Posts Tagged ‘EMDRIA.org’
Written by guest blogger, Crystal Whitlow, LCSW, Certified EMDR Therapist and EMDRIA Approved Consultant.
Although I had never been particularly interested in addictions work, I recently attended a workshop on the “Feeling State Protocol for Addictions” with Dr. Robert Miller, at the 2012 EMDRIA Conference in Washington, DC. Dr. Miller developed this protocol as an addition to, not the replacement of, the usual EMDR full protocol model in cases where addiction is being treated. In the workshop I attended, Dr. Miller focused specifically on behavioral addictions, described in the DSM as “the client feels compelled to do some behavior even if he/she knows that doing the behavior will have negative or destructive consequences.” Some examples are gambling, food, shopping or shoplifting compulsions, sex addiction and exhibitionism.
The primary focus of this protocol is targeting the positive feeling state that the client gains from the addictive behavior. Dr. Miller’s research shows that EMDR is helpful in resolving the state-dependent memories related to the addiction. For instance, with gambling addiction, the target may be the feeling of being a winner, gained from the first time the client won a big hand of poker. Reducing the desire for the addictive behavior is the goal. After targeting the positive feelings state, the usual EMDR protocol is used for any negative cognitions and feelings that have arisen around the addiction and client’s history of use.
I have used this protocol with a handful of long-term clients since returning from the conference. The results have been mixed between positive change and no change, most likely because I need more training in the protocol specifics. The most positive experience I’ve seen after using this new protocol is with a client I’ve seen on and off for 4 years, who recently presented again with an increased desire for foods that were triggering binge-eating. She was very willing to try the new protocol, and was able to identify the positive feeling state as “complete release of worries” and a “calm, clear mind” after the food binge. After one session working on reducing this positive feeling, she reported a drop from bingeing daily to zero binges in the two week period between appointments. I look forward to receiving more training in this exciting new protocol, especially since I work with many women with food and spending/shopping issues. If you’d like more information, you can visit Dr. Robert Miller’s website at www.fsaprotocol.com or find his published research in the November 2012 EMDR Journal.
Denver Regional EMDRIA Meeting
Date: January 25, 2013, 10:30 – 12:00pm
1776 South Jackson St.
Basement Conference room B
Denver, CO 80210
[ map link ]
* Park on the street rather than in the parking lot.
Food: Coffee, snacks, lunch items are available in the building cafeteria also located in basement.
“The Recent Traumatic Episode Protocol (R-TEP)”
A comprehensive approach to early EMDR Intervention, and incorporates and extends other standard EMDR protocols. It was developed by Elan Shapiro and Brurit Laub, who presented a program on this model in Denver in 2012.
Jay Fellers, LCSW and Jenny Bridges, LCSW
For more information and to RSVP contact the Denver EMDRIA Regional Network Coordinators:
Note: EMDRIA credits are not available for this program
In the EDMRIA Journal of EMDR Practice and Research (Volume 6, Number 2, 2012), there is an article entitled “Desensitization of Triggers and Urge Reprocessing for an Adolescent With Internet Addiction Disorder” by Hwallip Bae and Daeho Kim. Both are working in hospitals in South Korea. They state that up to 18% of children and adolescents in developed countries are affected by Internet addiction.
They provide one case study of a 13 year-old boy who was addicted to the Internet. This boy identified 7 triggers that made him want to play games on the Internet. He would play Internet games for five hours per day, and sometimes up to whole days. This was going on for four years and was impacting his education in a negative way. When his parents tried to control with situation it created constant stress in the family. With only 4 sessions of modified EMDR, the boy had success with his “level of urge to use the Internet” decreasing significantly. He was able to restrict his use to one hour per day.
They applied the DeTUR model developed by Popky to address the issue of Internet addiction, and did a research study to see what would happen with this protocol. This protocol modified the standard EMDR protocol. In the standard protocol, the therapist works with past, present, and future issues. In the DeTUR model, the therapist makes a list of triggers and finds the “level of urge to use” for each of those triggers. The work only focuses on the trigger and does not go back into past issues, unless the client during processing moves into older material. In order to modify the protocol, the therapist only works with the body sensations and level of urge to process. It follows up with future work to help integrate what was processed. Popky does note that many clients with addictions have experienced earlier trauma and that earlier trauma can be addressed with the standard EMDR protocol.
There are 12 steps to the DeTUR protocol:
- History, assessment and diagnosis
- Access internal resources
- Positive treatment goals
- Associated positive States
- Identifying triggers
- Desensitize each trigger
- Install positive state
- Test and future check
- Closure and self-work
- Follow up sessions
After the four sessions, the boy in the case study above reported that he felt less of a need to play, and using a timer helped him to stop at one hour. He felt less anger having to stop. They checked in with him six months later to find that he continued to have this success, and his mother confirmed that this was true.
Since this is only one case study, it will be interesting to see if they do more research what the results would show. With teens using computers and smartphones more and more, this seems like a real problem with children and needs to be looked at seriously, and EMDR maybe an important step in helping kids control their Internet addiction.
The March 2, 2012 edition of the New York Times featured a Q&A session with Dr. Francine Shapiro, the originator of EMDR, on the evidence on EMDR, one of the most highly researched therapies out there. She stated that the American Psychiatric Association (2004), Department of Veterans Affairs and Department of Defense (2010), and other worldwide organizations recommend EMDR as an effective treatment of Post Traumatic Stress Disorder. There have been 20 randomized controlled studies supporting the efficacy of EMDR.
Shapiro noted that the therapeutic relationship is important in therapy, but that EMDR really relies on the client’s own ability to heal which impacts the effectiveness of the treatment. There were questions raised on the efficacy of EMDR, and whether the placebo effect – of just being with a supportive therapist – could be the reason EMDR has been effective. Shapiro presented a study that was specifically designed to test the placebo effect, and demonstrated that the protocol is effective, and not because of the placebo effect. She also stated that client’s expectations of positive results did not impact the study either.
There were questions about the effectiveness of the bilateral stimulation and whether it is the exposure to the fear that allows the person to heal. This brought up an interesting discussion on the difference between exposure therapy and EMDR.
During reprocessing in EMDR, the client brings up something disturbing, and bilateral stimulation is added to a brief process. New material will keep emerging and the therapist guides the client through this process until all the material is no longer disturbing. Some exposure therapists believe that this brief exposure should make the client feel worse.
Unlike exposure therapy, an EMDR client does not have to tell the details of the event, and does not have “homework” of reviewing the traumatic event. In prolonged exposure therapy the client describes in detail the event as if reliving it. The story is repeated several times, and sometimes the client listens to the recording of the session at home as homework. This allows for habituation over time
A study (Ironson et al, 2002) found that 70% of the EMDR had good outcomes after 3 sessions compared to Exposure therapy where 17% of those in prolonged exposure group had good outcomes. Both have been found to be effective, but EMDR allowed the client to have less exposure to the traumatic event and no homework of listening to the event over and over.
The big question that always comes up when talking about EMDR, are the eye movements really are as effective as EMDR reports. This is still a controversial area. Some say that the eye movements interfere with the working memory processes (van den Hout et el, 2011) and another study links the same processes that occur during REM sleep (Stickgold, 2002). These reports show that the eye movements lessen the emotion and vividness of memories and help the client relax more. They also found the clients felt they had a better understanding of the truth of the event once they finished processing.
EMDR has been around for 20 years now, and there is some good research to support its use with the healing of trauma. The importance of more research being done will help answer the unknowns, and help more people to accept EMDR as a researched based therapy.
As I teach more around the country, I still here stories of therapists believing that there is no research to back up the efficacy of EMDR. I hope Dr. Shapiro will have more press time to spread the word to help solidify EMDR as solid trauma therapy. I am lucky to live in a city that embraces EMDR, and that therapists and clients ask for more all the time.
For those of you who have never heard Dr. Shapiro speak, she will be presenting at the 2012 EMDRIA Conference in Washington DC this year. It is a wonderful chance to hear from the originator of what she thinks is important in the development of this work.
Click HERE for information about the 2012 EMDRIA Conference.
Click HERE to read the New York Times article.
These are my top 5 picks on working with children. I have tried to include a variety of resources that will cover many age ranges. I highly recommend studying with the experts in person whenever you get a chance. Many of these authors teach at the EMDRIA conferences or offer their own workshops that you can find through EMDRIA’s website (EMDRIA.org) under “Training and Certification”.
Author: Adler-Tapia and Settle
I had the chance to study with Robbie Adler-Tapia and Carolyn Settle at an EMDRIA conference a couple of years ago. I was so impressed with these women that I just had to buy their book. These two are working very hard on establishing research for the efficacy of EMDR with children. This manual takes you through the 8 Phases of EMDR and how to apply it when working with children. It includes forms they use, scripts to say with detailed instructions. It is the “how to” book.
Author: Ann Waldon
This is a fun and playful workbook for children. It takes a child step by step through the EMDR process. One of my favorite parts of the book is that she includes envelopes to put Helpers in, Problems in. It’s a very creative way to teach “Containment” skills to children.
Authors: Tinker and Wilson
Living in Colorado, I’m very lucky with the wealth of EMDR experts who live in this area. Tinker and Wilson wrote this book in 1999 but it is still a valuable resource in working with children. There are lots of ideas on how to resource children and how to find targets. They also go into working with specific traumas such as: automobile accidents, lightning strikes, phobias, bereavement, complex trauma and much more.
Author: Victoria McGuiness
This book is for play therapists who have learned EMDR but are struggling with how to integrate the two modalities. One is very directive and one non-directive. McGuiness leads therapist through this process. She compares the two modalities, how working with children is different then adults, informed consent, integration, how to find targets and process through creativity.
Author: Ricky Greenwald
Ricky Greenwald is considered the expert in EMDR when working with children, especially teens. This book helps therapists with how to approach children with behavioral issues from how to interview them, helping with lack of motivation, self control skills, to trauma resolution. Greenwald includes thorough explanations, scripts and exercises that can be applied right away. If you work with teens this book will be a great resource for you.
You can find all of these books at our online Store:
If you have a suggestion for an EMDR book on working with children, please comment on this blog.
In the latest Journal of EMDR Practice and Research: Volume 5- Number 4, 2011, a study was done on the treatment of EMDR and migraines. This study was done in Istanbul hospital to see how effective EMDR in the treatment of trauma related to headaches. The sample was with people who suffered from headaches everyday.
Anyone who has ever suffered migraines knows that the pain can be debilitating. The World Health Organization (2004) reported that 1 in 20 people suffer from headaches everyday and 3000 daily migraine attacks occur per each million of the general population. Some headaches are caused from organic issues from illness or head traumas. While others have no underlying issues. Migraines can be accompanied by nausea, seeing auras, vomiting, dizziness, etc. Many headaches are treated with medications and/or behavioral treatments based on self-regulation skills such as relaxation training or biofeedback.
In the article another protocol was mentioned: Marcus (2008) developed a migraine treatment combining eye movements and diaphragmatic breathing, plus cranial compression – modifying the EMDR protocol. The breathing helps stimulate the parasympathetic nervous system, which brings on a relaxation response. Results showed this technique is effective in alleviating headaches. I studied with Marcus at the 2008 EMDRIA conference to learn his protocol and have found it quite effective in working with people who have headaches in the moment.
For this particular study there was an EMDR headache protocol developed:
- Traumatic events that connected to headaches – first headache remembered
- Any traumatic events that took place close to the headaches beginning
- First, worst, last
- Current Triggers
- Future template based on triggers
- Any other traumas not connected to the headaches
The results showed a significant decrease in headache frequency and duration with no reduction in pain intensity. Also, there was a decrease in the use of painkillers and visits to the ER.
I have found in my own treatment of headaches for clients that this approach works very well and that clients do experience some relief. When clients can process traumas that they haven’t been able to, it decreases the trauma response in the body. Helping clients learn to self-soothe, regulate when first signs of headaches appears, allows them to feel more in control of the headaches.
This was an exciting study and I hope EMDR therapists will start examining and working with headaches through the use of targeting traumas that help headache suffers digest old traumas so that they can be present in the moment.
For more detailed information on this study please join EMDRIA so that you can receive the quarterly journal.
The EMDR Research Foundation is helping therapists find ways to research and support EMDR. EMDR Research Foundation relies on continued support from EMDR therapists who believe in the value of EMDR.
The two studies that received the grants ($10,000 each):
- Pre-intra- and post= treatment EEG imaging of EMDR therapy related changes in a cortical of patients and healthy controls, conducted by Marco Pagani, Senior Researcher with the Institute of Cognitive Sciences and Technologies, CNR in Rome and Padua, Italy. They will be looking at cortical activations occurring during EMDR therapy using eye movement.
- A Functional neuroimaging study in PTSD patients versus healthy controls before and after EMDR psychotherapy: implications for the neurobiological mechanism of action of EMDR, conducted by Benedikt Amann in Spain. PTSD patients will undergo pre- and post-treatment of MRI scanning during trauma evoking and processing.
In order to keep funding research, the Foundation is inviting EMDRIA members to become Charter Members. You can pledge $15.00 a month to become a Charter Member of the Foundation’s Visionary Alliance. This is a tax-deductible contribution.
Charter Members are also eligible to win prizes:
- One-Year subscription to EMDR Therapist Network
- One week accommodations to a deluxe resort
- Tac-Audio Scan
- A CE Distance Learning from Trauma Institute & Child Trauma Institute
- and more
Remember any amount can help the cause. Take time to donate today:
During the 2011 EMDRIA Conference, Dr. Daniel Siegel, author of “Mindsight: The New Science of Personal Transformation” posed the question, “What is the definition of the ‘mind’?” Few people had learned a definition in their psychology training programs.
Siegel views the mind as “an emergent property that arises from the interactions of elements of a system – i.e. from the flow of energy within embodied neural activity and relational communication.” Simply put, he believes that the mind is different from the brain and is impacted by the exchange of energy in relationship.
As therapists, he suggests that being “mindful therapists” will have an impact on our clients mind and brain. Learning how to be present in a session with one’s own state can help regulate and change a client’s experience of self. Some of the skills to be a mindful therapist include: attuning, building trust, understanding and recognizing traumas. When a client is “seen””by the therapist, he feels that he is not so alone in the world, is understood, and is connected in the world.
In order to learn these skills, therapists must look within themselves to develop these skills first, so that they can be more present with their clients. One way to do this is through meditation and self-reflective exercises of mindfulness.
When an EMDR therapist becomes more conscious of this exchange of energy in one’s sessions, the therapist becomes very important to the healing process. Being witnessed is important to a client’s ability to process trauma.
In the Advanced EMDR Workshops at the Maiberger Institute (i.e. “PTSD,” “Somatic,” and “DBT“) skills are taught to help enhance the therapists’ ability to self-reflect and to be an important conduit in the therapeutic relationship.
Click HERE for more information on our Advanced EMDR Workshops:
Click HERE for more information about the EMDRIA Conference:
Click HERE for more information on Dr. Daniel Siegel:
Dr. Francine Shapiro was a keynote speaker at the 2011 EMDRIA Conference. She emphasized that Adaptive Information Processing (AIP) is still the working hypothesis in why EMDR works. The wonderful part of EMDR therapy is that the client’s brain has inherent wisdom of how to heal. The bilateral stimulation used in EMDR therapy helps activate this inherent wisdom of the brain, so that the client can heal from traumatic events. Dysfunctional symptoms decrease and clients feel more positive about themselves.
EMDR therapy works on three levels:
- working on the past traumatic event
- any present day triggers, issues or symptoms
- future fears
When traumatic material is worked on in each of these levels, the memory integrates fully so that the client feels at peace with the past, empowered in the present, and able to make choices for the future. This is done in 8 Phases of treatment so that client feels ready, safe, and resourced to be able to do this work.
Important in this process is the rapport between the client and therapist. This connection allows clients to feel support enabling them to trust that they are capable of moving through past traumas.
Dr. Shapiro shared a story of what a client said about EMDR: “My therapist is the banister of the stairs that I climb.” This is a beautiful metaphor of how the therapist is there to support the client as the client is navigating traumatic material. The lasting effects of EMDR can change one’s life profoundly. Clients report that they relate to others in new ways, see new possibilities in their lives, feel stronger about themselves, and find a deeper appreciation for life
The last thing that Dr. Shapiro emphasized was the continued need for research in the field of EMDR, and that funding is necessary because of cutbacks. Anyone who can dedicate money for research should contact the EMDR Research Foundation (www.emdrresearchfoundation.org). Also, any research that can be done in your practice can benefit the support of EMDR throughout the world. The research foundation can help guide you on how to set-up case studies in your own practice.
I encourage those of you who have never attended an EMDRIA conference to check it out in 2012 in Washington DC. And those of you who did attend this year, to share the knowledge your learned with your fellow colleagues through networking events and consultation groups. Or you can comment on this blog.
Together we can support each other to make a difference in the world.
Click HERE if you like to make a donation to the EMDR Research Foundation:
Click HERE if you would like to attend the 2012 EMDRIA Conference: