EMDR: History, Controversies & New Directions

Report
EMDR: History,
Controversies & Future
Template?
Tim Dunne
Chartered Clinical Psychologist/
Accredited EMDR Practitioner
Birmingham EMDR Midlands Regional Group
5th November 2008 ©
Introduction & Outline
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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
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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
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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
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“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
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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
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1st network = stimuli/cues that elicit the emotion
2nd network = contains information re the cognitive, motor, and
psychophysiologic responses to emotions
3rd 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
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Phase 1 : A Star is born
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Phase 2 : Intergalactic Star Wars
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Phase 3 : 3G EMDR: The Next Generation
A new star in the sky
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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
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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
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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
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“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
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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
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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 (Van
Etten & Taylor, 1998; Chambless et al, 1998; Davidson & Parker, 2001; Bradley et al,
2005; NICE, 2005; Seidler & Wagner, 2006; Cochrane Review, 2008)
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
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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?
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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
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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
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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
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AI uses a 4 stage process of :
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Discovering
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Dreaming
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Designing
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Delivering
Appreciative Inquiry
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For our purposes we shall focus on the first
stage (ie) Discovering
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Working in 3s initially
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Small groups
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Large group plenary session
Appreciative Inquiry
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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
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Website : www.carlowpsychology.ie
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Email : [email protected]

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