Tsai Performance Center

Overview of EMDR (Eye Movement Desensitization and Reprocessing)

• EMDR is a type of psychotherapy primarily used in treating trauma and PTSD.

• The method involves prolonged exposure to traumatic narratives akin to Prolonged Exposure (PE) therapy.

• Involves describing traumatic events in the present tense to facilitate processing.

• Includes bilateral stimulation, such as eye movements or tapping, during the narration of the trauma.

• Research indicates that the tapping and movement may not contribute additional therapeutic value beyond the exposure itself.

Effectiveness of EMDR

• Many individuals report significant improvements from EMDR therapy.

• There are substantial efficacy studies supporting EMDR's effectiveness for trauma-related issues.

• Although the therapeutic techniques (like eye movements) are commonly identified with EMDR, the core therapeutic benefit comes largely from the trauma exposure process itself.

Narrative Approach in EMDR

• EMDR therapy utilizes first-person narratives for self-reflection, such as impact statements on the client's current life.

  • Example: "After my trauma, I find it hard to trust others or go out alone."

• Clients write out their full trauma narrative and read it during sessions, engaging with therapists in discussions to challenge specific problematic beliefs connected to the trauma.

• Identifying key cognitions—like issues of power, control, and safety—is essential in therapy.

PTSD & Complex PTSD

• Traditional PTSD treatments focus on discrete trauma events, addressing experiences rather than chronic or repeated traumas (termed complex PTSD).

• Complex PTSD, not officially recognized in DSM-5, refers to pervasive and chronic trauma impacts without clear boundaries on discrete events.

• Symptoms of complex PTSD include emotional dysregulation, interpersonal difficulties, and overlap with symptoms from other disorders.

• Clinicians support patients to validate complex trauma experiences but remain cautious about labeling it as a separate diagnosis, given the complexities and challenges of treatment.

OCD (Obsessive-Compulsive Disorder)

• Definition of OCD

  • OCD is characterized by persistent obsessions (intrusive thoughts) and compulsions (repetitive behaviors).

  • Common obsessions involve fears of contamination, but OCD manifests in various forms.

  • Obsessions lead to distress, and compulsions provide only temporary relief while reinforcing the obsessive cycle.

• Therapeutic Approach for OCD

  • Effective treatment includes cognitive-behavioral therapy (CBT) combined with exposure and response prevention (EXRP).

  • Often aided by SSRIs, which help to stabilize patients and prepare them for intensive therapeutic work.

  • Patients can struggle with shifting their mindset and behaviors due to long-term habit formation of compulsive actions.

Specialized OCD Cases and Types

• Common Obsession Types:

  • Cleaning/Contamination

  • Symmetry and Order

  • Forbidden or Harmful thoughts (i.e., thoughts harm toward self or others)

• Anxieties and Compulsions:

  • Examples include a mother fearing she might harm her child due to intrusive thoughts or someone compulsively repeating prayers for perceived safety.

• Challenges in Treatment:

  • Patients often come to therapy feeling hopeless; clinicians must help them realize their compulsions restrict functionality and time.

  • Developing new beliefs around obsessions and aligning patients with the reality of not acting on compulsive urges is essential.

Related Disorders and Their Complexities

• Body Dysmorphic Disorder:

  • Patients obsessively perceive physical flaws that are invisible or minimal to others, leading to significant distress and dysfunction.

• Hoarding Disorder:

  • Characterized by excessive collection and inability to discard items, which creates living space disruption.

  • Treatment often necessitates home visits due to the nature of the disorder.

• Trichotillomania and Excoriation:

  • Hair pulling and skin picking represent body-focused repetitive behaviors that similarly involve compulsive actions.

  • Treatment options reflect traditional CBT methods that focus on alternative coping strategies and exposure tasks.

Conclusion

• EMDR and OCD are complex conditions that require understanding and tailored therapeutic approaches.

• Emphasis on patient narratives, conducting trauma processing, and applying cognitive-behavioral strategies are vital for effective treatment.

• Ongoing research and practice developments seek to enhance treatment efficacy for these challenging disorders.