This document summarizes a lecture comparing four treatment methods - CBT, EMDR, biofeedback, and hypnosis - for medically unexplained symptoms (MUS). It outlines the theoretical origins and main tools of each approach. While the methods have some unique elements, they also have many similarities in terms of addressing cognition, emotion, behavior, and the body. The document proposes pathways for clinicians to choose between or combine these evidence-based approaches for MUS based on each client's specific needs and symptoms. It argues that no single method is "pure" and that MUS have both psychological and biological causes requiring an integrated mind-body approach.

1. Tamar Dagan & Arnon Rolnick
EABCT Congress, 2015, Jerusalem
How do clinicians choose between
or combine
several evidence-based approaches
when treating MUS
(Medically Unexplained Symptoms)

2. What will this lecture include?
1. Theoretical comparison between 4 treatment
methods: CBT, EMDR, Biofeedback & Hypnosis
2. Presenting some pathways for clinicians to choose
between or combine the methods when treating
MUS, thru 3 case studies.
Dagan & Rolnick, EABCT Congress, 2015, JerusalemDagan & Rolnick, EABCT Congress, 2015, Jerusalem

3. Initial guidelines
1. Modern patients come with a self diagnosis, and/or request
for a specific treatment method – the patient fantasy
2. Fits my narrative education: The patient is the best expert for
both his problems and his problem’s solutions
3. Sometime the method they request, does not fit their
current resources, or the apparent origin of their symptoms.
4. Being familiar with several methods, enables a flexibility
to choose or to combine between them
Dagan & Rolnick, EABCT Congress, 2015, Jerusalem

4. Comparison between CBT, EMDR
Biofeedback & Hypnosis -1
Dagan & Rolnick, EABCT Congress, 2015, Jerusalem
HypnosisBiofeedbackEMDRCBT
Unconscious
resources
Stress
management
PTSDDepression
Originally
developed
Unconscious
conflicts or
negative self
hypnosis
Over activity of
sympathetic
system
Incomplete
brain process
of experience
The meaning
a person gave
to experience
Origin of
symptoms
Access
unconscious
recourses
Practicing
regulation
methods
Unpack the
neurological
linkages
Unpack the
cognitive
triangle
Main
Method
goal

5. Comparison between CBT, EMDR
Biofeedback & Hypnosis -2
Dagan & Rolnick, EABCT Congress, 2015, Jerusalem
HypnosisBiofeedbackEMDRCBT
Focus is
directed to the
relevant
channel
Focus on the
body, as
influenced by the
others
Focus on all
channels
simultaneously
- Behavior
- cognition
- feelings
- body
Original
focal
channel
The amazing
influence of
thoughts on
the body
-Sympathetic-
parasympathetic
systems.
FFF system
-Right- left
hemisphere.
-Amygdala-
Hypothalamus.
-FFF system
-Cognitive
triangle.
-Blocking
beliefs
Main
psycho
education
Imagination
Computer
software &
sensors
Bilateral
stimulus
Talking
Method
main tool

6. Comparison between CBT, EMDR,
Biofeedback & Hypnosis - 3
Dagan & Rolnick, EABCT Congress, 2015, Jerusalem
HypnosisBiofeedbackEMDRCBT
Past, present,
future
Relaxation at
arousing
situations
Past, present,
future
Past, present,
future
Generalizing
Main
component of
the protocol
Lately added
Main
component of
the protocol
One of the
modules
Mindfulness
Main
component of
the protocol
Mutual un-
judicial observing
the graphs
Main
component of
the protocol
Lately added
(ACT)
Acceptance

7. Comparison between CBT, EMDR,
Biofeedback & Hypnosis - 4
Dagan & Rolnick, EABCT Congress, 2015, Jerusalem
HypnosisBiofeedbackEMDRCBT
Some beautiful
suggestions
-The treatment
prime purpose. -
“Sandwich”
-Preparing
for trauma
reprocessing
-“Sandwich””
One of the
modules
Resource
enhancement
Self Hypnosis
Regulating
methods
NoneExposuresHomework
Subjective
Used several
times each
session
-Objective.
-Mutual
observations
Subjective.
- Used every
few minutes
Subjective-
Used only at
regulating
sessions
Monitoring

8. Comparing the four approaches find
more resemblance than distinguishing
• All are evidence based for pains, headaches & IBS (high correlation with PTSD)
• All defined as a short term therapy, usually 10-15 appointments, but can be shorter
or longer
• All speaks in four languages: cognitive, physical, emotional & behavioral
• All have elements of: monitoring, exposure to memories, emotions & behaviors,
psycho-education, resource strengthening, generalization. It is just the emphasis
that is different.
• The only unique elements are: brain processing (EMDR), home work (all except
EMDR), use of equipment (EMDR & Biofeedback) & objective monitoring
(biofeedback).
Dagan & Rolnick, EABCT Congress, 2015, Jerusalem

9. Pure EMDR
Known traumatic events
or improving achievements
Starting CBT Modules, followed by EMDR
Not pre-known Traumatic events, but
exposed through the CBT treatment
Starting EMDR, followed by CBT modules
Pre-known traumatic events that became
complicated with blocked beliefs,
problematic relations, avoidance, OCD, etc
Adding BF to this
sequence
When anxiety is added to
the other symptoms
Adding BF to this
sequence
When anxiety is added
to the other symptoms
Adding BF to this
sequence
When anxiety is added
to the other symptoms
Dagan & Rolnick, EABCT Congress, 2015, Jerusalem
Treatment pathways
BF + Hypnosis
Stress and pain reduction &
resource enhancement

10. Actually no method is pure
• Hypnosis is an excellent state of mind for doing EMDR or Biofeedback
• EMDR is actually working on the cognitive main goal: to unpack the
cognitive triangle, but uses the bilateral stimuli for reprocessing
• EMDR use short cognitive interweaves, and Hypnosis use long
cognitive suggestions, to fasten and deepen the biological and
emotional change
• Biofeedback uses behaviors and cognitions for challenging the
sympathetic system
• EMDR direct work with for pain is actually Hypnosis assisted by BLS
Dagan & Rolnick, EABCT Congress, 2015, Jerusalem

11. MUS is not purely psychological caused
nor purely biological caused
but a combined mind – body symptom.
Sometime only YET unexplained
My third client wrote to me yesterday night:
“I think there is a strong tie between body and mind. I
think that for long time I held myself from lots of concerns.
My back condition was bad, developing for years. From the
moment I decided to let go, to give myself, probably the
weak vertebra had collapsed.
Dagan & Rolnick, EABCT Congress, 2015, Jerusalem