The Integration of EMDR with the Trauma Resiliency Model
Somatic approaches integrate to potentiate healing. by Elaine Miller-Karas
Kathleen Wheeler, Ph.D., is a past president of the EMDR International Association and a psychiatric nurse practitioner. She is also the author of Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-To Guide for Evidence-Based Practice (3rd Edition), in which she develops a framework for practice that integrates the Community Resiliency Model (CRM) and the Trauma Resiliency Model (TRM) with Adaptive Information Processing (AIP)—the theoretical underpinning for Eye Movement Desensitization and Reprocessing (EMDR) Therapy. T
Elaine Miller-Karas: Can you describe EMDR? Kathleen Wheeler: Eye Movement Desensitization and Reprocessing (EMDR) therapy is an integrative eight-phase psychotherapy that has evolved from a technique that can be integrated into other models of therapy such as cognitive behavioral, transpersonal, family, psychodynamic, experiential, feminist, hypnosis, schema-focused and is also a full-fledged stand-alone psychotherapy approach. EMDR is the first trauma-informed psychotherapy approach developed to reprocess trauma through neural network integration. Adaptive Information Processing (AIP) is the guiding theory for EMDR Therapy. AIP posits that just as the body strives for healing, so too does the brain. Memories are the basis of health and pathology. When an adverse experience occurs, this information gets stored dysfunctionally with all the attending body sensations, thoughts, and feelings that were present at the time of the experience. In contrast, when the brain operates optimally, neural networks are interconnected, and information flows freely from one area to another. Francine Shapiro developed AIP based on the clinical results and research on EMDR therapy. More than 45 randomized clinical trials (RCTs) have supported EMDR’s efficacy for PTSD in addition to over 28 RCTs for other disorders such as major depression, bipolar, anxiety, substance use, pain, and psychosis. Numerous practice guidelines include EMDR Therapy as a Level A treatment for trauma. E M-K: Can you describe the role of the therapist in EMDR? KW: The eight phases of EMDR therapy are based on a comprehensive three-pronged approach that includes earlier life experiences, present-day triggers, and a future template of desired thoughts and actions. The EMDR therapist guides the person in reprocessing the memory/experience components, including emotions, thoughts, and body sensations that are thought to have been fragmented due to the original, disturbing experience. Reprocessing includes some form of bilateral stimulation (BLS). The BLS usually includes eye movements moving back and forth horizontally, although bilateral sounds or tapping may be used if eye movements are uncomfortable or contraindicated. There are numerous neurophysiological studies on the underlying mechanism of BLS, but one simple explanation is that the BLS stimulates the relaxation response (the parasympathetic nervous system) so that while the client is thinking of the disturbing event (sympathetic nervous system) the fragmented memories are able to connect and be integrated into the person’s adaptive memory networks. article continues after advertisement Biologically Wired to Heal
The Trauma Resiliency Model (TRM) is a clinical intervention based on research about the brain that reflects the knowledge that a biological response to stressful and traumatic events exists. TRM is both a model for trauma reprocessing treatment and a model promoting self-care. Symptoms are treated as common biological responses rather than pathological or mental weaknesses. The first six skills of TRM, also called the Community Resiliency Model (CRM), can help a person learn to monitor sensations for self-care. The TRM practitioner first helps the client learn the wellness skills for self-care and to give the client the confidence to bring their body and mind back into balance. Once the client knows they can regulate their nervous system during distress, the TRM practitioner can focus on helping the client reprocess traumatic experiences. Three additional skills of TRM are designed to promote this trauma reprocessing. TRM integrates the three portals of human experience (sensation, cognition, and emotions) to help clients reorganize their lived experiences after traumatic events. E M-K: You have become a student and practitioner of both the Community Resiliency Model and the Trauma Resiliency Model, and integrated both into your third edition. How are EMDR and CRM/TRM alike, and why do you refer to them as trauma-informed approaches? KW: The underlying philosophy of EMDR and CRM/TRM is one of hope; we are physiologically wired to heal. Healing or “making whole” is always possible. EMDR therapy is a trauma-informed psychotherapy approach in that a basic underlying tenet is not what is wrong with the person but what has happened to them. Most mental health problems and psychiatric disorders that are not organically based are caused by adverse life experiences. Shapiro (2018) explains that trauma results in information stored dysfunctionally in brain neural networks. The memory of the traumatic event is fragmented, so the thoughts, feelings, images, and sensations serve as triggers creating symptoms such as false negative beliefs about oneself, sadness, anxiety, flashbacks of images, and unexplained body sensations. Thus, connecting this dysfunctional information with the person’s adaptively stored information restores the underlying wisdom of the nervous system. A key concept for both CRM/TRM and EMDR is that of neuroplasticity; the brain can change throughout life. The EMDR therapist follows the client and encourages them to trust themselves in the process, similar to CRM/TRM. Both the TRM and EMDR therapist do not make interpretations or confront the person. The therapist cannot and does not predict where the person’s associations will go but only facilitates the client in reprocessing their experience. EMDR and TRM includes somatic reprocessing as well as the other components of the dysfunctionally stored memory, including the image, thoughts, and emotions.