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EMDR Research News February 2014

17 Feb 14, 08:00 Filed in: Research | News | Dissociative Disorders | 2014

There are seven new journal articles on EMDR therapy this month -- which you will find below the break -- including the second part of an article on “Dissociation of the personality and EMDR therapy in complex trauma-related disorders: Applications in phases 2 and 3 treatment” by Onno van der Hart, Mariëtte Groenendijk, Anabel Gonzalez, Dolores Mosquera and Roger Solomon. This article is available now to members of EMDRIA. In recognition of the many contributions of these authors to the understanding of EMDR therapy and Structural Dissociation, I am bringing you a special section on EMDR therapy and Structural Dissociation.

With each journal article referenced below, you will find the citation, abstract and author contact information (when available). Prior quarterly summaries of journal articles can be found on the EMDRIA website and a comprehensive listing of all EMDR-related research is available at the Francine Shapiro Library. EMDRIA members can access recent Journal of EMDR Practice and Research articles in the member’s area on the EMDRIA website. JEMDR issues older than 12 months are available open access on IngentaConnect.

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Special section on EMDR therapy and Structural Dissociation

Every clinician treating an individual with a dissociative disorder should be familiar with the treatment guidelines from the International Society for the Study of Trauma and Dissociation. These guidelines, last updated in 2011 are available for free download. Guidelines for treating dissociative disorder in adults, third revision. Journal of Trauma & Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD), 12(2), 115-187.

One of the best basic treatment manuals is this wonderful book by Suzette Boon, Kathy Steele and Onno Van der Hart. Published in 2011, Coping with trauma-related dissociation: Skills training for patients and therapists, is written for both patients and therapists. It includes sections on understanding dissociation and PTSD, using inner reflection, emotion regulation, coping with dissociative problems related to triggers and traumatic memories, resolving sleep problems related to dissociation, coping with relational difficulties, and help with many other difficulties with daily life.

First published in 2012 and revised in 2013, EMDR and Dissociation: The Progressive Approach by Anabel Gonzalez and Dolores Mosquera together with a number of contributing authors, brings forward a truly progressive model for how to approach the treatment of individuals with severe dissociative disorders using EMDR therapy. If you thought that EMDR therapy could not be used until after these patients have achieved stability in functions of every day life, this book will open your eyes to a broad range of EMDR interventions that can help resolve dissociative phobias, raise the level of mentalization and build basic capacities for self-care and self-compassion.

Another helpful guide for clinicians and clients is Sandra Paulsen’s 2009 Looking through the eyes of trauma and dissociation: An illustrated guide for EMDR therapists and clients. This book provides an easy to read guide to the integration of ego state therapy and EMDR therapy for clients with Dissociative Identity Disorder and their EMDR trained clinicians. It is filled with over 100 original cartoons describing the use of ego state therapy in preparation for trauma work with modified EMDR therapy protocols.

The classic text on the Model of the Structural Dissociation of the Personality is the 2006 book by Onno Van der Hart, Ellert R S Nijenhuis and Kathy Steele, The Haunted Self. Life is an ongoing struggle for patients who have been chronically traumatized. Based on the theory of structural dissociation of the personality in combination with a Janetian psychology of action, these authors have developed a model of phase-oriented treatment that focuses on the identification and treatment of structural dissociation and related maladaptive mental and behavioral actions. The foundation of this approach is to support patients in learning more effective mental and behavioral actions that will enable them to become more adaptive in life and to resolve their structural dissociation. This principle implies an overall therapeutic goal of raising the integrative capacity, in order to cope with the demands of daily life and deal with the haunting remnants of the past, with the “unfinished business” of traumatic memories. One of the strongest features of the book is the explanation of the varieties of dissociative phobias and how to address them.

By the way, if you have been wanting to learn more about the Model of the Structural Dissociation of the Personality and the work of Onno Van der Hart, you should be aware that Dr. Van der Hart has posted pre-prints of his many journal articles on his web site. If you have never visited this wonderfully designed and easy to navigate site I invite you to bookmark it and take a tour.

EMDR Therapy and Adjunct Approaches with Children: Complex Trauma, Attachment, and Dissociation (2012) by Ana M. Gomez provides a wide range of leading-edge, step-by-step strategies for clinicians using EMDR therapy and adjunct approaches with children with severe dysregulation of the affective system. This book offers developmentally appropriate and advanced tools for using EMDR therapy in treating children with complex trauma, attachment wounds, dissociative tendencies, and compromised social engagement. The book presents the theoretical framework for case conceptualization in EMDR therapy and in the use of the Adaptive Information Processing (AIP) model with children. A unique and innovative feature of this book is the masterful integration of strategies from other therapeutic approaches, such as Play therapy, Sandtray therapy, Sensorimotor psychotherapy, Theraplay and Internal Family Systems (IFS), into a comprehensive EMDR treatment maintaining appropriate adherence to the AIP model and EMDR therapy methodology. An digested excerpt of this book was published in 2012 in Volume 6 Issue 3 in the Journal of EMDR Practice and Research as “Healing the caregiving system: Working with parents within a comprehensive EMDR treatment.” This article is now open access.

The Child Survivor: Healing Developmental Trauma and Dissociation (2013) by Joyanna L. Silberg is a clinically rich, comprehensive overview of the treatment of children and adolescents who have developed dissociative symptoms in response to ongoing developmental trauma. In her review of this book, Christine A. Courtois wrote: "Joyanna Silberg has provided clinicians with a unique and indispensable resource for treating children and adolescents with dissociative symptoms. The EDUCATE approach that is the centerpiece of the book is an admirably concise, thorough, and clinically sophisticated guide to enable clinicians to fulfilling the book’s goal of assisting dissociative children to regain the foundational competences of self-determination and self-regulation. The clinical examples resonate with the experience of real-world clinical practice and illustrate practical strategies that every therapist needs." The publisher has made available ten Appendices from The Child Survivor for download in eResources tab of the book page. These include interviewing guides and standardized instruments such as the Child Dissociative Checklist (Version 3), the Adolescent Dissociative Experiences Scale - II, and The Child Dissociative Experience Scale and Post-Traumatic Stress Inventory (CDES/PTSI).

Journal Articles

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Buydens, S. L., Wilensky, M., & Hensley, B. J. (2014). Effects of the EMDR protocol for recent traumatic events on acute stress disorder: A case series. Journal of EMDR Practice and Research, 8(1), 2-12. doi:10.1891/1933-3196.8.1.2

Sarah L. Buydens, PhD Candidate, Registered Clinical Counsellor, #102-1022 Pandora Ave., Victoria, BC, Canada V8V 3P5. E-mail: BuydensPsychotherapy@gmail.com

Abstract

The purpose of this study was to evaluate the effectiveness of the eye movement desensitization and reprocessing (EMDR) protocol for recent traumatic events in the treatment of acute stress disorder. Within weeks of being exposed to an isolated traumatic event, 7 adults diagnosed with acute stress disorder were provided with multiple sessions of the EMDR protocol for recent traumatic events, an extended version of the EMDR therapy standard protocol. In each case, an individual’s subjective distress caused by the traumatic events was measured using the Impact of Events Scale-Revised and the goal of alleviating symptoms was accomplished. The positive results suggest the EMDR protocol for recent traumatic events may be an effective means of providing early treatment to victims of trauma, potentially preventing the development of the more severe symptoms of posttraumatic stress disorder.

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Kosatka, D., & Ona, C. (2014). Eye movement desensitization and reprocessing in a patient with Asperger’s disorder: Case report. Journal of EMDR Practice and Research, 8(1), 13-18. doi:10.1891/1933-3196.8.1.13

Donald Kosatka, MD, CT, MBA, Child and Adolescent Psychiatry Fellow (F1), Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859. E-mail: donald.j.kosatka@us.army.mil

Abstract

Eye movement desensitization and reprocessing (EMDR) has demonstrated efficacy in the treatment of posttraumatic stress disorder (PTSD). This case demonstrates the successful use of EMDR for the treatment of PTSD in a patient with Asperger’s disorder and examines potential pitfalls both in detecting and treating PTSD in patients with autism spectrum disorders. Our patient was a 21-year-old female with a diagnosis of Asperger’s disorder and multiple traumas stemming primarily from physical abuse at the hands of her peers in school. Treatment was provided in an accelerated format, being provided 3 days a week for approximately 3 weeks leaving at least 1 day in between sessions. After receiving 8 EMDR sessions, her scores improved on the Posttraumatic Checklist with effects maintained at 8-month follow-up.

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Laugharne, R., Marshall, D., Laugharne, J., & Hassard, A. (2014). A role for EMDR in the treatment of trauma in patients suffering from a psychosis: Four vignettes. Journal of EMDR Practice and Research, 8(1), 19-24. doi:10.1891/1933-3196.8.1.19

Dr. Richard Laugharne, Cornwall Partnership NHS Foundation Trust, Lodge Hill, Liskeard, Cornwall, United Kingdom, PL14 4EN. E-mail: r.laugharne@exeter.ac.uk or richard.laugharne@pms.ac.uk

Abstract

Many patients with a functional psychosis are likely to have a history of trauma and symptoms of post-traumatic stress disorder (PTSD); some may be traumatized by their psychotic symptoms. We present a series of vignettes to describe eye movement desensitization and reprocessing (EMDR) treatment of 4 patients suffering from a functional psychotic illness who had a significant history of trauma. After receiving EMDR, each patient showed an improvement in their PTSD symptoms and reported an improvement in the quality of their lives. Follow-up at 3-6 years indicated that the treatment effects were maintained, with changes evident in elimination of trauma-related delusions, reduction in anxiety and depression, fewer hospital admissions, and overall improved quality of life. Because a history of trauma and PTSD symptoms are more frequent in patients with a psychosis, and trauma may be an etiological component of psychosis, EMDR treatment needs to be researched and explored as a treatment opportunity.

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Logie, R. D. J., & De Jongh, A. (2014). The “Flashforward Procedure”: Confronting the catastrophe. Journal of EMDR Practice and Research, 8(1), 25-32. doi:10.1891/1933-3196.8.1.25

Robin David Julian Logie, PO Box 179, Chorley, Lancashire, PR6 0GN, United Kingdom. E-mail: info@robinlogie.com

Abstract

This article introduces the “Flashforward procedure,” which is a specific application of eye movement desensitization and reprocessing (EMDR). It is used for the treatment of irrational fears, for example, when a persisting fear continues after the core memories of past events have been fully processed. A theoretical background is presented, and the procedure is explained, together with 2 illustrative case studies. We describe psychological conditions and mental health problems for which the use of EMDR aimed at client’s flashforward might be appropriate, as well as indicating which stage in the therapeutic process is most applicable for the use of this procedure. Furthermore, the Flashforward procedure is compared with other EMDR applications and similar procedures in other therapies. Some implications are discussed.

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Pfefferbaum, B., Newman, E., & Nelson, S. D. (2014). Mental health interventions for children exposed to disasters and terrorism. Journal of Child and Adolescent Psychopharmacology, 24(1), 24-31. doi:10.1089/cap.2013.0061

Full text available online at: http://online.liebertpub.com/doi/pdf/10.1089/cap.2013.0061

Betty Pfefferbaum, MD, JD Department of Psychiatry and Behavioral Sciences College of Medicine University of Oklahoma Health Sciences Center P.O. Box 26901, WP-3470 Oklahoma City, OK 73126-0901 E-mail: betty-pfefferbaum@ouhsc.edu

Abstract

Objective: The purpose of this review is to describe interventions used with children who are exposed to disasters and terrorism and to present information about the potential benefits of these interventions.

Methods: A literature search conducted in January 2013 using relevant databases and literature known to the authors that was not generated by the search yielded a total of 85 studies appropriate for review.

Results: Intervention approaches used with children exposed to disasters and terrorism included preparedness interventions, psychological first aid, psychological debriefing, psychoeducation, cognitive behavioral techniques, exposure and narrative techniques, eye movement desensitization and reprocessing, and traumatic grief interventions. The investigation of these interventions is complex, and studies varied in methodological rigor (e.g., sample size, the use of control groups, outcomes measured).

Conclusions: Given the limitations in the currently available empirical information, this review integrates the literature, draws tentative conclusions about the current state of knowledge, and suggests future directions for study.

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Rathschlag, M., & Memmert, D. (2014). Reducing anxiety and enhancing physical performance by using an advanced version of EMDR: A pilot study. Brain and Behavior, Article first published online: 12 FEB 2014. doi:10.1002/brb3.221

Full text available online: http://onlinelibrary.wiley.com/doi/10.1002/brb3.221/pdf

Marco Rathschlag, Institute of Cognitive and Team/Racket Sport Research, German Sport University, Am Sportpark Mungersdorf 6, 50933 Koln, Cologne, Germany. E-mail: m.rathschlag@dshs-koeln.de

Abstract

Background

The main aim of this pilot study was to investigate an advanced version of eye movement desensitization and reprocessing (EMDR) for reducing anxiety.

Methods
Fifty participants were asked at two times of measurement (T1 and T2 with a rest of 4 weeks) to generate anxiety via the recall of autobiographical memories according to their anxiety. Furthermore, the participants were randomly assigned to an experimental group and a control group, and the experimental group received an intervention of 1–2 h with the advanced version of EMDR in order to their anxiety 2 weeks after T1. At T1 as well as T2, we measured the intensity of participants' anxiety with a Likert scale (LS) and collected participants' state (temporary) and trait (chronic) anxiety with the State-Trait Anxiety Inventory (STAI). In addition, we measured participants' physical performance in a test for the finger musculature under the induction of their anxiety.

Results
The results showed that participant's ratings of their perceived intensity of anxiety (measured by a 9-point LS) and the state and trait anxiety decreased significantly in the experimental group but not in the control group from T1 to T2. Moreover, the physical performance under the induction of participants' anxiety increased significantly in the experimental group from T1 to T2 and there were no significant changes in the control group.

Conclusions
The study could show that the advanced version of EMDR is an appropriate method to reduce anxiety.

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van der Hart, O., Groenendijk, M., Gonzalez, A., Mosquera, D., & Solomon, R. (2014). Dissociation of the personality and EMDR therapy in complex trauma-related disorders: Applications in phases 2 and 3 treatment. Journal of EMDR Practice and Research, 8(1), 33-48. doi:10.1891/1933-3196.8.1.33

Onno van der Hart, Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands. E-mail: o.vanderhart@uu.nl

Abstract

Eye movement desensitization and reprocessing (EMDR) psychotherapy can play a major role in phase- oriented treatment of complex trauma-related disorders. In terms of the theory of structural dissociation of the personality and its related psychology of action, a previous article described Phase 1 treatment— Stabilization, Symptom Reduction, and Skills Training—emphasizing the use of EMDR procedures in this phase. Phase 2 treatment mainly involves applications of EMDR processing in overcoming the phobia of traumatic memories and their subsequent integration. Phase 3 treatment focuses on further integration of the personality, which includes overcoming various phobias pertaining to adaptive functioning in daily life. This article emphasizes treatment approaches that assist therapists in incorporating EMDR protocols in Phases 2 and 3 of phase-oriented treatment without exceeding clients’ integrative capacity or window of tolerance.

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