EMDR (Eye movement desensitization and reprocesing)
"Si sufrimos de trastorno de estrés postraumático, podemos sentirnos internamente fragmentados, rotos, debilitados, explotados, divididos ... El flujo de pensamientos, la tensión nerviosa nos atrapa, traspasando todos los límites, saliendo de control. Incluso no podemos sentir los propios límites corporales.”
Qué es el EMDR
Emdr –cuyas siglas en español significan Desensibilización y Reprocesamiento por los Movimientos Oculares, proceden de sus acrónimas inglesas (Eye Movement Desensibilization and Reprocessing), cuya autora Francine Shapiro, lo descubrió de una forma casual en 1987. Es un abordaje psicoterapeútico con un enfoque integrador, a través de un procedimiento en el que interviene la estimulación bilateral, por distintos métodos y medios ( a través del terapeuta, autoestimulación, online).
Trabaja sobre el propio sistema de procesamiento del paciente (SPIA), que es un sistema intrínseco al paciente y que por diversos motivos (muertes, abusos psicológicos, emocionales, físicos, otras circunstancias u otros factores que acontecen o acontecieron en la vida del paciente) , bloquean el sistema y producen síntomas tales como (miedo, angustia, tristeza, dolor, baja autoestima, creencias del tipo, No valgo, soy tonto, estoy dañado para siempre, no puedo expresar mis emociones con seguridad, etc. ) y estos hechos, al no ser tratados, y tras un evento de vida genera un trastorno (depresión, trastorno obsesivo compulsivo, trastorno límite de personalidad, trastorno bipolar, adicciones, etc.).
También está recomendado en el tratamiento de las dificultades emocionales causadas por experiencias difíciles en la vida del sujeto, desde fobias, ataques de pánico, muerte traumática y duelos o incidentes traumáticos en la infancia hasta accidentes y desastres naturales. También se usa EMDR para aliviar la angustia y/o la fobia de hablar en público, para mejorar el rendimiento en el trabajo, en los deportes y en las interpretaciones artísticas, relacionados con el estrés postraumático.
Quién lo recomienda
American Psychological Association (APA; EEUU)
Organización Mundial de la Salud (OMS)
The International Society for Traumatic Stress Studies (ISTSS; EEUU)
National Institute for Health and Care Excellence (NICE; EEUU)
Royal College of Psychiatrists (RCPSYCH; Reino Unido)
Department of Health and social care (Reino Unido)
Substance Abuse and Mental Health Services Administration (SAMHSA; EEUU)
Canadian Agency for Drugs and Technologies in Health (CADTH; Canadá)
Asimismo, EMDR es utilizada como primera línea de tratamiento para el TEPT en diferentes países como Alemania, Países Bajos, Polonia, Turquía, Israel, Francia, Suecia, el Norte de Irlanda, EEUU y Reino Unido.
Mecanismos de acción que subyacen a esta terapia psicológica
Una revisión sistemática publicada recientemente en la revista Frontiers in Psychology (Landin-Romero, Moreno-Alcazar, Pagani, & Amann, 2018), recoge y resume los resultados de 87 ensayos clínicos randomizados y controlados organizados en tres grandes categorías acordes a las diferentes hipótesis explicativas sobre la eficacia de EMDR:
Faqs, Frequently asked questions about therapy
How can I take the first step to start therapy?
Opening up to a stranger makes us feel vulnerable and is often terrifying. We know that relationships, even those with professionals, are uncomfortable at first because it is difficult for us to get out of the comfort zone and we feel exposed.
The best thing you can do during this decision-making time is to be honest with yourself and be clear about what you need and what your expectations are . So the best thing is that you become aware of it and you can expose it from the beginning.
What type of therapy is the most suitable for me?
It depends on each case and situation, but what is recommended, especially when starting therapy, is to go once a week, in order to be able to commit to the process and appreciate the changes.
When it comes to therapy, the easiest way to understand how you might feel is to know whether the focus is active or passive. The goal of all have the same objective, to help the patient to face problems in an effective way and to find the solution in a less stressful way.
Psychodynamic, relational, and humanistic therapies tend to be more passive. The emphasis is on perception and the therapist probably takes a more reflective role. This is what we consider to be a more classical therapy.
New generation, cognitive-behavioral and contextual , mindfulness-based and solution-focused therapies tend to be more active.
The emphasis is on cultivating behavior change through new perspectives and skills.
Therapists using these approaches may be more directive, asking you to practice tools outside of the session.
Both approaches are valuable, but choosing one or the other will depend on what you are looking for. Personally I work from Logotherapy (humanistic approach) and as a cognitive-behavioral psychologist, from the Emdr and mindfulnes, so I can adapt both to the type of need you show, and within the process to alternate in one or another model, depending on be the most convenient in your dynamics. In addition to incorporating psychoenergetic processes within your need, and adapting to your noetic vision of the world.
From my point of view, passive approaches are useful if you are looking for a place to speak and feel supported.
However, active approaches are useful if you are motivated to make changes or want to learn new skills and tools to apply in your life.
What are the advantages of online therapy?
The main advantages offered by online therapy are several:
The main one is accessibility , both for people who reside in another country, people with some physical or emotional limitation (phobias, panic), as people who travel continuously, or have difficulties with schedules and displacement, online therapy is a way of working .
Another advantage it offers is saving time and money . This type of therapy requires less travel time, therefore being cheaper than face-to-face therapy.
Also, while some people may find face-to-face therapy closer, others will find it easier to express themselves or discuss their concerns with an online psychologist , as often happens when we chat or talk on the phone.
How does Online therapy work?
New technologies have changed the way we relate to each other. Now it is possible to receive psychological help online, or by phone if you prefer.
Online therapy has the same objectives as face-to-face therapy, but there will always be goals, depending on the case, that need to be worked in person.
It works in the same way, the only thing that changes is the way we communicate, since this will be by instant messaging, e-mail, call or video call.
The duration is also the same is 60 minutes.
You will need a mobile device and an internet connection.
Can all psychologists perform Emdr therapy?
Only psychologists and psychiatrists trained in EMDR training are qualified to offer these sessions. Specific training is required to apply the EMDR protocol.
Therefore it must appear in their formation.
How do I know if this therapy is right for me?
One area where the benefits of EMDR therapy have been extensively studied is in the treatment of PTSD (post-traumatic stress disorder). EMDR can help people who have experienced severe forms of trauma in childhood and adulthood.
But long-term benefits have been shown in patients with anxiety, eating disorders, stress, depression, panic attacks, among others .
How do EMDR sessions work?
EMDR sessions are held individually and in person or online in a private space and with total privacy and confidentiality.
It is a therapy with a specific application protocol which must be explained to the patient from the beginning.
As in all therapy, it consists of a preliminary interview phase to know the case and the patient's history, and later, together with the patient, the objective to be treated and where to start is marked. You must consider that between 2 to 3 sessions will be required to know your history , your needs, your expectations and to shape and design your personalized process.
During EMDR therapy sessions, the patient brings troublesome thoughts / memories from the past to mind to make them feel more comfortable in front of them.
As this is done, the easier it will be to deal with emotions (such as anxiety) that are associated with negative thoughts.
Who can benefit the most from EMDR therapy?
Anyone with post-traumatic stress disorder, anxiety, addictions, phobias, pain, depression, obesity linked to adverse experiences, or a history of traumatic events can find relief with the help of EMDR therapy.
It can be perfectly combined with other therapies.
What is it?
# Emdr - whose acronym in Spanish means Eye Movement Desensitization and Reprocessing and which comes from its English acronyms (Eye Movement Desensibilization and Reprocessing), whose author Francine Sha Piro discovered it by chance in 1987, is a psychotherapeutic approach with an integrative approach, through a procedure in which bilateral stimulation intervenes, by different methods and means (through the therapist, self-stimulation, online).
It works on the patient's own processing system (SPIA), which is an intrinsic system to the patient and that for various reasons (deaths, psychological, emotional, physical, or other types of abuse, or other factors that occur in the patient's life patient), they block the system and produce symptoms such as (fear, anguish, sadness, pain, low self-esteem, beliefs of the type, I am not worth, I am stupid, I am damaged forever, I cannot express my emotions with confidence, etc.) and These facts, when not being treated, and after a life event generates a disorder (depression, obsessive compulsive disorder, borderline personality disorder, bipolar disorder, addictions, etc.).
It is also recommended in the treatment of emotional difficulties caused by difficult experiences in the life of the subject, from phobias, panic attacks, traumatic death and grief or traumatic incidents in childhood to accidents and natural disasters. EMDR is also used to alleviate public speaking anxiety and / or phobia, to improve performance at work, in sports, and in artistic performances.
Who recommends it
American Psychological Association (APA; USA)
World Health Organization (WHO)
The International Society for Traumatic Stress Studies (ISTSS; USA)
National Institute for Health and Care Excellence (NICE; USA)
Royal College of Psychiatrists (RCPSYCH; UK)
Department of Health and social care (UK)
Substance Abuse and Mental Health Services Administration (SAMHSA; USA)
Canadian Agency for Drugs and Technologies in Health (CADTH; Canada)
Likewise, EMDR is used as the first line of treatment for PTSD in different countries such as Germany, the Netherlands, Poland, Turkey, Israel, France, Sweden, the North of Ireland, the United States and the United Kingdom.
Mechanisms of action underlying this psychological therapy
A systematic review recently published in the journal Frontiers in Psychology (Landin-Romero, Moreno-Alcazar, Pagani, & Amann, 2018), collects and summarizes the results of 87 randomized and controlled clinical trials organized into three large categories according to the different hypotheses explanatory about the effectiveness of EMDR:
H ipótesis based on psychological models: The most accepted hypothesis so far is the explanation based on the model memory workof Badeley and Hitch (Baddeley & Hitch, 1974).
E studies of functional neuroimaging have observed a restoration of cortical control, especially of frontal regions, over hyperactivated subcortical structures of the limbic system such as the amygdala; These recent investigations are part of the neurobiological models.
H ipótesis sustained in psychophysiological models in this category we find mainly two explanatory models:
The first of them is the one whose authors postulate that eye movements and the dual attentional task promote psychophysiological changes in the body, favoring a reduction in arousal through the activation of the parasympathetic nervous system.
The second proposal that has been put forward maintains that eye movements cause physiological changes similar to those that occur during the REM sleep phase (from the English "rapid eye movement"). This model holds that the integration of episodic memory into semantic memory occurs while we sleep.
(Benedikt Amann, Alicia Valiente, Ana Moreno, Miguel Angel Santed, Anabel Gonzalez)
There are numerous randomized controlled studies on EMDR Therapy that show clinical efficacy of this psychotherapy.
E sta effectiveness is reflected in several meta - analyzes and systematic reviews.
There are recent meta-analyzes showing that the eye movements included in EMDR procedures are an active ingredient of this psychotherapy.
#E MDR is recognized in most international Clinical Guidelines as one of the first-line treatments for post-traumatic stress disorder.
L os controlled randomized clinical trials (ERC) respond to the highest degree of scientific evidence because they control potential biases that may exist in clinical research. They are the medical procedures that allow demonstrating the scientific efficacy of a treatment and / or therapeutic intervention. We recall that at least two or three controlled studies were needed for a treatment to be considered as having scientific evidence.
There are currently thirty-four CKD that demonstrate the efficacy of EMDR therapy in the treatment of PTSD, 25 in the adult population (Acarturk et al., 2016; Arabia, Manca, & Solomon, 2011; Carlson, J., Chemtob, CM, Rusnak, K., Hedlund, NL, & Muraoka, 1998; Edmond, Rubin, & Wambach, 1999; Högberg et al., 2007; Ironson, Freund, Strauss, & Williams, 2002; Jarero, Uribe, Artigas, & Givaudan, 2015; Jarero, Artigas, & Luber, 2011; C. Lee, Gavriel, Drummond, Richards, & Greenwald, 2002; Marcus, Marquis, & Sakai, 2004, 1997; Nijdam et al., 2018; Nijdam, Gersons, Reitsma, De Jongh, & Olff, 2012; Power et al., 2002; Rothbaum, 1997;
Rothbaum, Astin, & Marsteller, 2005; Sack et al., 2016; Scheck, Schaeffer, & Gillette, 1998; E. Shapiro & Laub, 2015; F. Shapiro, 1989; Taylor et al., 2003; Ter Heide, Mooren, Van De Schoot, De Jongh, & Kleber, 2016; Van Der Kolk et al., 2007; Vaughan et al., 1994; Wilson, S., Becker,
LA, & Tinker, 1995) and 9 in the child and adolescent population (Ahmad, Larsson, & Sundelin-Wahlsten, 2007; Chemtob, Nakashima, & Carlson, 2002; de Roos et al., 2011, 2017; Diehle, Opmeer, Boer, Mannarino , & Lindauer, 2015; Fernandez, Abbasnejad, Mahani, & Zamyad, 2007; Jaberghaderi, Greenwald, Rubin, Zand, & Dolatabadi, 2004; Kemp, Drummond, & McDermott, 2010; Soberman, Greenwald, & David, 2002) (see Table 1). Likewise, beyond the treatment of PTSD, it has been seen in CKD that this therapy is effective and safe for the treatment of traumatic life events in people with other comorbid psychiatric pathologies (Behnammoghadam, Alamdari, Behnammoghadam, & Darban, 2015; Gerhardt et al., 2016; Hase et al., 2015, 2018; Hase, Schallmayer, & Sack, 2008; Novo et al., 2014; Perez-Dandieu & Tapia, 2014; Wanders, Serra, & de Jongh, 2008) (see Table 2).
Along these lines, a systematic review recently published in the journal Frontiers in Psychology collects a large part of these studies endorsing the efficacy and safety of EMDR in these clinical conditions (Valiente-Gómez et al., 2017).
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