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Eye Movement Desensitisation and Reprocessing (EMDR)

1. WHAT IS EMDR?

EMDR was discovered in 1987 by American psychologist, Francine Shapiro, when she noticed that eye movements influence the way we react to emotions, memories and behaviours. This process can identify the root of the underlying psychopathology. This treatment involves the therapist administering bilateral stimulation – while “watching” a certain image or concentrating on a specific thought, the patient looks at the therapist’s finger, or listens to a bilaterally administered sound or tapping. The patient’s brain subconsciously does all the work. The end result can mean different things for different people, but usually the patient is no longer troubled by traumatic memories.EMDR was discovered in 1987 by American psychologist, Francine Shapiro, when she noticed that eye movements influence the way we react to emotions, memories and behaviours. This process can identify the root of the underlying psychopathology. This treatment involves the therapist administering bilateral stimulation – while “watching” a certain image or concentrating on a specific thought, the patient looks at the therapist’s finger, or listens to a bilaterally administered sound or tapping. The patient’s brain subconsciously does all the work. The end result can mean different things for different people, but usually the patient is no longer troubled by traumatic memories.

EMDR can alleviate the symptoms of PTSD (Post Traumatic Stress Disorder) or other unresolved trauma experiences.

It has the following goals:

  1. Process disturbing memories (trauma is released and worked through)
  2. Reduces lingering effects of traumatic experiences (trauma does not affect the patient emotionally anymore)
  3. Develop adaptive coping mechanisms (new skills are developed and the patient can cope in the future without feeling distressed)
2. IS IT EVIDENCED BASED?

Yes. There is a lot of research (over 30 randomized controlled trials) that supports the use of EMDR. It is recommended by the World Health Organization, the American Psychiatric Association and the United States Department of Veterans Affairs.

EMDR is also one of the techniques Bessel van der Kolk describes in his well-known book about traumatic stress, The Body Keeps the Score.

3. IS IT SAFE?

Yes, it is very safe in the hands of a qualified therapist.
In the first weeks the patient might feel more “upset” and have more nightmares, but this will subside.

4. FOR WHICH PROBLEMS CAN IT BE USED?

EMDR is typically used for trauma – whether it be in the past or recent, severe or mild (small-t trauma). However, its applications are broad, including depression, addiction, low self-esteem, procrastination and chronic pain.

5. WHAT HAPPENS DURING THE PROCESS?

There are eight phases in EMDR therapy:

  1. History taking | The therapist takes down a comprehensive history. This includes identifying how the past has influenced current symptoms and identifying the inadequately processed memories and negative beliefs and memories to be targeted during EMDR. 
  2. Preparation | The therapist obtains informed consent from the patient. They explain the process to the patient (e.g. what they must do) and the patient learns calming techniques (safe place).
  3. Assessment | The therapist identifies the target memory, including negative and positive cognitions, and does the baseline assessments.
  4. Desensitisation | Next, the therapist applies bilateral stimulation until certain outcomes are reached.
  5. Installation | The positive cognition gained is installed until certain outcomes are reached.
  6. Body scan | The body scan technique is used to check whether processing is complete.
  7. Closure | Once the memory work is done, the focus shifts to the “here and now”, and the patient is stabilised.
  8. Re-evaluation | After each session the patient’s progress is checked. If there are remaining problems, they are identified.

The first three phases focus on diagnosis. The treatment begins in phases 4 and 5. During this time, the therapist follows a regime of bilateral gestures and the patient follows with his/her eyes.

6. HOW LONG IS THE DURATION OF TREATMENT?

Often only as few as three sessions are necessary. Some patients may take much longer, depending on individual factors, such as how many problems they want to work on.

7. HOW EFFECTIVE IS EMDR?

Typically, the equivalent of three 90-minute sessions produces 85-100% remission of PTSD with single trauma (see studies by Wilson, Becker, & Tinker;1995 & 1997).

Visit Emdria at https://www.emdria.org for more information.

The Brain and Trauma

1. WHAT IS TRAUMA

Trauma can be defined as:

  • Post Traumatic Stress Disorder (PTSD)- characterised by re-living the trauma (e.g. flashbacks), avoidance (e.g. do not want to go back to the place where it happened) and hypervigilance (e.g. startle easily).
  • Acute Stress Reaction- same symptoms as above, but less than 30 days have passed since the trauma happened.
  • Big T or small t trauma: Big T trauma is caused by a life and death situation e.g. being hijacked or sexually assaulted. Small t trauma is caused by less serious situations e.g. someone saying nasty things about you.
  • Trauma can be single or multiple.
2. WHAT ARE THE PROBLEMS THAT TRAUMA CAUSES
  • It keeps you in the past
  • It makes you feel as if you cannot control your thoughts or body
  • It steals your quality of life
  • It causes unpleasant psychical symptoms (pains, palpitations)
3. WHY DO OUR BRAINS REMEMBER TRAUMA

The main function of our brain is to keep us alive. So, we remember what happened so that we can prevent the same or similar danger from harming us.

4. HOW DO WE REMEMBER TRAUMA

The hippocampus and the amygdala together are called the limbic system. The amygdala keeps track of the emotional parts of the experience, and the hippocampus remembers the facts. Adrenaline (stress hormone that we make in times of stress which enables us to fight, freeze or flee) causes the hippocampus to stop functioning, and then the brain does not remember that the trauma has stopped. The frontal lobe is the part that enables us to plan, organise, self-monitor and control our responses needs to get the right message from the hippocampus-e.g. that the trauma has stopped.

5. WHAT CAN WE DO
  • Medication | SSRI antidepressants (e.g. escitalopram) to treat the underlying chemical imbalanceAnxiolytics (e.g. lorazepam) and sleeping pills may be used short-term.
  • Psychotherapy | Different techniques can be used: CBT (Cognitive Behavioural Therapy), DBT (Dialectical Behavioural Therapy), EMDR (Eye Movement Desensitisation Therapy)
  • Breath | Try just observing the breath.
  • Move | Movement helps us to ‘defrost’, so it is helpful to start moving. You can chooses any movement that you like, even walking around for 15 minutes will be good.
6. REMEMBER
  • The first goal is to improve the quality of your life NOW.
  • Not everyone needs trauma processing. Decide with your therapist what are the goals for your therapy.
  • It is not important to remember the details of the trauma, it is important to remember that the trauma has stopped.
  • Begin with your epilogue- you have made it!
  • Flashbacks are only a memory, it is not happening now.
  • Forgive yourself for freezing. Freezing is not giving consent.

The Brain and Panic Attacks

1. WHAT IS A PANIC ATTACK

A spontaneous, discreet episode of intense fear that begins abruptly and last for several minutes to an hour. Many different symptoms in the body can occur including:

  • Palpitations, chest pain
  • Difficulty in breathing, hyperventilation
  • Sweating
  • Dizziness
  • Needles and pins in fingers, trembling
  • Upset stomach, want to urinate frequently
2. WHAT ARE THE PROBLEMS WITH PANIC ATTACKS?
  • It is out of the blue | Because a panic attack starts suddenly, usually when we are relaxed, we cannot understand what caused it. This implies we cannot control it, and we do not know when it is going to come again.
  • Fear of consequences | The symptoms of a panic attack are quite severe, so we are scared it is dangerous. The is usually a fear that it is a serious medical condition like a heart attack, a stroke or that we are going mad.
  •  Anticipatory anxiety | Because the panic attack is so unpleasant, we become scared that we might get another panic attack. So even in the moments when we are fine, we begin to worry about the next panic attack.
3. WHAT ABOUT CHRONIC STRESS?

If the stress is there for 6 months or longer, a Generalised Anxiety Disorder can be diagnosed. There are also other symptoms such as irritability, insomnia, and muscle pains.

4. WHAT HAPPENS IN THE BRAIN?

When the brain perceives a danger, it signals to the adrenal glands to secrete adrenaline. The adrenaline works on the heart, lungs, and muscles to enable us to fight, flee or freeze. This happens in an instant, and we do not have time to ‘choose’ what we are going to do.

5. WHAT CAN WE DO
  • Medication | MedicationSSRI antidepressants (e.g. escitalopram) to treat the underlying chemical imbalanceAnxiolytics (e.g. lorazepam) and sleeping pills may be used short-term
  • Psychotherapy | Discuss the options with your psychologist. A modality like CBT (Cognitive Behavioural Therapy) can be effective.
  • Move | Any movement is good- whatever you like to do. Walking, dancing, soccer.
  • Breath | The problem with panic attacks is hyperventilation. Try to breath slowly, and make the out breath longer.
6. REMEMBER
  • A panic attack are just the effects of adrenaline. It comes from your own body and cannot harm you. You will survive the panic attack!
  • You cannot control or stop the panic attacks. Train yourself to become confident that you will be able to handle the panic attack when it comes.
  • Practice breathing and mindfulness to calm down before the panic attack starts.
  • Breath slowly, making the out- breath longer or breath in a brown paper bag.

Eye Movement Desensitisation and Reprocessing (EMDR)

1. WHAT IS EMDR?

EMDR was discovered in 1987 by American psychologist, Francine Shapiro, when she noticed that eye movements influence the way we react to emotions, memories and behaviours. This process can identify the root of the underlying psychopathology. This treatment involves the therapist administering bilateral stimulation – while “watching” a certain image or concentrating on a specific thought, the patient looks at the therapist’s finger, or listens to a bilaterally administered sound or tapping. The patient’s brain subconsciously does all the work. The end result can mean different things for different people, but usually the patient is no longer troubled by traumatic memories.EMDR was discovered in 1987 by American psychologist, Francine Shapiro, when she noticed that eye movements influence the way we react to emotions, memories and behaviours. This process can identify the root of the underlying psychopathology. This treatment involves the therapist administering bilateral stimulation – while “watching” a certain image or concentrating on a specific thought, the patient looks at the therapist’s finger, or listens to a bilaterally administered sound or tapping. The patient’s brain subconsciously does all the work. The end result can mean different things for different people, but usually the patient is no longer troubled by traumatic memories.

EMDR can alleviate the symptoms of PTSD (Post Traumatic Stress Disorder) or other unresolved trauma experiences.

It has the following goals:

  1. Process disturbing memories (trauma is released and worked through)
  2. Reduces lingering effects of traumatic experiences (trauma does not affect the patient emotionally anymore)
  3. Develop adaptive coping mechanisms (new skills are developed and the patient can cope in the future without feeling distressed)
2. IS IT EVIDENCED BASED?

Yes. There is a lot of research (over 30 randomized controlled trials) that supports the use of EMDR. It is recommended by the World Health Organization, the American Psychiatric Association and the United States Department of Veterans Affairs.

EMDR is also one of the techniques Bessel van der Kolk describes in his well-known book about traumatic stress, The Body Keeps the Score.

3. IS IT SAFE?

Yes, it is very safe in the hands of a qualified therapist.
In the first weeks the patient might feel more “upset” and have more nightmares, but this will subside.

4. FOR WHICH PROBLEMS CAN IT BE USED?

EMDR is typically used for trauma – whether it be in the past or recent, severe or mild (small-t trauma). However, its applications are broad, including depression, addiction, low self-esteem, procrastination and chronic pain.

5. WHAT HAPPENS DURING THE PROCESS?

There are eight phases in EMDR therapy:

  1. History taking | The therapist takes down a comprehensive history. This includes identifying how the past has influenced current symptoms and identifying the inadequately processed memories and negative beliefs and memories to be targeted during EMDR. 
  2. Preparation | The therapist obtains informed consent from the patient. They explain the process to the patient (e.g. what they must do) and the patient learns calming techniques (safe place).
  3. Assessment | The therapist identifies the target memory, including negative and positive cognitions, and does the baseline assessments.
  4. Desensitisation | Next, the therapist applies bilateral stimulation until certain outcomes are reached.
  5. Installation | The positive cognition gained is installed until certain outcomes are reached.
  6. Body scan | The body scan technique is used to check whether processing is complete.
  7. Closure | Once the memory work is done, the focus shifts to the “here and now”, and the patient is stabilised.
  8. Re-evaluation | After each session the patient’s progress is checked. If there are remaining problems, they are identified.

The first three phases focus on diagnosis. The treatment begins in phases 4 and 5. During this time, the therapist follows a regime of bilateral gestures and the patient follows with his/her eyes.

6. HOW LONG IS THE DURATION OF TREATMENT?

Often only as few as three sessions are necessary. Some patients may take much longer, depending on individual factors, such as how many problems they want to work on.

7. HOW EFFECTIVE IS EMDR?

Typically, the equivalent of three 90-minute sessions produces 85-100% remission of PTSD with single trauma (see studies by Wilson, Becker, & Tinker;1995 & 1997).

Visit Emdria at https://www.emdria.org for more information.

The Brain and Trauma

1. WHAT IS TRAUMA

Trauma can be defined as:

  • Post Traumatic Stress Disorder (PTSD)- characterised by re-living the trauma (e.g. flashbacks), avoidance (e.g. do not want to go back to the place where it happened) and hypervigilance (e.g. startle easily).
  • Acute Stress Reaction- same symptoms as above, but less than 30 days have passed since the trauma happened.
  • Big T or small t trauma: Big T trauma is caused by a life and death situation e.g. being hijacked or sexually assaulted. Small t trauma is caused by less serious situations e.g. someone saying nasty things about you.
  • Trauma can be single or multiple.
2. WHAT ARE THE PROBLEMS THAT TRAUMA CAUSES
  • It keeps you in the past
  • It makes you feel as if you cannot control your thoughts or body
  • It steals your quality of life
  • It causes unpleasant psychical symptoms (pains, palpitations)
3. WHY DO OUR BRAINS REMEMBER TRAUMA

The main function of our brain is to keep us alive. So, we remember what happened so that we can prevent the same or similar danger from harming us.

4. HOW DO WE REMEMBER TRAUMA

The hippocampus and the amygdala together are called the limbic system. The amygdala keeps track of the emotional parts of the experience, and the hippocampus remembers the facts. Adrenaline (stress hormone that we make in times of stress which enables us to fight, freeze or flee) causes the hippocampus to stop functioning, and then the brain does not remember that the trauma has stopped. The frontal lobe is the part that enables us to plan, organise, self-monitor and control our responses needs to get the right message from the hippocampus-e.g. that the trauma has stopped.

5. WHAT CAN WE DO
  • Medication | SSRI antidepressants (e.g. escitalopram) to treat the underlying chemical imbalanceAnxiolytics (e.g. lorazepam) and sleeping pills may be used short-term.
  • Psychotherapy | Different techniques can be used: CBT (Cognitive Behavioural Therapy), DBT (Dialectical Behavioural Therapy), EMDR (Eye Movement Desensitisation Therapy)
  • Breath | Try just observing the breath.
  • Move | Movement helps us to ‘defrost’, so it is helpful to start moving. You can chooses any movement that you like, even walking around for 15 minutes will be good.
6. REMEMBER
  • The first goal is to improve the quality of your life NOW.
  • Not everyone needs trauma processing. Decide with your therapist what are the goals for your therapy.
  • It is not important to remember the details of the trauma, it is important to remember that the trauma has stopped.
  • Begin with your epilogue- you have made it!
  • Flashbacks are only a memory, it is not happening now.
  • Forgive yourself for freezing. Freezing is not giving consent.

The Brain and Panic Attacks

1. WHAT IS A PANIC ATTACK

A spontaneous, discreet episode of intense fear that begins abruptly and last for several minutes to an hour. Many different symptoms in the body can occur including:

  • Palpitations, chest pain
  • Difficulty in breathing, hyperventilation
  • Sweating
  • Dizziness
  • Needles and pins in fingers, trembling
  • Upset stomach, want to urinate frequently
2. WHAT ARE THE PROBLEMS WITH PANIC ATTACKS?
  • It is out of the blue | Because a panic attack starts suddenly, usually when we are relaxed, we cannot understand what caused it. This implies we cannot control it, and we do not know when it is going to come again.
  • Fear of consequences | The symptoms of a panic attack are quite severe, so we are scared it is dangerous. The is usually a fear that it is a serious medical condition like a heart attack, a stroke or that we are going mad.
  •  Anticipatory anxiety | Because the panic attack is so unpleasant, we become scared that we might get another panic attack. So even in the moments when we are fine, we begin to worry about the next panic attack.
3. WHAT ABOUT CHRONIC STRESS?

If the stress is there for 6 months or longer, a Generalised Anxiety Disorder can be diagnosed. There are also other symptoms such as irritability, insomnia, and muscle pains.

4. WHAT HAPPENS IN THE BRAIN?

When the brain perceives a danger, it signals to the adrenal glands to secrete adrenaline. The adrenaline works on the heart, lungs, and muscles to enable us to fight, flee or freeze. This happens in an instant, and we do not have time to ‘choose’ what we are going to do.

5. WHAT CAN WE DO
  • Medication | MedicationSSRI antidepressants (e.g. escitalopram) to treat the underlying chemical imbalanceAnxiolytics (e.g. lorazepam) and sleeping pills may be used short-term
  • Psychotherapy | Discuss the options with your psychologist. A modality like CBT (Cognitive Behavioural Therapy) can be effective.
  • Move | Any movement is good- whatever you like to do. Walking, dancing, soccer.
  • Breath | The problem with panic attacks is hyperventilation. Try to breath slowly, and make the out breath longer.
6. REMEMBER
  • A panic attack are just the effects of adrenaline. It comes from your own body and cannot harm you. You will survive the panic attack!
  • You cannot control or stop the panic attacks. Train yourself to become confident that you will be able to handle the panic attack when it comes.
  • Practice breathing and mindfulness to calm down before the panic attack starts.
  • Breath slowly, making the out- breath longer or breath in a brown paper bag.