1. The European Network for Traumatic Stress Training & Practice www.tentsproject.eu

2. EMDR for treatment of PTSD and traumatic memories Dr. Kerstin Bergh Johannesson Specialist in clinical psychology

3. Overview Overview of EMDR Historic background Description of the EMDR method Proposed mechanisms of action Research Case example Summary

4. EMDR overview Trauma-focused psychotherapeutic method EMDR integrates elements of many psychotherapeutic schools: psychodynamic, cognitive behavioural, client-centered, body- centered

5. EMDR overview 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

6. 20 years ago Francine Shapiro – inventor of EMDR First publication 1989 Vietnam veterans, victims of sexual abuse –3 sessions – no longer meet criteria for PTSD!

7. Eye Movement Desensitization and Reprocessing - EMDR Originally EMD – Eye Movement Desenzitization Has developed from scientific scepticism to international acceptance

8. EMDR for treatment of chronic PTSD “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).

9. Processing of experiences Normally – experiences are processed Special circumstances lead to overload –Experiences are not processed –Memories will be stored in an unprocessed state –When triggered, the painful emotions are re-experienced– ”the invisible wound”

10. EMDR as a method Treatment focuses on how trauma affects present functioning Processing includes working on one individual trauma memory at a time Bilateral stimulation accompanies the client’s processing Therapist guides client through the process

11. What is EMDR? EMDR stimulates the innate brain capacity for information processing Treatment involves transmuting disturbing memories into an adaptive resolution

12. An eight phase approach Phase 4 – 6 unique to EMDR treatment 1.History taking phase 2.Preparation phase 3.Assessment phase 4.Desensibilization phase 5.Installation phase 6.Body scan phase 7.Closure phase 8.Re-evaluation phase

13. What does a session look like Specific memory – identification of components Onset with a representative picture/component of traumatic memory Start of an inner process of associations, with simultaneous bilateral stimulation (BLS), guided by therapist Client reports changes in associations Process repeated with short breaks

14. Proposed mechanisms of action Increased retrieval of memories by eye movements Taxing of working memory Connections to neurobiology: rem-sleep Mindfulness

15. EMDR for whom Adults - children Painful memories from –Traumatizing experiences –After disasters and terror attacks –Traumatic memories after bereavement Individual- and group setting

16. Research Many randomized controlled trials EMDR and cognitive behavioral therapy (CBT) equivalent efficay – Level A rating (ISTSS) For children fewer studies – Level B rating (ISTSS)

17. Case example: the policeman Newly graduated Threat full situation Policeman uses gun, wounds the suspect Charged for police malpractice Develops PTSD Begins EMDR-treatment after three months

18. EMDR session I Picture: The eyes of the suspect – Negative cognition: I am vulnerable – Positive cognition: I am capable enough, I can handle the situation Processing

19. EMDR session I Result: –I am capable enough, I can handle the situation ” I can find calmness inside myself” Further processing

20. EMDR session II Picture: car of suspect, big, high, dark –Negative cognition: I am threatened and can not defend myself –Positive cognition: I can defend myself Processing

21. EMDR session II Result –I can defend myself ”It feels irritating that the picture and the emotion need to exist!” Further processing

22. EMDR session III Picture:Charge for malpractice –Negative cognition: I am incompetent –Positive Cognition : I am competent Processing

23. EMDR session III Result –I am competent ”I did what I have been taught, I am proud of myself!” Further processing

24. EMDR summary Effective method for treatment of traumatic memories Fast (3-7 sessions for single trauma) Well tolerated by clients Robust results Clients with complex PTSD need more comprehensive treatment