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EMDR Manual

Indice Manual EMDR

  1. Introduction to EMDR
  2. . Psychological evaluation/intervention protocol proposed by Psious
    1. PTSD Evaluation
      1. Evaluation Objectives
      2. Useful tools for PTSD evaluation
  3. Usage Recommendations 
  4. Recommended Bibliography 

1. Introduction to EMDR

EMDR is a bilateral simulation technique where, on the one hand ocular movements are being carried out, and on the other hand the disturbing thought is kept in mind. (Marín, C., Guillen, A. I., Vergara, S., 2016).

This technique was thought for patients with post traumatic stress disorder (PTSD), for having lived traumatic experiences such as natural disasters, assaults, sexual abuse, etc. Saphiro(2001) differentiated between two types of trauma: “T” type, that corresponds to traumas with danger of death and “t” type, that corresponds to those situations with chronicity, like school bullying situations. According to Saphiro (2001), nearly all disorders can have a traumatic origin, so the use of EMDR is justified in other problems, such as: phobias, addictions, depressive disorders, generalized anxiety, OCD, body image in eating disorders, personality disorders and behavioural problems among others. The EMDR Virtual Reality environment will favor the spacious effect and relaxation due to the patient’s situation which will be at the top of a hill surrounded by trees and mountains. Also, the fact that the therapist doesn’t have to go with the ocular movements can favor and help the patient by the evocation of the disturbing thoughts.

2. Psychological evaluation/ intervention protocol

All the information in this section is indicative. Psious’ environments are therapeutic tools that must be used by the sanitary professional inside an evaluation and intervention process designed according to the characteristics and needs of the user. 

Remember that you have a General Clinical Guide where you will find more information on how to adapt the psychological intervention techniques (exposure with response prevention, cognitive restructuring…) to Psious’ environments.

2.1. PTSD Evaluation

In this section we propose different strategies and tools on how to evaluate TEPT, as a previous step to using the EMDR technique.

2.1.1  Evaluation objectives 

  • Evaluating the presence and comorbidity with other emotional disorders.
  • Evaluating the presence of reexperimentation, avoidance and activation increase.
  • Defining anxiogenic stimuli configurations and in what grade.
  • Evaluating presence of distorted thoughts.

2.1.2 Useful tools for the Posttraumatic stress disorder 

(PTSD) evaluation

Considering the evaluation objectives, we will enumerate some of the tools that can be useful to obtain relevant information about the characteristics of your user. Remember that good objectives definitions, patient characterization and planification of the intervention are important for the therapeutical efficiency and effectiveness just like the user satisfaction. In the bibliography you will find articles where you can revise the characteristics of the proposed tools:

  • Open or semi-structured interview
  • Structured interview ADIS-IV
  • CAPS-DX interview
  • Scale (TOP-8)
  • Índice Global de Duke DGRP

Self-report:

  • PTSD Symptom Scale 
  • Impact of Event Scale (IES)
  • MMPI PTSD Subscale
  • PTSD Symtom Scale (PSS)
  • Child PTSD Symptom Scale (CPSS)
  • Traumatic Events Questionnaire (TEQ)
  • Davidson Trauma Scale (DTS)
  • Mississippi Scale for Combat-Related
  • The critical war zone experiences (CWE) scale

3. Usage Recommendations

The environment for EMDR will be used to alleviate the symptomatology caused by one or several traumatic situations. For that, the idea is that the the patient, immersed in the scene, feels a certain relaxation feeling caused by the landscape and the environmental sounds. Then, the element that will guide the ocular movements will be introduced, and the speed and direction will be adapted depending on the objectives and characteristics of the subject. Remember that you can also add auditory stimuli that go together with the visual ones.

To favor a better sense of presence, the therapist can contribute with comments encouraging the patient to remember, and this way make the patient re-live the traumatic situation at a cognitive level.

4. Recommended Bibliography

Marín, C., Guillén, A. I., y Vergara, S. (2016). Nacimiento, desarrollo y evolución de la desensibilización y el reprocesamiento por medio de movimientos oculares (EMDR). Clínica de Salud, 27 (3), 101-114. http://dx.doi.org.sire.ub.edu/10.1016/j.clysa.2016.09.001

Shapiro, F., y Maxfield, L. (2002). Eye Movement Desensitization and Reprocessing (EMDR): Information Processing in the Treatment of Trauma. Journal of Clinical Psychology, 58(8), 933-946. http://onlinelibrary.wiley.com.sire.ub.edu/doi/10.1002/jclp.10068/epdf

Echeburúa, E., de Corral, P., Amor, P. J., Zubizarreta, I., y Sarasua, B. (1997). Escala de gravedad de síntomas del Trastorno de Estrés Postraumático: Propiedades Psicométicas. Análisis y Modificación de Conducta, 23 (90), 503-526. http://zutitu.com/FitxersWeb/20/ARTICULO10.pdf 

Bustos, P., Rincón, P., y Aedo, J. (2009). Validación Preliminar de la Escala Infantil de Síntomas del Trastorno de Estrés Postraumático (Child PTSD Symptom Scale, CPSS) en Niños/as y Adolescentes Víctimas de Violencia Sexual. PSYKHE , 18 (2), 113-126. http://dx.doi.org/10.4067/S0718-22282009000200008

Bobes, J., Calcedo, A., García, M.,François, M., Rico, F., González, M. P., Bascarán, M. T., y Bousoño, M. (2000). Actas Esp Psiquiatr, 28 (4), 207- 218. https://www.researchgate.net/profile/Julio_Bobes/ publication/229011090_Evaluacion_de_las_propiedades_ psicometricas_de_la_version_espanola_de_cinco_cuestionarios_ para_la_evaluacion_del_Trastorno_de_Estres_Postraumatico/ links/54a7a5740cf267bdb90a16b2/Evaluacion-de-las-propiedadespsicometricas-de-la-version-espanola-de-cinco-cuestionarios-para-laevaluacion-del-Trastorno-de-Estres-Postraumatico.pdf

Kimbrel, N. A., Evans, L. D., Patel, A. B., Wilson, L. C., Meyer, E. C., Gulliver, S. B., Morissette, S. B. (2014). The critical warzone experiences (CWE) scale: Initial psychometric properties and association with PTSD, anxiety, and depression. Psychiatry Research, 220 (3), 1118-1124. http://dx.doi.org.sire.ub.edu/10.1016/j.psychres.2014.08.053