Adaptive Information Processing, Targeting, the Standard Protocol, and Strategies for Successful Outcomes in EMDR Reprocessing

Adaptive Information Processing (pp. 5–8, 10)

EMDR is an integrative psychotherapeutic approach and is guided by an information processing model. Francine Shapiro developed a hypothetical model called the Adaptive Information Processing (AIP) model (changed from Accelerated Information Processing model in 1995) to provide a theoretical framework and principles for EMDR treatment. Accelerated information processing clarifies how EMDR works, and AIP guides how it is used. Dr. Shapiro recognized the need to more efficiently explain the consistent treatment effects being obtained and reported from EMDR.

Dr. Shapiro posits that inherent in the AIP model is a psychological self-healing construct similar to the body’s healing response to physical injury (2001). For example, if you get a splinter stuck in your finger, your body’s automatic response is to heal the area of injury. However, because the area is blocked by the splinter, healing cannot easily occur until the sliver is removed. In terms of mental processes, it is the inherent tendency of the information processing system to also move toward a state of health. So, when something mildly disturbing happens, you may think about it, talk about it, and process it. You usually find that, within a day or so, you are no longer thinking so intensely about the event and, when you do, you have come to a resolution. For instance, if you are angry at your spouse, you may start to remember that your spouse has some good qualities as well as these very annoying ones. It is a case of the mind adaptively processing the disturbing material and connecting that disturbance into the larger picture of the experience.

On the other hand, when a trauma occurs that is too large for your system to adequately process, it can become “stuck” (i.e., dysfunctionally stored) in the central nervous system. Maladaptive responses, such as flashbacks or dreams, can be triggered by present stimuli, and there may be attempts of the information processing system to resolve the trauma (Shapiro, 2001). When the system becomes overloaded as just described, EMDR is proving to be the treatment of choice for many to help restart this mental healing process and allow the traumas to be reprocessed.

The AIP model also posits that earlier life experiences set the stage for later life problems. Information from earlier disturbing life events can be physiologically and dysfunctionally stored in our nervous system if not properly assimilated at the time of the event. Problematic behaviors and disorders can occur as a result.

At the time of disturbing or traumatic events, information can be stored in the central nervous system in state-specific form (i.e., the negative cognitive belief and emotional and physical sensations the client experienced at the time of the traumatic event remain stored in the central nervous system just as if the trauma is happening in the now). Over time, a client may develop repeated negative patterns of feeling, sensing, thinking, believing, and behaving as a result of the dysfunctionally stored material. These patterns are stimulated, activated, or triggered by stimuli in the present that cause a client to react in the same or similar ways as in the past. Dr. Shapiro (2001) states in many ways throughout her basic text that the “past is present.” Negative beliefs and affect from past events spill into the present. By processing earlier traumatic memories, EMDR enables the client to generalize positive affect and cognitions to associated memories found throughout the “neuro” networks (i.e., memory networks), thus allowing more appropriate behaviors in the present.

Because the heart of EMDR is the AIP model, it is critical that the clinician have a clear understanding of it before proceeding with EMDR. An adequate conceptual understanding helps the clinician determine a client’s appropriateness for EMDR, as well as explain the process to the client during the preparation phase, so he has some understanding of the potential treatment effects. Table 1 highlights the before and after changes of EMDR in terms of the AIP model.

Figure 1 demonstrates in action the inherent information processing mechanism as it highlights the changes that occurred as a result of an individual’s dynamic drive toward mental health with the use of EMDR.

FIGURE 1

Adaptive information processing: Information processing mechanism. EMDR 5 eye movement desensitization and reprocessing. From An EMDR Primer: From Practicum to Practice (p. 10), by B.J. Hensley, 2009, New York, NY: Springer Publishing. Copyright 2009 by Springer Publishing. Reprinted with permission.

Types of EMDR Targets (pp. 16–24)

As you think about your client sessions, do you recognize any of the types of targets, including the ancillary targets (i.e., other factors that may be contributing to a client’s disturbance)? The following definitions are provided as a refresher:

Phase 3: Assessment (p. 22)

As target selection has been accomplished in previous phases, assessment is simply the measurements and amplification of the targets already selected. This is the phase where a client identifies the components of the target and baseline measures of his reaction to the process as its simplest explanation. The order of the EMDR components (i.e., image, negative cognitions [NC] and positive cognitions [PC], Validity of Cognition [VoC] scale, emotions, Subjective Units of Disturbance [SUD] scale, and body sensations) is specifically designed to access and stimulate dysfunctional target material. This is why a client’s level of distress may become increasingly more agitated during the process, and the clinician needs to be prepared to activate processing soon after completion of the assessment to ease his disturbance.

Identify, Assess, and Measure (pp. 63–64)

The three words that Dr. Shapiro uses to represent the assessment phase are identify, assess, and measure (2001). The clinician assists and supports the client in identifying a specific pivotal picture and assessing its toxicity. This is accomplished by determining the NC, PC, and specific negative emotion(s) and body sensation(s) associated with the event. Then baseline measurements of the client’s reactions to and progress within the phase are established and monitored.

Effective EMDR Equals Effective Targeting (pp. 88–89)

The assessment phase begins by confirming the specific target that the clinician and client previously agreed upon as part of an extensive treatment plan. In selecting the target, the clinician considered whether it was the most effective for resolving the client’s issue. An effective target leads the way to the dysfunctionally stored material and, thus, the dysfunctional memory networks. Targets generally emerge during a thorough assessment of the client’s presenting problems. From the client’s responses to the questions in the history-taking and treatment planning phase, the clinician is able to help identify salient targets for the client.

As stated earlier, in your initial interviews with the client, watch and listen for behavioral, emotional, cognitive, and physical cues; the duration of the presenting issue; how the problem manifests in the present; and what the client needs to be more adaptive in the future. In addition, assess whether the client possesses adequate affect tolerance and stability to process the negative states and access anything positive that may arise during the EMDR process.

EMDR Is a Three-Pronged Approach (p. 127)

In the client history-taking phase of Eye Movement Desensitization and Reprocessing (EMDR), the clinician begins the process of identifying past disturbances/traumatic experiences, present triggers, and anticipated future occurrences or situations. These are the true building blocks of EMDR. A client’s success with EMDR relies on a balanced focus on all three prongs of the EMDR protocol and the order of processing in which they are accessed and reprocessed. It is on these blocks—past, present, future—that the momentum and treatment effects can build and the healing process can be completed.

Building Blocks of EMDR: Past, Present, and Future (p. 128)

A client who has experienced a single traumatic event can usually be treated by targeting the disturbance/trauma-causing memory and additional incidents related to the primary event (e.g., car accident and related traumas: the car catching on fire while trapped in the car; being told she would never walk again; the long, difficult recovery). Clients who present with multiple issues and/or symptom presentations or with complex presentations of traumatic life events or extreme stress over a prolonged period of time will require a more comprehensive treatment approach. When a client’s history is traumatically complex, it is important to identify and treat these three areas of concern: touchstone memories, present triggers, and future alternative behaviors. Whether targeting single or multiple traumatic events, it is necessary to sequentially target the traumatic event(s) and present triggers that have manifested as a result and work on skills a client needs to be more successful or comfortable in the future.

FIGURE 2

Three-stage protocol: Targeting sequence model. From An EMDR Primer: From Practicum to Practice (p. 129), by B.J. Hensley, 2009, New York: Spinger Publishing. Copyright 2009 by Springer Publishing. Reprinted with permission.

In the first prong of EMDR treatment, the clinician and client work together to reprocess incidents associated with the presenting issue and, if present, the early and critical touchstone memories (i.e., crucial memories that set the foundation for a client’s current disturbance). The second prong is much like the first in that the clinician and client focus on reprocessing present triggers (e.g., people, circumstances, places, or other forms of stimuli that activate disturbing reactions or responses). The third prong focuses on alternative behaviors to aid the client in meeting his future therapeutic goals. Although past incidents, present triggers, and future outcomes associated with the presenting issue are initially identified in the assessment phase, they may also emerge anywhere throughout the eight phases (e.g., emergence of blocking beliefs or feeder memories, during reprocessing, between sessions).

Cognitive Interweaves

The cognitive interweave is a proactive and powerful strategy used in EMDR to manage abreactions and to facilitate blocked processing in order to achieve full therapeutic treatment effectiveness with challenging and highly disturbed clients. The following is excerpted from Hensley (2009, pp. 178–179; pp. 181–184).

Case Example 5a

Renee, age 25, was 10 years old when she was involved in a car accident in which her 34-year-old mother was seriously injured. Renee was strapped in the front seat opposite her mother, who was driving, when a semitruck hit them head on. Her vivid memories include her mother being unconscious and slumped over the steering wheel while Renee crawled out of the window of the car and rushed to the other side to help her mother. The impact of the semi rendered it impossible to budge the bent and crumbled door. No matter how hard she tried, she could not open the door to rescue her mother. The smell of gasoline helped Renee to choke back her tears as she tried to tug the door open. She was near hysteria when the firemen pushed her aside and pulled her mother out of the car just before it exploded into a fiery inferno. She stood and watched as her unconscious and helpless mother was removed from the car with a crowd of strangers looking on in horror. In a matter of minutes, Renee’s world became empty and unsafe, and she went on to live a life of anxiousness and uncertainty.

Renee, age 10 at the time of the crash, had experienced fear, terror, disbelief, and helplessness as she viewed her trapped mother, and she continued to experience deep sadness and guilt for her mother’s injuries. When Renee presented for therapy 15 years later, she was overweight, struggling with insomnia, and having frequent nightmares and flashbacks of the accident. She also suffered from depression and anxiety.

According to the Adaptive Information Processing model (Shapiro, 2001), Renee’s information processing system (i.e., her natural healing mechanism) “stalled on the track” on the day of the accident. The extreme levels of stress that she experienced that tragic day remained in the same emotional and cognitive state until EMDR helped her to clear the debris from the “track” and allowed natural processing to occur. What this means is that the disturbing memories left on the “track” (i.e., the image of her mother slumped helplessly over the steering wheel, the firemen pulling her away from the devastating scene, the fiery explosion, the range of emotions she felt throughout the event, the rise of her adrenaline as she climbed out of the car to rush to her mother’s aid) became stuck and isolated in a memory network in the same state-specific form as she had originally experienced it. This dysfunctional material stored in Renee’s nervous system subsequently was responsible for the symptoms described above, and she was eventually diagnosed with posttraumatic stress disorder (PTSD).

Even years later, when she passed by an automobile accident or heard about an explosion on the news, Renee experienced the same fear, terror, disbelief, and helplessness, just as if the accident was occurring all over again. The information (i.e., thoughts, images, cognitions, emotions, sensations) from the original accident had been isolated into its own memory network and frozen in time. No new learning appeared to be able to penetrate the steel lining that insulated the information in it. It was only when the memory networks were connected that insight and integration could naturally occur for Renee. With the aid of EMDR, Renee was able to bring up the accident and assimilate the related negative information into its proper perspective (i.e., that it belonged to the past). Renee was able to discharge the dysfunctional affect that caused generalization of the adaptive cognitive content throughout her memory network. The negative material had been isolated since the time of her accident.

During the majority of an EMDR session, adaptive processing spontaneously links dysfunctional or disturbing material to the appropriate memory networks. What would happen if this does not occur? What would have happened during the session if Renee’s “train” got stopped by “a fallen timber lying across the track” or if there had been a landslide or an avalanche and “her train could not move further down the track?” What resources are available to help Renee continue her healing journey? The answer is the cognitive interweave.

Choices of Cognitive Interweaves (p. 179)

Dr. Shapiro (2001) identifies and explains several choices of cognitive interweaves. To reiterate, the cognitive interweave is a deliberate effort by the clinician to mimic spontaneous processing by either directly infusing or eliciting information from the client. In doing so, the clinician is attempting to access the more adaptive memory network that contains information that is relevant to the client’s present processing. The cognitive interweave may consist of an educational statement, relevant question, or direction in terms of imagery, thought, or movement. It may consist of introducing new information or stimulating presently held information for the client.

Case Example 5a: Renee Cont’d

It was during an EMDR session where Renee ran into a huge timber lying on her “train track.” No matter what strategy was used to unblock processing, nothing seemed to work. When she accessed this particular part of the memory, Renee expressed inappropriate feelings of guilt for failing to be the one who got her mother out of the car. Nothing in Renee’s previous learning or education seemed to provide salvation from her guilt. What was needed was a piece of dynamite to obliterate the debris from the blocked “track.” During this session, a cognitive interweave was utilized to remove the timber from her “track.” It was used to strategically introduce new, but pertinent, information to Renee’s system to quick-start her stalled healing process.

The issue of responsibility comes to the foreground.

From the examples in Table 2, a number of different interweaves could have been utilized if continued processing did not cause a spontaneous change in her feelings.

In introducing the information in that manner, Renee was able to get in touch with her more adaptive adult perspective and assist in linking the information that was deliberately inserted to the appropriate memory networks. Remember, Renee’s perspective, somatic responses, and personal referents of the accident came from that of a 10-year-old, the age she was at the time of the accident. The cognitive interweave served to link dysfunctional information stored in an isolated memory network to Renee’s present-day adult and to activate the adaptive material stored in a healthier network. This provided her with a more realistic adult perspective of the accident.

After eliminating the guilt she had felt for her mother’s car accident, Renee realized that she was just a child at the time of the accident. Since the accident, she had difficulty riding in a car for sustained periods of time, and it was a struggle for her to drive. During a subsequent session, she began seeing images of the semitruck hitting them head on and her mother’s injured body slumped over the steering wheel. Renee’s reprocessing had stalled for the last few sets of bilateral stimulation. The following is how the clinician attempted to unblock her processing and her issue of safety played out during the session:

The clinician used a somatic interweave to help move “the train further down its track.”

The issue of safety emerges. The clinician probed further by eliciting information with a pertinent question:

Renee never made this connection, even though her mother had told her at the time of the accident that she had a seizure.

After this session, Renee was able to drive with a higher comfort level. She started to relax more and, as a result, actually became a better driver in her eyes. The resolution of her issue of safety also opened the door to various choices in her life. Previously, Renee had never traveled too far from home. It was beyond her comfort level. Being more comfortable behind the wheel empowered her to drive to different places and try new activities. She actually accepted a teaching position one summer that required her to drive 50 miles round-trip to another city.

After the issues of responsibility, safety, and choice were resolved, Renee was able to complete the session by reaccessing and fully reprocessing the original target. Once the block has dissipated, the client can continue the process of spontaneously resolving associated channels of dysfunctional material that may still exist.

Regardless of how a client moves through these important plateaus, the successful negotiation of one facilitates the possibility of resolution in the next. The client may successfully negotiate these plateaus on her own, or she may be assisted by the use of questioning or educating by the clinician.

Summary (p. 248)

Since its introduction in 1989, the treatment effects of EMDR continue to be experienced throughout the world by clients who have suffered from anxiety, depression, obsessions, phobias and panic, stress, relationship conflicts, addictions, chronic and phantom limb pain, grief, and more. Thousands of clinicians have been trained worldwide in this efficacious method since its inception, but many practitioners have chosen to lay EMDR aside and continue using only traditional treatment methods. Some may have deemed EMDR to not be a good fit with their current therapeutic model, work setting, or clinical population. Or, perhaps, managed care or limited sessions appeared to render EMDR impractical or impossible. Whatever the reason, the desire in writing the primer (Hensley, 2009) was to help newly trained EMDR practitioners keep on track and to provide a refresher for those who have not consistently used EMDR in their practices.

The intent of the primer (Hensley, 2009) is to provide a learning tool to assist newly trained and previously EMDR-trained clinicians to better understand the basic principles, protocols, and procedures of EMDR. Hensley’s (2009) primer is neither a substitute for formal EMDR training nor for Dr. Shapiro’s basic text (2001). I encourage you to go back and reread Dr. Shapiro’s (2001) basic text again to see what kernels of information leap off the page at you.