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

History EMDR - 1987 Francine’s walk in the park Current status – Evidence based treatment for trauma 3-6 sessions for single episode PTSD More 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 studies EMDR 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 studies Comparing 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 Model Present 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 phases History Preparation Assessment Desensitization Installation Body Scan Closure Re-evaluation

EMDR Three Prongs Past Present Future

Development of EMDR/EAP model 1990 Secret Service - peer support team training 1990 FBI - peer support team training Post Critical Incident Seminar 1995 Oklahoma City, US Attorneys Office September 11, 2001 New York City, US Department of Justice 2004 Department of State, Diplomatic Security 2010 US Senate EAP

Goals of EAP Model Enhances: the assessment, referral and treatment process, motivates clients towards treatment EAP’s ability to address short-term issues in-house, rates of client satisfaction and successful outcomes.

EMDR as assessment If 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 Model Initial EAP assessment to select appropriate clients Preparation EMDR utilization Follow-up/referral

Model – Selection of clients Appropriate 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 - Preparation Explanation of EMDR Discussion how it may help to improve current situation Reading material

Model: Preparation Assessment by Roger Initial discussion of goal(s) of session Safe/calm place or resource installation, or other stabilization methods, if appropriate Agreement for referral for follow-up, if needed

EMDR utilization Work stress issues Current crises Recent trauma Grief and loss issues Past distressing events that are currently being triggered

EMDR utilization Stabilization - safe/calm place and resource installation Distressing memories linked to present problem Present triggers Future template

Model: Follow-up and referral Quick follow-up (e.g. later the same day, next day) Ongoing follow-up as appropriate Referral for follow-up treatment as appropriate Ongoing support/further sessions as appropriate (can work with client’s current therapist)

Safe Place Positive image of place with safety/calm Close your eyes - notice feelings, sensations 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 eyes 5) 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 stimulation Once you have the safe or calm place, add bilateral stimulation - tapping with hands on thighs - butterfly hug Bring 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 stimulation If positive repeat several times If negative, stop, and use safe place without bilateral stimulation, or slow breathing to calm