EMDR Weaknesses

Spitalnick, Josh. Difede, JoAnn. Rizzo, Albert. O. Rothbaum, Barbara. “Emerging treatments for PTSD” Clinical Psychology Review, Volume 29, Issue 8, December 2009, Pages 715-726, ISSN 0272-7358, Web. 21 April 2016

William Harrar went into private practice in 1991 and continues to maintain a private practice. He provides professional consultations to other therapists and consults at local psychiatric units as well. He also provides psychotherapy to individuals, couples, and families. Dr. Harrar’s emphasis is brief treatments, especially treatments utilizing EMDR. His expertise in EMDR has afforded him as an approved consultant and certified therapist with the Eye Movement Desensitization and Reprocessing International Association (EMDRIA). Dr. Harrar also facilitates at national EMDR Institute trainings.

This paper will examine, compare and contrast Eye Movement Desensitization Reprocessing (EMDR) and Cognitive Processing Therapy (CPT) in the case of Joe, a fictional client with post-traumatic stress disorder from two tours of combat duty as a Marine Corps sniper in the Middle East, without the use of psychotropic medications. EMDR uses side-to-side eye movements in a one-on-one session with a clinician while the client focuses on a distressing memory until he or she reports reduced symptomology or no psychological distress; the clinician then has the client think of positive thoughts while continuing the exercises. EMDR has been the target of debate over its effectiveness, with some scholars suggesting that it is the “rewiring” of the brain that is most beneficial. CPT is often used when other processes of recovery fail. Therapy, administered individually or in a group, initially focuses on misconstrued beliefs of denial and self-blame for the traumatic incident and then addresses beliefs the client has about himself and the world in general. CPT uses talk therapy and worksheets with the goal of the client learning to make sense of what happened and fit it in with the beliefs about themselves and others. Findings suggest that each therapy has its advantages and which is best depends on how responsive the client is to each mode and the therapeutic alliance between the client and therapist.

Treatment of posttraumatic stress disorder is possible. The current treatment of PTSD encompasses several types of psychotherapy combined with a medication regimen. Cognitive therapy is one type of therapy used to combat PTSD. The goal of cognitive therapy is to allow the patient to slowly experience feelings, thoughts, and events associated with the trauma in a controlled setting. This allows the PTSD sufferer, to categorize the traumatic feelings associated with the event and assign a more positive meaning to them. Thus providing a coping mechanism. Another school of thought places the therapeutic focus on gradually exposing the PTSD sufferer to elements of the trauma. The goal is to desensitize the patient to the traumatic event. This allows the patient to resume a normal life. One other form of therapy used in treatment of PTSD is EMDR. EMDR or Eye Movement Desensitization and Reprocessing is a form of exposure therapy that places the emphasis on guided eye movements. The theory is that the movements help retrain how the brain reacts to memories of the traumatic event. Success has

Cognitive behavior therapy has become quite popular in use due to the short duration of time that counselors see a positive affect in their patients. This type of therapy doesn’t require as much time; therefore it is more affordable than some of the other types of therapeutics options. “Cognitive behavioral therapy is affective with a wide variety of maladaptive behaviors. There are several forms of cognitive behavioral therapy such as: rational emotive therapy, cognitive therapy, and multimodal therapy” (Dobson and Dozois - Paraphrase).

EMDR therapy, EMDR uses an eight-phase approach, referring to the past, present, and future aspects of the traumatic experience, and dysfunctional stress stored memories. The first Phase calls History and Treatment Planning. In this phase the therapist listens the patient's history and develops a treatment plan. In Phase II, the preparation, the therapist teaches the patient how to calm down him/herself with the help of relaxation techniques. The phase III is Assessment in which the therapist asks the patient to visualize the image of the disturbing event, then asks him/her to develop a positive cognition associating with that image. In Phase IV, Desensitization, the patient  focuses on the disturbing memories during short sessions of 15-30 seconds. At the same time, he/she also focuses on the alternative stimulation such as directed eye movements, slapping hands, or voices. This process repeats  many times until the patient's reaction to the target memory becomes less distressed. In Phase V, Installation, the therapist again with the use of bilateral stimulation asks the patient to remember the event about which the positive cognition is developed in the phase III, and makes sure that

I would also utilize eye movement desensitization and reprocessing (EMDR) therapy, which is commonly used for individuals suffering from post traumatic

The behavior I chose to modify and/or change is my Post Traumatic Stress Disorder (PTSD). I chose to decrease the duration of symptoms such as nightmares, flashbacks, avoidance, loss of focus, loss of memory, feelings of detachment, arousal, angry outbursts, loss of concentration, and chronic lateness in order to maintain and function on a normal day to day level.

It has been proven to have a better response rate.The Institute of Medicine recognized exposure therapies as the only treatment approach with sufficient empirical data to be deemed effective for PTSD (Institute of Medicine, 2007).While pharmacotherapy with SSRI can reduce symptoms, the most effective treatments involve understanding and overcoming avoidance behaviors (Foa & Rothbaum, 1998) Exposure therapy is a behavioral treatment for PTSD that aims to reduce your fear, anxiety and avoidance behavior by having you fully face, or be exposed to, thoughts, feelings or situations that are feared. During exposure therapy, the patient will face varying stimuli that stimulate the PTSD. This will go on until the intensity of the stimuli is

(2). EMDR therapy reduces trauma related symptoms and more efficient then other cognitive behavior therapy when working with clients who are dealing with post partum depression (Sharf, 2008).

Electronic medical records (EMR) can improve healthcare performance and cost efficiency in healthcare facilities. Improving healthcare performance includes patient safety, quality of care, and health status of the patients. Patient safety with medication errors continue to escalate, costing health care systems billions of dollars each year (Seibert, et al., 2014). An estimated 450,000 adverse drug events-medication errors that result in patient harm-occur annually, approximately 25% of which are preventable (Seibert, et. al, 2014). Overall, having an EMR helps improve healthcare delivery: no illegible handwriting, information can be shared on an instantaneous basis within a healthcare institution or between institutions, and review of previous

When ECT “hit” the medical scene in the 40s and 50s, it was unsafe and gruesome (Dahl, 2008). Treatment was often performed while the patient was awake, and their convulsions were not controlled at all – they were often strong enough to break bones. ECT hit its peak in the 1960s when three tenths of a million US citizens underwent the therapy yearly (Dahl, 2008). At that point, however, it was still “absolutely a cruel procedure” (Dahl, 2008). It is still yet to recover from its ghastly past, the general public still thinks of ECT as how it was portrayed in One Flew Over the Coocoo's Nest, and more recently, Requiem for a Dream (Fitzgerald, 2011). A psychiatrist summed up the current status of ECT very well saying, “Quite frankly, the stigma pushes people away from it, and it pushes some psychiatrists away from even recommending ECT, but most of the stigma related to ECT really is related to misconception” (Dahl, 2008).

The first argument for the use of ECT is the fact that majority of studies and modern literature show that this treatment is very successful in treating many psychological disorders. Evidence seems strongest for the efficacy in severely depressed patients, as well as manic patients (Reisner, 2003). When looking at those with major depression, the likelihood of substantial improvement ranges from 80-90% (Weiner & Krystal, 1994). In manic patients, Gabbard concludes that 80% of patients show “marked improvement” (2001, p.1272).

[When applying this type of therapy to treating a client with post traumatic stress disorder, EMDR is a reasonable choice because… ]

ERP is an effective and seemingly easy to implement. However effective ERP is, it relies heavily on the how effectively the therapist delivers the treatment (Fisher & Wells, 2005). Despite its seeming simplicity, some practitioners struggle to carry out the treatment properly (Gillihan, Williams, Malcoun, Yadin, & Foa, 2012). The first mistake which can inhibit progress of treatment, which therapists make is not pushing their patient far enough into exposure. Generally, after a certain period of time patients are supposed to be encouraged in