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Intervenciones Humanitarias para la Recuperación del Trauma con Terapia EMDR en Latinoamérica y el Caribe
Journal of EMDR Practice & Research
Abstract
Este artículo presenta un resumen de las Intervenciones Humanitarias para la Recuperación del Trauma con Terapia de Reprocesamiento y Desensibilización a través del Movimiento Ocular (EMDR) en Latinoamérica y el Caribe y proporciona al lector ejemplos de historias clínicas obtenidas en la primera línea de apoyo. A lo largo de los muchos años realizando trabajo de campo, hemos observado que el trauma psicológico, como consecuencia de las situaciones multifacéticas que enfrentan los individuos y comunidades después de un desastre, implica un gran reto. En el presente artículo, describimos las Intervenciones Humanitarias con Terapia EMDR realizadas desde 1998 en Latinoamérica y el Caribe, para tratar las perturbaciones psicológicas que se presentan en las y los sobrevivientes después de desastres naturales (ej. inundaciones, deslizamientos de tierra, terremotos), desastres provocados por el hombre, masacres humanas y violencia interpersonal severa. Se ha proporcionado tratamiento a niños, adolescentes y adultos sobrevivientes, frecuentemente en las comunidades donde ocurrieron los desastres; así como a auxiliadores y a pacientes con cáncer. Los protocolos de Intervención Temprana con Terapia EMDR son intervenciones breves y efectivas que pueden ser utilizadas en campo o en situaciones de emergencia. Existe un cuerpo de investigaciones que apoyan el uso de protocolos modificados de Terapia EMDR para tratar el trauma agudo en formatos de atención individual y grupal (Jarero, Artigas, & Luber, 2011).
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Experiencing cancer is a peculiar stressor within the infrastructure of posttraumatic stress disorder (PTSD) because this debilitating disease involves ongoing stressors and is both acute and potentially chronic. The experience can include a wide range of associated adverse events, such as tumor detection, diagnosis, severity of disease, and prognosis; aggressive treatment; disfigurement and bodily dysfunction; side effects of treatment; impaired physical, social, and occupational functioning; and sometimes, recurrence and diagnosis of terminal illness. This article provides a detailed description of the clinical application of the Eye Movement Desensitization and Reprocessing (EMDR) Integrative Group Treatment Protocol (EMDR-IGTP) Adapted for Adolescents and Adults Living with Ongoing Traumatic Stress for the patients with cancer. This protocol administers the eight phases of EMDR individual treatment to a group of patients using an art therapy format (i.e., drawings) and the butterfly hug (a self-administered bilateral stimulation method to process traumatic material). A previous study (Jarero et al., 2015) showed that after 6 sessions of EMDR-IGTP, there was a significant decrease in PTSD symptoms related to the diagnosis and treatment of different types of cancer in adult women. Effects were maintained at 90-day follow-up. In this article, we discuss how this protocol can be used to effectively provide intensive EMDR treatment to large groups of patients, and we provide detailed instructions for its provision to address one of the major psychological dimensions of cancer: the ongoing traumatic stress responses experienced by patients with cancer. A clinical example illustrates the treatment process.
This article reports the follow-up results of our field study (Jarero & Uribe, 2011) that investigated the
application of the eye movement desensitization and reprocessing (EMDR) Protocol for Recent Critical
Incidents (EMDR-PRECI) in a human massacre situation. A single individual session was provided to
32 forensic personnel of the State Attorney General in the Mexican state of Durango who were working
with 258 bodies recovered from clandestine graves. Pre-post results showed significant improvement for
both immediate treatment and waitlist/delayed treatment groups on the Impact of Event Scale (IES) and
Short PTSD Rating Interview (SPRINT). In this study, we report the follow-up assessment, which was
conducted, at 3 and 5 months posttreatment. Follow-up scores showed that the original treatment results
were maintained, with a further significant reduction of self-reported symptoms of posttraumatic stress
and PTSD between posttreatment and follow-up. During the follow-up period, the employees continued
to work with the recovered corpses and were continually exposed to horrific emotional stressors, with
ongoing threats to their own safety. This suggests that EMDR-PRECI was an effective early intervention,
reducing traumatic stress for a group of traumatized adults continuing to work under extreme stressors in
a human massacre situation. It appears that the treatment may have helped to prevent the development
of chronic PTSD and to increase psychological and emotional resilience.
This study presents the results of the application of the EMDR Integrative Group Treatment Protocol and Individual EMDR Therapy Protocol, to a total of 16 children (2 boys and 14 girls), aged between 9 to 13 years old, who attended a trauma recovery camp. All had been victims of severe interpersonal violence. The 14 girls had been victims of physical violence and rape; some for long periods of time, even years, by family members or acquaintances. One of the girls, as young as 11 years old, contracted a sexually transmitted disease as a result of the rape; another girl, besides of being repeatedly raped by her political grandfather, was blamed by him, for the rape he perpetrated on the younger sister; arguing she was responsible for looking after her. Regarding the two boys, in addition of being victims of physical and emotional violence; one of them witnessed how his father and cousin raped a female cousin; and the other one witnessed the attempted suicide of his father. All children were living with their families, characterized by being dysfunctional (e.g., knife fights between parents). To analyze the effects of treatment, a General Linear Model was used. There were analyzed three measures (pre-treatment, post-treatment and follow-up), obtained in the Subjective Units of Disturbance (SUD) and the Short PTSD Rating Interview (SPRINT) scores. The results showed a statistically significant effect of treatment in the between-subjects test for both the SUD and the SPRINT scores: (F [1,15] = 146.85, p < .000 and F [ 1,14 ] = 238.56 , p < .000, respectively. The statistical one-way Analysis of Variance (ANOVA) on the effects of treatment in all groups participating in the trauma recovery camps from 2011 to 2013, showed that after EMDR Therapy, participants had no significant differences in the SPRINT scores, this results denotes that the EMDR therapy had similar beneficial effect for all participants. Further research on the application of Group and Individual EMDR Therapy, as part of a multicomponent phase-based treatment for children and adolescents victims of severe interpersonal violence is needed.
The eye movement desensitization and reprocessing (EMDR) individual protocol for paraprofessional use in acute trauma situations (EMDR-PROPARA) is part of a project developed at the initiative of Dr. Francine Shapiro. This randomized clinical trial examined the effectiveness of the
protocol administered by experienced EMDR therapists. There were 39 traumatized first responders on active duty randomly assigned to receive two 90-min sessions of either EMDR-PROPARA or of supportive counseling. Participants in the EMDR-PROPARA group showed benefits immediately after treatment,
with their scores on the Short PTSD Rating Interview (SPRINT) showing further decreases at 3-month follow-up. In comparison, supportive counseling participants experienced a nonsignificant decrease after treatment and an increase in the SPRINT scores at the second follow-up. The significant
difference between the two treatments provides preliminary support for EMDR-PROPARA's effectiveness in reducing severity of posttraumatic symptoms and subjective global improvement. More controlled research is recommended to evaluate further the efficacy of this intervention.
This study evaluated a multicomponent phase–based trauma treatment approach for 34 children who were victims of severe interpersonal trauma (e.g., rape, sexual abuse, physical and emotional violence, neglect, abandonment). the children attended a week-long residential psychological
recovery camp, which provided resource building experiences, the eye movement desensitization and reprocessing integrative group treatment protocol (emdr-igtp), and one-on-one emdr intervention for the resolution of traumatic memories. the individual emdr sessions were provided for 26 children
who still had some distress about their targeted memory following the emdr-igtp. results showed significant improvement for all the participants on the child's reaction to traumatic events scale (crtes) and the short ptsd rating interview (sprint), with treatment results maintained at follow-up.
more research is needed to assess the emdr-igtp and the one-on-one emdr intervention effects as part of a multimodal approach with children who have suffered severe interpersonal trauma.
The eye movement desensitization and reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) has been used in its original format or with adaptations to meet the circumstances in numerous settings around the world for thousands of disaster survivors after natural or man-made incidents.
In this study, the EMDR-IGTP was applied during three consecutive days to a group of 20 adults during ongoing geopolitical crisis in a Central American country in 2009. Results in this uncontrolled study showed significant decreases in scores on the Subjective Unit of Disturbance Scale and
the Impact of Event Scale (IES). Changes on the IES were maintained at 14 weeks follow-up even though participants were still exposed to ongoing crisis. Controlled research is recommended to further evaluate the efficacy of this intervention.
This article reports the follow-up results of our field study (Jarero & Uribe, 2011) that investigated the application of the eye movement desensitization and reprocessing (EMDR) Protocol for Recent Critical Incidents (EMDR-PRECI) in a human massacre situation. A single individual
session was provided to 32 forensic personnel of the State Attorney General in the Mexican state of Durango who were working with 258 bodies recovered from clandestine graves. Pre-post results showed significant improvement for both immediate treatment and waitlist/delayed treatment groups
on the Impact of Event Scale (IES) and Short PTSD Rating Interview (SPRINT). In this study, we report the follow-up assessment, which was conducted, at 3 and 5 months posttreatment. Follow-up scores showed that the original treatment results were maintained, with a further significant reduction
of self-reported symptoms of posttraumatic stress and PTSD between posttreatment and follow-up. During the follow-up period, the employees continued to work with the recovered corpses and were continually exposed to horrific emotional stressors, with ongoing threats to their own safety. This
suggests that EMDR-PRECI was an effective early intervention, reducing traumatic stress for a group of traumatized adults continuing to work under extreme stressors in a human massacre situation. It appears that the treatment may have helped to prevent the development of chronic PTSD and to
increase psychological and emotional resilience.
This randomized, controlled group field study was conducted subsequent to a 7.2 earthquake in North Baja California, Mexico. Treatment was provided according to continuum of care principles. Crisis management debriefing was provided to 53 individuals. After this, the 18 individuals
who had high scores on the Impact of Event Scale (IES) were then provided with the eye movement desensitization and reprocessing (EMDR) Protocol for Recent Critical Incidents (EMDR-PRECI), a single-session modified EMDR protocol for the treatment of recent trauma. Participants were randomly
assigned to two groups: immediate treatment group and waitlist/delayed treatment group. There was no improvement in the waitlist/ delayed treatment group, and scores of the immediate treatment group participants were significantly improved, compared with waitlist/delayed treatment group paticipants.
One session of EMDR-PRECI produced significant improvement on symptoms of posttraumatic stress for both the immediate-treatment and waitlist/delayed treatment groups, with results maintained at 12-week follow-up, even though frightening aftershocks continued to occur frequently. This study
provides preliminary evidence in support of the protocol's efficacy in a disaster mental health continuum of care context. More controlled research is recommended to evaluate further the efficacy of this intervention.
Introduction. - This 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 literature. - An 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. Discussion. - EMDR 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. Conclusion. - EMDR 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.
Introduction. - This paper presents an overview of the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) that has been used since 1998 with both children and adults in its original format or with adaptations to meet the circumstances in numerous settings around the world for thousands of survivors of natural or man-made disasters and during ongoing geopolitical crisis. Method. - The author's intention is to highlight and enlightened the reader of the existence of this protocol that combines the eight standard EMDR treatment phases with a group therapy model and an art therapy format and use the Butterfly Hug as a form of a self-administered bilateral stimulation, thus providing more extensive reach than the individual EMDR application. Conclusion. - Randomize Controlled Trial Research is suggested to establish the efficacy of this intervention.
Eye movement desensitization and reprocessing (EMDR) is recognized as an effective and efficient treatment for trauma-related issues. This article describes an inte- grated EMDR and group treatment for children and adults traumatized by natural disasters in several Latin American countries. This protocol combines the eight standard EMDR treatment phases with a group therapy model. The hypothesis is that the resulting hybrid offers more extensive reach than did the original EMDR model, which was intended for use with individuals, and takes treatment efficacy and efficiency well beyond that expected from traditional group process. To illus- trate the application of the model, one formally meas- ured field study and nine pilot projects are described. The promising results of this intervention suggest that EMDR is an effective means of providing treatment to large groups of people impacted by large-scale traumatic events (e.g., natural disasters). Controlled research is needed to clarify this issue.
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).
Eye movement desensitization and reprocessing (EMDR) is a therapeutic approach guided by the adaptive information processing (AIP) model. This article provides a brief overview of some of the major precepts of AIP. The basis of clinical pathology is hypothesized to be dysfunctionally stored memories, with therapeutic change resulting from the processing of these memories within larger adaptive networks. Unlike extinction-based exposure therapies, memories targeted in EMDR are posited to transmute during processing and are then again stored by a process of reconsolidation. Therefore, a comparison and contrast to extinction-based information processing models and treatment is provided, including implications for clinical practice. Throughout the article a variety of mechanisms of action are discussed, including those inferred by tenets of the AIP model, and the EMDR procedures themselves, including the bilateral stimulation. Research suggestions are offered in order to investigate various hypotheses.
A comprehensive group intervention with 124 children who experienced disaster-related trauma during a massive flood in Santa Fe, Argentina, in 2003 is illustrated, utilizing a one-session group eye movement desensitization and reprocessing (EMDR) protocol. A posttreatment session was done 3 months after the treatment intervention to evaluate results. Results of this one-session treatment procedure, utilizing the EMDR-Integrative Group Treatment Protocol, showed statistically significant reduction of symptoms immediately after the intervention. These statistically significant differences were sustained at posttreatment evaluation 3 months later, as measured by psychometric scales, and by clinical and behavioral observation. Data analysis also revealed significant gender differences. Despite methodological limitations, this study supports the efficacy of EMDR group treatment in the amelioration and prevention of posttraumatic stress disorder symptoms, providing an efficient, simple, and economic (in terms of time and resources) tool for disaster-related trauma. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This report describes the reliability, validity, treatment sensitivity, diagnostic performance and normative values for the Short Post-Traumatic Stress Disorder (PTSD) Rating Interview (SPRINT), a brief, global assessment for PTSD. The SPRINT was administered to subjects participating in a clinical trial of PTSD and in a population survey assessing PTSD prevalence. The 8-item SPRINT includes questions assessing the core symptoms of PTSD, as well as related aspects of somatic malaise, stress vulnerability and functional impairment. Validity was assessed against the MINI structured interview, the Davidson Trauma Scale, Treatment Outcome for PTSD Scale, Connor-Davidson Resilience Scale, Sheehan Stress Vulnerability Scale, Sheehan Disability Scale and Clinical Global Impressions of Severity and Improvement Scales. Good test-retest reliability, internal consistency, convergent and divergent validity were obtained. The SPRINT was responsive to symptom change over time and correlated with comparable PTSD symptom measures. In victims of trauma, a score of 14-17 was associated with 96% diagnostic accuracy, whereas in those with PTSD, highest efficiency corresponded to a range of 11-13. The SPRINT demonstrates solid psychometric properties and can serve as a reliable, valid and homogeneous measure of PTSD illness severity and of global improvement.
The Clinician-Administered PTSD Scale for DSM-IV (CAPS) is a widely used assessment tool for (posttraumatic stress disorder) (PTSD). However, a shorter assessment tool may be beneficial for clinical work. Here, we compare such a tool, the Short PTSD Rating Interview (SPRINT) to the CAPS. We found that the SPRINT rating scale performs similarly to the CAPS rating scale in the assessment of PTSD symptom clusters and total scores, and that the SPRINT takes significantly less time to administer than the CAPS.
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A number of studies indicate that EMDR (eye movement desensitization and reprocessing) may be efficacious in treatment of children and young people with symptoms of posttraumatic stress. However, reports are limited in the use of the EMDR psychotherapy approach in situations of ongoing violence and trauma. This case study describes work with seven children in an area of ongoing violence who were subject to repeat traumas during the course of an EMDR psychotherapy intervention, using a group protocol. Results indicate that the EMDR approach can be effective in a group setting, and in an acute situation, both in reducing symptoms of posttraumatic and peritraumatic stress and in "inoculation" or building resilience in a setting of ongoing conflict and trauma. Given the need for such applications, further research is recommended regarding EMDR's ability to increase personal resources in such settings.
Samples of adults representative of Tezuitlán, Puebla and Villahermosa, Tobasco (combined N = 561), were interviewed 6, 12, 18, and 24 months after the devastating 1999 floods and mudslides in Mexico. Current DSM-IV PTSD and major depressive disorder (MDD) were assessed with the Composite International Diagnostic Interview. At Wave 1, PTSD was highly prevalent (24% combined), especially in Tezuitlán (46%), which had experienced mass casualties and displacement. Both linear and quadratic effects of time emerged, as PTSD symptoms initially declined but subsequently stabilized. Differences between cities lessened as time passed. Comorbidity between PTSD and MDD was substantial. The findings demonstrate that the international health community needs to be prepared for epidemics of PTSD when disasters strike developing areas of the world.
Psychological treatments can reduce symptoms of post traumatic stress disorder (PTSD). Trauma focused treatments are more effective than non-trauma focused treatments. This review concerns the efficacy of psychological treatment (excluding eye movement desensitisation and reprocessing) in the treatment of PTSD. There is evidence that individual trauma focused cognitive-behavioural therapy (TFCBT), stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There is some evidence that individual TFCBT is superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT was also more effective than other therapies. There is insufficient evidence to show whether or not psychological treatment is harmful. Trauma focused cognitive behavioural therapy should be considered in individuals with PTSD.
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