EXAM 2 REVIEW Flashcards
What are the 8 phases of EMDR?
Phase 1: History Taking
1. The therapist evaluates whether EMDR is appropriate for the client and identifies targets for treatment, which can include both significant (big-T) and less obvious (small-t) traumas.
Phase 2: Preparation
1. The therapist educates the client about the Adaptive Information Processing (AIP) model and how EMDR works.
2. Clients learn stabilization techniques, such as relaxation exercises, safe-place imagery, and resource development strategies, to enhance their ability to tolerate distress before moving into trauma processing.
Phase 3: Assessment
1. The specific trauma target is identified for processing.
Phase 4: Desensitization
1. Bilateral stimulation (BLS) is introduced, which may involve eye movements, auditory tones, or tapping to facilitate processing.
2. The goal is to reduce the distress level (SUD score) to 0 or 1.
3. Clients are guided to free-associate, allowing related memories and emotions to emerge and process naturally.
Phase 5: Installation
1. Once distress levels are reduced, the therapist helps strengthen the Positive Cognition (PC) identified in Phase 3.
The goal is for the PC to reach a Validity of Cognition (VOC) rating of 7, meaning the new positive belief feels completely true.
Phase 6: Body Scan
1. The therapist asks the client to scan their body for any residual physical tension or discomfort associated with the trauma. The goal is to ensure that no negative bodily responses remain when recalling the traumatic event.
Phase 7: Closure
1. The therapist ensures that the client returns to a state of emotional equilibrium before ending the session.
2. The client is instructed to keep a log or journal between sessions to note any disturbances or insights.The therapist also provides guidance on self-care and how to manage emotions between sessions.
Phase 8: Re-evaluation
1. At the start of the next session, the therapist reassesses previously processed memories to ensure lasting changes.
2. The client is asked to recall the trauma and reassess their SUD and VOC scores to confirm continued improvement.
What does the therapist ask the client to identify in Phase 3 of EMDR?
- A visual image representing the worst part of the traumatic event.
- A Negative Cognition (NC) that reflects the client’s current self-belief related to the trauma.
- A Positive Cognition (PC) that represents the desired self-belief.
- A Validity of Cognition (VOC) scale (1-7) to measure how true the positive belief feels.
- The Subjective Units of Distress (SUD) scale (0-10) to measure the intensity of the distress.
- Any associated body sensations related to the traumatic memory.
What is EMDR and how does it differentiate from other therapies?
EMDR is unique because it uses eye movements, tapping, or sounds to stimulate both sides of the brain, helping it reprocess traumatic memories in a more adaptive way. Unlike CBT, which focuses on changing thought patterns, EMDR works with the brain’s natural ability to heal by addressing how trauma is stored in the nervous system.
What is Bilateral Stimulation?
BLS involves eye movements, alternating auditory tones, or tactile tapping to facilitate the processing of traumatic memories.
It promotes dual attention processing, where the client maintains awareness of both internal distressing memories and external rhythmic stimulation.
What are the neurobiological effects of BLS?
It is thought to facilitate interhemispheric connection, allowing communication between the left and right hemispheres of the brain.
Functional MRI studies have shown that EMDR increases prefrontal cortex activation while reducing hyperactivity in the amygdala, which is responsible for fear and emotional responses.
There is also evidence suggesting an increase in hippocampal volume after EMDR treatment, indicating improved memory processing.
What is the Adapative Information Processing Model?
The Adaptive Information Processing (AIP) Model is the foundation of EMDR therapy. It suggests that psychological symptoms stem from traumatic memories that are improperly stored in the brain. These memories remain isolated and retain their original distressing emotions, sensations, and beliefs, making them easily triggered by present experiences.
EMDR works by reprocessing these memories, helping them integrate with healthier memory networks. This reduces emotional distress and modifies negative beliefs. By facilitating the brain’s natural healing process, EMDR allows people to recall past trauma without being overwhelmed by negative emotions.
What is the evidence behind EMDR?
EMDR has a strong research base supporting its efficacy in treating Post-Traumatic Stress Disorder (PTSD), with over 27 randomized clinical trials (RCTs) to date.
EMDR is included in many national and international treatment guidelines for trauma and PTSD, including those from:
1. American Psychiatric Association (APA, 2009)
2. World Health Organization (WHO, 2013)
3. National Institute for Health and Care Excellence (NICE, 2005)
4. Substance Abuse and Mental Health Services Administration (SAMHSA, 2011)
5. U.S. Department of Veterans Affairs/Department of Defense (DVA/DoD, 2010)
6. Studies of single-event trauma cases show 77% to 100% remission of PTSD symptoms after 3 to 6 EMDR sessions (Lee et al., 2002).
7. Rodenburg et al. (2009) found EMDR to be effective in children with PTSD, showing significant symptom reductions.
What is the long term effects of EMDR?
Studies indicate that the effects of EMDR are long-lasting.
Patients treated with EMDR continue to improve even after therapy ends, unlike medication-based treatments, where symptoms often return once the medication is discontinued.
What are the similarities between EMDR and TF- CBT?
- Both EMDR and TF-CBT are Level A treatments for PTSD, meaning they have the highest level of empirical support.
- EMDR and TF-CBT both follow structured, step-by-step treatment models that guide patients through trauma processing.
What is the MOA for EMDR and TF-CBT?
EMDR
1. Uses Bilateral Stimulation (eye movements, tapping, or auditory tones) to facilitate memory processing and integration.
TF-CBT
1. Uses cognitive restructuring, prolonged exposure, and behavioral techniques to help patients change trauma-related thoughts.
How is exposure to trauma different in EMDR and TF-CBT?
EMDR: Exposure is brief and interrupted; allowing for spontatneous processing with minimal distress.
TF-CBT: Direct, prolonged exposure to traumatic memories is required which can be highly distressing.
What is the cognitive component in EMDR and TF-CBT?
EMDR: Does not involve direct cognitive challenging of trauma-related beliefs. Instead, processing leads to spontaneous cognitive shifts.
TF-CBT: Actively challenges and restructures negative beliefs about trauma using cognitive techniques.
What is the homework, length of treatment, and dropout rates of EMDR and TF-CBT?
Use of Homework
EMDR: No homework required, making it less time-intensive for the client.
TF-CBT: Requires 1–2 hours of daily homework (e.g., journaling, exposure tasks, cognitive exercises).
Length of Treatment
EMDR: Fewer sessions needed—typically 3–6 sessions for single-event trauma.
TF-CBT: More sessions required, often 12–16 or more for effective trauma processing.
Dropout Rates
EMDR: Lower dropout rates compared to TF-CBT, as EMDR does not require prolonged distressing exposure.
TF-CBT: Higher dropout rates, as prolonged exposure can be overwhelming for some clients.
Which therapy (EMDR and TF-CBT) is suitable for different clients?
EMDR: More suitable for clients who struggle with direct exposure or who dissociate during trauma recall.
TF-CBT: Better for clients who can tolerate direct exposure and actively challenge their thoughts.
What is Cognitive Behavioral Therapy?
CBT helps individuals build coping skills by targeting the connection between thoughts, emotions, and behaviors. Patients and clinicians set clear, measurable goals and track progress through structured sessions. Homework assignments reinforce skills outside of therapy. By identifying and changing negative thought patterns, CBT helps improve emotional responses and behaviors. It combines cognitive restructuring (modifying irrational thoughts) with behavioral techniques (like exposure therapy and relaxation) to create lasting change.
What is cognitive restructuring?
Identify Negative Thoughts – You notice a thought that makes you feel bad, like “I’m a failure” after making a mistake.
Challenge the Thought – Ask yourself, “Is this really true? Am I being too hard on myself?”
Replace with a More Balanced Thought – Instead of “I’m a failure,” you reframe it as “I made a mistake, but I can learn from it.”
What is prolonged exposure?
The patient is exposed to the fear-inducing stimulus until anxiety naturally decreases.
What is heirarchial exposure?
Patients create a fear hierarchy and gradually work their way up from least to most distressing situations.
What is interoceptive exposure?
Individuals with panic disorders are exposed to internal sensations that mimic their anxiety symptoms to reduce fear responses.
What is in-vivo exposure?
Patients face real-life feared situations in a stepwise manner to develop coping mechanisms.
What is imaginal exposure?
Patients visualize feared experiences in therapy sessions, helping them process trauma or anxiety triggers.
What is skills training in CBT and what does it include?
Practical strategies to cope with distress, regulate emotions, and improve interpersonal interactions. This includes:
- Assertiveness Training
- Behavioral Rehearsal
- Contingenecy Management
- Social Skills Training
- Relaxation/Guided Meditation
- Homework Assignments
What does the Behavioral Rehearsal look like?
- Identify a core belief or assumption (“If I speak in public, I will embarrass myself”).
- Design an experiment to test this belief in a controlled setting (giving a short speech in a safe environment).
- Observe the actual outcome and compare it with the expected fear.
- Use the results to modify future beliefs and reactions.
What is the purpose of contingency management?
Patients are encouraged to use reinforcements and consequences to shape behavior change (e.g., reward systems).
What is Progressive Muscle Relaxation?
Patients tense and then relax different muscle groups to release stored tension.
What is the overbreathing technique?
This method helps control hyperventilation by slowing breathing patterns to prevent panic symptoms
What is the Socratic Dialogue?
a question-based technique that guides individuals toward self-discovery and insight by helping them critically examine their thoughts and beliefs.
What are the 7 types of Socratic questions used in therapy?
- Memory questions (“When did you first notice this thought pattern?”)
- Translation questions ( “What does feeling ‘anxious’ mean to you?”)
- Interpretation questions (“How does your fear of failure impact your daily life?”)
- Application questions (“How can you apply what you learned here in another situation?”)
- Analysis questions (“What evidence do you have to support this belief?”)
- Evaluation questions (“On a scale of 1–10, how much do you believe this thought now?”)
- Synthesis questions (“Can you think of an alternative explanation for this situation?”)
What are the guiding principles of Motivational Interviewing?
- Acceptance – Practitioners demonstrate respect for the client’s autonomy, affirm their strengths, and convey accurate empathy. This principle is influenced by Carl Rogers’ person-centered therapy,
- Compassion – The well-being of the client is prioritized above the practitioner’s own needs.
3.Evocation – MI operates on the belief that individuals already have within them the motivation and resources needed for change. The practitioner’s role is to “draw out” and reinforce the client’s intrinsic motivations.
What is the Transtheoretical Model (TTM)?
Also called the Stages of Change Model, explains how people change behaviors over time, like quitting smoking, eating healthier, or exercising more. It recognizes that change doesn’t happen all at once but in stages (5- Precontemplation, Contemplation, Preparation, Action, and Maintenance.)
How is MI incorporated into the Transtheoretical Model?
MI is particularly useful in the early stages (precontemplation and contemplation), helping individuals move towards a commitment to change.
MI has been integrated with TTM in substance abuse treatment programs. For example, the Center for Substance Abuse Treatment (1999) combined MI with TTM to enhance motivation and facilitate behavioral change.
What are the theories that support Motivational Interviewing?
- Cognitive Dissonance Theory (Festinger)
- Self Perception Theory (Bem)
- Reactance Theory (Brehm)
- Person-Centered Therapy (Rogers)
- Committment Language and Change Talk (Amrhein)
What are the phases of change in MI?
Engagement (Building a Trusting Relationship)
1. Establish a trusting relationship between the practitioner and the client. Without engagement, there is little hope for meaningful change.
Focusing (Clarifying the Direction for Change)
1. This phase narrows the target for change.
Evoking (Eliciting Motivation for Change)
1. This phase draws out the client’s internal motivation by exploring their reasons for change.
2. Amplify “change talk” (statements supporting change) and minimize “sustain talk” (statements defending current behavior).
Planning (Developing a Change Strategy)
1. When the client is ready, the practitioner helps develop a concrete plan for change. This phase reinforces commitment by encouraging specific actions.
2. Key techniques: Setting small, achievable steps, addressing potential barriers, and using affirmations.
What is the OARS communication skill used throughout MI?
O – Open-ended Questions
A – Affirmations
R – Reflections
* Repeat or rephrase what the client says to enhance understanding and highlight motivation.
* Example: Client: “I know I should quit smoking, but it helps with stress.” Practitioner: “Smoking helps you cope with stress, but you also see reasons to quit.”
S – Summarizing
What are strategies for handling resistance in a client relationship?
Rolling with Resistance
1. Instead of confronting or arguing, MI practitioners acknowledge the client’s perspective.
Reflective Listening and Reframing
Developing Discrepancy
1. MI helps clients recognize the gap between their current behaviors and future goals.
2. Example: “You’ve mentioned wanting to be healthier for your kids, but smoking makes you feel out of breath. How do you see those fitting together?”
Shifting to Change Talk
1. Instead of reinforcing sustain talk (staying the same), MI gently elicits change talk (reasons for change).
