Eye movement desensitization and reprocessing (EMDR) in PTSD

Eye movement desensitization and reprocessing (EMDR) is a treatment procedure which is widely accepted and used in clinical settings. Shapiro has developed this procedure as an effective technique for alleviating post-traumatic stress disorder (PTSD)

• also used in a wide variety of situations like phobias, test anxiety, dermatological disorders and pain management
  
  
• Shapiro constructed this therapy in a very structured way and she has explained different phases for EMDR, which helps the therapists to move through this therapy in a very systematic manner. Different phases of the therapy are explained below:
  
  
  • first phase of EMDR is the client history and treatment planning
    • a detailed history helps the clinician to identify the client's readiness and identify any secondary gains that maintain his/her current problem. By analyzing the dysfunctional behaviors, symptoms and specific characteristics, the clinician decides the suitable target for treatment. The targets which were focused to be the basis for client's pathology are prioritized for sequential processing
      
      
  • second phase is called preparation in which the therapist and client make a therapeutic relationship
    • therapist helps to set a reasonable level of expectations
      • he/she trains the person certain self-control techniques to close the incomplete sessions and to maintain stability between and during the sessions. The therapist instructs the client to use the metaphors and stop signals to provide a sense of control during the treatment session. The therapist explains about the client's symptomatology and also makes the person understand the active processing of the trauma
        
        
  • assessment is the third phase in which the client and the therapist jointly identify the target memory for the particular session
    • the patient is then instructed to recognize the most salient image associated with this memory and he/she will be helped to elicit negative beliefs associated with it which provide an insight about the irrationality of the particular event. Positive beliefs suited to the target are also introduced which contradict with his/her emotional experiences
      • The validity of cognition scale (VOC) and subjective units of disturbance scale (SUDS) are assessed to understand the appropriateness of positive cognition (how much he/she considers a particular statement is true for the target memory) and how distressing is the stored memory, respectively. Both these assessments are used as baseline measures. In the assessment phase, emotions and physical sensations associated with traumatic memory are also noted down
        
        
  • fourth desensitization phase, the client's disturbing event is evaluated to change the trauma-related sensory experiences and associations
    • increasing the sense of self-efficacy and elicitation of insight is also a part of this phase. In this phase, the client is asked to attend both the target image and eye movement simultaneously and is instructed to have openness to whatever happens. After each set of eye movements, the client is directed to take a deep breath and instructed to blank out the material to which he/she is focusing. Depending upon the client's response, the clinician directs his/her subsequent focus of attention and also directs the length, speed and type of stimulation used
      
      
  • fifth phase, the installation phase
    • the therapist attempts to increase the strength of positive cognition which is supposed to replace the negative one. Until the VOC reaches 7 or up to ecological validity, the most enhancing positive cognition is paired with the previously dysfunctional material during the bilateral stimulation
      
      
  • sixth phase is the body scan phase in which the client is asked to get the body scanned to know whether any somatic response considered as residues of tension related to the targeted event is still remaining. If it is present, the therapist targets this body sensation for further processing
    
    
  • closure is the seventh phase in which the self-control techniques, which were already taught, are used when reprocessing is not complete
    • helps in bringing the person back to a state of equilibrium. In this phase, the therapist explains what to expect between sessions and to maintain a record of disturbances that arise between sessions to use these targets if necessary for further sessions
      
      
  • reevaluation is the eighth phase in which review is carried out for optimal treatment effect and to check out additional targets

NICE state (4):

• Eye movement desensitisation and reprocessing
  • consider EMDR for adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented between 1 and 3 months after a non-combat-related trauma if the person has a preference for EMDR.
  • offer EMDR to adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 3 months after a non-combat-related trauma.

Reference:

• 1) Shapiro F. Eye movement desensitization and reprocessing (EMDR) and the anxiety disorders: Clinical and research implications of an integrated psychotherapy treatment. J Anxiety Disord 1999;13:35-67
• 2) Herbert JD, Lilienfeld SO, Lohr JM, Montgomery RW, O?Donohue WT, Rosen GM, et al. Science and pseudoscience in the development of eye movement desensitization and reprocessing: Implications for clinical psychology. Clin Psychol Rev 2000;20:945-71
• 3)Shapiro F. EMDR 12 years after its introduction: past and future research. J Clin Psychol. 2002 Jan;58(1):1-22
• 4) NICE (December 2018).Post-traumatic stress disorder (NG116)