Filetype PDF | Posted on 27 Sep 2022 | 3 years ago
Authentication
digital resources
168x Filetype PDF File size 0.12 MB Source: www.espacodamente.com
Letting Steam Out of the Pressure Cooker:
The EMDR Life Stress Protocol
DeanyLaliotis
EMDRInstitute,Inc., Washington, DC
The standard protocol of eye movement desensitization and reprocessing (EMDR) therapy has been well
established as an efficacious brief treatment for posttraumatic stress disorder (PTSD), addressing past,
present, and future aspects of a traumatizing event. This article provides instruction in the administration
of the EMDR Life Stress Protocol, which targets a significant recent experience or a life scenario that is
not necessarily remarkable as a stand-alone event (getting up every morning with dread, feeling anxious
about leaving the house) and which causes distress and impaired function such as has been commonly
reported during the COVID-19 crisis. This protocol involves minor but significant modifications within
EMDR therapy’s standard procedures. It uses the present-day experience as the Target Memory while
accessing briefly, the memory network of historical experiences that inform the client’s reactions to their
present circumstances. Successful processing is immediately followed by a Future Template to generate
an alternative pattern of response, optimizing the client’s capacity to respond adaptively to continued
life demands. The EMDR Life Stress Protocol differs from EMDR’s various recent events protocols, which
seektoreduceposttraumaticsymptomsfollowingarecenttraumaticeventorcrisis.Thoseprotocolsfocus
on the critical incident and ancillary events, and typically do not intend to activate memory networks of
related historical experiences. The article describes case conceptualization to offer a rationale for this
approach and provides a detailed description of this protocol, illustrated with case examples, highlighting
its application both as a psychotherapy approach and as a brief intervention.
Keywords: eye movement desensitization and reprocessing (EMDR) therapy; EMDR Life Stress Protocol;
crisis intervention; brief treatment; recent traumatic events; attachment
his article describes a way to work with recent are adaptively stored in memory networks, the learn-
traumatic events or ongoing life stress using ingthatcomesfromthesememoriescanbeeffectively
Teyemovement desensitization and reprocess- applied to current stressors that resemble these past
ing (EMDR) therapy (Shapiro, 2018). Originally, the experiences. When past experiences are inadequately
EMDR Life Stress Protocol was developed to work processed and maladaptively stored due to high levels
with complex clients who struggle with attachment of distress and arousal at the time, or the failure of sig-
issues as part of a more comprehensive EMDR nificant others to respond appropriately, the learning
psychotherapy (Laliotis, 2007, 2010). This modified that comes from these experiences is also maladap-
approach has been more recently applied as a stand- tive, informing the individual’s reactions to similar sit-
aloneEMDRtreatmentprotocolforclientsstruggling uations in the present. Since memory and learning
with the current COVID-19 crisis (Laliotis, 2020). are associative, the brain automatically makes these
Shapiro’s (2018) Adaptive Information Processing past–presentconnectionswhichinformhowwethink,
(AIP) model asserts that an individual’s response to feel, behave, and perceive situations in the present.
their current situation is informed by past experiences Based on this foundational tenet, it stands to reason
thataresimilarinnature.Whenthesepastexperiences that treatment of current stressors that allows access
Pdf_Folio:150
150 Journal of EMDR Practice and Research, Volume 14, Number 3, 2020
©2020EMDRInternational Association http://dx.doi.org/10.1891/EMDR-D-20-0003
to some of the earlier memories driving the client’s to think, feel, and behave appropriately in response
reactions will facilitate generalization of treatment to daily life tasks and demands. Without addressing
effects and memory consolidation. This can then be the sources or the effects of stress, the cumulative
expectedtoincreasetheclient’sstabilityandresiliency result over time impacts one’s physical, mental, and
in responding to similar circumstances in the future, emotionalhealth,sometimeswithdireconsequences,
especially if the stressors are ongoing, as is the case overwhelmingresourcesandexacerbatingunderlying
with COVID-19. weaknesses.
The current COVID-19 crisis is a stressful time
for most everyone and is inherently challenging for
many reasons. The fear of contracting the virus or
Crises and Stressors
infecting others, particularly family and coworkers,
Crisesandstressorsareapartoflifeandcantakemany
looms large, especially for those who are in jobs
forms.Whiletheyareinherentlytaxingduetothedis-
that require them to leave home in order to perform
ruption they cause, the danger they may pose, or the
their duties (Cava, Fay, Beanlands, McCay, & Wig-
ongoing challenges about the present and future, our
nall, 2005). Some develop catastrophic reactions to
ability to respond adaptively determines the degree
physical symptoms experienced during the quaran-
of impact these stressors will have (Lehrer, Woolfolk,
tine period (Rubin et al., 2016). The financial strain
&Sime,2007, 2020). From an AIP-informed perspec-
caused by unemployment, loss of a small business,
tive, when previously stressful experiences are inad-
or greatly reduced income generates fear and uncer-
equately processed, a person will likely have more
tainty about the future. Parents who work and have
difficulty responding adaptively to their current life
to attend to their children while quarantined at home
stressor(s), decreasing their capacity to cope, increas-
are managing competing demands without access to
ingtheirdistressandthelikelihoodofrespondingmal-
their usual resources (Sprang & Silman, 2013). The
adaptivelyinthefuture(Solomon,Laliotis,&Shapiro,
isolation of social distancing and stay-at-home orders
2020). With one’s capacity to respond adaptively fur-
can be a significant stressor (Manuell & Cukor, 2011),
ther diminished, there is a greater likelihood of suffer-
particularly for people who have a complex trauma
ing from a physical or mental disorder, such as acute
history or live alone without any physical contact.
stress disorder, posttraumatic stress disorder (PTSD),
Given that our neurobiology is geared for social con-
anxiety, or depression.
tact and human connection, over time these stressors
It is well established that the ability to respond to
will likely have a significant negative impact for many
life changes, challenges, and obstacles is central to
people (Wu et al., 2008). We also know from previ-
maintaining a sense of psychological and emotional
ousstudies on the effects of quarantine (Brooks et al.,
well-being. A person’s premorbid level of function-
2020) that additional stressors such as extended stay-
ing predicts to some degree one’s ability to respond
at-homeorders and inadequate supplies and informa-
adaptively to stress, particularly if they have a his-
tion provided by authorities add considerable stress
tory of psychiatric illness (Jeong et al., 2016). Life
to the inherent uncertainties of a public health cri-
stress, especially if it persists for prolonged periods,
sis. Perhaps a less obvious effect of quarantine is the
can have a negative impact on anyone’s sense of
disappearance of “place” or the loss of “place attach-
well-being. Symptoms of stress include but are not
ment,”anemotionalbondtoaphysicalspacethatwe
limited to mood fluctuations, such as anxiety and
assign meaning to (Moser, Moser, & McNaughton,
depression; bouts of anger, irritability, or restless-
2014). The importance of a sense of place has been
ness; feelings of overwhelm or shut down; lack of
observed across cultures and offers significant psy-
motivation or focus; excessive worry, sometimes
chologicalbenefits.NeuroscientificresearchbyMoser
accompanied by catastrophic thinking; sleeping too
et al. identified certain neurons described as “place
much or not enough; difficulty concentrating; hav-
cells” and “border cells,” that help us manage auto-
ing trouble with memory, loss of appetite or eat-
biographical memory through memories of people
ing too much (Marroquin, Tennen, & Stanton, 2017).
and events that occurred in the places we frequent.
Other manifestations of stress include somatic com-
It explains the common experience of one day being
plaints, such as digestive issues, headaches, stom-
the same as the next, combined with a subsequent
ach aches, chest pains, and muscle tension, as well
loss of identity that we derive from being in a famil-
as changes in heart rate and blood pressure. Ongo-
iar place, such as going to work, school, or a place of
ing stress can also have an impact on one’s ability
worship.
Pdf_Folio:151
Journal of EMDR Practice and Research, Volume 14, Number 3, 2020 151
Laliotis
CommonInterventions for Life Stress and Crisis experienced and taking baseline measurements of
Intervention the salient components. These components include
theimagethatrepresentsthemostdisturbingpart,the
Typically, when a client is in a crisis, the general con-
negative belief about self as it pertains to the mem-
sensus is to offer interventions that are specifically
ory, the desired belief about self, and the degree of
designed to stabilize the individual (Roberts, 2005).
believability the desired belief holds at the outset. The
Commoninterventions include generic skill develop-
validity of the desired belief is rated using the Valid-
ment, such as affect regulation, breathing exercises,
ity of Cognition (VOC) scale, from 1 (completely false)
relaxation, meditation, yoga, tai chi, and other mind-
to7(absolutelytrue).Theclient’scurrentemotionsand
fulnesspractices.Thepurposeoftheseinterventionsis
sensations are identified and measured with the Sub-
to help the client tolerate the situation and to provide
jective Units of Disturbance (SUD), using a scale from
momentary relief. In some treatment approaches,
0(calmorneutral)to10(mostdisturbing).Theclientalso
such as cognitive behavioral therapy (CBT), the ther-
identifies the location of body sensation.
apist may prescribe specific strategies to counteract
During EMDR processing, sets of bilateral stim-
maladaptive thoughts and behaviors with the goal of
ulation (BLS) are administered using visual, audi-
helping the client cope with the situation more effec-
tory, and/or tactile modalities, while the client is
tively (Datillio & Freeman, 2007). In either case, the
instructed to focus on the memory and the associ-
techniques or interventions applied provide tempo-
ations that spontaneously arise. Simultaneously, the
rary relief but do not address the underlying causes of
client is instructed to maintain dual attentionbetween
the individual’s reaction to their life stress. Therefore,
thepresentandpastthroughouttheprocess.Oncethe
the client’s underlying vulnerability and susceptibility
Target Memory has been successfully reprocessed, as
remainandarelikelytobetriggeredagain.
reported by the client and measured using the SUD
scale (calm, no disturbance reported), the therapist
linksthedesiredpositivebeliefwiththenewlyneutral-
EMDRTherapy
ized memory until the emotional linkage to the pos-
EMDR therapy (Shapiro, 2018) is recognized as itive belief is strong and congruent with the body as
an efficacious treatment for PTSD and is consid- measuredbytheVOC.Aclearbodyscanindicatesno
ered by many international associations as a front- somatic disturbance as the client holds the memory
line trauma treatment (e.g., International Society for andthepositivebeliefinmind,ensuringcompleteres-
Traumatic Stress Studies [ISTSS], 2018). It is also olution of the targeted memory. The three-pronged
applicable to a broad range of clinical issues across protocolofpast,present,andfutureensurestreatment
a variety of different treatment contexts (Shapiro generalization for present triggers and similar situa-
& Laliotis, 2011). As a comprehensive psychother- tions in the future.
apy approach informed by the AIP model, it theo-
rizes that difficulties in the present are informed by
EMDRTherapy for Recent Events and Ongoing
past experiences that are inadequately processed and
Trauma
maladaptively stored. EMDRtherapy’sthree-pronged
protocol addresses past, present, and future by Numerous EMDR treatment protocols have been
treating the neurophysiological storage of memory, developed to reduce symptoms of acute stress that
allowing the targeted memory and other, similar follow a critical incident, with at least seven ran-
memories to be reprocessed and successfully inte- domized controlled trials showing their effectiveness
grated with other, adaptively stored experiences. This in decreasing posttraumatic symptoms (see Shapiro
ensurescomprehensivetreatmenteffectsbyreprocess- &Maxfield, 2019, for a review). These recent event
ing disturbing past experiences that inform current protocols have also been used to treat posttraumatic
difficulties, targeting present triggers that remain dis- symptoms in situations where the trauma is ongo-
turbing due to second-order conditioning, and gen- ing. The types of trauma patients included cancer sur-
erating future templates of action to optimize one’s vivors (e.g., Jarero, Artigas, Montero, & Lena, 2008;
capacity to respond adaptively to future challenges Roberts, 2018); bombing victims (Shapiro & Laub,
(Shapiro, 2018). 2008);andrefugees(e.g.,Korkmazlar,Bozkurt,&Tan
There is an 11-step procedure for memory pro- Tunca, 2020; Lehnung, Shapiro, Schreiber, & Hof-
cessing that includes Phases 3–7 and is standard in mann, 2017; Lempertz et al., 2020). These protocols
EMDRtherapy(Shapiro,2001,p.222).Itinvolvesfully have been administered to both adults and children
accessing the targeted memory as it is currently being and in group and individual settings. Outcomes are
Pdf_Folio:152
152 Journal of EMDR Practice and Research, Volume 14, Number 3, 2020
Letting Steam Out of the Pressure Cooker
promising, showing significant reductions in symp- past–present collisions are the source of the client’s
tomsofposttraumaticstress. symptoms and the corresponding memories are the
focal point of EMDR therapy.
The goal of this protocol is not only to address
EMDRTherapy for Life Stress and Ongoing
the client’s reaction to the current situation that is
Crisis
generating symptoms, but to decrease the emotional
The EMDR Life Stress Protocol was initially devel- load from some of the earlier memories that inten-
opedbythisauthortoaddressmaladaptivepatternsof sify the client’s reactivity to the current situation. By
response related to attachment styles rooted in devel- titrating access to these channels of associations, the
opmental trauma (Laliotis, 2007, 2010). Clients with emphasis is more on reducing disturbance related to
developmental trauma and attachment issues often present-daysituationsandpreparationforlikelyfuture
experience daily life tasks and relationship demands scenarios, which are the primary goals when dealing
as stressful, exacerbated by their maladaptive reac- with an acute crisis situation or ongoing life stress.
tions linked to memory networks containing unre-
solvedpainfulmemories.Theprotocolwasdeveloped
Procedural Steps
to directly target these patterns of response as they
manifest in the client’s daily life, as one part of a com-
The procedural steps for the EMDR Life Stress Pro-
prehensive treatment plan in EMDR psychotherapy.
tocol are the same as those used in Phases 3–7 of
The expected outcome is a decrease in problematic
Shapiro’sstandardprotocol(Shapiro,2018),withthree
behaviors, without comprehensive processing of the
exceptions:
completememorynetwork.
• TheTargetMemoryisarecentexperienceorsce-
TheEMDRLifeStressProtocolcanalsobeapplied
nario (defined here as any situation that is unre-
as a stand-alone intervention for clients requesting
markable as a stand-alone event, but trigger the
brief treatment. Such clients may be having difficul-
person).
ties coping with ongoing life stress in ways that are
• The Desensitization Phase includes more active
a departure from their usual responses, due to the
interventionsonthepartofthetherapisttoaccess
unique demands of the situation. For example, care-
and limit channels of associations to include
taking an elderly parent during the pandemic can
the Floatback technique. The therapist redirects
trigger a maladaptive pattern of response, such as
the client back to the Target Memory more
getting overwhelmed, unable to make an appropri-
frequently, keeping the focus on resolving the
ate decision about their care. The client’s inability to
client’s reaction to their current situation.
respond more adaptively exacerbates their life stress,
• InstallationofaFutureTemplateofthesamesce-
making it even more unmanageable. It is clinically
narioorsimilarsituationimmediatelyfollowsthe
moreexpedient,therefore, to target the current situa-
resolutionoftheTargetMemory(SUDof0;VOC
tion where these maladaptive reactions present with-
of 7; clear body scan). While this is not a depar-
out fully activating the earlier memory networks.
turefromthestandardprotocol,thereisanadded
The EMDR Life Stress Protocol was exported from
emphasis on immediately generating an alterna-
its initial attachment-based application in EMDR psy-
tive pattern of response to optimize treatment
chotherapy as a response to the emergent clinical
effects by offsetting the strength of the patterned
demandsstemmingfromtheCOVIDcrisis.
reaction.
Treatment Conceptualization
Case Illustrations
Shapiro’s (2018) AIP model views inadequately pro-
cessed and maladaptively stored memories as the In this section, the use of this EMDR Life Stress
root cause of most pathology. In addition to recog- Protocol for an ongoing crisis is illustrated by describ-
nized mental health disorders, symptoms can include ing its application to three different case presenta-
unremitting emotional distress, dysfunctional pat- tions. Non-essential details in the cases are changed
terns of behavior, or medically unexplained somatic toprotecttheclients’anonymityandpseudonymsare
symptoms. When current events or conditions share used. Two cases highlight the use of the protocol as a
similarities with past experiences, the individual may brief intervention, while the third case shows how it
react in ways that exacerbate their current difficul- can be incorporated into a comprehensive treatment
ties, makingitevenmorechallengingforthem.These plan. The first case is a client who initiated treatment
Pdf_Folio:153
Journal of EMDR Practice and Research, Volume 14, Number 3, 2020 153
Laliotis
no reviews yet
Please Login to review.
