Autonomous EMDR protocol: large-group trauma therapy for therapy-reluctant populations

Autonomous EMDR protocol: large-group trauma therapy for therapy-reluctant populations (Autonomous EMDR protocol: large-group trauma therapy for therapy-reluctant populations)

 

Julien Bonnel, MS, Psychologist (private practice), EMDR Europe Consultant

 

Translated by: Specialist Psychologist Gizem Pozam

 

Background and Aims

• Most people who have experienced trauma see therapy as a sign of weakness and/or cannot afford it.


• Increased access to individual EMDR therapy only benefits those who wish to seek help.


• The growing number of EMDR practitioners and increased mental health consultations have not prevented suicide rates in the United States from rising.


• Education has a protective effect against suicidal ideation.


• Due to severe group-size limitations and the risk of abreaction, existing EMDR group protocols do not provide an adequate response.


• More user-friendly, psychoeducation-centered EMDR protocols are needed to reverse these trends.

Aim 1:

Identify the innovation of the a-EMDR protocol in removing major barriers and enabling the mass dissemination of trauma recovery tools.

Aim 2:

Appreciate the need for an accessible EMDR protocol that can be safely self-administered.

Aim 3:

Evaluate the hypothesis that requiring trauma exposure or group sharing discourages therapy-reluctant populations from seeking therapy.

Methods:

• The Autonomous EMDR (a-EMDR) protocol enabled small groups of participants to access phase 1–3 tools to manage their PTSD symptoms independently, without trauma exposure or any requirement to share personal information (Figure 3 and Figure 4).


• Participation in a-EMDR was available through:
  
  
  
  • The a-EMDR trauma "self-help kit" (a theoretical book and practical workbook containing psychoeducation on PTSD management and boundary techniques (Figure 5)) or
  
  
  • Five in-person Masterclasses (maximum 7 participants), limited solely to completing the manual and theoretical discussion.
  
  
  
  

1. Comprehensive psychoeducation


2. A comprehensive list of PTSD management exercises designed to further empower patients


3. A condensed treatment plan and a "simplified phase 3" completed by patients themselves


4. Immediate installation of the positive cognition through positive affirmations


5. Slow BLS during the treatment of memories (compared with fast BLS in the standard protocol)


6. Format adaptations (e.g., Masterclasses accessible to larger groups and webinars for groups of unlimited size)


7. Mass dissemination of EMDR made it possible to address the public mental health crisis

Identifying your trauma triggers: do it yourself

Reflection

1. In which specific situations do you currently tend to fall into a state of learned helplessness?


2. What "propaganda" goes on in your head when you are triggered?


3. What objective evidence allows you to recognize today that this propaganda is irrational?

Practice: Positive Cognition Post-It Affirmation

• Rate how strongly your negative cognition (NC) resonates with you (1–10)


• Write the positive cognition (PC) phrase that would free you from helplessness on a post-it note.


• Repeat it aloud while looking in a mirror whenever your NC resonates within you.


• Evaluate how much you can lower your NC score with your PC arrows.


• Self-administer BLS.


• *** Optional: add "Wim Hof Breathing" visualization or inspirational videos to accelerate the process.

Objective: Learn to lower your NC score with your PC arrows.

Results

EMDR phase 1–3 tools can be accessed satisfactorily in a group setting without abreaction

Key leaders in large organizations (e.g., the military) are interested in implementing the Masterclass

Patient vignette

1- Introduction

• A 50-year-old woman with alcohol use disorder (AUD) and difficult financial circumstances


• Sexually abused by both her father and grandfather as a child

2- Prominent presenting problems

• Recurring nightmares and flashbacks, hyperarousal, inability to cope with proximity to men


• Depersonalization, inability to perform even basic self-care or attune to bodily sensations

3) The client's Masterclass goals

• Reduce incest-related PTSD symptoms


• Better manage her emotions with her daughter


• Improve self-confidence


• Overcome alcohol dependence

Treatment outcomes

• The a-EMDR protocol can produce results without "intense phase 4-type" exposure


• Severely traumatized patients deserve the development of more bottom-up, user-friendly, non-invasive group protocols


• The depth of trauma treatment during phase 1–3 "involuntary exposure" has been underestimated


• The traditional assumption that phase 4–6 exposure is necessary for the full treatment of trauma merits investigation


• Limitations and next steps: the a-EMDR protocol is new and based solely on clinical experience; it will be important to confirm our initial findings with a randomized controlled trial.

Conclusions

a-EMDR

• May enable therapy-reluctant and disenfranchised populations to safely access "phase 1–3" tools without a therapist


• Sidesteps the 2 major drawbacks of existing group protocols: non-responsiveness and the need to share one's story in front of a group


• Could take the dissemination of EMDR to new heights


• Enables the treatment of highly complex attachment trauma at a deep level


• Can be safely administered in extra-large group settings (amphitheaters, webinars, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Autonomous EMDR protocol: large-group trauma therapy for therapy-reluctant populations

Julien Bonnel, MS, Psychologist (private practice), EMDR Europe Consultant

 

Background and Aims

• Most traumatized people see therapy as a sign of weakness and/or can’t afford it.


• Increased access to individual EMDR therapy only impacts those who wish to consult.


• Growing numbers of EMDR practitioners and increased mental health consultations have not prevented U.S. suicide rates from rising.


• Education has a protective effect on suicidal ideation.


• Due to severe size limitations and the risk of abreaction, existent EMDR group protocols do not representa an adequate response.


• More user-friendly and pyschoeducation-centered EMDR protocols are necessary to reverse these trends.

 

Aim 1:

Identify the novelty of the a-EMDR protocol in removing prime obstacles and allowing mass dissemination of  trauma recovery tools.

 

Aim 2:

Appreciate the need for an accessible EMDR protocol that can safely self-administered.

 

Aim 3:

Evaluate the hypothesis that requiring either trauma exposure or group sharing discourage reluctant populations from seeking therapy.

 

 

Methods:

 

• The Autonomous EMDR (a-EMDR) protocol allowed small groups of participants to: access phase 1-3 tools to manage their PTSD symptoms independently, without trauma exposure or requirement to share personal information (Fig.3 and Fig.4).


• a-EMDR participation was available via:
  
  
  
  • The a-EMDR trauma “self-help kit” (theoretical book and practice workbook (Fig.5) containing psychoeducation regarding PTSD management and boundary techniques) or
  
  
  • Five in-person Masterclass (7 people max) limited solely to manual completion and theoretical discussion.
  
  
  
  

 

 

 

• Exhaustive psychoeducation


• Comprehensive list of PTSD management exercises in a more patient-empowering manner


• Condensed treatment plan and “simplified phase 3” done by patients themselves


• Immediate installment of the PK via positive affirmations


• Slow BLS during treatment of memories (vs. fast BLS in standard protocol)


• Format adaptations (i.e. Masterclasses accessible to larger groups and webinars to unlimited-size groups)


• Mass dissemination of EMDR made possible to address public mental health crisis

 

Identifying your traumatic triggers buttons: just do it yourself

 

Reflection

• In what specific situations do you typically fall into a state of learned helplessness currently?


• What “propaganda” goes on in your head when you are triggered?


• What objectively allows you to know that this propaganda is irrational today?

 

Practice: The Possitive Cognition Post-It Affirmation

• Evaluate how much you NC resonates in you (1-10)


• Write on a post-it note the PK phrase that would free you from helplessness.


• Repeat it out loud looking in a mirror every time your NC resonates in you.


• Evaluate how much you are able to lower your NC score with your PK arrows.


• Self-administer BLS.


• *** Optional: add “Wim Hof Breathing” visualization, or inspirational videos to boost the process.

 

Objective: Learn to shoot down your NC with your PK arrows.

 

 

Results

EMDR phase 1-3 tools can be accessed in a group setting satisfactorily and without abreaction

Key leaders in large organizations (e.g. military) are interested in implementing Masterclass

 

Patient vignette

1- Introduction

• 50-year-old female with an alcohol use disorder (AUD) and difficult financial situation


• Sexually abused by both her father and grandfather as a child

 

2- Prominent presenting problems

• Recurring nightmares and flashbacks, hyperarousal, inability to handle proximity to men


• Depersonalization, inability to do most basic self-care or tune-in to bodily sensations

 

3) Client’s Masterclass objectives

• To reduce incest-related PTSD symptoms


• Better manage emotions with her daughter


• Improve self-esteem


• Overcome alcohol addiction

 

Treatment implications

• a-EMDR protocol can deliver results without “violent phase 4 type” exposure


• Heavily traumatized patients merit the creation of more bottom-up, user-friendly and non-invasive group protocols


• The depth of trauma treatment during phase 1-3 “involuntary exposure” has been underestimated


• The traditional supposition that phase 4-6 exposure is necessary for full treatment of trauma merits investigation


• Limitations and next steps: the a-EMDR protocol is new and based solely on clinical experience; it will be important to confirm our initial findings with a randomized controlled study.

 

 

Conclusions

 

a-EMDR

• May allow therapy-reluctant and disfranchised populations to access “phase 1-3” tools safely without a therapist


• Sidesteps the 2 major drawbacks of existing group protocols: abreaction and the need to share one’s story in front of a group


• Could take the dissemination of EMDR to new heights


• Allows treatment of highly complex attachment trauma at a deep level


• May be safely administered in XL group setting (amphitheaters, webinars, etc.)