Introduction

The effect of EMDR on Post-Combat Post Traumatic Stress Disorder The effect of EMDR on Post-Combat Post Traumatic Stress Disorder

Gonzalez-Ramos, L., Knight, J., Schofield, J., & Wochnick, B.Gonzalez-Ramos, L., Knight, J., Schofield, J., & Wochnick, B.

EMDR is mentioned in the Department of Veterans Affairs &Department of Defense in 2004 as offering rapid treatment effects for people suffering from PTSD including combat related PTSD. EMDR was used recently on wounded soldiers and the results found that it was an effective method in rapidly reducing their emotional disturbances after the cause of their trauma induced PTSD in war related settings.

Phases of EMDR for treating clients with PTSD:Phase 1: gather the clients’ history information involved with the specific trauma and their

conditions currently that cause the distress.Phase 2: Inform and prepare the client for specific EMDR treatmentPhase 3: Evaluates the particular experiences to be targeted. This could include including

current representative imagery, negative beliefs, disturbing emotions, associated physical sensations, and an initially desired positive cognitive structure.

Phase 4-6: This stage includes forms of bilateral stimulations including eye movements, taps on the hands, or auditory tones. This is the phase where the initial focus is the associations that arise from the trauma and which a decrease in negative emotions, new insights, change of beliefs, and the elimination of physical sensations associated with the event of trauma arise.

Phase 7: Guided imagery closure procedures are used at the end of treatment, to ensure equilibrium between sessions

Phase 8: Last stage in EMDR. It reevaluates the previous work and directs subsequent targets through the past events, the current triggers, and future behavioral reactions.

   In 2005 it was stated that EMDR could be more effective than more traditional forms of

exposure therapy in that it does not require any side preparations to achieve the full effects and uses much less attention to the trauma. Another recent study informed that as little as five EMDR sessions not only improved the quality of life but also showed beneficial changes in sleep patterns for the participants which was recorded through polysomnograms. This proves as an important implication of the EMDR treatment as sleep disturbances is of high concern in combat veterans suffering from PTSD.

Trauma can obstruct the information processing system of the brain which can result in the experience being stored as memory with all the images, emotions, physical sensations, and beliefs during the time of the original trauma. Similar events can then trigger those stored memories leading to the avoidance behaviors of PTSD. EMDR helps with this in that it seems to catalyze the brain’s own information processing system which permits the resolution of previous unresolved experiences with a lessening of emotional disturbances; it constructs a more adaptive cognitive structure and eliminates some of the evident symptoms of PTSD.

Early treatment can be beneficial in several way including not only improving the behavior of the individual, but can also aid in possibly allowing the veterans to continue with a military career. EMDR treatment could allow those veterans to continue on with the military which would be beneficial in that they would be coming back with experience instead of having no treatment for the PTSD and leaving because of discharge with common PTSD symptoms.

Results

Purpose

Conclusion

Case Study:A 25 years-old male and married U.S army specialist with 16 months of active duty suffers from common PTSD symptoms after combat including frequent nightmares, lack of appetite, staring spells, and ruminations of combat experience. The target memory which was identified for him as being the most upsetting was a combat incident where he had shot an Iraqi civilian and watched him struggle and die from his wound. He reported having feelings of immense guilt as he would picture this image through his mind and rated this memory as a 7 on the SUDS (Subjective Units of Disturbance Scale). After the initial set of EM (Eye Movement), the veteran reported that he felt tightness in his chest. Another session of EM and the image shifted to viewing the body shaking. Three more sets of EM were stimulated where the veteran reports viewing different images of dead bodies of fellow soldiers and Iraqi civilians. Recalling this memory gave the veteran the same feeling of guilt and that “chill” sensation which raised his SUDS score to a 9. After approximately 10 sets of EM, his SUDS score decreased to a 1. He reported being able to remember the traumatizing experience but having the realization that it was over and he needed to move on with his life. After just two more sets of EM his SUDS scores still remained at 1. Nurses reported that he had a renewed appetite, was more talkative, had a social demeanor and had suppressed nightmares. He said his score would never reach a complete 0 simply because he had witnessed something so traumatizing but that overall it did not bother him nearly as much as it used to. It is clear that over the sessions EMDR proved significant in reducing his SUDS scores from a 9 to a 1 in just 12 sessions, remaining that way even after the sessions were completed.

 Major Findings EMDR:PTSD patients who suffer from sleep deprivation, and sleep disturbances after typical

exposure therapies would greatly benefit from EMDR as a treatment. Unlike most exposure therapies, that use flooding and other invasive approaches, EMDR does not require the patient to give detailed accounts of their traumatic memories. This results in a far less of a traumatic therapy or treatment session for the patient. During the EMDR treatment, the patient also is aware of his or her ability to halt the treatment at any time. Typically during exposure therapies this is not the case. The EMDR procedure does not require certain aspects of other exposure techniques commonly used, including the creation of fear hierarchies or relaxation training.

The results for the use of EMDR in civilian related PTSD trauma has widely been accepted by clinicians for a number of years. Although, the effectiveness of EMDR therapy when specifically applied to combat-veterans has had mixed results in controlled studies.

Results EMDR:One or two sessions of EMDR has been proven as an effective immediate treatment for

combat veterans in reducing the patients SUDS levels when treating one specific traumatic memory. Whereas the treatment for a patient suffering from multiple traumatic memories, requires around twelve successive treatment sessions in order to lower the patients SUDS scores for the multiple traumatic memories.

In a study of Vietnam War veterans, 77% of patients who received twelve sessions of EMDR reported that they no longer had PTSD, these results were later maintained and consistent in a 3 and 9 month follow up session(Carlson et al., 1998).

Future ResearchEMDR has not always been used to treat combat-exposure related PTSD until recently.

Currently the use of EMDR in combat-related PTSD has been emerging as one of the more effective and immediate treatment options available to veterans suffering from PTSD. Although, there are many areas that future research needs to address in a controlled setting. One specific variable that needs to be examined pertaining to the effectiveness of EMDR, in relation to combat related PTSD, is to isolate and examine the variables of time since the traumatic incident and the number and type of the patient’s traumatic memories (Russell et al., 2006). Due to EMDR’s immediate effective results on PTSD, further research would be beneficial for current war veterans because it could lead to an immediate solution overseas for currently active military to return to the front lines as soon as possible, as well as assisting returning veterans into combat readiness.

EMDR Treatment:•Eye Movement Desensitization Reprocessing was discovered in 1987 by Psychologist Francine Shapiro. •The first official published study on the subject was in 1989. •EMDR has been and continues to be an empirically supported exposure treatment for clients suffering with anxiety associated with PTSD. •EMDR has also been successfully used to treat other anxiety disorders as well, such as phobias and more recently been used to treat psychological stress associated with cancer, depression, sexual dysfunction, eating disorders and even schizophrenia. •EMDR works on the premise of dual attention focus. •The action of the eye movement is proposed to serve as a catalyst, which cuts through the anxiety associated with the painful memory essentially cognitively reconfiguring the memory in a way that is more easily dealt with emotionally. •The idea of dual attention focus is where much of the controversy on the subject comes from. Post Traumatic Stress Disorder:•Combat related Post-Traumatic Stress Disorder is the consequence of violent conflicts around the world and is more relevant today because of recent wars. •PTSD is explained through a behavioral orientation and described as the conditioned fear responses to environmental and contextual cues. •The associated stimuli that can produce these persistent fear responses include such things as: crowded urban areas, highways, underpasses, suspicious debris on the side of the road, smells, sounds, and even a particular way a person is dressed. •PTSD symptoms can include: hypervigilance, depression, anhedonia, difficulty sleeping or staying asleep, nightmares, anxiety caused by stimuli which act as triggers, intrusive thoughts, avoidance behavior, re-experiencing the trauma, emotional distress and impaired functioning, social anxiety, heightened arousal, emotional numbing, physiological problems, immunal dysfunction, hypertension, high blood pressure, poor circulation, chronic physical pain, digestive problems, tremors, sweating, premature aging-wrinkles, difficulty breathing and shortness of breath, memory loss, difficulty concentrating, impaired memory retention and general irritability.•One of the most peculiar aspects of combat related PTSD is that these fear responses can persist years and even decades from traumatic periods of exposure as seen in veterans of wars from the distant past. •PTSD has lasting effects on families, friends and communities of those suffering from such debilitating symptoms.

•The search for effective treatments and therapies for combat related post-traumatic stress disorder (PTSD) have shown that exposure therapies tend to bring out better results in veterans with PTSD. Eye Movement Desensitization Reprocessing (EMDR), a therapy developed by Francine Shapiro, shows that through a step by step process of exposure and eye stimulations the individual can begin to reconfigure the way that they once thought about their traumatic experiences. Through a process split up into 8 phases EMDR has been shown to be an effective treatment to those who have suffered through traumas. EMDR has been shown to be helpful even after just two sessions, but the more sessions that a patient tends to have, the better the results. In this study we hypothesize that veterans with combat related PTSD will show greater results with EMDR than individuals with civilian related PTSD.

Methods