The Contribution of EMDR with Children Survivors of Mass Trauma

Saturday: 12.06.2010, 08.30 - 09.30

CV / Biographical Sketch:
Isabel Fernandez is a clinical psychologist working in Milan. She has received training in Cognitive Behavioural Therapy and has been working in the respective faculty of the Italian School of Cognitive Behaviour Therapy for 12 years, providing specialization training in psychotherapy. She has worked as a consultant psychologist at the psychiatric ward of Niguarda Hospital, conducting research projects in the clinical field. She is a Lecturer at the Catholic University of Milan and Rome and at “La Sapienza” University of Rome.
She is currently the Director of the Psychotraumatology Research Center of Milan and has published many papers, articles and books on trauma, EMDR and research projects in this field. She is an EMDR Europe Approved Trainer, Chairman of the Italian Association of EMDR and belongs to the Board of Directors of the Italian Federation of Scientific Psychological Societies.

She has directed and organized interventions with EMDR during mass disasters (The air crash on the Pirelli building in Milan and Molise's earthquake) and has worked in cooperation with Civil Defense and fire fighters to provide psychological support and trauma treatment to emergency workers. She has trained Psychology graduates, post-graduates and clinicians on trauma, EMDR and crisis intervention in Italy, Spain and South America.

Abstract:
This paper describes the application of EMDR as an early trauma-focused treatment with children involved in mass disasters (natural disasters, accidents and intentionally provoked incidents).

EMDR treatment was part of a comprehensive treatment of the population and was the elective treatment for children of those elementary schools, which were most exposed to the traumatic events.  In most cases, 3 cycles of EMDR treatment were organized at one month, three months and one year after the critical event. Individual sessions were used for the school children due to the serious exposure to trauma and grief including: threat to life, loss of friends and siblings.

Psychological support and EMDR treatment was provided to parents and school personnel, and this aspect has been considered fundamental in enhancing treatment results in children during the last interventions.

Results of questionnaires and clinical interviews to assess posttraumatic symptomatology before and after treatment will be shown along with follow up data. Treatment groups show a significant improvement after EMDR treatment. Results and statistical data regarding EMDR treatment with heavily traumatized children will be presented.

The author will discuss clinical aspects of using EMDR with children following recent traumas of great magnitude. Analysis and evaluation of children’s reactions and needs have highlighted significant epidemiological aspects.

The posttraumatic stress reactions of this group in developmental age will be discussed. EMDR treatment for parents and other adults involved in the disaster has proven critical when dealing with children’s symptomatology. Guidelines and indications for structured interventions with all parties involved (parents, school personnel, community) from our field studies will be presented. 

EMDR in the Treatment of Addiction -
Reprocessing of the Addiction Memory

Sunday: 13.06.2010, 09.00 - 10.00

CV / Biographical Sketch:
Michael Hase, Dr. med born on 31 July 1959 in Einbeck. He studied medicine at the Christian-Albrechts-University in Kiel from 1979 – 1985. After his military service, during which he worked as a physician, he started his training in  neurology and psychiatry in the ‘Neurologische Klinik Hessisch-Oldendorf’, which he continued at the ‘Zentrum für Psychiatrie Herten’. Dr. Hase has been working as a consultant at the ‘Psychiatrische Klinik 1 am Niedersächsischen Landeskrankenhaus Lüneburg’ since 1993 and has established a PTSD-unit. Since his training in EMDR in 1997, he has been working on the integration of EMDR in clinical psychiatry, psychosomatic medicine, psychotherapy and rehabilitation.
Dr. Hase is a founding member of the special interest group ‘acute trauma’ of the DeGPT e.V. He is a consultant with the regional psychosocial support unit of the police force and the health centre of the judiciary in Lower Saxony.
Michael Hase has been holding presentations on psychotrauma therapy and EMDR since 1999 at national and international conferences . He is also working on the development of an EMDR-addiction-protocol for the treatment of depression, chronic pain and the integration of EMDR into psychosomatic rehabilitation.
Dr. Hase is Chief Physician at the Department for Psychosomatic Medicine and Psychotherapy at the Reha Centrum Hamburg and is Head of the Department for Psychosomatic Medicine and Psychotherapy at the Diana Klinik in Bad Bevensen.

Abstract: 
The comorbidity of PTSD and substance abuse provides sufficient reason for treating patients, who are addicted, with EMDR while focusing on the PTSD diagnosis. However, there are several pathways leading to addiction, and PTSD is only one of them. Thirty years of addiction research have provided sufficient evidence for the crucial role of memory in drug dependency.
The Addiction Memory (AM) serves as a useful concept for “obsessive-compulsive craving” to be seen in drug addicted patients. The concept of an AM, and its importance in relapse occurrence and maintenance of learned addictive behaviour, has gained growing acceptance in the field of addiction research and treatment. The AM is interpreted as an individual-acquired memory following drug consumption in some individuals. The addiction memory is based on normal memory systems and systems of central nervous information processing. This is in accordance with the experience that the addiction memory can be activated at any time by relapse-endangering complexes as well as internal and/or external situations,   which are experienced as cravings by the person in question.. The implicit nature of the addiction memory seems to qualify it as a target for EMDR treatment.
Without adequate therapeutic interventions, it is hardly extinguishable, as shown in the animal model where a re-imprinting of the AM facilitated by steroids extinguished craving in opiate addicted rats. Thus, altering or extinguishing the AM in human addicts could add an important component to well-established treatment modalities. The reprocessing of the AM with EMDR should, thus, lead to measurable changes in addiction symptoms, if the AM qualifies for maladaptive memory within the AIP model. As the AM includes the urge to consume the drug being abused, more aptly named craving, reprocessing of the AM should lead to a reduction in craving.

Preliminary data demonstrates the efficacy to reduce craving in alcohol-addicted patients. Anecdotal reports from clinicians seem to indicate an effect of the reprocessing of the addiction memory in patients addicted to heroin or psycho-stimulants. According to research in the animal model, the same principles should apply.

There are, however, other aspects to addiction. Is there a difference between chemical dependency and other addictive behaviour? How much do we know already? What have we yet to discover? These questions lead to the direction of developing a comprehensive EMDR approach in the treatment of addictions.

Healing Depression by Treating Trauma?

Friday: 11.06.2010, 18.30 - 19.30

CV / Biographical Sketch:
Dr. Arne Hofmann is a specialist for internal and psychosomatic medicine and is Head of the EMDR-Institute in Germany. He entered the field of psychotraumatology in 1991 while working at the Mental Research Institute in Palo Alto, California and was the first recognized trainer to introduce EMDR in German speaking countries. In 1994 he started a specialized inpatient trauma program in a psychiatric hospital near Frankfurt, Germany. He helped develop aftercare programs after a major train accident in Eschede 1998, a school shooting in Erfurt in 2002 and in the wake of the Tsunami in 2004.
Dr. Hofmann served as a founding board member of the German-speaking Society of Traumatic Stress Studies (DeGPT) and is a member of a German national guideline commission on the treatment of PTSD. He is also the Vice President of EMDR-Europe.
Dr Hofmann is an active teacher, researcher and publisher in the field of psychological trauma and has taught at the Universities of Cologne, Witten-Herdecke and the Peking University. He is currently guest professor at Xiahua University in Sichuan (China).

Abstract: 
Scientific studies of EMDR have shown that it is one of the most effective tools for treating posttraumatic stress disorders. One of the lesser-known properties of EMDR is that it also seems to be an effective psychotherapy method in a number of disorders, which may have part of their origins in stressful memories. One of these disorders is chronic depression.

Severe depression is one of the most common mental disorders and affects between 5-15% of the general population during their lifetimes. Although many psychotherapeutic and pharmacologic interventions exist that are considered to be effective in depression, the treatment is less than satisfactory. High relapse rates (around 50% after two years), unsatisfactory remissions and suicidal risks are among the major problems.
Research shows that there may be a link between traumatic events (such as abuse experience in childhood) and the later occurrence of a depressive disorder. Research also shows that patients with a traumatic childhood history respond differently to treatment than patients without such a history do.

However, there is no published systematic study that tries to explore the potential use of trauma-specific treatments, such as EMDR, with depressive patients with a trauma history.

The presenter will report on the status of research on this subject and on a current controlled study, which is exploring the use of EMDR in depressive patients.   

Emotion Regulation and the Self in Complex PTSD

Sunday: 13.06.2010, 14.30 - 15.30

CV / Biographical Sketch:
Dr. Ruth Lanius graduated from the University of British Columbia with a combined M.D. and Ph.D. degree in Neuroscience in 1996. She continued her training at the University of Western Ontario where she completed her residency in psychiatry in 2000. She is an Associate Professor in the Department of Psychiatry at the University of Western Ontario. She established and directed the Traumatic Stress Service and the Traumatic Stress Service Workplace Program, services that specialize in the treatment and research of Posttraumatic Stress Disorder (PTSD) and related comorbid disorders. She currently holds the Harris-Woodman Chair in Mind-Body Medicine at the Schulich School of Medicine & Dentistry at the University of Western Ontario.

Her research interests focus on studying the neural correlates of PTSD using neuroimaging (functional magnetic resonance imaging) and treatment outcome research examining various pharmacological and psychotherapeutic methods. Her research is currently funded by several federal funding agencies.  Dr. Lanius is an ad hoc reviewer for numerous journals and granting agencies. She has lectured on the topic of PTSD in North America, Europe and Japan.

Abstract:
The lecture will focus on the core problems in PTSD related to early life trauma, including emotion dysregulation and fragmentation of the self. The neural correlates of emotional awareness, social emotion processing and self-monitoring will be described. Implications for stage oriented trauma treatment and early intervention will be discussed.

The Future of EMDR

Sunday: 13.06.2010, 15.30 - 16.30

CV / Biographical Sketch:
Andrew M. Leeds, Ph.D is a licensed Psychologist with 35 years of private practice psychotherapy experience. He practices in Santa Rosa, California.

Dr. Leeds is widely respected for his work as an EMDR trainer and consultant. He received initial EMDR training in 1991. He has conducted EMDR training for 15,000 clinicians during 140 training programs in the United States, Canada, France, England and Japan.

He is the author of A Guide to the Standard EMDR Protocols for Clinicians, Supervisors and Consultants (2009, Springer Publishing Company: New York) as well as book chapters and journal articles on EMDR. He has presented papers on EMDR for regional, national and international conferences. He presently serves as a member of the Editorial Advisory Board of the Journal of EMDR Practice and Research.

Dr. Leeds contributed to the evolution of EMDR by articulating, publishing and teaching the EMDR procedure, which he named Resource Development and Installation (RDI). In 1999 he received the EMDRIA award for creative innovation in the development of EMDR and the EMDR Institute Ronald A. Martinez, Ph.D. Memorial Award.

Abstract: 
In less than 20 years, EMDR achieved international acceptance as an empirically supported treatment for posttraumatic stress disorder. In achieving this recognition, EMDR has raised fundamental questions, both about the essential mechanisms of action of existing treatments and what the foundational principles should be for future approaches to psychotherapy.
Can EMDR best be explained as a variant on the exposure-extinction model of imaginal exposure? Will EMDR turn out to be an equally or more effective treatment for other anxiety disorders, for depressive disorders and for personality disorders, than other methods such as Cognitive Behavioural and Interpersonal Therapy? Is the Adaptive Information Processing model essential to the current use and the future of EMDR or is it merely an unproven and extraneous model? How will EMDR evolve over the next 20 years? For what conditions will it turn out to be most successful? How will the emergence of new technologies impact the delivery of psychotherapy in general and of EMDR? A glimpse of what lies ahead.

PTSD as an Information Processing Disorder

Saturday 12.06.2010  14.30 - 15.30

CV / Biographical Sketch:
Professor McFarlane is currently the Head of the University of Adelaide Node of the Centre of Military and Veterans Health. He is an international expert in the field of the impact of disasters and posttraumatic stress disorder. He is a Past President of both the International Society for Traumatic Stress Studies and the Australasian Society for Traumatic Stress Studies. He is the recipient of the Robert Laufer Award for outstanding scientific achievement in the study of the effects of traumatic stress.

Abstract:
Posttraumatic stress disorder is a challenging condition, as people become captured by their past experiences and have difficulty engaging with the present. At the core of this condition is the role of traumatic memories, which orientate the individual’s awareness and reactivity to reminders of the instigating traumatic event. The role of traumatic events has not been fully understood and grappled with in the full range of psychopathological conditions. This has important implications for the application of EMDR as a treatment for disorders above and beyond posttraumatic stress disorder.

However, the problems with information processing in PTSD go above and beyond the fear circuitry and reactivity to traumatic memories. Individuals with PTSD also have major difficulties with their self-orientation, which is reflected in deficits in default networks, the idling systems of the brain. These changes are indicative of problems in self-registration and free-floating reflection. Dissociative symptoms may relate to these abnormalities of individuals’ resting states as they reflect a sense of disconnection and integration of internal states into consciousness.

Secondly, posttraumatic stress disorder is associated with major problems in dealing with neutral environmental information. This is reflected in the symptoms of difficulty with concentration and emotional numbing. The underlying neurobiology of the working memory abnormalities in posttraumatic stress disorder will be highlighted. These studies show that, in PTSD, relatively simple attentional tasks recruit neural networks normally reserved for more demanding and higher order tasks.  When confronted with more demanding challenges, individuals with PTSD do not have any further capacity to allocate to processing complex environments. 

Individuals with PTSD also demonstrate a problem with switching their attentional focus from an idling to active state. The data suggests that they continue to use visio-spatial networks more than language-based systems for dealing with verbal tasks. This observation is in keeping with a broad body of literature, which suggests that there are problems with the processing of verbal memory tasks in PTSD.  EMDR, as a treatment, may have an advantage, as it is not so dependent on verbal representations of traumatic experiences as other treatment approaches.

Finally, an important development in the field is a better understanding of the patterns of abnormal cortical arousal that accompany the peripheral arousal abnormalities in PTSD. Quantitative EEG has given insights into the instability of the cortical neural networks. Neurotherapy represents a treatment that can further assist clinicians in the management of these patients. It is important to consider the underlying psychosomatic aspects of posttraumatic stress disorder and ensure that treatment addresses these components as well the traumatic memories. Treatment should be thought of as a staged process where the processing of traumatic memories is only one component of a disorder that impacts on a range of information processing domains.