A Model for the Flash Technique Based on Working Memory and Neuroscience Research

Research has shown that the Flash Technique (FT) appears to reduce memory-related disturbance and may reduce symptoms of posttraumatic stress disorder. This paper discusses the connections between FT and eye movement desensitization and reprocessing (EMDR) therapy. In FT, clients remind themselves of a traumatic memory without dwelling on it and focus instead on a positive engaging focus and then blink their eyes when prompted. This paper summarizes numerous models describing how the brain processes traumatic material and presents a model for how FT may work in the brain. It proposes that during the blinking, the patient's periaqueductal gray (PAG) may take over, sensing the reminder of the traumatic memory and reflexively triggering the amygdala. In Porges's neuroception model, the PAG assesses danger without going through the conscious brain. Recent fMRI data show that for patients with posttraumatic stress disorder, there is enhanced connectivity from the amygdala to the left hippocampus. Thus, triggering the amygdala may, in turn, activate the left hippocampus, which may then provide a brief access to the traumatic memory. Given the brief access, there is insufficient time for the amygdala to go into overactivation. The client remains calm while accessing the traumatic memory, thus setting up the prediction error necessary for possible memory reconsolidation. This process is repeated during blinking in FT allowing memory reconsolidation to proceed. This model requires experimental confirmation.

A Model for the Flash Technique Based on Working Memory and Neuroscience Research

This article presents a model for understanding how the Flash Technique (FT) may work in the brain and provides potential avenues for experimental confirmation. In the FT, the client reminds himself of a traumatic memory without dwelling on it but instead focuses on a positive engaging focus and then blinks his eyes as prompted by the therapist. Clients have reported signs of memory reconsolidation, for example, the memory getting blurry and a reduction in emotional response. While the originators of FT did not offer a detailed mechanism for FT, this article proposes that during the blinking, the patient’s periaqueductal gray (PAG) takes over, senses the reminder of the traumatic memory and reflexively triggers the amygdala. As part of a system suggested by Porges (2009) for neuroception, the PAG works reflexively to assess danger without going through the conscious brain. Recent fMRI data show that for posttraumatic stress disorder (PTSD) patients, there is enhanced connectivity from the amygdala to the left hippocampus. As a result, triggering the amygdala may, in turn, activate the left hippocampus, which may then provide a brief access to the traumatic memory. Given the brief access, there is not enough time for the amygdala to go into overactivation. The client remains calm while accessing the traumatic memory, thus setting up the prediction error necessary for memory reconsolidation. This process is repeated many times during blinking in FT to allow memory reconsolidation to proceed, in some cases, to completion. This model is open to experimental confirmation.

EMDR Treatment for Persistent Post Concussion Symptoms Following Mild Traumatic Brain Injury: A Case Study

The majority of people who experience mild Traumatic Brain Injury (mTBI) have a healthy recovery, where initial somatic, cognitive, psychological, and behavioral mTBI-related symptoms resolve naturally within hours or days. Unfortunately, a significant minority of people unfortunately develop persistent symptoms referred to as persistent Post Concussion Syndrome (pPCS), often causing severe long-term reduction in wellbeing and daily function. Psychological and neuropsychological treatments are typically limited to antidepressants, psycho-education on mTBI and pPCS, basic neuro-rehabilitative cognitive compensatory strategies, traditional Cognitive Behavioral Therapy, or no treatment at all. This paper discusses a single case study which demonstrates how Eye Movement Desensitization Reprocessing (EMDR) therapy might provide psychological improvement in clients who sustain mTBI who develop pPCS. The case example describes a 57-year-old man who sustained a mTBI from a serious road traffic collision as a pedestrian, and who developed pPCS. Treatment included nine, 1.5-hour EMDR sessions across a 5-month period (1st being an assessment). Measures of psychological symptom change and client feedback were taken at pretreatment, midtreatment, posttreatment, and aftertreatment had ceased to gauge long-term status. Measures were taken at 18-month follow-up and 4-year review (which followed litigation settlement). The novel viability for the application of EMDR for this client group is discussed.

Examination of Initial Evidence for Eye Movement Desensitization and Reprocessing as a Treatment for Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a debilitating psychological condition that impacts millions of people globally. The front-line psychological intervention for OCD is exposure/response prevention (ERP), however, many individuals do not respond to this treatment approach. Eye movement desensitization and reprocessing (EMDR) is a new therapeutic option which could be effective in treating OCD. This review examined the initial evidence for the effectiveness of EMDR in reducing OCD symptoms. Nine studies were included in the review, including six case studies and three group studies. Results indicate that EMDR is a promising candidate for treating OCD, with all studies showing EMDR therapy resulted in reduced symptoms from baseline. Results also indicated that EMDR may be as effective as ERP, and more effective than selective serotonin reuptake inhibitors (SSRIs) in treating OCD.

Exploring Therapists' Experiences of Applying Eye Movement Desensitization and Reprocessing (EMDR) Therapy with Clients Experiencing Psychosis

Little is known of the usability of Eye Movement Desensitization and Reprocessing (EMDR) as an intervention for those experiencing psychosis. This study aimed to explore therapists’ experience of using EMDR with this population. A qualitative design was employed using an inductive approach and a thematic analysis. Twenty therapists, who had used EMDR with this client group, took part in a semi-structured interview to explore their experiences of the intervention. Key themes were generated from the data: (a) Familiarity with psychosis and EMDR, (b) Acceptability of EMDR, (c) The importance of systemic factors, and (d) Keeping key therapy principles in mind. Findings highlighted the importance of supervision to build therapist confidence, the value of the multidisciplinary team and the need for a shift in beliefs surrounding the usefulness of EMDR to the wider system. Recommendations for individuals and services are provided.

The Flash Technique in a Low-Intensity Group Trauma Intervention for Healthcare Providers Impacted by COVID-19 Patients

The flash technique (FT) is a low-intensity individual or group intervention that appears to rapidly lessen the distress of disturbing and traumatic memories. This paper reports on the safety and effectiveness of group FT with 77 healthcare providers and 98 psychotherapists impacted by working with COVID-19 patients. One-hour webinars included 30 minutes of psychoeducation and two guided 15-minute FT interventions, focused on participants’ most distressing pandemic-related memory. Before and after each 15-minute FT intervention, they rated that memory using the 11-point zero-to-ten subjective units of disturbance (SUD) scale. Results from both interventions were highly significant with large effect sizes (p < .001, Hedges’ g = 2.01, Hedges’ g = 2.39). No adverse reactions were reported. For 35 participants who processed the same memory in both interventions, the pre–post SUD scores from the beginning of intervention #1 to the end of intervention #2 showed a significant reduction with a large effect size (p < .001, Hedges’ g = 3.80). For this group, both intervention #1 and intervention #2 showed significant reductions with large effect sizes (p < .001, Hedges’ g = 2.00) (p < .001, Hedges’ g = 1.18). Follow-up SUD scores were obtained from 58 participants, with the mean disturbance level showing a significant further decrease. These findings provide preliminary evidence that group FT appears to safely provide rapid relief from disturbing memories. FT merits further research.

Low-Intensity Interventions and EMDR Therapy

Unlike high intensity treatment, in which clients have face-to-face contact with a mental health specialist, clients in low-intensity treatment have limited or no contact with a specialist. Instead, their treatment is usually provided through self-help procedures, which are delivered via (guided) computer programs, books, or mHealth apps. Other treatments sometimes considered low intensity are brief treatments, group therapy, and interventions delivered by nonspecialists. Advantages include effectiveness, accessibility, efficiency, and affordability. Concerns related to safety, engagement, and adherence in self-help programs may be addressed by (asynchronous) therapist guidance. This article describes low-intensity treatments, and their relevance for eye movement desensitization and reprocessing (EMDR) therapy. Hundreds of randomized controlled trials (RCTs) have found self-help interventions to be efficacious, with many producing the same level of results as the traditional face-to-face procedure. Guided self-help cognitive behavioral therapy is recommended for the treatment of posttraumatic stress disorder in the guidelines of both the National Institute for Health and Care Excellence and International Society of Traumatic Stress Studies. Only three self-help-EMDR RCTs have been conducted. This author advocates for reconceptualizing EMDR group therapy as “guided EMDR-self-help therapy,” because it is a highly manualized, heavily scripted treatment, in which the client works independently on their own material. In this respect, it offers an excellent template for the future development of efficacious low-intensity EMDR interventions. Developing safe, easy-to-use, affordable, and readily available low-intensity interventions will make effective EMDR treatment available to many millions of people around the world.

Randomized Controlled Trial: Self-Care Traumatic Episode Protocol (STEP), Computerized EMDR Treatment of COVID-19 Related Stress

Healthcare workers and Mental Health clinicians are at heightened risk for mental health issues while they support their communities during the COVID-19 pandemic, and early psychological intervention is crucial to protect them. The Self-Care Traumatic Episode Protocol (STEP) is a computerized intervention adapted from the Eye Movement Desensitization and Reprocessing Group Traumatic Episode Protocol (EMDR G-TEP). This study evaluated the effectiveness of STEP for Mental Health clinicians in the context of COVID-19. Thirty-four Mental Health clinicians were randomly allocated to treatment (n = 17) or waitlist (n = 17). The Generalized Self-Efficacy Scale (GSE) and Depression and Anxiety Stress Scale (DASS- 21) were completed by the treatment group at baseline and 1-week follow-up postintervention and by the waitlist group at baseline, preintervention, and 1-week follow-up postwaitlist. Pre–post comparisons showed a significant decrease in depression, anxiety, and stress for Immediate Treatment, t(15) = −3.64, p < .01, d = .73, and for Delayed Treatment, t(15) = −3.53, p < .01, d = .68, There was also a significant increase in general self-efficacy for Immediate Treatment, t(15) = 2.87, p < .05, d = .46, and Delayed Treatment, t(15) = 3.72, p < .01, d = .56. The randomized controlled trial (RCT) indicated that STEP may be effective in increasing general self-efficacy and reducing symptoms of depression, anxiety, and stress among Mental Health clinicians in the context of COVID-19. Further research investigating the potential of utilizing the STEP intervention on a larger scale and with other populations is needed.

Use of EMDR-Derived Self-Help Intervention in Children in the Period of COVID-19: A Randomized-Controlled Study

Self-help treatments are an important intervention tool, with high accessibility and ease of application. To our knowledge, no research has previously been conducted on any self-help intervention derived from eye movement desensitization and reprocessing (EMDR) therapy. In this study, we evaluated the mental health status of children not directly affected by the pandemic and investigated the effects of using an EMDR-derived self-help intervention in children as a low-intensity treatment. The mental health status of 178 children was evaluated online via the State-Trait Anxiety Inventory for Children (STAIC) and Childhood Posttraumatic Stress Reaction Index (CPTS-RI). Then, children were randomly assigned to intervention and waitlist. A booklet containing EMDR-derived techniques was sent via the school online portal and the intervention was conducted. Posttests were administered 4 weeks later. The attrition rate was 45.5%, with 97 children completing the trial (intervention: 52; waitlist: 45). At baseline, 76.4% of children showed posttraumatic stress symptoms (PTSS) above threshold. Results showed a statistically significant decrease in the posttest PTSS scores for the intervention group compared to waitlist. The intervention group had significant pre–post improvement on all but one subscale, while the waitlist group showed significant increase in state anxiety on the STAIC. In conclusion, posttraumatic stress was found to be high in children during the COVID-19 outbreak period, and EMDR-derived self-help intervention appeared to be an effective psychosocial intervention tool.

Efficacy of EMDR Therapy on the Pain Intensity and Subjective Distress of Cancer Patients

The present study was carried out to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) therapy in treating pain and subjective distress of patients with cancer. A randomized controlled trial was performed on patients with cancer suffering from moderate to severe cancer pain in Yasuj, Iran, in 2019 and 2020. Sixty patients aged 30–60 years who fulfilled the inclusion criteria were selected using a consensus sampling technique. Patients were randomly assigned to EMDR therapy or control groups based on random block allocation. EMDR therapy was administered in six to eight daily 1-hour sessions. The control group received the standard treatment provided by the hospital. A Numeric Pain-Rating Scale (NRS) and the Subjective Units of Disturbance Scale (SUDS) were used to assess pain and subjective distress before and after the intervention in each session. The collected data were analyzed by descriptive statistics, chi-square test, and independent t test using Statistical Package for the Social Sciences (SPSS) version 24. The mean pain intensity and subjective distress score in the experimental group before and after the EMDR intervention were significantly reduced (p < .001). In the control group, no decreases in NRS and SUDS scores occurred at any time (p > .05). Differences in pain scores between the groups were statistically significant (p < .001). EMDR can effectively and sustainably reduce the pain and subjective distress experienced by patients with cancer. Thus, EMDR is a recommended therapeutic option to mitigate pain and subjective distress among patients with cancer.