Research digest written by BRIAND Enora, CALLARD Marlène, FORCIER Chloé, GAUDUCHON Anthony & JAGUENET Elsa
Key word : EMDR – Eye Movement Desensitization and Reprocessing, post-traumatic stress disorder, phobia, psychotherapie
The story of Mary
Mary, a 34 years old woman, has been suffering from a choking phobia for four years. At the beginning of the symptoms, she had a severe allergic reaction to an herbal concoction from a food store. She was treated in a hospital for the allergic reaction. After that period she refused to eat so she had a one-week psychiatric hospitalization, then an eating disorder is linked to the choking phobia.
In her story, Mary was adopted at three years old. She describes her adoptive mother as a cruel and unaffectionate person, she was strict and she physically abused Mary. Food was only offered at mealtimes. Ten years ago, she married her husband but he also physically abused her, especially by strangling her, and even after her allergic reaction.
She tried many psychotherapies. A brief psychodynamic therapy allowed her to work on her history to find the origin of her anxiety disorder. They hypothesized that her trouble was linked to an unresolved anger and dependence versus independence toward the mother figure. After that, a CBT program using desensitization allowed her to eat some food in hospital but not at home.
Finally, she did EMDR therapy. During the first session, she chose left-right body taps. She remembered something with her mother. As a child, a cabbage was stuck in her throat and her mother was screaming and put fingers in her throat to catch the piece of food. Through the next sessions, she recalled other moments of her life when she felt a heart racing or respiratory distress because of a choking feeling due to her mother or husband.
She did 20 EMDR sessions that allowed her to reduce her choking phobia. Because of the reduction of the symptoms, she did another CBT program to work again on her food avoidance. Now, she is relaxed and enjoys flavors of different meals.
What is EMDR ?
How does this technique work ? EMDR is based on the Adaptive Information Processing model, more simply called: AIT. An unresolved experience can cause a negative emotion to be stored in the neural networks. The traumatic experience remains stored in a separate neural network in its raw form, along with the original images, thoughts, feelings and body sensations. The information becomes frozen in time and no longer changes, as if a time capsule has been created (Croitoru, 2014). Nowadays, scientists have not completely elucidated the phenomenon of EMDR. One of the hypotheses retained to explain its effectiveness is that it allows the reprocessing of information in a process similar to that which takes place during REM sleep.
And in practice, how does it work? The typical course of a session is as follows: first of all the patient makes contact with a professional. With the help of the professional, the patient will be able to identify and delimit the problem, e.g. in which situation it occurs, at what moment ? Together they will determine the thoughts, emotions and sensations that occur during the problematic situation. This is followed by a desensitization phase using eye scans. Then a reprocessing phase with eye scans and positive emotions is implemented. Finally, a debriefing allows both participants to discuss the session.
For patients with vision troubles, the professional can use knee taping or earing stimuli, but it takes longer to get to the end of reprocessing.
Which patients can do EMDR ?
This method, discovered in the 1980s, is suitable for both children and adults who have suffered from traumas such as aggression, sexual abuse, wars, etc. It has been extended to other difficulties : depression, addictions, eating disorders, panic attacks, phobias, OCD, psychosomatic disorders, etc…
Can EMDR be dangerous ?
The answer to this question is clearly yes. During sessions, the patient is led to relive past traumatic events. So EMDR is contraindicated for people suffering from psychotic troubles (schizophrenia) or cognitive troubles (autism, mental disability), as well as very vulnerable patients, because of a severe risk of mental decompensation. Before starting EMDR sessions, the therapist has the duty to check the mental and cognitive resources of his patient : if the patient lacks resources, he will have to work on them with other tools. That’s why in every EMDR protocol, regardless of the patient’s profile, the therapist has an obligation to give his mobile number to the patient, so that the patient can call him anytime between sessions if he feels bad.
Why is EMDR still so unknown or misunderstood ?
EMDR is a fashionable technique in the field of clinical psychology, but quite unknown by general public. As shown by studies and neurosciences, this technic has nothing to do with magic, but it is quite complex to describe in simple terms unless you live the experience.
Another point that can lead to a confusion is that in France there isn’t any law to prevent anyone from practicing EMDR. As revealed by the Miviludes, a state service which fights against sectarian aberrations, numerous practitioners are not seriously formed to this complex technic, and can be very dangerous for vulnerable people.
When EMDR doesn’t work …
As for all therapies, the efficiency of EMDR is widely linked to the patient’s motivation to change. This can occur for example when a patient gets “secondary benefits” from his current situation, or when he has too much trouble mentalizing or accessing his emotions. But it can also happen when the therapist hasn’t focused on the most salient memory, such as in complex traumas. Sometimes, the patient moreover says what he thinks his therapist wants to ear, to avoid (consciously or not) more reliving. That’s why psychologists have to keep deeply aware of his own feelings and observations about his patient’s congruence.
Results and contributions of EMDR
First, EMDR, focused on the resolution of traumatic episodes, has been used to treat a specific disorder: post-traumatic stress disorder (PTSD). It is a therapeutic approach that has been proven to be effective because it has been extensively studied by scientists using brain imaging techniques. It has obtained, 20 years after the establishment of a therapeutic protocol, the highest level of proof of efficacy in this indication as well as recognition by the Health Agencies. Indeed, This approach has been validated by the French High Authority for Health (HAS in French) and by the World Health Organization (OMS in French).
In addition, it is currently being scientifically evaluated for other mental disorders in which traumatic memories and experiences have an important effect in triggering or maintaining the disorder, such as anxiety, depression, phobia, eating or sexual disorders, and schizophrenia etc… ( Haour & de Beaurepaire, 2016)
Numerous meta analyses (a systematic review of several studies, it is a statistical synthesis of studies) have been realized. In fact, new research evaluates the effect of EMDR on depressive symptoms. For instance, in the meta-analysis of Carletto and coll., (2021) the results suggest that EMDR can be considered an effective treatment for improving symptoms of depression, with effects comparable to other (active) treatments. The results show that one-third of people with depression could benefit from EMDR. It could therefore be considered an alternative to first-line treatments for depression, pending further research. Indeed, it would be very beneficial to avoid prescribing antidepressants as much as possible because they can have significant side effects.
However, it is important to carry out research to complete the scientific literature, particularly on the various disorders (anxiety, depression, etc.) (Yunitri and colll., 2020).
Conclusion
In conclusion, EMDR is a therapeutic technique that has proven to be effective. This technique allows people to reduce emotions linked to trauma, and thus reduces the medication prescribed during trauma, such as anxiolytic. But it may also be efficient for chronic pain sufferers who, through EMDR, can reduce the post-traumatic stress syndrome that chronicles the pain. However, this method is not protected by the French state : there is no legal framework for this practice, and so there are numerous abuses in the use of EMDR from people who are neither psychologists nor psychiatrists. Recently, psychologists and psychiatrists have alerted public opinion to the decompensation of patients following practices abusively claiming to be an EMDR protocol. Therefore, as with other methods, it is necessary to remain vigilant about EMDR, but this psychological method still remains very efficient for troubles as trauma and phobia.
Bibliography
Augeraud, E. (2019). 4. Indications et contre-indications de l’EMDR. Dans : Cyril Tarquinio éd., EMDR (pp. 45-55). Paris: Dunod. https://doi.org/10.3917/dunod.tarqu.2019.01.0045
Carletto, S., Malandrone, F., Berchialla, P., Oliva, F., Colombi, N., Hase, M., Hofmann, A. & Ostacoli, L. (2021, 1 janvier). Eye movement desensitization and reprocessing for depression : a systematic review and meta-analysis. European Journal of Psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2021.1894736
Croitoru, T. (2014). The EMDR revolution : Change your life one memory at a time, the client’s guide. Morgan James Publishing.
Haour, F. & de Beaurepaire, C. (2016, juin). Évaluation scientifique de la psychothérapie EMDR pour le traitement des traumatismes psychiques. L’Encéphale, 42(3), 284 288. https://doi.org/10.1016/j.encep.2016.02.012
Schurmans, K. (2007). A Clinical Vignette : EMDR Treatment of Choking Phobia. Journal of EMDR Practice and Research, 1(2), 118 121. https://doi.org/10.1891/1933-3196.1.2.118
Yunitri, N., Kao, C. C., Chu, H., Voss, J., Chiu, H. L., Liu, D., Shen, S. T. H., Chang, P. C., Kang, X. L. & Chou, K. R. (2020, avril). The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder : A meta-analysis of randomized controlled trials. Journal of Psychiatric Research, 123, 102 113. https://doi.org/10.1016/j.jpsychires.2020.01.005
Research digest written by BRIAND Enora, CALLARD Marlène, FORCIER Chloé, GAUDUCHON Anthony & JAGUENET Elsa