Riskilaste konverents 2012: Maire Riis: Emdr and children
EMDR with traumatized children 3.October 20121 Maire Riis Crisis Program for Children and Youth Laste ja Noorte Kriisiprogramm MTÜ firstname.lastname@example.org
Crisis Program for Children and Youth since 1994 (ferry “Estonia” disaster) Supporting children and families traumatized by the death of the close family member Working in individual and group settings With other childhood traumas Acute crisis intervention Teaching 2
Trauma in Childhood has long effectsAdverse Childhood Experience Study (ACE)(n=17,000) (Felitti, et al., 1998)Divorce Not just emotional distressDeath of parent 4 or more ACE Yelling more likely cancer, heart disease,Neglect more likely drugs, alcohol, suicideParent using alcohol / drugsParent with mental health problem(e.g.bipolar, PTSD) 7 or more ACE Sexual abuse even if no drinking, smoking, overeatingPhysical punishment 360% higher heart disease than 0Domestic violence Verbal abuse + witnessing violence > sexual abuse without verbal abuse & witnessing violence (Teicher et al. (2006). Sticks, Stones, and Hurtful Words: Relative Effects of Various Forms of Childhood Maltreatment)
Eye movement desensitization andreprocessing (EMDR) overview Trauma-focused psychoterapeutic approach originated by Francine Shapiro (first study 1989) Integrative psychotherapeutic model elements of many psychotherapeutic schools as psychodynamic, cognitive behavioural, client-centered, body- centered Treatment follows structured protocol Often limited amount of sessions Length of treatment depends on complexity of clinical picture Originally developed for adults but is easily adjusted for children 4
EMDR for whom Adults and children – for both Adjust according to the developmental level of the child ! Painful memories from Traumatizing experiences After disasters and terror attacks Traumatic memories after bereavement Other disturbing memories that have not been processed Recent research has also revealed that other, less dramatic life experiences can cause even more symptoms of PTSD than major traumas (F.Shapiro, 2012) Individual- and group setting Good results for children groups while adding drawing 5 F.Shapiro, in press, 2012
International treatment guidelinesEffective Treatments for PTSD The European Network of Traumatic Stress Studies - TENTS (2010) International Society for Traumatic Stress Studies – ISTSS (2009) EMDR and cognitive behavioral therapy (CBT) equivalent efficacy – Level A rating American Psychiatric Association – APA (2004) Department of Veterans Affairs & Department of Defense (2010) NICE - National Institute for Clinical Excellence,UK(2005) National Institute of Health and Medical Research, France (2004) National Board of Health and Welfare, Sweden (2010)www.emdr-europe.org 6
Research Many randomized controlled trials for EMDR during 20 years The first-line psychological treatment for chronic PTSD should be trauma-focused CBT or EMDR” (Bisson et al, 2007) “EMDR is an effective treatment for PTSD, and equally effective as exposure-based therapies” (Spates, et al, 2009). For children fewer studies – Level B rating (ISTSS) Rodenburg, G., Benjamin, A., de Roos, C., Meijer, A.N., & Stams, G.J, (November 2009). Efficacy of EMDR with children: A meta-analysis. In Clinical Psychology Review Issue 7 599 – 606. More studies need to be completed for EMDR adapted for use with children and adolescents. 7 http://consults.blogs.nytimes.com/references-on-e-m-d-r/
EMDR approach Adaptive Information Processing Model: The cornerstone of the EMDR approach: memory networks are the basis of clinical symptoms and of mental health The goal is to let the brain’s information processing system make new internal connections as the client focuses on the thoughts, emotions, memories and other associations that are freely made during the sets of bilateral stimulation. 8
EMDR as a therapeutic method Treatment focuses on how trauma affects present functioning Processing includes working on one trauma memory at a time Bilateral stimulation accompanies the client’s processing Therapist guides client through the process Children reprocess their traumas more quickly Parents are involved in the process 9
An eight phase approachPhase 4 – 6 unique to EMDR treatment1. History taking phase2. Preparation phase3. Assessment phase4. Desensitization phase5. Installation phase6. Body scan phase7. Closure phase8. Re-evaluation phase 10
What happens during EMDR?Traumatic memory EMDR Memory Less disturbingAssociated with disturbing Image Image Positive Cognition Cognitions Appropriate Affect Affect without disturbing Physical Sensations Physical Sensations(fragmented, not integrated) The past is present The past is past 11
What does EMDR session look likePhase 3 Assessment: (in connection to the memory) Memory: Father and grandmother fighting Worst part of the memory (image): I get scared, ´cause I don´t see my dad anymore Negative thoughts about oneself I can´t stand it(for child: mixed-up thoughts): (a “way out”) Positive thoughts(for child: good thoughts about yourself) I can handle it Emotions and body sensations:(for child: feeling-detector) I feel depressed, sad in my head, heart and stomach 12Certain scales are added to measure disturbance...
Phase 4: Desensitization The information processing system of the brain is stimulated so the memory can be transformed into an adaptive learning experience. Reprocessing (appropriate for the age) using bilateral stimulation until memory feels completely neutral: Eye movements (fingers, puppet) Tapping Tones After processing linking neutral memory to a psotive statement a positive sense of self can emerge It´s not my fault, I am strong It doesn´t bother me anymore 13
EMDR and children in Europe EMDR is being used in Europe to help children and adolescents with a wide range of anxiety-related problems, including single trauma, phobias, nightmares, school-related anxieties, bullying, medical problems, enuresis, social anxieties and fears, attachment problems, sexual and physical abuse, bonding, bereavement and depression. (J.Morris-Smith, 2007) 14 J.Morris-Smith, 2007. EMDR and children: Europe leads the way, Therapy for today, Vol8, 3.