Eye Movement Desensitization and Reprocessing Therapy

Eye Movement Desensitization and Reprocessing Therapy

 

Eye Movement Desensitization and Reprocessing Therapy

Eye Movement Desensitization and Reprocessing (EMDR) therapy has surfaced in the past two decades as one of the most innovative and effective psychotherapy interventions to treat disorders of adverse life experiences and trauma. Eye movement desensitization (EMD) was established in the late 1980s as a behavioral approach to treating PTSD. EMDR developed since clients experienced more than desensitization, and dysfunctional memories were being reprocessed (Wheeler, 2022). The purpose of this discussion is to describe EMDR therapy, evidence-based research, mechanism of action, stabilization, and processing.

EMDR

EMDR was developed purposely to process adverse life experiences and traumatic events with the purpose of the integration of the neural network. It can be independently used as a psychotherapy intervention or incorporated into other psychotherapy approaches as an adjunct to therapy (Wheeler, 2022). EMDR therapy is an integrative eight-phase psychotherapy founded on a comprehensive three-pronged strategy that comprises earlier life experience, current stressors, and desired future thoughts and actions. In EMDR, the therapist guides the client in processing cognitive, affective, and somatic material using procedures and protocols involving bilateral stimulation (BLS).

Evidence-Based Research

Various clinical trials have demonstrated the effectiveness of EMDR therapy in treating PTSD. Other studies support EMDR use in other mental disorders such as major depression, substance use, bipolar disorder, psychosis, anxiety disorders, and pain. EMDR therapy is incorporated in various practice guidelines on the treatment and processing of trauma. Researchers and healthcare professionals have researched and developed EMDR protocols for a wide range of diagnoses and disorders such as anxiety disorders, combat trauma, depression, medical trauma, unresolved grief, dissociative disorders, eating disorders, chemical dependency, and somatic problems (Rudiger Bohm, 2019). Similar to Trauma-focused CBT, EMDR therapy seeks to alleviate subjective distress and reinforce adaptive beliefs associated with the traumatic event (Marsden et al., 2018). However, EMDR does not include comprehensive descriptions of the event, first-hand challenging of beliefs, prolonged exposure, and homework. Research shows that EMDR takes less time, has a long-lasting treatment impact, and has lower drop-out rates than Trauma-focused CBT.

Mechanism of Action

The MOA of EMDR is unclear. However, five hypotheses have been developed to explain the MOA. The first hypothesis proposes that the double attention stimulation needed during EMDR promotes connection in the brain’s hemispheres and kick-starts the natural information processing system. The second hypothesis proposes that EMDR works by accessing adaptive information and integrating memory networks (Wheeler, 2022). Another hypothesis suggests that the BLS that constitutes the EMDR protocol fosters double attention to internal and external stimulation. In addition, the working memory hypothesis proposes that the double attention in EMDR requires individuals to split their attention between the BLS and an aversive memory so that the latter becomes reconsolidated and emotionally salient to a lesser degree (Wheeler, 2022). The most recent hypothesis explains EMDR MOA based on the default mode network and cerebellum activation. It focuses on the role of the cerebellum in memory reconsolidation, associative learning, and event-timing.

Stabilization

Stabilization and resourcing the client are fundamental to EMDR, particularly in the preparation phase. Client collaboration and empowerment are fundamental to all phases in the EMDR protocol. It is essential to explain to the client that current symptoms may be propelled by past experiences, how the current situation acts as a trigger for the past experiences, and how EMDR therapy can help (Rudiger Bohm, 2019). The three main types of resources used in stabilization include: Mastery resources such as patient’s memories of past coping; Relational resources like memories of positive role models; Symbolic resources from nature, religion, dreams, music, and future positive images. EMDR has particular protocols for stabilization which combine safe place, imagery, therapeutic interweaves, and containment exercises with BLS (Wheeler, 2022). Signs of stabilization include the lack of current life crisis, accepting the diagnosis, the ability to set and adhere to boundaries, identifying triggers, soothing oneself and reaching out to supportive persons, and communicating honestly with the therapist. With regard to mood stability, the client can have a depressed mood but is not labile.

Processing

Processing involves accessing all dimensions of memory, including behaviors, sensations, affect, cognition, and beliefs related to the experience. Processing fosters neural integration and connection of dysregulated memory fragments, eliminating blocks to information and energy flow. Processing in EMDR therapy accesses dysfunctionally stored embedded memories, which occurs in the condition of a safe therapeutic relationship with adequate resources (Wheeler, 2022). Signs that the client is processing during EMDR include changes in sensations, facial expression, and body movements; changes in feelings; sighing; cognition changes; memory becoming more distant or clearer; and changes in the incident of the event.

Conclusion

EMDR is a comprehensive psychotherapy intervention used in managing various disorders. They include depression, phobias, anxiety, trauma-related disorders, pain, addictions, behavioral and personality disorders, and relationship and sexual problems caused by adverse life experiences. Even though EMDR therapy has aspects of many psychotherapy approaches, the BLS and the unique elements of the EMDR protocol are vital factors for the efficacy of the psychotherapy approach.

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Reference

Marsden, Z., Lovell, K., Blore, D., Ali, S., & Delgadillo, J. (2018). A randomized controlled trial comparing EMDR and CBT for obsessive– compulsive disorder. Clinical Psychology & Psychotherapy, 25(1), e10–e18. doi:10.1002/cpp.2120

Rudiger Bohm, K. (2019). EMDR’s efficacy for obsessive compulsive disorder. Journal of EMDR Practice and Research, 13(4), 333–336. doi:10.1891/1933-3196.13.4.333

Wheeler, K. (2022). Psychotherapy for the advanced practice psychiatric nurse (3rd ed.). Springer Publishing Company.

 

DISCUSSION BOARD FACILITATION RUBRIC

 

1. 1. You should develop questions designed to stimulate discussion among your classmates and post them along with a case study (if you wish) at the beginning of the discussion module.  If there is a video showcasing particular technique, please post it or contact me with the information so that I can post it. I find that some folks are better visual and auditory learners, so this may help solidify the technique for them. You may also post supporting documents/research.

1. Questions stimulate beginning discussions – 10 points
2. Use of supporting documents/videos – 10 points

 

1. 1. You are responsible for facilitating ongoing discussion throughout the week and posting pertinent articles.  An unfolding case study may be one way of encouraging discussion. In this you give only part of the information on the first post, and halfway through the module give more. (20%)

1. Consistently facilitating ongoing discussions during the module – 5 points
2. Evidence that all group members are participating the facilitation – 5 points

 

 

1. 1. Post treatment and implementation of a specific psychotherapeutic approach and/or concern.  List the strengths and weaknesses of this particular strategy or issues that should be kept in mind.  also list any evidence-based practice guidelines or support for the technique. Failure to address these areas will result in a loss of points.

1. Treatment/implementation of the approach and any specific concerns – 10 points
2. Evidence based/informed guidelines addressed – 10 points

• Strengths and weaknesses of the approach identified – 10 points

 

1. 1. Due one week after your facilitation you are required to post a document summarizing the discussion from the week including a brief overview of the weeks discussion.  APA format should be utilized with the citation of references. This should be a true summarization of the discussions and not a cut-and-paste. Failure to do this results in an automatic grade of 70 or below.

1. Summarization of the technique and key words associated with the therapy – 15 points
2. Brief overview of the discussions (not cut and paste) – 10 points

• Summary posted in a timely manner and if the facilitation is a group, you MUST list what each group member was responsible for 5 points (note that submissions beyond two weeks late will be subjected to an additional 5 point deduction for each week they are late).

 

1. 1. Everyone should be aware of spelling and grammar on all postings.  As advanced practice professionals you should always be aware of your presentation of material. (This also applies to emails and text – it is compelling to use common text abbreviations, but when you have communications that are professional in nature, you should refrain from using those abbreviations.) Also, you should indicate when you are posting your opinion vs information from a source with appropriately utilized APA reference citations.  Where possible opinions and information should be backed up with evidence-based practice guidelines. (10%)

1. APA references are in the correct order (Moodle will not let you do the indentations) – 5 points
2. Spelling and grammar by all facilitators is professional and appropriate – 5 points.