Eye Movement Desensitiation

Eye movement desensitization and reprogramming, or EMDR, therapy is a controversial treatment forcing on people with post-traumatic stress disorder. In order to treat the trauma related problems, this method of therapy focuses on having the patient reliving the distressing event in order to think it is in a more logical and structured way. In Bruce Bower’s article EMDR: promise and dissent: new research enters debate over a highly touted trauma therapy – eye movement desensitization and reprogramming, he takes the readers through a typical therapy session by explaining that, “ A session of EMDR usually lasts about 90 minutes. The client first thinks about the earlier trauma and comes up with an image from the incident. He or she then chooses a current negative belief that goes with the image and a desired positive attitude toward it. A sexual abuse survivor, for instance, might come up with “I am damaged for life” and “I’m safe now,” respectively.” One unique aspect of EMDR is how this technique incorporates the use of body through rapid side to side eye movements and alternating sounds or taps on a series of body points. As the participant imagines the trauma and discussing the emotions and stress levels, the therapist simultaneously conducts the particular sensation to body such as holding up two fingers and moving them back and forth.

Individuals affected by borderline personality disorder are able to have normal and productive lives, by finding the correct support and treatment. Psychological therapies are the most effective form of treatment for individuals impacted by borderline personality disorder. Psychological therapies assist individuals in managing and understanding their behaviours, feelings and responses. Other forms of treatment can include counselling and therapy. Medicines such as antidepressants, mood stabilisers, and antipsychotics are also types of treatments. In combination with therapy and counselling, they might be helpful in treating symptoms of borderline personality disorder. Healthy habits such as getting enough sleep, eating healthy foods,

Individuals who suffer of such disorder are capable of changing their behavior and mindset drastically. For example, if the person is in a relationship they can love and idolize their partner at one instant and completely hate and seek revenge against them, if they feel their partner hurts them. At times, they even try to self-sabotage themselves by attempting to hurt themselves. Their personality characteristics are known to be demanding, intense, aggressive, and even feeling empty an abundant amount of times. Essentially an individual with borderline personality disorder are defined by the word “instability” as their behavior is completely unpredictable and rocky to their experiences (Buss & Larsen, 2001).

Borderline personality disorder is defined in its most simplest sense as being a mental health disorder that generates significant emotional instability. [1] In sufferers it generates a wide range of symptoms typically characterised into three groups; Problems regulating emotions and thoughts; impulsive behaviour without thinking of the consequences of actions; and lastly unstable relationships. Evaluating the most effective treatment(s) for BPD remains a target for mental health services as the disorder is associated with self harm and suicide attempts, with suicide attempts recorded in 69-80% of patients. [2]

The purpose of this literature review is to explore trauma-informed approaches to substance abuse interventions and to identify gaps in the literature that would benefit from further research in this area.

“Personality disorders have been documented in approximately 9 percent of the general U.S. population” (Angstman, Rasmussen, 2011). Emotional dysregulation disorder or its common name borderline personality disorder is a very serious and chronic disorder. The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) describes borderline personality disorder as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts” (Gardner, 2006). Within the last 20 years, psychologists and other mental health professionals have made tremendous strides in research on what exactly borderline personality disorder, some of its triggers and possible effective treatment options. Borderline personality disorder is defined as a disorder that generates severe emotional instability which can be a springboard that can lead to other stress induced mental and behavioral problems.

Dialectical behavior therapy (DBT) is an evidence-based treatment for borderline personality disorder (BPD) and PTSD (Cukor, 2009). The therapy focuses on a balance between change and acceptance. DBT is combined with individual psychotherapy and building skills groups to regulate emotion, mindfulness and distress tolerance. There are two stages associated with DBT. The first entails the use of DBT for individuals with BPD with significant trauma histories and PTSD (Welch & Rothbaum, 2007). Patients who have completed Stage 1 treatments targets severe behavior decontrol but must stay on Stage 1, if they continue to experience emotion dysregulation. In Stage II DBT, individuals begin exposure to their trauma experience. No data has been accumulated studying this application (Welch & Rothbaum, 2007). Dialectical behavior therapies teach the patient techniques for managing strong emotions through trauma-focused methods.

and is encouraged to process the trauma from different perspectives using cues from the therapist. The patient also repeatedly engages with their fear triggers.177

This disorder is a past cognitive behavioral treatment for chronically suicidal individuals.This is sometimes confused with BPD which is border personality disorder. Now this is also used with other disorders that have been found over the years. Depression and PTSD are other disorders that DBT help with. Now that DBT is helpful for so many other disorders they have found that there are at least four components that the patients can get out of it.

Though several personality disorders are highly complex and a challenge to treat, there are effective treatments available (“Treating Borderline” 1). The various treatments are broken down by method, the first of which being cognitive behavioral therapy, which attempts to alter the conscious thoughts and behavioral patterns of patients (Daniel); (“Treating Borderline” 2). Cognitive behavior therapy itself is broken down into two therapies, dialectical behavioral therapy and schema-focused therapy (“Treating Borderline” 2). Dialectical behavioral therapy, developed by Dr. Linehan, is centered on the basis that personality disorders are formed when hypersensitive patients are in situations which lack the emotional support they require, therefore leading to their “inability to regulate emotions” (“Treating Borderline” 2). Thus, the treatment serves to help the patient gain control over their emotion and behavior (“Treating Borderline” 2). The treatment itself consists of group and individual sessions and typically lasts approximately one year (“Treating Borderline” 2). During the group sessions, patients learn to become more aware of their behaviors and emotions through sessions pertaining to “problem solving, mindfulness meditation, and breath training“(“Treating Borderline” 2). In personal sessions, referred to as psychotherapy, the psychiatrist explains to the patient how the lessons from the group therapy sessions are applicable

After reviewing the mental status examination results and reviewing the client clinical, psychological and personal history. The client demonstrated five to six out of nine possible factors that are associated with Borderline Personality Disorder. Clearly, the client has additional symptoms that may not be view within the Borderline Personality Disorder characteristics but play a role on the behaviors that are associated with the disorder. The Diagnostic and Statistical Manual of Mental Disorder – 5th Ed (2013), describes Borderline Personality Disorder as, a pervasive pattern of instability of interpersonal, self-image, and affects and marked impulsivity, beginning by early adulthood and present in a variety of context as indicated by five or more characteristics.

Likewise, the author read that Borderline Personality Disorder (BPD) is described as instability in interpersonal relationship, self-image and mood, a fast fluctuation between emotional states, impulsive behaviour and an inclination towards self-harm and suicidal thinking (NICE 2009).

Eye movement desensitization regulation (EMDR) is a treatment that was developed in order to treat individuals who have gone through a traumatic experience. The goal of this treatment is to resolve dysfunctional traumatic memories by adequately accessing and processing them (Solomon, Solomon, & Heide, 2009). By completing this treatment the traumatic memories would no longer cause major distress to the individual and their negative beliefs about himself/herself would be reformulated (Shapiro, 2009). This treatment is done during individual therapy with a therapist and the client. The therapist completes this treatment by using a bilateral stimulation that will be explained further in this paper (Solomon & Shapiro, 2008).

This paper looks at the treatment of Eye Movement Desensitization and Reprocessing in treating individuals with PTSD. This is a very controversial treatment and more recently there has been quite a lot of research done on this treatment. The paper with indentify, the criteria for diagnosising an individual with PTSD, the specific treatment, other treatments for PTSD and the limitations of the research.

Borderline Personality Disorder (BPD) is characterized by fluctuation of self-image, lack of stable interpersonal relationships and pronounced and unpredictable impulsivity. The Diagnostic and Statistical Manual of Mental Disorders 5 (2013) also lists fear of abandonment, suicidal or self-harming behaviors, intense or inappropriate anger that is difficult to control as well as paranoid ideation or dissociative symptoms. Morcos and Morcos (2016) wrote that patients with BPD are often misdiagnosed with other trauma related disorders, such as PTSD, depression or bipolar disorder. According to Beatson, et al. (2016) there are additional issues in diagnosing older patients, as the criteria indicates that symptoms would have been seen early in the patient’s life, not later. Beatson, et al. (2016) also noted that there is a considerable lack of studies and literature concerning BPD in older patients, making the diagnostic process more difficult. In this case study we will be working with an older patient, one that was well into midlife before Borderline Personality Disorder was included in the DSM, to see if she fits the criteria for BPD and what treatment options might be available.