Eye Movement Desensitization & Reprocessing
Edited by: Marilyn Luber, PhD
EMDR
RESOURCES
IN THE
ERA OF COVID
-
19
EMDR
© 2020 All rights reserved.
Cover & Layout Design by Lew Rossi
© Marilyn Luber, PhD. 2020. is Introduction and Compilation of Resources is copyrighted under United States Law. EMDR
practitioners are encouraged to use this work in the treatment of their own clients. Under certain limited conditions, EMDR
practitioners and researchers may request and receive from one or more of the authors specic, written permission to use the
materials contained herein in new works they create. For further information on receiving permission to use the materials other
than with the practitioner’s own clients, please contact Marilyn Luber, PhD at marilynluber@gmail.com. All rights are reserved
Cover & Layout Design by Lew Rossi
© Marilyn Luber, PhD. 2020. is Introduction and Compilation of Resources is copyrighted under United States Law. EMDR
practitioners are encouraged to use this work in the treatment of their own clients. Under certain limited conditions, EMDR
practitioners and researchers may request and receive from one or more of the authors specic, written permission to use the
materials contained herein in new works they create. For further information on receiving permission to use the materials other
than with the practitioner’s own clients, please contact Marilyn Luber, PhD at marilynluber@gmail.com. All rights are reserved
© 2020 All rights reserved.
Edited by:
Marilyn Luber, PhD
Eye Movement Desensitization & Reprocessing
EMDR
RESOURCES
IN THE
ERA OF COVID
-
19
© 2020 All rights reserved.
To
Francine Shapiro
an inspiration at all times, but
especially in times of crises
© 2020 All rights reserved.
Marilyn Luber, PhD, is a licensed clinical psychologist and has a general private practice in
Center City, Philadelphia, Pennsylvania, working with adolescents, adults, and couples, especially
with complex posttraumatic stress disorder (C-PTSD), trauma and related issues, and dissociative
disorders. She has worked as a Primary Consultant for the FBI eld division in Philadelphia. In 1992,
Dr. Francine Shapiro trained her in Eye Movement Desensitization and Reprocessing (EMDR). She
was on the Founding Board of Directors of the EMDR International Association (EMDRIA) and
served as the Chairman of the International Committee until June 1999. Also, she was a member
of the EMDR Task Force for Dissociative Disorders. She conducts facilitator and consultation trainings and teaches other
EMDR-related subjects both nationally and internationally. Since 1997, she has coordinated trainings in EMDR-related elds
in the greater Philadelphia area. In 2014, she was a member of the Scientic Committee for the EMDR Europe Edinburgh
Conference. Currently, she is a facilitator for the EMDR Global Alliance to support upholding the standard of EMDR erapy
worldwide. She is also a member of the Steering Committee for the Future of EMDR erapy Project and on the Council of
Scholars. In 1997, Dr. Luber was given a Humanitarian Services Award by the EMDR Humanitarian Association. Later, in
2003, she was presented with the EMDR International Associations award “For Outstanding Contribution and Service to
EMDRIA” and in 2005, she was awarded “e Francine Shapiro Award for Outstanding Contribution and Service to EMDR.
In 2001, through EMDR HAP (Humanitarian Assistance Programs), she published, Handbook for EMDR Clients, which has
been translated into eight languages; the proceeds from sales of the handbook go to EMDR HAP organizations worldwide. She
has written the “Around the World” and “In the Spotlight” articles for the EMDRIA Newsletter, four times a year since 1997.
In 2009, she edited Eye Movement Desensitization and Reprocessing (EMDR) Scripted Protocols: Basics and special situations
(Springer) and Eye Movement Desensitization and Reprocessing (EMDR) Scripted Protocols: Special populations (Springer).
She interviewed Francine Shapiro and co-authored the interview with Dr. Shapiro for the Journal Of EMDR Practice and
Research (Luber & Shapiro, 2009) and later wrote the entry about Dr. Shapiro for E.S. Neukrug’s, e SAGE Encyclopedia of
eory in Counseling and Psychotherapy (2015). Several years later, in 2012, she edited Springer’s rst CD-ROM books: Eye
Movement Desensitization and Reprocessing (EMDR) Scripted Protocols with Summary Sheets CD-ROM Version: Basics and
Special Situations and Eye Movement Desensitization and Reprocessing (EMDR) Scripted Protocols with Summary Sheets CD-
ROM Version: Special Populations. In 2014, she edited, Implementing EMDR Early Mental Health Interventions for Man-Made
and Natural Disasters: Models, Scripted Protocols and Summary Sheets. In 2015, three ebooks were published that supplied
protocols taken from Implementing EMDR Early Mental Health Interventions for Man-Made and Natural Disasters: Models,
Scripted Protocols and Summary Sheets: EMDR erapy With First Responders (ebook only), EMDR erapy and Emergency
Response (ebook only), and EMDR erapy for Clinician Self-Care (ebook only). e text, Eye Movement Desensitization and
Reprocessing (EMDR) erapy Scripted Protocols and Summary Sheets: Treating Anxiety, Obsessive-compulsive and Mood-
Related Conditions and Eye Movement Desensitization and Reprocessing (EMDR) erapy Scripted Protocols and Summary
Sheets: Treating trauma-and stressor-related conditions were released in 2015. In 2019, Springer published Eye Movement
Desensitization and Reprocessing (EMDR) erapy Scripted Protocols and Summary Sheets: Treating medical-related issues
and Eye Movement Desensitization and Reprocessing (EMDR) erapy Scripted Protocols and Summary Sheets: Treating
eating disorders, chronic pain, and maladaptive self-care behaviors. In 2020, Luber compiled resources for and from the
worldwide EMDR community and put online, EMDR Resources in the Era of Covid-19.
© 2020 All rights reserved.
III
ANDRA
TUTTO BENE
{ Everything will be ne }
ANDRA
TUTTO BENE
{ Everything will be ne }
Italian Slogan during the Coronavirus
© 2020 All rights reserved.
Contents
© 2020. All rights reserved.
EMDR RESOURCES in the ERA of COVID19
Contributors
Foreword Derek Farrell, C. Psychol, PhD, CSi, AFBPsS
Preface
Acknowledgment
PART I
EMDR Responses to COVID-19 Around the World
Resource 1 Levels of Care for the Coronavirus
Regina Morrow
Resource 2 Italy and the Coronavirus: Suggestions for Clinicians During the Pandemic
EMDR Italy
Guidelines for Adults: Self-Protection for Adults
Guidelines for Children: Children Need to Understand What is Happening: Tips for
Parents, Caregivers, Teachers and Grandparents: What to say and how to say it
Coronavirus: How to Deal with It: Suggestions for Managing Fear in Children and Adults
Suggestions and Guidelines for Senior Citizens
Guidelines for First Responders: Self-protection for First Responders and Health
Professionals
Telephone Support: Guide for Counseling
COVID-19 Emergency: Guidelines on How to Communicate Bad News Over the Telephone
Resource 3 A Picture of Italy Affected and Striving with the Coronavirus: Phase 1
Isabel Fernandez
Resource 4 A Picture of Italy Affected and Striving with the Coronavirus: Phase 2
Isabel Fernandez
Resource 5 Recommendations for the Use of Online EMDR Therapy During the COVID-19 Pandemic
The Standards Committee, EMDR-Europe
Resource 6 EMDR Early Interventions in the Current COVID-19 Pandemic
Resource 7 A Turkish Response to Dealing with a Catastrophic Event: The COVID-19 Pandemic
Şenel Karama, Asena Yurtsever, Sefa Kaya, & Emre Konuk
Resource 8 The Global Child-EMDR Alliance
Ana M. Gomez
Resource 9 Therapy in A Time of Turmoil: Stray Thoughts
Deany Laliotis
© 2020 All rights reserved.
V
© 2020. All rights reserved.
PART II
EMDR-Related Stabilization Techniques
Resource 10 Self-Care Procedure for Coronavirus (SCP-C) for Mental Health Practitioners
Gary Quinn
Resource 11 Self-Care Procedure for Coronavirus (SCP-C) Worksheet for Mental Health Practitioners
Gary Quinn
Resource 12 The Butterfly Hug for the Coronavirus Pandemic
Ignacio Jarero
Resource 13 Four Elements Parent Activities
Judy Moench
PART III
Early EMDR Interventions
Resource 14 The EMDR Abbreviated Recent-Traumatic Episode Protocol (R-TEP)
(The “Sandwich Protocol)
Brurit Laub & Keren Mintz Malchi
PART IV
Early Self-Care Suggestions & Interventions
Resource 15 Healer, Heal Thyself: Self-Care in the Time of COVID-19
Catherine Butler
Resource 16 Letter from Roger Solomon
Roger Solomon
Resource 17 Strengthen Resilience: Promote Recovery
Roger Solomon
Resource 18 Group-Traumatic Episode Protocol Remote Individual & Self-Care Protocol (G-TEP RISC)
Elan Shapiro
Resource 19 The Self-Care Traumatic Episode Protocol (STEP)
Judy Moench
Appendix A EMDR Global Resources
© 2020 All rights reserved.
V I
Catherine M. Butler, EdD, MFT, is a clinician in private practice in San Diego, CA. Her practice focuses on the impact of PTSD
on rst responders and veterans. e area of compassion fatigue and burnout has been an interest for several years and she trains
extensively in the San Diego area for agencies, volunteer groups, and organizations that meet increasing demands for their services
and dwindling resources. She is a member of the San Diego EMDR Trauma Recovery Network (TRN) and works to assist the com-
munity aer critical incidents, as well as supporting the rst responder network as they meet emergent needs. Promoting strength,
resiliency and compassion within the treatment and rst responder community is the focus of her work and passion
EMDR Europe - Standards Committee, is an EMDR European Committee chaired by Richard Mitchell and co-chair, Kerstin
Bergh Johannesson. ey are tasked with upholding the standards of EMDR therapy. eir committee includes the following mem-
bers: Bjorn Aasen, Ludwig Cornil, Arne Hofmann, Ad de Jongh, Isabel Fernandez, Peter Liebermann, Udi Oren, Carlijn de Roos and
Michel Silvestre.
EMDR Italy Association is the ocial professional association that establishes, maintains and promotes the highest standards of
excellence and integrity in EMDR therapy practice, research and education in Italy. We have conducted approximately 700 inter-
ventions in the eld of acute traumatization for individuals and communities, working on a pro-bono basis. ese 7000 members of
the Association are part of a great network that communicates on a regular basis, sharing results, tools, and skills. e Association
provides psychological support in the aermath of critical incidents occurring in schools (suicides, sudden death of students or teach-
ers) and also in mass disasters like earthquakes, oods (such as the Genoa bridge collapse, Coronavirus pandemic). EMDR Italy has
intervened in the last 4 major earthquakes in Italy, providing support to the greater population, children, emergency workers, decision
makers and schools. ere is ongoing collaboration with the police, the military, with the Ministries of Education, Internal Aairs and
Defense, providing training, psychoeducation and interventions with their personnel exposed to traumatic events. We are a scientic
society endorsed by the Ministry of Health. We have been given an award by the President of the Italian Republic for our contribution
to society and to public mental health and for helping communities to recover and promoting resilience. During the COVID-19 pan-
demic, we are conducting almost 200 interventions. Our support is addressed to the population, to the health workers, to the families
and to schools (teachers and students). We are doing all these interventions in agreement and requested by the Institutions, hospitals,
the National Health service, schools, senior citizens homes, town halls, Civil Defense.
Derek Farrell, PhD is a Principal Lecturer in Psychology, an EMDR erapy Europe Accredited Trainer and Consultant, a Char-
tered Psychologist, Scientist and Associate Fellow of the British Psychological Society, and an Accredited Psychotherapist with the
British Association of Cognitive & Behavioral Psychotherapies (BABCP). He is past President of the EMDR UK & Ireland Board,
President of Trauma Aid Europe, Past Vice President of EMDR Europe Board, Chair of the EMDR Europe Practice Committee and a
participating member of the Council of Scholars Future of EMDR Project. He is involved in Humanitarian Trauma Capacity Building
programs in Pakistan, Turkey, India, Cambodia, Myanmar, ailand, Indonesia, Lebanon, Poland, Philippines, Palestine and Iraq.
His PhD in Psychology was researching survivor’s experiences of sexual abuse perpetrated by clergy and he has written several related
publications. Derek was the recipient of the ‘David Servan-Schreiber Award (2013) for Outstanding Contribution to EMDR erapy,
shortlisted for the prestigious Times Higher Education Supplement (TES) Awards (2017) for ‘International Impact’ for his Humani-
tarian Trauma Capacity Building work in Iraq with the Free Yezidi Foundation and Jiyan Foundation for Torture and Human Rights,
and awarded the Trauma Aid Europe ‘Humanitarian of the Year Award’ (2018).
Isabel Fernández, PsyD is a clinical psychologist working in Milan. She has been trained in Cognitive Behavioral erapy and has
been on the faculty of the Italian School of Cognitive Behavior for 18 years, providing specialization training in psychotherapy. She has
worked as a consultant psychologist at the psychiatric ward of Niguarda Hospital, conducting clinical research projects. Currently, she
is Director of the Psychotraumatology Research Center of Milan and has published many papers, articles and books on trauma, EMDR
and other topics. She is chairman of the Italian EMDR Association and President of EMDR Europe Association and a member of the
Board of Directors of the Italian Federation of Scientic Psychological Societies. She has been a member of the Standing Committee
Trauma and Disasters and the Board Prevention and Intervention (of the European Federation Psychological Associations) from 2005
to 2014. She has organized interventions with EMDR in mass disasters and has worked in cooperation with Civil Defense, Military
and Law enforcement and reghters to provide psychological support and trauma treatment for emergency workers. She trains grad-
uates students and clinicians in trauma, EMDR and crisis intervention in Italy and Spain. She has done research and published on
Post-traumatic stress reactions in children and adults in emergency settings and mass disasters. In 2019, she received the title of Knight
Commander from the President of Italy, for the contribution given to the population and communities through the Italian EMDR
Association, in the case of mass disasters.
Ana M Gómez, MC, LPC is the founder and director of the AGATE Institute. She is a psychotherapist, author, and international
speaker on the treatment of complex trauma, and dissociation and the use of EMDR therapy with children and adolescents. Ana
has worked extensively with families and program development to heal intergenerational trauma. She has led workshops and given
keynotes in more than forty cities in the U.S. and thirty cities throughout sixteen countries. She has presented many of her online
Contributors
© 2020 All rights reserved.
VII
workshops to large audiences all over the world.Ana is the author of EMDR erapy and Adjunct Approaches with Children: Complex
Trauma, Attachment and Dissociation and several book chapters and articles on the use of EMDR therapy with children and adoles-
cents. In addition, she is the author of multiple children’s books directed to increasing aect tolerance and emotional literacy as well
as to prepare children for EMDR treatment. Ana has developed numerous intensive training programs and protocols that include
the EMDR-Sandtray Protocol & e Systemic, EMDR - Attachment Informed Program to Heal Intergenerational Trauma & Repair the
Parent-Child Attachment Bond. www.AnaGomez.org
Ignacio (Nacho) Jarero, PhD, EdD, is the world pioneer in the provision of EMDR therapy in a group format, AIP-informed
Advance Psychosocial Interventions for trauma-exposed populations, and AIP-informed Remote Assistance. For his humanitarian
services around the world with near 200 deployments since 1998, he has received the Francine Shapiro Award, the International
Crisis Response Leadership Award, and the Psychotrauma Trajectory Award. For his research work with EMDR therapy, he received
the EMDRIA Outstanding Research Award. Dr. Jarero is EMDR Institute Senior Trainer of Trainers and Advance Specialty Trainer
and has conducted seminars and workshops around the world with participants of 67 dierent countries. He is a co-author of the
EMDR Protocol for Recent Critical Incidents and Ongoing Traumatic Stress
©
(EMDR-PRECI), the Protocol for Paraprofessionals use
(EMDR-PROPARA), the Acute Stress Syndrome Stabilization (ASSYST) AIP-informed procedures in group, individual and remote
formats, and the EMDR Integrative Group Treatment Protocol
©
(EMDR-IGTP) that has been applied worldwide with natural or hu-
man provoked disaster survivors. He is also the author of the AIP-informed Advance Psychosocial Interventions for Trauma-exposed
Populations Training Program.
Şenel Karaman, BA is a Psychologist, EMDR Europe Accredited Consultant and President, of EMDR Trauma Recovery, Turkey.
He specializes in Family erapy, Brief erapy and EMDR therapy. His adult patients suer from complex trauma, recent trauma
and crisis situations. For 20 years, he has provided psychological support to clients dealing with natural disasters, terrorist attacks,
plane crashes, trac accidents, and harassment, as a therapist and manager of intervention teams. He also assisted in the development
of the following books, “e Art of Being a Parent,” “Tool Bag for the Psychological Counselor,” “Every Child Can Trust Him,” and
psychological board games.
Sefa Kaya, BA is a Family and EMDR erapist from Turkey. Currently, he is studying Counseling Psychology. He works with chil-
dren, adolescents and children addressing their recent and old trauma as well as anxiety, neglect and abuse. He is assistant to the Pres-
ident of the EMDR Trauma Recovery Group during the Elazig earthquake 2020 project. He is working in the project helping health
workers, patients with COVID-19 and their families.
Lorraine Knibbs, MSc, is an EMDR Europe Accredited Consultant, EMDR Trainer in Training and University Lecturer, teaching
Masters’ Programs in EMDR therapy and also Counselling and Psychotherapy Practice. She has taught and trained nationally in the
UK and Ireland and more widely internationally on EMDR humanitarian projects in Poland, Greece, and the Middle East. Lorraine
is Past President of EMDR UK: Vice President of Trauma Aid Europe. She is a member of the Council of Scholars and its working
committees of training and credentialing and training and accreditation. She is published in the eld.
Emre Konuk, MA, is a Clinical Psychologist. He received his undergraduate degree at Istanbul University, followed by a graduate
degree in Clinical Psychology at Bogazici University. He received his Family erapy Training at the Mental Research Institute (MRI),
Brief erapy Center, Palo Alto. He became a pioneer in Turkey establishing psychotherapy as a profession by founding the Institute
for Behavioral Studies (DBE Davraş Bilimleri Enstitü) in 1985, with the vision of providing psychological services to individuals,
couples and families. In 1998, he established the Organizational Development Center in order to contribute to the improvement and
growth of organizations and Human Resources. He is an EMDR Institute and EMDR Europe Trainer, President of e Institute for
Behavioral Studies-Istanbul, President of EMDR Association and EMDR-HAP-Turkey and General Secretary of Couples and Family
erapy Association-Turkey. He was a Board Member for the Turkish Psychologists Association, Istanbul Branch between 1990-2002,
and President and Projects Coordinator between 1998-2002. At present, he is a member of the Ethics Committee for the Turkish Psy-
chologists Association. From the 1999 Marmara Earthquake, he has been responsible for EMDR-HAP and EMDR Basic Trainings in
Turkey. More than 600 professionals have been trained during EMDR and several HAP projects. He has participated in EMDR-HAP
projects in ailand, Palestine, Kenya, Lebanon and Iraq. His major concern is to establish EMDR as a major therapy approach in
Turkey.
Deany Laliotis, LICSW, is the Director of Training for EMDR Institute, Inc., and has been part of Francine Shapiros teaching facul-
ty since 1993. An international trainer, clinical consultant, and practitioner of EMDR therapy, Deany specializes in the psychotherapy
of EMDR with a particular emphasis on using the therapeutic relationship as an integral part of treating attachment trauma. Deany
was awarded the Francine Shapiro Award for Outstanding Service and Clinical Excellence by the EMDR International Association in
2015. She has authored and co-authored several articles and book chapters and currently maintains a private clinical and consultation
practice in Washington, DC.
© 2020 All rights reserved.
VIII
Brurit Laub, PhD, is a senior Clinical Psychologist, with over 30 years of experience working in community mental health in Israel.
She was also a teacher and supervisor at the Machon Magid School of Psychotherapy at Hebrew University in Jerusalem and at dierent
marriage and family counseling centers. She is an accredited hypnotherapist, and a supervisor in psychotherapy and family therapy.
She presents workshops concerning models developed independently and together with colleagues on narrative therapy, script chang-
ing therapy, coping with monsters, dialectical cotherapy, a trans-generational tool. and work with subpersonalities nationally and
internationally. She has published 15 articles on the above topics in International and Israeli journals. n 1994, she coauthored, with
S. Homan and S. Gafni, “Co-therapy With Individuals, Families.” In 2006, she collaborated again with S. Homan on “Innovative
Interventions in Psychotherapy.” She lives in Rehovot and is in private practice. In 1998, she became an EMDR Facilitator and she is an
EMDR-Europe Accredited Consultant. She has been involved with HAP trainings in Turkey and Sri-Lanka. She developed a Resource
Connection Envelope (RCE) for the Standard EMDR Protocol and presented it in workshops and for EMDR conferences in Tel-Aviv,
London, Vancouver, Denver, Istanbul, and Norway. With Esti Bar-Sade, she developed the Imma EMDR Group Protocol, which is an
adaptation of Artigas, Jarero, Alcalá, and López’s IGTP. Together with Elan Shapiro, she presented their Recent Traumatic Episode
Protocol (R-TEP) in Israel, Europe and the USA. She coauthored two publications about the R-TEP protocol in the Journal of EMDR
Practice & Research with Elan Shapiro and Nomi Weiner. She lives in Rehovot and is in private practice.
Keren Mintz Malchi, PhD, is a clinical Social Worker, psychodynamic psychotherapist and a certied Marital and Family era-
pist and supervisor. She is a faculty member at the School of Social Work- University of Ariel, Israel, and reaches numerous traumas
and family-oriented courses. With over twenty years of clinical experience, she is an expert on complex trauma, dissociation and
body-oriented psychotherapy who is trained as a Somatic Experiencing Practitioner (SEP). As a certied EMDR consultant, facilitator
and trainer in trainer, she is highly involved in the EMDR Israel community, devoted to the development of EMDR therapists in Israel,
supervising and teaching implementation of EMDR psychotherapy with complex clients. She supervises the sexual trauma clinic at
Poleg public mental health clinic, Lev Hasharon Mental Health Center. Keren has published a number of articles and a book chapter
in recent years, and has presented at over 10 conferences and learning seminars in Europe and Israel. Keren is co-chair of the EMDR
research committee in Israel and dedicated to the development of EMD research in Israel. She is in private practice in Israel, as a
therapist and consultant.
Paul W. Miller, MD, DMH, MRCPsych, is a psychiatrist; accredited EMDR Trainer within EMDR Europe and an EMDR institute
facilitator. He has served as Chair of the Training subcommittee, EMDR UK and Ireland Association and introduced EMDR therapy
to psychiatry in Northern Irelands National Health Service. In January 2011 he founded Mirabilis Health – a private psychiatrist-led
clinic specializing in EMDR therapy. Professor Miller is a popular international speaker on topics including EMDR therapy for psy-
chosis. He is involved in the School of Nursing at UU, providing training at an introductory skill level for EMDR therapy to every
Mental Health Nurse. ese are practical steps towards the pragmatic translation of trauma-sensitive research, demonstrating the
validity of the traumagenic model for mental disorders and which acknowledges the ecacy of Eye Movement Desensitization & Re-
processing therapy. He is currently Visiting Professor, Faculty of Life and Health Sciences, School of Nursing and is exploring the use
of Low-Intensity EMDR and EMDR therapy within e Centre for Maternal, Fetal and Infant Research (MFIR) and supervises PhD
candidates exploring this application of EMDR therapy. He has been a part of an informal Technical Review with Global Initiative for
Stress and Trauma Treatment (GIST-T), as one of the expert reviewers, because of the innovative work in developing a training scheme
for midwives. Member of the Council of Scholars; he is part of the Future of EMDR erapy Project (FOET). e Council is an intellec-
tual community of 35 EMDR international thought-leaders, working together within the Project parameters to produce material that
will advance the eld, establish the parameters of EMDR ecacy, and identify areas for future research. e Project will determine
EMDR therapys core elements and dene what constitutes a treatment modication. It will also work on developing global standards
for training and competency which are objective and evidence informed. He Chairs the Training and Credentialing Workgroup.
Judy Moench, PhD, RPsych is the former President of EMDR Canada and works as a Registered Psychologist in a Private practice
in Edmonton, Alberta, Canada. She is an Adjunct Professor at the University of Alberta, an EMDRIA approved consultant, and an
EMDR R-TEP / G-TEP trainer. Judy assisted in compiling the initial G-TEP manual for working with groups who have been involved
in a recent traumatic event. e manual has been translated into many languages and is being used in dierent parts of the world.
She has had the opportunity to speak locally, nationally, and internationally. Judy has served as Executive Director in a not-for-prot
counselling agency and worked extensively with schools. She is the coordinator of the Disaster Response Network for the Psychologists
Association of Alberta and has consulted in the development of post-incident treatment for rst responders. Judy has recently enjoyed
adding her erapy Dog into the private practice.
Regina Morrow Robinson EdS, LMFT, LMHC, Reg is an EMDR trainer for the EMDR Institute and Connect EMDR, Sr executive
R-TEP/G-TEP Trainer, EMDRIA Consultant. She has served as Orlando, FL EMDRIA regional coordinator and TRN coordinator,
EMDRIA committees focused on dening competency in EMDR therapy. She has presented at the EEI Summit on Community
Response Networks. Reg has more recently provided consultation to organizations seeking to incorporate EMDR therapy into their
systems of care for sta, patients and clients. She has been practicing for 32 years in both agency and private practice and now has a
virtual private practice.
© 2020 All rights reserved.
IX
Gary Quinn, MD, is a psychiatrist and Director of e Jerusalem EMDR Institute. He specializes in Crisis Intervention, the treat-
ment of Anxiety and Depressive Disorders, and the treatment of Post-Traumatic Stress Disorder following military trauma, terrorist
attacks and motor vehicle accidents. He is the Co-Founder, former Co-Chairman and current Vice Chairman of EMDR-Israel. He has
conducted numerous trainings in Israel and runs supervision groups. He is the Trainer of Trainers in Asia for the EMDR Institute
Inc. and is a Senior Trainer in Asia and the United States. He participated as a trainer for HAP (Humanitarian Assistance Programs)
in Turkey following the earthquake of 1999, in ailand, aer the tsunami in 2004, as well in Romania and Cambodia. He has vol-
unteered in medical hospitals aer terrorist attacks and treated patients with ASD and PTSD in bomb shelters using EMDR, EMD
and the group disaster protocol. He developed the Emergency Response Protocol (ERP) to treat victims of trauma with EMDR within
hours of the incident, when patients are suering from speechless terror with multiple rapid ashbacks. He has presented this work at
a conference in trauma (United Kingdom and Ireland), the EMDR Society (Glasgow, Scotland), to the World Psychiatric Association
Regional (Seoul, South Korea) and the EMDR European Conferences (Paris, London, Amsterdam and Vienna). He was invited to
Singapore as a PTSD expert to address the Psychiatric, Psychological and Medical staff as well as policy makers from the Department
of Mental Health. He was the keynote speaker at the Singapore International Conference on treatment of Acute Stress Disorder. He
served as a consultant in the Ohio State University Stress, Trauma and Resilience (STAR) Program and has presented at Grand Rounds
on, “EMDR, PTSD and Medical Systems Trauma” at Ohio State University Department of Psychiatry.
Elan Shapiro, MA, e 2016 David Servan-Schreiber Award went to Elan Shapiro for his outstanding contribution to EMDR therapy,
in the development (with Brurit Laub) of the Recent Traumatic Episode Protocol (R-TEP), with its variation of the Group Traumatic
Episode Protocol (G-TEP). R-TEP is an integrative protocol that incorporates and extends existing EMDR protocols within a new
conceptual framework, together with additional measures for containment and safety. EMDR Europe has recognized the vision and
achievement of Elan Shapiro, who has helped draw attention to the neglected subject of Early EMDR Intervention and the need for
developing and researching specialized EMDR protocols for therapeutic interventions in the wake of catastrophes such as natural and
man-made disasters. is has resulted in signifi antly boosting research and innovation in the eld over the last 14 years, as demon-
strated by the increasing publications in scientific papers and books sections. He has given over 100 presentations and seminars held
worldwide. His work has contributed in the establishment of extending EMDRs therapeutic potential in recent trauma to a borderless
audience, as well as increasing the visibility of EMDR, by bringing the EMDR R-TEP worldwide, promoting EMDR’s global role. Elan
Shapiro brings years of mental health care expertise in the treatment of recent trauma to his role and a strong passion for nurturing
and training EMDR psychotherapists from all corners of the world. He became active in EMDR very early in his career in 1989 and
served as an EMDR Institute Facilitator and was a founding member of EMDR Europe. In 2003, he was elected Secretary of the EMDR
Europe Executive Committee and Board, serving two terms until 2011, is an EMDR Europe Accredited Consultant, and currently
Chair of the EMDR Europe Website Committee. He has written and co-written over 20 articles on Early EMDR Intervention topics,
including book sections and conference presentation and continues to write, teach and present extensively on the most recent innova-
tions and renements of the protocols in the treatment of recent trauma.
Roger Solomon, PhD is a Psychologist and Psychotherapist specializing in the areas of trauma and grief. He is Program Director and
Senior Faculty for the EMDR (Eye Movement Desensitization and Reprocessing) Institute and provides basic and advanced EMDR
training internationally. He also provides advanced specialty trainings in the areas of grief, emergency psychology, and complex
trauma. Currently a consultant with the US Senate (through their in-house employee assistance program) Dr. Solomon has provided
direct services, training, and program consultation to many government agencies including the FBI, Secret Service, NASA, U.S. State
Department Diplomatic Security, Bureau of Alcohol, Tobacco, and Firearms; U.S. Attorneys, and numerous state and local law en-
forcement organizations. Dr. Solomon has planned critical incident programs, provided training for peer support teams and has pro-
vided direct services following such tragedies as Hurricane Katrina, September 11 terrorist attacks, the loss of the Shuttle Columbia,
and the Oklahoma City Bombing. Internationally, he is a Visiting Professor with Salesiana University in Rome, Italy and consults with
University of Rome (La Sapienza) and Polizia di Stato in Italy. He has authored or coauthored 41 articles and book chapters pertaining
to EMDR, trauma, grief, and law enforcement stress.
Asena Yurtsever, MA is a Clinical Psychologist, EMDR Europe Accredited Consultant and Trainer, EMDR R-TEP/G-TEP Trainer,
Family erapist, Psychodramatist and Vice President of the EMDR Association Turkey. She supports the EMDR Trauma Recovery
Group locally and internationally. She worked with the Marmara Earthquake victims (1999), survivors of a mall re (2013), Syrian ref-
ugees (2014), families of victims of the Soma mine disaster (2015), survivors of the Atatürk Airport explosion(2016), victims’ families
of the Beşiktaş stadium bombing(2016), coup attempt survivors (2016), family and friends of plane crash victims (2018), Elazig earth-
quake victims (2020), health workers, people who have Covid-19 and their families (2020) in Turkey. She took part in EMDR trainings
in Northern Iraq with EMDR Trauma Aid Europe and does consultancy in Lebanon within EMDR Trauma Aid Europe. Asena wrote,
Art Psychodrama (2013) and Liyo and the Deer who Looks for Courage (2019). Also, she has co-written chapters on migraine treat-
ment, disaster response during the 1999 Marmara earthquake, and G-TEP with Syrian refugees.
© 2020 All rights reserved.
X
Foreward
C
urrently, we are living through the most extraordinary of times. Covid-19, known as the Coronavirus, has created
a global crisis the likes of which have not been seen in over 100 years. It has changed our present world – how we
emerge, as indeed emerge we will, this narrative is still to be written.
e Spanish u pandemic of 1918 is estimated to have infected about one-third of the planet’s population. As this virus
spread there were no eective drugs or vaccines to treat this killer u strain. Citizens at the time were ordered to wear masks,
close schools, shops and movie theatres, and businesses were shuttered – a similar approach adopted in response to Covid-19.
is time of anxiety and uncertainty appears on many levels: prognosis, bereavement, testing, shortages of personal pro-
tective equipment (PPE), eective treatment interventions, managing existing resources,and how best to protect our vital
rst responders, keyworkers, health and social care providers, and shield populations from infection. Although Covid-19
creates large numbers of asymptomatic cases, about 20% develop more severe symptoms. However, for some, it is proving
deadly. e loss of loved ones wrecks the world as we know it: trauma and grief go hand-in-hand.
Protection involves living with unfamiliar public health measures, infringement of our personal freedoms, nancial hard-
ship, and protracted periods of social isolation and distancing.
O
n the political stage, a compound eect relates to oen conicting messages from our Governments and International
Organizations Rumour and speculation can fuel anxiety. Having access to good quality information becomes essential.
But while it is important to stay informed,there are also many things we can do to support and manage our well-being
during such times.
Even though we can have “no health without mental health,”people are resilient and do not succumb to psychopathology.
Nonetheless, self-care is essential. An inspirational writer, Eleanor Brownn (2014), acknowledges:“Rest and care are so
important. When you take time to replenish your spirit, it allows you to serve others from the overow. You cannot serve
from an empty vessel.” Self-care is not selsh;it is imperative in the assistance of others.
EMDR therapy is an empirically supported, internationally-recognized psychological trauma treatment. Its theoretical
orientation-that of Adaptive Information Processing-oers an explanation as to how trauma memories, stored dierently
in the brain, lead to maladaptive responses.erefore, these memories require processing to a more adaptive resolution.
e AIP model is bigger than the Covid-19 pandemic in that it explains trauma symptoms and provides us with a means
as to how best to intervene in alleviating trauma suering.
EMDRResources in theEra of Covid-19,edited by Marilyn Luber, is thereforemosttimelyand welcome.ere is no one
more appropriate than Marilyn to encourage, collect, edit, and bring these resources to us. In her seven prior volumes, she
edited a compendium of EMDR protocols, resources and procedures to support and enrich the EMDR community. is
oneis frontloaded by powerful narratives from one of the countries which experienced rst-hand the devastating impact
of this deadly virus:Italy. Isabel Fernandez provides a poignant, and indeed moving,account as to how the Corona Virus
came to Italy in all its traumatic might. However, Isabel’s account also provides insight, guidance, leadership, and a strate-
gy for moving forward.
A s
econd narrative highlights the transition to remote working and how this impacts EMDR therapy clinical practice. For
some, this has been a monumental change –forothers, less so. Nonetheless,theRecommendations for theUse of Online
EMDR erapy During the COVID 19 Pandemicareoutlined by the EMDR Europe Standards Committee in a way that
oers good sense, and rich experience.
e core element of this resource is that of self-careoftherapists,that has long been one of Marilyn’s passions. If EMDR
therapy is to contribute as a trauma response to Covid-19, then the strength, skill, resilience, and resourcefulness of our
EMDR therapists are essential. Without this, the tree will fade away. Marilyn presents resources for our clients, for our-
selves, and for other practitioners to use as a source of healing.
ese are challenging times. We will come through this, not as we did before, but hopefully,stronger, kinder, and more
resilient. Let usfollow Marilyn’s lead andwrite this next chapter together. is,for sure, is what Francine would have
wanted from us. We’ve got this.
Take care, stay safe & make good choices
Derek Farrell
17thMay 2020
© 2020 All rights reserved.
XI
W
hat a dierence a pandemic makes! is time last year, most of us could not have considered what we
have been experiencing in the winter and spring of 2020. We would have thought it a bad TV drama
and turned away. However, we are now living in an unprecedented time. Not one of us has been in a situation
remotely like this where almost the whole world has shut down. Travel is at a standstill. Streets are empty. Most
shops are closed and oen boarded up. e stores that are open are only for essential services: pharmacies,
groceries, liquor, hospitals and veterinarians for emergency situations. We are not able to see our loved ones
and we must stay six feet away from each other wearing masks. How strange that a small, spikey virus called
SARS CoV-2 has brought our vibrant world to a stop.
What does it mean? What can we do? When presented with a new situation, we have to adapt or perish. Are we
up to the task? e uncertainty of this disease’s trajectory is chilling. It is a virus that has come upon us and, as
yet, we have no vaccine, with nothing in sight for quite a while. e virus is all around us unconstrained and
unstoppable. Our hope has been “to atten the curve” – so that we do not overwhelm our healthcare systems-
by self-isolating or by staying in quarantine. Most predictions say that without a vaccine, we will all be infected
with the disease – some mildly, some more severely and many will die. e impact on us economically is
staggering, and governments and world health organizations are having to weigh the collapse of our nancial
systems vs. the risk of death to our citizens.
e physical eect on our bodies is only rivaled by the psychological tsunami we are feeling, and will only
increase as this silent horror continues. e whole range of negative aect is amongst us: from the fear of
getting the virus to the terror of testing positive for the SARS CoV-2 diagnosis and facing our own mortality;
from the distress of not seeing our loved ones to the anguish of not being with the ones we treasure while they
are sick and dying; from the anger of having to self-isolate day aer day to the rage at the lack of planning and
execution on the part of the governments worldwide. In addition, there is the dissmell and disgust at people
who are not doing the bare minimum of wearing a mask to protect themselves and others, to our collective
shame when not washing our hands as many times as we need to 24/7. As surely as we are surrounded by the
virus, we are lled with this multitude of feelings without our usual outlets and coping mechanisms to release
them and move forward. How do we address these needs while we are sequestered in our homes and the mental
health workers amongst us have to move to the new platform of Telehealth or use the telephone to respond to
this loud cry for help?
Another part of our psychological response is that those who have the virus are in a life-death struggle literally,
while everyone else who has yet to be infected is in fear of that life-death struggle with the virus. is is how
trauma is born. When we feel we are in a battle for our own mortality, we can become traumatized, or when
we watch people with whom we are connected go through that struggle, we can be traumatized vicariously.
Symptoms can include signs such as intrusive memories of the traumatic events, recurrent dreams, ashbacks
to the event, and/or feeling the intense or prolonged psychological stress or physiological reactions that
happened at the time of the exposure. Other indicators are when we avoid the distressing memories, thoughts
and/or feelings, and try to stay away from external reminders that arouse these feelings. Our cognitive processes
can be aected and create diculties when trying to remember parts of the event, while, at other times, there
are persistent and exaggerated negative beliefs or expectations about ourselves, others or the world. We can
think that it is our fault and this thought is accompanied by a persistent negative emotional state that can
include fear, horror, anger, guilt, and/or shame. Our interest in things that used to engage us might decrease
as we grow increasingly detached and nd it dicult to experience positive emotion. We may become more
irritable and have angry outbursts or engage in reckless or self-destructive behavior. We might easily startle and
become hypervigilant and be unable to concentrate or sleep well. We can have many of these symptoms or just
a few but they are enough to cause great diculties in our daily lives.
Preface
© 2020 All rights reserved.
XII
Most traumas happen as an incident, so we can deal with it and put it in the past. However, there are other
traumas that are ongoing and are not going away. at is the case with COVID-19. is situation is an ongoing
trauma and we will have to prepare to deal with it over the long-term. We need to nd ways to cope and get
strong that will last us through time and build up our resilience.
e seed for EMDR Resources in the Era of COVID-19 grew out of hearing how Isabel Fernandez and her
colleagues were responding to the pandemic that was sweeping the world. In the US, the pandemic began to
get air-time in March 2020. Places like Wuhan, China, Iran and Italy were in the news as the rst places of the
outbreak. It was still far away from us in the US. I was already struggling with a death in my family in January
and was only paying a bit of attention to what was happening. Isabel was sequestered with her family at home,
leading the charge of EMDR practitioners in Italy and charting a way forward. I later heard that Jinsong Zhang
and her team in China were working to support her country men and women.
I helped Isabel with the English translation of EMDR Italy and her work, and my colleague, Gary Quinn, with
his Self-Care Procedure for the Coronavirus (SPC-C). However, my husband and I were literally attened
by the virus for three weeks and I was unable to continue. I vaguely thought about this project but truly
COVID had taken over and I was not able to think much. As I began to get better, personally informed by the
devastating psychological and physical eects that the virus could have, I reached out to my colleagues who
were helping their patients, friends and family in this battle. I knew from rst-hand experience how I needed
help during those dark days and my EMDR colleagues came through. My experience informed my editorial
touch, and my passion to publish these resources promptly and without fee for the benet of my colleagues
and all of our patients. Many of our EMDR experts have provided their knowledge, their wisdom, and their
experiences to EMDR Resources in the Era of COVID-19.
ese resources are here for you to review and use as needed. Not every resource works in every setting or with
every patient. Look through them, try them out, and then select whatever you nd valuable. Please distribute
them to others who would nd them helpful.
In Part I, there are nine resources with the focus on EMDR Responses to COVID-19 Around the World. e
rst chapter, by Regina Morrow, is an excellent resource concerning how to understand EMDR therapy
interventions in the framework of level of care. Isabel Fernandez and EMDR Italy wrote guidelines for Italy’s
response to the Coronavirus to help their fellow practitioners in Italy and around the world. Isabel also wrote
two chapters on Phases 1 and 2 of dealing with the pandemic and what to expect. e Standards Committee
from EMDR Europe shared its recommendations on how to use Online EMDR therapy. Paul Miller, Derek
Farrell and Lorraine Knibbs discussed important questions concerning EMDR early interventions and
scaling up our work with EMDR to address the huge need in the world for trauma treatment. ey did this
by considering that an EMDR-informed response with non-mental health, frontline sta and non-mental
health professionals could be eective with supervision. Emre Konuk and his team discussed how EMDR
practitioners are structuring their response to the pandemic in Turkey and what they do to choose and work
with their population; they have even included preliminary statistical results from their study using this
method. Ana Gomez and EMDR child and adolescent clinicians from 30 countries created “e Global Child-
EMDR Alliance.” is chapter showcases the richness of their collaboration by way of songs, books, dances
and webinars in many languages. ey will be available for free through their YouTube channel and their
website www.globalchildemdral liance.com when they raise enough funds to launch it. e section ends
with a transcription of Deany Laliotis’ reections on the challenges to ourselves and our patients during this
perilous time.
© 2020 All rights reserved.
XIII
Part II includes four resources addressing EMDR-Related Stabilization Techniques. Gary Quinns e Self-Care
Procedure for Coronavirus (SCP-C) is a very helpful way to work with patients and colleagues concerning the
range of their feelings during the pandemic. e next chapter is a worksheet that goes with the SCP-C. e
Buttery Hug (BH) – created by Lucy Artigas – is well-represented by her husband, Ignacio Jarero. ere is
a link to a YouTube video of Nacho doing the BH concerning the Coronavirus, as well as a transcription of
the script used. e last chapter is Judy Moench’s transformation of Elan Shapiro’s Four Elements for Stress
Management Exercise into a colorful way for parents to teach their children to calm their mind and bodies.
ere is one resource in Part III concerning Early EMDR Interventions. Brurit Laub and Keren Mintz
Malchi use their expertise in EEI to create an abbreviated version of the Recent-Traumatic Episode Protocol,
alternately called “e Sandwich Technique,” to ll a niche for a relatively concise intervention that helps
clients focus their process. e sandwich eect comes from the dialectical movement occurring when there is
rst an opening resource-then the trauma intervention-nishing with the closing resource; this ends with the
client feeling more integrated with a sense of well-being.
Part IV is focused on Early Self-Care Suggestions and Interventions. is section is vital to our own and our
clients’ well-being. Chapters by Catherine Butler and Roger Solomon highlight the types of behaviors to cope
during these tempestuous times and how to support resilience and our own strengths. e last two chapters
are oshoots of Elan Shapiro’s Group-Traumatic Episode Protocol. e chapter by Elan highlights how to work
remotely in a group to promote self-care in a structured manner. e Self-Care Traumatic Episode Protocol by
Judy Moench is to help clinicians who are feeling overloaded develop resources in a short period of time. Both
chapters explore the dierent protocols and point clinicians in a direction to get further training concerning
these useful tools.
In accordance with Dr. Francine Shapiro’s motto, “Research, Research, Research,” we invite you to do your
own research on the eectiveness of each resource. Research will move forward the work we are needing and
supporting as an EMDR community. Any of the authors, as well as our regional associations, such as EMDR-
Europe, EMDRIA, EMDR Canada and EMDR-Asia, will be happy to assist you.
EMDR Resources for the Era of COVID-19 is available in an electronic format.
Experts in our eld have come together during this pandemic to inform and support us as we work on the
frontlines and on Telehealth to respond to the needs of those who need us. is book is not a comprehensive
look at all the resources available but was put together to aid practitioners in their search to address this
dicult time and to point them in directions that will support and enhance their skills. As always, the
goal is to assist us in using what we know and what we learn to enrich our eectiveness as EMDR therapy
practitioners.
In closing, I would like to ask you to consider taking 15 minutes a day – anyone can do something for
15 minutes – for self-care to support your staying safe in body, mind and spirit. My wish is that all of us
worldwide emerge from this time more hopeful, stronger, resilient and even more committed to healing the
worlds traumas and discord, and supporting humanity in its journey into health and cooperation.
Marilyn Luber
© 2020 All rights reserved.
XIV
Acknowledgements
I
am accustomed to dealing with challenges in my life by isolating and immersing myself in my books, writing
and/or editing them. It is how I cope with diculty. e year 2020 was no dierent. Having been through a
grueling last 8 months with my mother as she travelled the last days of her own 94-year personal journey ghting
Lung Cancer that had metastasized to her brain in April 2019 and ended on January 19, 2020, I was numb. My
husband and I were spent. My mother was gone. It was such a relief because she had suered so much. e relief
took over and it anesthetized me to the nality of this moment and took over my recollections of her. e main
memory was of her last hours. I was glad to push it away and not focus on it too much. I was just doing what I
had to do and January gave way to February, and then, it was March 2020.
It started with my husband’s exhaustion, followed by my own severe headache, pain in my jaw, and
overwhelming fatigue. My primary physician, Vicki Bralow, thought it was the u, at rst. I did what I usually
do – immersed myself in doing something outside myself. e pandemic was upon us. I was marveling at Isabel
Fernandez, and my colleagues in Italy, and what they were doing to cope. ey put together guidelines to help
with ways for practitioners to respond to the pandemic, and I oered to work on their English translation. As
I was doing this, it occurred to me that we were all in need of these so I decided to create a resource toolkit to
assist my EMDR colleagues. My Israeli colleague, Gary Quinn, was working on his update to his Immediate
Stabilization Procedure to address the coronavirus pandemic. With Brurit Laub, we contributed to Gary’s work
as he began to do webinars to support other practitioners and rst responders across the globe. Eventually, he
called it the “Self-Care Procedure for Coronavirus (SPC-C).
But, something was happening to me. My next symptom was a sore throat. Having had strep in the past and
being afraid of letting it go untreated, I asked my physician for a referral to get tested. By then, her oce was
closed by order of the Governor of Pennsylvania. Although I knew that we were in an unprecedented time, it
really hit home when I went to UrgentCare and was told that they were not allowed to test for strep because of
the risk of infection by COVID-19. I will never forget the physician standing in the doorway fully masked and
gowned, not coming into the room, and just pointing in the direction of omas Jeerson University Hospitals
testing site up the street. She told me I had to get tested. I had forgotten my cell phone -a rare occurrence- so
I had them call my husband to tell him what was going on. In retrospect, I should have had him come to
UrgentCare so that he could get tested as well. In the cold and rainy weather, I walked up to the testing site under
a tent with space heaters. ere was so much rain in this parking lot-turned-testing-site that they were sweeping
the water out with brooms. Aer a while, sitting in this wet and cold space, the nurse came over, she told me to
open my mouth. I did, I got swabbed, and was told I would get a call about the results. ey did not say how long
it would be.
On late Tuesday night March 24
th
, the day aer I got tested, I noticed that there was an email to get my test
results from the Jeerson portal. I remember just staring at the screen, not understanding what it said. I took
a screenshot and sent it to my physician. It said, “Testing was performed using the cobas(R) SARS-CoV-2
test – Detected.” Until I spoke to her directly at about 10:30pm at night, I didn’t realize I had tested positive for
COVID-19. Bob and I just thought we had the u. I was scared. I had already been doing Telehealth and self –
isolating at home with my husband since the 15
th
of March. I had also worked the day I got the diagnosis, and
started my Telehealth day that Wednesday despite not feeling well. My husband was unable to get out of bed.
I push through when faced with adversity. By noon, I could barely hold my head up and had to admit defeat;
there was no way I could go on speaking to my patients. I called each one, cancelled that aernoon and the rest
of the week. What surprised me was that I was not putting my patients rst; the virus was leaving me no choice.
I crawled into bed and barely lied my head for 3 weeks. I had made a big pot of chicken soup – that and toast
with jelly saw us through several weeks of illness. We could barely move. My husband lost 11 pounds and I lost 9;
© 2020 All rights reserved.
XV
we could barely get anything down. ank heavens we could let Henry, our miniature schnauzer, out into our
garden because our dog walker, understandably, did not want to come to our house. We could not walk him.
We were barely moving. By this time, I was not even listening to TV or the radio. I just wanted quiet. Truthfully,
it was a blur except for the sheer terror of waiting for my husband and me to have the “cytokine storm” I kept
reading about. He was too sick, so I worried for both of us. For the most part, I stayed in bed, watched “Anne
with an E” and kept my head down. At the worst moments of terror, I reached out to Gary who did his SPC-C
procedure with me several times. at helped to calm me down. I also reached out to two friends/physicians,
Stuart Wolfe and Steve Diamond, and my own physician, and they were supportive. My wonderful friends and
family were calling, wanting so much for us to be feeling better – but we werent and I hated disappointing them.
is virus just was moving at its own rate and it was tenacious. Aer week three, I began to li my head and
weakly look around.
I remembered how my friend and colleague, Nacho Jarero, had me and other friends keep in daily contact with
him while he was in the midst of the devastation of the Haitian Earthquake when he went to assist. I asked my
friends and family to do the same, and appreciated the messages on email, texts and phone calls we received,
even when I couldn’t always respond. ey helped buoy us up. By week four, I was getting better enough to take
some air. However, that was when I began to un-numb from the death of my mother. My friend, Brurit, was
there and worked with me with her “Abbreviated Recent-Traumatic Episode Protocol/Sandwich Protocol.” Until
then, I had been emotionally drained and was so pessimistic! It helped me to get present and start dealing with
life around me. I got back to working on this ebook.
We are now 53 days aer our rst symptoms. I have been working with colleagues from all over the world to
bring this ebook to you. I want to acknowledge and thank Regina Morrow, Isabel Fernandez, Paul Miller, Derek
Farrell, Lorraine Knibbs, Emre Konuk, Senel Karama, Asena Yurtsever, Sefa Kaya, Ana Gomez, Deany Laliotis,
Gary Quinn, Nacho Jarero, Judy Moench, Brurit Laub, Keren Mintz Malchi, Catherine Butler, Roger Solomon,
and Elan Shapiro for the resources you have contributed to this book.
I would like to acknowledge the extraordinary work of Lew Rossi for creating the cover and layout design for this
work. Lew, I dont know what I would have done without you during the publishing of this book and the other
editions you have helped me see to fruition. ank you.
I would also like to thank our friends, family and patients who were so concerned about our wellbeing and let
us know through their emails, texts and phone calls of their love, support and prayers (in no particular order):
Herb, Steve, Diane, Bob H., Isabel, Robbie, Arlene G, Phyllis K., Margie, Bob G., Mona, Liz, Amy, Marlena,
Uri, Shelley, Ron, Jim, Dan, Doreen, Dirk, Sushma, Deany, Arlene S., Jodi, Larry, Joann, Lew, Eran, Udi, Elan,
Isabelle, Sheila, Harry, Miguel, Steve H., Irene F-H., Nacho, Lucy, Emre, Zeynep, Louise, Jay, Betty Lou, Bennet,
Zona, Barb, Irene, Aliki, Jack, Sheri Y., Maggie, Jim, Michael B., Siobhan, Annie T., Paul, Robert, Steve R., Debby,
Rosalie, Andre, Reyhana, Roger, Queenie, Catherine, Ana Lucia, Olivier, Ad, Renee, Rob, Andrea, Susan, Jorge,
Evelyn, Cinnie, Michael, Aaron, Abby, Maddie, Emmie, Scott B., Victoria, Sheila, Meryl L., Sheri S., Phyllis G.,
Jim, Bill, Joci, Louise, Susie, Jay, Robert, Les, Cathy, Karen, Anz, Steve H., Brad, Juliet, Jen, Lisa, Rosie, Joel,
Bobby, Bob R., Bob W., Je, Susan, Kazumi, Dennis, Marybeth, Donny, Diane, Carol, Hank, Bill, Victor, AJ,
Arne, Michael H., Richard, Emily, Judi, David, Roz, Hillary, Lindy, Virginia, Cory, Victor, Rise, and Matt. ank
you, it is only through the bright light that you oered during this dark time that we found our way back.
To Henry Raymar Luber, our sweet miniature schnauzer, who endured the disruption of his routine with some
confusion but inevitably adapted in his usual endearing and intrepid style.
© 2020 All rights reserved.
XVI
To Wanda Hammoud whose insistence on antibiotics for Bob may well have saved his life.
To Bob Herbst who texted or called me every day through this dark time.
To Stuart Wolfe and Steve Diamond who shepherded me through my worst days.
To Gary Quinn and Brurit Laub who understood what I needed when I didn’t and helped me through this
dicult time.
To my stepdaughter, Meryl Raymar Harrell, not a day went by that Meryl was not FaceTiming me (sometimes
her dad was too sick to get on) to check on us and nd out what we needed. I am sorry for the times that we
couldn’t even manage the phone. She sent us all manner of comfort and toys for Henry; however, the most
important was interacting with her, Sam, Faith and Peter and seeing them in real time.
To Vickie Bralow, our physician, who could not have been more there for us then and now. ank you, thank
you, thank you. I dont know what we would have done without you.
I would also like to thank our friends, family and patients who were so concerned about our wellbeing.
To my partner in life and in COVID, Bob Raymar. Our journey through the virus was in tandem. Oen when
one of us could not get out of bed, the other would step in and help out, and vice versa. We survived and are both
so grateful to be here today and for each other.
In the end, I want to acknowledge my mother, Shirley Luber, who had a glorious and well-lived life; she is now at
peace.
I also want to remember my friend, my family, Francine Shapiro who gave us EMDR therapy and a way to bring
light where there is darkness. ank you, Francine.
© 2020 All rights reserved.
XVII
PART I
EMDR Responses to COVID-19 Around the World
I
n Part I, there are nine resources with the focus on EMDR Responses to COVID-19 Around the
World. e rst chapter, by Regina Morrow, is an excellent resource concerning how to under-
stand EMDR therapy interventions in the framework of level of care. Isabel Fernandez and EMDR
Italy wrote guidelines for Italys response to the Coronavirus to help their fellow practitioners in
Italy and around the world. Isabel also wrote two chapters on Phases 1 and 2 of dealing with the
pandemic and what to expect. e Standards Committee from EMDR Europe shared its recom-
mendations on how to use Online EMDR therapy. Paul Miller, Derek Farrell and Lorraine Knibbs
discussed important questions concerning EMDR early interventions and scaling up our work with
EMDR to address the huge need in the world for trauma treatment. ey did this by considering
that an EMDR-informed response with non-mental health, frontline sta and non-mental health
professionals could do under supervision. Emre Konuk and his team discussed how EMDR prac-
titioners are structuring their response to the pandemic in Turkey and what they do to choose and
work with their population; they have even included preliminary statistical results they have from
their study using this method. Ana Gomez and EMDR child and adolescent clinicians from 30
countries created “e Global Child-EMDR Alliance.” is chapter showcases the richness of their
collaboration by way of songs, books, dances and webinars in many languages. ey will be avail-
able for free through their YouTube channel and their website www.globalchildemdralliance.com
when they raise enough funds to launch it. e section ends with a transcription of Deany Laliotis’
reections on the challenges to ourselves and our patients during this perilous time.
PART I
EMDR Responses to COVID-19 Around the World
I
n Part I, there are nine resources with the focus on EMDR Responses to COVID-19 Around the
World. e rst chapter, by Regina Morrow, is an excellent resource concerning how to under-
stand EMDR therapy interventions in the framework of level of care. Isabel Fernandez and EMDR
Italy wrote guidelines for Italys response to the Coronavirus to help their fellow practitioners in
Italy and around the world. Isabel also wrote two chapters on Phases 1 and 2 of dealing with the
pandemic and what to expect. e Standards Committee from EMDR Europe shared its recom-
mendations on how to use Online EMDR therapy. Paul Miller, Derek Farrell and Lorraine Knibbs
discussed important questions concerning EMDR early interventions and scaling up our work with
EMDR to address the huge need in the world for trauma treatment. ey did this by considering
that an EMDR-informed response with non-mental health, frontline sta and non-mental health
professionals could do under supervision. Emre Konuk and his team discussed how EMDR prac-
titioners are structuring their response to the pandemic in Turkey and what they do to choose and
work with their population; they have even included preliminary statistical results they have from
their study using this method. Ana Gomez and EMDR child and adolescent clinicians from 30
countries created “e Global Child-EMDR Alliance.” is chapter showcases the richness of their
collaboration by way of songs, books, dances and webinars in many languages. ey will be avail-
able for free through their YouTube channel and their website www.globalchildemdralliance.com
when they raise enough funds to launch it. e section ends with a transcription of Deany Laliotis’
reections on the challenges to ourselves and our patients during this perilous time.
© 2020 All rights reserved.
XVIII
1
1
Level of Care
Considerations for
EMDR Therapists in
the Time of COVID-19
Regina Morrow Robinson
Introduction
he EMDR therapy model is rapidly evolving. The idea that EMDR therapy can offer a full
range of response when it comes to mental health needs is new. There are commonly-
known crisis response models that -even if outdated or have demonstrated lack of empirical
support-continue to be used because they are well known. While EMDR therapy to date must be
delivered by a trained therapist to be EMDR therapy, there is a new push to broaden the scope of
EMDR by finding ways for it to be used with paraprofessionals under the supervision of an
EMDR trained and licensed clinician. Also, it is helpful to ask questions such as how do EMDR
therapy and Adaptive Information Processing fit within the continuum of care? How do EMDR
therapists compare and contrast our resources with other interventions and models already in
existence? The Global Initiative for Stress and Trauma Treatment (GIST-T) and EMDRIA.org
have been advocating for EMDR therapy placement in the continuum of care around the world.
This article is another step in that direction. I welcome your thoughts on it.
We practice in all parts of the world, in all sorts of settings, with high levels of resources and low
levels of resources. Our clients, as well, have great diversity of resources available. The mental
health community and EMDR community have hundreds of interventions to select from. How do
T
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2
we navigate selecting the most efficient and effective level of care for those impacted by
COVID-19 when we are possibly stretched thin or on the opposite end, twiddling our thumbs
hoping to help!
Each individual lives in a unique environment, country, political climate, exposure to ongoing,
reoccurring, and distinct events of stress and access to resources such as readily available health
and mental health care. Each therapist has a wide range of skills, experience, and risk tolerance
available. Conceptualizing levels of care within diverse conditions is no small feat!
The purposes of exploring levels of care concerning EMDR are the following during the
COVID-19 Pandemic and beyond.
Psychoeducation: Creation of a relatable way to talk about mental health services (non-drug
focused) to Stakeholders (medical care providers, others directing care to those who need it,
clients and payors).
Pandemic Response: Placement of EMDR products in the delivery of care in COVID-19 times
among other non EMDR models and products of care.
Guide for New Therapists: Guiding newly trained therapists when to use each protocol or
procedure.
Guide for Organizations: Guiding discussions with organizations (such as hospitals, first
responders, schools, and other stakeholders) needing to determine how to integrate EMDR into
their response for staff and patients.
EMDR Early Intervention: Advancing the concept of EMDR early intervention can in many
cases, prevent the progression of after effects of exposure to high stress and trauma.
Effect of Social Distancing on Care Delivery: Looking into how social distancing impacts and
even drives changes to our capacity to deliver care?
Understanding Triage for EMDR Practitioners
Triaging and allocating resources efficiently are challenges facing mental health providers amid
COVID-19. Medical systems around the world practice triage. Can EMDR therapists learn to
communicate within the conceptualization of triage?
Definitions of Triage
1 : the sorting of and allocation of treatment to patients and especially battle and disaster victims
according to a system of priorities designed to maximize the number of survivors.
2 : the sorting of patients (as in an emergency room) according to the urgency of their need for
care. Merriam-Webster, Definition of Triage. Triage | Definition of Triage by Merriam-Webster
Triage is the term applied to the process of classifying patients at the scene according to the
severity of their injuries to determine how quickly they need care. Careful triage is needed to
ensure that resources available in a community are properly matched to each victim's needs.”
Should our community become swamped with demand for services, here are some of the
questions to think about:
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3
How do we triage and pair best fit levels of care with which client?
How do we begin to change the mindset of the larger community that mental health treatment is
reserved for high levels of dysfunction when we are increasingly aware that early intervention
prevents high levels of dysfunction?
What are the levels of care for mental health?
How do we move from least restrictive to most restrictive?
How do we move from the fewest resources to the greatest amount of resources utilized by
providers and clients?
How do we move from client self-delivered to therapist-delivered to intensive therapist- delivered
to inpatient? The level of maladaptive verses adaptive responses does suggest a process to sort by.
These are points to continue to develop and expand upon within the EMDR community.
A Design for Creating Levels of Care
Here are some variables to consider for creating levels of care design:
Intensity of Need: Intensity of need of client based on pre-existing resources within the client and
level of exposure to stress or trauma.
Responses to Stressor: The client’s adaptive and maladaptive responses to the stressor.
Time Since Exposure: The client’s time since exposure to stressor; minutes to decades.
Time Frame of the Distress: One-time exposure to ongoing exposure with limited sense of safety.
Time and Expense Cost to Client: Minimal cost of time and expense to the client. Least to greatest
amount of resources (time, expense) for the client to achieve results.
Time and Expense Cost to Therapist: Least to greatest amount of resources (time, expense,) from
the therapist
Providers’ Resources: Pre-existing resources within the provider of care (competency, knowledge,
experience, skills, risk tolerance).
Evidence-Based: Evidence-based models, protocols, procedures and international guidelines.
Other things to consider are the following:
How to move a client from one level of care to another when the previous one is determined to be
insufficient?
How do we quickly assess need for greater level of care?
How do we minimize barriers to care?
Prior to Stressor - What Resources Were Available?
Prior to stressor or trauma exposure, preventive resources and variables to consider -that may
impact a client, community, or therapist’s capacity to respond- might be:
Adequate resources for safety
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Secure food supply
Safe connection with others (in home, community, region, country, world)
Adequate sleep hygiene
Physical health exercise
Readily available health and mental health care
Reasonable stressors
No recent trauma exposure, if history of trauma; it has been effectively addressed.
Post Stressor or Trauma Exposure
Early intervention is suggested to best prevent acute stress disorder, PTSD, delayed onset PTSD,
and secondary disorders to exposure. What are the best fit resources available to the EMDR
therapist designed to respond to the stressor?
A Proposed Format of Levels of Care for Efficient and Effective Use
of Resources
LEVEL 1: Self-Administered:
Steps a person takes on a daily or weekly basis to maintain wellness. It is recommended that for
some individuals, a consultation with a physician or therapist are needed before initiation.
Examples of self-administered self-care are the following:
Daily Self-Care Routines: Sleep, nutrition, exercise, meditation, connection with stable healthy
others, goal setting, daily purpose or work, spiritual practices, and others.
Apps: Use of applications on phone, tablet or computer for education and commitment to a
wellness process. Often, apps invite connection with safe others and a larger community. Built in
accountability is often an integral component for apps.
Stabilization Exercises: Books, video/you-tube, guided stabilization exercises are abundant.
EMDR Therapy Related Resources:
o The 4 Elements Exercise developed by Elan Shapiro, is a simple 4-step exercise designed to
create a sense of calm and control. It is an integral part of the EMDR Recent Traumatic Episode
Protocol (R-TEP) and the Group Traumatic Episode Protocol (G-TEP). You can access a video
recorded version of the 4 Elements created by United Kingdom National Health Care System
(NHS) 1stcontact.net: Present Safety and Four Elements Exercises. Also, see Judy Moench’s
Four Elements Parent Activities (Resource 13).
o The Butterfly Hug developed by Lucina Artigas is a gentle way to self-administered bilateral
stimulation by simply and elegantly wrapping one’s arms around oneself and alternatingly
tapping. Additional ways to access versions of the Butterfly hug created by United Kingdom
National Health Care System (NHS) 1stcontact.net: Using the Butterfly Hug to help with acute
ongoing distress, Grounding and Stabilization using the Butterfly Hug.
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o Developed by Ana Gomez for children is a free downloadable book for everyone to share. It has
been translated into 18 languages.
o Self administered (G-TEP-STEP), developed by Judy Moench is a web-based version of the
contained structured G-TEP RISC (Remote Individual & Self Care) protocol which can be self-
delivered. STEP is not recommended for anyone who is suicidal or has a diagnosis of
dissociative or psychotic disorder. It is in 2 languages French and English. It is newly developed
to address COVID-19 and currently undergoing a feasibility study to ensure it is a safe and
effective resource to offer to clinicians, medical personnel and first responders. This is a treat to
look forward to once the research is complete.
o Everyoneok.be developed by Professor Elke van Hoof from Belgium is also a web-based
contained structured version of the G-TEP protocol embedded inside Dr Hoof’s stress
management system. Participants complete a prescreening and are not permitted to advance in
the process if there are exclusion indicators of suicidality, substance abuse, dissociative process
or psychotic qualities. If the participant has been personally affected by the coronavirus, seriously
unwell or has lost someone to the coronavirus, the participant is encouraged not to move forward
but instead seek professional mental health treatment. It is provided in 3 languages. It is newly
developed to address COVID-19.
LEVEL 2 Paraprofessional-Guided:
These approaches can be delivered one to one or as group-guided experiences that cover Level 1
self-administered material and additional psychoeducation (see above section). Education topics
may include: What is stress or trauma? And/or, what are normal reactions to abnormal situations?
There are no discussions of stress or trauma, or talk about the disturbance. The purpose is the
teaching of stabilization and calming skills.
Non-Bilateral Approaches
Critical Incident Stress Debriefing (CISD): Critical Incident Stress Management (CISM)
originally developed by Dr. George S. Everly and Dr. Jeffery Mitchell. Although still widely
used, it is no longer recommended by international guidelines due to questions about safety.
CISM indicates it is not therapy. The 7 core components of CISM are:
1. Pre-Crisis Preparation: This includes stress management education, stress resistance, and
crisis mitigation training for both individuals and organizations.
2. Briefings: Disaster or large-scale incident, as well as, school and community support
programs including demobilizations, informational briefings, “town meetings” and staff
advisement.
3. Defusing: This is a 3-phase, structured small group discussion provided within hours of a
crisis for purposes of assessment, triaging, and acute symptom mitigation.
4. Critical Incident Stress Debriefing: This (CISD) refers to the “Mitchell Model” (Mitchell and
Everly, 1996), a 7-phase, structured group discussion, usually provided 1 to 10 days post
crisis, and designed to mitigate acute symptoms, assess the need for follow-up, and if
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possible provide a sense of post-crisis psychological closure. The Mitchell Model 7 Phase
Discussion: Introductions, Fact Phase, Thought Phase, Reaction Phase, Symptom Phase,
Teaching Phase, & Re-entry.
5. Support: One-on-one crisis intervention/counseling or psychological support throughout the
full range of the crisis spectrum.
6. Interventions: Family crisis intervention, as well as, organizational consultation.
7. Follow-up & Referral: Follow-up and referral mechanisms for assessment and treatment, if
necessary.
Psychological First Aid (PFA): Developed in 2006 jointly by the U.S. Department of Veterans
Affairs with the National Child Traumatic Stress Network, PFA is an evidence-informed modular
approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce
initial distress, and to foster short- and long-term adaptive functioning. PFA indicates it is not
therapy. These resources provide education for providers, parents, children and a mobile app.
Bilateral Approaches
Acute Stress Syndrome Stabilization (ASSYST-I, ASSYST-G, ASSYST-R): Developed by Dr.
Ignacio Jarero “I” for individual “G” for group and “R” for remote are designed to be
implemented shortly after exposure to facilitate client’s AIP system spontaneous processing of
information within their window of tolerance.
Self-Care Procedure for Coronavirus (SCP-P): Developed by Dr. Gary Quinn, M.D. He
modified the Immediate Stabilization Procedure (ISP) procedure to fit better the demands of
COVID-19. It is first delivered by a therapist and then taught to the client for self-administration
in an ongoing manner.
Acute Traumatic Incident Processing (A-TIP): Developed by Roy Kiessling, (A-TIP) utilizes
bilateral eye movements to help desensitize the survivor to the traumatic event to the point where
talking about it may be of help. It has recently been updated and is now to include Critical
Incident Desensitization (CID).
Levels 3-8 are provided by trained Mental Health Professionals utilizing a variety of psychotherapy
models and interventions. There is a current group of EMDR experts forming the Future of EMDR
Therapy (FOET) working on many EMDR-related issues and “What is EMDR? is one of them.
Look forward to further advancements defining the parameters of EMDR therapy.
Note: In 2019, EMDRIA changed the definition of EMDR therapy to include administered by a trained-
EMDR therapist. The above levels of care, therefore, cannot be called EMDR therapy according to EMDRIA.
This may be different in other parts of the world. Some of the procedures listed utilize bilateral stimulation
but do not meet the full definition of EMDR therapy, according to EMDRIA, as it currently stands, on one or
more criteria. Some protocols listed below may not have sufficient research to prove their effectiveness.
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LEVEL 3: Stabilization
The goal of immediate stabilization is to assist the client to regulate affect utilizing a small
amount of the therapist’s time when the client is hyper or hypo aroused, often immediately after
the exposure while avoiding activation of the trauma material.
Self-Care Procedure for Coronavirus (SCP-P): Dr. Gary Quinn M.D. modified the Immediate
Stabilization Procedure (ISP) procedure to better fit the demands of COVID-19. It is first
delivered by a therapist and then taught to the client for self-administration in an ongoing manner.
Flash Technique (FT): According to Dr. Phillip Mansfield (20?), “FT is a minimally intrusive
option that does not require the client to consciously engage with the traumatic memory. This
allows the client to process traumatic memories without feeling distress.”
ASSYST-I, ASSYST-G, ASSYST-R: Developed by Dr. Ignacio Jarero “I” for individual, “G
for group and R for remote are designed to be implemented shortly after exposure to facilitate
the client’s AIP system spontaneous processing of information within their window of tolerance.
Focus is placed on acute intrusive somatic and sensory components of the experience.
LEVEL 4a Group Formats:
Activation and processing of trauma material occurs in this level. Therefore, guided supervised
training is highly recommended for the models listed below. This level requires that the therapist
and assistant be well trained and technologically equipped to provide the protocol in a group
either face-to-face or remotely. In addition, adequate resources are planned for and are available
to manage clients unable to continue with the group process or who find the group process does
not provide sufficient results.
EMDR Group Traumatic Episode (EMDR G-TEP) : Developed by Elan Shapiro, the
EMDR G-TEP is highly structured and contained. It addresses the demands of an ongoing
early intervention situation such as COVID-19, utilizes a highly structured worksheet allowing
participants to draw components of their experience. Drawing can be highly effective for
clients who, for many reasons, are unable to talk their experience out loud. There is no talk of
disturbance and this prevents cross contamination of disturbance in the group. It is designed for
group sizes of up to 12.
EMDR Group-Traumatic Episode Remote and Individual Self Care (G-TEP RISC) :
Developed by Elan Shapiro in response to COVID-19. It is a modified version of G-TEP.
It can be used for therapist self-care, 1:1 applications and remote applications. In the future
after accumulating experience working individually with G-TEP RISC, including supervision/
consultation, therapists will be encouraged to utilize it in remote group delivery.
EMDR Integrative Group Treatment (EMDR IGTP) : Developed by Ignacio Jarero, Lucina
Artigas, Teresa Lopez Cano, M. Mauer, & Nicte Alcala, EMDR-IGTP is also designed to meet
the demands of an on-going early intervention situation such as COVID-19. It was originally
designed for face-to-face delivery to group sizes of up to 150 people, utilizing art and bilateral
stimulation. Adults, adolescents and older children can benefit from this model. It requires
minimal materials and a trained support team in addition to the leader.
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Both EMDR G-TEP and EMDR IGTP have good research and active ongoing research studies now.
LEVEL 4b: One to One Format
Activation and processing of trauma material is required. Delivered in a one-to-one format soon
after exposure.
Recent Event Protocol (REP): Developed by Dr. Francine Shapiro, REP was designed to
respond to a single recent event that had not yet consolidated into long term memory. It was not
designed to focus on an ongoing event such as COVID-19. In the US, REP is required by
EMDRIA to be a component of EMDR therapy trainings. EMDR and EMDR REP are an integral
foundation of the following two EMDR protocols and procedures.
EMDR Recent Traumatic Episode (R-TEP): Developed by Elan Shapiro and Bruit Laub
(2008). It is designed to meet the demands of an ongoing, early intervention response that includes
focus on the episode, screening and extra built-in containment, due to the intensity of the event. It
utilizes EMD and EMDr processing strategies. Therapists assess each individual report from the
client between sets to ensure the client remains focused on the episode and is within their window
of tolerance. Should larger themes beyond the episode block progress, the therapist is advised to
expand to the Standard EMDR Protocol until the block is resolved then return to R-TEP.
EMDR Group Traumatic Episode Remote and Individual Self-Care (G-TEP RISC): See above.
EMDR Protocol for Recent Critical Incidents and Ongoing Traumatic Stress (EMDR PRECI):
Developed by Ignacio Jarero and Lucina Artigas, it was designed to address critical incidents that
continue over a long period of time and where there is no post-trauma period of safety for memory
consolidation. As a result, there is an ongoing lack of safety, and the consolidation in memory of the
original critical incident is prevented. In this way, the memory network remains in a permanent
excitatory state, expanding with each subsequent stressful event in this continuum, with the risk of
PTSD and comorbid disorders growing with the number of exposures. Adjusting the eye movements
length and speed to the clients’ needs helped the processing of the material. It is transportable, ease to
use, time-effective, has no homework and works cross-culturally.
To compare the above models further, refer to Jarero, I., Artigas, L., & Luber, M. (2011).
The Coronavirus Helping Box (EMDR version): Developed by Ana Gomez, this is a therapist-
guided resource for walking a child through working with EMDR. Parents can be invited to
participate. This is a free resource for therapists and in 3 languages.
Acute Traumatic Incident Processing (A-TIP): Developed by Roy Kiessling, (A-TIP) utilizes
bilateral eye movements to help desensitize the survivor to the traumatic event to the point where
talking about it may be of help. It has recently been updated and now includes Critical Incident
Desensitization (CID).
Non EMDR/AIP-Informed Models that Fit into this Level of Care:
Trauma Focused Cognitive Behavioral Therapy (TF-CBT) and CBT for Trauma evolved
from CBT and focuses on children, adolescents and their families. Thoughts, emotions, and
behaviors are explored. The research indicates it is effective. The requirements of homework can
create compliance difficulties for some clients. It is sometimes challenging for a client to verbalize
to another their internal experience. This procedure can be delivered 1:1 or within a family.
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LEVEL 5: One to One Format
An episode-focused approach is aimed at just prior to the start of the stressor to the point the
client is sitting with the therapist for treatment. This allows the opportunity to address the
ongoing nature of the event.
EMDR Recent Traumatic Episode Protocol (R-TEP) (see above)
EMDR Protocol for Recent Critical Incidents and Ongoing Traumatic Stress ( EMDR PRECI ) (see above)
LEVEL 6: One to One Format
There is a broader life focus to include events outside of the current episode.
EMDR Therapy (EMDR) developed by Dr. Francine Shapiro (1995, 2001, 2018) is a 3-pronged
model that incorporates life experiences from birth to death. During an early intervention response
provided by a therapist, it may become apparent that untreated difunctionally-stored life experiences
are blocking the resolution of the current experience. The therapist, with client consent, expands the
scope of the therapy contract to include addressing the earlier dysfunctionally-stored material utilizing
the full 8 phases and 3-prong model.
EMDR 2.0: Developed by Ad de Jongh and Suzy Matthijssen. EMDR 2.0 is an adjusted version of
EMDR therapy based on Francine Shapiro’s earlier work, and follows the Standard EMDR protocol.
These include adjustments with more emphasis on the components that have been found to
be effective based upon laboratory research, particularly with regard to motivating and activating the
client and then desensitizing the activated material. It follows the practice based upon the following
research findings that: i. a memory must be fully activated, to maximize the effect of EMDR therapy,
ii, more arousal, both in relation to the memory, and in general, is associated with a stronger
desensitizing effect on the memory, iii, the greater the working memory load, the greater the
desensitizing effect that occurs, iv, modality-specific taxation can provide an additional effect, and
iv, unexpected surprise effects can interrupt the reconsolidation of the memory. The underlying
studies can be found at https://psycho-trauma.nl/emdr-2-0. The direct link to register for the
workshop ≈ https://beacon360.content.online/xbcs/S1524/catalog/product.xhtml?eid=17547 or
www.enhancingtraumatreatment.co
LEVEL 7: One to One Format
Intensive outpatient EMDR therapy is provided in extended sessions of 3 + hours in a day or
multiple days in a row in an outpatient setting.
LEVEL 8: One to One Format & Group
Inpatient due to self-harm or other factors suggesting unable to keep oneself safe. A client may
voluntarily decide to attend an intensive residential program to be free of their daily commitments
to focus on their own care. EMDR therapy is incorporated into inpatient programs from once a
week, once daily or several hours a day. Both individual and group protocols are utilized.
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In Summary
Items to explore further:
Where can we place the additional EMDR-inspired interventions within levels of care?
How do we expand the research capacities of our community to address effectiveness of prevention
and reduction of distress?
How do we prove it is cost effective?
What are the most efficient and valid methods of assessment? Keep in mind Francine Shapiro’s
motto: Research, Research, Research.”
How to we upscale our capacity to both provide care and provide trainings to therapists and
paraprofessionals?
This is a conversation for all EMDR therapists and other mental health professionals to become
engaged in. Together, we see a much broader perspective across countries, economies, health
care systems, cultures, struggles and capacities. There are many more procedures and protocols
to add to the Levels of Care, both from within and outside the EMDR community. By building a
far more comprehensive list, we can pursue a greater effort to compare and contrast the
continuum of care and language to discuss it with people outside the mental health community.
Together we can build the architecture of an EMDR response to stress and trauma. EMDRIA’s
Council of Scholars is hard at work trying to answer these questions and more. What is your
opinion?
Please share your thoughts with Reg at rdmorrow17@gmail.com
© 2020 All rights reserved.
References
Artigas, L., & Jarero, I. (2010). The Butterfly Hug. In M. Luber (Ed.), Eye movement Desensitization and
Reprocessing (EMDR) Scripted Protocols: Special Populations, pp. 5-7. New York, NY: Springer Publishing
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European Commission on (2020). Mobility and Transport. Which hospital? The importance of field triage.
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Mitchell, J.T. & Everly, G.S. (1996). Critical Incident Stress Debriefing: An Operations Manual.
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Quinn, G. (2020). Self-Care Procedure for Coronavirus (SCP-P). https://www.emdr-israel.org
Shapiro, E. (2011). The 4 Elements Exercise. https://EarlyEMDRintervention.com
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EMDR Canada Annual Conference, Québec City, QC
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https://EarlyEMDRintervention.com
Shapiro, E., & Laub, B. (2009). The recent-traumatic episode protocol (R-TEP): An integrative protocol for early
EMDR intervention (EEI). In M. Luber (Ed.), Eye Movement Desensitization and Reprocessing (EMDR)
Scripted Protocols: Basics and Special Situations, 251-269. New York, NY: Springer Publishing Co
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition: Basic
Principles, Protocols, and Procedures, pp 223-5. New York: NY: Guilford Publications, Inc.
Van Hoof, E. (2020). Everyoneok.be. https://Everyoneok.be
© Regina Morrow Robinson 2020. This Resource is copyrighted under United States law. EMDR practitioners are encouraged to use this work in
the treatment of their clients. Under certain limited conditions, EMDR practitioners and researchers may request and receive written permission to
copy the materials contained herein in new works they create. For further information on receiving permission to use the materials other than with
the practitioner’s own clients, please contact the author at rdmorrow17@gmail.com. All rights are reserved.
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2
Italy and the
Coronavirus:
Suggestions for
Clinicians During
the Pandemic
EMDR Italy
he following series of guidelines, suggestions and tips grew out of the work that we/EMDR
Italy have been doing with clients and groups during the outbreak of the Coronavirus
pandemic in the earliest days of the pandemic. These are based on our collective experience and
our work in the field with a large number of responses to disasters all over Italy and the world.
Guidelines for Adults: Self-Protection for Adults
When a catastrophic event occurs, it has a strong impact on individuals and their community.
When there is an ongoing situation like the Coronavirus pandemic or a critical event, people
often respond with a great deal of emotion. As a result, it is possible that people will not function
at their best during their exposure to the event and afterwards. Here are some suggestions to help
us during these times.
T
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What to Expect
Phases that can occur from the time you are exposed to the present:
Acute Phase: You may feel the following during this phase: unimportant, a sense of derealization
(feeling your surroundings are not real), not like yourself, numb, confused, space and temporal
disorientation. Shock is a normal mechanism allowing us to maintain a certain distance from the
event; this can help us absorb the impact and attend to the immediate needs of the situation.
Emotional Impact Phase: This phase includes a variety of emotions such as sadness, guilt, rage,
fear, confusion and anxiety. Somatic reactions can also develop, like physical disorders such as
headaches, gastrointestinal issues, etc., and difficulties finding a state of calm.
Coping Phase: During this phase, we try to cope by finding a way to understand what happened
and using all our resources. We ask questions such as: “Why did it happen?” What can I do?
“Why now?” etc.
Most common reactions that might occur over the course of several days or weeks:
Intrusive Thoughts: Recurring images; involuntary and intrusive memories (flashbacks).
Avoidance: Wanting to avoid related thoughts or feelings; avoiding anything to do with the
event/the situation.
Depressed Mood and/or Persistent Negative Thoughts: Negative beliefs and expectations about
ourselves or the world such as thinking: “The world is totally dangerous.”
Self-blame: Persistent and irrational feelings of guilt about self or others for having caused the
traumatic event or its consequences, especially if having had contact with those infected.
Guilt: Feelings of guilt for having survived/not been infected.
Negative Emotion: Persistent negative emotions related to the trauma/threatening situation such
as feeling fear, horror, rage, guilt, persistent shame even after the situation is getting better.
Sleeping and/or Eating Dysregulation: Difficulties falling asleep, frequent awakenings and
nightmares, or hypersomnia (sleeping for long periods of time). Eating too much or too little.
Anhedonia: Strong loss of interest in pleasant activities.
Overwhelm: Being overwhelmed by daily tasks and having to restructure daily activities; feeling
paralyzed.
Note: There are marked individual differences in the appearance, duration and intensity of these reactions.
What We Can Do
Recognize our own emotional reactions and the difficulties that we might have.
Do not deny feelings. Remember, it is normal for everyone to have emotional reactions when an
unexpected, unforeseeable and threatening event/situation occurs.
Monitor our physical and emotional reactions.
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Remember, we are not alone. Even when we are not in contact physically, we are part of a larger
system. This organization can support and help us emotionally and psychologically.
Talk about the critical event/situation to others. This helps us to release emotional tension.
Respect that others’ may have different emotional reactions and action/behaviour that may be
difficult to understand from our point of view.
Keep in touch with others. Establish a new, predictable daily routine during this time.
Ask for help from people we trust and with whom we feel safe.
Take some time to recover. It is not necessary to focus on what is happening 24/7. Pay attention
to our needs. Distance ourselves from the event/the situation by sleeping, resting, thinking,
crying, being with our loved ones, etc.
Protect our emotional health by accessing support services as needed.
Obtain psychological support focused on reprocessing traumatic memories and reactions
resulting from the event/the situation, as needed.
Limit access to media to once or twice a day. Often, when a critical incident is occurring, our
response is to find meaning through spending a lot of time reading the commentary and watching
the news. It is important to protect and limit ourselves from excessive exposure.
Use official channels as our sources of information, such as the World Health Organisation
website: https://www.who.int and follow its guidelines on hygiene practices.
Remember that a positive attitude and avoiding catastrophic thoughts help us and our
community.
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Guidelines for Children: Children Need to Understand What is
Happening: Tips for Parents, Caregivers, Teachers and
Grandparents: What to Say and How to Say It
In “emergency” situations, when a serious critical event affects us, there is a highly emotional
impact on the individual and the community. Victims of a traumatic event experience a
disruption in their mental and emotional balance; they are on a constant alert that compromises
the feeling of safety. Children and adults are well equipped to face difficult situations as long as
they are appropriately supported.
Reactions to traumatic events can be numerous. There is not a right or wrong way of feeling and
expressing sorrow and concern. In moments of danger, children need to refer to their caregivers;
however, when the caregivers are exposed to the same event, children might notice and react to
the arousal in adults, who should reassure them. It is very important for adults to find
psychological support and help in order to deal with their normal stress reactions and provide
their children with the necessary emotional safety. When exposed to a dramatic event, children
express their feelings in a different way from adults and according to the children’s age and
development stage.
After being exposed to a chronic situation like the Coronavirus threat, children might feel
different emotions: sadness, guilt, rage, fear, confusion and anxiety, also as a consequence of the
prolonged isolation and the upset daily routine. They can also develop somatic reactions with
physical symptoms (headache, stomach-ache, etc.). There are strong individual differences in the
manifestation, duration and intensity of these reactions. The processing process is subjective: it is
possible that some children experience only one of these reactions, while others experience many
of them at the same time, for one day or for a longer period.
Here are the Most Common Reactions:
Stress often arises in the form of rage and irritability. Children might address their rage and
irritability to the people closest to them (parents, friends). Keep in mind that rage is a healthy
feeling and can be expressed in an acceptable way.
Boredom can be linked to the effort of keeping up with the different pace of distance
education activities. Because of the pandemic, some countries had to close schools, children
have to stay home and education activities have to take place online. Keep in mind that a
radical change of environment can generate confusion and lead to struggling in following
instructions. Reassure the children and explain to them that these measures were suggested
by experts in order to protect them.
Pain is expressed through behaviour. According to the age, it is possible that children do
not express their worries verbally. They can become irritable, have concentration problems,
re-enact moments of the event they witnessed, draw images that recall what they heard about
the infection. They can be afraid of things that did not scare them before or show behaviours
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that are typical of previous development stages: they go back to doing things they did in the
past or play games they played when they were younger.
Difficulty in sleeping and/or eating. Trouble falling asleep, frequent awakenings and
nightmares, or hypersomnia, which means sleeping for many more hours).
Lack of energy. Fatigue, difficulties in social interaction and tendency to self-isolation.
Need for more attention from parents or caregivers. Children can struggle more to separate
from caregivers because they are afraid something bad can happen to them or their relatives
or that they might die.
These reactions are normal, especially when there are important changes in the everyday life and
in the daily routine of a child
What You Can Do with Children
Let children know that it is normal to be overwhelmed, scared or worried. Explain that all the
feelings are fine (normalize and validate reactions).
Do not deny what you are feeling, explain that it is normal. Acknowledge that adults have
emotional reactions too after such an unexpected event and that all reactions are normal and
manageable. Discomfort is created when suppressing emotions, not when they are expressed.
This way, children will have a role model and will learn that they can trust you and tell you
about their emotional states.
Hear what your child is saying. Don’t say: “I know how you feel”; “It could be worse”;
“Don’t think about it”; “You will be stronger thanks to this”. These expressions that the
adults use to reassure each other can interfere with showing emotions and painful feelings
that are a consequence of the catastrophic event.
Tell the truth and stick to the facts. Do not pretend that nothing is happening or try to
minimize it. Children are great observers and they will worry more if they notice
inconsistencies. Do not dwell on the magnitude of the consequences of the Coronavirus
situation, especially with little children.
Use simple words, appropriate to the children’s age. Do not over-expose them to traumatic
details and leave a lot of room for questions. If you struggle with a question, take time by
saying: “Mum doesn’t know, she will look for more information and when she has it, she will
tell you, ok?”
Show children that they are safe now. Also, other important adults in their life are too.
Always give information sticking to reality and facts.
Remind them that there are trustworthy people who are taking care of fixing the
consequences of the event. Tell them that people are working to make sure we do not have
any more problems like this (“Did you see how many doctors are working? They are all very
good people that know how to help adults and children that are in trouble.”)
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Be open and try to talk with a reassuring voice.
Let children talk about their feelings. Reassure them that even if the situation is bad, together
you can deal with it. This way, it will be easier for you to check the emotional state they are
in and help them in the most appropriate manner.
Children can have angry outbursts. Help them talk about the reasons that they are angry with
words. This can help them to gain more control to learn how to regulate it (“Are you angry?
Do you know that I am angry too?)”
Children can show feelings of guilt. If so, it is important to reassure them that they are by no
means involved in the events (“It is not your fault if…”).
Restrict exposure to the media. People affected by the Coronavirus threat need to find a
meaning for what is happening and therefore spend a lot of time checking the news on TV,
radio and the internet. It is important that children are never left alone while there are
programs related to the event. Do not forbid checking the news but choose a moment during
the day or 10 minutes to do that together (selecting the news beforehand) and to explain to
children what exactly is being said. Focus the attention on the most reassuring details (for
instance, the doctors that are helping) and give children all the time they need to ask
questions.
Keep the family routine as much as possible. This is important because it is reassuring. Do
not give too many presents or organize extra activities. Keeping the routine is the most
natural and healthy thing you can do.
If you do not see any improvement in your children’s reactions, it is useful to address the
problem to trained professionals who can help.
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Coronavirus: How to Deal with It: Suggestions for Managing Fear
in Children and Adults
For Everyone:
Media: Our warning and fear systems are constantly activated when we overexpose ourselves
to news from the internet, radio and television. Check the news, twice a day: but, not before
going to sleep.
Hygiene: Follow the best hygiene practices indicated by our country’s institutions and health
system.
Official Media Resources: Information is important. Best to use official sources of
information such as WHO, ECDC, local institutions.
Strong Emotion: Strong emotions such as fear or agitation are normal reactions. We know
that talking about emotions can help us to feel better.
Routine: Follow your usual routine as much as possible, while respecting community
regulations.
Sleep: Keep a regular sleeping routine, as much as possible.
Positive Attitude: Remember that a positive attitude helps ourselves and our community.
Decision-Making: When we are stressed we can have difficulties concentrating and making
decisions. This is a normal consequence of stress. We need to be easy on ourselves.
Positive Influences: Get in touch with people who make us feel good: this helps us to clear
our minds and calm our fears.
With Children:
Truth-telling: Tell the truth about what is happening with simple words.
Show Suitable Images and Information: Dedicate one time during the day to look at
information together to explain what is happening and make the content reassuring and easy
to understand.
Love and Attention: It is crucial to our children’s wellbeing to give them love and attention at
all times, but especially when there is an ongoing crisis situation.
Retain Routine Positive Habits: Let children keep their routine and positive habits like playing
or studying.
Reinforce Positive Resources: Emphasize to our children that many experts such as researchers,
doctors, nurses, the police, etc. are working to re-establish a safe environment and to help
people who are ill. Highlight the positive aspects of the intervention.
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Suggestions & Guidelines for Senior Citizens
Listen to This!
It is normal to be afraid. Fear that makes us follow our doctor’s instructions is a protective kind
of fear. Listen when doctors tell us to not go out and “shelter in place.”
In these days of the Coronavirus, we might feel isolated, abandoned, lonely, anxious, irritable or
confused. Often, we have intrusive thoughts that keep coming back. These reactions often can occur
when our minds are reacting to stressful situations. Staying at home is a way for us to help ourselves and
others. When we all follow the instructions precisely, we help our friends, relatives and also first
responders, who are working to assist those most in need.
Keep Informed: Use only reliable institutional sources like the World Health Organization.
Follow Hygiene Practices: Adhere to suggestions by your country’s institutions and health system.
Normal Feelings During This Stressful Time of the Coronavirus: We may feel the following:
o Isolated or abandoned
o Lonely
o Irritable
o Confused
o Anxious
Intrusive Thoughts: We may have thoughts about the situation that won’t go away.
Restrict Media Use: Turn off the TV, the radio and the internet. Choose only one or two moments during
the day to check the news, however, not before you are going to sleep.
Keep a Routine: Keeping busy decreases tension. Do the things you like to do -as much as you can- such
as cooking, knitting, reading books and magazines, cleaning the house or washing a car, etc.
Physical Activity: Simple exercises can help you relax and fall asleep.
Eat Regularly: Make sure to eat meals as regularly as possible.
Communicate: Talk and spend time with family and friends. We all communicate in different ways! Ask
how to make a video call or how to use “WhatsApp” to keep in regular contact.
Share Concerns: Talk to someone trustworthy about concerns, problems and feelings. Communicate with
people who are more positive in their thinking. Positive emotions help.
Share Your Life Experiences: Tell your children, grandchildren and friends about your childhood, for
example, how you used to spend time.
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Guidelines for First Responders: Self-Protection for First
Responders and Health Professionals
When a serious critical event -like the Coronavirus pandemic- affects the whole world, the
emotional impact on individuals, first responders, medical staff and communities is profound.
When the first responders are also victims of the same incident, their emotional reactions can be
so intense that they can interfere with their functioning during and after the crisis.
These are some of the types of normal reactions that occur:
During Work Hours
During working hours, you can experience some of these reactions:
Disorientation from the chaos in front of you.
Stress due to over-exposure to requests such as victims’ calls for help, and so many needs to be
addressed at once, etc.
Helplessness or inadequacy.
Omnipotence and inability to perceive your own limits.
Identification with victims and/or relatives.
Frustration and rage for not being recognized and/or for the institutional disorganization.
After Work & At Home
At the end of your shift and/or at home you may experience the following:
Emotions such as sadness, guilt, rage, fear, confusion and anxiety.
No emotion/or feeling numb.
Somatic reactions with physical symptoms such as headaches, gastrointestinal disorders, etc.
Difficulty in calming down and relaxing.
Note: There are significant, individual differences in how these reactions show up and how long and
intense they are. Some may have only one of these reactions while others have many of them at the
same time. The reactions can last for one day or for a longer period.
Four Phases of Response
There are four different phases and each one of them is associated with specific reactions:
1. Alarm:
Alarm is when you first feel the impact of the critical event, such as when you found out how
catastrophic the Coronavirus really is.
These are the types of reactions that can occur:
Physical: Accelerated heart rate, increased blood pressure, breathing problems.
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Cognitive: Disorientation, difficulty in understanding the information received and the
seriousness of the event.
Emotional: Anxiety, dizziness, shock, inhibition.
Behavioural: Reduction in efficiency, increased activation level, communication problems.
2. Mobilization:
In the Mobilization Phase, first responders and medical staff start moving onto the scene. The
previous phase’s experiences and reactions are present in a smaller way. However, these
responders are now mobilizing to do their job which gives them purpose to plan a focused
and coordinated action. This phase means long working hours under excessive pressure.
3. Action:
The focus of the Action Phase is when the first responder starts his/her work helping the
victims. During this time, emotions are high and sometimes confusing.
These are the types of reactions that can occur:
Physical: Accelerated heart rate, increased blood pressure, rapid breathing, nausea,
sweating and shaking.
Cognitive: Memory problems, disorientation, confusion, loss of objectivity, difficulty in
understanding.
Emotional: Feeling of invulnerability, euphoria, anxiety, rage, sadness, numbness.
Behavioural: Hyperactivity, increase in the use of alcohol, tobacco and drugs, tendency
to argue, loss of efficiency and efficacy in the first aid actions.
4. Letting Go:
The Letting Go Phase marks the end of the intervention and when everyone comes back to
their work and social routine.
These reactions can occur in this phase:
Return of Unwanted Emotions: Emotions that were forgotten or repressed during the
heat of the action come back and need to be processed.
Missing the Team: The intense connection of the team has ended and the team member
may have many feelings about the loss of these connections.
In conclusion, according to the phase and the characteristics of each individual involved in the
operation, there are many different physical, cognitive, emotional and behavioural reactions.
The most common reactions that can last for some days or weeks after the intervention are the
following:
Intrusive Images/Thoughts: Recurring images of the scene/aspects of the scene and disturbing
thoughts associated with the event that intrude into your mind.
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Feeling of Excessive Anxiety/Fear: Increased sense of agitation, and fears that were not there before.
Avoidance: Procrastination, lack of interest in going to the scene, thoughts about leaving the job, etc.
Excessive Reactions to Ordinary Stress: Inability of modulating reactions to external requests, loss
of temper on a more frequent basis.
Increased Irritability: Presence of unmotivated rage.
Sense of Isolation: Feeling of abandonment and loneliness, need to be by self, not wanting to talk to
anyone, feeling of “being different.”
Mental Confusion: Concentration problems and/or incapability of making decisions, alteration of
normal capacity for judgement.
Relational Problems: Difficulties in the relationship with colleagues, relatives and friends.
What Can You Do?
These are the types of helpful actions you can take:
Identify your Emotions: Know how to recognize your own emotional reactions and the
difficulties that you might have during the exposure and after it, so you can decompress as soon
as possible from the effects of stress.
Acknowledge Your Emotions: Do not deny your feelings but remember that it is normal for
everyone to have emotional reactions because of such tragic events.
Monitor Physical and Emotional Reactions: Be able to monitor your physical and emotional
reactions, recognizing your own activation systems.
Take Time-off: Plan some time off to recover your physical and mental energy.
You Are Part of a Team: Remember that you are not alone, but you are part of a system and an
organization that can support and help first responders themselves.
Be Compassionate: Look at your emotional state without judging yourself.
Speak About What Happened: Talk about the critical events that happened while on duty,
helping to release emotional tension.
Respect Others’ Reactions: Respect others’ emotional reactions, even when they are completely
different and difficult to understand from our point of view.
Use Supportive Services: Protect your emotional health by accessing the supportive services
offered to first responders. Talk to an expert that has specific information about post-traumatic
reactions and who can facilitate and accelerate the resolution of the reactions themselves.
Debriefing: Access, when and if possible, debriefing services that includes the decrease of
emotions and defusing of the experience offered to first responders’ teams. There are specific
tools for supporting and preventing post-traumatic stress reactions, which can be used
effectively in the few hours right after the first responder’s intervention.
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Protecting Yourself Allows You to Protect Your Population
Emergency-trained mental health professionals can provide help and emotional support to you. It
is important for you to learn how to recognize and manage your own reactions in different
emergency situations. However, sometimes you may feel overwhelmed by a feeling of
impotence and lack of control or other issues that might get triggered. If your reactions persist
and you do not see any improvement, it can be useful to address the problem with trained
professionals. In a short series of individual or group sessions, they can help you to deal with
your reaction. EMDR therapy is a psychotherapy for recent event trauma that can be helpful as
you deal with the Coronavirus pandemic and the stressful circumstances related to it.
EMDR
According to the World Health Organization (WHO), EMDR (Eye Movement Desensitization and
Reprocessing is one of the main tools for treating Post-Traumatic Stress Disorder. EMDR Therapy is
used to prevent the development of psychological issues that can arise after a critical or potentially
traumatic event. In 1987, EMDR was developed by Francine Shapiro using the theoretical model, the
Adaptive Information Processing (AIP) system. The aim of EMDR Therapy is to re-activate the
brain’s self-healing process and to reprocess the most disturbing moments connected with the critical
event or period that was experienced. Over the years, several recent event protocols were developed.
The main protocols used during EMDR interventions in the aftermath of a recent traumatic event are
the following: the Protocol for Recent Traumatic Events (2018); The Recent Traumatic Episode
Protocol (R-TEP) (Shapiro & Laub, 2008); The EMDR Protocol for Recent Critical Events (EMDR-
PRECIS) (Jarero, Artigas & Luber, 2011), the EMDR Integrative Group Treatment Protocol (IGTP)
(Jarero & Artigas, 2009) and the Group Traumatic Episode Protocol for EMDR (G-TEP) (Shapiro,
2017). In conclusion, EMDR can represent a useful tool to turn a negative life event into a
constructive event that can be an opportunity for learning, for personal development and for
psychological growth.
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Telephone Support: Guide for Counseling
This is a guide for mental health practitioners who offer telephone support to medical staff or
personnel or groups from institutions or agencies. Healthcare professionals often experience
secondary trauma during/after major disasters and catastrophes such as the coronavirus outbreak.
Guidelines
Gather Personal Information: Ask for personal information such as name, telephone number,
place of work, job, etc. Keep in mind any privacy policies at the service/institution concerning
the gathering of personal information.
Introduce Yourself and the Intervention Structure: Introduce yourself and how the intervention will
be structured. Clarify that this is a specific and specialized intervention aimed at reducing stress.
Self-Introduction: For example: “I am___________________, I work in the emergency field and I
am a member of ___________ Association”
Introduction of Goals: “The aim of this telephone support today is to reduce your stress and the
emotional impact you have been experiencing during the Coronavirus outbreak. I want to help you
recover and come back to feeling safe in your daily life. Your employer/institution wants you to have
whatever psychological support that you need. The purpose is to support you and not to judge what
happened or look for whom is responsible. I want to have the opportunity to talk about your
experience with you and have a place for you to give voice to your reactions to this critical situation.
Ultimately, I will talk to all involved in this emergency situation. The call will not be recorded, and
no notes will be taken during the conversation. I am hoping that you will talk with me now. Is that ok
with you?”
Questions to ask Mental Healthcare Workers:
Would you like to tell me how this has been for you?”
How are you coping?”
What were your reactions after you realized what was going on?
During these days/weeks, did you experience problems in sleeping, eating, concentrating?
Did you feel more irritable? Or did you have other reactions?”
Explanation for Reactions/Psychoeducation Phase:
All the reactions you described are normal reactions that normal people have when faced
with an abnormal situation. These reactions are known as stress reactions and can last for
a few days or go on for several weeks. You have already mentioned some of them. Other
symptoms that people might have after a critical event are the following:
Cognitive Symptoms: They include memory and concentration problems, difficulty in problem
solving, denial, and/or sense of unreality.
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Emotional Symptoms: These symptoms include feeling vulnerable, rage, sadness, anxiety,
depression, irritability, and/or numbness.
Behavioural Symptoms: This is when you find yourself doing the following: isolating, avoiding,
acting with hostility, changing your eating habits by eating too much or too little, self-
medicating, and/or sleeping dysregulation.
Coping Questions:
What helped you in facing the event?”
Were there moments of strength?”
In the following hours and days, what gave you some relief and help?”
Every one of us has developed personal strategies to reduce stress in critical moments of our life.
What strategies helped you during difficult moments in the past?”
Other Strategies Helpful to Reduce Stress:
Self-Knowledge: Understanding the psychological and physical effects of stress and strong emotions,
and recognizing the way you react when you are alarmed.
Remember Achievements: Keeping a mental record of your past achievements.
Mental Rehearsal: Use mental rehearsal to help plan how to react in difficult situations.
Words to Avoid: Avoid saying “Why?” or “If only…”
Regulate Basic Functions: Eat and sleep well.
Share Feelings: Write / Talk about how you feel with friends, colleagues, etc.
Take Space for Yourself: Give yourself enough time to breathe and come back to normal functioning.
Physical Activity: Exercise and relax to decrease physical stress. Alternating physical exercise and
deep relaxation can decrease chemicals released by stress and can help you to sleep better.
Encourage Routines: Go back to some routine if possible such as your daily tasks, and plan to do
activities you enjoy.
Further Questions: Ask, “Is there anything you would like to add or ask?”
Closing Thoughts: Say, “Thank you for having shared such private and painful moments in your life.
I am at your disposal and, if you agree, we can talk again next week about how you feel and how
your reactions are evolving. I would like to say one last thing: we said that your reactions are
normal, but if they persist, they do not go away or they worsen, I am available to help you recover.
You can contact me directly at this number…”
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COVID-19 Emergency: Guidelines on How to Communicate Bad
News Over the Telephone
COVID-19 emergency is changing our way of communicating with patients’ families. Often, a phone
call is the only way to talk to family members. Increasingly, medical staff have to give clinical
information -and often bad news- over the phone. It is normal to feel uncomfortable, nervous and
worried about making a phone call to families, especially if we know that we have to communicate
bad news like a diagnosis, deterioration in a loved one’s condition or his/her death. It is also different
than how medical staff usually handle these situations and may cause concern for the staff as well.
We can divide the phone call into 3 stages: 1. Opening; 2. Communication; 3. Closure
1. Opening
Goal: To make a phone call to a patient’s family in a calm and empathic manner.
Grounding: Before making the phone call, give yourself a moment (only a few seconds or
minutes are necessary) to focus your attention on your body, where you are and what is
surrounding you. In this way, you can compose yourself and be calm.
Pay Attention to Your Voice and Modulate its Tone: Remember that your voice is the only cue
that a family member has to help him/her prepare emotionally for what you will say next.
Always Greet the Family Member Calmly: When you are calm, it helps the family member to
remain calm. Remember, if you are in a hurry and anxious in your approach when speaking, it
increases the alarm in the family member.
Introduce Yourself: Make sure to say your full name and from where you are calling, even if you
have talked to the family member other times. Introducing yourself, or reminding the family
member who you are, helps the other person reduce their alarm or apprehension.
2. Communication
Goal: To communicate information about a loved one to a family member with compassion and
understanding.
Communicate Clearly and Briefly: Use simple words. Avoid medical terminology when
possible. If you have to use medical language, be sure to explain what the terms mean.
Choose Words Accurately: Before the phone call, prepare what you want to say and how to say
it, in order to be empathic and supportive.
Give Warning that Bad News is About to Follow: Find out if the family member is alone or with
someone. Either way, invite the person to sit down: “Please sit down on a chair or on the sofa, I
am afraid I have got some bad news, 2 hours ago your father, Charles…” When we have to
communicate a death or a deterioration in conditions, it is essential to find a phrase to prepare
the person to the fact that he/she is going to hear bad news. Use expressions like:
Unfortunately” or (only if you have to communicate the death)I am very sorry to have to tell
you that…”. Use the persons’ first name and the degree of relationship: I am very sorry to tell
you that your husband John…”
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Be Direct and To the Point: Being direct is less stressful than saying too much. Share what
happened, if it is appropriate, such as how their loved one was sedated and did not suffer during
the process.
Leave Space for Silence and Grief: After communicating the bad news, leave time for the news
to be digested and for the person to react. Keeping quiet while someone is crying (especially
over the phone) is difficult. It is easy to feel helpless, but silence is a way to communicate that
we are there, and we are not leaving the person alone. Every now and then, if appropriate, you
can break the silence by saying some simple words like “I am sorry.”
Leave Time for Questions: Listen, without interrupting. If the family member is not asking
questions, say something like: Are there any questions you would like to ask?” Give all the
information you can, but not so much to be traumatic and overwhelming. When communicating
the death of a loved one, be informed about what, when and how the death happened. It is most
important to know and communicate if the person expressed a wish or said something for his/her
loved ones before passing away. The family will often ask questions about that.
3. Closure
Goal: To tell the family member/s what will happen next.
Give Practical and Technical Information: Tell the family member/s the practical and technical
information that they need to know. Explain what will happen next, who and when the family
will be contacted, and where they will move the person, if relevant.
Psychological Services: Inform the family member/s that there are psychological services
dedicated to helping them. Psychological service members will call, if they request it, and help
them address their grief or stress, depending on what the family member/s need/s.
Inquire What Support Family Member/s Have After the Call: It is important to ask what the
person will do right after the phone call and if he/she has thought about which friends or
relatives to contact to have support. Help them if they have no plan.
Take Time for Yourself: Give yourself time to go back to a state of calm. The continuous
requests for assistance are a burden that wears medical personnel out. Look at your emotional
state without judging yourself.
Safeguard Your Emotional Health: Take advantage of the support systems offered to medical
staff.
© Isabel Fernandez 2020. This Resource is copyrighted under United States law. EMDR practitioners are encouraged to use this work
in the treatment of their clients. Under certain limited conditions, EMDR practitioners and researchers may request and receive written
permission to use the materials contained herein in new works they create. For further information on receiving permission to use the
materials other than with the practitioner’s own clients, please contact the author at segreteria@emdritalia.it. All rights are reserved.
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© 2020 All rights reserved.
3
A Picture of
Italy Affected
and Striving to
Cope with the
Coronavirus:
Phase 1
Isabel Fernandez
he coronavirus or COVID-19 is a reality that is affecting European countries in different
ways. The purpose of this text is to share the reflections of what we have experienced,
observed and done in dealing with the Coronavirus emergency. By writing down our reflections
and the lessons that we have learned in Italy, we hope that they may be of use to those in other
countries.
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Psychological Issues, Challenges and the Coronavirus
There are a number of issues to be considered while working with people who have been
affected by the Coronavirus pandemic:
Complexity: The Coronavirus emergency has added even more complexity to our complex world.
Even though people had been dealing with their usual difficulties in the financial, work, family
dynamics and relational field that often cause them anxiety and suffering, on top of that they are
facing the threat of the Coronavirus that has changed the basic ways they conduct and organize
their lives.
Vulnerability: The virus activated a feeling of vulnerability, where people feel exposed to an
invisible “threat or enemy” that is difficult to fight. There are no arms, vaccines or tools to deal
with it, only isolation.
Isolation: Isolation means putting a whole organized life “on hold.” This means that it is no
longer possible to do the normal things: connect with friends and family, travel (even within the
city), go to work, and/or have a social life.
Overwhelm: Because we are a social species, having to isolate is overwhelming and difficult to
tolerate over a long period of time.
Too Fast: This complex change happened almost overnight and it was too fast, for us to process.
Adaptation: We had to help our minds to adapt to this emergency. We had to adapt our mental
and cognitive schemas so that we would behave differently in a week. We had to learn that the
normal ways that filled our lives were no longer available. We are having to put up with the fact
that we have to live without all these things and put our daily life on pause.
Connection: Keeping connection with our friends and loved ones has been partially resolved by
using technology such as Skype, WhatsApp, FaceTime, Zoom and many other channels and
devices. If this would have happened before this technology, our sense of isolation and
overwhelm would have been much worse.
Exposure
We first learned about this virus when we heard about what was going on in China. In these early
days, China seemed very far away. The threat approached with the diagnosis of the first Italian
patient and we began to feel that the virus was drawing closer, but since it was only one person,
we were not really worried. Patient No. 1 had had dinner with a friend who had just returned
from China. He was 38 years old, healthy and was living in a normal, small town in the North of
Italy. He could have been any of us. Within 3 days, we were in a state of emergency. People
rushed to the supermarkets to buy food, leaving the shelves empty. We know this is a very
ancient and reptilian brain reaction for survival. Once people were reassured that food was not a
problem, the situation changed completely and we could see people entering supermarkets and
grocery stores, one at a time, which was an unusual behavior as well.
In the past weeks, psychological reactions have had different phases. We know that in the
following weeks, we will see other reactions that we cannot even begin to imagine.
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One issue that we have to keep in mind is that even though these restrictions are imposed on
everybody at the same level, people will be processing what is happening differently.
Restrictions & Provisions
Restrictions and provisions from the Government were concrete proof of what was happening. We
were told to stay at home, close our shops, only go to shops that were fundamental to our lives.
There were penalties for shops, bars or restaurants that were still open after the new rules and what
was difficult to accept was that penalties were applied to people for just walking on the street.
We were being asked to trust completely what the government and politicians said and this was
also unusual. However, when it became clear that the Prime Minister and the government were
relying on scientists, researchers, virologists and infection virolgists, people did exactly what
they were told to do.
Emotions Related to the Coronavirus Pandemic
Fear of Getting Infected: The fear of getting infected is one of the most common
emotions. This fear is adaptive and normal. It is functional in order to encourage people
to behave in a way that prevents infection. It will be a challenge after the risk is over to
neutralize this fear, since the activation of the fear and the exposure to the threat is going
on for a long period of time.
Anger: Anger is connected to fear and also to the restrictions and to the lack of freedom
to do activities that are normally important for people. It is a special kind of anger, since
there is no one to blame for what is happening. There might be a search for the one who
is responsible for this, like the government, the Chinese people or China as a country.
This kind of behaviour although dysfunctional, can also be functional because it gives a
meaning to what is happening. For example: If I find the one who is at fault, it is easier to
understand from a cognitive perspective. I can label it and this is comforting sometimes,
even if it is simplistic. In fact, what is happening is much more complex than this.
Panicking: As numbers go up and the situation seems out of control, panicking is
occurring. The peak here is coming, it is getting worse every day, even if we are all doing
the necessary things. The feeling is that we could be completely at the mercy of this
virus. This situation will have long lasting effects on our psyche and will be a risk factor
for future situations that might be associated to the Coronavirus emergency.
Suffering: People that got infected feel rejected, furthermore the heavy isolation that they
have to go through because of the risk of infecting others, while needing support, is
creating a lot of suffering. This is a situation when you are sick and needy and nobody
can be of support and people have to stay away from you, except for the medical staff.
Blame: People also blame themselves for having infected other people who may be
seriously ill. This is going to have an impact on beliefs about themselves, being rejected
and feeling at fault are strong emotional and cognitive mechanisms.
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Rejection: Some rituals, social rules and codes started to change. We had to change our
behaviors to include: not shaking hands, staying one meter (6 feet away) away from your
friends, not getting close to talk to people. The old social rules disappeared more and
more as the numbers of infected people and those who died increased. It was hard not to
take it personally, as we were all now doing this with each other. The first reaction was to
feel rejected and not important.
Depression: As days went by, people started to feel the lack of so many of their day to
day experiences: contact with others, meaningful activities that used to make them feel
good and give value to their lives. This can drive some people to depression because of
the deprivation that they are feeling and the isolation that they are experiencing.
Threat: Daily, we are feeling the threat that keeps increasing and spreading. We are
exposed to the daily statistics that tell us that the risk is not going down and that the
pandemic is reaching all the countries. These numbers are updated constantly are very
disturbing.
Reality of the Coronavirus Spreading
Statistics from the first week of the Coronavirus in Italy:
1000 infected
30 died (per day)
35 recovered (per day)
Statistics after 3 weeks for the Coronavirus in Italy:
47.860 infected
793 died (per day)
689 recovered (per day)
Because our safety depended on others’ behaviors to follow the directives of the government, if
people were not following them, people would get angry and feel helpless.
One of the most difficult parts of this emergency is that we are not able to plan and do projects.
We are left unable to plan any kind of activity and we end up feeling that the emergency will last
forever; we have lost our perspective.
As clinicians, we have to be aware that there will be major psychological risk factors as a result
of the quarantine or lockdown.
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Concerns About Coping Mechanisms During the Pandemic
These are the concerns about coping mechanisms during the pandemic:
Avoidance: The lock down can have long lasting effects, since it is an “avoidance” response.
At this time, we are avoiding people, physical contacts, places, crowds, etc. It is possible that
going back to normal might not be easy for everyone.
Catastrophic Thoughts: During lockdown it is easy to develop catastrophic thoughts and
interpretations of what is happening. It is suggested that people listen to the official sources
of information. Often, people tend to look for answers and solutions through other channels
to give them a sense of control. For instance, there is no basis that if we eat spicy food our
immune system becomes stronger. However, people want to believe this so that they have a
sense of more control. It is important to fight this by highlighting only the information that
we need: Stay at home, wash your hands, etc.
Unresolved and Complex Grief: Seriously infected people who need hospitalization,
especially seniors but not only seniors, are dying. The most difficult is that in these
conditions their relatives cannot take care of them and cannot accompany them as they pass
away. Relatives cannot say good bye and cannot grieve them with the usual cultural rituals
that normally help and give relief (like having a funeral where family and friends can
comfort each other). Unresolved and complex grief will be a significant scenario that
clinicians will have to deal with in the near future.
Sanitary Measures: Because of the prolonged situation, it has been hard to keep up with
normal sanitary conditions, not to mention the more recent need for many more burials. We
are not used to these kinds of conditions especially when we seem to have no real control of
the pandemic.
Important Ways to Cope
Several factors are involved in the way the situation will evolve:
Individual level: The importance of individual’s compliance with the official guidelines.
Group Level: It is important that smaller and larger groups monitor their behavior to limit the
spread of the virus.
National Level: It is critical to provide information on a national level concerning how the
affected populations will be managed.
International Level: We know that countries did not start with prevention regulations at the
same time and many countries lost a lot of time. Many countries have not been coordinated
in their efforts concerning the pandemic. We do not know how the effects of the strategies
used by other countries will impact our own. This is especially of concern, regarding the
policies for traveling and for facing new challenges that will come up.
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EMDR Italy
The Italian EMDR Association in the last 20 years has done around 700 interventions in
emergency situations and mass disasters. All the experience and expertise we have gathered
through these years had to be adapted to this new emergency related to Coronavirus. We know
every critical event is different from the others that we might have dealt with, but this emergency
is very special, because of its unique characteristics.
Since the beginning, on February 21st, the Italian National Association and all its members have
been trying to make a difference concerning psychological support and prevention for the
wellbeing of all those who have been strongly affected by the pandemic: medical staff (doctors
and nurses), people infected, families of those infected, and the population in general.
We really felt that we could make a difference since as clinicians, our priority is to use our
psychological expertise to help and communicate the necessary information accurately to reduce
anxiety and panic and to support all the people who have been in close contact with the disease
(patients, relatives and health workers). The Italian EMDR Association received many requests
from institutions, hospitals, local health units, Health Protection Agencies and municipalities.
We have been active on the field, providing psychological support to the population, to the
people who have lost a loved one to the disease, to the health workers and the people who work
long hours in this emergency every day and who are exposed to patients and to new stressing
situations.
In these weeks, EMDR Italy have been sharing their experience and material with other
European countries, so they could have a base that could be useful and concrete.
The Role of Our Membership
The contribution our Association members have given has been exceptional. They have
responded to support requests from all over our country and members in all regions have been
helping.
Activating EMDR Italy
In many mental health services, our members spoke to their directors, to their administration and
suggested that these services create an official partnership with the National EMDR Association.
It is in this way that EMDR Italy partnered with other institutions to manage the psychological
support for the population and the medical staff. In many towns and cities, members contacted
the different levels of administrations to help link these services with EMDR Italy. When the
number of requests was too high, other members were available from other cities to reply to the
phone. People in need were able to connect to volunteer EMDR clinicians who were available
for that kind of support through calling a special toll number.
In some areas of the National Service, there was only one practitioner trained in EMDR. We
offered to train the rest of their staff in Early intervention and Psychological Support that was not
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EMDR therapy but general psychological support. This was an excellent way to give them
concrete tools and to introduce them to EMDR therapy. A team of experienced clinicians from
the Association was created to coordinate the high numbers of requests and interventions that
were developing every day. These expert teams of 5 people were giving support and guidance to
membership as they were activated.
Medical Practitioners
We are aware that our medical practitioners were being exposed to great risk and concerns:
Dealing with many patients at the same time
Not having sufficient resources for the pandemic emergency
Exposed to the infection
Many becoming sick with the virus and/or dying
Fear of infecting their families to the point of deciding to live and sleep elsewhere in order
not to infect their children and relatives.
They are one of the most important populations in need of psychological support during the
emergency, but their need will be even greater in the future when they go back to their day to day
routine after this unparalleled emergency.
Directors of medical staff in hospitals, mostly working in resuscitation and ICU, are aware that
their personnel needs and they have requested specific psychological support such as EMDR.
They are advising their personnel to call the Association and to get assigned to a clinician. Most
of the work will be done probably at the end of the emergency, since medical staff are focused
on taking care of the current needs of their patients and are not paying attention to their own
emotional response, except for some of them who are devastated.
Many doctors and nurses are getting infected and some are dying. For their colleagues this is not
only traumatizing, but they do not have the time and space to grieve their colleagues and friends.
Every doctor or nurse that gets infected is a reminder to the others that they could be the next
one. This experience and also the fact that they have to deal with many patients at the same time
with the added anxiety of not having enough respirators or life support for so many patients is
very traumatizing to healthcare personnel.
Videos
We produced videos on stress reactions, stress management, EMDR. Also, we made videos to
help jail directors and their personnel, the National Health Service for medical teams and for the
population, in general. These videos are 5 minutes long and are very practical, especially for
doctors and nurses who do not have the time to call or have psychological support right now. We
have had good feedback. They are watching them and following the suggestions that were
tailored for this Coronavirus emergency, for instance, what to do at the end of the shift, etc.
In emergencies, things change quickly, information may often be conflicting, and it can confuse
the population – both health workers and common citizens. This is the reason why we created
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specific texts for different targets (children, elders, medical staff). We made these texts available
to all the Association members so they could distribute them in their community, schools,
drugstores, etc. We sent them also to the national health structures and facilities and they put
them on their websites and sent it to their personnel. The Association website, the discussion list
and Facebook were also important channels to disseminate information and to send useful news,
practical tools and protocols for this emergency.
EMDR Italy Support
We were surprised and pleased that so many stakeholders in our country were asking the EMDR
Association for help such as hospitals, citizens, medical teams, Town Halls, the National Health
System, the psychological associations, the jails (there were riots inside the jails since visitors were
not allowed, so the staff was greatly traumatized from the riots, as well as the coronavirus), etc.
After 8 weeks of the Coronavirus emergency, through its members, EMDR Italy through its
members is offering support to the following:
26 Hospitals
46 Municipalities (big cities and towns)
13 National Health Service Centers
5 Regional/State Health Services (covering around 15,000,000 inhabitants) of Northern Italy
11 different associations and NGOs
4 Regional/State Psychological Associations
The National Psychological Association
Network of jails’ administrators in Northern Italy
Costa Cruises (where guests and crew members were infected during the Cruise)
Ministry of Education (programs for teachers and students of all ages regarding the
Coronavirus emergency)
7 Local Health Authorities (ASL)
17 Senior citizens home
1 Midwives Association
9 independent groups of EMDR clinicians
We organized a free seminar focused on EMDR protocols and tools applied to the Coronavirus
emergency. Through streaming, this seminar helped our members (5300 members out of 7100
attended) in the following ways:
Understand their stress reactions
Feel part of a professional community in this time of isolation
Learn to use the same tools to work with EMDR from the same perspective
Increase their level of competency
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As a result, we are able to connect as a professional community, while being asked to isolate
ourselves and remain alone. In this way, we could remind our membership that a concrete
organization exists even though there is great uncertainty and unpredictability at this time. As
one of our members wrote to us:
Dear colleagues,
I attended with a lot of interest the seminar regarding the emergency that we are
going through in this time of our lives.
The seminar has been very useful from a professional point of view, since you gave
us concrete tools to deal with what is going on and it has been important also from a
psychological point of view. Again, I felt the enthusiasm for our work and it
confirmed our role as EMDR clinicians. The seminar was useful also for my family,
and clients, since I felt more confident and they could feel it.
The dedication that you showed to us was amazing. I appreciated the way you do
this, not only with expertise but also with humanity and strong values.
I live and work in Palermo and I am part of the EMDR group that is giving tele
psychological assistance.
I have been working with EMDR for many years with good results and I am proud of
being part of this Association. Thanks again for everything!
Lucrezia
Media & Connections
We have been interviewed everyday by radio, TV and newspapers. At the same time, we had to
produce a lot of material for those who we are helping, for our members and psychoeducational
materials for the population, in order to allow them to work in the same way.
The Ministry for Education asked us for material for children, adolescents, teachers and parents
to distribute in partnership with the EMDR Association.
Our members are creating a lot of initiatives in their communities with the support of the EMDR
National Association. They are all working pro bono and are coordinated by the team of
experienced members of the Association.
Members who are living abroad, like in London or Spain, are organizing support for Italians that
live in those places. Our support has been to help them to implement services and find colleagues in
Italy who could help them with the calls that they were receiving, using WhatsApp, Skype, etc.
We are doing all this by phone, Skype, Zoom, etc. We were surprised that our work could be
done remotely and be so effective, even with groups of doctors and nurses.
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Conclusion
Emergency Concerns: During an emergency, people respond according to their own personality,
characteristics and the abilities they have learned in life. Many will develop anxiety or fear; others
will become depressed, etc. It is important to know that these effects will not stop with the end of the
emergency but they might persist in the medium-long term or they might even grow and generalize
to a number of situations that used to generate no disturbance before.
Providing an Environment of Safety: During an emergency, and particularly in this case when we are
fighting against an “invisible” enemy, the people might feel in constant danger and they might feel
constant fear. This feeling of threat has the priority over the cognitive-rational structures because this
is a question of survival and hence it is innate and irrational. In this first phase, it will be important to
provide the people with a sense of safety and remind them that there are things that we can do, so we
are not so helpless. When providing support even in this situation, we noticed that it is possible to
find resources, positive aspects or situations, where the client was able to feel safe. It has been
fundamental in order to promote safety, to provide information and psychoeducation on what is
happening and how and why we are reacting in the way we are.
Support Official Channels of Information: In situations of emergency, people feel the irrational need
to be reassured and to have control over what is happening. Hence, many will feel the need to follow
the online news constantly. Quite often, however, they will get fake news: since it is written to stir an
emotional impact, it will become viral and difficult to manage. It has been necessary to repeat how
important it is to follow the official channels, like the website of the Ministry of Health, or other
official websites managed by health organizations, to reassure the population and not to disseminate
panic as fake news often does.
Legitimize Emotional Responses: Explain the coronavirus as if it were an “invisible enemy” difficult
to control and to predict. This emergency has been challenging our normal emotional responses those
we are used to as human beings. This is the reason why strong anxiety and concern may arise. Trying
to normalize and legitimate all these emotions can be helpful to calm down the client and to explain
what is happening inside them.
Support Resilience: Just as our body is equipped with an immune system, our brain is able to adapt
psychologically to adverse situations, thanks to its resilience. It is important to extend the perspective
of what is happening: we are not helpless even if we cannot change things. We can change our
reactions and perspectives, the way we see what we are experiencing.
Constructive Viewpoints: Provide a constructive view of what we are experiencing: It is possible to
find resources in each situation, which can be used. This is an opportunity to devote time to a slower
life, to our family and ourselves. In this moment, we can do things that have never been a priority for
us. Now we can do them and use technology streaming and platforms – we are all isolated but we
are all connected as a community at the same time.
Support What We Can Do: Because of all these factors, it is not possible to predict results. Many
people may feel difficulties due to this unpredictability. Providing simple and clear instructions on
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what to do allows people to feel safer and lessens the unpredictability of the situation. For instance,
washing your hands, cleaning all home surfaces, paying attention if you sneeze or cough, etc., but
also emotional and psychological strategies to feel grounded and safe.
Focus on the Here and Now: The fact that we cannot make plans at this moment may create new
challenges and feelings, since we are not used to not making plans. However, it is important to state
that we must focus on the here and now. This is a great opportunity to simplify our lives that are
generally very complex and fast. We have the possibility to explore this simpler and easier life that
the Coronavirus emergency is compelling us to conduct, changing our hierarchy of priorities.
Community: Throughout the whole country a new sense of community has developed. People have
found ways of sharing nice and pleasant moments, in creative ways, like opening their windows, or
going out on their balconies or terraces and singing together or playing. Through the Internet,
WhatsApp, etc. many things can be shared like having a virtual drink together or celebrating events.
People that lived in the same building and had never met, now have a WhatsApp chat sharing
information on grocery stores or to help if someone is in great need in the building… So, it is very
positive to see that when individuals cannot make it alone, the group comes up in a natural way to
help and support each other.
The Contribution of EMDR Therapy: From a health perspective, specific scientific protocols have
been pursued, following medical protocols, knowledge and expertise. From the psychological point
of view, we must also address the needs and dynamics that are being triggered in the people, through
the research-based protocols of EMDR therapy considered effective, according to the International
guidelines.
Generosity: The last thought is about the generosity of the members of our National EMDR
Association. They are not only clinicians but they are aware of EMDR Therapy and how this can
make the difference in emergencies. Despite the fact that our whole country is going through a very
stressful and traumatic situations, our members exhibit the spirit of EMDR when they reach out and
help those populations in need.
Isabel Fernandez is the Chairman of EMDR Italy Association and President of the EMDR Europe
Association.
© Isabel Fernandez, 2020. This Resource is copyrighted under United States law. EMDR practitioners are encouraged to use this work
in the treatment of their clients. Under certain limited conditions, EMDR practitioners and researchers may request and receive written
permission to use the materials contained herein in new works they create. For further information on receiving permission to use the
materials other than with the practitioner’s own clients, please contact the author at segreteria@emdritalia.it. All rights are reserved.
39
© 2020 All rights reserved.
4
A Picture of Italy
Affected and
Striving to
Cope with the
Coronavirus:
Phase 2
Isabel Fernandez
Introduction
he Coronavirus threat has had a deep impact on our emotions, cognitive schemas, as well as
on our sense of control and safety, generating new anxieties and worries and suddenly
changing our lives and habits. As many countries have started to ease the lockdown measures and
we are entering a new phase, it is extremely important to consider that the psychological impact of
the pandemic might not be over and the population might still be at risk for developing symptoms
of psychological distress. According to very important and well-known researchers in the field of
stress and traumatic stress such as Van der Kolk (2015) and McFarlane (2009), a significant number
of individuals, despite having initially been able to cope with a traumatic event, over time begin to
present symptoms of discomfort. For example, after mass disasters like the one connected to the
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COVID-19 pandemic, symptoms often increase during the first 6 months and have a key role in the
late onset of psychopathological disorders. Therefore, it is essential to intervene as soon as possible.
EMDR therapy protocols for early intervention can have a major role protecting people’s
psychological health, giving immediate relief and providing them with tools to prevent the future
onset of psychiatric disorders or other stress reactions. At the same time, EMDR therapy can be
very effective in accompanying the next phases that will be coming in the next months as we
address the opening up of our countries.
In the coronavirus pandemic context, people who are particularly at risk of developing PTSD are
COVID-19 patients who have perceived their life in danger, their families and health-care staff.
Others at risk are relatives and friends of victims of COVID-19 who are grieving because they
could not take care of their loved ones while they were dying and were not able to hold funeral
services, due to social distancing measures. This critical and unexpected situation has certainly
caused discomfort, also, to the people that have not been infected or that have not suffered any
severe trauma. The risk of catching the virus and the compulsory measures of social distancing
might themselves cause symptoms like fear, anxiety, depression, irritability and insomnia.
Therefore, there are many psychological consequences that will manifest over time related not only
to COVID-19 threat and its aftermath but to the greater population’s experience of being in social
isolation as well.
Research
Effects of Quarantine
Articles published in scientific journals confirm that quarantine, if prolonged and not voluntary, can
have short- and long-term effects at a physical and psychological level, causing an increase in
anxiety, mood disorders and addictions. We are a social species and isolation entails a sense of
deprivation and a loss of social contact that make us suffer, since being part of a group and social
closeness are linked to our ancient sense of survival. For instance, the National Institute for Health
Research’s (NIHR) Health Protection Research Unit (HPRU) in Emergency Preparedness and
Response funded an important review (Brooks et al, 2020) of articles published on MEDLINE,
PsycINFO and Web of Science about the psychological impact of quarantine. This research has
analysed previous disease outbreaks: researchers have examined 24 studies that were done across
10 countries and included people with SARS, Ebola, H1N1 influenza pandemic, Middle East
Respiratory Syndrome (MERS), and equine influenza. The review has shown a wide range of
negative psychological effects of quarantine, including post-traumatic stress symptoms, depression,
confusion, anger, fear, and substance abuse. The study, published in The Lancet, has found that
these psychological effects can be long-lasting and they have a stronger impact on people that have
a history of mental illness and on health-care workers. In particular, according to this research,
hospital staff showed:
Detachment
Anxiety
Irritation
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Sleep disorders
Concentration difficulties
Deterioration of performance
Reluctance going to work or considering resignation
Some studies found that after 3 years, the population had a high level of post-traumatic symptoms
and 9% had depression symptomatology.
The main author, Dr Samantha K Brooks of the Department of Psychological Medicine, King’s
College London, has stated:
This Review suggests that quarantine is often associated with a negative psychological effect.
The evidence that a psychological effect of quarantine can still be detected months or years
later albeit from a small number of studies is troubling and suggests the need to ensure
that effective mitigation measures are put in place as part of the quarantine planning process.
Our review suggests that health-care workers deserve special attention from their managers
and colleagues, and that those with vulnerable mental health would need more support during
the quarantine.
Another systematic review published in Brain Science (Vlachos et al., 2020) shows how isolation
can have a severe impact on physical and mental health, due to the neuroendocrine and immune
response. The research, done with a group of parents and children, showed that quarantined
children developed post-traumatic symptoms four times higher than the control group.
Other studies of this review reported other reactions in the population, like confusion, fear,
difficulty in managing anger, numbness and sleep disorders, panic attacks, deterioration of couple
or family relationships and difficulties related to cohabitation. These studies highlight the
possibility of developing general psychological symptoms like depression, problems of anger
management, sleep disorders, fear, problems of fear extinction, and anxiety, as well.
Suicide
In addition, we have to consider another important set of adverse effects that the pandemic might
have on the population, which impacts on quality of life and increases the risk of suicide.
Population’s vulnerability to suicidal behaviour during a pandemic has been analysed in a study
published in The Lancet (Gunnel et al., 2020). According to this research, a sense of loss is an
important factor affecting mental health and could precipitate suicide. People realize how much
they have lost during 2 months of lockdown: not only social relationships, but also job
opportunities and financial resources. The Inter-Agency Standing Committee (IASC) on Mental
Health and Psychosocial Support -initiated by the World Health Organization (WHO) – has
guidelines that highlight the effect of the prolonged exposure to stressors during the pandemic,
that can lead to long-term consequences within communities, families and vulnerable individuals.
This can include deterioration of social networks, local and national economy, and stigma towards
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survivors of COVID-19. This has a very negative psychological impact, so it is necessary to
undertake actions that can reduce stigma and discrimination.
Domestic Violence
Another important consequence of the pandemic is the likely increase of domestic violence, due
to the lockdown and the lack of services and external support. People with important previous risk
factors are also likely to develop mental health problems or exacerbate existing ones,
experiencing relapses and other negative outcomes.
Post-Lockdown
It is essential not to take for granted that once lockdown will finish, everything will go back to
normal without consequences for the general public health. Mental health consequences are likely
to be present for longer and develop much later after the pandemic. Even when we will no longer
have to stay at home and we will be allowed to go back to our routines, our minds might not
always be able to turn off the switch and return to life as it was before. We need to decrease the
accumulated stress that we have been exposed to during the last months and let it drain away; this
takes time and it can be different for each of us.
Role of EMDR Therapy
Preventive interventions for resilience building and follow-up is essential. Psychological
interventions must be meaningful and take-into-account all the phenomena and mechanisms
mentioned above because they will play an important role in people's health in the coming months
and years. It is important to intervene during quarantine in order to minimize these risks, and
EMDR can have a fundamental role to prevent PTSD and other psychological disorders from
developing. EMDR can be effective in reducing the stress caused by social isolation, working in
the most distressful moments of the isolation period, especially by using EMDR Early
Intervention strategies and strategies.
According to the October 2018 guidelines published by the International Society for Traumatic
Stress Studies (ISTSS), psychological interventions such as EMDR not only result in a clinically
significant reduction of symptoms and in improved functioning / quality of life, but are also
considered interventions "with evidence in adults as early treatment in the acute phase.”
In the case of EMDR, a single session within the first 3 months of a traumatic event has already shown
effectiveness for the prevention and treatment of PTSD. EMDR also had a standard recommendation
for interventions performed within the first 3 months in multiple sessions. It is considered equal to
CBT-T, a cognitive behavioral therapy focused on trauma. This shows how costs in terms of duration
of the psychological interventions are very low and at the same time can be effective. The costs of a
non-intervention in the acute phase are very significant both in terms of suffering and discomfort, but
also in terms of medium and long-term services and pharmacological treatment.
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How to Prepare for the New Post-Lockdown Phase
Compulsory vs Voluntary Quarantine
No previous research has made a comparison between the psychological effects of compulsory
and voluntary quarantine. However, studies indicate that reinforcing the altruistic aspect of
quarantine as a way of protecting the others could make it easier to bear the stress and frustration
of the situation.
Everyone is now conscious of the potential social and economic consequences of COVID-19,
which is why we must be aware of these risks and implement measures to reduce their impacts.
Communication and transparency are crucial. Voluntary quarantine, carried out as an altruistic act
to protect others, will always be associated with less serious consequences than the compulsory
quarantine. Quarantine was compulsory during the COVID-19 outbreak in Italy, but it has been
beneficial to present it as an altruistic act towards the others anyway. It can be useful to make a
plea for altruism, reminding people the benefits that quarantine has for the society.
Adjust Gradually
Once quarantine ends and the lockdown measures are lifted, it is essential to adjust gradually to
the change. Just as life in the cities does not immediately return as it was before, we too have to
get used to going back to normal a step at a time. However, just like the body, the mind has its
own immune system that naturally tends to heal. We adapted to the lockdown very fast and we
used all our resources to adjust to it, in the same way we will acclimate to the new phase that will
be coming in the next months.
We are aware that the capacity to process this difficult experience is in our power, but it all
depends on our personal history and the resources that we have or we can put in place. A useful
coping strategy is to look for incidents from our past when we were put under strain and identify
them: What helped to me the most at that time? What was the vision, the thought, the message
that allowed me to overcome that moment?” It may have been sheer determination and/or the
belief in a project. We can use the resources that are already present and that proved to be
effective in other situations or periods of our lives.
Health-care workers (nurses, doctors, ambulance drivers, lab technicians, etc.) are among the
most exposed people and are subject to extreme stress and risk of burnout. Without a specific and
focused professional support, they risk psychological distress that can lead to full-blown
psychological disorders.
The Role of Thoughts & Emotions
Thoughts and emotions are very important. Another essential strategy to overcome this moment is
to get in touch with our emotions: sense of loneliness, discouragement, anger, frustration. Let's
ask ourselves what thoughts are associated with these emotions: “I will never make it,” “What
have they done to me?” etc. These negative thoughts that leave no escape and are catastrophic
must be changed since they have a strong impact on emotions. What we say to ourselves, our
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self-talk, especially if negative, also prevails over the reassurance from others. Being told: “It will
be all right, don't worry” is useless if I keep having the same thoughts. The concept is that we are
in a situation where we are not in control of what is happening, we cannot change the external
conditions but we can instead change our self-talk. It's important to understand the situation for
what it is. In the meantime, take the time to process it and accept the feelings of frustration, but
without continuously ruminating over the situation.
The Floatback is always an important way of identifying and resolving negative feelings and
states of mind. Trying to concentrate on the disturbing feelings, thoughts and sensations and
floating back to see when we have experienced the same things before can be useful in order to
unhook the connection between the past and the present. The coronavirus lockdown can trigger
earlier experiences when needing to stay at home during a long illness, or isolation in childhood.
In the years to come, clinicians – especially EMDR clinicians- will find when they do case
conceptualization with their clients that there are targets and experiences from this pandemic that
will be contributing to their difficulties. Very likely, memories of this pandemic will be included
in therapeutic treatment plans of many clients. Those who do not develop symptoms or reactions
now, might be triggered in the future and the experience of this pandemic could be reactivated,
precipitating disorders like anxiety, mood disorders, etc.
Some Practical Recommendations to the Post-Lockdown Phase
First Recommendation: It is important to prioritize. Some activities will open soon, not all of
them. Therefore, we should start choosing the things we would like to do, but gradually. We will
not be able to see all our friends, let's decide who we would like to meet first.
Second Recommendation: It is important to acknowledge the inevitable feelings of anger that are
related to fear and to the sense of constraint. Usually, in these situations, we try to make sense of
this anger by finding a culprit: China, WHO, etc. become targets of our frustration. It would be
more adaptive to see what happened as an event bigger than us and anyone else. Be aware that
everyone has done their best and that sometimes there are situations that are beyond anyone's
control. It is important to always keep in mind that instead of looking for culprits, we need to
focus on practical things that can be done and are being done to solve what depends on us.
Third Recommendation: Isolation can cause phobias, related to the long exposure to avoidance.
Having been isolated for a long time, we may find it difficult to go out, to the point we do not
want to go out anymore or do not go out without anxiety. The solution is to gradually start going
out again, wearing masks and/or taking other necessary precautions without developing obsessive
behaviour. We could also go to the opposite extreme, where we try to do everything we have been
forbidden to do. This can put us in danger again and expose us to the risk of being infected. It is
important to remember that the easing of lockdown does not mean that the risk is over. If we do
not follow the instructions and the rules, we could be even more exposed to infection.
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References
Brooks, S. K. Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G.J. (March,
2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet,
395, 10227, 912-920.
Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur, N., Khan, M., O’Connor, R.C., & Pirkis,
J. (April 2020). Suicide risk and prevention during the Covid-19 pandemic, Lancet Psychiatry,
https://doi.org/10.1016/S2215-0366(20)30171-1
Vlachos, I.I., Papageorgiou, C. & Margariti, M. (March 2020). Neurobiological trajectories involving social
isolation in PTSD: a systematic review. Brain Science, 10(3)
ISTSS, (October 2018). PTSD prevention and treatment guidelines. Methodology and recommendations.
https://istss.org/clinical-resources/treating-trauma/new-istss-prevention-and-treatment-guidelines
© Isabel Fernandez, 2020. This Resource is copyrighted under United States law. EMDR practitioners are encouraged to use this work
in the treatment of their clients. Under certain limited conditions, EMDR practitioners and researchers may request and receive written
permission to use the materials contained herein in new works they create. For further information on receiving permission to use the
materials other than with the practitioner’s own clients, please contact the author at segreteria@emdritalia.it. All rights are reserved.
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5
Recommendations
for the Use of Online
EMDR Therapy
During the COVID-19
Pandemic
The EMDR Europe
Standards Committee
Introduction
s the Covid-19 continues to develop rapidly and more of our member countries are in
lockdown, it is necessary to update the previously issued guidelines for online EMDR
therapy. We will continually review and update this information as needed in light of future
developments.
As EMDR therapists, we are facing a new challenge which we have not encountered before. It
will not be possible for many of us to offer face-to-face consultation or therapy to clients in need.
However, there is a substantial amount of existing information from practitioners who have used
online EMDR therapy for many years. During the present circumstances in which it is
impossible to work face-to-face, these experiences need to be acknowledged.
A
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Use of EMDR Online Therapy
Research
There is no existing evidence to show whether there is a difference between online and face-to-face
EMDR therapy. There are some small, uncontrolled studies not using EMDR which indicate there is
no difference. For statistical reasons, undertaking controlled research on the difference between face-
to-face and online EMDR therapy would be a vast undertaking, requiring a considerable number of
participants. Such research is unlikely to happen soon.
It is therefore impossible to conclude from existing research whether or not there are any
differences between face to face and online EMDR therapy.
Anecdotal Evidence
There is a substantial body of anecdotal information from experienced EMDR practitioners throughout
Europe which appears to show online EMDR treatment to be as effective as face-to-face EMDR therapy.
The anecdotal evidence seems to be just as strong for online EMDR treatment with children as it seems
to be with adults. Given the lack of available research and the fact that the crisis will continue for some
time, it is reasonable to rely more heavily on the anecdotal information and to recommend the use of
EMDR online therapy for any appropriately assessed client, both ongoing clients and new clients.
Indeed, there is a distinct advantage in using online EMDR therapy in the present crisis because it will
allow EMDR therapy to be offered to many clients who would otherwise not be able to receive it.
During the present coronavirus crisis, online EMDR therapy – that follows the Standard EMDR
therapy Protocol – is therefore recommended for all clients who are appropriately assessed.
In addition, we want to stress the following:
o We support the use of EMD, EMDr, and Recent Events Protocols, as well as stabilization
and grounding, psychoeducation, Safe Place and Resource Installation and enhancement.
o There is a need for caution when working with complex clients.
o There is a need for therapists to follow their national regulations and insurance policies
regarding online therapy.
o The importance of adhering to the base of our practice, which is our EMDR Europe Code
of Ethics, especially when we lack experience and knowledge.
Treatment Skills & Risks
Are special treatment skills required in applying the EMDR protocol online? Again, research cannot
help us. We must still rely on the anecdotal evidence and practical experiences, and this appears to
show that the Standard EMDR Protocol works well; there is no need to alter it. The most critical issues
are that clinicians should only work with clients who are within their present level of competence, and
that they are appropriately supervised, as would be standard practice with face-to-face clients.
Any risks from online EMDR therapy appear to be similar to those experienced by
clinicians working face-to-face. Nevertheless, the actions that a therapist can undertake
in online therapy to adjust to several risks are limited.
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Technical & Practical Skills Involved in Running an Online Session
There is a range of technical and practical skills that a therapist will require to run a productive
online EMDR session. Most EMDR clinicians are unlikely to have worked online and will need
help. There is a substantial amount of existing information from practitioners who have used this
method for many years. Some national associations are already collecting this information to
share with their members and are running skill-sharing webinars on how to operate an online
session.
The EMDR Europe Standards Committee
Bjorn Aasen
Kerstin Bergh Johannesson
Ludwig Cornil
Arne Hofmann
Ad de Jongh
Isabel Fernandez
Peter Liebermann
Richard Mitchell
Udi Oren
Carljin de Roos
Michel Silvestre
© Isabel Fernandez, 2020. This Resource is copyrighted under United States law. EMDR practitioners are encouraged to use this work
in the treatment of their clients. Under certain limited conditions, EMDR practitioners and researchers may request and receive written
permission to use the materials contained herein in new works they create. For further information on receiving permission to use the
materials other than with the practitioner’s own clients, please contact the author at segreteria@emdritalia.it. All rights are reserved.
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© 2020 All rights reserved.
6
EMDR Early
Interventions in the
Current COVID-19
Pandemic
Paul Miller, Derek Farrell &
Lorraine Knibbs
Introduction
MDR therapy is one of the empirically-supported treatments for the psychological effects of
trauma, that is endorsed by the World Health Organization (WHO, 2013), United Nations
High Commission for Refugees ((UNHCR, 2015) and the International Society for Traumatic Stress
Studies (ISTSS, 2019). As examined in the ISTSS guidelines, the majority of the current research
demonstrates its effectiveness with Post-Traumatic Stress Disorder (PTSD) and Complex PTSD.
Additionally, EMDR has been a component in multiple trauma capacity building projects throughout
the world including Syria (Acarturk et al., 2016), Pakistan (Farrell et al., 2013), Myanmar (Mehrotra,
2014) and Northern Iraq (Farrell et al., 2020), it has also been widely deployed as an early
intervention (See Appendix 1 & 2). There is strong consistent evidence that EMDR Early
Intervention (EEI) significantly reduces symptoms of PTSD, with effects maintained at follow-up
(Shapiro and Maxfield, 2019).
E
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Eye Movement Desensitization and Reprocessing (EMDR) therapy was introduced in 1989 and has
evolved to become a comprehensive psychotherapy, guided by Shapiro's Adaptive Information
Processing (AIP) model. This model equips clinicians with a means to understand cases in a trauma-
focused manner, assisting with treatment planning and delivery (Shapiro, 2007). This model views
most mental health disorders as stemming from unprocessed earlier disturbing events and has opened
the door for EMDR treatment of multiple disorders. There are more than 44 randomized controlled
trials that have investigated EMDR treatment of posttraumatic stress disorder (PTSD), early traumatic
stress, and traumatized children (Maxfield, 2019). In addition, 28 randomized controlled trials have
assessed its utility in major depressive disorder, bipolar disorder, psychosis, anxiety disorders,
obsessive compulsive disorder, substance use disorder and pain (Maxfield, 2019).
EMDR therapy skills are traditionally provided as an additional training for mental health
professionals. In this context, it is meaningfully-structured in terms of its training curriculum,
supervision provision and accreditation requirements. In Northern Ireland, a Department of Health
commissioned a course that runs through Queen’s University Belfast, training experienced mental
health nurses in EMDR therapy: the program takes nurses through to Accredited Practitioner level.
A second Masters Degree level course for Advanced Nurse Practitioners is going live in the next
academic year at Ulster University with EMDR therapy and the AIP model as core elements.
Pedagogically, it provides trauma-focused skills to those with pre-existing mental health professional
skills, allowing for the addition of trauma-focused psychotherapy to established mental health settings.
The EMDR All-Ireland Association was launched in 2020, having previously been a part of EMDR
UK & Ireland. In the coming months, fifteen additional, experienced, EMDR Consultants will be
accredited for Ulster (Northern Ireland, plus Donegal, Cavan & Monaghan), having completed a two-
year trauma capacity building project led on the Island of Ireland. This greatly enhances the capacity
to supervise and encourage clinicians towards accreditation; increasing trauma treatment capacity.
The Need for Stress & Trauma Treatment
The various international initiatives of Humanitarian/ Trauma Capacity Building projects, led by
colleagues’ from within the EMDR therapy community, highlight the major discrepancies between
demand and supply in relation to addressing the global burden of psychological trauma. This endeavor
needs to explore how EMDR-focused trauma interventions can be adapted for non-mental health
workers so as to bridge the gap created by lack of capacity (Blenkinsop et al., 2018). To date, there are
three models currently being trialed in Low-and middle-income countries (LMIC’s), each of which are
both Adaptive Information Processing (AIP) and EMDR therapy informed. They are the following:
Trauma Counselling Curriculum: This arose from the Mekong Trauma Capacity Building
projects for Cambodia, Thailand, Indonesia, Vietnam, and Myanmar.
Trauma Psycho-Social Support (TPSS+): Developed by Trauma Aid Germany, it is
being tested in the Middle East.
Global Initiative on Stress & Trauma Treatment (GIST-T): This project is located in
Geneva and is targeting more within the High and Middle-Income Countries.
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This shortage of mental health personnel is particularly apparent following large-scale crises in
low- and middle-income countries (LMICs), but in all reasonable likelihood, we are likely to face
similar challenges in the aftermath of the current Pandemic. Non-mental-health professionals
could create additional capacity; extending mental health capacity, not to replace or compete with
licensed mental health professionals. Currently PhD students at Ulster University are exploring
such applications and international examples already exist in LMICs. This includes exploring how
EMDR therapy techniques can be taught to specialist, non-mental health professionals such as
Midwives so that these skills can be deployed quickly at point of need. There are already
endeavors that have identified mental health champions amongst midwifery services; we can
build on these specialist nurses’ skills with additional EMDR therapy-based skills. For example, a
midwife can be taught to use EMDR-based stabilization procedures to calm a state of panic,
following an unexpected instrumented birth or birth complication. Ostensibly, this focuses on
creating ‘state’ change, rather than trait change, thus reducing presently held levels of distress and
anxiety, without processing the traumatic elements of the situation.
As part of Humanitarian/ Trauma Capacity building training curricula, both the EMDR Group-
Traumatic Episode Protocol (GTEP) and EMDR Protocol for Recent Critical Incidents (PRECI)
are taught to both mental health, and non-mental health participants. Admittedly, the non-mental
health workers are taught a slightly diluted version of both protocols. It is important to highlight
that both of these EMDR Group Protocols are effective, but at the same time, there are important
distinctions between the two.
EMDR-PRECI is a blunter instrument but is more effective in dealing with large populations.
GTEP is more precise, allowing more time to process trauma memories than PRECI.
Both use the support of Emotional Protection Teams who are from within the local community.
In addition, both PRECI and GTEP are meant to be early interventions effectively used within
the first 3-months post trauma.
Given that the psychological impact of trauma is recognized as having distinct phases: immediate,
acute and chronic; it is not unusual that the trauma-focused treatments have developed with a
similar focus. EMDR Early Interventions (EEI) are those that are implemented within 3-months of
the trauma exposure; they are observed to significantly reduce PTSD symptoms acutely and these
effects have been shown to be maintained at follow-up (Shapiro and Maxfield, 2019). In the present
pandemic, we are mindful of the dual function of EEI’s: they reduce and resolve immediate distress
and they also act as a triage, identifying those individuals who are unable to benefit from them and
require higher levels of specialist input. Both are desirable in the present context of Covid-19.
The Group-Traumatic Episode Protocol (G-TEP) has been chosen in the All-Ireland context as
many clinicians are familiar with it having been trained via Dr. Derek Farrell in Worcester
University and local trainings through its creator, Elan Shapiro. Additionally, the methodology
provides a practicum sheet, which acts as a guide to the people engaging in G-TEP online. This is
widely believed to be beneficial for implementation in the current context where online delivery is
an apparent necessity, due to social distancing constrictions applied by both Governments on the
Island of Ireland.
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EMDR Therapy’s Response to the Pandemic
In terms of training delivery, in the context of the pandemic, training has already been
successfully delivered with social distancing in place within facilities such as Soldier Centre in
the USA http://www.soldier-center.org developed and operated by retired Colonel EC Hurley
[Personal communication] and it has also been employed as online trainings by international
colleagues including Mara Tesler Stein (USA/Israel); Jamie Marich (USA) and Esly Carvalho
(Brazil). These colleagues have also collaborated with the authors in regards to the delivery of
online EMDR therapy, utilizing online training to assist EMDR trained therapists to continue
EMDR therapy provision using online platforms such as Zoom, SKYPE, and Microsoft Teams
amongst others. The EEI, G-TEP protocol has been successfully implemented online for this
purpose. G-TEP serves four purposes:
1. Trauma symptom reduction
2. Prevention of deterioration of symptoms
3. Triage risk assessment
4. Community empowerment
5. Stabilization
The primary focus of GTEP is trauma memories, that drive traumatic stress responses. In
accordance with Social Distancing, it would not be appropriate to offer individual face-to-face
sessions and internet-based G-TEP (iGTEP) is being utilized as an efficient manner of
implementing EEI in an online environment. iGTEP is currently being used to support EMDR
therapists through online groups (Farrell, 2020). This support with EEI aims to ameliorate the
toxic stress that frontline staff are exposed to, rendering it tolerable (Shapiro and Maxfield, 2019).
Working with Frontline Healthcare and Workers
Lai (Lai et al., 2020), explored the mental health of frontline health care and emergency workers,
reporting depression, anxiety, insomnia and psychological distress. Presently, frontline workers
are experiencing high levels of emotional strain, physical and mental exhaustion, distress about
co-workers’ health, intense fears about shortages of essential equipment, concerns about
infecting family, anxiety around unfamiliar roles and expanded workloads (Ayanian, 2020):
compounded by limited access to meaningful mental health services. As the pandemic
progresses, mental disorders may subside naturally for some; others will experience persistent
symptoms impacting on all areas of functioning.
Psychological Trauma Lens
The psychological trauma lens is a very useful way to view the current pandemic. We may
consider trauma as being an experience for which a person is not adequately prepared, resulting
in an overwhelming of the normal coping strategies; leading to the generation of dysfunctional
memory networks: AIP postulates that these result in later psychological disorder and related
behavioral issues such as addiction and mood disorders (Shapiro, 2007, Gauhar, 2016).
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Risk Factors
In regards to the mental health risks posed to front line staff by the current pandemic, a number
of key risk factors related to the later development of trauma have been identified in first
responders. Research shows that an effective workplace, with clear support and governance is
vital in decreasing the risk of later psychological trauma (Maguen et al., 2009). In a model that
included gender, ethnicity, traumatic exposure prior to training, current negative life events, and
critical incident exposure over the last year, routine work environment stress was most strongly
associated with PTSD symptoms. Routine work environment stress mediated the relationship
between critical incident exposure and severe affective symptoms and between current negative
life events and PTSD symptoms. Therefore, ensuring that the work environment is functioning
optimally protects against the effects of work-related critical incidents and negative life events
outside of the workplace (Maguen et al., 2009). Research has shown that PTSD severity is
related to factors that included “dissatisfaction with organizational support” and “insecure job
future.” The research notes that when there is a perceived lack of support, and insecurity in
respect to the job, an increased severity in PTSD is manifest (Maia et al., 2011). Effective mental
health support is a vital asset in helping staff feel valued and supported and EMDR therapy as an
EEI allows for early effective interventions that can reduce later suffering and at the same time
acts as an effective triage, indicating those cases who require one to one trauma-focused
psychotherapy (Saltini et al., 2018).
Conclusion
In summary, access to EEI can be deployed relatively rapidly through the current EMDR
therapists with recent increases in supervisory capacity allowing for upskilling of those who
require it. EMDR-based techniques that can be employed as EEI can also be taught to non-
mental health professionals such as non-mental health frontline staff. Lessons learned from other
international trauma capacity building projects that use EMDR inform our choices and a
Department of Health commissioned course exists, which can identify trained experienced
mental health nurses for deployment now and provide a pathway for more to be trained through
to accredited practitioner status.
References
(UNHCR), U. H. C. F. R. 2015. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): Clinical
Management of Mental, Neurological and Substance Use Conditions in Humanitarian Emergencies, UN
High Commissioner for Refugees (UNHCR).
Acarturk, C. Konuk, E., Cetinkaya, M., Senay, I., Sijbrandij, M., Gulen, B. & Cuijpers, P. (2016). The
efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and
depression among Syrian refugees: results of a randomized controlled trial. Psychological Medicine, 46,
2583-2593.
Ayanian, J. Z. 2020. Mental Health Needs of Health Care Workers Providing Frontline COVID-19 Care.
JAMA Health Forum, 1, e200397–e200397.
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Blenkinsop, C., Maxfield, L., Carriere, R., Nickerson, M., Farrell, D., Oren, U., Luber, M. & Thomas, R.
(2018). White Paper - Eye Movement Desensitization and Reprocessing Early Intervention (EMDR EI).
EMDR Early Intervention and Crisis Response Summit. Natick, Boston, USA.
Farrell, D. (2020, May). Rising to the Challenge. The Need for Trauma-Informed Services and Opportunities
for EMDR Interventions. Paper presented at the Global Summit Conference Breaking the Cycle of
Violence: EMDR Interventions for Recovery from and Prevention of Interpersonal Violence, Natick,
MA. (This would be a more accurate citation for your presentation)
Farrell, D., Keenan, P., Knibbs, L. & Hicks, C. (2013). A Q-Methodology Evaluation of an EMDR Europe
HAP Facilitators Training in Pakistan. J EMDR Prac Res, 174-185.
Farrell, D. Kiernan, M.D., De Jongh, A., Miller, P.W., Bumke, P., Ahmad, S., Knibbs, L., Matthes, C.,
Keenan, P. & Matthes, H. (2020). Treating implicit trauma: a quasi-experimental study comparing the
EMDR Therapy Standard Protocol with a ‘Blind 2 Therapist’ version within a trauma capacity building
project in Northern Iraq. Journal of International Humanitarian Action, 5, 3.
Gauhar, Y. W. M. (2016). The Efficacy of EMDR in the Treatment of Depression. J EMDR Prac Res,
10, 59-69.
ISTSS (2019). Posttraumatic Stress Disorder Prevention and Treatment Guidelines Methodology
and Recommendations ISTSS PTSD Guidelines-Methodology and Recommendations. Illinios:
International Society for Traumatic Stress Studies.
Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao,
L., Huang, M., Wang, H., Wang, G., Liu, Z. & Hu, S. (2020).2020. Factors Associated With Mental
Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network
Open, 3, e203976-e203976.
Maguen, S., Metzler, T.J., McCaslin, S.E., Inslicht, S.S., Henn-Hasse, ,C., Neylan, T.C. & Marmar, C.R.
(2009). Routine work environment stress and PTSD symptoms in police officers. J Nerv Ment Dis,
197, 754-60.
Maia, D.B., Marmar, C.R., Henn-Haase, C., Nobrega, A., Fiszman, A., Marques-Portella, C., Mendlowicz,
M.V., Coutinho, E.S. & Figuiera, I. (2011). Predictors of PTSD symptoms in brazilian police officers:
the synergy of negative affect and peritraumatic dissociation. Rev Bras Psiquiatr, 33, 362-6.
Maxfield, L. (2019). A Clinician's Guide to the Efficacy of EMDR Therapy. J EMDR Prac Res, 13, 239-246.
Mehrotra, S. 2014. Humanitarian Projects and Growth of EMDR Therapy in Asia. J EMDR Prac Res,
8, 252-259.
Saltini, A., Rebecchi, D., Callerame, C., Fernandez, I. Bergonzini, E. & Starace, F. (2018). Early Eye
Movement Desensitisation and Reprocessing (EMDR) intervention in a disaster mental health care
context. Psychology, Health & Medicine, 23, 285-294.
Shapiro, E. & Maxfield, L. (2019). The Efficacy of EMDR Early Interventions. J EMDR Prac Res,
13, 291-301.
Shapiro, F. (2007). EMDR, Adaptive Information Processing, and Case Conceptualization.
Journal of EMDR Practice and Research, 1, 68-87.
World Health Organization. (2013). WHO Guidelines on conditions specifically related to stress, Geneva,
Switzerland, WHO Press.
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© 2020 All rights reserved.
Appendix 1
Dr. Ignacio Jarero’s Publications as Leader / Co-author
1 Jarero, I., Artigas, L., & Hartung, J. (2006). EMDR integrative treatment protocol: A post-disaster
trauma intervention for children & adults. Traumatology, 12, 121–129.
2 Jarero, I., Artigas, L., & Montero, M. (2008). The EMDR integrative group treatment protocol:
Application with child victims of a mass disaster. Journal of EMDR Practice and Research, 2, 97–105.
3 Jarero, I., & Artigas, L. (2009). EMDR integrative group treatment protocol. Journal of EMDR
Practice & Research, 3(4), 287–288.
4 Jarero, I., & Artigas, L. (2010). EMDR integrative group treatment protocol: Application with adults
during ongoing geopolitical crisis. Journal of EMDR Practice and Research, 4(4), 148–155.
5 Jarero, I., & Uribe, S. (2011). The EMDR protocol for recent critical incidents: Brief report of an
application in a human massacre situation. Journal of EMDR Practice and Research, 5(4), 156–165.
6 Jarero, I., Artigas, L., & Luber, M. (2011). The EMDR protocol for recent critical incidents:
Application in a disaster mental health continuum of care context. Journal of EMDR Practice and
Research, 5(3), 82–94.
7 Jarero, I., & Artigas, L. (2012). The EMDR Integrative Group Treatment Protocol: EMDR group
treatment for early intervention following critical incidents. European Review of Applied
Psychology, 62, 219-222.
8 Jarero, I., & Uribe, S. (2012). The EMDR protocol for recent critical incidents: Follow-up Report of
an application in a human massacre situation. Journal of EMDR Practice and Research, 6(2), 50-61.
9 Jarero, I., Amaya, C., Givaudan, M., & Miranda, A. (2013). EMDR Individual Protocol for
Paraprofessionals Use: A Randomized Controlled Trial Whit First Responders. Journal of EMDR
Practice and Research, 7(2), 55-64.
10 Jarero, I., Roque-López, S., Gómez, J. (2013). The Provision of an EMDR-Based Multicomponent
Trauma Treatment with Child Victims of Severe Interpersonal Trauma. Journal of EMDR Practice
& Research, 7(1), 17-28.
11 Jarero, I., Uribe, S. (2014). Recent Trauma Response: Actions for an Early Psychological
Intervention. In M. Luber (Ed.). Implementing EMDR early mental health interventions for man-
made and natural disasters: Models, scripted protocols, and summary sheets (pp. 75-85). New
York, NY: Springer Publishing.
12 Jarero, I., Roque-López, S., Gómez, J., Givaudan, M. (2014a). Second Research Study on the
Provision of the EMDR Integrative Group Treatment Protocol with Child Victims of Severe
Interpersonal Violence. Iberoamerican Journal of Psychotraumatology and Dissociation, 6(1),
1-24. ISSN: 2007-8544.
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© 2020 All rights reserved.
13 Jarero, I., Roque-López, S., Gómez, J., Givaudan, M. (2014b). Third Research Study on the
Provision of the EMDR Integrative Group Treatment Protocol with Child Victims of Severe
Interpersonal Violence. Iberoamerican Journal of Psychotraumatology and Dissociation, 6(2),
1-22. ISSN: 2007-8544.
14 Jarero, I., Artigas, S. (2014). The EMDR Protocol for Recent Critical Incidents (EMDR-PRECI). In
M. Luber (Ed.). Implementing EMDR early mental health interventions for man-made and natural
disasters: Models, scripted protocols, and summary sheets (pp. 217-228). New York, NY: Springer
Publishing.
15 Jarero, I., & Artigas, L. (2014). EMDR Integrative Group Treatment Protocol (IGTP) for Adults. In
M. Luber (Ed.). Implementing EMDR Early Mental Health Interventions for Man-Made and Natural
Disasters: Models, scripted protocols, and summary sheets (pp. 253-265). New York, NY: Springer.
16 Jarero, I., Uribe, S. (2014). Worst Case Scenarios in Recent Trauma Response. In M. Luber
(Ed.). Implementing EMDR early mental health interventions for man-made and natural disasters:
Models, scripted protocols, and summary sheets (pp. 533-541). New York, NY: Springer Publishing.
17 Jarero, I., & Artigas, L., Uribe, S., García, L, E., Cavazos, M.A., & Givaudan, M. (2015). Pilot
Research Study on the Provision of the EMDR Integrative Group Treatment Protocol with Female
Cancer Patients. Journal of EMDR Practice and Research, 9(2), 98-105.
18 Jarero, I., Uribe, S., Artigas, L., Givaudan, M. (2015). EMDR protocol for recent critical incidents:
A randomized controlled trial in a technological disaster context. Journal of EMDR Practice and
Research, 9(4), 166-173.
19 Jarero, I., Artigas, L., Uribe, S., García. L.E. (2016). The EMDR Integrative Group Treatment
Protocol for Patients with Cancer. Journal of EMDR Practice and Research, 10(3), 199-207.
20 Jarero, I., & Artigas, L. (2016). EMDR Integrative Group Treatment Protocol Adapted for
Adolescents and Adults Living with Ongoing Traumatic Stress. In M. Luber (Ed.). EMDR
Therapy Treating Trauma and Stress Related Conditions: scripted protocols, and summary
sheets (pp. 169-180). New York, NY: Springer.
21 Jarero, I., Rake, G., & Givaudan, M. (2017). EMDR Therapy Program for Advance Psychosocial
Interventions Provided by Paraprofessionals. Journal of EMDR Practice and Research, 11(3).
22 Jarero, I., & Artigas, L. (2018). AIP model-based Acute Trauma and Ongoing Traumatic Stress
Theoretical C0nceptualization. Iberoamerican Journal of Psychotraumatology and Dissociation,
10(1), 1-7.
23 Jarero, I., Givaudan, M., Osorio, A. (in press). Randomized Controlled Trial on the Provision of the
EMDR Integrative Group Treatment Protocol Adapted for Ongoing Traumatic Stress to Female
Patients with Cancer-Related Posttraumatic Stress Disorder Symptoms. Journal of EMDR Practice
and Research.
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© 2020 All rights reserved.
Appendix 2
Published Research on EMDR Early Interventions: Protocol for Recent Traumatic Events, Recent
Traumatic Episode Protocol (R-TEP) and Group-Traumatic Episode Protocol (G-TEP)
1 Covers, M., De Jongh, A., Huntjens, R., De Roos, C., Van Den Hout, M., & Bicanic, I. (2019). Early
intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of
post-traumatic stress symptoms in recent rape victims: study protocol for a randomized controlled
trial. European Journal of Psychotraumatology, 10(1), 1632021.
https://doi.org/10.1080/20008198.2019.1632021
2 Oosterbaan, V., Covers, M., Bicanic, I., Huntjens, R., & de Jongh, A. (2019). Do early interventions prevent
PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual
assault. European Journal of Psychotraumatology, 10(1), 1682932.
https://doi.org/10.1080/20008198.2019.1682932
3 Proudlock, S. & Peris, J. (2020) Using EMDR therapy with patients in an acute mental health crisis. BMC
Psychiatry 20, 14 (2020). https://doi.org/10.1186/s12888-019-2426-7
4 Brown, R. C., Witt, A., Fegert, J. M., Keller, F., Rassenhofer, M., & Plener, P. L. (2017). Psychosocial
interventions for children and adolescents after man-made and natural disasters: A meta-analysis and
systematic review. Psychological Medicine, 47(11), 1893–1905.
https://doi.org/10.1017/S0033291717000496
5 Tarquinio, C., Rotonda, C., Houllé, W., Montel, S., Rydberg, J., &Minary, L. et al. (2016). Early
Psychological Preventive Intervention for Workplace Violence: A Randomized Controlled Explorative and
Comparative Study Between EMDR-Recent Event and Critical Incident Stress Debriefing. Issues in Mental
Health Nursing, 37(11), 787-799. doi: 10.1080/01612840.2016.1224282
6 Gil-Jardiné C, Evrard G, Al Joboory S, Tortes Saint Jammes J, Masson F, Ribéreau-Gayon
R, Galinski M, Salmi LR, Revel P, Régis CA, Valdenaire G, Lagarde E. (2018). Emergency room
intervention to prevent post concussion-like symptoms and post-traumatic stress disorder. A pilot
randomized controlled study of a brief eye movement desensitization and reprocessing intervention versus
reassurance or usual care. J Psychiatr Res.;103:229-236. doi: 10.1016/j.jpsychires.2018.05.024.
7 Gil-Jardiné, C., Al Joboory, S., Jammes, J., Durand, G., Ribéreau-Gayon, R., Galinski, M., Salmi, L. R.,
Revel, P., Régis, C. A., Valdenaire, G., Poulet, E., Tazarourte, K., & Lagarde, E. (2018). Prevention of post-
concussion-like symptoms in patients presenting at the emergency room, early single eye movement
desensitization, and reprocessing intervention versus usual care: study protocol for a two-center randomized
controlled trial. Trials, 19(1), 555. https://doi.org/10.1186/s13063-018-2902-2
8 Shapiro E &Laub B (2015). Early EMDR intervention following a community critical incident: A
randomized clinical trial. Journal of EMDR Practice and Research, 9(1), 17-27.
http://dx.doi.org/10.1891/1933-3196.9.1.17
9 Tarquinio, C., Rotonda, C., Houllé, W., Montel, S., Rydberg, J., & Minary, L. et al. (2016). Early
Psychological Preventive Intervention for Workplace Violence: A Randomized Controlled Explorative and
Comparative Study Between EMDR-Recent Event and Critical Incident Stress Debriefing. Issues in Mental
Health Nursing, 37(11), 787-799. doi: 10.1080/01612840.2016.1224282
10 Wesson, M., & Gould, M. (2009). Intervening Early with EMDR on Military Operations A Case
Study. Journal of EMDR Practice and Research, 3(2), 91-97. doi: 10.1891/1933-3196.3.2.91
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© 2020 All rights reserved.
G-TEP Research planned, conducted & published Jan 2020
Elan Shapiro (Group-Traumatic Episode Protocol – group version of
Recent-Traumatic Episode Protocol)
1. Lehnung, M., Shapiro, E., Schreiber, M., & Hofmann, A. (2017). Evaluating the EMDR Group
Traumatic Episode Protocol (EMDR GTEP) with refugees: A field study. Journal of EMDR Practice
and Research 11(3). https://doi.org/10.1891/1933-3196.11.3.129
2. Roberts, K. A. (2018). The Effects of the EMDR Group Traumatic Episode Protocol, G-TEP with
cancer survivors. Journal of EMDR Practice and Research, 12(3), 105-117. DOI: 10.1891/1933-
3196.12.3.105.
3. Yurtsever, A., Tükel, F., Konuk, E., Çetinkaya, M., Zat, Z., & Shapiro, E.D. (2018). An Eye
Movement Desensitization and Reprocessing (EMDR) Group Intervention for Syrian Refugees with
posttraumatic stress symptoms: Results of a randomized controlled trial. Frontiers of Psychology.
Vol 9. https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00493/full
4. Tsouvelas, G., Chondrokouki, M., Nikolaidis, G., Shapiro, E. (2019). A vicarious trauma preventive
approach. The Group Traumatic Episode Protocol EMDR and workplace affect in professionals
who work with child abuse and neglect doi. 10.26386/obrela.v2i3.123
© Paul William Miller, Derek Farrell, Lorraine Knibbs 2020. This Resource is copyrighted under United States law. EMDR
practitioners are encouraged to use this work in the treatment of their clients. Under certain limited conditions, EMDR practitioners
and researchers may request and receive written permission to use the materials contained herein in new works they create. For further
information on receiving permission to use the materials other than with the practitioner’s own clients, please contact the authors
at mirabilishealth@me.com, lorraineknibbslk@gmail.com, derekpfarrell@gmail.com. All rights are reserved.
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© 2020 All rights reserved.
7
A Turkish Response
to Dealing with a
Catastrophic Event:
The COVID-19
Pandemic
Şenel Karaman
Asena Yurtsever
Sefa Kaya &
Emre Konuk
Introduction
he Turkey EMDR Trauma Recovery Group consists of 500 psychotherapists who
received EMDR training and are carrying out the EMDR, Humanitarian Assistance
Programs of the EMDR Association Turkey. They are volunteers.
When any massive traumatic event occurs in Turkey, the Turkey EMDR Trauma Recovery
Group immediately take action, gets organized and gives therapy for free. The group decides
how and by which methods to respond to each event, teams are formed, its budget is prepared
T
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© 2020 All rights reserved.
and the response begins. It is a quite experienced, dynamic and active group who have responded
to almost all of our country’s traumatic events, beginning with the 1999 Marmara earthquake,
including other natural disasters, terror attacks and mining accidents.
From the first days when the Coronavirus Pandemic started, The Turkey EMDR Trauma
Recovery Group engaged its members to deal with this event. As of March 2020, 450 volunteer
EMDR Therapists, have been carrying out Online EMDR and psychological support work for
those affected by the virus. In this article, a summary of the work done follows, including the
research doc<