Exploring Best Practices: The Use of Eye

Movement Desensitization and

Reprocessing in the Treatment of Trauma

Presented by:
Jennifer Barr, LCSW
Apalachee Center, Inc.
FACT Team Leader
Tallahassee, Florida
This presentation was adapted from the original presentation EMDR: Eye Movement
Desensitization and Reprocessing co-created by Jennifer Barr, LCSW & Eman Moustafa,
LMFT.

Disclaimer:
THIS

MATERIAL IS BEING
PRESENTED FOR EDUCATIONAL
PURPOSES ONLY.
PLEASE BE ADVISED THAT
ATTENDEES WILL NOT BE
QUALIFIED TO PRACTICE EMDR
AFTER THIS TRAINING.

What is EMDR?
Eye

Movement Desensitization and

Reprocessing (EMDR) is an integrative
psychotherapy approach that has been
extensively researched and proven effective
for the treatment of trauma. EMDR is a set
of standardized protocols that incorporates
elements from many different treatment
approaches. To date, EMDR therapy has
helped millions ofpeople of all ages relieve
many types of psychological stress.
(emdria.org/)
Video: EMDR in Practice:
http://www.youtube.com/watch?v=zBtqWrs2-K0

What

are your reactions to the video?

History & Overview of

EMDR

Francine Shapiro, PhD, founder

20 years of developing EMDR
Adaptive information processing
Psychotherapeutic approach vs.

theory

technique
Requires therapist basic clinical skills
Basic EMDR protocol
Advanced protocols developed (adapted
for specific types of trauma: recent
events, eating disorder, pain issue,
working with children, traumatic grief,
chronic childhood trauma/attachment
issues, etc.)

Understanding Trauma and

the
Brain
Dan Siegels brain model (the fist)
Brain

activation in trauma (think of an almost

car accident)
Memory storage fragmented and statedependent
The terror generalizes to environmental
elements (even benign ones)
Triggers then initiate similar trauma reactions
PTSD: persistent re-experiencing, arousal, and
avoidance
Normal brain processing is not completed,
reprocessing is needed
In comes EMDR (the desensitization to combat
the avoidance so that reprocessing can occur)
It is not in the past, and you cant just get
over it!!!

EMDR as a Trauma
Treatment
Uses the natural processing of the brain (arm

injury analogy)
Minimizes re-traumatization of the traumatized
person
Avoidance versus processing (BLS)
Traumatic memory fragmentation
Actually treats trauma at a biological brain level
Memory storage: hot memory vs. bad memory
Processing occurs at a heightened speed, not all
elements are discussed as in talk therapy
Board analogy targeting sequence plan
Three-pronged approach: Addresses the past
memory, current trauma reminders, and future
anticipation of trauma reminders

Target Populations
Empirically

researched and validated

treatment for trauma
Evidenced-based treatment approach for
Post Traumatic Stress Disorder (PTSD)
Recommended by the VA for trauma
survivors (all trauma populations)

Anecdotal

evidence for the treatment

of phobia(s) and panic disorder(s)
Limited research exists regarding efficacy

Is EMDR Effective?
Research & Evidence Base
EMDR

is widely recognized as an
acceptable and appropriate
treatment methodology for trauma
A wide research base exists
The research is composed of metaanalyses, random clinical trials, nonrandomized studies and other
supporting studies
A comprehensive list of clinical trials
can be found at: EMDR Institute: The
Efficacy of EMDR

EMDR Endorsements

American Psychiatric Association (2004). Practice Guideline for the

Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress
Disorder. Arlington, VA: American Psychiatric Association Practice
Guidelines: --EMDR is recommended as an effective treatment for
trauma.

According to a taskforce of the Clinical Division of the American

Psychological Association, the only methods empirically supported
(probably efficacious) for the treatment of any post -traumatic stress
disorder population were EMDR, exposure therapy, and stress inoculation
therapy. Note that this evaluation does not cover the last decade of
research.

Department of Veterans Affairs & Department of Defense (2010). VA/DoD

Clinical Practice Guideline for the Management of Post Traumatic Stress.
Washington, DC: Veterans Health Administration, Department of Veterans
Affairs and Health Affairs, Department of Defense. ----EMDR was placed
in the Category of the most effective PTSD psychotherapies. This A
category is described as A strong recommendation that clinicians provide
the intervention to eligible patients. Good evidence was found that the
intervention improves important health outcomes and concludes that
benefits substantially outweigh harm.

California Evidence. Based Clearinghouse for Child Welfare (2010).

Trauma Treatment for Children. http://www.cebc4cw.org. ----EMDR and
Trauma -focused CBT are considered Well-Supported by Research
Evidence.

The Research Shows

Jarero, I., Artigas, L., & Luber, M. (2011). The EMDR protocol for recent critical incidents:
Application in a disaster mental health continuum of care context. Journal of EMDR Practice
and Research, 5,82-94.Participants were treated two weeks following a 7.2 earthquake in
Mexico.One session of EMDR-PRECI produced significant improvement on symptoms of
posttraumatic stress for both the immediate treatment and waitlist/delayed treatment
groups, with results maintained at 12-week follow-up, even though frightening aftershocks
continued to occur frequently.

Marcus, S., Marquis, P. & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR
in an HMO setting.Psychotherapy, 34, 307-315. Funded by Kaiser Permanente. Results show
that 100% of single-trauma and 77% of multiple-trauma survivors were no longer diagnosed
with post-traumatic stress disorder after six 50-minute sessions.

Rothbaum, B. O. (1997). A controlled study of eye movement desensitization and

reprocessing in the treatment of post-traumatic stress disordered sexual assault victims.

Bulletin of the Menninger Clinic, 61, 317-334. Three 90-minute sessions of EMDR eliminated
post-traumatic stress disorder in 90% of rape victims.

Nijdam, M.J. Gersons, B.P.R, Reitsma, J.B., de Jongh, A. & Olff, M. (2012). Brief eclectic
psychotherapy v. eye movement desensitisation and reprocessing therapy in the treatment
of post traumatic stress disorder: Randomised controlled trial. British Journal of Psychiatry,
200,224-231. A comparison of the efficacy and response pattern of a trauma-focused CBT
modality, brief eclectic psychotherapy for PTSD, with EMDR . . . Although both treatments are
effective, EMDR results in a faster recovery compared with the more gradual improvement
with brief eclectic psychotherapy.

Hogberg, G. et al., (2007). On treatment with eye movement desensitization and

reprocessing of chronic post -traumatic stress disorder in public transportation workers: A
randomized controlled study. Nordic Journal of Psychiatry, 61,54-61. Employees who had
experienced person-under-train accident or had been assaulted at work were recruited. Six
sessions of EMDR resulted in remission of PTSD in 67% compared to 11% in the wait list
control. Significant effects were documented in Global Assessment of Function (GAF) and
Hamilton Depression (HAM-D) score. Follow-up: Hgberg, G. et al. (2008). Treatment of posttraumatic stress disorder with eye movement desensitization and reprocessing: Outcome is
stable in 35-month follow -up. Psychiatry Research. 159, 101-108.

For more studies go to:

http://www.emdria.org/associations/12049/files/EMDR%20Research%202013.pdf

Components of the Model

Phase

1: History taking & Client

selection
Phase 2: Preparation Checklist
Phase 3: Assessment
Phases 4-7 (Reprocessing Procedures):
Desensitization; Installation; Body
Scan; Closure
Phase 8: Reevaluation

Phase 1: History taking &

Client selection
The

goal(s) of Phase 1 is to collect routine

background information about the client
Clinicians use their typical history or intake
forms (i.e. Psychosocial Assessment);
Informed consent is obtained;
EMDR is explained and incorporated into the
clients treatment plan

The

clinician must determine the clients

ability to engage in the EMDR process, as
well as the clients ability to cope with
stressful situations
Oftentimes, before the EMDR process is
started, the client and clinician spend time
developing resources and coping skills

Phase 1: History taking &

Client selection
Adaptive

Information Processing (AIP)

Case Conceptualization

The clinician assesses if current symptoms

are caused by earlier, unresolved traumatic
experiences
Single incident/single issue or symptom
Multiple issues/symptoms
Strengths and deficits are assessed
Target memories are explored
Coping skill building

Phase 1: History taking &

Client selection
Three-Pronged

Protocol

Past
What incidents are contributing to current
problems?
What skills are needed?

Present
What distressing symptom(s) is the client
experiencing now?

Future
What does the client want to happen?

Phase 1: History taking &

Client selection
Clinical

concerns

Client stability
Rule out Dissociative Identify Disorder

Acute presentations
substance abuse; suicide; self injury

Stabilization/appropriate coping skills

Medical considerations
Medications; eye pain

Time considerations
Is the client and therapist available for needed
sessions?

Phase 1: History taking &

Client selection
Targeting

Sequence Plan

The clinician begins exploring dominant

irrational beliefs and developing positive
beliefs that will be installed during future
sessions
Dominant irrational beliefs about the self
translate in to negative cognitions (NC)

I
I
I
I

am a bad person
cannot trust anyone
am weak
deserve to die

What the person prefers to believe about the self

translates in to the positive cognition (PC)
I am fine as I am
I did the best I could
I am adequate

Phase 2: Preparation
Phase
This phase takes one to four sessions for most
clients (for others with traumatized background
or other diagnoses, it can take longer)
The therapist will be working on three main
areas
Establishing a therapeutic relationship of trust between the
client and the therapist
Psycho-education: Explain the theory of EMDR, how it is
done, and what the person can expect during and after
treatment
Teach the client a variety of relaxation techniques for self
soothing in the face of any emotional disturbance that may
arise during or after a session (Resource Development)

When

the client is ready, therapist works with

client to identify the first target to be worked on
(can be a current trigger or past memory)

Phase 2: Preparation Phase

Resource

Development: What does the

person need to be able to face the
terrifying experience?

Think of a beloved friend or family member

A place of safety
A comforting memory or experience
A special object
A quality of courage, strength, compassion,
confidence, love, etc.

Using

bilateral stimulation (slow

movements) to reinforce positive
memory networks
Relaxation exercises & Self-soothing
techniques
Exercise: Calm/Safe place

Phase 3: Assessment
Setting

a baseline before
reprocessing
Activate memory with image
Identify negative cognition or
belief
Create positive belief (gives
hope)
The emotions, the body, and
SUDS

Phase 3: Assessment

Select a target memory

I almost drowned in a pool when I was 14 years
old.
Image
The bottom of the swimming pool.
Negative Cognition (NC)
I am not in control.
Positive Cognition (PC)
I am now in control.
Validity of PC
Clinician utilizes 1-7 scale
Emotions
Terror, out of control, I am dying
Physical sensation
Tightness in chest, cant breathe, stomachache
Subjective Units of Disturbance Scale (SUDS)
Clinician utilizes 0-10

Phases 4-7 (Reprocessing Procedures):

Desensitization; Installation; Body Scan;
Closure
Phase

4: Desensitization

Phase

5: Installation

Phase

6: Body Scan

Phase

7: Closure

BLS is used to process the image, using the NC and

SUDS
This part can take most of the session or multiple
sessions
BLS is used to install the PC; the goal is to have a
VOC of 7
BLS is used to process any physical sensations left
in the body
It is important to debrief the client and advise that
reprocessing may continue after the session
Determine if containment or relaxation exercise is
needed by client to tie up loose ends

Phase 8: Reevaluation
Once

reprocessing of the original memory target

is complete and client returns in the next
session, disturbance related to the re-processed
memory is once again assessed

Why?

Sometimes target was not completed

or other material was triggered between
sessions

Therapist assesses current level of disturbance

If client remains at a SUDS=0, resourcing or new target
may be tackled
If client shows some level of disturbance when the original
target is brought up, reprocessing continues with current
upsetting image and baseline (NC/PC do not need to be
elicited again)
Reevaluation

occurs throughout course of therapy

Light bars are often

used to simulate the
BLS (visual)

BLS can also be simulated

while holding pulsating
devices (tactile)

Finger puppets are

often used for BLS
with children

The client
can also
listen to
music
alternating
from ear to
ear
(auditory)

How to become a Certified EMDR

Therapist

From EMDRIA Certification Criteria:

1) EMDRIA Approved Training

2) License/Certification: Show evidence of a

license/certification/registration as a mental health professional.

3) Do you have at least two years experience in your field of

license/ certification/ registration?

4) Have you conducted at least 50 EMDR sessions with at

least 25 clients?

5) Have you received 20 hours of consultation by an

Approved Consultant in EMDR?

6) Attach letter or letter(s) of recommendation from one or

more Approved Consultant(s) in EMDR, regarding your
utilization of EMDR while in the consulting relationship

7) Attach two letters of recommendation regarding your

professional utilization of EMDR in practice, ethics in
practice, and professional character.

8) Attach certificates of completion of 12 hours of EMDRIA

Credits (continuing education in EMDR).

9) EMDRIA's Professional Code of Conduct. Applicants must

read and verify on the application form that they agree to adhere to
EMDRIA's Professional Code of Conduct.

EMDR Resources
EMDRIA.org

(EMDR International Association for

training, membership, research, find a therapist
link and therapist support)
Emdrhap.org (EMDR Humanitarian Assistance
Program: for training, materials, and service work)
Emdr.com (EMDR additional training, information
and resources)
Eye Movement Desensitization and
Reprocessing Basic Principles Protocols and
Procedures (Book by Francine Shapiro; technical
resource for therapists)
Getting Past Your Past (Book by Francine
Shapiro; offers practical procedures that
demystify the human condition and empower
readers looking to achieve real change)

Other types of Trauma

Treatment
Prolonged

Exposure (PE)
Cognitive Processing Therapy (CPT)
Trauma-Focused CognitiveBehavioral Therapy (TF-CBT)
Art therapy
Hypnotherapy
Structured Play Therapy
Trauma release exercises (TRE)
Specialized Massage therapy

Other Trauma Training

Links

EMDR

International Association www.emdria.org (training and certification

link)
National Institute for Trauma and Loss in
Children - www.starrtraining.org/about-tlc
Cognitive Processing Therapy through the
Medical University of South Carolina cpt.musc.edu/index (free)
National Child Traumatic Stress Network www.nctsn.org/resources/training-andeducation
Trauma-Focused Cognitive Behavioral
Therapy through the Medical University of
South Carolina - tfcbt.musc.edu (free)

Additional Trauma Resources

EMDR

International Association (emdria.org)

Clinicians Trauma Update
(www.ptsd.va.gov/professional/newsletters/ctuonline)
The International Society for Traumatic Stress
Studies (istss.org)
National Center for Posttraumatic Stress Disorder
(www.ptsd.va.gov)
National Institute of Mental Health (nimh.nih.gov)
The PTSD Alliance (ptsdalliance.org)
Traumatic Stress Education and Advocacy
(www.sidran.org)
National Child Traumatic Stress Network
(nctsnet.org/resources/topics/treatments-thatwork/promising-practices)

Any questions?
What

will you take away from this

presentation?
Did you learn anything you can
use in your own work?
Do you know how to find a
certified EMDR therapist for client
referrals?
Who wants to learn EMDR?
Thank you!