emdr: eye movement desensitization response valerie bryant, phd [email protected]

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EMDR: Eye Movement Desensitization Response Valerie Bryant, Valerie Bryant, PhD PhD [email protected] [email protected]

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EMDR: Eye Movement Desensitization Response

Valerie Bryant, PhDValerie Bryant, [email protected] [email protected]

EMDR

• Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is based on an information processing system designed to resolve symptoms resulting from disturbing life experience.

• It is a structured approach addressing past, present, and future aspects of disturbing memories.

EMDR• Short & long term treatment

• For children and adults

Addresses cognitive, emotional and physiological memories.

Procedures are structured and follows sequential and step by step protocols.

Resourcing

• Empirically-tested for PTSD but also used for other anxiety disorders such as performance anxiety, panic attacks, stage fright, complex PTSD

• Problem is identified by client

Frontal Lobe • In humans, the frontal lobe reaches

full maturity around age 25 marking cognitive maturity.

• The frontal lobe contains most of the dopramine-sensitive neurons, which are associated with reward, attention, long-term memory, planning and drive.

• A reduction of dopramine in the prefrontal cortex is related to poorer performance & inefficient functioning of working memories and slight increased risk for schizophrenia.

• The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control, and social and sexual behavior.

• Frontal area is the most common region of injury following mild to moderate traumatic brain injury (Levin et al., 1987).

Left Brain  Right BrainCognitive EmotionsLogical IntuitiveObjective SubjectiveRational RandomAnalytic Holistic Language Non-verbal SynthesizingLooks at parts Looks at wholes

TRAUMA MEMORY

• In trauma, information is processed and stored differently in the brain. – Encoded, processed, stored and retrieved

differently – Trauma memory is timeless and immutable

vs. narrative memory – Reactivated by trigger stimuli vs. narrative

memory upon intent – Activation of one element evokes all other

elements automatically

What is Post-Traumatic Stress Disorder? 309.81

PTSD is an anxiety disorder that can develop in some people after witnessing, participating or being exposed to a terrifying event or ordeal in which grave physical harm occurred or a threat has occurred.

Numbing, avoidance, intrusive flashbacks, physiologic hyperarousal Other variables: age, gender, natural resilience, nature & number of

trauma events

COMPLEX PTSD

• Classic PTSD including triad of:

a. Dissociation & Reenactments

b. Somatization c. Affect Dysregulation

shown by difficulty modulating anger, chronic self-destructive & suicidal behaviors, difficulty moderating sexual involvement, impulsive risk-taking behaviors & emergence of pathological self-care behaviors.

CLIENT HISTORY • Risks: History of dissociation, eye problems, inability to

tolerate stress during between sessions, medical problems (heart problems, high-risk pregnancy); poor therapist relationship, seizures, self-injurious behaviors, alcohol or substance abuse, severe life stressors.

• Strengths

• History of trauma

• Maladaptive Coping Styles

• Cognitive Schemas

Therapy Process Client will focus simultaneously on the image, the negative cognition, and the disturbing emotion or body sensation.

• BLS

• After a set of eye movements, the client is asked to report briefly on what has come up; this may be a thought, a feeling, a physical sensation, an image, a memory, or a change in any one of the above.

• Initially, a therapist asks to focus on this image, thought, and begins a new set of eye movements.

• From time to time a therapist may ask the client about her or his SUDS. The desensitization phase ends when SUDS reaches 0 or 1.

PREPARATION

• Therapeutic alliance

• Education about trauma—triggers hard-wired by old & new experience :smell, taste, sound, place

• Affect Tolerance: safe place, light stream, mindfulness, yoga…

• Informed Consent

PROTOCOL

• Picture (IMAGE) What is the worst part of that incident now?

• N/C-• P/C• VOC-as you bring up that

picture, how true does it feel to you now (1-7 is completely true)

• Emotions • SUDS• Location of Body

Sensations

RESOURCE INSTALLATION• Imagine the kind of person or quality that would help you

to respond differently.• What resources might others need to get through a

distressful situation? • When you think about what it means to have this

resource, what comes to mind?• What would it be like imagining that resource already in

your body?• And if you felt more??, What would follow from that?• As you imagine being able to feel….do….notice where

you experience it in your body? Notice your thinking.. • 4-12 sets• Psycho-educational: Apply resources for mildly daily

challenging events, anniversaries, anticipating anxious situations, use daily to reinforce…

Performance Enhancement

• The first step in performance enhancement is to define your goals, and any limit or ceiling you are encountering. What are your strengths?

• Where do you want to be, when?

• What factors are slowing you in reaching your goals or what could speed your success?

SAFE PLACE

• Before beginning EMDR for the first time, it is recommended that a person identifies a safe calming place, an image or memory that elicits comfortable feelings and a positive sense of self.

• Safe place applied later bringing closure to an incomplete session or to help a client tolerate an upsetting session.