EMDR: History, Controversies & Future Template?

5 th Tim Dunne Chartered Clinical Psychologist/ Accredited EMDR Practitioner Birmingham EMDR Midlands Regional Group November 2008 ©

Introduction & Outline

       Background to today Beginnings of EMDR Precursors of EMDR Three phases Issues & Controversies in the literature Future Template: Whither EMDR?

Appreciative Inquiry (AI) Introduction to workshop

Doctoral Research Project

 Therapists’ Beliefs about EMDR  What explanations do EMDR Therapists use to understand how EMDR works in practice?

 How do Therapists from different backgrounds integrate EMDR into their clinical practice?

 Do therapists from different backgrounds have more/less difficulty in integrating EMDR into their clinical practice?

Literature Review

       Only 3 surveys to date of Therapists using EMDR Lipke (1995) surveyed the first 1200 Therapists trained by Shapiro Lyhus (2003) surveyed how Therapists integrated EMDR (N=532). Web based survey DiGiorgio et al (2004) conducted qualitative study of integration issues (N=3) All 3 surveys were done in USA and used either Qual or Quan methods My survey is cross-cultural and uses both Qual and Quan methodology Focus group today is part of the Qualitative approach (Appreciative Inquiry)

Beginnings

       “Walk in the park” Shapiro published first paper in 1989 (a) quickly followed by a case study 1989 (b) Initially called EMD Considered to be a type of desensitisation approach EMD morphed into EMDR as Shapiro (1991) came to understand that fear reduction and anxiety were part of a comprehensive reprocessing of the T experience She discovered that negative emotions were replaced with positive feelings, insights occurred and body sensations changed Often a new self of the self emerged during treatment sessions

Beginnings

    Transformation of the T experience thru rapid learning process led Shapiro to adopt the Information Processing Model as the theoretical underpinning of EMDR This was adopted from the IP model of Lang (1977;1985) who described 3 systems of information related to emotional experiences that are organized and stored as semantic memory Foa & Kozak’s (1986) “Emotional Processing” model and Chemtob et al (1988) suggested that a fear structure is stored in long term memory Network = information about stimuli, their meanings and responses to these stimuli (autonomic arousal, escape & avoidance). Can be evoked by a wide range of stimuli such as sounds, odours and body sensations

Lang’s IP model

         1 st network = stimuli/cues that elicit the emotion 2 nd network = contains information re the cognitive, motor, and psychophysiologic responses to emotions 3 rd network = incorporates meaning attributed to the cues and responses All components of the T are activated when one element is stimulated Powerful emotions can be triggered by a wide variety of stimuli Once the emotions are evoked they can feel as real as they did during the actual T experience These networks are not static but in constant state of evolution & refinement Emotions = “bottom - up” rather than “top-down” Three networks linked by Associative processes

Three Phases in Development of EMDR

 Phase 1 : A Star is born  Phase 2 : Intergalactic Star Wars  Phase 3 : 3G EMDR: The Next Generation

A new star in the sky

    Before Shapiro’s first paper in 1989 there had only been 6 controlled studies of all psychological therapies for PTSD Since 1989, there have been 26 controlled studies on EMDR & PTSD alone EMDR Spurred rapid increase & interest in the treatment of PTSD Early EMDR papers were somewhat “evangelical” in tone (Gallo, 1996) admittedly not Shapiro herself

A new star in the sky

 Shapiro rapidly moved from the Pavlovian type explanation to the Accelerated IP model and from there to Adaptive IP model to explain the phenomena she observed in treatment of PTSD  She has always maintained that EMDR is an evolving therapeutic procedure which is still in its evolutionary first stages

Intergalactic Star Wars Break Out

   Literature become polarized quite quickly Critics of EMDR (Herbert & Meuser, 1992; Lohr et al, 1998; Lilienfield & Arkowitz, 2007; Rosen et al, 1998; Herbert et al, 2000; McNally, 1999 etc) reacted strongly to the claims made for EMDR Accusations of faking results, ethical violations, “mesmerism”, “pseudoscience”, “neurobabble”, slurs of personal aggrandisement, ad hominem attacks and innuendo of personal financial gain were all made by different writers against Shapiro

Colourful Quotations

        “The novel component of EMDR (EMs) adds nothing to the traditional imaginal exposure component” (Lohr, Tolin & Lilienfield, 1998) “What is effective in EMDR is not new and what is new is not effective” (McNally, 1999) APA Task Force (Chambless et al, 1998) were “EMDR puppets” (Herbert et al, 2000) “The research results were faked or unduly influenced by Francine Shapiro” (McNally, 1999) “Pseudoscience” (Herbert et al, 2000) “EMDR has been promoted to a range of professionals including massage therapists and chiropractors” (Herbert et al, 2000) “Shapiro’s 1989 study was a marketing tactic touting a single session cure” (Herbert et al, 2000) All of these charges have been explored and rebutted by Greenwald (1999 a & b), Perkins & Rouanzoin (2002) and Smith & Poole (2007)

Intergalactic Star Wars Break Out

  Serious methodological criticisms of the early Shapiro papers included failure to independently confirm PTSD diagnosis, reliance on subjective measures (SUDS) & the fact that Shapiro herself conducted all treatments and assessments which introduces possibility of experimenter bias Confusion also around role of EMs, misreading of her claims in the early papers, selective reporting of her data, omission of key research findings and ignorance of basic EMDR protocols (Perkins & Rouanzoin, 2002; Greenwald 1996)

3G EMDR: The Next Generation

    Consensus has emerged in the literature that EMDR is as effective as (TF)CBT in treatment of PTSD 7 meta-analytic reviews have reached similar conclusions ( 2005; NICE, 2005; Seidler & Wagner, 2006; Cochrane Review, 2008 ) Van Etten & Taylor, 1998; Chambless et al, 1998; Davidson & Parker, 2001; Bradley et al, EMDR is more effective than relaxation therapy, non-directive therapy, medication or waiting-list controls in treatment of PTSD Professional & Govt bodies such as APA (1998), ISTSS (2000), Dutch National Steering Committee on MH (2003), Dept of Veterans Affairs USA (2004), NICE UK (2005) have all accepted that EMDR is an effective treatment for PTSD

3G EMDR: The Next Generation

    Seidler & Wagner (2006) – “The efficacy of EMDR is no longer in doubt” Van der Kolk (2007) demonstrated that EMDR is more effective than SSRIs in the treatment of PTSD EMDR research on anxiety disorders, phobias, test anxiety, gambling, phantom limb pain & bereavement in recent years have all shown positive effects In 20 years EMDR has moved from a simple technique to a psychotherapy in itself

New Directions: Whither EMDR?

        Integration continues – multi-modal and with other therapies Multi-modal = use of EMDR with specific populations such as substance misusers & sex offenders Shapiro’s later writings (2007) and Dworkin (2005) demonstrate EMDR’s integration with Family Therapy Question of the issue of EMs is still unresolved – more research needed Parker & Dignall (2007) demonstrated the superiority of EMs over no EMs in a verbal learning memory task, including the ability to distinguish distracter words “If I had to do it over again, I might name it Reprocessing Therapy” – Shapiro (2001) Shapiro emphasizes that the goal of treatment is to help the individual client grow and develop within a “stable social system” (2001) EMDR = “synclectic” approach (ie) one that synthesizes and synergizes with other approaches but that ultimately goes beyond all other approaches in its uniqueness where the whole is greater than the sums of its parts

Appreciative Inquiry

    AI is an Orgl Development research approach developed by Cooperrider & Srivastva (1987 & 1990) AI aims to help Orgs to change, renew and develop staff performance AI asks questions in a particular way by asking people to envision the future (Future Template?) and fostering positive relationships between staff/teams In this way AI claims to enhance a system’s capacity for collaboration and change

Appreciative Inquiry

    The basic idea is to build Orgs around what works rather than trying to fix what doesn’t AI acknowledges the contribution of individuals/small teams in order to increase trust and Orgl Dev AI aims to create meaning by drawing from stories of concrete successes AI has been used successfully across many sectors including health & social care, local govt, religious institutions and the private sector

Appreciative Inquiry

 AI uses a 4 stage process of :  Discovering  Dreaming  Designing  Delivering

Appreciative Inquiry

 For our purposes we shall focus on the first stage (ie) Discovering  Working in 3s initially  Small groups  Large group plenary session

Appreciative Inquiry

    The aim in this workshop to give each individual a chance to reflect on their own “peak experience” of using EMDR in twos (30 mins) Share these reflections with another pair in order to pull out common elements of this ideal experience (30 mins) Finally, to bring all the sub-groups together in one large group to identify common elements from the pairs work and the small groups ( 1 Hour) Reflection on the outcomes and findings from this experience

Contact Details

 Website : www.carlowpsychology.ie

 Email : [email protected]