EMDR Therapy Treatment of Grief and Mourning in Times of COVID-19 (Coronavirus)

Death of a loved one is universally distressing. The stressful conditions of COVID-19 can compound the trauma of a loss. Consequently, the mourner has to deal with: (a) the loss of a loved one; (b) potential complications of grief and mourning caused by COVID-19 (e.g., sudden and unexpected death, a loved one's suffering, inability to be physically present to offer comfort or say good-bye, social distancing interfering with funeral and religious ceremonies); and (c) personal disruption caused by COVID-19 (e.g., disruption of employment and daily living routines, fears related to safety and uncertainty). Further, grief can be complicated by prior unresolved losses and trauma, including attachment-based trauma, which would also need to be identified and treated. This article presents a framework for treatment of grief and mourning with eye movement desensitization and reprocessing (EMDR) therapy. EMDR treatment, guided by the Adaptive Information Processing model, can be informed by other frameworks, including attachment theory and the Dual Process Model, which are described. A case example is presented to illustrate treatment of a client whose father died due to COVID-19.

Recovery, Interrupted: The Zeigarnik Effect in EMDR Therapy and the Adaptive Information Processing Model

This theoretical article proposes that the Zeigarnik effect (ZE) (i.e., better memory for interrupted rather than completed tasks) explains the formation of traumatic memories as incomplete tasks. These tasks are thought to foster pathological rumination toward their completion while simultaneously stoking avoidance. After looking at the role of the ZE in the development and maintenance of posttraumatic stress disorder (PTSD), the article examines the physiological substrates of the ZE, including brain network imbalance, excessive autonomic nervous system activation, and prospective memory acuity for incomplete events. Eye movement desensitization and reprocessing (EMDR) therapy is proposed as uniquely capable of providing closure to interrupted facets of traumatic recollection, as this treatment may facilitate greater memory reconsolidation and inhibition of Zeigarnik reminders than extinction-based models. The ZE may be implicated in the overall EMDR treatment effect, as it is activated in several EMDR phases. Specifically, the use of brief interrupted exposures during EMDR reprocessing may benefit from the ZE in resolving traumatic events. Eye movements themselves are also considered interruptions to rumination upon traumatic memory. Recommendations for the further use of the ZE are described, and suggestions are made for future research. Protocol modifications and interweaves which mobilize the preceding insights are also provided.

EMDR Case Formulation Tool

This article describes a diagrammatic clinical tool to be used when formulating cases in eye movement desensitization and reprocessing (EMDR) therapy. Based on the Adaptive Information Processing (AIP) model, the EMDR Case Formulation Tool is a way of illustrating psychological difficulties, mapping out the relationships between six key elements: unprocessed traumatic experiences, triggers, intrusions, negative beliefs, and symptoms, as well as resilience. From the diagrammatic formulation, a narrative formulation can be developed. The case formulation tool can be shared with the client, used to guide treatment planning, in supervision, and in case consultations. The use of the tool is explained and its clinical applications demonstrated with case examples.

Behandlung psychosomatischer Störungen – Psychotherapie mit Eye-Movement Desensitization and Reprocessing

Zusammenfassung. Dysfunktional gespeicherte Gedächtnisinformationen sind eine mögliche Ursache psychosomatischer Störungen. EMDR (Eye-Movement Desensitization and Reprocessing) basiert auf dem «Adaptive Information Processing Model». Dieser psychotherapeutische Ansatz kann zur Behandlung psychosomatischer Störungen eingesetzt werden, um die pathogenen Informationen zu aktivieren und von einem dysfunktionalen in einen adaptiven Zustand zu überführen. EMDR hat sich wissenschaftlich für die Behandlung posttraumatischer Belastungsstörungen bewährt, während die Behandlung von psychosomatischen Störungen ein neueres Einsatzgebiet darstellt. Kürzlich haben Studien die Wirksamkeit von EMDR bei Migränekopfschmerzen, Hautkrankheiten, Magen-Darm-Erkrankungen, chronischem Fatique-Syndrom, chronischem Schmerzsyndrom und Phantomschmerzen dokumentiert.

Synthesis and Realization (Personification and Presentification): The Psychological Process of Integration of Traumatic Memories in EMDR Psychotherapy

The theory of the structural dissociation of the personality proposes a precise description of the psychological phenomena involved in the integration of traumatic memories. According to this theory, memories are successfully integrated in a narrative—that is, stored in an adaptive memory network—when there has been synthesis of the different elements (affects, cognitions, images, sensorimotor reactions, behaviors) for each moment of a particular event, and when realization has occurred. Realization implies personification and presentification. Personification is the ability individuals have to feel that they have experienced (traumatic) events. Presentification is the ability to realize that the event took place in the past and is over now. In this article we present these concepts and how they relate to eye movement desensitization and reprocessing (EMDR) psychotherapy and its underlying hypothesis of adaptive information processing. The article describes how EMDR therapists can use these concepts to better understand the reprocessing of their clients and possible blocking of this reprocessing. Understanding the concepts of synthesis, personification, and presentification makes it possible for EMDR therapists to choose the specific supportive interventions and cognitive interweaves that will best support the adaptive information processing. Such psychological phenomena should attract more attention in the future in EMDR clinical research and practice.