EMDR or Eye Movement Desensitization and Reprocessing in PTSD Theory: trauma (T like rape/war or t like teasing)-> faulty info

processing (dissociation, strong negative emotion)-> no long-term adaptive memory formed. Procedure: therapist accesses ("activate") memory in brief, sequential sessions. Pt attends to memory and external stimuli simultaneously to allow proper formation of a neural synapse placing the memory in long term storage. Phases: 1. History- readiness, identify memories in the past and current stressors if applicable 2. Coping skills- therapist ensures pt has multiple ways of handling stress, adds some if needed (imagery, stress reduction techniques). Use during/between sessions. **Contraindications: detached retina/glaucoma, +/- neurological/epilepsy, unconscious at time of trauma, severe dissociation, unstable drug/alcohol abuse, suicidal, psychotic, no response after multiple tries, malingerers, legal cases pending** 3-6. Processing. Pt IDs vivid visual image; negative belief about self; emotions/ sensations related to memory. Focus on image while also focusing on bilateral stimuli (lateral eye movements following therapist's hands, hand tapping, or audio tones). Mind blank after and report sensations, therapist chooses next focus of attention; multiple cycles/session. If distressed, redirect with tools. If no distress, replaces negative belief (once pt reports none) with positive one and use that in subsequent sessions 7. Closure- log book 8. Examine progress 3-step Protocol: 1) Past is processed 2) Present is desensitized 3) Future toolbox On the Neural Basis of EMDR (2009): qEEG-Brain stimulation during EMDR allows for depotentiation of fear memory synapses in the amygdala during an evoked brain state resembling slow wave sleep; amplifies power of low-freq rhythm in memory areas Timeline 1987: Shapiro first notices association between eye movements and memory quality/PTSD 1990: First training workshops in EMDR 1991: EMDR Institute/ EMDR Networker (publication w clinical info for EMDR) are created 1993: First randomized clinical trial with PTSD in Veterans showed success 1995: First civilian trials; Shapiro publishes book- "accelerrated information processing model" 1998: EMDR vs desensitization tx; equally/more effective 2001: EMDR: Basic Principles and Procedures; accelerated information processing model -> adaptive information processing model 2002: CBT vs EMDR in adult PTSD pts equally effective, no homework time w EMDR -Studies: War, injury/illness trauma, sexual abuse with child/adult, natural disaster and stabilization phase of PTSD, Body Dysmorphic d/o, Borderline Personality d/o, Conduct d/o 2007: Journal of EMDR Practice and Research Randomized, blinded study comparing pharmacotx to EMDR. 88 PTSD patients received 8 wks with
fluoxetine (1st line SSRI; amitriptyline also found to be effective), EMDR, or placebo pill. Primary outcome was CAPS (Clinican Administered PTSD scale), secondary outcome was Beck Depression Inventory-II. No statistically sig difference at post-tx between fluoxetine and EMDR, but f/u at 6 mon showed 75% of adult-onset and 33% of child-onset PTSD survivors (58% total) acheived asymptomatic functioning compared to none in the fluoxetine group; also had less selfreported depressive sx. In child-onset, neither acheived complete sx remission but fluoxetine showed a more consistent reduction in sx (greater variation in response with EMDR). Did not test combination tx.

Reference w links to all articles mentioned and major milestones in EMDR:

www.emdr-europe.org/upload/editor/EMDR%20Milestones%20-Louise%20Maxfield%202009.pdf