The Wedging or Strengthening Technique has been modified in Germany and is called the Absorption Technique to create resources to deal with what the client is concerned about in the future, or having stress about working with eye movement desensitization and reprocessing (EMDR) in the future, a present trigger or even an intrusive memory. Having clients imagine a strength or skill that would help them during the problem often helps them to reduce their anxiety. Focusing on a specific strength or coping skill may create a wedge of safety or control that will assist clients with the difficult situation in the future. During the Future Phase of the Inverted Protocol for Unstable complex post-traumatic stress disorder (C-PTSD) use the Absorption or Wedging Technique to develop as many different resources for the different issues about which the client might be concerned.

This chapter serves as a one-stop resource where therapists can access a wide range of word-for-word scripted protocols for Eye Movement Desensitization and Reprocessing (EMDR) practice, including the past, present, and future templates. Client history taking is an important part of well-prepared clinicians’ understanding of their clients. The Time Line Script is based on a number of personal communications with other EMDR clinicians. Start with the best events and ask for the negative events in the session. When all of the memories are gathered, it is helpful to plot them onto a “Positive and Negative Memories Map”. This Map allows for a visual presentation along the time line of the client’s life and offers a window into what the important landmarks of the client’s life were for the clinician and client to see together.

The Inverted eye movement desensitization and reprocessing (EMDR) Standard Protocol for complex post-traumatic stress disorder (C-PTSD) is a structured way to assist these clients to reduce their symptoms to the point where they are stable enough to work with more and more of their old memory clusters of the past, such as most often childhood abuse, neglect, and numerous secondary traumas after that. The protocol seems to be especially useful in clients with psychiatric hospitalization histories or inpatient settings. There are three foci for the Inverted Standard Protocol for unstable C-PTSD based on inverting the EMDR Standard Protocol to meet the needs of unstable C-PTSD clients: the future, the present, and the past. The constant installation of present orientation and safety (CIPOS) method assists clients in reducing the stress of triggers of older trauma material in a more controlled manner without getting overwhelmed by the old material.

Studies show that there is a high risk for relapse in major depression (MD). Each depressive episode increases the risk of relapse by 15” and the episodes get more severe with each relapse. It is the third most common cause for primary health consultation and the leading cause of disability from ages 15 to 44. Research shows that distinct psychosocial stressors precede most of the depressive episodes by 1 or 2 months (episode triggers). Following the Adaptive Information Processing (AIP) model, DeprEnd© is an eye movement desensitization and reprocessing (EMDR) therapy protocol that addresses an important cause of depression that may also contribute to the maintenance of the symptoms of the disorder: pathogenic memory networks. In the DeprEnd© protocol, four main types of memories are addressed and worked with: classic traumatic memories (Criterion A), often non-Criterion A-based episode triggers, belief systems, and depressive and suicidal states.

When it is time to begin memory processing when treating depressive patients, it is usually best to focus on Episode Triggers first. The Episode Trigger is defined as the stressful and sometimes traumatic event/s that occur/s for most patients 1 or 2 months before the depressive episode starts. Most of these events are not classical traumatic events that that include danger for one’s life, but events that come from stressful interpersonal relationship events like losses, separations, and humiliations. This chapter describes some of the most common patterns of depressive reactions to such events. The use of the Symptom Event Map is encouraged to chart patients’ negative events and their depressive episode(s), according to a timeline. This helps the patient to understand and the therapist to build a treatment strategy. The chapter also describes some of the different types of depression that can be identified on the Symptom Event Map.

Finding a certified eye movement desensitization and reprocessing (EMDR) therapist is an important step in receiving effective treatment. For organic causes of depression, it is helpful to consult with a primary care physician or psychiatric specialist. EMDR therapy is important to consider when there are depressive relapses. There are nine randomized controlled studies that show that EMDR therapy is successful or equivalent to other therapies and more studies are in process. There is a clear connection between the effectiveness of EMDR treatment and the qualification of therapists. Professional qualifications, as well as quality training, are important in EMDR. Please consult regional EMDR associations for information on qualified therapists. Positive chemistry is important for a good treatment outcome as well.

The Symptom Event Map is one of the most helpful tools for treatment planning in the DeprEnd Protocol for the treatment of depression as it charts depressive episodes and their intensity, Episode Triggers, and Compensation Zones. The Symptom Event Map is made of two unrelated maps: the symptom map charts the intensity of the depressive episode(s), and the trauma map plots the stressful life events, including or not including Criterion A incidents with their appropriate Subjective Units of Distress (SUD) levels. The Symptom Event Map is an effective tool to chart the course of depressive episodes and identify the Episode Triggers. Viewing the image of the course of the depressive events, including Compensation Zones of full recovery, help clinicians with their treatment planning and case conceptualization. It also points out the targets that will be helpful in relapse prevention. This chapter introduces the Symptom Event Map and provides a case example.

About 60% of all depressive patients suffer from mental health comorbidities. In many cases, the comorbidity of these depressive patients is posttraumatic stress disorders (PTSDs), complex PTSD (C-PTSD), and/or moderate to severe dissociative disorders. While structured research in this patient group is still in its infancy, in this chapter we cover what we have learned by treating many of these complex patients. It is clear that the greater the complexity with which patients present, the more psychoeducation, resourcing, and eye movement desensitization and reprocessing (EMDR) memory reprocessing sessions are needed. Often, complex patients have faced years of treatment and are not diagnosed accurately. Those considered treatment resistant are often patients with a history of trauma/PTSD or a dissociative disorder. The first step for these patients is to help them understand their disorder and to stabilize them before any EMDR processing. We have observed that when these steps are taken, complex and dissociative patients make real progress with their trauma and then their depressive disorder.

This book introduces a new, successful, research-based, and proven approach to treat depressive disorders. In this introduction, we give an overview of the successes and limitations of current guideline-based treatment of depressive disorders as well as a first overview of our 12 years of research in this field. We found that an approach that considers depression as a stress- and trauma-based disorder is critical for treating depressive patients, especially patients who do not respond well to current guideline-based treatment. Eye movement desensitization and reprocessing (EMDR) therapy is the centerpiece of this new treatment and has already shown its effectiveness in treating depression successfully in a number of controlled studies. This book contains many case studies and information to inform the practice of EMDR-trained clinicians.

In this chapter some practical consequences of the paradigm shift to understand depression as a stress- and trauma-based disorder are discussed. As successful eye movement desensitization and reprocessing (EMDR) therapy helps to resolve these memories, the authors show how EMDR therapy works with depressive patients. Randomized controlled trial (RCT) studies demonstrate that not only is EMDR therapy for depressive disorders at least equal to other treatments, but there are more complete remissions. The EMDR DeprEnd Protocol is a significant step forward in the treatment of depressive patients and in the reduction of depressive relapses. This is important as the effect of treatment-resistant depression leaves patients at risk for suicide and families to bear the loss of their family member. Improved treatment possibilities would also occasion economic savings. With more knowledge about the importance of childhood memories in the development of depression, we can also do much more for primary prevention of depression.