EMDR and early psychological intervention following trauma

IntroductionThis article evaluates developments in the field of early psychological intervention (EPI) after trauma in general and the place of early eye movement desensitization and reprocessing (EMDR) intervention (EEI) in particular. The issues and dilemmas involved with EPI and EEI will be outlined; related research presented and the current status evaluated.Literature and clinical findingsReviewing the literature and drawing on findings from initial research and case studies, the rationale and contribution that EMDR therapy has to offer is discussed relative to current evidence and theory regarding post-traumatic stress syndromes and trauma memories. The relative advantages of EEI will be elaborated.Discussion and conclusionIt is proposed that EEI, while trauma memories have not yet been integrated, may be used not only to treat acute distress but may also provide a window of opportunity in which a brief intervention, possibly on successive days, could prevent complications and strengthen resilience. Through the rapid reduction of intrusive symptoms and de-arousal response as well as by identifying potential obstructions to adaptive information processing (AIP), EMDR therapy may reduce the sensitisation and accumulation of trauma memories.     

The ambiguity of loss affects some,but not all autobiographical memories: redemption and contamination,agency and communion

ABSTRACT

Compared with clear-cut loss by death, ambiguous loss is defined as a loss that is not definite because the person is missing or mentally absent but physically present (e.g., through Alzheimer's disease). We expected the ambiguity of loss to show in psychologically more compromised loss memories and self-defining memories, but not in autobiographical memories in general. Thirty Chinese adults who had lost a parent through death, thirty whose parent had gone missing, and thirty who cared for a demented parent narrated their loss experiences and memories of sad and turning-point events as well as self-defining memories. Individuals with ambiguous loss narrated the loss and a self-defining memory with more contamination and fewer redemption sequences, and only the loss memory with fewer themes of agency and communion than individuals with definite loss, but not in memories of sad and turning point events. Effects of ambiguity of loss were independent of prolonged grief, which in turn independently predicted some of these effects. Thus the ambiguous quality of loss predicts effects on loss memories and self-defining memories independently of psychiatric symptoms.     

Mental ghosts and the process of grief

Abstract

Grieving the death of a loved one is an experience that many people will face at least once in their lifetime, but the lack of widely accepted guidelines as to what constitutes “normal” grieving results in mourning being a common experience with little universality. Memories may keep the deceased alive in the minds of the survivor and may even interfere with the formation of new relationships. This article considers the process of grieving the loss of a spouse and some of the individual factors, such as age, sex, and personal beliefs, that may account for variability in grief experiences. While several modeh detailing the grief process are discussed, the inappropriateness of establishing expectations for the nature and duration of grief is argued for.     

EMDR therapy: An overview of its development and mechanisms of action

IntroductionThis article examines the history and development of Eye Movement Desensitization and Reprocessing (EMDR), from Dr. Francine Shapiro's original discovery in 1987, to current findings and future directions for research and clinical practice.Elements of the literatureAn overview is provided of significant milestones in the evolution of EMDR over the first 20 years, including key events, research and scientific publications, and humanitarian efforts. The authors also describe the Adaptive Information Processing (AIP) model, which is the theoretical basis of the therapy; they address the question of mechanisms of action, and EMDR's specific contribution to the field of psychotherapy.DiscussionEMDR is an integrative psychotherapy, which sees dysfunctionally stored memories as the core element of the development of psychopathology. In its view of memory, it integrates information that is sensory, cognitive, emotional and somatic in nature. The EMDR protocol looks at past events that formed the presented problem, at the present situations where the problem is experienced, and at the way, the client would like to deal with future challenges.ConclusionEMDR is a 25-year-old therapy that has accumulated a substantial body of research proving its efficiency, and is now part of many professional treatment guidelines. The research is pointing to its potentially large positive impact in the fields of mental and physical health.     

Psychopathology Symptoms,Rumination and Autobiographical Memory Specificity: Do Associations Hold After Bereavement?

Symptoms of psychopathology are associated with overgeneral memory retrieval. Overgeneral memory is hypothesized to be the result of an emotion regulatory process, dampening emotional reactions associated with retrieval of distressing specific memories. However, higher post‐loss symptom severity has been related to higher specificity of loss‐related memories recalled on the Autobiographical Memory Test. This may imply that such memories are ‘immune’ to the reduced specificity effect. We aimed to test this idea by investigating, for the first time, associations of depressive and complicated grief symptoms and depressive and grief rumination with autobiographical memory specificity on a sentence‐completion task (SCEPT) in a bereaved sample. One hundred ninety‐one adult mourners (89% women) filled out questionnaires and the SCEPT. A main finding was that higher depressive and complicated grief symptom and grief rumination levels were associated with reduced specificity of non‐loss‐related memories but not with specificity of loss‐related memories. Implications of these results are discussed. Copyright © 2015 John Wiley & Sons, Ltd.     

EMDR as a treatment for improving attachment status in adults and children

IntroductionThe purpose of the article is to examine the current literature regarding evidence for positive change in attachment status following Eye Movement Desensitization and Reprocessing (EMDR) therapy and to describe how an integrative EMDR and family therapy team model was implemented to improve attachment and symptoms in a child with a history of relational loss and trauma.LiteratureThe EMDR method is briefly described along with the theoretical model that guides the EMDR approach. As well, an overview of attachment theory is provided and its implication for conceptualizing symptoms related to a history of relational trauma. Finally, a literature review is provided regarding current preliminary evidence that EMDR can improve attachment status in children and adults.Clinical findingsA case study is described in which an EMDR and family therapy integrative model improved attachment status and symptoms in a child with a history attachment trauma.ConclusionThe case study and literature review provide preliminary evidence that EMDR may be a promising therapy in the treatment of disorders related to attachment trauma.     

A systematic analysis of distressing near-death experience accounts

ABSTRACT

Near-death experiences (NDEs) are usually associated with positive affect, however, a small proportion are considered distressing. We aimed to look into the proportion of distressing NDEs in a sample of NDE narratives, categorise distressing narratives according to Greyson and Bush’s classification (inverse, void or hellish), and compare distressing and “classical” NDEs. Participants wrote down their experience, completed the Memory Characteristics Questionnaire (assessing the phenomenology of memories) and the Greyson scale (characterising content of NDEs). The proportion of suicidal attempts, content and intensity of distressing and classical NDEs were compared using frequentist and Bayesian statistics. Distressing NDEs represent 14% of our sample (n?=?123). We identified 8 inverse, 8 hellish and 1 void accounts. The proportion of suicide survivors is higher in distressing NDEs as compared to classical ones. Finally, memories of distressing NDEs appear as phenomenologically detailed as classical ones. Distressing NDEs deserve careful consideration to ensure their integration into experiencers’ identity.     

Comparison Of Narratives Of Loss Experiences Of World War Ii and Vietnam Combat Veterans

Abstract

While their continuing grief now is receiving periodic media attention, for years and even decades, American soldiers who fought in World War II (WWII) and who fought in Vietnam have suffered their life-altering experiences of loss in silence. Many of the WWII generation now have died and cannot share their grief with us. We as scholars of loss and trauma have a special obligation to reach out to the living survivors of WWII for information about their experiences. As has been often noted (e.g., Kuenning, 1990), for years after the conclusion of the Vietnam War, the stories of loss and grief of Vietnam veterans were not welcomed. The purpose of this chapter is to report some comparative narrative evidence from veterans of these two wars. Our major question was whether strong differences between groups in perceived long-term impact of combat experience would be reported.     

Parallel Process

Summary

This article addresses parallel processes between the author (a therapist) and client when each are mourning the death of their mother. Similarities and differences in their experience and reaction are discussed. The effect of the client's unexpressed grief from her early childhood loss is explored. The author also examines her own, more recent loss and develops a new perspective on its consequences. Tools are presented to help the client work on her grief, especially when the issue is “motherloss.” The impact of the therapeutic process on the client and author is delineated, and the client's reactions to ending her therapy are analyzed.     

Eye movement desensitization and reprocessing (EMDR): An overview

Eye movement desensitization and reprocessing (EMDR) is a recently developed psychotherapy procedure which has been reported to dramatically increase efficiency in the treatment of psychological disturbances rooted in traumatic memories. Following a review of the research on EMDR's efficacy, clinical considerations are addressed, including the client's experience and the potential for negative effects or treatment failure. Finally, the role of EMDR in clinical practice is discussed. Initial reports are encouraging, and further research is recommended. Clinicians who choose to use EMDR are urged to obtain formal training.     

Mother as Messenger of Love and Death

For mothers, the act of giving birth also brings them close to death as well as other human experiences. The mother represents the dual structure of life and death in the mind. It was this unconscious convergence that stirred the interest in reconsidering the subject of the loss of children and its effect on individual development. This article demonstrates what happens when death triumphs over life chronologically close to birth. The author presents a clinical report on a six-year-old girl, Dinah, who suffered the effects of the mother's mourning. She illustrates the therapeutic approach to mourning over time, at moments in which the shadow of pain is more clearly present. These are moments when the loss must be brought to consciousness, because of the unconscious effects it has on the survivors. Dinah's problems were not caused by the loss itself, but rather the fact that the loss occurred in a phase of her emotional development when she was only a baby an unable to react in a mature manner.     

The Relationships Among Grief Experience,Problem-Solving Appraisal,and Depression: An Exploratory Study

Abstract

Research has consistently shown a relationship between problem-solving appraisal and depressive symptoms. This study expands that research by including grief symptomatology as a variable. A college student sample completed the Problem-Solving inventory, the Beck Depression Inventory, and the Revised Grief Experience Inventory. Consistent with hypotheses, those individuals who had experienced the death of a close loved one within the previous 5 years reported significantly higher levels of grief and depression than those who had not experienced such a loss. However, the group that had experienced the death of a close loved one did not report significantly worse problem-solving scores than the group that did not. This study also examined the relationships among problem-solving appraisal, depressive symptoms, and grief symptoms within the subsample that had experienced the loss of a close loved one within the previous 5 years. Consistent with predictions, grief symptoms were associated with depressive symptoms and self-appraised ineffective problem solving. The results of this study extend the research on grief and mourning. Also, the results expand our understanding of the grief process by providing preliminary evidence for the role of problem solving in this process     

Do Patients With Psychosis Experience Loss and Grief As a Result of Their Illness?

BACKGROUND: Depression and suicidality are frequently reported in patients with psychosis and schizophrenia, but the grief process that may be associated with this illness has not been systematically studied. In this study, we examined whether patients diagnosed with psychosis identify, grieve, and mourn losses engendered by the illness. METHOD: 24 patients diagnosed with psychosis in the past five years were surveyed to indicate whether their illness led to losses, and to describe their responses to the losses. Psychosis-related perceived losses were surveyed using three subscales of a loss and grief questionnaire (loss of self, self-care, and roles). Their relationship with beliefs about the illness, symptomatology, coping style, and self-efficacy and insight was studied. RESULTS: 23 (96%) patients named specific losses, and 16 patients (67%) reported feelings associated with grief and mourning. More than half reported loss of self-esteem at the onset of illness and only half saw themselves as having improved in the past month. Patients reported more loss within the past month than at the onset of illness. In the past month, patients with an intact sense of self experienced greater self-efficacy (r = .568, p < .004) while those with loss of self reported feelings of shame (r = ?.582, p < .003). Only patients with insight associated the onset of illness with loss. In the past month, most patients saw themselves as experiencing loss. DISCUSSION: The study results suggest that at some distance from diagnosis, patients still experience themselves as having much loss due to their illness. These unresolved feelings may indicate complicated mourning. Insight appears to be associated with the ability to look back at the onset of the illness and recognize that it engendered losses. Further study of the process of and barriers to grief and mourning is recommended. In clinical practice, the assessment of grief as a part of post-psychotic recovery could lead to providing more appropriate treatment and lead to a positive outcome.     

Suicide,Loss, and Mourning

ABSTRACT: The intensive treatment of six suicidal patients has been used to explore the relationships among object loss, the mourning process, and suicide. These relationships may be condensed in two propositions: (a) suicidal behavior stems from an arrested grief reaction in which the subject is unable to complete the process of mourning for a lost object; and (b) the suicide's pathological loss reaction is brought about by developmental defects, primarily deficiencies in self-love and individuation. The suicidal subject's mournïng reaction is arrested in one or more of the first three stages of grief: shock, protest, or detachment from the lost object.     

THE SURVIVING SIBLING: THE EFFECTS OF SIBLING DEATH IN CHILDHOOD

This paper considers the case of childhood mourning in which there is an increased possibility of a pathological grief reaction, due to an incapacity to sustain mourning and an inability to comprehend death. The death of a sibling in childhood is a complex loss to manage, the outcome of which is inextricably linked with parental grief. Maladaptive parental mourning processes, including the phenomenon of the ‘replacement child’, are explored. The effects of this loss on the surviving sibling can give rise to a variety of symptoms that may impair emotional development. Amongst the main responses experienced by the surviving sibling is that of a guilt reaction, not only for having survived when the sibling did not, but also a fear that harboured death wishes may have caused the tragedy. Premature death anxiety and distorted concepts of illness are further possible outcomes of this event. It is suggested that the primary deprivation a child may experience when their sibling dies is the emotional absence of their parents who are preoccupied with their own grief.     

Trauma Accommodation and Anniversary Reactions in Children

Anniversary reactions in traumatized children have been well recognized in the literature. Examined herein are temporal issues in the mourning process often realized by traumatized children. The case study of Laura is presented as a clinical illustration of problems in trauma accommodation that include anniversary reactions in children. Anniversary reactions in children are more common than is generally recognized in clinical practice. Such reactions are more likely to be found among children who exhibit persistent, repetitive, but insufficient efforts of trauma mastery through their incomplete grief and inadequate mourning process. Clinical issues are discussed.     

Contributors

Abstract

This paper studies the interaction of the clinical theories of two major British theorists, Melanie Klein and Donald Winnicott. Through three clinical examples, we see how the “Klein-Winnicott dialectic” operates in a significantly developmental fashion to advance and fulfill clinical work. Winnicott’s “object survival” is looked at in developmental conjunction with Klein’s “mourning” as a primary clinical and developmental process. This interaction also captures the essence of working with the aggression of a self that has been traumatically disrupted within its early development. This paper demonstrates how such work leads to the assimilation and grieving of primal object loss, evolving into a “developmental mourning process.” This developmental mourning includes the working-through of an “abandonment depression” in the character-disordered patient. A clinical example in a 1989 essay on “psychic pain” by Betty Joseph is used to set up the clinical challenge of going beyond the symptomatic clinging behavior of developmental arrest, into full psychic birth as a separate other, an Other who can relate to an Other. Conclusively, the subjective visceral affect noted and monitored in its clinical dimensions here is that of human “heartache,” which can also include regret.     

Vers une nouvelle appréhension des mathématiques par traitement EMDR : actualités et perspectives

ObjectiveEMDR for Eye Movement Desensitization and Reprocessing developed since 1989 by F. Shapiro has demonstrated its effectiveness in the treatment of Post Traumatic Stress Disorder (PTSD). In Science of Education, no study has been previously developed in the application of EMDR protocols. The purpose of this article is to demonstrate the relevance and effectiveness of EMDR in supporting cognitive and emotional remediation of students in Master 1, with respect to mathematics, preparing Schools Teacher contest. The first encounters with the students revealed, through their discourse, an aversion to mathematics linked to one or more particularly painful experiences in a learning situation. Mathematics may cause anguish, sometimes tinged beliefs such as “I’ll never be able to… I am very bad at math”. This represents even an insurmountable obstacle in the professional life of some.MethodsNearly 170 students in Master 1 “Professor of the Schools” registered on the ESPE (College of the Teaching profession and Education) were asked about their relation to mathematics, both in their emotions as their self-efficacy. Among those who suggested a traumatic memory in a learning situation in mathematics, forty were selected and divided into two groups. The control group received two hours of information about relaxation techniques that could be used before mathematics. The other group benefited of the EMDR treatment according to the standard protocol in eight phases.ResultsThe results showed that students who received EMDR treatment experienced after treatment and one month later, a significant decline in their negative emotions with mathematics and an increase in the strength of their self-efficacy, unlike the control group.DiscussionEMDR demonstrates its effectiveness in reprocessing beliefs and emotions of students with respect to mathematics and opens ways of research in Educational Sciences. So, it will be necessary, from the principle of alternated bilateral stimulation, to develop specific protocols for the struggling students, to measure the effects in the long term and develop them in a group situation.