This chapter illustrates how Eye Movement Desensitization and Reprocessing (EMDR) can be applied in the treatment of specific fears and phobic conditions. It includes summary sheets to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. Treatment of a fear or a phobic condition cannot be started if the therapist is unaware of the factors that cause and maintain the anxiety response. The main features of a specific phobia are that the fear is elicited by a specific and limited set of stimuli that confrontation with these stimuli results in intense fear and avoidance behavior, and that the fear is unreasonable and excessive to a degree that interferes with daily life. The DSM–IV–TR distinguishes the following five main categories or subtypes of specific phobia: Animal type, Natural environment type, Situational type, Blood, injury, injection type, and other types.
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Eye movement desensitization and reprocessing (
EMDR) therapy may be particularly useful for phobic conditions with high levels of anxiety, with a traumatic origin or with a clear beginning, and for which it is understandable that resolving the memories of the conditioning events would positively influence its severity. This chapter illustrates how EMDR therapy can be applied in the treatment of specific fears and phobic conditions. It discusses four cases where clients actually underwent the dental treatment they feared, most within 3 weeks following EMDR Therapy treatment. The efficacy of EMDR therapy was also tested in a randomized clinical trial among 30 dental clients who met the DSM-IV-TR criteria of dental phobia, and who had been avoiding the dentist for more than 4 years, on average. Clients in the EMDR Therapy condition showed significant reductions of dental anxiety and avoidance behavior as well as in symptoms of posttraumatic stress disorder (PTSD).
The standard Three-Pronged Protocol for Eye Movement Desensitization and Reprocessing (
EMDR) therapy guides the overall treatment of the client. It consists of a “three-pronged” (past, present, and future) approach in which initially past events, then present issues, and finally anticipated future situations are targeted in therapy. The Flashforward Procedure has appeared to be an effective application of EMDR therapy to deal with the second of the three-pronged approach. It is a procedure to address clients’ irrational fears and anticipatory anxiety responses that persist after the core memories of past events have been fully processed. The fear of future catastrophe is a key component in several psychological conditions--obsessive-compulsive disorder (OCD) and specific phobias. When clients have been carefully prepared and therapists know their clients well, the Flashforward Procedure can become another valuable tool in the EMDR therapist’s toolkit.
This chapter describes possible interactions between trauma and psychosis and offers several methods for conceptualizing a case to facilitate the application of eye movement desensitization and reprocessing (
EMDR) in the treatment of people with psychosis. A psychotic disorder is often accompanied by at least one comorbid disorder, such as posttraumatic stress disorder (PTSD), depressive disorder, social phobia, substance abuse and dependence, or obsessive-compulsive disorder. A comprehensive treatment program offered by a multidisciplinary team is recommended. This includes pharmacotherapy, case management, cognitive behavioral therapy (CBT), supported employment, family interventions, and peer support. Standardized treatment protocols are feasible without adaptations and are effective in treating comorbid PTSD. Both antipsychotic medications and medication preventing motor side effects of anti-psychotics can affect cholinergic receptors. It can be difficult to judge the distress that a patient experiences during EMDR, due to some of the negative symptoms of schizophrenia.
When panic disorder is accompanied by severe avoidance of places or situations from which escape might be difficult or embarrassing, it is specified as “panic disorder with agoraphobia”. Despite the well-examined effectiveness of Eye Movement Desensitization and Reprocessing (
EMDR) Therapy in the treatment of posttraumatic stress disorder (PTSD), the applicability of EMDR therapy for other anxiety disorders, like panic disorders with or without agoraphobia (PDA or Pathological Demand Avoidance), has hardly been examined. This chapter illustrates how EMDR therapy can be applied in the treatment of panic disorder with or without agoraphobia. The EMDR protocol for panic disorders with or without agoraphobia is scripted. To determine whether a client suffers from panic disorder with or without agoraphobia, and its severity, a standardized clinical interview, such as the Structured Clinical Interview for DSM-IV Axis I disorders should be administered.