(Eye Movement Desensitization and Reprocessing therapy, EMDR) was developed by an American Francine Shapiro and has been used very successfully in the treatment of PTSD. In 1987, while walking, she noticed that eye movements reduce stressful memories.

The method is based on the notion that any traumatic information is unconsciously processed and absorbed by the brain during sleep- in REM sleep(other names: rapid eye movement sleep, REM sleep, REM sleep - rapid eye movement). It is during this phase of sleep that we see dreams. Severe trauma disrupts the natural process of processing information, which leads to recurring nightmares with awakenings and, of course, to distortions of REM sleep. Treatment with repeated series of eye movements unblocks and accelerates the processing of traumatic experience.

It is carried out from 1-2 to 6-16 treatment sessions lasting 1-1.5 hours. The average frequency is 1-2 times a week.

Standard desensitization and processing procedure contains eye movements 8 stages.

1) Safety assessment

Psychotherapist analyzes the entire clinical picture and highlights the goals of treatment. The EMDR method should only be used in patients who are able to cope with a possible high level of anxiety during the session. For this reason, the therapist first helps to cope with current problems and only then takes on long-standing psychotraumas. At the end, the future is also worked out by creating and fixing in the patient's imagination " good example» behavior.

At this stage, patients also learn to reduce stress via:

• imagination safe place,
• technology luminous flux(imagining a healing ray of light that penetrates the body),
• independent using eye movements or neuromuscular relaxation.

2) Training

Establish productive trusting relationship with the patient, explain the essence of the method of desensitization and processing by eye movements. Find out what types of eye movements of the proposed ones are the most comfortable for the patient. The appearance of pain in the eyes when performing movements requires an immediate cessation of treatment with an ophthalmologist's consultation to clarify possible contraindications to loads on the oculomotor muscles.

For testing the psychotherapist shows 2 touching fingers of his hand at a distance of 30-35 cm from the patient's face, and then with gradual acceleration moves his fingers left and right to the edge of the visual field. They select the optimal distance to the fingers, the height of the hand, the speed of movement (maximum is required, but without discomfort). If the patient fails to follow the fingers or a malfunction occurs (stopping, involuntary eye movements), it is usually enough for the patient to press his fingers on his closed eyes. Check the effectiveness of other eye movements - in a circle, diagonally, figure eight. Vertical eye movements (up and down) calm and reduce anxiety, suppress dizziness and nausea.

One eye movement is a complete cycle back and forth. In the technique of desensitization and processing with eye movements, series of 24 movements, the number of which can be increased to 36 or more.

If eye movements are not possible or uncomfortable, use alternative methods of stimulation:

• in turn tapping on the patient's palms lying on his knees and facing upwards,
• in turn doctor snapping fingers near the ears.

Teaching patients to reduce anxiety technique "Safe place". It is proposed to remember a quiet place where he felt completely safe, and focus on this image. The image is enhanced by the suggestion of the psychotherapist, as well as 4-6 series of eye movements. In the future, if necessary, the patient can on one's own to return in imagination to a safe place.

Also explain to the patient that he can terminate the process at any time, by raising his hand or giving another prearranged signal. This serves as an additional factor in patient safety.

3) Definition of the object of influence

The therapist defines purpose of exposure. In PTSD, the goals of exposure can be a traumatic event, nightmares, and other experiences.

After choosing the target of exposure, the patient is offered choose an image that reflects the most unpleasant part traumatic event, and then asked to verbalize painful self-image(in the present tense and in one's own name), for example: " i'm nothing», « i did something bad», « i can't trust myself», « I don't deserve respect" and etc.

Next, you need to define positive view- how the patient wants to be at the present time when he remembers the traumatic situation: “ I'm good the way I am», « i can trust myself», « I control myself», « i did the best i could», « i can handle it". This positive representation is used later, in the 5th stage (installation). A positive self-image facilitates the correct reassessment of events and contributes to a more adequate attitude towards them. The adequacy of such a self-representation is offered to the patient to be intuitively assessed on a 7-point scale (SSP). If 1 (minimum) score is scored, meaning " complete inconsistency with the true self-image”, the therapist must weigh the realism of the patient's wishes.

After that, the patient calls aloud negative emotions that arise when he focuses on trauma and painful self-images, and also assesses the level of anxiety by Scale of subjective anxiety(SSB) from 0 (complete rest) to 10 points (maximum anxiety).

4) Desensitization

The goal is to reduce the patient's level of anxiety.

At this stage, the patient should follow the movements of the fingers psychotherapist, while simultaneously recalling the most unpleasant part of the traumatic event and at the same time repeating to himself (not aloud) painful ideas like “ i'm nothing», « i did something bad". After each series of eye movements, the patient is told: Now rest. Breathe in and out. Let everything go as it goes". Then they ask if there are any changes in visual images, thoughts, emotions and physical sensations (these are indicators of the internal processing of psychotrauma).

Usually, alternating such series of eye movements with rest leads to a decrease in emotional and physical tension, and memories become more comfortable. The purpose of the desensitization stage is to reduce the patient's level of anxiety when remembering the trauma to a minimum level of 0 or 1 on the BSS (Subjective Anxiety Scale).

In the process of treatment with the method of desensitization and processing by eye movements, it is possible short-term increase in negative emotions or reaction (abreaction). However, the response is slightly different than with hypnosis because the patient retains double focus(on psychotrauma and on a sense of security in the present) in contrast to complete immersion in hypnosis. During an EMPG session, the adjustment occurs 4-5 times faster than trance. If a reactive has begun, the therapist increases the number of eye movements to 36 or more in order to complete the reactive as much as possible during the current series.

If, after 2 consecutive series of eye movements, the patient does not feel any changes in thoughts and emotions, you need to change direction of eye movements. The inefficiency of changing 2-3 directions of eye movement indicates a blocked processing (additional strategies.

Additional Strategies for Blocked Recycling:

1) Change in direction, duration, speed, or range eye movements. The best way is to combine these methods.

2) During the selection of eye movements, the patient is asked focus only on the sensations in the body(without the image of psychotrauma and positive self-representation).

3) Patient Stimulation openly express repressed emotions and move freely. At the same time, eye movements are carried out.

4) Pressure by the patient (finger, hand) in the place of discomfort, while negative sensations decrease or associative images appear, which are affected in the future.

5) Focusing on another aspect of the event(think of a different image of the psychotrauma, change the brightness of the presentation, recolor it in black and white). Or focus on the most disturbing sound stimulus.

6) Cognitive Interweaving- combine the thoughts and feelings of the patient with the auxiliary information of the psychotherapist. There are various options for cognitive interweaving:

1. psychotherapist explains to the patient correct understanding of past events and his role. The patient thinks about what was said during a series of eye movements.
2. redefining the traumatic situation through contacting people who are important to the patient. For example, a participant in hostilities felt guilty that his best friend in battle did not follow the order of the commander to duck down and was killed, while the patient himself ducked down and remained alive. The psychotherapist advised me to think about what the patient would have ordered to do if the 16-year-old son of the patient were in the place of a friend. After the answer "crouch!" and a series of eye movements, the feeling of guilt was significantly reduced, and the processing of the situation was completed.
3. usage suitable analogies(metaphors) in the form of parables, stories or examples from life. The therapist draws parallels with the patient's situation and gives hidden clues to solve the problem. This can be done both during the series of eye movements, and before it with a suggestion to reflect during the series.
4. Socratic dialogue(named after the ancient Greek philosopher Socrates). During the conversation, the therapist consistently asks questions, leading the patient to a certain logical conclusion. After the suggestion to think, a series of eye movements is carried out.

In the course of processing the main psychotrauma in the mind of the patient, additional negative memories. They should be made the focus of the next series of eye movements. During the treatment of PTSD in combatants, it is necessary to process all associative material (combat episodes, memories, sounds, sensations, etc.).

When all associations are processed, you should return to the original goal(psychotrauma) to perform additional series of eye movements. If within 2-3 series no new memories appear, and the level of anxiety according to the SSB is not higher than 1 point out of 10 (ideally 0 points), then they proceed to the next (5th) stage - installation.

5) installation

The goal is to increase and consolidate the patient's self-esteem by linking positive self-image with psychotrauma.

After desensitization (stage 4), the patient is asked to remember his positive view(how he wanted to see himself at the 3rd stage) and ask if it is suitable now. Many patients refine or even change the self-image that is meaningful to them.

Then the patient is offered think about psychotrauma taking into account the voiced positive self-image and answer to what extent it corresponds to the truth. The patient is asked to recall the trauma from the position of a positive self-image, while the psychotherapist conducts the number of series of eye movements necessary to consolidate the effect.

If reinforcement was a complete success (7 points on a subjective 7-point Representation Correspondence Scale), then proceed to the stage of body scanning (6th stage). If, due to incomplete processing of additional memories and negative beliefs, the desired (maximum) level of consolidation cannot be achieved, then the treatment of DPDH is postponed to the next session, and this one is completed (stage 7 - completion).

6) body scan

The goal is to eliminate residual discomfort in the body.

If the fixation at the installation stage was successful (6-7 points on a subjective 7-point scale), a scan is performed. The patient is asked to close his eyes and, imagining the trauma and positive self-image, mentally go to all parts of your body from head to toe.

All areas of discomfort or unusual sensations should be reported. If discomfort is detected somewhere, it is worked out with the help of a new series of eye movements. If there is no sensation at all, then a series of eye movements is performed. When pleasant sensations arise, they are enhanced by an additional series of DPDH. Sometimes you have to go back several stages to process new negative memories that have surfaced.

7) Completion

The goal is to achieve emotional balance by the patient, regardless of the completeness of the processing of psychotrauma.

To do this, the therapist uses hypnosis or the "Safe Place" technique(described in stage 2). If processing is not completed, then after the session, an unconscious continuation of processing is likely. In such cases, the patient is advised to write down (remember) disturbing thoughts, memories and dreams. They can become new targets for exposure to DPG sessions.

8〉 Revaluation

The goal is to test the effect of the previous treatment session.

Reassessment is carried out before each new session of desensitization and eye movement processing. Psychotherapist evaluates the patient's response to previously processed goals. It is possible to process new goals only after complete processing and assimilation of the previous ones.

Features of the DPDH method in the treatment of combatants

Many veterans of military conflicts suffer from painful feelings of self-blame in connection with their actions during the hostilities. Need to be explained to the patient:

1. if the patient were really as bad a person as he thinks, then wouldn't suffer so much. Conscience does not torment bad people for decades.
2. already suffering no help for the dead, but they will greatly interfere with the full life of the survivors.
3. painful symptoms of PTSD are the result of the retention of psychotrauma in the neural networks of the brain, and treatment will help to get rid of the "stuck" of the negative. It is important to note that the acquired combat experience will remain in the memory, because the treatment is aimed only at getting rid of suffering and feelings, and not at losing memory of military events. Treatment will help you live a more fulfilling life, give you more opportunities to honor the memory of the dead and help former colleagues in difficult times.

In addition to the feeling of self-blame, big problem are outbursts of uncontrollable anger. They can lead to family breakdown and problems with the law. Treatment with a psychotherapist will help you better control your behavior. Additionally patients are trained:

• technique "Safe place",
• relaxation exercises,
• self-use of eye movements for calming.

Treatment of patients with PTSD using the EMDH method is highly effective and can completely eliminate unpleasant symptoms. It is possible to combine DPDH with other psychotherapeutic methods, as well as with medications.

The use of the DPDH method in the treatment of sexual disorders

Minimum 11% former combatants need sexological assistance. In the presence of PTSD, this level is even higher, but most of them, for various reasons, do not turn to a sexologist. Most common the following problems:

• anxious anticipation of sexual failure (psychogenic erectile dysfunction),
• effects of alcohol abuse
• relationship problems due to PTSD symptoms.

Against the background of sexual failures, such people increase jealousy, a outbursts of anger become more destructive and unpredictable. Based on the foregoing, the treatment of sexual disorders must necessarily be included in the rehabilitation program for people with PTSD, which will allow them to increase self-esteem, achieve psychological comfort and harmonize relationships in marriage.

You can help patients who:

• can't forget their failures in bed,
• received negative information about their potency,
• have false beliefs about sexuality,
• remember any events that cause anxiety and fear of sexual intercourse.

2-6 sessions are carried out with a frequency of 1-2 per week. The duration of each 1-1.5 hours.

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy developed by Francine Shapiro for the treatment of post-traumatic stress disorder (PTSD) caused by experiencing stressful events such as violence or combat.

According to Shapiro's theory, when a person experiences a traumatic experience or distress, this experience can "overlap" the possibilities of his coping mechanisms, then the memory and stimuli associated with the event are processed inadequately and dysfunctionally stored in isolated areas of memory. The goal of therapy is to process these stressful memories and allow the patient to develop more adaptive coping mechanisms.

There are two opinions about the mechanism of the DDG. Shapiro says that despite the different processes that make up EMDR, eye movements add to the effectiveness by triggering neurological and physiological changes that facilitate the processing of traumatic memories in therapy. Other researchers believe that eye movement is not a necessary component, but an epiphenomenon, a side effect, and EMDR is just one form of desensitization.

Description of the method

EMTP integrates elements of psychodynamic, exposure approaches, cognitive, interpersonal, experiential and body-oriented psychotherapies, but contains a unique element of bilateral stimulation (eye movements, sound and tactile stimulation) in each session.

EMDR uses a structured eight-phase approach that addresses past, present, and future aspects of traumatic experiences and dysfunctionally stored stress memories. During the processing phase, the patient focuses on disturbing memories for short sessions of 15-30 seconds. In doing so, it simultaneously focuses on alternative stimulation (eg, therapist-guided eye movements, hand clapping, or bilateral auditory stimuli).

In each session of this dual attention, the patient is asked about the associative information that comes up during the procedure. New material usually becomes the focus of the next session. The process of holding double attention on the alternative stimulus and personal associations is repeated many times during the session.

When a distress or traumatic event is isolated or a single event occurs (eg, a traffic accident), approximately three sessions are required for a complete treatment. If a person experiences multiple traumatic events leading to health problems - such as physical, sexual or emotional abuse, parental neglect, serious illness, accident, serious injury or impairment leading to chronic impairment of health and well-being, and war trauma , treatment can be long and complex, multiple trauma may require more sessions to complete the healing and lasting results

Efficiency ratings[

Recent studies are evaluating EMDH as an effective treatment for PTSD. The International Society for the Study of Stress guidelines categorizes EMDR as an effective treatment for PTSD in adults. Several international guidelines include EPDH as a recommended treatment after physical injury.

Several studies using meta-analysis have been conducted to evaluate the effectiveness of treating PTSD with different methods. In one of them, DPDH is estimated to be equal in effectiveness to exposure therapy and selective serotonin reuptake inhibitors. Two other independent meta-analyses show that conventional exposure therapy and EPDH have the same effect immediately after treatment and in the subsequent evaluation. A 2007 meta-analysis of 38 randomized controlled trials of PTSD treatment recommend either cognitive behavioral therapy (CBT) or EMDH as first-line treatment for PTSD