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--- emdr [2023/12/23 20:42] – [Bessel van der Kolk] tom
+++ emdr [2025/02/07 15:23] (current) – [What does the process look like?] tom
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 ==== What does the process look like? ====
-[[emdr|EMDR]] is widely recommended by many of the leading mental health organizations around the world. The treatment process consists of multiple phases, including:
+Research has established a strong link between the proper application of the Eye Movement Desensitization and Reprocessing (EMDR) standard protocol and positive therapeutic outcomes. Consequently, strict adherence to this protocol is essential for maintaining EMDR’s empirical effectiveness and robustness [( :harvard:Maxfield2002>>
+authors   : Maxfield, L., & Hyer, L.
+title     : The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD.
+publisher : Journal of Clinical Psychology, 58(1), 23–41.
+published : 2002
+url       : https://doi.org/10.1002/jclp.1127
+)]. The protocol consists of eight structured phases, each incorporating specific procedures and standardized questions. These phases are outlined in Table 1.
-**Phase 1:** History and Treatment Planning. The first phase of EMDR is a history-taking session, where you and your therapist will identify possible targets for therapy. With a greater understanding of you and your needs, your therapist will then develop a treatment plan that targets:
+=== The Eight Phases of the EMDR Standard Protocol ===
-  * the event(s) that occurred
+^ Phase ^ Description ^
-  * the current
+| **Phase 1: Patient History and Treatment Planning** | Gathering patient history, identifying symptoms, formulating a case conceptualization, and creating a treatment plan. |
-  * the present circumstances that cause distress
+| **Phase 2: Preparation** | Establishing a therapeutic alliance, providing psychoeducation on trauma and EMDR therapy, and enhancing emotional regulation skills. |
-  * the necessary abilities or behaviours needed to learn in the long term
+| **Phase 3: Assessment** | Identifying target memories, activating traumatic memory components (image, negative cognition, positive cognition, emotions, bodily sensations), and assessing distress levels using a 0-10 scale. |
+| **Phase 4: Desensitization** | Processing traumatic memories through dual-attention tasks (e.g., guided bilateral eye movements) until distress is no longer reported. |
+| **Phase 5: Installation** | Reinforcing a positive cognition associated with the traumatic memory. |
+| **Phase 6: Body Scan** | Conducting a full-body scan to identify and release residual distress linked to the memory. |
+| **Phase 7: Closure** | Ensuring patient stability post-session and making necessary follow-up arrangements. |
+| **Phase 8: Reevaluation** | Reviewing progress and assessing treatment effectiveness in subsequent sessions. |
-**Phase 2**:  Preparation. During the second phase of EMDR, your therapist will guide you in learning different coping and relaxation strategies to handle emotional distress. These stress reduction techniques are meant for you to use during and between sessions. Since EMDR tends to produce rapid change, the goal is to maintain balance and equilibrium in your day-to-day life.
+=== Overview of the EMDR Process ===
-**Phases 3-6**: Assessment. During the third phase, you and your therapist will identify particular memories and the components associated with them, including:
+The primary goal of EMDR therapy is to minimize distress associated with traumatic memories while strengthening positive self-referential beliefs. The therapist facilitates the process by guiding the patient through structured memory activation and bilateral stimulation exercises.
-  * A detailed mental picture of a target event (from phase 1)
+The process begins with **Phase 1**, where the therapist gathers the patient’s history, identifies PTSD symptoms, and selects target memories for treatment. In **Phase 2**, the patient is prepared for trauma processing through psychoeducation and coping strategies.
-  * A negative belief about yourself associated with the event
-  * Relevant emotions and physical sensations
-**Phases 4-7**: Treatment. These phases focus on using EMDR therapy techniques to treat the targeted memories. While focusing on the mental image, emotion, or belief, your therapist will ask you to follow specific eye movements. These movements are also known as bilateral stimulation and can include other repetitive activities such as tapping.
+**Phase 3** involves assessing the identified traumatic memory. The therapist asks the patient to recall the most distressing aspects of the memory while evaluating their negative and positive cognitions, emotions, and bodily sensations. The level of distress is measured using the Subjective Units of Disturbance Scale (SUDS) ranging from 0 (no distress) to 10 (extreme distress).
-Afterwards, your therapist will ask you to clear your mind and pay attention to the thoughts and feelings that arise spontaneously. Once they're identified, your therapist may direct your attention back to the traumatic memory and move forward with another.
+In **Phase 4**, desensitization begins. The patient processes the memory using bilateral stimulation (typically rapid eye movements guided by the therapist’s hand or a light bar). After each set of eye movements, the therapist assesses spontaneous patient responses and encourages further processing until the distress associated with the memory is neutralized (SUDS score of 0).
-In case you get distressed, your therapist will guide you in returning to the present moment. This process is repeated until the distress over specific thoughts, images, or memories starts to fade.
+**Phase 5** focuses on reinforcing a positive cognition using the Validity of Cognition (VoC) scale, which ranges from 1 (completely untrue) to 7 (completely true). The patient recalls the traumatic memory while mentally repeating the positive cognition alongside bilateral stimulation until the VoC score is maximized.
+**Phase 6** involves a body scan to identify any lingering distress. If any physical discomfort is detected, additional processing is applied. In **Phase 7**, the session is concluded, ensuring that the patient is stable and comfortable before ending.
+The final phase, **Phase 8**, occurs at the start of the next session. The therapist reviews the previous session’s outcomes, evaluates progress, and determines the need for further treatment.
+==== Treatment Duration and Effectiveness ====
+EMDR therapy sessions typically last between **60 and 90 minutes** and may be conducted individually or in group settings. While randomized controlled trials on group EMDR are limited, emerging evidence suggests that it effectively reduces PTSD symptoms [( :harvard:Kaptan2021>>
+authors   : Kaptan, S. K., Dursun, B. O., Knowles, M., Husain, N., & Varese, F.
+title     : Group eye movement desensitization and reprocessing interventions in adults and children: A systematic review of randomized and nonrandomized trials.
+publisher : Clinical Psychology and Psychotherapy, 28, p784–806.
+published : 2021
+url       : https://doi.org/10.1002/cpp.2549
+)]
+ . Sessions are traditionally scheduled weekly, though intensive formats with daily or twice-daily sessions have also been shown to be effective [( :harvard:Bongertz2017>>
+authors   : Bongaerts, H., van Minnen, A., & de Jongh, A. (2017).
+title     :  Intensive EMDR to treat PTSD patients with severe comorbidity: A case series.
+publisher : Journal of EMDR Practice and Research, 11(2), 84–95.
+published : 2017
+url       : https://doi.org/10.1891/1933-3196.11.2.84
+)].
+Studies indicate that some individuals no longer meet PTSD diagnostic criteria after just **five EMDR sessions** following a single-incident traumatic event [( :harvard:Nijdam2012>>
+authors   : Nijdam, M. J., Gersons, B. P. R., Reitsma, J. B., de Jongh, A., & Olff, M.
+title     : Brief eclectic psychotherapy versus eye movement desensitization and reprocessing therapy in the treatment of posttraumatic stress disorder: Randomized clinical trial.
+publisher : British Journal of Psychiatry, 200(3), 224–231.
+published : 2012
+url       : https://doi.org/10.1192/bjp.bp.111.099234
+)]. However, for individuals with PTSD stemming from multiple traumatic experiences, treatment typically requires **8 to 12 sessions** in routine clinical practice. For a comprehensive description of the EMDR protocol, refer to Shapiro (2018).
-**Phase 8**: Evaluation. In the final phase of treatment, you'll examine your progress.
 ===== EMDR example sessions: =====
@@ Line 110: / Line 147: @@
 ==== Critique of EMDR and Francine Shapiro ====
-A summary and current view on the topic :
+A summary, historical overview and and the current states of affair on the topic :
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