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The EMDR Integrative Group Treatment Protocol: Application With Child Victims of a Mass Disaster

  • EMDR Mexico and the Mexican Association for Mental Health Support in Crisis
  • Asociación Mexicana para Ayuda Mental en Crisis A.C.

Abstract and Figures

The EMDR Integrative Group Treatment protocol (EMDR-IGTP) has been used in different parts of the world since 1998 with both adults and children after natural or man-made disasters. This protocol combines the eight standard EMDR treatment phases with a group therapy model, thus providing more extensive reach than the individual application of EMDR. In this study the EMDR-IGTP was used with 16 bereaved children after a human provoked disaster in the Mexican State of Coahuila in 2006. Results showed a significant decrease in scores on the Child's Reaction to Traumatic Events Scale that was maintained at 3-month follow-up. Although controlled research is needed to establish the efficacy of this intervention, preliminary results suggest that EMDR-IGTP may be an effective means of providing treatment to large groups of people impacted by large-scale critical incidents (e.g., human-provoked disasters, terrorism, natural disasters).
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Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 97
© 2008 Springer Publishing Company DOI: 10.1891/1933-3196.2.2.97
t 2:35 a.m. on February 19, 2006, there was
an explosion in the Pasta de Concho mine,
trapping 65 miners. The Nueva Rosita region
became the international media center of attention
when rescue efforts were broadcast worldwide from
this carbon mine in the Mexican State of Coahuila.
Unfortunately after several days all hope was lost,
the rescue failed, and the miners were offi cially de-
clared dead. Media attention then shifted to related
political issues, because the disaster had been caused
by negligence in mine security. Although the explo-
sion remained in the political spotlight for weeks, the
families of the dead miners—their parents, wives, and
children—and the members of the rescue team—re-
ceived no mental health support to alleviate their
deep grief, anguish, and distress.
In May, when political conditions had become fa-
vorable, a member of the Asociacion Mexicana para
Ayuda Mental en Crisis (AMAMECRISIS) fl ew to the
region to plan the provision of services. AMAMECRISIS
is a nonprofi t nongovernmental organization (NGO)
whose mission is to prevent or alleviate the human
suffering provoked by psychological trauma. This NGO
has more experience working in situ with survivors of
natural or human-provoked disasters than any other
agency in Latin America.
AMAMECRISIS provided the following services:
In May, psychoeducation for 50 social workers who
gave support to the families of the dead miners.
The social workers were taught strategies to cope
with compassion fatigue.
In May, meeting with the local mental health pro-
fessionals who were working with the children on
a daily basis in the schools to plan this fi eld research
In June, training eight mental health professionals
in the Nueva Rosita region. The therapists received
full scholarships for EMDR basic training and two
advanced trainings with EMDRIA credits: EMDR
integrative group treatment protocol and resources
for more debilitated clients.
The EMDR Integrative Group Treatment Protocol:
Application With Child Victims of a Mass Disaster
Ignacio Jarero
Lucina Artigas
AMAMECRISIS, México City, México
María Montero y López Lena
UNAM, México City, México
The EMDR Integrative Group Treatment protocol (EMDR-IGTP) has been used in different parts of the
world since 1998 with both adults and children after natural or man-made disasters. This protocol
combines the eight standard EMDR treatment phases with a group therapy model, thus providing more
extensive reach than the individual application of EMDR. In this study the EMDR-IGTP was used with
16 bereaved children after a human provoked disaster in the Mexican State of Coahuila in 2006. Results
showed a signifi cant decrease in scores on the Child’s Reaction to Traumatic Events Scale that was
main tained at 3-month follow-up. Although controlled research is needed to establish the effi cacy of
this intervention, preliminary results suggest that EMDR-IGTP may be an effective means of providing
treatment to large groups of people impacted by large-scale critical incidents (e.g., human-provoked
disasters, terrorism, natural disasters).
Keywords: EMDR; group treatment; Latin America; human-provoked disaster; posttraumatic stress; children
98 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008
Jarero et al.
In June, implementing this fi eld research study with
provision of the EMDR Integrative Group Treat-
ment protocol to 16 bereaved children. Treatment
was provided by the eight local therapists in col-
laboration with the AMAMECRISIS team.
In September, follow-up with children, parents,
and teachers.
The Treatment of Trauma
Eye movement desensitization and reprocessing
(EMDR; Shapiro, 2001) is a psychotherapeutic ap-
proach proven to be effi cacious in the treatment of
posttraumatic stress disorder (PTSD; American Psychi-
atric Association, 2004; Bisson & Andrew, 2007; Bleich,
Kotler, Kutz, & Shalev, 2002; Chemtob, Tolin, van der
Kolk, & Pitman, 2000). Published studies have inves-
tigated the effects of EMDR following man-made and
natural disasters (Grainger, Levin, Allen-Byrd, Doctor,
& Lee, 1997). EMDR has been reported effective in
treating children following a hurricane in Hawaii
(Chemtob, Nakashima, Hamada, & Carlson, 2002),
with victims of the 9/11 terrorist attacks in New York
City (Silver, Rogers, Knipe, & Colelli, 2005), and with
victims of earthquakes in Turkey (Korkmazlar-Oral &
Pamuk, 2002).
A separate body of literature also describes the ef-
fectiveness of non-EMDR group therapy approaches
for disaster intervention. Following the 1988 earth-
quake in Turkey, Goenjian et al. (2005) provided four
30-minute cognitive behavioral (CBT) group sessions
and an average of two individual sessions to children
in a school-based intervention. They found that the
grief-focused treatment was effective in reducing
PTSD symptoms and halting the progression of de-
pression. In another study in Athens, Giannopoulou,
Dikaiakou, and Yule (2006) provided a 7-week group
CBT treatment to children traumatized by an earth-
quake. Results showed improvement in symptoms
of PTSD and depression that continued at follow-up.
These studies suggest that the postdisaster imple-
mentation of mental health intervention programs to
children can reduce trauma-related psychopathology.
However, all of these treatments required the chil-
dren’s attendance over a period of several weeks, a
requirement that may be hard to implement in some
disaster or refugee settings.
The EMDR Integrative Group
Treatment Protocol
The EMDR Integrative Group Treatment protocol
(EMDR-IGTP) was developed by members of AM-
AMECRISIS when they were overwhelmed by the
extensive need for mental health services after Hur-
ricane Pauline ravaged the western coast of Mexico in
1997. The team arrived expecting to provide one-on-
one EMDR to just a few individuals but were greeted
by more than 200 distressed children and adults who
had lost families and homes. The challenge was how
to treat so many people simultaneously with a pow-
erful trauma therapy (EMDR) that was originally in-
tended for use with only one patient at a time ( Jarero,
Artigas, & Hartung, 2006). The result was the EMDR-
IGTP, a protocol that combines the eight standard
EMDR treatment phases with a group therapy model
(Artigas, Jarero, Mauer, López Cano, & Alcalá, 2000;
Jarero, Artigas, López Cano, Mauer, & Alcalá, 1999).
It is hypothesized that the resulting format offers more
extensive reach than individual EMDR applications
and that the treatment may produce a more effective
outcome than that expected from traditional group
We recommend that the EMDR-IGTP be part
of comprehensive programs for trauma treatment
with victims of disasters. Because of its utility, it has
been used in multiple settings around the world. For
example, Fernandez, Gallinari, and Lorenzetti (2004)
reported that the group intervention appeared to
successfully alleviate symptoms for all but 2 of the
236 students who witnessed an airplane crash in Italy.
Adúriz and colleagues (in press) used the EMDR-IGTP
with 220 child victims of a fl ood in Santa Fe, Argen-
tina, in 2003 and reported signifi cant improvement
that was maintained at 3-month follow-up. Similarly,
results with 44 children following the Piedras Negras
ood in Mexico in 2004 ( Jarero et al., 2006) showed the
effi cacy of the approach. Scores on the Subjective Units
of Disturbance Scale (SUDS) and the Child’s Reaction
to Traumatic Events Scale (CRTES) showed large
changes from pretreatment to posttreatment and at
follow-up (see Table 1).
Anecdotal reports in other situations are consistent
with these results. Gelbach and Davis (2007) stated that
the EMDR Humanitarian Assistance Program (HAP)
regularly teaches this approach to local clinicians.
It . . . seems to be equally effective cross-culturally,
and it has the advantage of reaching more people
more quickly, involving larger segments of the
community. Paraprofessionals can be taught to
lead the groups under supervision of a clinician,
which allows wide application in societies that
have a few clinicians. For instance, in Guajarat,
India, after a major earthquake, newly trained
clinicians conducted group sessions that reached
thousands of symptomatic children. In Chennai,
Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 99
The EMDR Integrative Group Treatment Protocol
India, after the tsunami, HAP-trained clinicians
treated 5,000 children in these groups in 1 year.
(p. 399)
EMDR-IGTP has also been used in its original for-
mat or with adaptations to meet the circumstances to
assist victims of fl ooding in Acapulco, México, 1997,
Posoltega, Nicaragua, 1998, Caracas, Venezuela, 1999,
Santa Fé, Argentina, 2003, and Piedras Negras, México,
2004; earthquake survivors in Pereira and Armenia in
Colombia, 1999, Adapazari, Turkey, 1999, and San
Salvador, El Salvador, 2001; child refugees of the Alba-
nia and Kosovo War, in Germany, 1999; and survivors
of the tsunami (Adúriz et al., in press; Artigas et al.,
2000; Gelbach & Davis, 2007; Jarero et al., 2006; Jarero
et al., 1999; Korkmazlar-Oral & Pamuk, 2002; Wilson,
Tinker, Hofmann, Becker, & Marshall, 2000).
Description of the Procedure
EMDR-IGTP is administered by an EMDR clinician
who leads the team and who is assisted by other
clinicians or paraprofessionals previously trained in
this protocol. The assisting clinicians or paraprofes-
sionals are called the “Emotional Protection Team”
(EPT). Teachers can also be of great assistance, help-
ing the children write their names, ages, and SUD
The protocol application takes 50 to 60 minutes.
A ratio of 8–10 children for each mental health profes-
sional is recommended. A team of fi ve clinicians (one
leading the protocol and four doing the Emotional
Protection Team work) can treat 40–50 children, a
total of 160–200 children in 4 hours of work.
Phase 1—Client History
During Phase 1 of the protocol, team members edu-
cate teachers, mothers, and relatives about the course
of trauma and enlist these individuals to identify chil-
dren who have been affected by the traumatic event.
Team members have to be aware of the needs of the
clients within their extended family, community, and
Phase 2—Preparation
Phase 2 of the protocol begins with an exercise in-
tended to familiarize the children with the space and
objects included in the intervention, to establish rap-
port and trust, and to facilitate group formation. Toys
such as a doll dolphin can be used to familiarize the
children with the expression of emotions (e.g., they
imitate the expressions of the dolphin). Once appro-
priate rapport is established, the children are guided
through a safe/secure place exercise, which provides
them with a coping skill. The children are repeatedly
validated regarding their feelings and other posttrau-
matic symptoms.
Phase 3—Assessment
Instead of being asked to visualize the target incident,
as in traditional EMDR, the children are instructed to
think about the aspects of the event that made them
now feel most frightened, angry, or sad, and then to
draw that image on the paper provided (see Figure 1,
drawing A). They are then shown a diagram that
depicts faces representing different levels of nega-
tive emotion (from 0 to 10, where 0 shows no distur-
bance and 10 shows severe disturbance) and asked to
select the face that best represents their emotion and
to write the corresponding number on their picture,
thus providing the team with ratings of subjective dis-
turbance (SUD).
Phase 4—Desensitization
The children are asked to look at their picture (e.g.,
Figure 1, drawing A) and to provide their own alter-
nating bilateral stimulation with the Butterfl y Hug
(Artigas et al., 2000) by crossing their arms and tapping
TABLE 1. Results From the EMDR-IGTP Studies in Mexico and Argentina
Number of
SUD Scores CRTES Scores
Posttreatment Pretreatment
Piedras Negras,
Mexico 44 9.2 1.3 32.8 8.3
Santa Fe,
Argentina 220 7.3 2.2 26.4 10.8
Source. Adúriz et al., in press; Jarero et al., 2006
100 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008
Jarero et al.
themselves on the chest in a bilateral alternating fash-
ion. The children are then instructed to draw another
picture of their own choice, related to the event, and
rate it according to its level of distress. Processing
continues with the child looking at the second picture
and using the Butterfl y Hug. The process is repeated
twice more so that there are four pictures (Figure 1).
The level of distress associated with the incident is
then assessed by asking the child to focus on the draw-
ing that is most disturbing and to identify the current
SUD level. This number is then written on the back of
the paper (see Figure 2, upper left corner).
Phase 5—Future Vision (Replacing
Phase 5 of the standard EMDR protocol cannot be
conducted in large groups since each participant may
have a different SUD level. Also, some children can-
not progress any further in the group protocol to
reach an ecological level of disturbance. This may be
because they have blocking beliefs, previous prob-
lems or trauma, and/or require additional time for
processing. Consequently, the group protocol utilizes
the future vision to identify adaptive or nonadaptive
cognitions (e.g., I want to die and be with my dad in
heaven) that are helpful in evaluating the child at the
end of the protocol. The children draw a picture that
represents their future vision of themselves, along
with a word or a phrase that describes that picture
(see Figure 2). The drawing and the phrase are then
paired with the Butterfl y Hug.
Phase 6—Body Scan and Phase 7—Closure
In Phase 6, the children are instructed to close their
eyes, scan their body, and do the Butterfl y Hug.
Finally, in Phase 7, the children are instructed to re-
turn to their safe/secure place.
Phase 8—Re-Evaluation
Phase 8 takes place immediately after the group inter-
vention: The team leader and the Emotional Protec-
tion Team members have a debriefi ng about which
identifi ed children may need individual attention and
which may need thorough evaluation to identify the
FIGURE 1. Example of a child’s drawings before and during EMDR-IGTP treatment.
Note. The numbers represent the child’s self-reported SUD scores.
A) Drawing A: The fi gures trapped inside the mine (his father one of them) are saying: “Ha,” “Help,”
“Help us” (SUDS = 5).
B) Drawing B: “Me” and “Picture of my Dad” (SUDS = 10).
C) Drawing C: “My mother,” “me,” “Bertha,” “Martha” (his sisters) (SUDS = 0).
D) Drawing D: “My Dad” (SUDS = 0).
Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 101
The EMDR Integrative Group Treatment Protocol
nature and extent of their symptoms and any comor-
bid or preexisting mental health problems. Determi-
nation is made by considering the reports of their
teachers and relatives, the CRTES results, the entire
sequence of pictures and SUD ratings, body scan,
the future vision cognition, and the Emotional Pro-
tection Team Report. After the evaluation, the team
members work with the identifi ed children by using
the EMDR-IGTP in smaller groups or by providing
individual treatment.
In June 2006 the treatment team provided the above-
described protocol with children whose fathers had
died in the mine explosion. Measurements were taken
at pretreatment, posttreatment, after 1 week, and at
3 months.
Treatment Team
The team consisted of four professionals from AMA-
MECRISIS and eight local mental health professionals
who had received training in EMDR and EMDR-IGTP
Sixteen children whose fathers had died in the mine
participated in the fi eld study. They ranged in age from
6 to 12 years; 11 were male, 5 female. All of their mothers
and teachers participated in the Phase 1 procedure and
provided information about the children’s diffi culties.
The Child’s Reaction to Traumatic Events Scale (CRTES;
Jones, Fletcher, & Ribbe, 2002) was derived from the
Impact of Events Scale (Horowitz, Wilner, & Alvarez,
1979). It is a 15-item self-report measure designed to as-
sess psychological responses to stressful life events. Re-
sponses are scored according to a Likert scale, where
0 = not at all, 1 = rarely, 3 = sometimes, and 5 = often.
In addition to a total score, the CRTES provides scores
for two subscales: intrusion and avoidance. Scores less
than 9 are considered low distress, between 9–18 mod-
erate distress, 19 and over high distress. Although it is
a self-report measure, the questions were read aloud
to the younger children by the EPT members. Their
responses were recorded by the EPT. This measure
was administered to the children at pretreatment, at
1-week posttreatment, and at 3-month follow-up.
FIGURE 2. Example of the same child’s drawing of his imagined future.
Note. The Spanish statement reads “Feliz = Happy. Pintor = Painter.” The zero represents the child’s
self-reported SUD score at the end of Phase 4 for the most disturbing drawing.
102 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008
Jarero et al.
A modifi cation of the Subjective Units of Distur-
bance Scale (SUD; Shapiro, 2001; Wolpe, 1958) was
used. Instead of asking the children to simply rate the
level of their disturbance, they were shown a diagram
that depicts faces representing different levels of nega-
tive emotion (from 0 to 10, where 0 shows no distur-
bance and 10 shows severe disturbance) and asked to
select the face that best represented their emotion and
to write the corresponding number on their picture.
Children were assisted in this process by members of
the EPT. SUD ratings were taken for each of the four
pictures, and at the end of Phase 4 for the most dis-
turbing drawing.
Sixteen bereaved children participated in the study.
All of the children completed the EMDR-IGTP and
two required individual therapy. There were no dif-
ferences in response between the girls ( n = 5) and
( n = 11) boys.
The changes during the treatment process are
evident in the content of the children’s drawings (see
Figure 1) and are refl ected in their SUD scores. As
shown in Figure 3, the SUD scores decreased for each
subsequent picture. The fi nal score was reported for
the “most disturbing” picture. There was a decrease
in SUD ratings from a mean of 8.6 before processing
to 1.0 at the end of Phase 4.
At pretreatment, the children’s scores on the CRTES
measure placed them in the high distress range, in-
dicating a high level of psychological response to a
stressful life event. The posttreatment CRTES scores
were obtained after 1 week. They indicated a low
level of distress and showed a signifi cant decrease ( t =
8.09, p .001) from the pretreatment scores. Follow-
up scores taken at 3 months showed a maintenance of
treatment effect and a signifi cant difference from the
pretreatment scores ( t = 8.30, p .001; see Tables 2
and 3 and Figure 4).
The present study was an uncontrolled fi eld study,
with treatment provided in a natural setting to a
group of traumatized and bereaved children follow-
ing a man-made disaster. The results indicated sig-
nifi cant improvement on measures of self-reported
distress and posttraumatic stress. The low scores on
the CRTES measure at 3-month follow-up (Figure 4)
suggested that the treatment benefi ts were maintained
for that period of time. Also of clinical interest was the
progressive drop in distress measured by SUD scores.
It should be noted that these results are based on an
uncontrolled fi eld study and that the conclusions are
limited by this methodology. One cannot state with
certainty that the results can be fully attributed to the
treatment. However, the rapid shift in SUD ratings
Boys & Girls
8.63 3.54 2.68 2.09 1.05
7.27 5.09 3.36 2.18 0.09
10 2 2 2 2
FIGURE 3. Treatment process changes as measured by mean SUD scores for
the four pictures and for the most disturbing picture at the end of Phase 4.
Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 103
The EMDR Integrative Group Treatment Protocol
during the session and corresponding changes in
CRTES scores suggest that the treatment was a causal
factor. Although controlled research is needed to es-
tablish the effi cacy of this intervention, preliminary
results from this fi eld study suggest that early inter-
vention following man-provoked disaster may pro-
duce signifi cant reductions in children’s symptoms of
posttraumatic stress. A further limitation of this study
is the lack of formal diagnosis. However, diagnosis and
formal assessment are time-consuming and may not
be readily available in rural settings, third-world coun-
tries, or communities devastated by disaster. Conse-
quently the application of this simple group procedure
to alleviate distress and to identify individuals requir-
ing more extensive treatment has great utility. Further
assessment can then be conducted for those individu-
als identifi ed in the group protocol, and individual
treatment can subsequently be provided.
EMDR-IGTP has been used in its original format or
with adaptations to meet the circumstances in multiple
settings around the world after natural or human-pro-
voked disasters. The protocol offers an extensive out-
reach, with a team of fi ve clinicians able to treat 160–200
children in a 4-hour period. The preliminary results
suggest that the EMDR-IGTP could be an effective
means of providing treatment to large groups of people
TABLE 3. Comparison of Pretreatment Scores
With Posttreatment and Follow-Up Scores on
the CRTES Measure
(1 Week)
(3 Months)
t = 7.30 (df, 10)
p .000
t = 6.77 (df, 10)
p .000
t = 3.48 (df, 4)
p .025
t = 3.34 (df, 4)
p .012
Boys &
t = 8.09 (df, 15)
p .000
t = 8.30 (df, 15)
p .000
TABLE 2. Scores on the CRTES Measure
(1 Week)
(3 Months)
Boys 39.00 (12.46) 14.36 (2.73) 12.91 (3.36)
Girls 37.20 (12.26) 14.80 (3.42) 12.60 (3.13)
Boys & Girls 38.44 (12.00) 14.50 (2.85) 12.81 (3.19)
Note. Mean and standard deviations for the pre and post and
follow-up scores on the Child’s Reaction to Traumatic Events
Boys & Girls
38.44 14.5 12.81
39 14.36 12.91
37.2 14.8 12.6
Pre Post
FIGURE 4. Mean scores on the CRTES measure.
Note. Scores on the Child’s Reaction to Traumatic Events Scale taken at pretreatment, 1-week
posttreatment, and 3-month follow-up.
104 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008
Jarero et al.
impacted by large-scale critical incidents (e.g., human-
provoked disasters, terrorism, natural disasters).
This is consistent with the fi ndings of other studies
that have investigated the application of EMDR-IGTP
with groups of children subsequent to man-made
and natural disasters. In Italy, Fernandez et al. (2004)
described sustained reduction of symptoms for over
95% of 244 children. In Colombia, Adúriz and col-
leagues (in press) reported signifi cant improvement
for children that was maintained at 3-month follow-
up. Similarly in Mexico, Jarero et al. (2006) described
positive results with the treatment of 44 children (see
Table 1). Anecdotal reports in other situations have
included the application of the protocol with trau-
matized adults and are consistent with these results
(Gelbach & Davis, 2007).
We are in agreement with Norris and colleagues
(2002, 2004), who called for early and ongoing inter-
ventions with disaster victims. More research is needed
to investigate this protocol and to evaluate its effi cacy.
This protocol should be applied only to a group of
persons who have experienced the same critical inci-
dent. The use of this protocol is not recommended,
for example, for a group of children who have had dif-
ferent childhood traumatic experiences. The IGTP is a
modifi cation of standard EMDR protocols and allows
the treatment to be provided simultaneously to a large
number of traumatized individuals who have survived
a community disaster. The results of the current study
suggest that the therapy effectively decreases the dis-
tress related to the critical incident.
Some of the benefi ts of EMDR-IGTP are its trans-
portability; it can be easily implemented in most com-
munities, and few supplies are needed. It is very brief,
requiring only 2 hours. Distressed children are identi-
ed through this process so that they can be provided
with further treatment. In addition, based on our ex-
perience in other studies using the protocol and from
anecdotal reports, it appears that the model can be
applied in ways that respect cultural values of vic-
tims. Given the multiple large-scale critical incidents
that occur frequently on our planet and the resultant
suffering and posttraumatic distress, the potential for
offering hope and healing is encouraging. The pre-
liminary and promising results of this study strongly
suggest the importance of future controlled research
to evaluate this protocol.
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Correspondence regarding this article should be directed to
Ignacio Jarero, Boulevard de la Luz 777, Jardines de Pedregal,
éxico City, 01900. E-mail:
... One of the first application of EMDR in a group context regards the development of the EMDR-Integrative Group Treatment Protocol (EMDR-IGTP) (Jarero et al., 2008(Jarero et al., , 2013. This protocol was created by members of the Mexican Association for Mental Health Support in Crisis (AMAMECRISIS) when they were overwhelmed by the extensive need for mental health services after the hurricane Pauline ravaged the western coast of Mexico in 1997. ...
... Participants were recruited by the team of a Clinical Centre for the trauma-treatment project (2018) and adapted to a group setting by using the EMDR-IGTP protocol described above (Jarero et al., 2008(Jarero et al., , 2013 and slightly adapted by the authors to the setting and patients' population. Tre treatment consisted in 5 main modules as described in Table 1. ...
Objective: To explore the acceptability and the effectiveness of an Eye Movement Desensitization Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) for patients with a history of recurrent traumatic episodes of interpersonal nature. Method: Seven women were recruited from a Trauma Centre and were offered EMDR-IGTP, consisting of 10 semi-structured group sessions. Participants were assessed through a set of standardised clinical measures before the treatment, at the end of it, and after 1 and 3 months since its conclusion. Results: EMDR-IGTP was well accepted by all participants. After the intervention and at 1 and 3 months follow-up, patients showed a significant reduction of dissociative symptoms, traumatic symptoms and improved emotional regulation. Conclusions: This study suggests that GITM-EMDR therapy can be a helpful treatment for people who experienced traumatic episodes of interpersonal nature and supports more extensive research in this direction.
... First is the uncertainty of the involvement of medicines in the efficacy of TSP. As suggested by the outcome of the Butterfly Hug, somatic BLS on the body surface itself has a strong therapeutic effect (Jarero et al., 2008), so it is possible that monotherapy by TSP-EMDR may be effective enough for treating cPTSD. On the other hand, the benefits and effectiveness of combination therapies have been shown by previous studies, especially in the treatment of various mental diseases, such as those between psychotherapy and pharmacotherapy (Miklowitz et al., 2021;Zhou et al., 2020) and between antipsychotics and Kampo (Rathbone et al., 2007;Zeng et al., 2007). ...
The triadic therapy based on somatic eye movement desensitization and reprocessing (EMDR) for posttraumatic stress disorder (TSP) is a combination therapy for complex posttraumatic stress disorder (cPTSD), which comprises simplified EMDR, triplet of micro-dose medicines, and a pair of Chinese medicines. The EMDR procedure is a tactile bilateral stimulation on the body surface with minimum verbal intervention within 15 minutes every 2 weeks in a period of 2–3 months. In this study, 22 adult patients were treated with TSP. The Impact of Event Scale—Revised, Beck Depression Inventory (second edition), and Global Assessment of Functioning scores of the patients were significantly improved. Moreover, TSP is a safe treatment procedure in terms of titration, cost-effectiveness, and time-effectiveness. It could also treat multiple difficulties in patients with cPTSD from medical problems to socioeconomic problems.
... Jarero et al. (2013) have also developed the EMDR-PROPARA, an adaptation for paraprofessional use of the EMDR Protocol for Recent Critical Incidents (Jarero et al., 2011). EMDR-IGTP has a long history of supporting victims of natural disasters and refugees (Adúriz et al., 2009;Jarero & Artigas, 2012;Jarero et al., 2008;Karadag & Karadeniz, 2020;Trentini et al., 2018). Currently, it is being used to support people traumatized and displaced by violence and military conflict in Ethiopia (Abebe & Ashman, 2022). ...
There are not enough psychotherapists to offer individual trauma intervention to the tens of millions of people traumatized around the world. Eye movement desensitization and reprocessing (EMDR) is a proven trauma treatment but requires substantial time and financial resources for training. One solution may be low-intensity intervention with the flash technique (FT) offered one-on-one online and based on highly scripted instructions in which participants can work on their distressing memories independently. The FT is a protocol that was originally developed for the preparation phase of EMDR and only requires a few hours of training. In this study, we aim to explore whether a scripted FT protocol used by inexperienced student clinicians might be effective. Nine master-level social work students, trained in FT and under licensed supervision, offered individual FT treatment online using a scripted protocol. Participants were admitted to the study with an Impact of Event Scale—Revised (IES-R) score of >24. Pre- and posttreatment surveys were collected from 30 participants who each received 6 sessions of individual therapy. No follow-up study data was collected. The IES-R data dropped from a pretreatment mean of 45.97 ( SD = 14.5, 95% CI = [40.78, 51.16]) to posttreatment mean of 25.33 ( SD = 14.92, 95% CI = [19.99, 30.67]), with a p -value of <.00001 and a Cohen’s d = 1.4, showed a large effect size. Interpretation of the study results is limited due to a lack of a control group and a relatively small sample size ( n = 30). Furthermore, since we did not follow participants posttreatment, the impact of the intervention over time is unknown for this study. Even so, the data suggested that the scripted FT protocol might be usable even by inexperienced student clinicians, paving the way for its use as a low-intensity trauma intervention.
... Es importante señalar que dentro de algunos de los protocolos de EMDR, el uso de la creación de imágenes ha estado presente; por nombrar solo algunos ejemplos, el protocolo grupal para víctimas de desastres naturales (Jarero, Artigas, Montero y López, 2008); o el de Piñuel y Cervera (2016) para el tratamiento del mobbing y bullying. Actualmente en Estados Unidos, se realizan formaciones específicas para capacitar a terapeutas EMDR en el uso del arte dentro de sus intervenciones. ...
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This work describes the clinical experience, in the combined use of art therapy and the Eye movement desensitization and reprocessing therapy (EMDR), with victims of bullying in adolescent patients with obesity. It is explained how this combination of methodologies has been useful, considering the somatic memory of the event, complementary and convergent in the use of images, physical in the case of art therapy and mental in EMDR and how both have served for the symbolization process. The clinical experience is supported by a literature review, which illustrates how other art therapists have followed this work path or have been influenced by EMDR therapy, creating their own protocols for trauma intervention. In addition, theory is also offered on the stigma of weight, bullying and trauma. A clinical case vignette is integrated to illustrate some of the functions observed. I use the clinical notes to show the observed changes, as well as the scale of subjective units of disturbance (SUD) and the scale of validity of cognition (VOC).
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La thérapie de désensibilisation et de retraitement par les mouvements oculaires (EMDR) est considérée comme un traitement fondé sur des données probantes pour le traitement du trouble stress post-traumatique (TSPT) chez l’adulte, mais il y a des différences dans la façon dont les diverses directives internationales de traitement jugent la solidité de cette base de preuves. En outre, dans des domaines autres que le TSPT de l’adulte, les principales lignes directrices diffèrent encore davantage quant à la solidité de ces preuves et quant au moment où on utilisera l’EMDR. En 2019 a été lancée la Commission de chercheurs sur l’avenir de la thérapie EMDR ( Council of Scholars : The Future of EMDR Therapy Project ). Plusieurs groupes de travail ont été créés dans cette commission, l’un d’entre eux étant centré sur la recherche. Le présent article a été produit par ce groupe de travail. Le groupe a tout d’abord conclu qu’il y avait cinq domaines pour lesquels il existait une certaine base factuelle indiquant que l’EMDR était efficace, mais que davantage de données étaient nécessaires pour augmenter la probabilité qu’elle soit prise en compte dans les futures directives internationales de traitement. Ces domaines couvraient le TSPT chez les enfants et les adolescents, les interventions EMDR précoces, les TSPT liés aux conflits armés, la dépression unipolaire et la douleur chronique. Les recherches portant sur le rapport coût-efficacité de la thérapie EMDR ont été en outre identifiées comme l’une des priorités à aborder. Nous avons employé un système de hiérarchisation pour classer et évaluer les preuves dans les différents domaines abordés. Après avoir évalué les 120 études de résultats relatives à ces domaines, nous concluons ici que pour deux d’entre eux (le TSPT chez l’enfant et l’adolescent, et les recherches portant sur les interventions EMDR précoces), la force des preuves est évaluée au niveau le plus élevé, tandis que les autres domaines obtiennent le deuxième niveau le plus élevé. Nous formulons également quelques recommandations générales pour améliorer la qualité des futures recherches sur l’efficacité de la thérapie EMDR.
This chapter focuses on the process of eye-movement desensitization and reprocessing and its uses in the course of psychotherapy for children who have experienced medical trauma and other forms of traumatic events, either episodically or chronically. The use of bilateral stimulation does not have to involve eye movements, but can consist of bilateral stimulation in tactile form, or auditorily. The possible neurophysiological mechanism of action of this form of psychotherapy is discussed. We highlight some of the techniques used most commonly with children, including in the context of play psychotherapy. A part of the proceedings consists in identifying bodily sensations that the child or adolescent associates with traumatic memories and with reenactments of the past. The process of gradual approximation and “decoupling” of memories from the reexperiencing of trauma is described. The formal use of the process involves specific training and the ability to use it within a therapeutic context. We also describe the use of bilateral stimulation techniques with large groups of children exposed to events like earthquakes, hurricanes, and other overwhelming situations.KeywordsEye movement desensitizationEmotional reprocessingPosttraumatic stress disorderReexperiencing traumatic memoriesEmbodiment of traumaMedical trauma
Il contributo della terapia EMDR (Eye Movement Desensitiza- tion and Reprocessing) nel campo del trauma è stato molto significativo. Secondo la ricerca e le linee guida internazionali, la terapia EMDR può dare un grande contributo alle popolazioni esposte a esperienze traumatiche. Per questo motivo, dopo l'inizio della guerra in Ucraina, è stato importante integrare l'EMDR in iniziative di supporto psicosociale che sono state attuate nei diversi Paesi con i rifugiati ucraini. Il protocollo EMDR è stato opportunamente adattato e integra- to, mentre si lavorava in condizioni instabili, con diverse popolazioni esposte a situazioni create dalla guerra.
Technical Report
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Acute stress disorder (ASD) was introduced in DSM-IV to describe posttraumatic stress disorder (PTSD) symptoms that (a) occur in the initial month after trauma and (b) predict subsequent PTSD. Longitudinal studies have shown that most people who develop PTSD do not initially meet ASD criteria, which led to the decision in DSM-5 to limit the ASD diagnosis to describing acute stress reactions without any predictive function. Controlled trials have shown that trauma-focused cognitive behavior therapy is the treatment of choice for ASD, and is superior to pharmacological interventions. Recent longitudinal studies have challenged previous conceptualizations of the course of posttraumatic stress, and highlighted that people follow different trajectories of adaptation that are influenced by events that occur after the acute posttraumatic period.