Worried About Finishing EMDR

[eli]

I've had 3 EMDR sessions for mild-moderate PTSD over the last three weeks and my therapist has said she thinks I will only need two more sessions. I'm worried about stopping before I'm sorted, as I'm still reacting very badly to triggers, especially noise triggers which occur daily (my PTSD is from events with previous neighbours so any noise I hear from next door will set me off).

Does anyone have experience with completing a course of EMDR? How do you know when you're ready to stop? What happens when you stop, do you just go cold turkey, or do they give you coping techniques?

I'm worried because although I feel it's definitely helping, I don't feel ready to stop, and I've tried using CBT type coping techniques before and don't find them at all helpful, in fact they make things worse as I get frustrated when they don't work and end up more anxious and panicked.

If anyone has any experience of advice I'd be very grateful, thanks.

[drpattijane]

The EMDR therapy protocol has three prongs: first you target the old stuff - the original event(s) that led to your PTSD. Second, you target current triggers - such as you describe, and third, you do what's called a "future template" that sets you up to deal successfully with any future triggers/events that might occur. After all three prongs, you will know you're ready to stop EMDR therapy. In addition, EMDR therapy uses a scale to determine level of disturbance, and when your SUD (Subjective Units of Disturbance) goes down to a 0 or 1 (on a scale of 10 where 10 is the worst disturbance you can imagine, and 0 is no disturbance at all). It also uses a scale to measure your positive belief about yourself (e.g. I can handle it, or I'm safe now... etc.) and that measure will also indicate that you're done with treatment.

So your description of your experience right now sounds like you need more EMDR processing, and it's quite possible that will all be complete in a few more sessions. But between you and your T, it will be obvious when treatment is completed successfully!

As a recently retired psychologist, I used EMDR therapy as my primary psychotherapy treatment and I've also personally had EMDR therapy for anxiety, panic, grief, and “small t” trauma. As a client, EMDR worked extremely well and also really fast. As an EMDR therapist, and in my (now retired) role as a facilitator who trained other therapists in EMDR therapy (certified by the EMDR International Association and trained by the EMDR Institute, both of which I strongly recommend in an EMDR therapist) I have used EMDR therapy successfully with panic disorders, PTSD, anxiety, depression, grief, body image, phobias, distressing memories, bad dreams, and many other problems. It's a very gentle method with no significant "down-side" so that in the hands of a professional EMDR therapist, there should be no freak-outs or worsening of day-to-day functioning.

EMDR therapy was originally created for PTSD but is now used for many other issues. For PTSD, it is considered a first-line treatment by organizations such as ISTSS (International Society for Traumatic Stress Studies), the American Psychiatric Association, the American Psychological Association, the Department of Veteran Affairs, the Department of Defense, the Departments of Health in Northern Ireland, UK, Israel, the Netherlands, France, and other countries and organizations. There are 35 randomized controlled (and 20 nonrandomized) studies that have been conducted on EMDR therapy in the treatment of trauma to date. And more excellent research now on the use of EMDR therapy with generalized anxiety disorder, treatment of distressful experiences that fail to meet the criteria for PTSD, dental phobia, depression, body dysmorphic disorder, chronic phantom limb pain, panic disorder with agoraphobia, obsessive-compulsive disorder, and peer verbal abuse.

One of the initial EMDR therapy phases (Phase 2) involves preparing for memory processing or desensitization (memory processing or desensitization - phases 3-6 - is often what is referred to as "EMDR" which is actually an 8-phase method of psychotherapy). In this phase resources are "front-loaded" so that you have a "floor" or "container" to help with processing the really hard stuff, as well as creating strategies if you're triggered in everyday life. In Phase 2 you learn a lot of great coping strategies and self-soothing techniques which you can use during EMDR processing or anytime you feel the need.

In phase 2 you learn how to access a “Safe or Calm Place” which you can use at ANY TIME during EMDR processing (or on your own) if it feels scary, or too emotional, too intense. One of the key assets of EMDR therapy is that YOU, the client, are in control NOW, even though you weren’t in the past, during traumatic events, or whatever disturbance(s) on which you’re working. You NEVER need re-live an experience or go into great detail, ever! You NEVER need to go through the entire memory. YOU can decide to keep the lights (or the alternating sounds and/or tactile pulsars, or the waving hand, or any method of bilateral stimulation that feels okay to you) going, or stop them, whichever helps titrate – measure and adjust the balance or “dose“ of the processing. During EMDR processing there are regular “breaks” and you can control when and how many but the therapist should be stopping the bilateral stimulation every 25-50 passes of the lights to ask you to take a deep breath and say just a bit of what you’re noticing, anything different, any changes. (The stimulation should not be kept on continuously, because there are specific procedures that need to be followed to process the memory). The breaks help keep a “foot in the present” while you’re processing the past. Again, and I can’t say this enough, YOU ARE IN CHARGE so YOU can make the process tolerable. And your therapist should be experienced in the EMDR therapy techniques that help make it the gentlest and safest way to detoxify bad life experiences and build resources.

Grounding exercises are essential. You can use some of the techniques in Dr. Shapiro's new book "Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR." Dr. Shapiro is the founder/creator of EMDR but all the proceeds from the book go to two charities: the EMDR Humanitarian Assistance Program and the EMDR Research Foundation). The book is an easy read, helps you understand what's "pushing" your feelings and behavior, helps you connect the dots from past experiences to current life. Also gives lots of really helpful ways that are used during EMDR therapy to calm disturbing thoughts and feelings.

Pacing and dosing are critically important. So if you ever feel that EMDR processing is too intense then it might be time to go back over all the resources that should be used both IN session and BETWEEN sessions.

I can't say enough good things about EMDR therapy. It's changed my life both as a person/consumer, and as a therapist. It has been so satisfying to have someone come in for help and then to witness them get through their issues and finish therapy relatively quickly (compared to regular talk therapy, it's like night and day). I am both humbled by and grateful for this wonderful method that heals suffering.