yes
19. Forrest, M. S. (1995, June). Self-soothing and the multiple trauma survivor. Presentation at the EMDR Network Conference, Santa Monica, CA.
Language: English
Format: Conference
Abstract:
Remember the joke about the doctor who says, "The operation was a success, but the patient died"? That's how some clients feel
about EMDR. They succeed in accessing deep and important material, but find themselves extremely depressed and/or anxious in
the days afterward. For these clients, who are often survivors of multiple trauma such as long-tenn child abuse or incest, the ability
to self-soothe (both during and after an EMDR session) makes the difference between whether they regard EMDR as a useful tool or
a necessary evil.
To find out what self-control techniques work best for such clients, I interviewed EMDR clients (all women) who had experienced
long-term sexual abuse in childhood.
The first thing I learned was that for survivors of multiple trauma, the ability to feel safe starts long before EMDR is ever used.
Many women cited their relationship with their therapist as the foundation of their feeling safe with EMDR: "I trust my therapist
absolutely." One client's therapist told her he had used EMDR himself: "That made a huge difference to me," she said.
Other advance work included planning and taking preventative measures. Planning means picking the right time (and pace) for
doing EMDR: being sure the therapist and/or other support people will be available in the days after the session; not driving or
going back to work afterward (if possible); being able to have plenty of alone time; and going slowly, doing EMDR in small
increments. "I didn't expect myself to go out in the world and be social afterward. I was pretty raw for a few days, sometimes for a
whole week," B. told me.
Planning also means taking preventive measures, such as teaching the client how to find "a safe place." Most clinicians know the
importance of this, but one of the women I interviewed was emphatic that creating a safe place was very different from being able to
go to it when she was in a session and reliving the experience of being a three-year-old overwhelmed by extreme grief or terror. She
said she needed a lot of practice accessing her safe place and some special interventions (see below) to get through the intense times.
Being able to self-soothe between sets of eye movements was very difficult for most clients. "I cry all the time we do it," S. told me.
"I have to sit near the door and not have my therapist sit too close," said M. Another woman said, "We do the eye movements for a
few seconds and we talk in between."One successful intervention, especially for clients overwhelmed by the intensity of their
feelings, involved the therapist asking his client to listen to the sound of his breathing and to breathe along with him. Another
clinician has his client when she gets extremely upset ask her "inner guide or "higher power" whether it's "okay to continue;" a third
asks, "Is there more underneath or is it time to wind down?" Letting the client control the pace and progress of his/her own
processing can be an important way to teach self-trust -- especially to people for whom loss of power was endemic to their abuse.
Some clients are able to repeat special phrases or afirmations over and over between sets to calm themselves. L., a ritual abuse
survivor, said she grounds herself by silently reciting a mindfulness verse from Zen master Thich Naht Hanh in time with her inbreath
and out-breath: "In, out. Deep, slow, Calm, ease. Smile, release. In, out. Deep, slow ......
Different kinds of self-soothing techniques work best after the eye-movement sets are completed.
Immediately afterwards, while still in session, one client said she falls asleep for a few minutes -- she finds this a big help in
countering the dissociated state in which she typically concludes an EMDR session. Another said she and her therapist share a cup
of tea and talk over what happened as a way to "come down" and normalize the experience.
Some clinicians close a session by doing eye movements to reinforce the client's safe place. One woman said her therapist has her
"cement the present in place" by doing eye movements on either a present-day image, an image of her inner child in the safe place, or
a positive statement.
Francine Shapiro has often said that what happens after the EMDR session can be as important as what happens during it. The
women I interviewed felt exactly the same way. They had learned the necessity of talung exquisitely good care of themselves in the
hours and days that follow. "I take time-and time out," declared B., who often has a delayed fear reaction following EMDR.
Most clients said they go home and either curl up in bed or in a favorite rocking chair with their stuffed animals. They cry, sleep,
write in their journals, draw pictures, listen to music, look at favorite photographs, and/or call a support person. M. uses self-talk to
ease her feelings: "I say to myself, 'You know that knot of fear. I know it's only fear. I know that nothing is going to hurt me right
now'." For others, going home immediately is not the best option: D. takes a walk along the shores of Long Island Sound; C., the
mother of three young children, finds solace in a favorite bookstore.
Sometimes all the planning in the world doesn't help: the abreaction seems to launch the client back to the age she was when she
was abused - and she simply can't remember how to calm herself. To counter this, several clients said they carry a list of things
they can do to quiet themselves. S. finds reading mystery stories comforting("At the end you always find out what really happened."), but has to keep two of them on her bedside table at all times: "If they're not in full view, I forget about using them."
One interesting example of "assigned" self-soothing was given by a ritual abuse survivor who was new to EMDR. After a session
when a lot of memories came up about how her sexuality was used and degraded during the abuse, her therapist gave her very
specific instructions on how to care for herself, including buying a romantic nightgown and soaking in bath salts for 45 minutes;
listening to romantic music; and not touching or kissing her partner for 48 hours. "It worked out great!" she told me happily. "I felt
SO pretty and so safe."
The conclusion I reached about how multiple-trauma survivors learn to self-soothe in the face of the intense feelings EMDR can
trigger is not revolutionary. The recipe is: Step 1. Plan for the worst. Step 2. Let the client select the self-soothing techniques that
specifically fit for her or him. Step 3. Make sure s/he is able to use these techniques no matter how intense his/her emotions are.
Sometimes this will call for the therapist to take an active role by either leading the client in specific calming techniques or by
assigning very clear-cut homework.
If the recipe calls for planning and practicing, then the pot in which the ingredients are cooked is labeled "TRUST"-trust before
initiating EMDR, trust during the eye movements, and trust after the sets are completed. Unless the client deeply trusts the
clinician, the method itself, and his or her own capacity to go into the feelings and me out safely, the recipe for success with
EMDR can turn into a recipe for disaster.
Accuracy Verified: Yes