RUNNING HEAD: Assignment #2 Best Practices

Assignment #2: Best Practices PTSD & EMDR

Natasha Sakchekapo-Lalande

Assignment #2: Best Practices

Post-Traumatic Stress Disorder (PTSD) is a debilitating, symptom-stricken, and

both physically and emotionally painful disorder. PTSD can be caused by a variety of
traumatic situations, and these situations are known to cause significant stress to a
person. The diagnosis of PTSD can occur within one month or more of the traumatic
incident, and patients must experience certain symptoms to obtain PTSD diagnosis.
Symptoms of PTSD are exhausting, and there is quite a lengthy list. Not only does
PTSD affect an individuals mental health, but also physical, medical, and social wellbeing. There are several therapies and interventions that professionals use when
working with PTSD, but research has shown how Eye Movement Desensitization and
Reprocessing (EMDR) has worked effectively and specifically to PTSD.
Pharmacotherapy is also often used with PTSD, and in partner to the intervention.
Many people argue that traumatic events are undefinable. In the DSM-5 the
stressor criterion requires exposure to death, threatened death, actual or threatened
serious injury, or actual or threatened sexual violence (Sareen, 2014, p. 461). Many
people throughout the world would be able to fit criteria to be diagnosed with PTSD, and
in sad reality, many people have experienced trauma in their lives but go without help.
Nowadays it is too common to encounter traumatic experience, even if an individual is
just going to the grocery store. A traumatic experience can be a car accident, loss of a
loved one, being involved in a robbery, getting a purse stolen, experiencing a rough
flight, etc.
Symptoms of PTSD include persistent negative beliefs and expectations about
oneself, persistent distorted blame of self of other, dissociative symptoms, feelings of
detachment and constricted affect (Sareen, 2014, p. 461). Many people who have

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PTSD experience severe uncomfortableness, vivid flashbacks, and high amounts of

anxiety. There are four core features to PTSD: 1) experiencing or witnessing a stressful
event; 2) re-experiencing symptoms of the event that include nightmares or flashbacks;
3) efforts to avoid situations, places, and people that are reminders of the traumatic
event; and 4) hyper arousal symptoms, such as irritability, concentration problems, and
sleep disturbances (Sareen, 2014, p. 460). These symptoms must be present for at
least one month, and must interfere with work or home life functioning. Re-experiencing
symptoms include flashbacks, reliving the trauma, feeling intense fear, helplessness,
and horror. Avoidance and numbing symptoms include isolation from others, less
interest in activities, and completely repressing past traumatic memories. Arousal
symptoms include increased emotions, difficulty sleeping, and outbursts of anger or
irritability. Symptoms can last for longer than 12 months after the trauma (Gupta, 2013,
p. 86).
PTSD has a higher frequency of a wide range of medical conditions (Gupta,
2013, p. 87). Individuals who suffer from PTSD often feel physical pain, and are likelier
to experience cardiovascular, respiratory, musculoskeletal, neurological, and
gastrointestinal disorders, diabetes, chronic pain, sleep disorders and other immunemediated disorders according to various studies (Gupta, 2013, p. 87). In my first-hand
experience with PTSD, I have seen the crippling effects. The medical conditions
sometimes come out of nowhere, and are unavoidable. Sleep hygiene is also greatly
affected, insomnia and nightmares are reported by 70% of PTSD patients (Gupta,
2013, p. 87). Socially, people with PTSD struggle with interpersonal problems,

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parenting difficulties, and reductions in household income (Sareen, 2014, p. 462).

Suicide is also a risk for people who suffer from PTSD.
A popular intervention for PTSD is the Eye Movement Desensitization and
Reprocessing therapy. Francine Shapiro developed this therapy. On a walk in the park
in 1987, Shapiro noticed when thinking about troubling memories, moving her eyes
back and forth eased her emotions and calmed her down. EMDR is usually completed
in a 90-minute session where the therapist will move their fingers back and forth and
ask you to recall the traumatic event. EMDR encompasses the complex emotional
responses following a distressing event by looking at affect, physical sensations,
cognitions, and emotions and beliefs concurrently (McGuire, Lee & Drummond, 2014,
p. 278). Through integrating treatment of physical, mental, and psychological well-being
of an individual, EMDR demonstrates a complete treatment approach. Individuals need
to be able to process not only their recollection and details of what happened, but all of
the physical and emotional sensations they felt as well. For example, if somebody were
to get attacked and sexually abused, the setting, the sounds and smells during the
event, the physical appearance of the attacker, and their beliefs and values would all be
actively working. These aspects to their event would affect where they go, who they talk
to, what they wear, and all of their senses would be in hyper-arousal state following the
traumatic event. If this individual used EMDR treatment, they would feel a relaxation
response, facilitating reprocessing of memories by decreasing distress (McGuire, Lee
& Drummond, 2014, p. 279). In a client focusing both on their emotions and the eye
movements, this may disrupt the storage of traumatic memories, decreasing the
episodic quality of the memory and therefore decreasing the symptoms of PTSD

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(McGuire, Lee & Drummond, 2014, p. 279). The process of completing the eye
movements desensitizes patients to anxiety and integrates information processing
(Chen et al, 2014, p. 1). The eye movements are of dire importance to this therapy, and
are the main part of effectively using this therapy. The eye movements unblock the
information-processing centers of the brain, creating a connection between stored
information on previous events and adverse outcomes that is used to generate a
response to a current stimulus (Chen et al, 2014, p. 2). It has been suggested that the
bilateral eye movements may facilitate interhemispheric interaction, resulting in
improved processing of the memory (McGuire, Lee & Drummond, 2014, p. 279). These
movements increase communication between both sides of the brain, and therefore
results in processing. EMDR not only helps in dealing with the trauma and emotions, but
also enhances the capability of the brain. The eye movements are not the only aspect to
successful outcome in EMDR, this therapy also integrates elements from other
psychotherapies such as cognitive-behavioral, interpersonal, experiential and bodycentered therapies (Rothmayr, 2003). In having all of these different therapies, EMDR
holistically approaches individuals and ensures every anxiety/trauma affected area is
touched on. EMDR is built to help people alleviate their symptoms and develop positive
coping mechanisms when feeling anxiety. There is research that suggests that EMDR
may be superior to other treatment models in terms of treatment efficiency (McGuire,
Lee & Drummond, 2014, p. 277). In using EMDR, symptoms are known to reduce
quicker than if one were to use another therapy. Individuals feel rather relieved once the
pain and interference of their symptoms go away which results in fewer treatment
sessions required for the same outcome in comparison with other types of therapy

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(McGuire, Lee & Drummond, 2014, p. 277). In comparing EMDR to prolonged

exposure, individuals have reported that the exposure was more distressing,
particularly in the first session, than EMDR (McGuire, Lee & Drummond, 2014, p. 277).
It is hard for people with PTSD to discuss the details, sounds, and smells of the event
that happened to them. In having an individual speak about it, it retriggers symptoms of
fear, temptation to avoid feeling or processing their emotions, and almost immediately
shuts down their thought processing. When repressed memories are brought to the
surface, an individual often feels mentally and physically tempted to run and hide from
encountering those particular memories. In EMDR, being able to recall the emotions felt
during that tragedy, and then being guided through the processing of that information is
effective. The eye movements show similar attributes to mindfulness. When focusing on
the present moment, an individual feels focused, their muscles relaxed, and their mind
sharp. EMDR focuses on the troubling thoughts, and attempts to process them in a
natural, and somewhat easy manner. EMDR mechanisms involve components of
mindfulness, cognitive restructuring, exposure to the memory, and a sense of personal
mastery (McGuire, Lee & Drummond, 2014, p. 279). Individuals using EMDR get to
experience relaxation, being in the here and now, and they also get to develop a high
sense of accomplishment. There is no better feeling than controlling emotions, not
feeling afraid, and being able to properly process information rather than repressing or
avoiding it. There have been several studies that have shown fewer dropouts in EMDR
groups, leading to the proposition that EMDR is both tolerated and a more efficient
treatment model (McGuire, Lee & Drummond, 2014, p. 277). EMDR has shown to be
effective without the prescription of several hours of homework (McGuire, Lee &

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Drummond, 2014, p. 277). Individuals suffering from PTSD should not be exposed
repeatedly to their traumatic experience, especially if they are alone. In having less
sessional homework, clients are able to take a break to process what happened in the
session. In using EMDR, clients are encouraged to let whatever happens happen and
just notice (McGuire, Lee & Drummond, 2014, p. 278). There are eight stages to
EMDR treatment. In the first phase, clients are most stressed as they have to discuss
thoughts and symptoms. In this phase, the therapist also sets the goals of treatment.
The first phase is a collaborated approach to the core of the treatment. The worker and
client partner together and discuss positive beliefs to use in later phases of the
treatment. The client is seen as the expert, and only needs to address emotion that they
are ready to explore. The treatment is progressive in addressing more painful emotions,
and is based on when the client is ready to do so. In the second phase, it is the workers
duty to ensure the client is stable before they begin to discuss their past traumas. In
phases three to six, images, beliefs, emotions and body sensations that are related to
the threatening event are identified (Rothmayr, 2003). It is during these phases that the
eye movements are utilized. The movements are repeated until the individuals distress
begins to lessen while thinking about their traumatic event. After the distress is
lessened, individuals are instructed to think of a positive belief (Rothmayr, 2003). In
phase seven, the client writes down anything that could be related to the traumatic
event. In phase eight, which is usually conducted in the next treatment session,
changes to the clients situation is evaluated (Rothmayr, 2003). EMDR has been
effective for many individuals around the world, but there is still plenty of opportunity for
research and studies. EMDR focuses on dealing with trauma, anxiety, and processing

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troubling memories; this therapy can be used not only with PTSD, but with many other
mental illnesses. EMDR has demonstrated effectiveness and efficiency in the treatment
of PTSD, and future research and directions for EMDR are abundant (McGuire, Lee &
Drummond, 2014, p. 280).
In pharmacological treatment of PTSD, selective serotonin reuptake inhibitors,
including sertraline and paroxetine, are most commonly prescribed to reduce PTSD
symptoms and prevent relapse (McGuire, Lee & Drummond, 2014, p. 278). Medication
is often prescribed to reduce symptoms of PTSD, but is not solely depended on to help
with the disorder. Therapy is the best practice to PTSD, and it is known that medication
should not replace evidence-based psychotherapies as a primary treatment unless
patients are unable or unwilling to engage in therapy (McGuire, Lee & Drummond,
2014, p. 278). SSRIs are usually prescribed because the brain is not receiving enough
of a chemical called serotonin. This chemical affects the way an individual feels. In
taking SSRIs, there is a change in the balance of serotonin. The change seems to help
brain cells send and receive chemical messages, resulting in higher moods. SSRIs
address the symptoms one feels, reduces them, and also assists as a sleeping aid.
SSRIs often come with significant side effects including weight gain, nausea, vomiting,
agitation, etc.
In my research for EMDR professional development opportunities, each one I
came across required a Masters level entry requirement. For future training, the Niagara
Stress and Trauma Clinic offers a 60-hour basic EMDR training. The training schedule
shows that they will be coming to Thunder Bay in April & June 2017. There are three

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parts to this training. Part one is 3 days, 15 didactic hours and 12 practicum hours.
This section of the training helps workers with simple PTSD cases. Part two is 3 days,
15 didactic hours, and 8 practicum hours. This part offers techniques and protocols for
working with complex PTSD and special populations (Niagara Stress and Trauma
Clinic, 2014). The last part is 10 hours consultation with an EMDRIA-Approved
consultant. The consultation gives the workers support they need to successfully
integrate EMDR into their practice (Niagara Stress and Trauma Clinic, 2014).This
training is very extensive and thorough, and although it is just basic it is very academic.
It is open to clinicians holding at least a Masters-level education in a counselling field.
Membership in a professional association with a Code of Ethics and sanctioning ability
is also required. There is an all-inclusive training fee of $2,100, with payment plans
available. All of the course materials are included in this fee. There are two instructors to
this training. Barbara Horne, MASc, RMFT, is an EMDRIA-Approved Consultant who
has personally taught more than 60 courses since 2007. She has been practising in the
Niagara area since 1987. She regularly presents on EMDR to conferences in Canada
and the USA (Niagara Stress and Trauma Clinic, 2014). Lastly, Philippe Gauvreau,
PsyD, is also an EMDRIA-Approved Consultant and has worked with the
Niagara Stress & Trauma Clinic since 2007 as Facilitator, joining as an Instructor in
2010. Now NSTCs French Language Director, Philippe offers both English and French
Basic Trainings and regularly presents in both languages to conferences in Canada
(Niagara Stress and Trauma Clinic, 2014). This training is offered several times
annually, and for those students pursuing further education in Social Work, I believe this

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would be a beneficial opportunity to learn from. The training teaches how to use EMDR,
when to use EMDR, and the techniques involved in EMDR.
REFERENCES

Chen, Y., Hung, K., Tsai, J., Chu, K., Chung, M., & Chen, S. Chou, K. (2014). Efficacy
of eye-movement desensitization and reprocessing for patients with post-traumatic
stress disorder: a meta-analysis of randomized controlled trials. Plos One, 9(8), 116.
Gupta, M. A. (2013). Review of somatic symptoms in post-traumatic stress
disorder. International Review of Psychiatry, 25(1), 86-99. doi:
10.3109/09540261.2012.736367
McGuire, T. M., Lee, C. W., & Drummond, P. D. (2014). Potential of eye movement
desensitization and reprocessing therapy in the treatment of post-traumatic stress
disorder.Psychology Research and Behaviour management, 7, 273-283.
Niagara Stress and Trauma Clinic. (2014). Consultation and training for emdr therapists.
Retrieved from http://stressandtraumarelief.com/emdr-training-schedule.php
Rothmayr, C. (2003, September 24). Treating post-traumatic stress disorder (ptsd) with
emdr. Retrieved from http://healthpsych.psy.vanderbilt.edu/EMDR_PTSD.htm
Sareen, J. (2014). Post-traumatic stress disorder in adults: impact, comorbidity, risk
factors, and treatment. The Canadian Journal of Psychiatry,59(9), 460-467.