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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
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