Complex Trauma and EDMR Therapy: A Case Study Analysis

This case study examines the application of Eye Movement Desensitization and Reprocessing (EDMR) therapy in treating complex trauma. The document begins by defining complex trauma and its symptoms, including shame, trust issues, and emotional dysregulation, and then introduces EDMR as a psychotherapy approach. It details the eight phases of EDMR therapy, including history taking, preparation, assessment, desensitization, installation of positive beliefs, body scan, closure, and reprocessing. A literature review supports the use of EDMR for various conditions, such as sexual abuse, self-harming behaviors, and PTSD. The case study focuses on Marie Douglas, a 25-year-old woman with a history of date rape and subsequent anxiety, and demonstrates the application of EDMR through its phases. The case highlights how EDMR helps clients process traumatic memories, reduce negative beliefs, and improve emotional regulation, ultimately leading to positive outcomes, such as reduced anxiety and improved relationships. The case study concludes by emphasizing the therapy's effectiveness and the importance of future research and clinician training.

Eye Desensitization Movement and Reprocessing (EDMR) and its
impact on Complex Trauma

What is Complex Trauma?
• Complex trauma is an interpersonal challenge
that exploits a feeling of being trapped
(Tarocchi et al., 2013).
• It can be planned, extreme, ongoing or
repeated.
• The impacts of the trauma are more severe,
persistent and often cumulative.
• This causes the individual to combat shame,
trust issues, reduced self esteem, regulating
emotions and identity crisis (Cook et al., 2017).

• The individual might develop coping strategies like substance abuse,
excessive work, overeating, self harm etc.
• This impacts the well being of the individual negatively impacting the
health and emotion. It impacts their family life and daily activities as
well.
What is Complex Trauma?

Victims of Complex trauma
disorder
• Partner violence
• Chronic sexual, psychological or physical
abuse
• Victims of kidnapping and hostage
• Indentured Servants
• Victims of slavery
• Human trafficking
• Sweatshop workers
• Neglect

Symptoms of Complex trauma
disorder

The four stress responses

Treatment of Complex trauma
• Psychotherapy
• Eye desensitization and reprocessing (EMDR)
• Medication

What is EDMR?
• Eye movement desensitization and
reprocessing (EMDR) is a treatment
process that is exploited to attenuate the
distress that is related with traumatic
memories, it reformulates negative
believes and reduction in physiological
arousal (Shapiro, 2014).
• This exploits therapist directed lateral
eye movements are most common but
there are other stimuli which includes
hand tapping and audio stimulus.

EDMR
• The principle of EDMR is that this therapy exploits the individual’s
rapid, rhythmic eye movements which dampen the potential of the
emotionally charged memories of the traumatic events that occurred
in the past.
• EDMR therapy is a eight phase therapy and the eye movements are
exploited in one part of the session.
• The client’s thoughts, feelings and behaviour are the natural outcome
of the therapy that are observed and are considered to be the robust
indicators of the emotional health and resolution of the individual
undertaking the EDMR therapy (Shapiro & Forrest, 2016).

EMDR Phase 1
• This phase is known as the history taking session and
based on that a treatment plan is made by the
therapist.
• This phase emphasises on the specific skills
development and behaviours that will be required by
the client in the future (Shapiro, 2017).
• It is directed at the childhood events rather than the
adult onset stressors (Pagani et al., 2013).
• The clients gain insight of the situations and resolves
the emotional distress with aid of the therapy and start
to change their behaviour.

• The therapist ensures that the client handles the
emotional distress in a variety of different ways.
• This phase ensures educating the client about
various imaginary as well as the stress reduction
techniques that is exploited by the client during
the sessions and in between as well (McDonald,
Borntrager, & Rostad, 2014).
• The objective of this phase is to produce rapid and
effective change in the client and ensuring client
maintains the equilibrium (Chen et al., 2015).
EMDR Phase 2

• It is during this phase that the therapist identifies the components of
the target.
• The client then selects the best image that describes the incident and
selects a negative cognition that describes a dysfunctional,
maladaptive self assessment in relation to the participation of the
client in the incident (Novo et al., 2014).
• This negative cognition is measured in 1 to 10 subject units of
disturbance (SUD) (Wesselmann, 2013).
EMDR Phase 3

• The entire brain is required to access the integrative functions of
reflective thought as well as meaning making order to heal the
trauma.
• By exploiting bilateral stimulation rhythmic alteration is triggered
between the right and the left hemispheres of the brain while
pondering on the traumatic event (Meier et al., 2013).
EMDR Phase 4

• This phase is called the installation phase this is because this phase
focusses on elevating the power of positive cognition that is identified
by the client and replaces the negative cognition with it.
• The calibre of the treatment effects is then measured exploiting the
Validity of Cognition (VOC) scale.
EMDR Phase 5

• This phase is called the body scan phase
where the body of the client is exploited
as a gauge.
• The client is requested to ponder on the
traumatic incident in mind and the
residual tension in the form of body
tension is identified.
• The reprocessing in this therapy exploits
these targeted somatic feelings (Briggs et
al., 2015).
EMDR Phase 6

• This phase is known as the closure where the therapist asks the client
to maintain a log for the entire week.
• The log should contain and enlist any related material that the client
may encounter.
• This phase ensures to aid the client in recalling about the self calming
activities that was learnt in phase 2.
EMDR Phase 7

• This phase of the therapy mainly deals with
the progress that the therapy has made so far.
• This phase processes all the related historical
events, the current incidents that elicit the
distress of the client and also deals with the
future events that will require discrete
response.
EMDR Phase 8

Literature Review on the use of
EDMR
• It is exploited mainly for treating complex trauma symptoms and the
subjects spend reduced time for scanning the environments for
threats.
• Another significant area in which EDMR is widely exploited is Sexual
abuse to alleviate trauma that is related to it as well as for better
social functioning of the traumatized victim (Briggs et al., 2015).
• This therapeutic event has been successfully used to treat the self
harming behaviours.
• This therapy reduces the stress that police officers face and are highly
stressed due to their occupation (Pagani et al., 2013).

• This therapy is effective in combating primary disorders related to
dermatology in which psychological stress plays an important role in
pathogenesis of the disease.
• The disorders like attention deficit, hyperactivity disorder, dissociative
disorders, self esteem issues, spiritual development and personality
pathology can be treated exploiting EDMR (Meier et al., 2013).
Literature Review on the use of
EDMR

Efficacy of the therapy
• Eye movement and desensitization is thought to be an effective
treatment because recalling distressing events is emotionally
upsetting when the attention is diverted.
• It exploits natural function of the body, rapid eye movement as its
basis.
• It is of great benefit to treat people with substance abuse and PTSD.
• This therapies allowed the individual to be exposed to the thoughts
and memories.
• There is no strong psychological response observed.

Opportunities of EMDR therapy
• This therapy is in a juvenile stage in comparison to the other basic
psychotherapies, hence greater number of studies should be done to
discover the various areas in which this therapy can be effectively
exploited.
• This therapy should be introduced to budding clinicians as this
therapy has an immediate effect on the clients in aid to reducing their
stress.

EMDR Case Study
The case study involves about an adult Marie Douglas, 25 years of age and
working in the IT industry. She stays with her parents and no siblings. She is
supposedly in a stable relationship with her fiancée but she often becomes very
reactive and ends up in a heated up conversation with him. This is hampering
her relationship. It was also noticed in office that Marie used to become
paranoid and nervous before going for a one on one session with her
immediate boss in his cabin.
In her diary Marie had mentioned that she had been date raped in her college
day. It was her first ever date she was going to and had a very high expectation
that seemed shattered and had impacted her. Fred, her fiancée got to know
about it and wanted to help her combat the situation and head for a better
future.

EMDR Case Study
Phase 1: An in-depth history- this involves inclusion of life events,
family systems and strength as well as the currently available
resources.
• Marie was a victim of being date raped when she was in college and
she is combatting anxiety and she finds it difficult to develop and
nurture a meaningful long term relationship.
• She was into talk therapy but to no aid.
• She never confronted with the trauma surrounding the incident and
was quite efficient in avoiding as well as dealing with the trauma of
the incident.

Phase 2: Preparation for EDMR- This exploits the use of eye movements, tactile
sensations or bilateral sounds.
• Marie had lost a sense of choice or control over her emotional life. She felt
she was flooded with anxiety and needed some aid to make her feel safe
again.
• In the EDMR therapy, the therapist helped her recollect instances and times
when she had felt safe.
• She was also given tools to exploit in between the sessions to combat with
her anxiety.
• The next session Marie stated that comparatively she felt calmer and could
control her emotions.
EMDR Case Study

Phase 3- Assessment and setting an EDMR target: The trauma that is to
be worked on in the desensitization step is diagnosed at this step. This
is the trauma that is the target and identify the image, the beliefs as
well as the body sensations that are associated with the events.
• Marie realised that the incident had a much intense effect on her life
than she had ever allowed herself to feel.
• She understood that the feeling of helplessness seeded in her and she
felt the same repeatedly when encountering stressful situation with
her boss and even when she was at home alone in the evenings.
EMDR Case Study

• Marie realized during this therapy that she had compromised for the
vulnerability that she was encountering by keeping a distance with
people when they drew close to her.
• Marie also recognised that she felt confident about taking care of
herself as well as she wanted to nuture self-allowance and not resist
herself from developing a loving nurturing relationship.
EMDR Case Study

Phase 4-Desensitization: The identified trauma is primarily stored in the limbic and in the right
hemisphere of the brain.
• Marie was asked to think about the trauma incident and image the worst part of her
experience while exploiting bilateral eye movement. Marie stated that she felt disconnected
and numb on thinking about the episode.
• She was able to tolerate the uncomfortable and vulnerable emotions through careful pacing
that came up with the thought of the incident.
• Gradually a series of memories popped up for Marie as she started to think about the trauma
that dealt with associations at other instances of her life when she felt depressed and
isolated.
• Eventually the thought of rape did not make Marie get filled with uncontrolled emotions and
anxiety with respect to that trauma.
• This therapy also boosted her self confidence.
EMDR Case Study

Phase 5: Installation- This phase ensures guidance to positive beliefs as well as the
self awareness that is gained through by completing of the desensitization phase.
• Marie at this phase was feeling much stronger mentally and in control when
thinking about the rape. She gradually realized that it she was not to be blamed
and be the reason that caused it and there were changes she could make in her
approach to the world. This reflects on the new experiences that she is feeling.
• Marie was able to think of being at home alone and the vulnerability that she
used to feel and she allowed a new sense of strength to infuse her being.
• She felt more open to the tendency of taking the risk of allowing someone close
to her.
EMDR Case Study

Phase 6- Body scan: The body is exploited as gauge that is used to verify
the successful completion of the EDMR process.
• Marie’s body was scanned t check for the presence of any lingering
tension as well as to allow the release of any residual distress.
EMDR Case Study

Phase 7: Closure- This phase of the therapy ensures the effective work
of desensitization to be fitted between sessions. This phase helps to
free up the individual by asking them not to ponder about the
traumatic material between the sessions.
• Before the end of each session it was ensured that Marie felt
grounded and complete with the process pursued that day.
EMDR Case Study

Phase 8: Re-evaluation- The objective of the re-evaluation is to access
the efficacy of the treatment and aid to the rest of the unresolved
feelings.
• Marie was asked about her feelings when she things about rape and
she shared that she no longer had any disturbed thoughts with
respect to the incident. She also stated that she felt lighter
throughout the week and she could effectively control her emotions
and did not feel provoked to get angry towards her boyfriend.
EMDR Case Study

References
• Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., ... & Mallah, K. (2017). Complex trauma in children and
adolescents. Psychiatric annals, 35(5), 390-398.
• Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. D. (2013). Therapeutic assessment of complex trauma: A single-case time-series study. Clinical
case studies, 12(3), 228-245.
• McDonald, M. K., Borntrager, C. F., & Rostad, W. (2014). Measuring trauma: Considerations for assessing complex and non-PTSD criterion a
childhood trauma. Journal of Trauma & Dissociation, 15(2), 184-203.
• Chen, L., Zhang, G., Hu, M., & Liang, X. (2015). Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult
posttraumatic stress disorder: systematic review and meta-analysis. The Journal of nervous and mental disease, 203(6), 443-451.
• Novo, P., Landin-Romero, R., Radua, J., Vicens, V., Fernandez, I., Garcia, F., ... & Amann, B. L. (2014). Eye movement desensitization and
reprocessing therapy in subsyndromal bipolar patients with a history of traumatic events: a randomized, controlled pilot-study. Psychiatry
Research, 219(1), 122-128.
• Wesselmann, D. (2013). Healing trauma and creating secure attachments through EDMR. Healing moments in psychotherapy. New York:
WW Norton & Company, 115-28.
• Meier, C., Behrends, J., Teutloff, C., Astakhov, O., Schnegg, A., Lips, K., & Bittl, R. (2013). Multi-frequency EDMR applied to microcrystalline
thin-film silicon solar cells. Journal of Magnetic Resonance, 234, 1-9.
• Briggs, S., Pearce, R., Dilworth, S., Higgins, I., Hullick, C., & Attia, J. (2015). Clinical pharmacist review: a randomised controlled
trial. Emergency Medicine Australasia, 27(5), 419-426.
• Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological
and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71.
• Shapiro, F., & Forrest, M. S. (2016). EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. Basic Books.
• Pagani, M., Högberg, G., Fernandez, I., & Siracusano, A. (2013). Correlates of EMDR therapy in functional and structural neuroimaging: A
critical summary of recent findings. Journal of EMDR Practice and Research, 7(1), 29-38.
• Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford
Publications.

Appendix
• Related videos for further explanation
https://www.youtube.com/watch?v=8552cfDn8pQ
https://www.youtube.com/watch?v=hJDrMDT_ezU
https://www.youtube.com/watch?v=hKrfH43srg8