Applying EMDR to somatic disorders

• somatisation by Michael Owen, 11/16/97
  
  

One of the notable features of working within the EMDR treatment framework is that one does not need to determine in advance whether the procedure can be or will be effective in order to offer EMDR. EMDR appears to produce treatment effects via rapid changes at a neuropsychological level (van der Kolk, 1997, p 20; Shapiro, 1996).

These features have led experienced EMDR trained clinicians to sometimes offer EMDR in situations in which they did not have any other research validated specific treatments to offer their clients. Working within the theoretical framework of the Accelerated Information Processing paradigm, clinicians can adapt EMDR to meet a variety of clinical challenges beyond those that have controlled research validation. A similar process took place in the early years of the “cognitive revolution.” After early research showed that cognitive methods could be effective in treating certain types of depression, clinicians began to explore how to adapt the “new” cognitive approach to other populations for which there were no effective treatment such as chronic substance abusers and personality disorders.

An example of such an extension of EMDR related to somatic disorders is an instance in which Linda Vanderlaan, Ph.D. found herself in South America confronted with a young girl with a recent amputation in an urban residential facility for rural children separated from their parents for medical procedures. The girl was experiencing intense phantom limb pain (PLP) and severe psychological distress. Without any known, effective treatment method to offer the young girl relief, Dr. Vanderlaan offered her EMDR. The girl calmed rapidly. The next day the girl asked for another EMDR session during which Dr. Vanderlaan was astonished to find that, not only was the girl’s phantom limp pain dissolved, never to return, but she moved through the mourning process for her lost leg and spoke of looking forward to being able to play once more with her age mates after she was fitted with a prosthesis.

Reports of this remarkable story, led Robert Tinker, Ph.D. and Sandra Wilson, Ph.D to review the research PLP. In their review of the literature they learned that PLP is remarkably treatment resistant. They then conducted a pilot study on 7 PLP patients (Tinker, Wilson, Becker,1997) and have reported promising findings as they have reached the one year follow up on most of their subjects. They are now seeking funding for a controlled comparison trial that will include Magnetic Encephalograph (MEG) brain scans along with standard psychometrics.

The consistent patterns of treatment responses observed in effective EMDR treatment sessions has led many competent and previously skeptical researchers and clinicians from a variety of schools of thought to conclude that EMDR produces rapid changes on a neurological level. van der Kolk’s recent (1997) pilot SPECTscan data appear to reinforce these impressions and to support Francine Shapiro’s theoretical formulation of the accelerated information processing model.

At the 1997 EMDRIA Conference while watching videotaped excerpts of treatment of one of the PLP patients treated by Dr. Tinker, I noted that the nature of the shifts that could be observed in the face and in the verbal reports from one set of eye movements to the next were essentially equivalent to the types of changes observed in traumatized individuals with PTSD diagnoses during typical EMDR sessions.

There undoubtedly is a complex interplay between the effects of EMDR reprocessing on emotional and cognitive functioning and on the underlying neurological mediating processes. What is intriguing to consider are the theoretical convergencies between affect theory and EMDR in that both describe the impacts on complex aspects of our functioning based on effects produced via fundamental underlying neurological processes. I will touch on some of these convergencies in a second commentary.

Andrew M. Leeds, Ph.D.

Private practice, Santa Rosa, CA, USA and Senior Trainer EMDR Institute, Pacific Grove, CA, USA.

Shapiro, F. (1996) Eye movement desensitization and reprocessing (EMDR): Evaluation of controlled PTSD research. Journal of Behavior Therapy and Experimental Psychiatry, 27, (3) 209-218.

van der Kolk (1997) The Psychobiology of Posttraumatic Stress Disorder, Journal of Clinical Psychiatry, 58 (supplement 9) 16-24.

Tinker, R., Wilson, S.A., Becker, L. (1997) Treatment of Phantom Limb Pain with EMDR: Two Videotaped Case Studies with Pre and Post Measures. EMDR International Association Conference, San Francisco, July 13, 1997.

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