Emdr Presentation

  • 5,143 views
Uploaded on

What EMDR is and how it works

What EMDR is and how it works

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
5,143
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
155
Comments
0
Likes
1

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. EMDR Treatment With Juvenile Delinquent Populations CJC 2004 Jay D. Fellers, LCSW
  • 2.
    • EMDR-- Eye Movement Desensitization and Reprocessing is a psychological method for treating emotional difficulties that are caused by disturbing life experiences, ranging from traumatic events such as combat stress, assaults and natural disasters, to upsetting childhood events.
    • EMDR is also being used to alleviate performance anxiety and to enhance the functioning of people at work, on the playing field, and in the performing arts.
    • EMDR is a complex method that brings together elements from well-established clinical theoretical orientations including psychodynamic, cognitive, behavioral, and client-centered treatments. For many clients, EMDR provides more rapid relief from emotional distress than conventional therapies.
    What is EMDR?
  • 3. EMDR “ Looking Through Hemispheres” An Introductory Video Dr. Francine Shapiro Dr. Bessel van der Kolk David Grand, CSW
  • 4. EMDR: An Accelerated Information Processing Model
    • Within everyone is a physiological information processing system, that processes experiences to an adaptive state.
    • Under normal circumstances, this information processing may occur during thinking, talking, expressive/artistic activities, and/or dreaming.
    • Information is stored in Memory Networks—images, thoughts, feelings, physical sensations.
    • Memory Networks are organized around the earliest related event.
  • 5. EMDR: An Accelerated Information Processing Model
    • Traumatization has been described as a disruption of the inherent information processing system that normally leads to integration and adaptive resolution following upsetting experiences (van der Kolk & Fisler, 1995)
    • In trauma, however, a malfunction of this natural information processing system occurs such that the experience of the trauma remains “frozen”, manifesting in persistent intrusive thoughts, negative emotions and self-referenced beliefs, and unpleasant body sensations.
  • 6. TRIGGERS Components of Traumatic Memory EMOTIONS BELIEFS SENSATIONS PICTURES TRAUMA
  • 7. EMDR: An Accelerated Information Processing Model (cont.)
    • EMDR specifically targets traumatic material and appears to restart this ‘stalled’ information processing in a focused manner, facilitating the resolution of the traumatic memories through the activation of neurophysiological networks in which appropriate and positive information is stored.
  • 8. What Happens during EMDR?
    • A traumatic memory and associated cognitions, emotions, and somatic distress are identified.
    • The client is engaged in bilateral stimulation while experiencing various aspects of the memory.
    • The clinician stops the bilateral stimulation at regular intervals to ensure that the client is processing adequately.
  • 9. What Happens during EMDR?
    • The client processes information about the negative experience, bringing it to an "adaptive resolution."
    • The "three-pronged approach" addresses:
    • 1) earlier life experience.
    • 2) present-day stressors.
    • 3) desired thoughts and actions for the future.
    • EMDR treatment may last from 1-3 sessions to 1 year or longer for complex problems.
  • 10. Why Do Clients Seem to Respond Well to EMDR?
    • EMDR is a client-centered approach that allows the clinician to facilitate the mobilization of a client's own inherent healing mechanism which stimulates an innate information processing system in the brain.
    • The EMDR model acknowledges the physiological component in emotional difficulties. The EMDR protocol directly targets these physical sensations, along with negative beliefs, emotional states, and other disturbing symptoms.
  • 11. Why and how does EMDR work? Hypothesized Mechanisms
    • Many hypotheses have been put forth to explain the possible mechanism of change related to EMDR, but a definitive explanation has not been confirmed.
  • 12. EMDR: Hypothesized Mechanisms One hypothesis was proposed by Harvard Medical School sleep researcher Robert Stickgold, Ph.D. at the 1998 EMDRIA Annual Conference:
  • 13. EMDR : Hypothesized Mechanisms “ EMDR facilitates the processing of traumatic memory by activating brain systems normally activated during REM sleep.”
  • 14. EMDR: Hypothesized Mechanisms
    • Bessel van der Kolk, M.D. of Boston University School of Medicine states (Boston Globe, 1998):
    • “ In a recent EMDR study, in collaboration with the New England Deaconess/Beth Israel Neuroimaging Laboratory, brain scans were used to measure how brain activity changes after effective treatment.”
  • 15. EMDR: SPECT IMAGES—PTSD (Amen, 2003)
    • No Treatment-- EMDR & St. John’s Wort
    • Increased Cingulate, Basil Overall Improved Activity
    • Ganglia, & Limbic Activity
  • 16. EMDR: SPECT IMAGES—PTSD (Amen, 2003)
    • No Treatment-- EMDR & St. John’s Wort
    • Increased Cingulate, Basil Overall Improved Activity
    • Ganglia, & Limbic Activity
  • 17. What is the Research Indicating the Efficacy of EMDR?
  • 18. Research Demonstrating the Efficacy of EMDR
    • EMDR is an empirically valid treatment for civilian post traumatic stress disorder recognized by the American Psychological Association.
    • EMDR received an A/B rating from the International Society for Traumatic Stress Studies (ISTSS).
  • 19. Research: Efficacy of EMDR for Civilian PTSD
    • Marcus, Marquis, & Sakai (1997) study:
    • Results showed Kaiser HMO projected to save $2.8 million annually using EMDR for PTSD.
  • 20. Research: Efficacy of EMDR for Civilian PTSD
    • Three of four studies comparing EMDR and CBT showed EMDR to be more efficient (Ironson, Freud, Strauss, & Williams, 2002; Lee, Gavriel, Drummond, Richards, & Greenwald, 2002)
  • 21. EMDR Research: Panic Disorder & Phobias
    • Goldstein & Feske (1994)
    • Choking phobias (De Jongh, & ten Broeke, 1999)
    • Simple phobias (De Jongh, ten Broeke, & Renssen,1999)
    • Blood and injection phobias (Kleinknecht, 1993)
  • 22. Other EMDR Research
    • Symptoms arising after a natural catastrophe (Grainger, Levin, Allen-Byrd, Doctor, & Lee, 1997)
    • Test Anxiety (Mayfield & Melnyk, 2000)
    • Crisis Intervention (Solomon, 1998)
  • 23. EMDR Research Re: Conduct Disorder
    • EMDR Treatment for Children With Treatment Resistant Disaster-Related Distress (Chemolab & Nakashima, 1996)
    • Enhancement of Victim Empathy Along With Reduction in Anxiety & Increase of Positive Cognition of Sex Offenders After Treatment With EMDR (Datta & Wallace, 1996)
    • EMDR For Boys With Conduct Problems (Soberman, Greenwald, & Rule, 2000)
  • 24. EMDR & Conduct Disorder (cont.)
    • Trauma & Conduct Disorder (Puffer, Greenwald, & Elrod, 1998)
    • The Role Of Trauma in Conduct Disorder (Greenwald, 2000)
    • A Trauma-Focussed Individual Therapy Approach for Adolescents With Conduct Disorder (Greenwald, 2002)
    • MASTR Therapy for Adolescents with Conduct Problems (Greenwald, 2002)
  • 25. EMDR Research Re: Substance Abuse
    • EMDR Treatment Protocol Based on a Psychodynamic Model of Chemical Dependency (Omaha, 1997)
    • DETUR: A New Approach to Working With Addictions (Popky, 1998)
    • EMDR Chemical Dependency Treatment Manual (Vogelmann-Sine, Sine, Smyth, & Popky, 1998)
  • 26. EMDR Research
    • There is much research in progress.
    • See “Efficacy of EMDR,” updated yearly by the EMDR Institute.
      • www.emdr.com
      • www.emdria.org
      • www.emdrhap.org
      • www.andrewleeds.net
  • 27. The Eight Phases of EMDR Treatment 1. Client History and Treatment Planning 2. Client Preparation 3. Assessment 4. Desensitization 5. Installation 6. Body Scan 7. Closure 8. Reevaluation
  • 28. Client History and Treatment Planning
    • Intergenerational Genogram
    • Negative Cognition Inventory
    • Assess Level of Dissociation
    • Substance Abuse Assessment
  • 29. Client Preparation
    • Establish Trust
    • Stabilization & Safety
    • Motivation—External vs. Internal;
    • Precognition, Cognition, Determination,
    • Action, Motivation
    • Resource Development—Cognitive,
    • Affective, Self-Soothing (Safe Place)
  • 30. The Core of EMDR Treatment ASSESSMENT PHASE DESENSITIZATI0N PHASE INSTALLATI0N PHASE SOMATIC
  • 31. The Core of EMDR Treatment ASSESSMENT PHASE Presenting Issue Picture Negative Cognition (NC) and Positive Cognition (PC) Validity of Cognition (VOC) Emotions/Feelings Subjective Units of Distress (SUDS) Location of Body Sensation DESENSITIZATI0N PHASE Potential Responses: Pictorial Processing, Cognitive Processing, Emotional Processing, Sensory Processing Associative Links and Feeder Memories Informational Plateaus: Responsibility, Safety, and Choices INSTALLATI0N PHASE Integration of Positive Cognition with Targeted Information and VOC Check SOMATIC OR BODY SCAN
  • 32. Brief Therapy Inside Out Video EMDR: Working Through Grief Dr. Francine Shapiro with Jon Carlson, Psy.D., Ed.D. Diane Kjos, Ph.D.
  • 33. Childhood Trauma Case Example
    • Client
    • A 17 year old male struggling with negative conclusions about himself resulting from being physically abused by his stepmother, witnessing domestic violence, biological mother’s substance abuse.
    • Presenting Problems: Marijuana dependence, delinquent behavior, truancy, poor peer choices, conflict avoidance, hypervigilence, guilt, self-hatred, mistrust of others, and a sense of hopelessness and helplessness.
    • Negative Cognitions: I am weak. I need to get high to deal with the pressure.
    • Positive Cognitions: I can get through anything. I can deal with it without getting high.
    • Assessment Components
    • Picture: Stepmother pulling him out of his bed and whipping him—age 5
    • Negative Cognition: I'm weak.
    • Positive Cognition: I can get through anything.
    • VOC=4
    • Emotions/Feelings: Fear, sadness, anxiety, hopelessness
    • SUDS=8
    • Location of Body Sensation: Tension in the neck and shoulders, knots in stomach, palpitations in chest.
  • 34. Traumatic Memory Age 5 Physical Abuse by Step-mother TRIGGERS
    • Getting ready for school
    • Conflict
    • Female anger
    EMOTIONS BELIEFS SENSATIONS PICTURES Fear, sadness, anxiety, hopelessness
    • I am weak. I need to get high to deal with the pressure .
    • Tension in neck and shoulders
    • Knots in stomach
    • Palpitations in chest
    • Stepmother pulling him out of his bed and whipping him—age 5
    Childhood Trauma Case Example (cont.)
  • 35. Childhood Trauma Case Example Possible Information Processing Shifts : Responsibility Safety Choices
  • 36. Childhood Trauma Case Example (cont.)
    • Possible Information Processing Shifts Related to Concepts of Responsibility, Safety, and Choices:
    • Responsibility:
    • I was too young to defend myself.
    • Dad never stopped her.
    • Safety:
    • I’ll never have to live with her again.
    • I’m not weak anymore.
    • Choices:
    • I don’t need to pity myself.
    • I won’t use this anymore as an excuse.
  • 37. Substance Abuse Case Example
    • Client
    • A 17 year old male struggling with negative conclusions about himself resulting from being physically abused by his stepmother, witnessing domestic violence, biological mother’s substance abuse.
    • Presenting Problems: Marijuana dependence, delinquent behavior, truancy, poor peer choices, conflict avoidance, hypervigilence, guilt, self-hatred, mistrust of others, and a sense of hopelessness and helplessness.
    • Negative Cognitions: I am weak. I need to get high to deal with the pressure.
    • Positive Cognitions: I can get through anything. I can deal with it without getting high.
    • Assessment Components
    • Picture: Biological mother calling him asking for money—for drugs?
    • Negative Cognition: I need to get high to deal with the pressure.
    • Positive Cognition: I can deal with it without getting high.
    • VOC=5
    • Emotions/Feelings: Fear, sadness, anxiety, hopelessness
    • SUDS=6;
    • Urge to use=6
    • Location of Body Sensation: Pain in lower back
  • 38. Substance Abuse Trigger: Role Reversal & Substance Abuse by Mother TRIGGERS
    • Mother calling
    • Female need
    EMOTIONS BELIEFS SENSATIONS PICTURES Upsetting, disappointing, Confusion, frustration, Pressure, temptation
    • I am weak. I need to get high to deal with the pressure .
    • Pain In Lower Back
    • Mother calling him in AM, on way to borrow money
    Substance Abuse Case Example (cont.) URGE TO USE
  • 39. Substance Abuse Case Example (cont.)
    • Possible Information Processing Shifts Related to Concepts of Responsibility, Safety, and Choices:
    • Responsibility:
    • I’m doing what I’m afraid she’s doing.
    • I use this as an excuse to get high.
    • Safety:
    • I don’t have to feel pressured
    • I’m not weak anymore.
    • Choices:
    • I don’t have to take her call.
    • I can tell her no.
  • 40. Resource Development Installation
    • Identify Characteristics or Qualities Needed to Deal with Problem
    • Identify Existing Examples of Quality
      • Own Examples—feelings & body sensation
      • Others’ Reports of Own Quality—feelings & body sensation
      • Known Others’ Quality—feelings & body sensation
      • Others (Fact or Fiction) Quality—feelings & body sensation
      • Symbol (i.e. Animal) of Quality—feelings & body sensation
    • Reinforce each example with 3 Short Sets of Bilateral Stimulation
    • Anchor Cue Word of Quality
    • Install Future Templates
  • 41. Substance Abuse RDI Example
    • Client
    • A 15 year old male struggling moderate family conflict, peer pressure.
    • Presenting Problems: Marijuana dependence, delinquent behavior, truancy, poor peer choices, conflict avoidance, and a sense of hopelessness and helplessness.
    • Negative Cognitions: I am easily tempted.
    • Positive Cognitions: I have self control.
    • Identify Characteristics or Qualities Needed to Deal with Problem
    • Picture: Peers talking about using drugs. He thinks about skipping class and getting high.
    • Qualities Needed: Self Control , Thinking About Consequences Before Acting, Staying Focused on Goals, Choosing Right From Wrong, Keeping Busy.
  • 42. Substance Abuse RDI Example (cont.)
    • Identify Existing Examples of Quality
      • Friend tries to get him to smoke, says no without thinking—proud, good feeling in chest
      • Peer asks him to ditch class with him, says no—feels good, shoulders relaxed
      • Admires another friend, refuses to get high—admires, gut
      • Skateboarder peer doesn’t use—good feeling, warm behind ears
      • Jesus, tempted a lot, never gave in—good feeling, chest
  • 43. Substance Abuse RDI Example (cont.) Reinforce each example with 3 Short Sets of Bilateral Stimulation (less if negative content arises) Anchor with “Self-Control” Install Future Templates re: Peers talking about using drugs, thinking about skipping class and getting high, using anchor & recalling inner resources, imagining doing something different. Note emotions and body sensations, reinforce with short set of bilateral stimulation.
  • 44. Homework
    • Between-Session Work Inherent—Processing Continues
    • Noticing what comes up (thoughts, memories, feelings, body sensations, dreams, nightmares, conflicts, etc.)
    • Remembering the Big 3—thoughts, feelings, body sensations
    • Noticing spontaneous positive changes
    • Remembering to Use Self-Soothing Techniques i.e. Safe Place
  • 45. EMDR Websites
      • www.emdr.com
      • www.emdria.org
      • www.emdrhap.org
      • www.andrewleeds.net