Today’s blog post will examine treatment of psychosis using EMDR, or Eye Movement Desensitization and Reprocessing, a therapeutic intervention for trauma that follows an eight-phase, three-pronged protocol.
EMDR reprocesses past disturbances, present events and future scenarios, all of which may act as triggers. EMDR also helps clients develop preferred responses to situations.
EMDR can be utilized for:
- one or more events which have had a negative impact on a person’s functioning;
- acute stress;
- ingrained negative core beliefs about oneself and the world;
- behaviors and feelings which a person would like to change;
- situations that trigger disturbances;
- disturbing body sensations;
- dreams or nightmares;
- disorders like PTSD, Acute Stress Disorder, and Adjustment Disorders.
- urges and addictions.
Psychotic Symptoms
Many things can trigger psychotic symptoms or episodes. The topic of psychosis is an important one for therapists and the public alike; psychosis, or psychotic breaks, can feel scary, and may be accompanied by paranoia, delusions, somatic disturbances, and other symptoms corresponding with a variety of disorders. Negative imagery may intrude into the person’s awareness; these can prompt frightening future-oriented fantasies (de Bont et al., 2019).
EMDR Therapists
An article published in 2021 in the Journal of EMDR Therapy Practice & Research, can help us understand how EMDR may be utilized to help clients resolve symptoms of psychosis.
In this article, “Exploring Therapists’ Experiences of Applying EMDR Therapy With Clients Experiencing Psychosis,” the authors Rebecca Phillips, Pamela McSherry, Cathryn Pinto & Tess Maguire address the use of EMDR as an intervention for people who are experiencing psychosis. The authors have found that at least 20% of individuals suffering through psychosis also have histories of trauma. EMDR (Eye Movement Desensitization and Reprocessing) addresses dysfunction ally stored traumatic memories as it helps resolve PTSD symptoms, including hallucinations, delusions, mood disturbances, and self-esteem issues (Phillips, R., 2021). In addition, studies have shown that EMDR can help alleviate symptoms of psychosis, including depersonalization – and derealization, and may therefore be utilized to target psychosis outside of PTSD (Phillips et al, 2021).
In their article, Phillips et al., interviewed EMDR therapists about their experiences working with psychosis. Therapists with more familiarity around treating psychosis felt more self-confidence, since they had already acquired the ability to conceptualize how treatment should unfold (Phillips et al., 2021). These therapists also understood how trauma and psychosis are related, and therefore could help clients remain within their window of tolerance during sessions (Phillips, R., 2021). The window of tolerance keeps the client focused on reprocessing without triggering hyper or hypo-arousal. The use of stabilization techniques and exercises can help clients maintain focus on the present moment (Phillips et al., 2021).
Outside help in the form of social and family supports, and also case management, allows both clients and EMDR therapists the space to focus on the specific work to be done, the latter which includes spending quality time building a strong therapeutic alliance (Phillips et al., 2021).
Therapists were able to use EMDR with good outcomes, even when clients were experiencing symptoms like hallucinations (Phillips et al., 2021). EMDR is very user-friendly, as it eschews homework, thus allowing both client and therapist breathing room in which change can happen (Phillips et al., 2021). Reprocessing of disturbances can happen quickly with EMDR, thereby facilitating more relief for clients (Phillips et al., 2021). The EMDR therapy model, as a whole, has continued to develop and evolve, with new models concentrating on feeling states or more recent events (Miller, 2015).
EMDR Adapted for Psychotic Symptoms
Psychotic phenomena, when taken as targets for reprocessing using EMDR, can act as a bridge to previously dysfunctionally-stored material which can then be metabolized psychologically (Miller, 2015). Once the client and therapist have worked together to identify targets contained within the dysfunctionally-stored material, and understanding that these targets trigger clients into experiencing delusions, hallucinations, unwanted behaviors, and other disturbing, emotional and cognitive symptoms, the therapist will teach the client how to stay grounded in the present moment (Miller, 2015). This preparation phase may last for one or more sessions, with elements also woven into succeeding sessions (Miller, 2015). During this early phase, the therapist will be helping the client understand how the brain works;
- how EMDR works;
- how to use the Stop signal and feel in control during every session;
- how to imagine and use the Safe Calm Place;
- how to develop and use an imaginary room that exists outside of time and space;
- and how to use metaphors during reprocessing so that clients can remain within their window of tolerance (Miller, 2015).
Our next blog post will continue examining the use of EMDR for psychosis, and will look at the next phases and how they are applied for this special topic. See you then!
References
de Bont, P., de Jongh, A., & van den Berg, D. (2019). Psychosis: An emerging field for EMDR research and therapy. Journal of EMDR Practice and Research, 13(4), 313-324.
Miller, P. W. M. D. M. (2015). EMDR therapy for schizophrenia and other psychoses. Springer Publishing Company.
Phillips, R., McSherry, P., Pinto, C., & Maguire, T. (2021). Exploring Therapists’ Experiences of Applying EMDR Therapy With Clients Experiencing Psychosis. Journal of EMDR Practice and Research, 15(3), 142-156.