4PPPT Emdr Igtpoverview February2024

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EMDR INTEGRATIVE GROUP TREATMENT PROTOCOL FOR ONGOING

TRAUMATIC STRESS OVERVIEW© (EMDR-IGTP-OTS) ©
Presentation · March 2024
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EMDR INTEGRATIVE GROUP
TREATMENT PROTOCOL FOR
ONGOING
TRAUMATIC STRESS ©
(EMDR-IGTP-OTS)
OVERVIEW
By Ignacio (Nacho) Jarero
JANUARY 2024
ALL RIGHTS RESERVED (2017-2020)

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PROTOCOL
BACKGROUND
ALL RIGHTS RESERVED (2017-2020) 2

by AMAMECRISIS and Scaling Up, LLC
The EMDR
Integrative Group
Treatment
Protocol (EMDR-
IGTP)© for early
intervention was
born in 1998 with
a mango tree as
the roof and sea
sand as the floor.

by AMAMECRISIS and Scaling Up, LLC 3
It is the first EMDR protocol for individual treatment in a
group format/setting and was created in 1998 out of necessity
by members of the Mexican Association for Mental Health
Support in Crisis after hurricane Pauline.
WHY DID WE DEVELOP
AN EMDR-IGTP VERSION
FOR ONGOING
TRAUMATIC STRESS?

We developed the
EMDR-IGTP for Ongoing
Traumatic Stress (EMDR-IGTP-
OTS)© to provide EMDR
therapy treatment to
populations living with
recent, present, or past
prolonged adverse
experiences (e.g., ongoing,
prolonged, or life-long
traumatic stress).

Like the African orphans in this
picture
LUZAKA,ZAMBIA, AFRICA. SEPTEMBER 2017
OVER 150 ORPHANS TREATED.
COURTESY OF ELLEN PACE.

The refugees in Ethiopia
Kelly Smyth-Dent teaching
the Butterfly Hug in Ethiopia
in 2018 ALL RIGHTS RESERVED (2017-2020)
In the year 2020, we
developed the EMDR-
IGTP-OTS-REMOTE© to
provide Online EMDR
therapy to healthcare
professionals working in
10 hospitals with
COVID-19 patients.
Pérez, M.C., Estévez, M.E., Becker, Y., Osorio, A., Jarero, I.,
& Givaudan, M. (2020). Multisite Randomized Controlled
Trial on the Provision of the EMDR Integrative Group
Treatment Protocol for Ongoing Traumatic Stress Remote
to Healthcare Professionals Working in Hospitals During
the Covid-19 Pandemic. Psychology and Behavioral Science
ALL RIGHTS RESERVED
International Journal. 15(4):1-12.
(2017-2020)
The EMDR-IGTP-OTS
administers the eight
phases of the standard
EMDR individual treatment
in a group format/setting,
using art therapy (i.e.,
drawings, symbols) and the
Butterfly Hug (BH), as a
self-administered bilateral
stimulation (BLS) method
to reprocess traumatic
material.
Artigas, L., & Jarero, I. (2014). The Butterfly Hug. In M. Luber

(Ed.). Implementing EMDR Early Mental Health Interventions
for Man-Made and Natural Disasters (pp. 127-130). ALL RIGHTS New York,(2017-2020)
RESERVED
NY: Springer. by AMAMECRISIS
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WHY DO WE USE THE BH
FOR THE REPROCESSING OF
THE ADVERSE EXPERIENCES
IN OUR GROUP
PROTOCOLS?

“After leading the Hurricane survivors in an
exercise called the Light Stream
Technique…Nacho asked me to bring closure to
the exercise. I was happily playing with a small 4-
year-old boy who, between laughs and
spontaneous hugs, asked me, and when you
return home ... who will hug me? … I put myself in
the center of the circle of people… And, in a
moment of inspiration, I answered him with the
Butterfly Hug”
Lucina (Lucy) Artigas
Butterfly Hug Originator

To our Aztec Mexican Culture, the Butterfly symbolizes
the Soul or the Vital Breath of the Warriors… And
serves as a reference to that which is limitless….

The BH instruction: “Stop when you feel in your body that it has
been enough and lower your hands to your lap” allows for
enough sets of BLS for reprocessing the pathogenic material
and helps to regulate the stimulation in order to maintain the
patients in their window of tolerance allowing for appropriate
reprocessing.
Jarero, I & Artigas, L (2021). The EMDR Therapy Butterfly Hug Method for Self-Administered Bilateral Stimulation.
Iberoamerican Journal of Psychotrauma and Dissociation, 11(1), 1-7. www.revibapst.com

by AMAMECRISIS
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With the BH patients have
total control over their
BLS.
It is thought that the
control obtained by
patients over their
bilateral stimulation may
be an empowering factor
that aids their retention of
a sense of safety while
reprocessing pathogenic
memories.
Jarero, I & Artigas, L (2021). The EMDR Therapy Butterfly

Hug Method for Self-Administered Bilateral Stimulation.
Iberoamerican Journal of Psychotrauma and Dissociation,
11(1), 1-7. www.revibapst.com ALL RIGHTS RESERVED (2017-2020)
All the material is copyrighted. All rights are reserved 15
Lucy Artigas (the BH originator)
believes that the BH is acceptable
around the world because children,
adolescents, and adults all have a
HUMAN BODY in common, that is
sensitive and grateful to the security
provided by the warm feeling of the
hands-on the chest ... Hands that
gently touch the specific area where
our heart is when crossing. The heart
is grateful to receive the alternating
‘flapping’ of the hands…

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We have been informed that if you do the BH on your chest, you
are touching acupuncture points from the Kidney and Stomach
channels who are specifically related to fear and anxiety.
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From the Working
Memory theory
perspective, the BH is
an active dual attention
task that increase the
working memory
taxation, making the
pathogenic memory,
less vivid and less
emotionally and
somatic charged.

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PROTOCOL’S MAIN
OBJECTIVES

Be a component of a
symptom trajectory-
based stepped-care
approach for trauma-
oriented treatment.
Treat individual
prolonged adverse
experiences in a group
setting.
Reprocess pathogenic
memories.

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Reduce or eliminate
posttraumatic symptoms
(e.g., PTSD, anxiety and
depression).
Bring to conscious
awareness those aspects
of the adverse
experiences that were
dissociated.
Facilitate the expression

of painful emotions or
shameful behaviors.

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Condense the
different aspects of
the pathogenic
memories into
representative and
more manageable
images.
Increase patient's
perception of mastery
over the distressing
components of the
adverse experiences.

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The Emotional Protection
Team offers the patients
support and empathy.
Identify those who need

further assistance
(symptom trajectory-based
stepped-care approach).
Normalize reactions: The

patients can see that their
reactions are normal since
other patients have similar
reactions.

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PROTOCOL´S
ADVANTAGES

 The group setting allows for a
group administration of individual
EMDR treatment, ensuring that
many individuals can be treated
simultaneously. This is highly
valuable in settings where resources
are limited.
 Also, the group setting reduce the

stigma associated with mental
health services, normalize
psychosocial support, and creates a
sense of belonging, offering
emotional support to participants.

 The structured worksheet promotes a
sense of pathogenic memories'
containment.
The highly manualized treatment
protocols, facilitate treatment adherence.
Treatment can be delivered
online or in-person in non-
private settings such as
under a mango tree, in
shelters, open-air clinics,
and so forth.
Patients in the group do

not have to verbalize or
write information about
the adverse experiences,
preventing the other
participants and clinicians
Secondary Traumatic Stress
(STS) or Vicarious Trauma.

The protocols are suitable
for large-scale, post-
traumatic situations and
chaotic conditions, and
also for small groups (e.g.,
families).
All treatment and

pathogenic memories'
exposure take place in the
affect-regulating presence
of the Emotional
Protection Team.
Protocols are designed to

be a structured and time-
limited treatment
intervention easily taught
to both new and
experienced EMDR
clinicians.
EMDR clinicians can
be assisted by specially
trained allied
professionals (e.g.,
medical doctors, social
workers, nurses), in
particular situations
where the availability
of EMDR clinicians is
limited.

The Emotional Protection Team (EPT) plays a crucial role
during the protocols administration.
For example:
 Provides the Neuroception of security for the
participants.
 Bring support to participants to follow the
protocol’s instructions correctly.
 Answers participants’ questions.
 Are the leader’s eyes and ears in particular with
large groups.
 Provide 1-1- intervention between sets or at the
end of the protocol intensive administration to
those clients/patients who need more time to
finish reprocessing the distressing material.
30
The pathogenic
memories are not
visualized mentally
as in the standard
EMDR protocol, but
instead are
represented
concretely in the
participants’
drawings or symbols.

Drawing is superior
to activities such as
reading or writing
because it forces
the person to
process information
in multiple ways:
visually,
kinesthetically, and
semantically.
The Surprisingly Powerful Influence of Drawing on Memory.

Myra A. Fernandes, Jeffrey D. Wammes, Melissa E. Meade (2018)
Current Directions in Psychological Science Volume:ALL
27RIGHTS
issue: 5, page(s): 302-308
RESERVED (2017-2020)
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Drawing promote
the integration of
elaborative, pictorial,
and motor codes,
facilitating creation of
a context-rich
representation.
The Surprisingly Powerful Influence of Drawing on

Memory. Myra A. Fernandes, Jeffrey D.
Wammes, Melissa E. Meade (2018) Current Directions
in Psychological Science Volume: 27 issue: 5, page(s):
ALL RIGHTS RESERVED (2017-2020)302-308
All the material is copyrighted. All rights are reserved by AMAMECRISIS and Scaling Up, LLC 33
Relying on drawings
or symbols presents
a special advantage
to provide culturally
sensitive and
effective treatment
for patients who
struggle to connect
to their cognitive
states or feel guilty
or ashamed.
Also, drawings are

used for effective
reprocessing with
patients with lower
levels of literacy.
Shapiro, F. (2016). Clinician’s Corner: EMDR Therapy. International Society for Traumatic
Stress Studies. Stress Points. ALL RIGHTS RESERVED (2017-2020)
Clients afraid to
have a crayon or
pencil in their
hands, like women
from Iraq, who are
punished with the
death penalty if
they receive
education, can use
a Sandbox and
draw with their
fingers.

Intensive EMDR
Therapy:
The protocols can be
provided on subsequent
days, two or three times
a day, and there is no
need for homework
between sessions. This
reduces the risk of
discontinuation of
treatment and research
attrition.

Intensive EMDR Therapy
Evidence suggests
that more frequent
scheduling of
treatment sessions
maximized PTSD
treatment outcomes.
Gutner, C. A., Suvak, M. K., Sloan, D. M., & Resick, P. A. (2016). Does timing matter? Examining
the impact of session timing on outcome. Journal of Consulting and Clinical Psychology, 84,
1108–1115.
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Cultural Sensitiveness,
Diversity & Inclusion
These Protocols are

culturally sensitive and
reduce cultural
resistance, even to
members of reticent
cultures to therapeutic
treatment (e.g., military,
first responders),
because the protocols…

Are minimally intrusive
and respect privacy.
Do not require creating

a narrative of the
adverse experiences.
Do not require verbal or

written disclosure of
details, prolonged re-
living the traumatic
experiences, or
homework.

“Therapists’
reports
highlighted the
EMDR-IGTP
cultural
sensitivity”
Hurn, R., Barron, I. (2018). The EMDR Integrative Group Treatment

Protocol in a Psychosocial Program for Refugee Children: A
Qualitative Pilot Study. Journal of EMDR Practice and Research,
12(4), 208-223. ALL RIGHTS RESERVED (2017-2020)
by AMAMECRISIS
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Ethiopia, 2018 Are cost-effective. People are treated more
Refugees camp. quickly, with fewer therapists, and involving larger
segments of the community, allowing for
equitable care.
Allows EMDR Therapy treatment to be
more affordable and accessible to all
people, no matter their socioeconomic
status.
Working Memory Taxation
These Protocols have

two active dual
attention tasks
performed during the
protocols that
overload the working
memory:
 Drawings.
 The Butterfly Hug.

SOME EXAMPLES OF
POPULATIONS TREATED WITH
THE EMDR-IGTP AND EMDR-
IGTP-OTS PROTOCOLS

Disaster survivors.
 Healthcare
professionals working
with Covid-19 patients.
 Refugees.
 Terrorist attacks
survivors.
 Children survivors of
ongoing war trauma.
 War Veterans.
 Patients with cancer.
 Survivors of a 50-year
long internal armed
conflict in Colombia.

Rape victims.
 Children victims of severe
interpersonal violence.
 Caregivers of patients with
dementia.
 Women survivors of domestic
violence.
Adolescents with multiple
adverse childhood
experiences.
Chronic pain patients.

What is the research
evidence behind
these protocols?

As of February
2024, all 47 (forty-
seven) EMDR-
IGTP and EMDR-
IGTP-OTS
research studies
have been
published in peer-
reviewed journals.
48
TO KNOW MORE ABOUT THE
EMDR-IGTP-OTS
GO TO
WWW.SCALINGUPEMDR.COM
All the material is copyrighted. All rights are reserved 49

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See discussions, stats, and author profiles for this publication at: https://www.researchgate.

EMDR INTEGRATIVE GROUP TREATMENT PROTOCOL FOR ONGOING

Presentation · March 2024

Ignacio Nacho Jarero

The user has requested enhancement of the downloaded file.

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020) 2

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020) 5

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020)

Artigas, L., & Jarero, I. (2014). The Butterfly Hug. In M. Luber

ALL RIGHTS RESERVED (2017-2020) 11

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020)

Jarero, I & Artigas, L (2021). The EMDR Therapy Butterfly

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020) 19

ALL RIGHTS RESERVED (2017-2020)

Facilitate the expression

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020)

Identify those who need

Normalize reactions: The

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020) 24

 Also, the group setting reduce the

ALL RIGHTS RESERVED (2017-2020)

Patients in the group do

ALL RIGHTS RESERVED (2017-2020)

All treatment and

Protocols are designed to

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020)

The Surprisingly Powerful Influence of Drawing on Memory.

The Surprisingly Powerful Influence of Drawing on

Also, drawings are

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020)

These Protocols are

ALL RIGHTS RESERVED (2017-2020)

Do not require creating

Do not require verbal or

ALL RIGHTS RESERVED (2017-2020)

Hurn, R., Barron, I. (2018). The EMDR Integrative Group Treatment

These Protocols have

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020) 44

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020)

ALL RIGHTS RESERVED (2017-2020) 47

All the material is copyrighted. All rights are reserved 49

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