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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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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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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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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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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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 documentation concerning the Coronavirus Pandemic in Turkey.
Structural Basis of the Organization
Teams
The work done for those affected by the Coronavirus (Covid-19) Pandemic, consists of 29 teams
giving Online EMDR Therapy with 10 sub-units, providing support service to the organization as
follows. Each team has a leader who assumes the role of a facilitator and approximately 15
EMDR Therapy volunteers are involved in each team. The EMDR Trauma Recovery Group
volunteers carry out all the work.
Supervisors Team
The EMDR Trainer leads the Supervisors team and they carry out the work and interventions
needed online with the general principals and rules of EMDR. Each supervisor has his/her own
team. At least once a week, they have supervision meetings with the team. By discussing the
treatment of each client, clinicians begin to notice common problems in the sessions and have the
opportunity to come up with alternatives and other solutions. They determine what trainings are
needed and set them up.
Coordination Team
The Coordination Team carries out all the operations that are needed within the EMDR Trauma
Recovery Group. They help structure the operation of the whole system online, while adding
volunteers to teams, structuring the members of the team, supporting the coordination between
the teams, and helping volunteers come up with solutions to the problems occurring in teams and
emergency cases.
Social Media Team
This team determines all the social media announcements, visuals, slogans and hashtags. They
create live broadcasts about the organization for social media.
Bureaucracy & Communication Team
The Bureaucracy and Communication Team carries out the correspondence and negotiations
with all public institutions, and prepare press releases.
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WhatsApp & E-mail Application Teams
Clients may reach the EMDR Trauma Recovery Group in two ways:
WhatsApp
Sending requests for help through a web address or email
The members of these two teams control the messages received and decide whether the people
sending the messages meet the criteria for inclusion. If clients meet the criteria, they are sent a
form to fill out. If they do not meet the criteria, they refuse the application. The people who are
selected meet the following criteria:
COVID-19 diagnosis
Relative/s diagnosed with COVID-19
Relative/s who died from COVID-19
Daily contact working with COVID-19 patients such as hospital health care workers and
those in government departments
Translation Team
This team translates the materials that are written in different languages and necessary for the
organization into Turkish and, if needed, to English.
Morale Team
It is important to support the volunteers of the organization who are giving help to victims of a
mass event. The Morale Ream responds to any difficulty the volunteers may encounter. This
team consists of experienced EMDR therapists who treat volunteers and their families with
EMDR, as needed.
Psychiatric Counseling Team
The Psychiatric Counseling Team makes the medical assessment of the problems that the clients
bring, when needed.
Project Team
This team is responsible for writing up projects and funding applications.
Team Leaders
Each team has a leader who assumes the role of a facilitator. Leaders both direct the clients to the
volunteers in their teams and solve the problems that occur. They support how the team relates to
other systems of the organization.
Functioning
The system for the EMDR Trauma Recovery Groups is set up to be online. At no time is there
face-to-face contact. All the documents are created and signed by using Googles’ documents,
sheets and forms.
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A. General Principles: The Board of Directors creates bylaws for the EMDR Trauma
Recovery Group:
1. Serious Work: The work of the EMDR Trauma Recovery Group is taken very seriously.
2. Teamwork: Establish the Organization Team. Our motto is, “Good things are done together.”
3. Planning: Plan for methods to be applied, the budget and trainings.
4. Use a Manual: Prepare manual for each event/project.
5. Invitation: EMDR Trauma Recovery Group volunteers get calls from people wanting to
be part of this project.
6. Open Communication: Always establish open communication. Create a WhatsApp group
for those who want to help with social media
7. Team Building: Always work in teams. Build teams according to the event type; each
team is provided with a supervisor and an experienced leader.
8. Recovery: Another motto is, “Ready to help, trained to assist recovery.” Support
workshops specific to the event and distribute manuals.
B. COVID-19 Online Psychological Support and EMDR Study
1. COVID-19 Target Audience
a. Who Becomes a Client? /Client Selection Criteria
1. Relatives of people who lost their lives due to the coronavirus.
2. Diagnosed persons and their relatives.
3. Health care personnel, law enforcement officers who serve civilians directly,
municipal officers, the crisis management concerning the epidemic and the people
working in support services.
4. Families of #3
2. First Steps: How it Starts?
a. Infrastructure for the online system is established.
b. The Supervisors Team was created to make decisions about how to proceed
concerning supervision and the needs of the EMDR Trauma Recovery Team:
The Supervision Team gives a workshop to all the volunteer EMDR Therapists
on doing Online EMDR R-TEP Therapy.
The Supervision Team prepares the manual for the event including the following:
1. The Coordination Team creates a structure, functioning, policies and rules for
the EMDR Trauma Recovery Group.
2. The Coordination Team creates a video on how Online EMDR Therapy is
done.
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3. The Coordination Team creates stabilization techniques for online platforms.
4. The Coordination Team creates a video on how to do Online R-TEP.
c. The Social Media Team creates social media strategic planning and the writes an
application (for what?).
d. The Social Media Team puts out a call for volunteers.
e. The Social Media Team announces to the public that there is an online EMDR and
Psychological support for people feeling fear and anxiety, Regarding the Covid-19
Pandemic.
3. Volunteer Application:
a. To be a volunteer in the organization, fill out the “Volunteer Application Form.” This
includes pertinent personal information, educational background, Level 1 and Level 2
EMDR training, number of years practicing EMDR therapy and a consent form for the
EMDR Trauma Recovery Group and accepting the rules of the organization.
b. Assess the application and include applicants who have had an accredited EMDR Basic
training, are volunteers for the EMDR Trauma Recovery Group and accept the rules of
the organization.
c. Add to the WhatsApp groups of the EMDR Trauma Recovery Group volunteers.
d. The President of the EMDR Trauma Recovery Group and Consultants and Trainers
choose team leaders and supervisors based on applicant’s experience, performance and
EMDR training level.
e. Create a WhatsApp group for each team. All information and correspondence is
through WhatsApp.
4. Planning with the Supervisor Group
a. Determine client selection criteria.
b. Decide the interventions, protocols and stabilization techniques to be used.
c. Determine who gives what trainings for the professional development of the
volunteers. For the COVID-19 pandemic, EMDR R-TEP (Shapiro & Laub, 2008)
was chosen to help deal with the acute stress period.
d. Determine supervision times, frequency, length and settings.
e. Determine number of sessions for each client.
Note: In the two studies with Syrian migrants and EMDR R-TEP, the average
number of sessions was 4.13 and 4.16 (Acarturk et al. 2015, 2016). For the 1999
Marmara Earthquake, the average number of sessions was 5.2. Increase number of
sessions when necessary.
f. Check in to see if difficulties are arising with clients and help to generate problem solving.
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g. Determine distribution of clients to therapists.
h. The Supervisors Group focuses on managing the most useful service for the public
based on the circumstances and organizing learning and development opportunities
for the EMDR therapists.
i. Supervisors of volunteer teams hold weekly online meetings to assess client progress.
C. Professional Development and Trainings
1. The Supervisors Group reviewed the literature and information on applications of online
trainings/telehealth and prepared a manual distilling the best information on how to do online
EMDR Therapy.
2. The training for online therapy was based on The Manual for Online EMDR Therapy. EMDR
Recent Traumatic Episode Protocol (R-TEP) training was included in the manual.
3. Teach the EMDR Recent Traumatic Episode Protocol (R-TEP) training to volunteers.
4. A series of online seminars were given to explain this project to the volunteers. The
importance of following every step accurately concerning using the forms, applications and
criteria for clinical judgements was emphasized.
5. Offer seminars to increase the morale and motivation of the group by telling the story of how
EMDR has assisted healing world-wide. This is supported by the recollections of the more
experienced volunteers.
6. Support therapists working to help people affected by the pandemic through national and
international webinars and YouTube channels. The channel name is “EMDR Travma
Iyilestirme Grubu.” Webinars and YouTube videos are private and can only be watched by the
volunteer therapists. If you are interested, contact EMDR Turkey and become a volunteer.
D. Social Media and Press Release Announcements
1. The Social Media Team chooses the platforms, languages and promotion strategies to
support EMDR therapy, the work of the EMDR Association and EMDR Trauma
Recovery Group.
2. Provide updates by making online live broadcasts for the public, besides the social media posts.
3. During the live broadcasts, introduce the EMDR Trauma Recovery Group’s work and
purpose, explain EMDR Therapy and its effectiveness, teach the public about the
symptoms they might be experiencing (psycho-education) during the pandemic.
4. Continue to inform all news agencies of the current work and create opportunities to
participate in programs on television and radios.
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E. Triage: After the announcement of the study to the public, client applications arrive.
These are the next steps:
1. Requests come through WhatsApp or e-mail, they are evaluated and if they meet the
client criteria, the “Client Information Form” (Appendix 1) is sent. While the Trauma
Recovery Group can intervene in any situation, primarily, it gets involved in projects for
those directly affected by the event. Those affected directly by COVID-19 were selected
as the target group.
2. If clients do not meet the criteria, they are not accepted for treatment. They are referred to
other professionals and organizations where they can get free treatment.
3. Clients who exhibit psychotic or serious dissociative symptoms in the application or first
session are referred to their psychiatrists.
F. Forms/Scales
1. There are three different forms within the Client Information Form (see Appendix 1). These
are the following:
a. Personal Information Form
b. The Impact of Event Scale (IES-R)
c. Consent Form
2. Clients acknowledge that the process will be online and the Impact of Event Scale (IES-
R) is be filled out, after a week, and after a month, following the completion of the
process. Clients are accepted into the study and into the system once they check all the
boxes in the Consent Form.
G. Client Guidance
1. Therapists select the times and days they can work on the project. Each team consists of the
therapists who have selected the same times and days of the week.
2. The Information Form is sent to the leader of the team that is working on the time and
day selected by the client for the initial interview on the form.
3. For the first weeks, leaders will refer clients to the most experienced EMDR therapists. This
way, less experienced therapists will have the opportunity to monitor and learn about the
process once more via supervision. Cases will be given to less experienced therapists in the
following weeks, once they are considered ready.
4. Therapists call the clients and make an appointment for an interview. Clients and therapists
together determine the day, time and frequency of their sessions.
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H. Sessions – Framework
1. Sessions are online using applications such as Skype or Zoom. Clients are encouraged to
use a wide-screened monitor, if possible.
2. Sessions are limited to 5 sessions. Additional sessions can be made if necessary.
3. Therapists will – under no circumstances – ask for payment, accept a fee for the session –
even if clients offer – or direct clients to any organization or service that gets money for
the service.
4. Explain that these 5 sessions will only be about the symptoms related to the pandemic and
Covid-19 and other subjects will be excluded from the sessions.
5. Clients who drop-out or are having problems with their therapists will be contacted by the
team leader and can be referred to another therapist.
6. Methods used:
a. Therapists will apply EMDR R-TEP Protocol.
b. During sessions, therapists will only use EMDR therapy.
I. Supervision
1. Each team has a supervisor. They meet online at least once a week. Therapists present
their cases, explain roadblocks, describe the course of the sessions and receive feedback.
Supervision meetings are 90 minutes.
2. The Supervisors change teams, once a month, to supervise other teams. In this way,
therapists will be able to see different points of views.
3. The Supervisors make sure each case is on the right track (the best possible track), while
also supporting inexperienced therapists to learn.
J. Closure Criteria
1. According to the EMDR R-TEP process, interviews are ended once all PODs are worked
on and the Traumatic Episode is completed.
K. Monitoring/Follow-up
1. The Impact of Event Scale is submitted at least one week after the completion of the
interviews.
2. The Impact of Event Scale is sent once more, at least one month, after the completion of
the interviews.
3. Clients whose results have not improved and continue to experience symptoms are called
back for further assessment.
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Statistics
Statistical results given below are the initial data obtained between March 26 and May 4, 2020.
Obtained data are collected in a research format. Required permission is obtained with the
Consent Form. Findings obtained after the program will be written in a scientific format and
submitted to a vetted journal.
Note: There is a N = 426. The results below show only a fraction of clients as many have not yet
finished the intervention. The rest of the data will be forthcoming and analyzed after the clients’
completion of their interventions.
These are the tables with the data that has been analyzed so far.
1. Gender & Occupational Group Distribution of All Applicants
Table 1. Gender Distribution of All Applicants
Gender
Frequency (n)
Percentage (%)
Female
334
78.40
Male
92
21.60
Table 2. Occupational Group Distribution of the Total Applicants
Occupational Group
Frequency (n)
Percentage (%)
Health & Related Occupations
(Police forces, Municipality, the Red Crescent, etc.)
219
51.40
Coronavirus Carriers
78
18.30
Relatives of Coronavirus Carriers
70
16.43
Relatives of Coronavirus Victims
59
13.84
2. Gender & Occupational Group Distribution of the Clients with
Completed Treatments
Table 1. Gender Distribution of Clients with Completed Treatments
Gender
Frequency (n)
Percentage (%)
Female
79
79.8
Male
20
20.2
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Table 2. Occupational Group Distribution of Clients with Completed Treatments
Occupational Group
Frequency (n)
Percentage (%)
Health and related occupations
(Police forces, Municipality, the Red Crescent, etc.)
68
68.7
Coronavirus Carriers
13
13.1
Relatives of Coronavirus Carriers
13
13.1
Relatives of Coronavirus Victims
5
5.1
3. Impact of Completed Treatments on the Results of IES-R Scale Levels of Clients
Histogram graphs were used for the two variables and score distributions were determined as
normal. “T” Test was applied for the paired samples to determine the impact of the experimental
process that was applied. “T” Test results are given in Table 3.
Table 3. “T” Test Results of the scores obtained from the pretest and final rest for impact of event scale
N
X
Ss
t
p
Pretest
99
46.22
11.45
13.09
.00
Post Test
99
26.28
11.85
According to the results -obtained from the “T” Test- that were applied to determine the impact of
EMDR Therapy, post test scores are significantly different from the pretest scores (t=13.09, p<.01).
The results show that the pretest arithmetic mean of the citizens effected by the Coronavirus is X =
46.22 while the post-test arithmetic mean is X = 26.28.
Preliminarily, it is possible to say that the EMDR Online Therapy is efficient in lowering PTSD symptoms.
References
Acarturk et al.(2015), EMDR for Syrian refugees with Posttraumatic Stress Disorder symptoms; results of a
pilot randomized controlled trial. European Journal of Psych traumatology., 6:1, 27414.
Acarturk et. Al. (2016) The Efficacy of EMDR for post-traumatic stress disorder symptoms and depression
among Syrian refugees; results of a randomized controlled trial. Psychological Medicine, 46, 2583-2593.
Cambridge University Press.
Konuk et all (2006) The effects of Eye Movement Desensitization and reprocessing (EMDR) Therapy on
post-traumatic stress disorder in survivors of 1999 Marmara, Turkey, Earthquake. International Journal of
Stress management, 13, 3, 291-308.
Shapiro , E., & Laub, B. (2009). The New Recent Traumatic Episode Protocol (R-TEP). In M. Luber (Ed.),
Eye movement desensitization and reprocessing (EMDR) scripted protocols: Basics and special situations
(251–270). New York: Springer Publishing.
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Appendix 1: “Client Information Form
Personal Information Form
The Personal Information Form includes the following:
1. Name, Surname ___________________________________________________________
2. Gender __________________________________________________________________
3. Age ____________________________________________________________________
4. Telephone _______________________________________________________________
5. Contact in case of emergency ________________________________________________
6. Email __________________________
7. Check the criteria that applies to you:
a. Relatives of the persons who lost their lives due to the coronavirus.
b. Diagnosed persons and their relatives.
c. All the health care personnel, law enforcement officers who give service to these
persons directly, municipal officers, the crisis management concerning the epidemic
and the people working in support services.
d. Families of all the health care personnel, law enforcement officers who give service
to these persons directly, municipal officers, the crisis management concerning the
epidemic and the people working in support services.
8. Job _____________________________________________________________________
9. City ____________________________________________________________________
10. For health and similar employees, have you made close contact with someone diagnosed
with coronavirus (COVID-19)?
11. For health and similar employees, are you in a team directly in contact with coronavirus
(COVID-19)?
12. Preferable times and days for treatment
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The Impact of Event Scale (IES-R)
Administer the IES-R pre and post treatment.
Online Consultancy Consent Form
The example below shows the type of consent form we have used for this study:
Dear Client,
This is the Online Consultancy Consent Form we are using for our study. Please read the
information carefully concerning your rights and our responsibilities. This information is important
for us to serve you better and to support the online consultancy process more effectively:
1. For many years, online therapy has been used all over the world as a practice proven to be
effective in terms of psychological health when face-to-face interviews are restricted or
inappropriate.
2. The success of our study depends on the cooperation and open communication between client
and therapist.
3. What is spoken during the session will remain between you and your therapist, unless you give
your consent for the therapist to consult with someone else. However, in cases such as abuse,
suicide risk, or threat to yourself or your relatives, we may share information about you with the
legal authorities, in accordance with our professional ethical principles and laws without your
permission.
4. We believe the data collected is scientifically valuable and can be used for academic purposes.
However, all information concerning your identity will be encrypted.
5. Sessions take 50 minutes. However, the meeting period may exceed 50 minutes or may take a
shorter amount of time, if deemed necessary by both parties.
6. You can ask your therapist about the therapy process, and his or her training and experience.
7. If your therapist arrives late for the session, your session time will still last 50 minutes. When
you arrive late for the session, your therapist does not add to the interview time, the session ends
at the normal time. It is your responsibility to be on time.
8. We will do everything to ensure that you will not be disturbed during the session, The door of
the room will be closed. You are also responsible for ensuring that these sessions are not
disturbed as well: please turn off any screens that you bring into the session. Do not use alcohol
or drugs before the session, as they may interfere with your therapeutic experience. Your
therapist may suggest that you contact a psychiatrist to assess your condition, if necessary.
9. The sessions will not be recorded digitally. Clients’ privacy will be protected by encrypting the
personal data you provided. If you approve the informed consent form, you undertake to protect
the privacy of the therapist under the law of personal data protection. In other words, you agree
to not make any type of recording of the session.
10. By accepting the above conditions for online therapy, you are saying that you understand these
conditions and agree to each of them. You also agree not to record any part of the sessions or
allow others to listen to the sessions by phone or other devices without prior agreement.
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11. If you behave in a disrespectful manner such as engaging in verbal insults, long speeches or
unsuitable behaviors for the situation, your practitioner may end the conversation.
12. Once you have filled in the Application Form, all data but especially the question asking you
“the reason of your application,” is protected by our center under the law of personal data
protection of Turkish law.
I accept the online sessions. Also, I agree that I have read and understood this Statement of Consent.*
* I approve as the legal guardian of those under 18 years of age.
If you fill in and confirm the information below, you agree to continue your online sessions
with our therapist.
Date:
Name (printed):
Signature:
© Emre Konuk 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 konuk@dbe.com.tr. All rights are reserved.
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8
The Global
Child-EMDR
Alliance
Ana M. Gomez
hen the Coronavirus crisis became a reality for all of us, initial despair and fear took over.
Clients of all ages were reporting increased anxiety, stress and fear. Uncertainty was free-
floating amongst all of us. However, I was reminded of the incredible resiliency and strength that we
all possess, especially when we work together. At this point, I knew this was much bigger than
anticipated and required a much greater response. I remembered the story of the Tabonuco trees that
had survived for many years in very rough terrains and strong hurricanes, in addition to structural
instability. These trees survived through collaboration as they hold each other’s roots to exchange
nutrient and provide support to sustain the strong winds.
This is when the idea of creating a global alliance came. Immediately, I started to call child and
adolescent EMDR trainers and experts around the world. When I mentioned the idea of organizing a
global group that could help our children and youth, it was received with incredible passion and
excitement.
W
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Quickly, trainers and consultants from the UK, Ireland, Turkey, Holland, Germany, Japan, Australia,
Ecuador, Brazil, Argentina, Canada, Colombia, Puerto Rico, Ireland, Italy, Spain, the USA and Israel
joined initially. Now, we have child EMDR leaders, trainers and consultants from over 30 countries in
our Global Alliance.
The resources I am presenting here have been created by an incredibly dedicated group of people. This
group has worked diligently and tirelessly to create webinars at no cost for EMDR clinicians. Story
books, songs, guidelines and resources for emotional regulation and much more for children, adolescents,
parents and EMDR clinicians have been created in a short period of time. We have followed the teaching
of the Tabonuco trees and are holding each other as we get through this difficult time.
The Global Child-EMDR Alliance has formed four basic groups and added different task forces to
divide the work load:
1. Children
2. Adolescents
3. Parents
4. EMDR Clinicians (Social media)
Each task force has been responsible for developing resources for that specific group as well as supporting
each other’s efforts. Resources developed have been quickly translated into multiple languages.
Below, is a summary of some of the current resources being distributed to all EMDR clinicians as
well as children, adolescents and parents. It is important to highlight that we have done all this work
with very little financial support and we have all donated our time, our resources and in some cases
our own money.
In the future, when we have the resources to put our website online:
www.globalchildemdralliance.com. All of our material will be available there.
In addition, there are three YouTube channels:
1. Spanish/Portuguese:
https://www.youtube.com/channel/UCh36gfueRMq9zTiYqiRG4wA?view_as=subscriber
2. English and multiple languages:
https://www.youtube.com/channel/UC1RyVUunlxD-7G1cTn7ymIA
3. Turkish & English:
https://www.youtube.com/channel/UCQs45EkJvyRmwnQt6bCeNg?view_as=subscriber
In the meantime, please download what is available on my website’s COVID-19 resources page and
contact me with your information if you would like to be informed when the Global Child-EMDR
Alliance is up and running: https://www.anagomez.org/covid-19-resources/
Also, there are other websites available below for your immediate use.
Note: If you see a resource without a website or contact information, it will be available on the website or
the YouTube channel at a later date.
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Global Child-EMDR Alliance Resources
Free Webinars for EMDR Clinicians
Close to 15,000 clinicians from all over the world have registered to attend our past free
webinars. These webinars remain open and available for viewing and new ones will be offered in
the future. We also have our own YouTube channel where you can continue to access our free
resources.
1. Recording of EMDR Child Therapy During the COVID-19 Crisis Webinar: Organized by
the “EMDR Clinicians Task Force” (presenters in alphabetical order: Amy Terrell (USA),
Ana M Gomez (USA), Ann Beckly-Forest (USA) & Susan Darker-Smith
(UK)) https://youtu.be/55tVV9RzRr8
2. Recording of EMDR Adult Psychotherapy During Corona Crisis Webinar: Invited
presenters in alphabetical order: Dolores Mosquera (Spain), Isabel Fernandez (Italy), Kathy
Steele (USA), Tamra Hughes (USA). These presenters also donated their time.
Adult Covid: https://youtu.be/yQMhZ39ktnI
https://www.youtube.com/watch?v=yQMhZ39ktnI&feature=youtu.be
3. En Español Grabaciones: Terapia EMDR con Niños en Tiempos del COVID-19:
Presenters in alphabetical order: Ana M Gomez (USA/Colombia) & Glenda Villamarin
(Ecuador). https://www.youtube.com/watch?v=xQuiZBs1OvA
4. Recording of “The Corona Times: Navigating the Challenges & Building Bridges with
our Teenage Clients: Organized by the “Adolescent Task Force.”
Presenters in alphabetical order: Alexia Tsilimpokou (Greece), Annie Monaco (USA), Eva
Malte (Denmark), Jillian Hosey (Canada), Joel Manzano Mojica and Maria Lopez (Puerto
Rico) https://youtu.be/Yug9eh0N_Ws
5. Recordings: Parenting Times in Coronavirus Era: Organized by the “Parent’s Task Force”
Presenters in alphabetical order: Cathy Schweitzer (USA), Debra Wesselmann (USA), Maria
Zaccagnino (Italy), & Stefanie Armstrong (USA)
https://vimeo.com/409766915
6. Free Webinar, sponsored by the Children’s Task Force. This presentation will be available in
our YouTube channel: Presenters in alphabetical order: Ana M Gomez (USA/Colombia),
Daniela Lempertz (Germany), Derya AltinaY (Turkey), Esty Bar-Sade (Israel) Linda
McGuire (Ireland), Michel Silvestre (France), Susan Darker-Smith (UK).
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Books & Workbooks for Children
1. Hili and the Coronavirus
Esty Bar-Sade (Israel)
Available in the following languages: English, Arabic, Hebrew, Japanese
2. Little Zebra’s Lovey Dance
Derya Altinay (Turkey)
Available in the following languages: English & Turkish
https://www.youtube.com/channel/UCQs45EkJvyRmwn-Qt6bCeNg?view_as=subscriber
3. Journey to Atlantis: Reaching the Resources During Coronavirus Times
Derya Altinay (Turkey)
Available in the following languages: English & Turkish
4. Beating the Virus and Winning the World
Linda McGuire (Ireland)
Available in the following languages: German, Hebrew, Turkish, Japanese.
https://youtu.be/btevHHzMoUQ
5. Corona de Invisible
Linda McGuire (Ireland)
Available in the following languages: English, Turkish
https://youtu.be/9ciy87C1xt8
6. The Seashell
Susan Darker-Smith (UK)
Available in the following languages: English, Polish
7. Max and the Virus, Max and His Sister & Max Going Back to School
Michel Silvestre (France)
Created in Doodle by: Susan Darker-Smith (UK)
8. How to Talk About Coronavirus to Children
Anna Rita Verardo (Italy)
Available in the following language: Italian, English & Japanese
https://www.facebook.com/AssociazioneEMDRItalia/videos/496523731025383/UzpfSTE0
ODc5NDE0NDY6MTAyMjIzNDc3NTU5NTEyNTY
9. The Story of the Oyster and the Butterfly: The Coronavirus and Me
Ana M Gomez (USA/Colombia)
Available in the following languages: English, Spanish, French, German, Hebrew,
Portuguese, Japanese, Serbian, Chinese, Hungarian, Creole, Greek, Albanian, Romanian,
Italian, Turkish, Polish, French, Tamil, Finnish, Afrikaans, Albanian, Estonian
https://www.anagomez.org/covid-19-resources
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10. The Coronavirus Helping Box (EMDR version)
Ana M Gomez (USA/Colombia)
Available in the following languages: English, Spanish, Portuguese.
https://www.anagomez.org/covid-19-resources
11. The Story of the Global Child-EMDR Alliance
Susan Darker-Smith (UK)
12. My Book of Resources
Alexandra Kerasioti & Alexia Tsilimpokou (Greece)
Available in the following languages:
English http://online.fliphtml5.com/zdfdw/hvuv
Greek http://on line.fliphtml5.com/zdfdw/yemx
13. Just Like the Cactus
Alexandra Kerasioti & Alexia Tsilimpokou (Greece)
Available in the following languages:
English http://online.fliphtml5.com/zdfdw/ochb
Greek http://online.fliphtml5.com/zdfdw/ik iy
Songs for Children During Corona Times
1. The Lovey Dance
Derya Altinay (Turkey)
Available in the following languages: English, Turkish
2. The Oyster Dance
Derya Altinay (Turkey)
Available in the following languages: English, Turkish
3. Oh Corona
Linda McGuire (Ireland)
Available in the following languages: German, Hebrew, Turkish, Japanese.
https://www.youtube.com/watch?v=0DPTKXRTCf0
4. D-Do the Dance!
Susan Darker-Smith (UK)
5. Rainbows follow Rain / Love is the Connection
Susan Darker-Smith (UK)
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Additional Resources for Children
1. A video showing children how to use strategies for self- regulation is now available. This
video was recorded by the “Children’s Task Force.” In alphabetical order: Ana M Gomez
(USA/Colombia), Daniela Lempertz (Germany), Derya AltinaY (Turkey), Esty Bar-Sade
(Israel) Linda McGuire (Ireland), Susan Darker-Smith (UK)
https://www.youtube.com/watch?v=wirIpC6T3fo
2. The “Children’s Task Force” has created a survey using Survey Monkey which is being
distributed now seeking to investigate the main issues children are still struggling with and
the resources that they are utilizing to help themselves that have been effective. Developed
by: Linda McGuire (Ireland), Susan Darker-Smith (UK)
https://www.surveymonkey.co.uk/r/WLBRGCS
We will utilize the information from this survey to better serve our children and create
additional EMDR resources.
3. The Butterfly Heart Hug
Linda McGuire (Ireland)
https://www.youtube.com/watch?v=9LhJXFC3UOU
Books & Stories for Adolescents
1. Noi, adolescentiiin vremea coronavirus ului INSTRUCTIUNI PENTRU
SUPRAVIETUIREA EMOTIONALA
Anna Rita Verardo (Italy)
Available in the following language: Italian
2. The Corona Times
Jillian Hosey (Canada)
Available in the following languages: English, Finnish, Greek, Spanish, Romanian, Danish, Hebrew
3. The Teen Mandala Book: My Guide to Coping with Coronavirus
Joel Manzano & Maria Lopez (Puerto Rico)
Available in the following languages: Danish, Spanish, Arabic, English, German, Greek, Hebrew,
Italian, Japanese, Portuguese
Resources for Parents
1. Help for Parents and Caregivers During the Time of the Coronavirus
Available in the following languages: Danish, English, German, Italian
https://www.youtube.com/watch?v=hFfwK40Oodc (English version recording: Help for
Parents During COVID-19” created by the Parent’s Task Force).
2. Italian version recording: “Help for Parent During COVID-19” created by the Parent’s Task
Force and Presented by: Maria Zaccagnino (Italy).
https://www.youtube.com/watch?v=mNgk96G06Uo
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3. German version recording: “Help for Parent During COVID-19” created by the Parent’s Task
Force and translated by Daniela Lempertz (Germany).
https://youtu.be/jvFwQzak4XA
4. Japanese version recording: “Help for Parent During COVID-19” created by the Parent’s
Task Force and translated by Miyako Nishi Shirakawa and Japanese team (Japan).
https://youtu.be/-ceGN6_QN1Y
5. Spanish version recording presented by Glenda Villamarin (Ecuador) from the Parent’s Task
Force: “Help for Parent During COVID-19”
https://vimeo.com/409796553?fbclid=IwAR1UG2telp688J1ITasCJ8rQ7rbwiXyeJv5lpPRUk
3W5T-puPX78K_BXjQg
Social Media
1. The “Clinicians Task Force and Social Media” has created a Facebook page for the Global
Child EMDR Alliance and a Facebook group:
https://m.facebook.com/pages/category/Mental-Health-Service/Global-Child-EMDR-
Alliance-110539197240016
This is where resources created by the Global Child EMDR Alliance are shared with clinicians and
the public. Amy Terrell (USA) & Ann Beckly Forest (USA) have worked diligently to maintain
these groups.
2. “La Alianza Global Infanto-juvenil de Iberoaméricahas a Facebook page and the group has
a YouTube channel, also:
YouTube ≈ https://www.youtube.com/channel/UCh36gfueRMq9zTiYqiRG4wA?view_as=subscriber
Facebook https://www.earlyemdrintervention.org
https://www.facebook.com/alianzaglobalemdrinfantojuvenil/photos/p.10204091150038
1/102040911500381/?type=1&theater
3. The “Adolescents Task Force” has created an Instagram account for teens
https://www.instagram.com/globalchildemdralliancetr
4. We have three YouTube channels:
a. One developed by the Spanish speaking countries members of the alliance:
https://www.youtube.com/channel/UCh36gfueRMq9zTiYqiRG4wA?view_as=subscriber
b. The YouTube channel for resources in English and multiple languages
https://www.youtube.com/channel/UC1RyVUunlxD-7G1cTn7ymIA
c. Turkish & English created by Derya Altinay (Turkey) and her Turkish team:
https://www.youtube.com/channel/UCQs45EkJvyRmwnQt6bCeNg?view_as=subscriber
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Translation
Multiple translators around the world have supported our efforts. Many of them are our own
Global Alliance members. We are incredibly grateful for their help and support.
Logistics
I want to recognize the work of all the people that have done significant logistics work and
donated their time to support the Global Alliance’s efforts such as Jim Mason and many of the
Global Alliance members’ partners, family and friends.
This is truly an inspiring group of people -from around the world- who came together and
created massive amounts of resources, in just five weeks. This group is showing the power that
we have when we work together and in collaboration. This pandemic has brought pain and grief
but has also brought out the best in all of us and this group is a testimony to this. I am honored to
be among such a compassionate, wise and remarkable clinicians and human beings!!
I want to recognize the work of all the people that have done significant logistics work and
donated their time to support the Global Alliance’s efforts such as Jim Mason and many of the
Global Alliance members’ partners, family and friends.
© Ana M Gomez. 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 info@gomez.org . All rights are reserved.
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9
Therapy in a
Time of Turmoil
Transcription
from Livestream
Webinar
Deany Laliotis
Introduction
am grateful that we can all gather together during this very uncertain time. I am truly moved
by the extraordinary response to this seminar, as it speaks to the level of commitment we
have as a community to healing and helping people during this time of crisis and turmoil. I am
also honored to be part of your journey to become a better therapist in the face of these new set
of challenges.
Our lives and our work are not the same as they once were. I hardly recognize it. For me, it’s
been three weeks since I’ve seen my family, my friends, my colleagues and my clients. For some
of you, it’s just starting to happen now, and for others, it’s been this way for months already.
I
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Nervous System When Under Threat
However long it’s been, our nervous systems are all getting the message that we are under threat.
Our sense of safety has been ruptured, our sense of continuity all but gone, and we’re deluged
with stories about life and death while we deal with the inherent uncertainty of our times.
So, how is your system responding? Are you plowing through as if everything is under control? Are
you over functioning, particularly with clients who are really struggling? Are you numbing out,
minimizing what’s going on; perhaps avoidant, or getting too much into the weeds with the details?
Are you eating a little too much chocolate drinking too much alcohol, or staying up watching the
news and not getting enough sleep because you’re so agitated by the time you go to bed?
Herd Mammals & Connection
You’ve probably experienced most of the above responses, as you, too, are struggling with the
uncertainty and unpredictability of what’s happening. We are all experiencing some level of fear. As
herd mammals, we are wired to feel it together, as if we’re being chased by a predator in the wild.
That’s the good news and the bad news. The good news is that we can come together as we have
here today to stay connected to one another…to be in our herd. The downside is that fear is
contagious. We can fuel one another’s fears, too. Our client’s fears can easily touch into our own…
and then what? Well, of course that will happen. It’s inevitable as we go through this together.
Resourcing vs. Reprocessing
One of my consultees was describing working with an Infectious Disease doctor as her client. He
is working on the front lines of this pandemic and is anxious and exhausted. He shares with his
therapist that they tried a viral remedy at the hospital that made the COVID patients worse. He is
fearful that they will not be able to help them get better. Meanwhile, the therapist is asking
questions in consultation about how to best proceed with this client, feeling like he was too
overwhelmed to proceed with memory processing. What became clear as we continued to talk
about it, was that SHE, TOO, was feeling fearful about whether or not she could help HIM! Once
she was able to make the connection, (that is, that his fear became hers), she got really clear that
the client was resourced enough to tolerate the processing and that would be far more effective
than resourcing strategies.
That’s actually been one of the big questions in every consultation group I’ve done in the last
three weeks. Therapists were saying that because there is so much stress that we should just be
focusing on stabilizing our clients…well, maybe that’s true, but maybe, that depends.
Transitioning to a New Way of Doing EMDR Therapy
Questions like this one among many, many other concerns, is what prompted me to offer this
seminar. My email has been blowing up with questions about how to transition to an online
format; how you actually administer the processing, and, oh, by the way, what should we be
focusing on when our clients are presenting with a crisis of one kind or another?
By now, many of you have figured out the technical aspects of administering EMDR processing
procedures online, and there’s a lot out there about it, so we won’t be focusing so much on that
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today. Implicit in these queries, however, is the recognition that we are all in unchartered
territory. My goal for us today is for you to walk away feeling like you’re not going at this alone;
but instead, you are a part of the herd of EMDR therapists all over the world, and that you’re
walking away with a deeper appreciation of the inherent challenges of being a healer during a
time of crisis. Some of you might remember Fracnine teaching about issues of safety and talked
about the fear of being cut out of the herd.” We’re in that fear. For us as a community, this is a
time for social cohesion and mutual support. We need our community to remain resilient if we
are going to continue to bring our best selves to this work in this time of turmoil.
Switching to a Virtual Platform
I recently came home from a ski vacation on March 14th just as the crisis was escalating in this
country. I was concerned about my exposure after being in crowded areas such as passenger
vans, buses, trams, and of course, airplanes, with people from all over the world. My husband,
Dan, and I made the decision that switching to a virtual platform was the only socially
responsible thing to do. So, I contacted all my clients and consultees via email of this decision
with detailed instructions on how to access the platform. One client, who has severe attachment
issues, reacted with anger, feeling alone and abandoned. I shared my concerns with her, but it
didn’t help. Reluctantly, I agreed to meet with her in person, observing the social distancing
guidelines, to see what we could figure out.
So, clearly, she was being triggered, but there is also a truth to her experience. She may not
actually see me in person for a long time. For someone who was abandoned as a child, that’s a
major crisis. In our in-person session the next day, I shared with her my concerns about being
exposed and exposing others, and, in addition to not seeing my clients, I also was not seeing my
aging mother, who lives alone, or my kids or grandkids. I didn’t want to take the chance that I
could get someone sick.
My willingness to be open and transparent with her, to share my fears and my own personal
sense of vulnerability helped us turn the corner together. She discovered that she was not alone
in her experience. We were actually going through it together. Yes, this is our collective trauma.
What I learned from her early on in this crisis was that being more transparent, or HUMAN, was
necessary. Rather than concealing my fear, I shared my personal experience in a way that offset
her feeling alone. I used a most valuable and real resource…our connection.
How Do We Stay Grounded in this New Normal?
Now, is every client going to welcome our self-disclosures? Probably not. Some of our clients
will find it more anxiety-provoking to bring them into a shared reality. That said, how do we
keep ourselves grounded in our own experience while, at the same time, navigating the needs of
our clients?
Offering Hope with Stories of Triumph
I think there are a number of dimensions we are all managing as part of this situation. The first
one is about life and death, as I indicated earlier. We ARE under threat. People are dying and
going to continue to die, some, needlessly. Some of us will lose someone we love. Some of you
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may have already lost someone you love. You may or may not have been able to see them before
they died. That makes me think about what I have to say to people I really care about like my
mother, for example, who is 85 and lives alone. What if I don’t see her again in person? What do
I want her to know? In addition to talking to her every day, I am writing her letters and putting
them in the mail so she receives them in hand (after wiping, of course) and can read them the
old-fashioned way…sometimes over and over again. With each letter, I share my appreciation
for her and my father, particularly, what is helping me get through this. As a first-generation
immigrant from Greece who came to America after the second world war, she had the experience
of coming to this country experiencing a very different life…suddenly. She had no extended
family, no friends, no language, no sense of place, no sense of belonging. Yet, I grew up in
community, feeling safe and nurtured. My parents came with nothing and made a life for us.
That is a story of triumph over adversity. It’s important that we look for these kinds of stories,
for ourselves, and for our clients. It keeps us hopeful that we, too, can get through this.
Another client of mine has a brother who is currently in the hospital because of a sudden
diagnosis of late-stage colon cancer. She received a call from him last week just before our
session that this may be the last time they speak to each other. She was devastated. He is alone in
the hospital and he may die alone. She is bereft. They only recently reconnected after years of
being estranged…so, the impending loss created an opportunity for conversations they might not
have had otherwise.
Along the lines of life and death, our friends with whom we went on vacation with, tested
positive for the virus. While they were experiencing symptoms the week before, I am meeting
with my clients and consultees, while quietly managing this pit in my stomach.Are they going
to be okay???” “Are we going to be okay?” “How am I going to handle it if they get really
sick...if I get sick?Good question, when you have people who are depending on you as a source
of support. So, I ask you, have you thought about how you’re going to handle it with your clients
if you get sick???
So, with the same client I shared with you earlier who felt alone and abandoned, I brought it up
with her in our next session (which was virtual). I really wasn’t sure how to handle this
probability, or what the best course of action would be. Of course, not everyone is the same. But
some clients are more vulnerable than others, so, this time, I decided to enlist her in the
conversation. So, I asked her, “How are WE going to handle it should I get sick?” We discussed
how she wanted to be informed; if she wanted the option to meet with someone else if it was a
prolonged illness, etc. Ironically, she was actually relieved and reassured by the conversation.
You can be sure all of our clients are all wondering about that same thing. Again, being more
transparent and relational helped. There was no magic bullet.
There Are No “Right” Answers
I think the other part of it for me was that I truly didn’t know what the “right” answer was. That
needed to be okay, too. If I could give myself permission not to have the “right” answer, and
allow myself and her to struggle with it, maybe that’s as good as it gets some of the time. That
has been another important lesson.
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Staying Present
Also inherent in that lesson is the importance of staying present in a moment to moment way. As
EMDR therapists, we’re good at that. We track the unfolding of experience in real time helping our
clients tolerate NOW what they couldn’t tolerate at the time. So, when our clients are coming into
session struggling with the uncertainty and discontinuity of their lives, the challenge is to bring it
into the moment. So, when my client was saying, “I feel soooooo alone,” she needs me to help her
discover that she can tolerate her fear now in a way she couldn’t before, AND she is not alone in it.
That’s one way we help co-regulate our clients’ experience. That, however, requires US to be
grounded in the present moment, feeling into the familiarity of the connection, while at the same
time, managing our own sense of loss and disruption. It’s easy to get swept into the contagion of the
moment, and before you know it, you’ve spent the better part of the session listening to their
anxiety and fear rather than helping them with it.
The Importance of How We Listen
So, while we do need to listen to our client’s stories, HOW we listen is more important. As I say to
my students, “Our clients will do in EMDR processing what they do in their lives.” And, in this
time of crisis and turmoil, that is even more so the case, both for us as well as for our clients. How
we do what we do, or don’t do, for that matter, is amplified. So, if you’re more on the avoidant side,
it’s easy to listen to the crisis of the day, and get seduced into the details of the pandemic, rather
than to also listen with that third ear. Third ear listening goes something like, “How is my client’s
reaction to shifting to a virtual platform, for example, indicative of the issues we’re working on in
therapy? So, for my client who was really angry about having to make this shift, it wasn’t just about
her abandonment issues, it was also about her inflexibility, which is a habituated pattern of response
for her. It was an opportunity to talk about how her upset about the change she had no control over
was self-inflicted, and that it was her reaction that was the source of her suffering. So, we were able
to talk about how she learned that that’s what there was to do; to get angry (rather than scared or
sad, or hurt) and agreed to work on it as a Target Memory (TM). In this case, the Floatback took us
to a TM of watching her parents have a violent fight after her mother had done something her father
disapproved of. Not surprisingly, the memory was about witnessing this pattern of behavior in
others, rather than something that had happened to her. The other issue here is that the
unpredictability of her childhood situation makes change REALLY hard for this client because
change is experienced as a threat; that something bad is inevitably going to happen.
We Can Help Clients Change in This Time of Rapid Change and Uncertainty?
But you know what? Change is hard and these are HARD TIMES. So, how do we help our clients
in this time of rapid change and uncertainty? In this example, I took it as an opportunity to make a
past-present connection, work on the memory network of threatening experiences in her childhood
in the service of helping her respond more adaptively to the changes in the near future. So, how do
we decide whether to, 1) continue with our EMDR work using the standard protocol with the
current context; or 2) when do we pivot away from what we’ve been working on and narrow the
focus, using recent events protocols, stabilization interventions, crisis intervention strategies, or
targeting current triggers with EMD?
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QUESTION #1 From the Audience: This question is from California: “I’ve been social
distancing since March 12th, offering virtual EMDR sessions using bilateral audio where I’m
able to control the length of the BLS passes. I’m only seeing my EMDR clients that have
excellent ego strength, low dissociation, low-stress conditions and healthy supports at home. The
sessions are going very well, and clients are expressing relief that it feels equivalent to being in
my office. I’ve stopped doing EMDR with my C-PTSD clients, though. I’m hoping you can give
some guidance on working with people at a distance that might need EMDR processing but are
more challenging to work with. I fear not being able to sense their needs in the room or to
intervene in a crisis. My instinct is to continue but would appreciate any guidance you could
offer for working with dysregulated and challenging clients via telehealth.”
Wow, what a great question! I’m sure everyone is struggling with this right now. There isn’t an
answer to your question, but I do think there are guidelines. First of all, I’m glad your instinct is
to continue. That’s really great! I understand your reasoning that, for clients whose level of
psychosocial functioning is not as high, you want to be more conservative. However, we need to
task ourselves around what is factoring into our clinical decisions?
We want to be careful about withholding treatment or making an arbitrary shift away from trauma
work to resourcing and stabilization just because there’s a lot going on right now AND your client
has C-PTSD. Yes, there’s a lot going on right now. And yes, many of our more complex clients
are really struggling. And yes, if they are getting further destabilized by their circumstances in a
way that threatens their safety, then stabilizing them is absolutely what there is to do. And, part of
the work also involves tasking your clients around what they need to be doing for themselves in
between sessions. This needs to be a team effort. From our end, we need to offer what we can to
keep them from having to be psychiatrically hospitalized, especially right now, because there’s a
really good chance they will be further traumatized, if they can even get in at all.
Even with clients who are not as debilitated but are easily challenged and dysregulated by these
circumstances, doing some EMD to desensitize the trigger, and rehearsing the use of an
established resource to help them cope with their anticipatory fears in the near future using future
rehearsal is a good idea, as you suggested. That’s what the recent event protocols are about:
focusing on the most disturbing part, then the next most disturbing part, etc., without opening up
the memory network. Again, we want to be mindful of what is informing our choices. The client
I referred to earlier who was triggered by the change to an online format has complex PTSD. She
has a disorganized attachment, a personality disorder, she doesn’t work, her husband died, and
she lives alone. I made the decision to meet with her in person when I did because I knew she
was in real trouble. So, I made the adjustment. She’s stable again, so we can continue with the
work. AND, what stabilized her was that I met her in her distress, but also asked her to step up to
meet me in making the adjustment.
Pros & Cons of Working Virtually
That said, a question I have is this: If you could continue to see your clients in the office while
we were going through this pandemic, would you still change course? In other words, how much
of your reluctance is informed by the inherent stressors of the circumstances and your clients’
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reactions to it, versus doing the work on a virtual platform that is both new for you as well as
your clients? If it’s more about THAT, then let’s talk about the pros and cons of working
virtually and how making some adjustments in HOW we work online can make it work!
Here’s what I know and have heard from colleagues about their experiences with virtual EMDR therapy:
It’s more challenging for us as well as for our clients.
It’s exhausting. It does gets better with time.
It can be more difficult to track the client’s experience virtually. Yes, but we can learn.
It’s more demanding for us because we can’t see the client’s entire body to track the subtle
non-verbal cues or shifts in the client’s experience. Yes, that’s true, so develop your virtual
felt sense. Not everything needs to be tracked visually.
It can be more difficult to maintain contact online versus in person, especially during
reprocessing. In fact, you will be oscillating between connection and disconnection.
Think of it through an attachment lens: How is a client who has an anxious attachment likely to
respond to EMDR processing online? You can you can help them adjust by inviting them to
FEEL into the familiarity of their connection with you. How about an avoidant? Actually,
avoidants do quite well online. Now if you, the therapist, are also more avoidant, that may not
work out as well as a combination. How about the client who has a disorganized attachment and
is easily dysregulated? You’re going to have to work harder to keep them present. You punctuate
the work with more time in between for grounding and reorienting. These are topics for another
time, but for now, it’s one of the lenses you can look through.
While these are all variables, if not demand characteristics of working online, we ALL need to
make the adjustment if we are going to maintain the continuity of care for our clients. It’s not a
matter of whether or not to continue with EMDR therapy virtually. It’s a question of how?
Everyone I have done memory reprocessing with who made the transition from in person to
online unilaterally were surprised that it worked as well as it did. They report that it’s not the
same as being in person. That’s true. But it works, and, it works well. You have to establish how
the BLS is going to be administered. My suggestion is that you try to mimic what you’ve used in
the office. With one woman, who uses multiple modalities because, she purchased an
inexpensive app that has audio, too. And, from time to time, she is also tapping herself.
More importantly, here’s what I’ve learned from my clients:
In the first couple of meetings, I’ve asked more often throughout the session how they’re
doing, both in and out of processing.
I ask what helps in the processing/what doesn’t. I acknowledge that we’re both on a
learning curve and appreciate their patience.
Using my voice during sets helps keep them connected to me and helps with dual awareness
for the client; sometimes, I shorten the sets and take more time in between sets.
With clients who are good at self-regulation, I let them start and stop the set.
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I use my nonverbals more.
I ask about the body more often.
Check in with the client more frequently (sometimes because I’m not sure; other times
because I want to cross-check my assessment of what is happening to make sure I’m on
track). Yes, I’m learning, too.
How Are We Doing?
Another factor that we need to talk more about isn’t about our clients. It’s about us. We’re going
through a lot, too. If you’re feeling overwhelmed right now because of what is going on; your
situation at home is stressful; your clients are struggling; or someone you love is sick; in the
hospital or worst case, has died, you should be thinking seriously about your ability to stay
present to the client’s experience and keeping them safe. This is not the time to push through.
This is the time to reach out for support. We’re in this for the long haul, so we need to be
thinking more about how we’re going to be taking care of ourselves so we can continue to be
available to the people who are counting on us. So, if that’s the case, then YES, it is a REALLY
good idea to slow things down.
Starting with New Patients Virtually
QUESTION #2 From the Audience: “Should we take on clients we’ve not met in person and
go beyond stabilization with EMDR?” I hate to say this, but it depends. As Francine always said,
“this is not a cookie cutter.” Our job is to figure out how to best meet the needs of our clients
given both the external as well as internal resources and variables. That includes in person versus
virtual. Another important factor is timing.
What is the level of urgency to help this person? Is it imminent, as it is with these front-line
health-care workers? In times like these, resourcing may end up feeling like plugging up a hole
that spouts up somewhere else. At other times, it may be more prudent to wait.
While I have taken on clients virtually that I have never met in person, there is a woman that I
met with recently (virtually), that, after three sessions, we mutually agreed that it would be best
to wait until we could meet in person. The decision was based on the fact that there was no
longer the urgency to address the issue as it had subsided; and, there were extended family
staying at her house right now that would make it more challenging to carve out the time and the
privacy she would need. We left it open that, if she changed her mind, she could contact me.
Otherwise, she will check back in once we can resume in person meetings.
In the first vignette, I referred to a case where the therapist was struggling with her client who is
an Infectious Disease doctor and was struggling with whether to stabilize only or proceed with
processing? This patient is someone she has never met with in person, and because of his home
situation is meeting with her in his car. They used the current stressors in the hospital and his NC
which is, “I’m not enough,” and it readily linked to specific childhood experiences. She enlisted
him in the decision about whether to proceed with processing or not, and his response was
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overwhelmingly, YES. So, their plan is to target the recent trigger(s) in the hospital ER using the
Full standard protocol, allowing it to go back to the past, but not to “just let whatever happens,
happen.” We discussed the urgency of getting symptom relief in the present in order to optimize
his current level of functioning, in part by taking some of the pressure off from the earlier
memories and taking it back to target more frequently. IF, the client was to start getting
overwhelmed, the therapist knows to close down the channels of association and shift to EMD on
the current trigger.
In a situation like this, you can argue for using a recent events protocol, which also makes sense.
However, in this case, his trauma is ongoing, and taking the pressure off from the earlier
memories, as long as he can handle it, will yield far better treatment effects.
Now, having said all this, I have to circle back to the therapist. In this example, I know this
therapist is very capable of managing uncertainty in memory processing and is very good at
making on the spot adjustments to help keep her clients emotionally safe. If this were a more
novice therapist, or a therapist who is particularly risk-averse, we would be having a different
conversation.
Loss of Continuity
I’d like to talk about what else we’re all going through. We’ve lost our sense of continuity.
There’s not as much we can count on right now in the same way we could before. Change is one
thing; disruption is another. We can get so over focused on this situation that we lose sight of
what we can do for ourselves and our clients to help maintain a sense of continuity.
One of my consultees was expressing frustration that she is finding herself functioning more as a
crisis counselor than a trauma therapist. She went on to describe working with a client online
who is home with her family and who was frequently being interrupted by family members
coming into her room during the session. I asked the therapist how she responded to the
situation. She went on to describe her frustration because the family was being disruptive, and
she couldn’t control for it. She went on to describe that an additional frustration what that she
was finding herself putting out more fires for her clients rather than doing trauma work. So, I
asked her, “By the way, what are you working on in therapy with this client that you’re having
such a hard time getting to?” She replied, “We’re working on helping her have better
boundaries.” Of course, as soon as she said that, we all laughed, as she realized what had
happened. Instead of harnessing the opportunity to help her client “in vivo” with the issue they
had been working on, she instead, went into problem-solving mode, which for her, was her
reaction to her anxiety and frustration due to the lack of control she is experiencing having to
conduct therapy out of her office.
Does this story resonate with you? I hope so. We are all out of our familiar routines, our spaces,
our comfort zones; we’ve lost our sense of being in control of our physical environments and our
proximity to the people and things we love and are familiar to us. So, what is your response
when your routines are disrupted? Is that your cue to go into management mode in the service of
getting things “back to normal?” In these times, it’s actually more about trying to establish a
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“new normal.” While there is a real disruption to our lives, our challenge, both for ourselves as
well as for our clients, is to establish SOME continuity. Do your clients have routines? Do you
have routines, or are you putting out fires? Yes, we’ve all had to scramble to make these
adjustments. For me, maintaining my exercise program because the gym is closed meant that I
had to make an appointment with myself in the mornings and to keep it in the same way I keep
my appointments with others. It took me a couple of weeks, but I feel so much better now that I
have more continuity in my day. That helps ground me and prepare me for my day’s work, not to
mention that I feel better! Part of being a therapist during these times, is to help our clients with
healthy routines and self-care strategies. So, think about adopting some of those self-care
strategies you are espousing for your clients! As Carl Rogers said, “I have always been better at
caring for others than I have been at caring for myself. But in these later years, I have made
progress!” We don’t have the luxury of waiting until we’re old and wise. The time is now.
QUESTION #3 From the Audience: This is from Donna who is working with a nurse.For
several weeks now, I have been working with a client who is a registered nurse anesthetist. She has
recently been transferred out of her specialty to provide support in the ICU at the hospital where she
works, taking care of COVID patients. Parts of her are feeling exhausted, fearful, sad, and resentful.
At the same time, she is feeling grief and compassion for humanity. I sometimes feel at a loss as to
what to say as I try to provide the best support for her. I am interested in any feedback and
suggestions you might have.”
That’s a great question! And, thank you for working with our healthcare workers who are on the front
lines. It sounds like she has been a client of yours before the pandemic broke out. A couple of
thoughts: 1). Normalize her experience. Acknowledge the disruption. This is not the work she signed
up for and, at the same time, she signed up to be a nurse that helps people who are sick. 2). What part
of her experience is what ANY reasonable person would feel in this situation, and what part(s) is more
about HER and what she brings to it? What grabs my attention is her feeling resentful. What is it
about her history that would explain that reaction? That is the AIP-informed question. For the sake of
example, I will make up a story that feeling resentful for doing something she doesn’t want to do to
help someone may have a childhood connection that could even be related to her becoming a nurse.
So, I would invite her to be curious about her feelings of resentment and explore what might be
driving it? I’m guessing she also feels bad about feeling resentful, which isn’t helping her.
Dealing with Loss
Lastly, and perhaps most importantly, I think the biggest challenge for all of us right now and for the
foreseeable future is about dealing with loss. Loss has been a thread throughout this talk. We have
anticipatory losses, and we have real losses.
I have a client right now who is in the middle of chemotherapy treatments for cancer that was
discovered in January. Her life has been completely turned upside down. She’s a therapist, who is not
only having to deal with her own mortality and vulnerability in an acute way, but she is also trying to
continue to see her clients while she is losing her hair and has “chemo brain.” Her response is to plow
through it. “I can do this,” “I’m okay,” etc. Well, meanwhile, she has elected NOT to tell her patients
that she is ill. While that is a very personal decision, my job as HER therapist is to gently point out to
her that, while it is COMPLETELY understandable that she wants to push through this and maintain
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some level of control and normalcy over her life, at the same time, I am asking her to consider that
how she’s managing her sense of loss may not be the best course of action for her or her patients.
Helping her acknowledge her adaptation gave us the necessary opening to approach her sense of loss
in the moment so she could make contact with it in a way that allowed her to be more present to
herself as well as to her clients.
In terms of the EMDR piece of her work, we targeted the trauma of her diagnosis with success. The
recent triggers came up after we shifted to a virtual platform when the pandemic broke and, of course,
feeling even more vulnerable than before. We targeted a recent trip on public transportation where she
became really frightened of catching the virus and dying from it.
We are Going Through a Collective Trauma
QUESTION #4 From the Audience: “As an EMDR therapist and Consultant from a
European country I get a lot of questions about how to use EMDR online with the heightened
anxiety and stress of everyone, therapists and patients alike. Many of us have endured traumatic
losses. The specificity of the loss, not being allowed to say goodbye, and knowing that, in their
last hours they spent most of it alone, as the medical team comes in fully submerged in hazard
clothing and get in and out as quickly as they can (kind of like a pitstop), and then they’re left
alone for hours…. How do we manage our own losses, while, at the same time helping our
clients with theirs?”
Healing Versus a Cure
This question really speaks to the fact that we are going through a collective trauma. No one is
untouched by what is happening now. When that is what our patients bring to us and we are
either going through it at the same time or have been through it, how do we provide a container
for the human suffering that is universal to all of us? I don’t claim to have an answer for you,
because to offer one would be to trivialize the breadth and depth of human loss, especially when
the parallels are so close to home. My counsel to you is to use your own humanness and to be
transparent (in an appropriate way, of course), and to be a mirror for your patient’s pain, in part,
by sharing that you understand their pain all too well. As you described in your question, the
only thing worse than the loss itself is going through it alone. Perhaps there isn’t a cure, but there
is healing when we can open our hearts and nurture a wounded soul.
Tara Brach, a friend and colleague, who is now a renowned meditation teacher says, “We’re not
survivors of the fittest. We are survivors of the nurtured.” I think that applies all too well in this context.
In Tara’s new book, “Radical Compassion,” she offers a mindfulness practice that I think could
be a great resource for us as well as for our clients. She refers to RAIN as a spiritual reparenting
practice. The acronym is as follows:
The R, is to Recognize (our experience and bring our attention to it);
The A, is for Allowing (ourselves to make contact with our experience);
The I, is to Investigate (more deeply into what we’re experiencing);
The N, is for Nurturing (to help dissolve the sense of a separate self);
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Then, as EMDR therapists, we can install that positive feeling state so it becomes a frame of
reference as well as a new memory.
Existential Times
Socio-political and Cultural Context
So, I think in closing, this is an existential time. We must now more than ever, address our
clients’ clinical issues in the larger socio-political and cultural context in which we are all in
together. Just as landlords are reducing or delaying rent payments, we, too, have to be flexible in
our fee policies. If a client can’t afford to continue their therapy, how do you plan to address it?
Just like the probability of some of us getting sick with COVID; we have to be prepared for these
eventualities. Get together with your peers and talk about your cases. We should ALL be talking
about our cases. As a Consultant, review some of the specialized protocols such as the recent
events protocol or the enhanced EMD (the 2.0) with your consultees. You can combine EMD
with an EMDR-related intervention such as RDI or other resourcing strategies with clients who
are more easily dysregulated. We have so many ways of using this methodology with our clients
now. As a fellow health-care provider, offer your services to the local hospitals. You can become
a community organizer and start making a list of EMDR therapists who are willing to work with
these front-line workers who are risking their lives to save others.
Assigning Meaning
This is also a time to help our clients assign meaning to their experiences, especially loss. This is
way beyond a reset. The social order as we know it is changing. How it changes depends in part
on how we relate to it. Are you going to be a passenger on this train, hoping for the best or
expecting the worse, or are you going to be an active participant that will help shape the future?
As my students have heard me say a million times, “It’s not just about what happened. It’s also
about what happened next.” So, in this context, it’s not just about what’s happening, it’s also
about what we do in response to what’s happening.
Stay Connected
Every day we ask our clients to be brave and to venture into the unknown. Now more than ever, we,
too, need to be brave. We’re all in response to one another, so when you have a good experience in
virtual EMDR therapy, share it! It’s another story of triumph in the face of adversity. If you have a
failure experience, or EMDR processing didn’t work, or you encountered some other challenge
experience with virtual EMDR therapy, talk to someone about it. Try to understand what happened
so you can learn from it. Share what you learned so we can learn from it. We’re in this for a bigger
cause. Francine left us with her legacy of EMDR as her offering to alleviate suffering and promote
world peace. Let’s not squander it. We have to look for these moments of opportunity to be the
change we are seeking, not only to transform trauma but to transform the world. As Heraclitus said,
The only thing that is constant is change.”
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In honor of Francine, I would like to close with one of her favorite poems that she would recite at the
end of a training. Many of you have heard this story. It seems appropriate to read it to you in closing:
A HOPI ELDER SPEAKS
You have been telling the people that this is the Eleventh Hour.
Now you must go back and tell the people that is The Hour.
And there are things to be considered….
Where are you living?
What are you doing?
What are your relationships?
Where is your water?
Know your garden.
It is time to speak your truth!
Create your community.
Be good to one another.
And do not look outside yourself for the leader.
Then he clasped his hands together, smiled, and said, “This could be a good time!
There is a river that is flowing very fast. It is so great and swift that there
will be those who are afraid. They will try to hold on to the shore.
They will feel that they are being torn apart. They will suffer greatly.
Know the river has its destination. The elders say we must let go of the shore, push
off into the middle of the river, keep our eyes open, and our heads above the water.
And I say, see who is in there with you and celebrate! At this time in history,
we are to take nothing personally, least of all, ourselves. For the moment
that we do, our spiritual growth and journey comes to a halt.
The time of the lone wolf is over. Gather yourselves! Banish the word
struggle from your attitude and your vocabulary. All that we do now
must be done in a sacred manner and in celebration.
“We are the ones we’ve been waiting for!”
© Deany Laliotis 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 info@deanylaliotis.com. All rights are reserved.
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PART II
EMDR-Related Stabilization Techniques
P
art II includes 4 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 – created by Lucy Artigas – is well repre-
sented 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
Moenchs transformation of Elan Shapiros Four Elements for Stress Management Exercise into a
colorful way for parents to teach their children to calm their mind and bodies.
PART II
EMDR-Related Stabilization Techniques
P
art II includes 4 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 – created by Lucy Artigas – is well repre-
sented 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
Moenchs transformation of Elan Shapiros Four Elements for Stress Management Exercise into a
colorful way for parents to teach their children to calm their mind and bodies.
© 2020 All rights reserved.
XIX
10
Self-Care Procedure for
Coronavirus (SCP-C)
for Mental Health
Practitioners
Gary Quinn
Edited by Marilyn Luber & Brurit Laub
he coronavirus pandemic is challenging for mental health practitioners. Stabilization
relating to temporary disasters, whether man-made or natural, is done by recognizing that
the past danger is over. The ongoing nature of the coronavirus crisis mainly raises concerns
about dangers in the present and future. Therefore, it requires a new way of stabilization than the
ISP® (Immediate Stabilization Procedure). The Self Care Procedure for Coronavirus (SCP-C)
for Mental Health Practitioners attempts to achieve this goal by dynamically adapting to this
specific global situation.
This procedure can be used once by a mental health practitioner and then becomes a self-care
procedure to be used as needed.
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The SCP-C for Coronavirus can be used with concerns such as:
“I AM AFRAID I MIGHT GET THE VIRUS”
“I AM AFRAID I HAVE THE CORONAVIRUS
“IT IS MY FAULT THAT I INFECTED OTHERS”
“I AM ALONE OR ISOLATED”
“I WILL HAVE NO MONEY”
SCP-C Basic Concepts
1. Negative Thoughts: these thoughts lead to negative, strong, exaggerated, emotional states.
Type I Negative Thoughts are associated with feelings of anxiety, helplessness, panic, fear, loneliness,
depression and anger, such as:
I cannot handle this.”
I am not in control.
I am helpless”
Examples of client’s statements:
“I am worried that I (my family and/or friends) will become ill.- Anxiety
“I feel sick” and/or “I have fever. - Anxiety
“I am going to die.” Fear, Anxiety, Panic
“I am afraid my parents, grandparents, spouse, children are going to die.” Anxiety, Fear, Panic
“It is overwhelming.” “I cannot stand it.” - Anxiety
“The government and health department are at fault for not doing enough.” - Anger
“The government and health department are at fault for doing too much (ordering
isolation/quarantine).” - Anger
“I will have no money.” - Anxiety
“I cannot handle being in isolation/quarantine.” - Helplessness, Anxiety, Anger
“It is not fair.” – Anger, Helplessness
Type II Negative Thoughts are associated with feelings of guilt, inadequacy, regret such as :
It is my fault that my family/ friends got coronavirus.”
I did something wrong.
I should have known better.”
Examples of client’s statements:
It is my fault I got (could have gotten) coronavirus. - Guilt
It is my fault my family and friends got (could have gotten) coronavirus.” - Guilt
It is my fault that I did not buy enough antiviral spray, toilet paper, etc.” - Inadequacy, guilt
“I sold and lost significant money when the stock market started to fall.” - Regret
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2. Positive Thoughts: These thoughts do not feel true at first. After SCP-C, they feel true and are associated with
positive feelings.
Tapping in SCP-C refers to Rapid Alternating Bilateral Tactile Stimulation and can calm a person with its use.
Because the Coronavirus is contagious, we do not want mental health practitioners touching clients.
Tap rapidly 1-2 passes per second or 60-120 passes per minute.
One pass = left tap, then right tap.
If the client is on a telephone, without being able to see you visually, tap your phone rapidly so the
client hears the tapping.
Note:
1. Please note that the SPC guidelines have not undergone formal clinical trials to date,
and current data regarding its success, while encouraging, is still only anecdotal. There
is no data yet that using SPC will be successful in treating stress symptoms related to
the particular concerns of the COVID-19 virus. Your use of this procedure is up to you
solely.
2. The SCP-C is to be used only for situations related to the coronavirus. If other past
illness/es or memories come up direct clients back to their coronavirus issue. If they
keep returning to past traumas, then stop SCP-C and refer to another mental health
practitioner.
SCP-C Script
Step 1: Introduction
Goal: To introduce yourself to the client.
Say, “My name is ________________ (state your name).”
Say, “I’m here to help you.”
Say, “What is your name?”
Say, Can you tell me in a few sentences what is your concern?”
Write the client’s concern in the initial contact form.
Step 2: Preparation
Goal: To introduce the SCP-C to the client.
Say, “There is a procedure that uses tapping that has helped other people and I think will be helpful
for you. You can do it, by tapping with your hands on your knees or with the big Butterfly Hug
Say, Place the heels of your hands on your thighs so the tips of your fingers are on the top of your
knees and then lightly tap with your fingers, first one hand, then the other.”
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Say, “Another way of tapping is the big Butterfly Hug. Cross your arms and put your right hand on
your left arm, and your left hand on your right arm.
Say, I will demonstrate and tap along with you.
Say, “Which way of tapping suits you best?”
After the client choses the way to tap, say the following:
Say, “Tap with me, alternating left to right.
The tapping will help you feel calmer. Is this ok with you? I will continue, unless you tell me to stop.
At any time during our work, you can tell me to stop or raise your hand to indicate you want to stop.”
Say, Stop tapping.”
Step 3: Assessment
Goal: To clarify and specify the client’s negative thoughts and feelings
Say, “While thinking of your concern ____________ (stated during introduction) with the coronavirus,
what are your negative thoughts? Here are some typical negative thoughts:
Say, “Is it?”
Type I Negative Thought
I cannot handle this.”
“I am not in control.”
“I am helpless.”
Say, “Or is it?”
Type II Negative Thought
“It is my fault that family/ friends got coronavirus.”
“I did something wrong.”
“I should have known better.”
Say, What are you thinking?”
Write the client’s negative thought in the initial contact form.
Type I
Say, “When you say this negative thought _______(state Type 1 negative thought) what feelings
come up now?
Say, “Typical feelings can be anxiety, helplessness, panic, fear, loneliness, sadness or anger.”
Say, “Or is it?”
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Type II
Say, “When you say this negative thought _______(state Type 1I negative thought) what feelings
come up now?
Say, Typical feelings can be guilt, inadequacy regret.
Say, “Or is it both?”
If it is both, first complete Step, 4, Type 1 Negative Thought, then go back to Step 4, Type 2 Negative
Thought.
Write the client’s feelings in the initial contact form.
SUDs (Subjective Units of Disturbance Scale)
Say, “Please tell me how disturbed you are feeling now. On a scale of 0 to 10 where 0 is no
disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does it
feel now?” ______/10
Step 4: Stabilization
Goal: To recognize and communicate the client’s ability to learn to handle anything that may happen.
Stabilization is done by tapping rapidly while hearing/saying a positive thought.
Type I Positive Thoughts
These positive thoughts reduce feelings of anxiety, helplessness, panic, fear, loneliness,
depression, anger, and increase a sense of control and calmness.
Say, “Start tapping.”
While client is tapping for about one minute say these sentences often:
Say, “You can learn to be in reasonable control of what you can be in control of.
Say, “You can learn to deal with this.”
Say, “You can learn to have options within the framework you are now living.”
After about one minute,
Say,Stop tapping. Take a breath. Let it go."
Continue saying the 3 phrases in one-minute segments over 5 minutes.
Say, Please tell me how disturbed you are feeling now. On a scale of 0 to 10 where 0 is no
disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does it
feel now?”___/10
If SUDs are 3 or less with no Type II Negative Thoughts, go to Step 5: Closure.
If the SUDs = greater than 3, continue with supportive phrases.
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While tapping for a minute, use the phrases from the list below. Notice the ones that most apply to you.
Say, “Start tapping.”
Say, “The alternating tapping will help reduce your distress.”
Say, “When you are calm, as you are becoming, it strengthens your immune system to prevent
illness and helps you recover.”
Say, “Being in isolation (alone) is a way to be in control of what you can be in control of, by
preventing you from becoming infected or infecting others.”
Say, “You can learn to be in reasonable control of what you can, you cannot be in control of what
someone else thinks, feels, says or does.”
Say, “This pandemic is temporary and will end.”
Say, “The vast majority of people recover from this virus.”
If people are symptomatic:
Say, The fever you have shows that your body is fighting the virus.”
Say, Stop tapping. Take a breath. Let it go.”
Say, Please tell me how disturbed you are feeling now. On a scale of 0 to 10 where 0 is no
disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing
does it feel now?” ___/10
If SUDs are 3 or less with no Type II Negative Thoughts, go to Step 5: Closure.
If the SUDS = greater than 3, continue with supportive phrases.
Say, Start tapping”.
While client is tapping for about one minute say these sentences often:
Say, You can learn to be in reasonable control of what you can be in control of.
Say, You can learn to deal with this.”
Say, You can learn to have options within the framework you are now living.”
After about one minute,
Say, Stop tapping. Take a breath. Let it go.”
Continue saying the 3 phrases in one-minute segments over 5 minutes.
Say, Please tell me how disturbed you are feeling now. On a scale of 0 to 10 where 0 is no
disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing
does it feel now?”___/10
If SUDs are 3 or less with no Type II Negative Thoughts, go to Step 5: Closure.
If client uses Type II Negative Thoughts come up at any time during Steps 1 through 4, continue below.
© 2020 All rights reserved.
Type II Positive Thoughts
These positive thoughts reduce feelings of guilt, inadequacy, and/or regret and increase a sense
of self-acceptance.
Say Start tapping”.
While client is tapping for about one minute say these sentences often:
Say, You did the best you could with the information you had at the time.”
Say, “Whatever happened, happened and you can deal with this from this moment on.”
Say, Stop tapping. Take a breath. Let it go.”
Continue saying the 3 phrases in one-minute segments over 5 minutes. Then check the SUD’s.
Say, Please tell me how disturbed you are feeling now. On a scale of 0 to 10 where 0 is no
disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does it
feel now?”___/10
If SUDs are 3 or less go to Step 5: Closure.
If the SUDs = greater than 3, continue with supportive phrases.
While tapping for a minute say the following phrases from the list below. Notice the ones that
most apply to you.
Say, Start tapping”.
Say, You did the best you could with the information you had at the time.”
Say, “We now know that people who have no symptoms can be infectious, so you may not have
been able to prevent this. You did the best you could with the information you had at the time.
Say, “It takes time to learn and follow all the instructions of social distancing and special hygiene
measures".
Say, “Whatever happened, happened and you can deal with this from this moment on.”
Say, “Please tell me how disturbed you are feeling now on a scale of 0 to 10 where 0 is no
disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does
it feel now?” ___/10
If the SUDs = 3 or less, go to Step 5: Closure.
If the SUDS = greater than 3, continue with supportive phrases.
Say, Start tapping.”
While client is tapping for about one minute say the following sentences often:
Say, You did the best you could with the information you had at the time in the past.”
Say, “Whatever happened, happened and you can deal with this from this moment on.”
After about one minute,
Say, Stop tapping. Take a breath. Let it go.”
Continue this for about 5 minutes
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Say, Please tell me how disturbed you are feeling now. On a scale of 0 to 10 where 0 is no
disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does it
feel now?” ___/10
No matter what the SUDs, go to Step 5: Closure.
Step 5: Closure
Goal: To identify useful Positive Thoughts. To give information about follow-up.
Self-Care
Give the client the Self-Care Procedure (SCP-C) Worksheet for clients.
Say, “Please take a look at the Positive Thoughts that were helpful and underline or circle them.
If other Positive Thoughts came up during stabilization, please write them down now on the
worksheet. You can use these Positive Thoughts with rapid tapping any time you need.”
Say, “Would it be OK if we contact you to find out how are you?
If the client agrees, take down his/her information:
Name:
Telephone:
If the mental health practitioner has a legal issue concern about using this with someone new,
have the client sign and date the Disclaimer below:
DISCLAIMER: This document is intended for the use of trained professional healthcare practitioners only.
Following a session with a trained healthcare practitioner, clients may use this procedure which is being
provided as a service in light of the global CORONAVIRUS health crisis to potentially assist in the decrease
of stress related to the Coronavirus only. Please note that the SPC-C guidelines have not undergone formal
clinical trials to date, and current data regarding its success, while encouraging, is still only anecdotal. There is
no data yet that using SPC-C will be successful in treating stress symptoms related to the particular concerns of
the COVID-19 virus. Your use of this procedure is solely up to you.
In the event that a client using this procedure does not feel a sufficient reduction in stress or any other
psychological issues, it is strongly recommended that the client contact a mental healthcare practitioner
immediately. The author makes no guarantees, either expressed or implied, regarding the efficacy of the
treatment procedures contained herein and makes no guarantee that following the guidelines herein will
provide effective treatment for symptoms of stress or any condition related thereto. This procedure relates
solely to situations related to the current Coronavirus crisis and should not be used to deal with any other types
of psychological trauma.
Client’s signature Date
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Self-Care Procedure for Coronavirus (SCP-C)
Initial Contact Form
Date: ___________ Time begins:
Client Name: Age: ________
City _____________________ State _______________ Country __________________________
Mental Health Practitioner’s Name:
Telephone:
Coronavirus Concern:
Negative Thought/s: Type 1 Type II Both
Negative Feelings:
Pre-Intervention SUDs: ___/10
Post-Intervention SUDs: ___/10
Time Ended:
Agree to follow-up phone call: Yes No
Client signature: (if possible) otherwise verbal agreement
Telephone Number:
Follow-Up Contact: ___________________________ Date of Follow-Up:
Current SUDs: ___/10
Additional Services Needed: Yes No
If yes, provide details:
Go to the website at EMDR-Israel.org for updates and information about doing research.
Please send the initial contact form information (no name) to SPC.C.COVID19@gmail.com
Please describe and send any adverse effects that might have occurred when administrating SCP-C.
© Gary Quinn 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 SPC.C.COVID19@gmail.com. All rights
are reserved.
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11
Self-Care Procedure
for Coronavirus
(SCP-C) Worksheet
for Mental Health
Practitioners
Gary Quinn
Edited by Marilyn Luber & Brurit Laub
he concerns about the coronavirus are mostly about possible ongoing dangers in the
present and future. SCP-C can help reduce negative feelings and increase calmness and
sense of control.
Instructions for Using SCP-C on your own:
Tapping in SCP-C refers to Rapid Alternating Bilateral Tactile Stimulation and can calm a
person with its use.
Tap rapidly 1-2 passes per second, or 60-120 passes per minute. One pass = right tap then left tap.
Say, “Place the heel of your hand on your thigh so the tips of your fingers are on the top of your
knees and then lightly tap with your fingers. Or you can tap the big Butterfly Hug. Cross
your arms and put your right hand on your left arm, and your left hand on your right arm.”
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You can choose which type of thoughts are most helpful for you to use while tapping:
1. Type I Positive Thoughts to reduce feelings of anxiety, helplessness, panic, fear, loneliness,
sadness, anger, and increase a sense of control and calmness.
If you feel these feelings, start tapping and combine the tapping with the positive thoughts
below:
I can learn to be in reasonable control of what I can be in control of.
I can learn to deal with this.”
I can learn to have options within the framework I am now living.”
Add any new, Type I Positive Thoughts that you have had:
“Stop tapping. Take a breath. Let it go.”
Often repeating the above 3 sentences for about 5 or 10 minutes are enough to achieve calmness.
If you need more positive thoughts continue:
“The alternating tapping will help reduce my distress.”
“When I am calm, it strengthens my immune system and helps me prevent illness and can
heal me.”
“Being in isolation (alone) is being in control of what I can be in control of by preventing
me from being infected or infecting others.”
“I can be in reasonable control of what I can, I cannot be in control of what someone else
thinks, feels, says or does.”
“This pandemic is temporary and will end.”
“The vast majority of people recover from the coronavirus.”
If you have coronavirus symptoms you can say:
The fever I have indicates that my body is fighting the virus.
“Stop tapping. Take a breath. Let it go.”
Continue, until you become calmer.
If the distress continues, please contact an EMDR Therapist, or other mental health
professional for further assistance.
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2. Type II Positive Thoughts to reduce feelings of guilt, inadequacy, and/or regret and
increase a sense of self-acceptance.
If you feel these feelings, start tapping and combine the tapping with the positive thoughts
below:
Tap for about one minute saying or thinking the sentences that are helpful to you often:
I did the best I could with the information I had then.”
“Whatever happened, happened and I can learn to deal with this from this moment onward.”
Add any new, Type II Positive Thoughts that you have had:
“Stop tapping. Take a breath. Let it go.”
Often repeating the above 2 sentences for about 5 or 10 minutes are enough to achieve
calmness.
If you need more positive thoughts continue:
I did the best I could with the information I had then.”
“I now know that clients who have no symptoms can be infectious, so there was no way I
could have prevented this.”
“It takes time to internalize all the instructions of social distancing and special hygiene
measures".
“Whatever happened, happened and I can learn to deal with this from this moment onward.”
“Stop tapping. Take a breath. Let it go.”
Continue until calmer.
If the distress continues, please contact an EMDR Therapist or other mental health
professional for further assistance.
© Gary Quinn 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 SPC.C.COVID19@gmail.com. All rights are reserved.
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12
The Butterfly Hug
for the Coronavirus
Ignacio Jarero
gnacio Jarero has used YouTube to show how to do “The Butterfly Hug for the Coronavirus
Pandemic. Here is the link:
https://www.youtube.com/watch?v=BGl5QOFHtbE&feature=youtu.be
This is the transcription of his YouTube video:
Hello, I am Dr. Ignacio Jarero, also known as Dr. Nacho. I am a field worker, mental health
professional with almost 200 deployments around the world, working in worst case scenarios
after natural or human disasters. I would like to share with you what I have been using over the
past 23 years for my emotional self-care during deployment. The name of this is “The Butterfly
Hug.” The Butterfly Hug was developed by the Mexican clinician named Lucina or Lucy
Artigas, following Hurricane Paulina in 1998 in Mexico. Since that time, it has been used around
the world in many settings, with thousands of children, adolescents and adults who have
experienced adverse life experiences.
I
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This is a self-administered bilateral stimulation method to process distressing or adverse life
experiences and the person using this method has total control.
The Butterfly Hug helps in the processing of unpleasant or annoying emotions and/or physical
sensations produced by the distressing or adverse experiences.
At this moment, I am going to show you how to do the Butterfly Hug. Please, follow my
instructions. One hand like this (right hand held straight up), the other hand like this (left hand
held straight up) interlock your thumbs, place your hands on your chest, middle fingers below
the clavicle and do this. Alternate movement (tapping using the right hand and then the left
hand). At your own pace, very good. Very good.
Step 1: Right before dinner or after a distressing event, do the following: with eyes open or
partially closed, not totally closed, run a mental movie of the whole distressing event or the
whole day, if you are doing this on a daily basis. For example, if you are a front liner in a
hospital or in another setting helping people with the coronavirus issue, start from right before
the beginning, until today, or even looking into the future for any distressing scenario that you
have imagined. Once you finished running the movie, go to Step 2:
Step 2: Observe your body, not just notice, scan your body and assess your level of disturbance
from 0 which is no disturbance to 10 which is the maximum disturbance that you can feel. From
0 to 10, the maximum disturbance you can feel.
Step 3: Do the Butterfly Hug while walking or sitting in a chair pretending you are marching at
your own pace. Like this (he demonstrates tapping and marching). Now, with your eyes open or
partially closed, run a mental movie of the whole distressing event or the whole day if you are
doing this on a daily basis, I recommend it, from right before the beginning until today or even
looking into the future to any distressing scenario you have imagined. At the end of the mental
movie, stop the Butterfly Hug and the walking or marching in your own seat. Now, breathe
deeply (takes a breath) twice. Again, breathe deeply twice.
Step 4: Observe and notice your body. Scan your whole body. Then assess your level of
disturbance now from 0 which is no disturbance to 10 which is the maximum disturbance you
can feel. Now, if your disturbance is 4, 5, 6 up to 10, repeat steps 3 and 4 until your disturbance
reaches levels between 0, 1, 2, or 3. Again, if your disturbance is 4 or more, repeat steps 3 and 4
until your disturbance reaches levels between 0, 1, 2, or 3.
Important note. If your distressing symptoms do not decrease or increase, contact immediately a
mental health professional expert in trauma treatment.
Thank you very much for your attention and Butterfly Hugs for each one of you.
© Ignacio Jarero 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 nachojarero@yahoo.com. All rights are reserved.
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13
Four Elements
Parent Activities
Judy Moench
he 4 Elements was developed by Elan Shapiro in 2007 to use as a stress reduction
technique. It has been modified here for use with children. In this chapter, you will see the 4
Elements slides along with a poster that parents can use with children. An e-book and additional
posters are also available for free at prepped4learning.com. The e-book is essentially designed
as a guide for parents to help teach children how to calm their mind and body while using the
slides and doing other activities. It provides discussion topics, activities, posters to print or
download, tips and hints, along with suggested scripts.
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Elan Shapiro created The Four Elements Exercise for Stress Management which has been an exciting part of a school
program currently being developed.
Lucy Artigas developed the Buttery Hug, another form of bilateral stimulation, which is an important component of
this program.
Francine Shapiro created the ground-breaking methodology EMDR therapy.
© Judy Moench 2020. This Resource is copyrighted under United States law. For further information, please contact the author at prepped-
4learning@gmail.com. All rights are reserved.
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PART III
EMDR Early Interventions
T
here 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 helped clients focus their process. e sandwich eect
comes from the dialectical movement that occurs when there is rst an opening resource-then
the trauma intervention-nishing with the closing intervention; this ends with the client feeling
more integrated and having a sense of well-being.
PART III
EMDR Early Interventions
T
here 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 helped clients focus their process. e sandwich eect
comes from the dialectical movement that occurs when there is rst an opening resource-then
the trauma intervention-nishing with the closing intervention; this ends with the client feeling
more integrated and having a sense of well-being.
© 2020 All rights reserved.
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14
The EMDR
Abbreviated Recent-
Traumatic Episode
Protocol (R-TEP
(The “Sandwich”
Protocol
Brurit Laub &
Keren Mintz Malchi
he EMDR Abbreviated Recent-Traumatic Episode Protocol (R-TEP) Protocol is an
adaptation of the EMDR R-TEP protocol and is intended for use as a short, episode/time-
framed focused intervention (such as for the coronavirus outbreak), and takes approximately 40-
60 minutes to complete. It can also be referred to as the “The Sandwich Protocol” because it is
made up of three parts: an opening resource, a Point of Disturbance (PoD), and a closing
resource. The protocol may be used a number of times, as needed. A self-help protocol is
currently being drafted as well.
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There are three kinds of Early EMDR Interventions:
Procedures for Stabilization and Containment: In the first group of interventions, bilateral
stimulation (BLS) is used to install a resource. For instance, in the 4 elements (E. Shapiro,
2007) the BLS is used to install a safe place, together with three stabilizing somatic exercises.
In the Emergency Response Procedure (ERP; Quinn, 2009) or in the Self Care Procedure for
the Coronavirus (SCP-C, see Resources 7&8), rapid BLS is used to install positive thoughts.
Focused Processing with One Target: A second group of interventions, utilizes either limited
or focused processing with one target. For instance, the EMDR Integrative Group Treatment
Protocol (IGTP; Jarero, Artigas, & Hartung, 2006) or the Imma Group Protocol (Laub & Bar-
Sade, 2014) use very brief associative processing with resource installation at the beginning
and end. The EMD protocol (F. Shapiro, 2004) which was reintroduced for use in emergency
situations, is also a focused protocol, with a restricted range of associations due to frequent
returns to the target. It does not include specific resources.
Focused Processing with Several Targets: The third group of interventions includes protocols
for focused processing with several targets or points of disturbance (PoDs) like the Protocol
for Recent Traumatic Events (RE, REP; F. Shapiro, 1995), the EMDR Protocol for Recent
Critical Incidents (EMDR-PRECI; Jarero, Artigas & Luber., 2011) , the EMDR Recent-
Traumatic Episode Protocol (R-TEP; E. Shapiro & Laub, 2009), the Group-Traumatic
Episode Protocol (G-TEP; E. Shapiro, 2014), Self-Care and Individual Traumatic Episode
Protocol (SCI-TEP: E. Shapiro, see Resource 18 and the Self-Care Traumatic Episode
Protocol (STEP; Moench, see Resource 19).
The EMDR Abbreviated Recent-Traumatic Episode Protocol (R-TEP) belongs to the second
group of protocols, however, the authors believed there was a need for a relatively brief
intervention with an increased level of resource focused processing. The two resources come
before and after the processing of one Point of Disturbance (PoD) -forming a “sandwich” to
facilitate a dialectical movement between trauma memory networks and adaptive ones (Laub,
Weiner, & Bender, 2017). This is expected to facilitate integration and restore a sense of mental
and physical equilibrium. The intervention may be helpful when there are time constraints. The
protocol may be used a number of times, as needed.
In summary, The EMDR Abbreviated Recent-Traumatic Episode Protocol (R-TEP) provides a
short, resourced processing of one point of disturbance, by a present and active therapist who
makes use of four focused strategies and various interweaves to facilitate integrative processing.
It also provides “a sandwich effect,” activating resources at the beginning and at the end of
processing to contain and facilitate adaptive processing. The intervention may be helpful
especially when there is high emotional arousal, limited access to resources in the present and/or
when there are time constraints. For clients who need a lengthier intervention, the R-TEP/G-
TEP, or, at times, the Standard EMDR Protocol, will be more appropriate. Since this protocol is
new and research is beginning, it is recommended that the protocol be studied further to
determine its efficacy. Early work with the EMDR Abbreviated Recent-Traumatic Episode
Protocol (R-TEP) anecdotally suggests it can be helpful in the situations described above.
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The EMDR Abbreviated Recent-Traumatic
Episode Protocol (R-TEP) Notes
Stage 1:
The therapist inquires briefly if the client is relatively stable; this means that the client is able to
stay within the window of tolerance, and if not, is responsive to the therapist’s attempts at
assistance. The therapist also inquires if clients have sufficient support and asks clients for
consent to do this EMDR episode/time-frame focused intervention.
Stage 2:
Bilateral Stimulation
If clients find the eye movements difficult during the processing, they can tap without moving
their eyes. Otherwise, all BLS will be carried out with open eyes.
Stage 3:
It is important for the processing to be focused and resourced, in order to stay “on track,” to keep
clients in their window of tolerance, and to facilitate adaptive processing in a limited time.
Focusing is achieved through four strategies that go back-to-target (PoD): EMD, EMDr,
Containing and Pairing. Resourcing is obtained through a supportive presence and continual
therapeutic interweaves. A supportive presence means therapists actively use their physical body
to create an atmosphere of mutuality and safety. Relational interweaves, accentuate therapists’
presence and client-therapist connection, with somatic interweaves facilitating integrative
processing.
EMDr Strategy
Most of the processing will be carried out with the EMDr strategy, using the range of associations
limited to the episode/time-frame alone (such as the coronavirus outbreak time-frame). If
associations outside of this range come up, such as childhood experiences, the therapist will validate
the association, and then return to the target (the PoD).
Say, “What you just said is really significant, and let’s go back from here to where we started from
________(state the PoD). What do you notice? Has anything changed?
Following the client’s response, ask for the level of disturbance (SUD), now. If the SUD is not
ecological (0-3), continue with processing.
EMD Strategy
If the point of disturbance (PoD) is intrusive (recurs repeatedly) or if an intrusive experience
comes up during processing, make use of the EMD strategy, with the range of associations
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limited to the PoD only. If an association comes up that is related to the episode/time-frame, or
outside of that, gently ask the client to return to the target (PoD).
Say, “Let’s go back to the point where we started, so that your system can focus again, process the
PoD and let it go. What do you notice now? Has anything changed? ״
Following the client’s response, ask for the level of disturbance (SUD). If the SUD is not ecological
(0-3), continue processing. Keep sets short (approximately 10 passes). After 7 sets of EMD
processing, if there is no change in the SUD level, continue processing with the EMDr strategy.
Containing Strategy
Containing is achieved by going back to the target (PoD). Use sound clinical judgment to
reorient, refocus or to keep clients in their window of tolerance. It is applied even when the
associations are in the appropriate domains of EMD or EMDr. The containing strategy can be
effective, for instance, when grounding is needed or there is looping. Then use appropriate
interweaves and relatively short BLS sets. This strategy contributes to containment, as it requires
an internal process of reorganization on the part of the client. It also accentuates therapists’
engaged presence.
Pairing Strategy
If a client has made an adaptive association (any positive thought, emotion or sensation, or a
combination of these), it is important to emphasize the association and pave the way for further
change in the point of disturbance through pairing. To do this, validate the resource and ask the
client to go back to target (PoD).
If an adaptive association comes up towards the end of processing, allow for an additional set of
BLS to further strengthen the association, listen to what comes up and then continue with Pairing
by returning to the PoD.
Say, “What you just said is a really valuable resource. Let’s take that back with us to where
we started from. When you go back to the target with the resource close at hand, what do you
notice? Has anything changed?”
In summary, return to the PoD in the following circumstances:
When the associations have gone out of range (according to the two strategies, EMD and EMDr).
In order to provide greater containment when deemed necessary.
Following an adaptive association (any positive thought, emotion or sensation, or a
combination of these).
If an adaptive association comes up towards the end of processing, return to target after
allowing for an additional set of BLS to strengthen the association.
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Marking Resources
During processing, write down the letter “R” next to each positive association that comes up (any
positive thought, emotion or sensation, or a combination of these). This allows easy tracking of the
resources at the end. Please write down the resources so that you can use them later. If you don’t
usually take notes during processing, you may write down the resource on the tracking sheet.
Note: In light of the fact that processing is short, it is vital that it be as resourced as possible. Therefore, it
is important to bring an active and supportive presence to the work, applying several therapeutic
interweaves to help the process move towards integration. After each interweave, ask the client to proceed
with BLS. Somatic interweaves are especially helpful for letting go of negative body sensations, as are
relational interweaves of presence, support and attunement. Mark down any interweaves that were used
during processing in the tracking sheet.
Somatic Interweaves
Below is a list of somatic interweaves that can be helpful to facilitate processing (See Levine,
2010, 2012; Shapiro, 2018(, and may be used following your clinical judgement.
When there is an association to an image, a thought or an emotion comes up, say the
following:
Say, “Notice your body. You know, your body is always talking. When you notice that
_____________ (repeat the image, thought or emotion), what happens in your body? Your body
is letting go now of some of those difficult sensations.”
Following a body sensation that has come up, or that may feel “stuck,” say the following:
Say, “If that sensation could speak, what would it say?” (For instance, if your chest could
speak, what would it say?”)
If the client makes a body movement during processing, or during the sharing of
associations, ask the following:
Say, “I would like for us to notice that movement that you just made, and repeat it, really,
really slowly, from the beginning of the motion until its very end. Let’s do that.
Give the client time to repeat the motion.
Say, “What did you notice as you repeated that motion?”
If the client feels a sensation ask the following:
Say, “Place your hand where you feel the sensation -whether it is pleasant or unpleasant- and
notice what comes up.”
Pendulation. Use pendulation following an unpleasant body sensation that has come up,
does not stop, or feels “stuck.” Please have clients connect to a pleasant or neutral place
in their bodies:
Say, “I will ask you to search for a pleasant or neutral place in your body.”
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Wait for clients’ response.
Say, “Great, now we will move back and forth, a few seconds each time, between the
unpleasant sensation, and then the pleasant one. Let’s try that, just move back and forth,
resting at each spot for a few seconds, back and forth, back and forth, until the unpleasant
sensation lessens or melts away. Great.”
If the client cannot find a pleasant or neutral sensation, you may direct him to a place of
neutrality in the body, such as the earlobe or the tip of the nose.
Say, “Please focus on ___ ( your earlobe/tip of your nose ) and then the unpleasant sensation.
Just move back and forth, resting at each spot for a few seconds, back and forth, back and
forth, until the unpleasant sensation lessens or melts away. Great.”
Use the “Voo” Exercise (Levine, 2010) to balance arousal levels.
Say, “Now we will do a breathing exercise together that will help to pick up your energy level
and let go of unpleasant sensations. We will be making a Voo sound together that will cause
vibrations that will affect the longest nerve in your body, the Vagus, which comes out of our
brainstem all the way down through all of our vital organs, like the heart, lungs, and gut. The
‘Voo’ sound is made by taking in a deep breath, and then, on the out breath, gently making the
sound ‘Voooooo,” sustaining it through the full exhalation; vibrating the sound from the belly.
At the end of the breath, we will briefly pause, allowing the next breath to fill our belly and
chest. Then we will make the sound again, until it feels complete. The important thing is to let
both sound and breath expire fully, pausing and waiting for the next breath to come on its own,
when it is ready. Let me show you.”
Demonstrate once for the client, on your own. Then, do it twice with the client.
Say, “Now let’s do two Voo’s” together. Ready? Let’s take a deep breath in, and Voooooo…”
Relational Interweaves
It is also important to use relational interweaves throughout the process:
Say, “You’re working beautifully,” “Great, just continue,” “Just let yourself ride the wave a
bit…. I’m with you, you’re not alone.”
Relational Somatic Interweaves
Remember, your own body is a significant potential resource. Use non-verbal attuned gestures to
help the client rebalance within the connection. For instance, nod, smile, make use of facial
expressivity, vocal tone, mirroring, and/or use cadence sounds, such as “Yes, yes.”
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The EMDR Abbreviated Recent-Traumatic Episode Protocol (R-TEP) Script
Stage 1: History Taking Brief Intake and Building a Therapeutic Alliance
Therapeutic Alliance
Start by introducing yourself, including your professional background, and then ask clients to
introduce themselves as well.
Say, “Hello, I am ____(state name). I am _______(state profession). Please tell me something about
yourself.”
If the intervention is part of a coronavirus research project:
Say, “We are going to do this EMDR intervention as part of the research project. You will receive
some self-report questionnaires afterwards to fill out.”
Ask clients how they are doing, if they have enough support, and to sign the consent form for the
intervention in the tracking sheet (see below).
Say, “How are you doing during these difficult times. Are you getting enough support? I would
appreciate if you could read over the consent form for this intervention and sign it.”
The Problem
Inquire about the problem that clients would like to work on.
Say, Tell me briefly, in one or two sentences about what is bothering you. What you would like to
work on? If we were to do a good job together, what would you like to see happen?
Stage 2: Preparation - Explanation, Bilateral Stimulation, and an Opening Resource
General Explanation
The explanation will include psychoeducational information on stressful situations and on EMDR.
Say, Today we will be doing the EMDR Abbreviated Recent-Traumatic Episode Protocol (R-TEP)
which is made up of three parts, like a sandwich: a resource, a disturbance and a resource.
When we experience events that are “too much, too fast, too soon,” or when we must face
stressful situations for a prolonged period of time, our nervous system gets “overloaded” with
threat reactions such as fight, flight, freeze. Over time, this translates into an accumulation
of negative images, sounds, emotions, thoughts, body sensations and behavioral patterns.
These experiences get stuck in the brain, and the purpose of the present intervention is to
release some of that “charge” through resourced and focused processing, aimed at personal
well-being and balance. Many times, such processing leads to a sense of resiliency and
personal growth, as well.
Bilateral Stimulation
Say: Bilateral stimulation, or side-to-side stimulation, of eye movements or tapping, that we will
shortly try out together, accelerates processing in EMDR. I will demonstrate some different
types of bilateral stimulation, or BLS, so that you can choose the one that is right for you.”
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Demonstrate the different types of BLS with clients and practice them together.
Butterfly Hug
Say, For the Butterfly Hug, cross your hands over your chest and begin tapping on your chest
from one side to the other. In addition, move your eyes from side to side as fast as you can.”
Tapping
Say, “For tapping, place your palms on the outer part of your thighs, close to the knee, and tap,
alternating near the right knee, and then near the left one. Or, place your hands, shoulder
width apart, on a table, and tap the tabletop with your palms, alternating from side to side.
For both options, move your eyes from side to side, as fast as you can.”
Eye Movement Side to Side
Say, “For eye movements, move your eyes between two fixed dots in the room, or if the intervention
is being carried out via teletherapy, between the two edges of your computer screen.
Say, During processing, it’s important to do eye movements. At first, it may be a bit difficult, but
most people usually get used to it. You can do the eye movements with or without tapping as
well. Let me know which type of BLS you prefer. You can also change the BLS any time.
Say and demonstrate with your hand, If you would like to stop at any time, just give me the stop
sign, by raising your hand like this.”
Opening Resource (Laub, 2001):
Say: Before we start to work on the problem that you shared _______________
(state problem), I would like you to recall a moment when you felt good about yourself.
You
felt whole. What is the first thing that comes up for you?
CONNECTING WITH THE RESOURCE
After clients share what came up, ask about the emotions and body sensations that go with the memory.
Say, What emotions come up for you when you focus on that memory? What body sensations
come up?
Say, Now, let’s strengthen the connection to your resource. Try to focus on one image of the
resource, and we’ll slowly tap with the Butterfly Hug.
Do the Butterfly Hug, tapping slowly. Gesture for the client to join you.
Say: “Notice what you see…. hear…. smell…. notice the emotions that are coming up…. your body
sensations. When you’re done, give me a signal.
After a set of 6-10 slow passes (one pass = two taps, one on the right and one on the left), signal
for clients to end.
Say, What came up? What emotions and body sensations came up?
Ask clients to carry out another set of tapping to strengthen the connection to the resource.
Say, “Go with that.”
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NAMING THE RESOURCE
Say, Now I will ask you to give a name, a word or a sentence, to your resource. Notice, where in
your body the positive sensation that goes with the memory is located. Let’s strengthen the
connection between the resource, the name and the positive sensation one more time.”
Direct clients to do one more set of Butterfly Hugs tapping to install the connection
Say, “Continue to do the Butterfly Hug as you think of the resource and the name of your resource.”
Say, What we just did is create an entrance to your resource. Now, you can reconnect with your
resource whenever you would like to.
Write down the resource on the tracking sheet provided.
Say, In times of stress, sometimes, our positive memories aren’t accessible, even though they are
still inside of us. So, I suggest that we do a short exercise (the Voo or a breathing exercise),
which will help you feel more stabilized.” See below for scripts.
Stage 3: Assessment - Identification of the Point of Disturbance (PoD( and its
Assessment
Google Search for Identifying the Point of Disturbance (PoD)
Say: “Now I will ask you to scan the Coronavirus
o u t br e a k,
from the time everything started
and up until today, including any worries that you may have regarding the future. Please do
the scan, not in any particular order, like in a Google Search. When any disturbance comes
up, let me know what it is. We’ll do this search with the bilateral stimulation that you chose.
Assessing the Point of Disturbance (PoD)
Assessment will be carried out as in the Standard EMDR Protocol, without using the Validity of
Cognition (VoC) scale. Provide active assistance in finding the negative and the positive cognitions.
Image
Say, When you focus on the PoD that you brought up, what image comes to mind?
Negative Cognition
Say, When you focus on the PoD, what is the negative belief you have about yourself, now?
Positive Cognition
Say, When you focus on the PoD, what positive belief do you have about yourself, now?
Emotions
Say, When you focus on the PoD, and say to yourself ___________ (repeat the negative cognition),
what emotions do you feel, now?
Subjective Units of Distress (SUD)
Say, “How disturbing is it for you, on a scale of 0 to 10, where 0 is no disturbance or neutral,
and 10 is the highest disturbance imaginable?
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Body Sensations
Say, Where do you feel it in your body?
Write down the point of disturbance (PoD) and its components on the tracking sheet.
Stage 4: Desensitization Focused Processing
Instructions for Processing
Say, Now, let’s start with the point of disturbance (PoD) that you have chosen. During the
processing, I’ll ask you to let whatever comes up, come up. Anything that comes up is OK.
We’re just noticing, without judgement. It’s just like riding a train, with the scenery
changing- moment by moment. From time to time, I will ask you to go back to a certain
point in the memory so that your system can have a chance to refocus and reprocess
it. It’ll be just like “Zooming In” or “Zooming Out”.
Say, Please bring up the PoD, with the negative belief____________ (repeat the NC), and
notice where you feel it in your body. And, let’s start the bilateral stimulation (or BLS).
When something comes up for you and you want to share, please stop and do so.”
If clients do not stop to share their associations on their own, stop them after about 15 seconds of
processing.
After each set of BLS, ask for clients’ responses.
Say: Take a deep breath. What came up? Continue with processing until the SUD is
ecological )0-3(.
When going back to the target (PoD), ask for the SUD, according to clinical judgment.
Use “Back To Target” strategies as needed:
EMDr Strategy
If associations outside of this range come up, such as childhood experiences, the therapist
will validate the association, and then return to the target (the disturbance).
Say, What you just said is really significant… and let’s go back from here to where we
started from ______________________ (state the disturbance). What do you notice?
Has anything changed?
Following the clients’ response, ask for the level of disturbance (SUD), now. If the SUD is not
ecological (0-3), continue with processing.
EMD Strategy
If the point of disturbance is intrusive (recurs repeatedly) or if an intrusive experience comes
up during processing, make use of the EMD strategy, with the range of associations limited
to the point of disturbance only. Keep sets short (approximately 10 passes). If an association
comes up that is related to the episode/time-frame, or outside of that, gently ask clients to
return to the target (disturbance/PoD).
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Say, “Let’s go back to the point where we started, so that your system can focus again,
process the disturbance and let it go. What do you notice now? Has anything
changed?
"
Following the clients’ response, ask for the level of disturbance (SUD). If the SUD is not
ecological (0-3), continue processing. After 6-7 sets, if there is no change in the SUD level,
continue processing with the EMDr strategy.
Containing Strategy
Use the containing strategy, where you ask clients to go Back-To-Target /(PoD) in order to
reorient, refocus or keep clients in their window of tolerance, such as when grounding is
needed or there is looping. Use appropriate interweaves and provide relatively short BLS sets.
Say, I think it may be helpful, at this time, to go back to the point where we started
________(state PoD). Can you go back to where we started and take a look? What do you
notice? Has anything changed?”
Pairing Strategy
If a client has made an adaptive association, validate the resource and ask the client to go
Back To Target (the disturbance/PoD).
Say: What you just said is a really valuable resource… let’s take that back with us to where
we started. When you go back to the target with the resource close at hand, what do you
notice? Has anything changed?
If an adaptive association comes up towards the end of processing, allow for an additional set
of BLS to further strengthen the association, listen to what comes up and then continue with
Pairing by returning to the to target.
Processing the point of disturbance will continue for approximately 20-30 minutes. If the
client’s SUD level is ecological, you may proceed to installation of the positive cognition.
Say, ““How disturbing is it for you, on a scale of 0 to 10, where 0 is no disturbance or
neutral, and 10 is the highest disturbance imaginable?
If the SUD is not ecological, offer to do the Voo exercise, or a different breathing exercise,
with the client.
Say: You’ve done a good job. Our time is up now, and we have to finish. We can do a
somatic exercise together, called “the Voo,” or a different breathing exercise, in
order to regulate your body and reach stabilization.
The “Voo” Exercise (Levine, 2010)
Say, “Now we will do a breathing exercise together that will help to balance your energy
level and let go of unpleasant sensations. We will be making a Voo sound together
that will cause vibrations that will affect the longest nerve in your body, the Vagus,
which comes out of our brainstem all the way down through all of our vital organs,
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like the heart, lungs, and gut. The ‘Voo’ sound is made by taking in a deep breath,
and then, on the out breath, gently making the sound ‘Voooooo”, sustaining it
through the full exhalation; vibrating the sound from the belly. At the end of the
breath, we will briefly pause, allowing the next breath to fill our belly and chest.
Then we will make the sound again, until it feels complete. The important thing is to
let both sound and breath expire fully, pausing and waiting for the next breath to
come on its own, when it is ready. Let me show you.”
Demonstrate once for the client, on your own. Then, do it twice with the client.
Say, “Now let’s do two Voo’s” together. Ready? Let’s take a deep breath in, and
Voooooo…”
Another option for stabilizing is a breathing exercise.
The Breathing Exercise (from the 4 Elements for Stress Management, Shapiro, 2007)
Say, “Simply noticing the breath helps us feel centered and supported. Now breath in through
your nose, letting the air go all the way to your stomach as you count 4 seconds
(1..2..3..4)…. then gently hold for 2 seconds (1…2) and then breath out for 4 seconds
(1..2..3..4). Let’s take a minute for about 6 deeper slower breaths like this. [Pause]. Repeat
this six times.”
At the end of the breathing exercise, for clients with an incomplete session, skip stages 5 and
6 and proceed to stage 7 (Closure).
Stage 5: Installation
Install the positive cognition (PC) if the SUD level is ecological (realistic), between 0-3.
New PC
Say: We are nearing the end, does _______________ (repeat the original PC) still fit, or
would you like to choose a different statement instead?
Checking the VoC
Say, “How true does the positive belief __________________ (repeat the PC) feel to you on
a scale of 1 to 7, where 1 means that it doesn’t feel true at all, and 7 means that it
feels the truest?”
Listen to the client’s answer.
Say, “Can you hold the PoD that we worked on, in your mind, together with the words
____________________ (repeat the PC), and let’s do another set of BLS.”
Direct the client to perform two sets of BLS, ask what comes up and check the VoC level each time.
Say, “Go with that.”
Say, “What comes up?”
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Say, “How true does the positive belief ____________________ (repeat the PC) feel to you
on a scale of 1 to 7, where 1 means that it doesn’t feel true at all, and 7 means that it
feels the truest?
Stage 6: Body Scan
The Body Scan is carried out according to the Standard EMDR Protocol.
Say, “When you bring up the PoD that you had with the words ____________ (repeat the
PC), notice what happens in all the different areas of your body -from the top of your
head all the way down to your feet. What sensations do you feel?
Direct the client to perform BLS in order to enhance the positive sensations, or to release
unpleasant ones.
Say, “Continue to do BLS as you release the unpleasant sensations and enhance the
positive ones.”
Say, “What came up now?”
Direct the client to perform an additional set of BLS on the body sensations.
Say, “Notice your body sensations and go with that.”
Stage 7: Closure – Validating Resources and the Closing Resource
Validating Resources
Repeat all of the resources, or adaptive associations, that came up during processing, starting
with the opening resource.
Say, “We are coming to an end point, you did a great job. Some important resources came
up during our work together, and I’d like to remind you of them.”
Share significant resources with the client.
The Closing Resource
Say: “And now, as we end, I would like to ask you if there’s any story that you can tell me,
about you and your life experiences, from the time that you were born, until today. A
story that could help teach me why you are capable of dealing with the disturbance we
worked on? A story that would reflect actions that you have taken in the past, challenges
that you overcame, your values or beliefs, and/or things you hold dear to your heart?
Connecting to the Closing Resource
After clients share their stories (or a group of stories), ask what emotions, body sensations and
thoughts came up.
Say, What emotions come up when you focus on that memory, or on that group of your
memories? Does any positive belief go with them?
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Say, Now, let’s hold the connection to your story, which is your closing resource- with the
Butterfly Hug. Focus on one memory, or on the whole group (if more than one has
come up), and start tapping slowly. Notice what thoughts, emotions and body
sensations come up.״
Start tapping with the Butterfly Hug, asking the client join you. After approximately 6-10 slow
sets, gesture for the client to finish tapping.
Say, What came up? Did you notice any emotions, any body sensations, or thoughts that came up?
Ask the client to perform an additional set of Butterfly Hugs to install the resource.
Say, “Now I will ask you to give a name, a word or a sentence
to your resource. Notice,
where in your body, the positive sensation that goes with the memory, is situated.
Let’s strengthen the connection between the resource, the name and the positive
sensation one last time.
Direct the client to do one more set of tapping to strengthen the connection.
Say, “Let’s do one more set to strengthen the connection.”
Say, What we just did is create an entrance to your resource. Now, you can reconnect
with your resource whenever you would like to.
Write down the closing resource with its components on the tracking sheet.
Note: If clients do not connect to the closing resource, ask them to choose one of the resources
that was validated at the end of processing, or any other resource. The resource will be installed
like the Opening Resource.
Words When Parting
Say, “I really appreciate the good work you’ve done, and the fact that
you took the time to
give you and your experiences some space. If you feel the need for any further
intervention, please speak with _________ (identify contact for client).
"
Stage 8- Reevaluation - Follow Up
Begin the next session-if there is one-with reevaluation. Make sure the tracking sheet was filled
out. If you do any symptom questionnaire before the intervention, do a follow-up one week after
it, and three months later.
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References
Jarero, I., Artigas, L., & Hartung, J. (2006) EMDR integrative group treatment protocol: A post-
disaster trauma intervention for children and adults. Traumatology,12(2).
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. doi:10.1891/1933-3196.5.3.82
Laub. B. (2001, December) The healing power of resource connection in the EMDR standard
protocol. Emdria Newsletter, special edition.
Laub, B., & Bar-Sade, E. (2014). The Imma EMDR Group Protocol in In M. Luber (Ed.), Eye
movement desensitization and reprocessing (EMDR) scripted protocols: Basics and special
situations (pp. 267-276) . New York: Springer Publishing.
Laub, B., Weiner, N., & Bender, S.S. (2017). A dialectical perspective on the AIP model and
EMDR therapy. J. EMDR Research and Practice,11(2), pp-112-120
Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores
Goodness. Berkeley, CA: North Atlantic Books.
Levine, P. (2012). Healing trauma: A pioneering program for restoring the wisdom of your
body. Lexington, KY: ReadHowYouWant.
Quinn, G. (2009). The emergency response protocol (ERP). In M. Luber (Ed.), Eye movement
desensitization and reprocessing (EMDR) scripted protocols: Basics and special situations
(pp. 271–276). New York: Springer Publishing.
Shapiro, E. (2007). 4 Elements Exercise. Journal of EMDR Practice and Research, 2, 113–115.
Shapiro, E. (2014, June). Recent simplified individual and group applications of the EMDR R-
TEP for emergency situations. Paper session presented at the annual meeting of EMDR
Europe, Edinburgh.
Shapiro , E., & Laub, B. (2009). The New Recent Traumatic Episode Protocol (R-TEP). In M.
Luber (Ed.), Eye movement desensitization and reprocessing (EMDR) scripted protocols:
Basics and special situations (251–270). New York: Springer Publishing.
Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols,
and procedures. New York, NY: Guilford.
Shapiro, F. (2004). Military and post-disaster field manual. Hamden, CT: EMDR Humanitarian
Assistance Program.
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles,
Protocols and Procedures. pp. 173-175.
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The EMDR Abbreviated Recent-Episode Protocol (R-TEP)
Tracking Sheet
Brurit Laub & Keren Mintz Malchi
Tracking sheet (May, 2020)
Date__________ Start Time:__________ End Time___________
Session Number 1____ 2____ 3____
Client’s Name: (May also be written as an abbreviation) __________________ Age:
Location:
Clinician’s Name: Phone Number:
Agreement for Follow-up: Yes No
Client Signature:
Phone Number:
Intervention Summary:
Opening Resource (Summary of resource, emotions, body sensations and name):
Point of Disturbance (PoD):
Picture:
Negative Thought:
Positive Thought:
Emotions:
Body Sensations:
SUD Level at the beginning of the intervention: ____/10
SUD Level at the end of the intervention: ____/10
Positive Thought (If different at end of processing):
VoC:__/7
Resources in the Processing:
Closing Resource (Add thoughts, emotions, sensations and name):
Follow-up: Reevaluation as done in the Standard EMDR Protocol and symptom questionnaire before the
intervention, one week after, and 3 months later.
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© Brurit Laub 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 practitioners own clients, please contact the authors
at bruritlaub7@gmail.com; malchikeren@gmail.com. All rights are reserved.
The EMDR Abbreviated Recent-Traumatic Episode Protocol Summary
Building rapport, ascertaining stability and client support system.
Therapeutic Alliance
Tell me briefly about what is bothering you…. What you would like to work on? If we were to do a good
job together, what would you like to see happen?”
The Problem
Psychoeducation- Explanation about stressful situations and EMDR therapy.
Explanation
The bilateral stimulation, or side-to-side stimulation, of eye movements or tapping, that we will try out
together shortly, accelerates processing in EMDR. I will demonstrate some different types of bilateral
stimulation, or BLS, so that you can choose the one that is right for you.”
BLS options: BH, tapping, EM.
Demonstrating BLS
Before we start to work on the problem that you shared _____ (state problem), I would like you to
recall a moment when you felt good about yourself…. You felt whole…. What is the first thing that comes
up for you?”
Connecting with the resource (Emotions, Body Sensations)
BLS + Cueing
(If the client did not connect to the OR, proceed with a somatic exercise for stabilization).
Opening
Resource (OR)
Google Search: “Now I will ask you to scan the period of the Coronavirus outbreak, from the time
everything started and up until today, including any worries that you may have regarding the future.
Please do the scan, not in any particular order, like in a Google Search… When any disturbance comes
up, let me know what it is. We’ll do this search with the bilateral stimulation that you chose.”
Assessment:
Google Search +
Assessment of PoD
As in the Standard EMDR Protocol (without VoC).
Focused Processing of the PoD, using:
o 4 “Back to Target” strategies: EMDr, EMD, Containing., Pairing,
o 3 groups of interweaves: Somatic, Relational, Somatic/Relational
o Marking Resources
Desensitization
As in the Standard EMDR Protocol (but only if the SUD is ecological, (0-3).
Installation
As in the Standard EMDR Protocol.
Body Scan
Validating Resources: “We are coming to an end… you did a great job. Some important resources came
up during our work together, and I’d like to remind you of them.”
Closing:
Validating
Resources +
Closing
Resource :
Closing Resource: “And now, as we end, I would like to ask you – If there’s any story that you can tell
me, about you and your life experiences, from the time that you were born, until today…..A story that
could help teach me why you are capable of dealing with the difficulty we worked on? A story that would
reflect…. actions that you have taken in the past…. challenges that you overcame… your values or
beliefs… and/or things you hold dear to your heart?
Connecting with the resource (Emotions, Body Sensations)
BLS + Cueing
(If the client did not connect to the CR, you may install one of the resources that came up during reprocessing
Begin next session with reevaluation as in the Standard EMDR Protocol.
Provide research questionnaires when relevant.
Reevaluation
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PART IV
Early Self-Care Suggestions & Interventions
P
art 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 high-
light 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 to develop resources in a short period of time. Both
chapters explore the dierent protocols and point clinicians in a direction to get further training
concerning these useful tools.
PART IV
Early Self-Care Suggestions & Interventions
P
art 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 high-
light 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 to develop resources in a short period of time. Both
chapters explore the dierent protocols and point clinicians in a direction to get further training
concerning these useful tools.
© 2020 All rights reserved.
X XI
15
Healer, Heal
Thyself: Self-Care
in the Time of
COVID-19
Catherine M. Butler
s the world watches the dominos fall in increasingly complex patterns, with layer upon
layer of concerns, risks, and fear, no one on the planet is currently living with any kind of
physical or emotional immunity. Not even 9/11 brokered the kind of diverse needs that we see
today and will continue to see in the days and weeks to come.
Those who have worked in disaster scenarios over their careers know that often what is offered
at the time is psychological first aid at best, and that the survivors are then referred to higher
levels of care outside of the scene. But, this time, we are all impacted by the fragility of our
biome and have personal implications on top of our professional opportunities and obligations.
We are not outside the scene.
We are living in it, too.
A
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Everyone needs something from us, and now more than ever, the challenge must be to keep your
emotional bucket as full as it can be.
No matter how you feel, you are a beacon to others: sharing your light, support and hope that
cuts through the panic, despair and overwhelm. We join all the other “necessary” professions
who are going to work on the physical front lines of this war, but our realm is the emotional front
line. Therapists are consciously aware of what living with the handiwork of fear looks like in the
present day but our challenges will surely be more significant in the long term.
Our intake questions of the future will undoubtedly ask about what resources the client had
during the season of COVID-19 and what happened.
For now, in the interest of brevity, and in the spirit of promoting self-care in a time of chaos, I’d
like to share this little anecdote with you that, if applied conscientiously, can fit in with the
practical things we all know to do.
A colleague of mine came to the counseling profession from a career as a police officer. He
faced it all, stood on the line of life and death, and had to go from one crisis to another every
shift for 30 years. Upon retirement, he became a psychologist, focused on the impact of post-
traumatic stress injuries for first responders.
He seemed to move with grace through all kinds of situations and always knew what to do.
I commented on that Yoda-like quality and asked him how he did that.
He said: When I don’t know what to do, I just show up and do my next right thing.
Think about that for a moment. Really think about it.
We don’t know what the next news report will say, or the next step that forces the community into
deeper personal isolation will be, or when we can give someone we love a hug.
But, in the present moment, ask yourself what the next right thing is for you….and do that.
The next right thing isn’t big. It’s not about waiting in line at Costco. That might come later in
the day but for your first step, bring it down to a place of power that puts yourself first. We get
so busy we overlook the basics.
Take the pain reliever you need because you woke up with a headache three hours ago.
Go get some water, and actually drink it.
Go to the bathroom.
Have you eaten? When?
What will help you sleep better tonight?
Take 3-5 deep breaths and give your brain 10 percent more clarity.
Ask for help.
Get some gum or hard candy going, to trick your parasympathetic nervous system into
thinking you are not so stressed. If you can generate saliva, your body calms down.
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When you work in the realm of what is possible versus what is impossible, the success of that
step will inform the next thing you need to do. In this fashion, you can take care of the many
demands and needs that surround you personally and professionally right now. Just that small
step. Then the next.
Reducing exposure to the constant flow of information is necessary. I treat media exposure
almost like a food sensitivity: I can eat it but I won’t feel good! Limit the saturation by agreeing
to check in to a reputable local and national news source at the end of the day, when all the
significant stories of the day have been synthesized down and crystallized. This way you avoid
the “breaking news” that may not be news at all eventually.
When you have done your next right thing, it gives you the confidence to speak to your clients
with confidence that they, too, have the resources they need to do their next right thing. Bring
the meta-concerns down into a place of personal power that is manageable, supportive and most
of all, empowering and kind.
Put the air mask on yourself and set yourself up for the physical and emotional marathon ahead.
Use the tools that work for you, and put a note on your computer monitor that says “What’s my
next right thing?”
Go with that.
With respect and appreciation for you all, be well and stay well!
© Catherine Butler. 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 catherine@butlertherapy.com
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16
Letter from
Roger Solomon
Roger Solomon
Hello My Dear Colleagues,
am passing on to you a brief, modified version of an outline I have used for resilience. May
some of it be helpful to your clients, and you. As I send this off to Marilyn Luber (thanks
Marilyn for coordinating this), I have some personal thoughts I want to pass on. I am reflecting on
lessons learned from dealing with past tragedies that may be helpful now, and for future tragedy.
I am writing this and hearing on the news how more people are testing positive for COVID-19 and
dying. (So now it’s time to turn off the news - a truly great coping strategy - don’t inundate yourself
with the media.) Many of us and our clients are getting triggered because the present has dangers
and the future is unknown. Now we have to martial our personal resources and those of our clients.
We need to have a resilient attitude. Resilience is much more than, as one soldier put it, “Suck it up
and move on.” It is a mindset that fosters a survival attitude, a commitment to deal with adverse
I
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situations in an adaptive way. I believe Salvatore Maddi (2013) got it right in his concept of
hardiness, which includes the concepts of commitment, control, and challenge.
Commitment: We count, and are important; our family is important, our life is important, and
our work with our clients is important, therefore let’s make a commitment to deal with this
situation. This is an important quote that has inspired me:
W.H. Murray: Until one is committed, there is hesitancy, the chance to draw back, always
ineffectiveness. Concerning all acts of initiative (and creation), there is one elementary truth
the ignorance of which kills countless ideas and splendid plans: that the moment one definitely
commits oneself, then providence moves too. A whole stream of events issues from the decision,
raising in one's favor all manner of unforeseen incidents, meetings and material assistance,
which no man could have dreamt would have come his way. Boldness has generous, power,
and magic in it. Begin it now.”
The bottom line: MAKE A COMMITMENT TO DEAL HEAD ON AND DIRECTLY WITH
THIS CRISIS
Control: We are not in control of what we are confronted with, but we can control our response
to it. Vulnerability is part of the human condition, and we have to accept this. But, we are not
helpless, we have control over how we deal with it.
How do policemen get back on the street after a line of duty shooting? They focus on their
tactics, their training, their ability to respond, and of course, their trust in their fellow officers.
You may be able to relate to this -some of you have had an auto accident- how did you get
back to driving? You perhaps realized that yes, an accident can happen again, but it does not
mean it’s going to. Further, you probably had a sense of control, “I can drive defensively,” or
“I can keep aware of my surroundings,” and so on. In other words, you knew you had some
control and knowing there is some control is enough for people get back into life.
The bottom line: WE ARE NOT HELPLESS, WE HAVE CONTROL OVER HOW WE
DEAL WITH IT
Challenge: There is much to be gained from getting through this crisis. We will grow, gain
wisdom, become stronger and this makes it worthwhile to deal constructively with this
situation. If it seems too much, break it down into smaller, doable steps. Identify family,
friends, and community resources that you can rely on for help and reach out. These are
challenging times and getting through this makes us stronger. So, renew your commitment to
deal with this crisis.
All around me I see people rising to the challenge, helping one another, our country and other
countries responding with numerous programs, and we can help our clients keep going.
The bottom line: CHALLENGES HELP US GROW, GAIN WISDOM AND BECOME
STRONGER
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Coping with Fear
In my many years of working with law enforcement and military personnel involved in traumatic
incidents I have learned that following moments of “Oh Shit,” where we are focused (even
overwhelmed) by our sense of vulnerability and powerlessness, we can focus on our resolve to survive
and “pump up” tremendous strength. Fear can be very useful. Critical incidents can potentially mobilize
the tremendous strength of the survival instinct. Under adverse conditions, our response can come from
a frame of mind of strength, control over this strength, clarity of mind, and increased alertness: the
survival resource (Solomon, 1991).
As I might say to a first responder: “Can you recall a time when your back was against the wall, its ‘do
or die,’ and you had to do something? Remember the moment you knew what you had to do, and started
to do it - that moment of commitment?”
When the client can acknowledge such a moment say, Focus on your ability and capability to
respond.How does that feel, strong or weak? (usually strong). Controlled strength or wild (usually
controlled)? Clear thoughts or jumbled (usually clear).”
If the client feels agitated or is experiencing fear, I ask them to move further into their response and feel
their “ability and capability to respond,” while doing slow, deep breathing to relax and focus on their
ability to respond.
I have used this in many contexts with many people who have experienced many different kinds of
adversity. When talking to the widow of a police officer about this model and asking her if she could
relate to the moment of positive response after her tragedy. She replied, “Oh yes, you mean my first
moment of empowerment.” That says it exactly.
Caution: Some people may become very triggered when entering the moment of vulnerability
awareness. Instead, focus on being safe in the here and now, it’s over, and even though I was scared -
maybe even thinking that life may end- it did not, and at this moment “I am alive.”
One Day at a Time
Lessons from September 11, 2001 and Hurricane Katrina
I learned many things from dealing with tragedy, but to be brief, I will describe a couple of the more
important lessons.
In the immediate aftermath of September 11, people were scared. In trying to do a calm/safe place
exercise, I found many people no longer had a safe place. What I found useful was asking the person to
come up with a “power stance” where the person felt grounded, strong, capable, and then I enhanced
the stance with bilateral stimulation. This was also helpful during Hurricane Katrina. In Hurricane
Katrina, I worked with many people who were living in temporary shelters, had lost their safe place, and
did not know when things would get better. As one client put it, “I know I can focus on getting through
today – plan for tomorrow but ground myself in getting through today.”
The cliché, “one day at a time,” was very helpful. One person was very scared after September 11, and
very afraid of the future. The planes continually circling overhead were a trigger. This person watched
what had happened from a nearby office building and currently was involved in the immediate
government investigation and response (a trigger in itself). We targeted the worst image (the second plane
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hitting the tower), using the Recent Event Protocol. As processing proceeded, the client connected the fear
to childhood circumstances, and said (I kid you not): “I am feeling what my therapist calls my ‘kid shit.’
Then the client was able to put things in perspective, and said,I have to take one day at a time.” This
was said with such conviction and sincerity, that the true wisdom of these words struck me. This person
knew he could cope with today. (This also points out the importance of identifying past memories that are
“feeding” the current level of disturbance. Protocols that focus on recent events are indeed important and
helpful, but at some point, past underlying memories need to be identified and processed.)
It is also important to remember this crisis will end, it is not forever and we will adapt.
Group Cohesion
Lessons from the Shuttle Columbia tragedy (disintegrated on reentry February 1, 2002).
I provided support through NASA’s Employee Assistance Program, an outstanding group of competent,
dedicated mental health professionals. A year later an informal outcome study on level of stress and
ability to cope showed that those centers that provided interventions fostering group cohesion and
support were functioning and coping better than centers that did not provide these interventions.
Similarly, my experience in working with law enforcement agencies and military strongly points to the
importance of group cohesion. Those military units and law enforcement teams experienced
interventions that fostered group support and cohesion experienced less trauma and higher morale than
units and teams that received no intervention.
In times of distress, we are wired to reach out to others for safety. It is time now for our community of
therapists to not only support our clients-our main mission-but ourselves. We need to lock arms
(virtually, of course) and go forward, fostering resilience with ourselves as well as our clients. Stay in
touch with each other, be there, reach out.
Roger M. Solomon, Ph.D.
Senior Faculty & Program Director, EMDR Institute
References
Maddi, S. R. (2013). Springer Briefs in Psychology. Hardiness: Turning stressful circumstances into
resilient growth. Springer Science + Business Media.
Murray, W.H. (1951) The Scottish Himalayan Expedition London: J.M. Dent & Sons.
Solomon, R.M. (1991). The dynamics of fear in critical incidents: Implications for training and
treatment, in J.T. Reese, J.M. Horn, and C. Dunning (Eds.) Critical Incidents In Policing, Revised,
pp. 327-358. Washington DC: U.S. Government Printing Office.
© Roger Solomon, 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 rogermsolomon@aol.com. All rights are reserved.
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17
Strengthen
Resilience:
Promote
Recovery
Roger Solomon
nderstanding and promoting resilience during this COVID-19 pandemic can help our
clients and augment what we do with EMDR therapy. This is part of a program I do for
emergency personnel and first responders on resilience, and hopefully is applicable not only to
clients, but to clinicians as well.
EMDR Therapy: A Paradigm of Resilience
EMDR therapy is an approach that is applicable to crisis intervention (within the first few days
of a critical incident), for symptom relief, as well as comprehensive treatment. EMDR is a
paradigm of resilience. With successful processing of a negative experience, adaptive, self-
enhancing perspectives emerge. This guides future behavior. As Solomon and Shapiro (2013, p.
286-287) said:
In terms of the Adaptive Information Processing model, resilience, coherence and
resourcefulness are responses based upon the affects and perspectives that characterize the
memories that are stimulated by the current experience. When people are confronted
U
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by adversity, adaptive information stored in their memory networks is available for coping
with the challenge. A high level of resilience, sense of coherence, and learned
resourcefulness results from the person’s ability to make full use of functionally stored
information and abilities acquired in his or her life.
Below, various perspectives on resilience and coping will be presented to enhance the mindset
and provide the adaptive information needed when clients or practitioners are coping with this
new challenge. Let’s start with the concept of resilience.
Resilience
Resilience can be described in many ways:
Positive capacity people have to cope with stress; a dynamic process where people
exhibit positive behavioral adaptation when they encounter significant adversity or
trauma (Luthar, Cicchetti, and Becker, 2000).
Developed ability to be flexible and adapt rapidly to changing circumstances,
acknowledging there is a stressful situation and being able to focus on one’s ability to
react and respond with mental and emotional strength.
Ability to regain balance after adverse circumstances by learning from it and utilizing
lessons learned to deal with present and future life.
Life may never go back to the way it was. Therefore, we have to move through and
integrate adverse circumstances and create a new normal. “What happens to us becomes
part of us. Resilient people do not bounce back from hard experiences; they find healthy
ways to integrate them into their lives.” (Greitens, 2015, p.23)
“Sense of coherence” (SOC). SOC is an orientation to life pertaining to the ability to
comprehend a stressful situation and to use available resources for movement in a health-
promoting direction with a feeling of confidence. Resilience is promoted when a stressful
event is experienced as comprehensible, manageable, and meaningful
(Antonovsky,1987).
Note: It is not that resilient individuals never experience negative affect, but rather the negative affect does
not persist. Resilient individuals are able to profit from the information provided by the negative affect. It is
finding meaning and learning that enriches the present and informs the future.
Let’s look further at Antonovsky’s SOC in light of the three important qualities of resilience as
he described it to support your clients:
Comprehension of an Event: We can understand what happened and how it happened,
even if we may never know why something happened. Importantly, we can comprehend
the implications of the event on health and wellbeing, and face it. With COVID-19, some
clients may need help understanding what has happened and what is happening now, and
what the implications are.
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Manageability: There are constructive strategies to cope with an event, circumstance and
consequences. What is happening is difficult, but can be managed. We are in control of
our response to the situation. Provide clients with problem solving, affect regulation, and
grounding strategies, with focus on their ability and capacity to respond.
Positive Meaning: Understand the impact of an event, its significance in your
life, and what can be done to make it a positive experience. There is the opportunity to
know friends and family at a different level through continued positive and supportive
contact, to learn new coping skills and enhance existing ones, creative ways to be with
oneself, and come out stronger by coping with adversity.
Antonovsky went on to create “Salutogenesis:” this is a medical approach focusing on factors
that support human health and well-being, rather than on factors that cause disease. More
specifically, the "salutogenic model" is concerned with the relationship between health, stress,
and coping. We can use it to address the positive growth factors that can occur as a result of a
traumatic event or situation.
Salutogenic Effects Possible When Dealing with Trauma and Adversity
Trauma can have salutogenic effects. Here are some ways to think about trauma and
adversity that can increase resilience and Sense of Coherence:
Positive Aspects of Trauma Experience
Leads to positive growth (Tedeschi & Calhoun, 2004).
Reinforces person’s ability to deal with adversity. As one policeman involved in a line-of-
duty shooting put it: “Surviving my incident and facing my worst fear has taught me a lot.
I can use the wisdom and strength gained to deal with other life challenges.”
Clarifies values and puts life in perspective. A fireman responding to the Oklahoma City
bombing learned: “I have always stopped to smell the roses, now I linger a little longer.”
After the September 11 attacks, a medic noted: “Now I know what is really important to me.”
Promotes closer interactions with others.
Supports an appreciation of life.
Engenders a sense of competence and resilience as a result of the experience.
Salutogenic Effects
People directly involved in an incident can experience coping/survival resources, moments of
strength, and adaptive coping response that enhance self-efficacy. To elicit these positive
moments, ask:
Were there any moments in dealing with this (situation, incident, crisis or in the aftermath),
where you felt competent, effective, strong, or good about what you did?
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Did you do something that helped mitigate the impact of the (situation, incident, crisis) either
during or after the incident?
Did you learn anything new or different about yourself after experiencing this event?
Did you do something to help others? (Helping others helps oneself.)
What have you already done (or been doing) to deal with this situation?
The positive coping measures that you took ___________(state what the client did) were
really helpful and supports your moving forward.
Resourcing
Create a Resource: Create a resource by guiding a client to focus on the positive actions that
were taken (mental and physical) to deal with a stressful situation. Focusing on a moment of
adaptive action, and the feeling that goes with the ability and capability to respond, evokes a
resourceful frame of mind that balances out the moments of vulnerability. (See Dynamics of Fear
model below)
Bilateral Stimulation: Reinforce and enhance these moments of strength, positive coping and
forward direction with bilateral stimulation.
Cue Word: The client can come up with a cue word or phrase associated with this resourceful
state of mind (with the connection being enhanced with sets of bilateral stimulation).
Future Rehearsal: Do future rehearsal by guiding the client to imagine coping with an
anticipated stressful situation, while experiencing this positive, strong frame of mind (using the
cue word). If positive, enhance with bilateral stimulation. If negative associations arise, stop
bilateral stimulation, explore and address the issue according to the needs of the client.
Resilient Attitudes
Reinforce the resilient attitudes below verbally and by using bilateral stimulation.
I am vulnerable, but not helpless.
I can focus on my ability (skills) and capability (resolve, focus, and skills) to respond.
I have strengths to see me through, and vulnerabilities that can be managed.
After coming to grips with my sense of vulnerability, I can emerge stronger and utilize
this strength to deal with other life challenges.
Hardiness (Maddi, 2013)
The idea of hardiness has to do with the following:
Commitment: I am important enough to fully involve myself in dealing with the problem.
I can face it.
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Control: I have the ability to influence the outcome of a problematic situation, either
positively or negatively.
Challenge: In dealing with this problem. I can learn and grow from it so it is worth
dealing with the situation fully, with commitment.
What prevents Hardiness?
Low self-esteem: I am not important. I am not worthy.
Lack of self-efficacy: I’m not capable/I’m powerless.
External locus of control: I am powerless/no control.
Fear/avoidance of dealing with situation: I’m not safe.
Lack internal resources: The client does not have sufficient adaptive information,
positive experiences, or skills.
Note: Memories underlying the above factors can be identified and processed, along with processing
present triggers and applying future template for each trigger.
Broadening Your Perspective
Help clients see the bigger picture or look at the situation from different perspectives:
Finding Alternatives
What is your best description of the stressful circumstance. Reflect on it fully.
o Who are the people involved?
o What are the likely implications or effects of this situation?
o What is troublesome to you about all this?
o How does it make you feel/impact on you?
Think of what you could do to make the circumstances worse than they are.
Think of what you could do to make the circumstances better than they are.
To make things better.
o What would have to change?
o Would you or others have to act differently?
Changing Perspective
Commonplace Perspective: This happens to many people, not just you.
Manageability Perspective: Realizing it could be worse makes the situation more tolerable,
enabling you to approach it long enough to solve it.
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Improvability Perspective: Imagine ways to improve the circumstance rather than to just have
passive optimism that does little to change it.
Becoming More Optimistic (Seligman, 1998):
Time limited vs. Forever: Present circumstances will not last forever.
Specific to Situation vs. Generalized: When it is specific, it does not take over one’s whole life.
When it is generalized, it feels all encompassing.
Internalizing vs. Externalizing: Internalizing -such as: “It’s all my fault”- prevents seeing the
external factors and circumstances contributing to the situation that need to be dealt with.
Circumstance Defines Me vs. Circumstances are What Happened to Me: Circumstances are
what happened to me, they do not define me.
Powerless over Situation vs. Control over One’s Reaction to the Situation: A person may have
no control over a situation, but can control their response to it.
One Day at a Time
The cliché, One day at a time,” really can be helpful.
Help the client realize things will continue to evolve, and even though we don’t know the
future, we can focus on getting through this day.
The client’s challenge is to get through the day in an adaptive manner.
The client can help others get through the day (helping others helps oneself).
Dealing with Fear & Vulnerability
(adapted from Dynamics of Fear, Solomon, 1991)
The Importance of Fear: You may have experienced (still are?) tremendous fear and been
confronted your sense of vulnerability.
Automatic Response: Realize fear is an automatic response to the perception of danger and is
not a sign of weakness.
Use of Fear: Fear can be utilized to exercise caution, increase alertness, and mobilize great strength.
Using Fear to Mobilize Survival: Critical incidents and crises can potentially mobilize the
tremendous strength of the survival instinct.
The Survival Resource: Under adverse conditions, our response can come from a frame of
mind of strength, control over this strength, clarity of mind, and increased alertness-the
survival resource.
Transform Fear to Strength: Policemen involved in line of duty shootings have taught me how
in milliseconds fear can be transformed to strength.
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The following model – Dynamics of a Critical Incident – is an attempt to put in words something
that takes place beyond words – beyond thought – but hopefully illustrates how adversity can
harness and focus the strength that comes with our instinct to survive.
Dynamics of a Critical Incident
Here Comes Trouble: You become aware of a threatening situation.
Oh Shit!: You become aware that you are in trouble, and may feel weak, vulnerable, or not in control.
This is the moment of vulnerability awareness.
I've got to do something: You acknowledge the danger is real and you must act to survive or gain
control over the situation.
Some people think: NO WAY, I am not going to let this happen to me (or you).
Transition from Internal Focus to External: Now you make the transition from an internal focus on
vulnerability to an external focus on the danger.
Survival/Coping (“I will survive”): You focus on the danger in terms of your ability to respond to it.
Maybe you start responding automatically as your previous training and experience comes forward.
Consciously or instinctively you come up with a plan, start to react, and feel more balanced and in
control.
Here Goes: Here goes is the moment of commitment. There is the resolve to act, whether instinctual or
planned, which mobilizes tremendous strength. Your frame of mind is focused: characterized by strength,
control over this strength, clarity of mind, and increased awareness. This is the survival resource.
Response: You go for it, with your response fueled by the survival resource.
Lessons Learned: If we focus solely on the danger, we tend to feel weak, vulnerable and out of
control. If we focus on our ability and capability to respond to the situation, we feel more balanced
and in control, and strong. That's why it's important not to dwell just on the danger, but to focus on
our ability to respond.
Life after “Oh Shit!”: After a critical incident, it is natural that one may dwell on the moments of
"Oh Shit". But you can get stuck here. While it is important to face feelings of vulnerability (“Bad
things can happen to me”) you must also give yourself credit for what you did to respond. One
policeman put it this way, “There is life after ‘Oh Shit.’” Remember, sometimes doing “nothing” is
the best “something” you could have done!
The moment of “HERE GOES” can be used as a resource (see above).
Commit: Acknowledge the danger and vulnerability, and then focus on your ability and
capability to respond. You may not be able to control the situation, but you can control your
response to it. Take a step forward, plan, think of your choices, and commit:
Concerning all acts of initiative and creation there is one elementary truth — that the moment
one definitely commits oneself then divine providence moves too. All sorts of things occur to
help one that would never otherwise have occurred and which no man could have dreamed
would have come their way. (Johann Wolfgang von Goethe)
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Stress Reduction Strategies
Talk it Out: Talk to friends, family, clergy, medical personnel, therapists, etc.
Write it Out: Journal.
Work it Out: Exercise.
Relax it Out: Do deep relaxation, visualization, autogenic training, and/or meditation.
Self–Care: Eat healthy, avoid substances that reduce functioning, and get proper sleep.
Create a Structure / Routine: make a daily schedule for yourself that includes healthy
rituals. Having a structure provides predictability and sense of control.
Engage: Engage in activities that affirm your identity.
Think Positively: I can’t control what is going on around me, but I can control my response to it.
Maintain Life Balance: Maintain balance with yourself, work, intimacy, social, and spiritually.
If one area of your life goes down, rely on other areas of your life for support and balance.
Actively Seek & Utilize Support: Reach out to others.
We Are All in This Together – Let's Lock Arms (Virtually) & Go Forward!
In Closing
EMDR therapy can be utilized to enhance resilience. As Solomon and Shapiro (2013) state:
EMDR therapy is designed to identify and process the past memories that underlie difficulties in
coping, to address present situations that trigger disturbance, and to enable the development of a
positive memory template for future adaptive behavior. The processing of pivotal memories
facilitates a rapid learning experience that transforms the negative perspective and affects into
more neutral or even positive ones. These then become the basis of resilience by enhancing one’s
ability to cope effectively with subsequent related stressors. Processing the dysfunctionally-stored
memories that underlie current maladaptive behaviors enables a person to bring to bear on future
adverse circumstances the full potential of his or her functional capacity and available personal
resources. (p. 287).
The overall goal of coping with resilience, going for it, is encapsulated in one of my favorite
quotes by W.H. Murray (1951) who elaborated on Goethe’s quote:
Until one is committed, there is hesitancy, the chance to draw back, always ineffectiveness.
Concerning all acts of initiative (and creation), there is one elementary truth the ignorance of which
kills countless ideas and splendid plans: that the moment one definitely commits oneself, then
providence moves too. A whole stream of events issues from the decision, raising in one's favor all
manner of unforeseen incidents, meetings and material assistance, which no man could have dreamt
would have come his way. Boldness has generous, power, and magic in it. Begin it now.”
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References
Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay
well. San Francisco: Jossey-Bass.
Davidson R. (2000). Affective style, psychopathology, and resilience: Brain mechanisms and
plasticity. American Psychologist, 55, 1196–1214.
Greitens, (2015). Resilience: Hard-Won Wisdom for Living a Better Life. New York: Houghton
Mifflin Harcourt, 2015,
Luthar, S. S., Cicchetti, D., and Becker, B. (2000). The construct of resilience: A critical evaluation
and guidelines for future work. Child Development, 71, 543- 562.
Maddi, S. R. (2013). Springer briefs in psychology. Hardiness: Turning stressful circumstances into
resilient growth. Springer Science + Business Media.
Murray, W.H. (1951) The Scottish Himalayan Expedition. London: J.M. Dent & Sons.
Seligman, Martin. (1998). Learned Optimism. New York, NY: Pocket Books.
Solomon, R.M. (1991). The dynamics of fear in critical incidents: Implications for training and
treatment, in J.T. Reese, J.M. Horn, and C. Dunning (Eds.) Critical Incidents In Policing,
Revised, pp. 327-358. Washington DC: U.S. Government Printing Office.
Solomon, R. & Shapiro, F. (2013). EMDR and adaptive information processing: The development of
resilience and coherence. In K. Gow & M. Celinski (Eds.), Trauma: Recovering from Deep
Wounds and Exploring the Potential for Renewal. New York: Nova Science Publishers.
Tedeshi, R.G., & Calhoun, L.G. (2004). Posttraumatic Growth: Conceptual Foundation and
Empirical Evidence. Philadelphia, PA: Lawrence Erlbaum Associates.
© Roger Solomon, 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 rogermsolomon@aol.com. All rights are reserved.
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18
Group-Traumatic
Episode Protocol
Remote Individual &
Self-Care Protocol
(G-TEP RISC)
Elan Shapiro
Description of the Group Traumatic Episode Protocol Remote Individual &
Self Care Protocol (G-TEP RISC)
n adapted Group-Traumatic Episode Protocol (G-TEP) training has been developed for the
“Age of Corona” that trains EMDR clinicians in the use of the G-TEP worksheet for
remote individual application. The G-TEP Remote Individual & Self Care (RISC) Protocol has a
number of advantages for keeping the client safe and contained. The step-by-step structured
worksheet establishes a concrete representation of present, past and future resources that
A
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envelope the Trauma Episode. The form of self-BLS employed engages eye movements and
focused processing procedures to ensure short chains of association. Step 1 of the worksheet
teaches stress management and has a screening function for readiness, as well as being an
extended preparation. The new composite worksheet can be simply printed out on home printers
or hand drawn.
The training has three parts that permit flexibility for remote delivery since they can be done
separately or together:
Part 1: This is a one-hour video sent to the EMDR clinician participant that serves as an
introduction, overview and preparation for Parts 2 and 3 of G-TEP RISC.
Part 2: This is done several days later online, after participants have watched the video
and prepared the worksheets and materials needed. It takes an hour and a half and
consists of questions and answers following Part 1, reviewing basic concepts of EMDR
Early Intervention and a guided role play practice with a trainer who will demonstrate the
procedures of the protocol script. This would enable clinicians to use the worksheet for
Self-Care, until they do Part 3.
Part 3: This is a three-hour experiential practice delivering the protocol as a group leader
and receiving it as a group member. The practice is conducted in groups of four closely
supervised by the trainers. It is recommended when possible to do parts 2 and 3 together.
After completing all 3 parts of the remote G-TEP-RISC training, although this is equivalent to
the usual full G-TEP training, participants are advised to work only individually when working
remotely with clients. They work with groups face-to-face. Supervision is recommended.
For further information: EarlyEMDRintervention.org
© Elan Shapiro, 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 elanshapiro@gmail.com. All rights are reserved.
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19
The Self-Care
Traumatic Episode
Protocol (STEP)
Judy Moench
he Self-Care Traumatic Episode Protocol evolved following a conversation between Elan
Shapiro and Judy Moench. STEP is a video series that was developed using the concepts of
earlier work of Elan Shapiro and Bruit Laub. It is based on the principles of the Adaptive
Information Processing Model (AIP). The Group Traumatic Episode Protocol (G-TEP) was
created for groups after the Recent Traumatic Episode Protocol (R-TEP) was found successful
with individuals.
STEP was initiated during the Covid-19 crisis to assist Mental Health clinicians and medical
staff to decrease stress and increase coping during this difficult time. Due to the inability to meet
in person, this computer adapted AIP informed protocol was born. The idea was initiated in order
that clinicians -who are feeling overwhelmed by current events can- within a typical 1.5 hour-
session, combine stabilization activities to ensure a present focus, have the ability to process the
on-going overwhelming event(s), and develop containment strategies to allow them to continue
to work effectively on the front lines.
T
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STEP includes initial screening to ensure suitability for moving forward with the protocol as well
as a short psycho-educational component. Those who are suitable, move forward to do
stabilization and further screening. The worksheet-based protocol follows for those who meet the
criteria. Following the protocol, a containment video is recommended. For some, further referrals
are suggested if needed.
The videos have an easy to follow format. They will be available on the EMDR Canada website
initially for EMDR Canada members to use as a self-care tool and to complete initial research on
efficacy of the protocol. Following the initial study, the protocol will be more widely available if
efficacy is determined. Check the Prepped 4 Learning website for updates on availability
https://prepped4learning.com. We would like to thank EMDR Canada for their support of this
program. If you would like to gain access to STEP following the study, please email Judy
Moench prepped4learning@gmail.com and we will add your name to our list for additional
information.
© Judy Moench 2020. This Resource is copyrighted under United States law. For further information, please contact the
author at prepped4learning@gmail.com. All rights are reserved.
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Appendix A ~ Global Resources
_____________________________________________________________________________________________
In the Beginning
The EMDR Institute of Francine Shapiro
Web site: ~ http://www.emdr.com
Contact: Robbie Dunton ~ rdunton@emdr.com
_____________________________________________________________________________________________
EMDR Worldwide Associations Contact Information
A F R I C A
Botswana
Contacts: Alex Hooijschuur The Netherlands ~ a.hooijschuur@home.nl
Mrs. Jeldau Rieff ~ jeldau.rieff@ssint.org NGO Stepping Stones International
Ms Petunia Mogotsi ~ Mogotsipetunia@gmail.com University of Botswana
Trauma Aid NL Hellen Hornsveld
Burundi
Contact: Annick Nikokeza ~ merlnne@yahoo.fr
Cameroon
Contacts: Carrol Kamwe ~ kamwe06@gmail.com | Christine Pola ~ polachristine9@gmail.com
Cyprus
Contact: Photini-Ipsmiller Demetriou ~ phofidemetriou@hotmail.com
Congo-Democratic Republic of (to the Southeast of the Congo River)
Contacts: Masika Yvonne Duagani ~ yvduage@gmail.com | Marc Ombeni ~ marcombeni@gmail.com
Anna Przewlocka Alves (France/Poland)
Congo- Republic of (to the Northwest of the Congo River)
Contact: Masika Yvonne Duagani ~ yvduage@gmail.com
Ethiopia
Contacts: Selamawit Tesfaye ~ Selam998@yahoo.com | Hilina Taye ~ thehilina@gmail.com
Ghana
Contact: Carrie Cutshall ~ carrie@havencounselingok.com
Kenya
Association: EMDR Kenya http://emdrkenya.org
Facebook https://www.facebook.com/EMDR-Kenya308930532455310
Contacts: Alice Blanchard ~ aliceb.blanchard@gmail.com | Gisela Roth ~ dr.roth.ac@aimint.org
Catherine Mbau | Father Francis Ndolo | Beatrice Murunga ~ beamurunga@yahoo.com
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Libya
Contact: Anwar Younis ~ anwaryounis7777@gmail.com
Madagascar
Contact: Anne Dewailly ~ dewailly.anne@gmail.com
Hasina Bakohariliva ~ angehacy@yahoo.fr
Morocco
Contact: Abderrazzak Ouanass ~ ouanass9@yahoo.fr
Namibia
Contact: Ulf Janisch ~ ulf.jarisch@mybookstation.co.uk
Rwanda
Contact: Jamuel Muhayimana ~ jamuel.muhayimana@gmail.com
Saudi Arabia
Contact: Norah Fahad ~ norah.aldawsari@gmail.com
South Africa
Association: EMDR South Africa/Africa
Linked In ≈ https://www.linkedin.com/groups/4312044/profile
Contact: Reyhana Seedat ~ rravat@iafrica.com
Sudan
Contacts: Bjorn Aason ~ bjaasen@roros.net
Aline Braun ~ aline96@hotmail.com
Tanzania
Contacts: Mrema Kilonzo ~ ihanokilonzo@gmail.com | Praxeda Swai ~ praxjames76@yahoo.com
Lusajo Kajula
Uganda
Contacts: Lois Ochienglois ~ ochienglois@gmail.com | Rosemary Masters ~ rdcmasters@aol.com
Rev Dismas Eddie Bwesigye ~ revdismas@gmail.com | Alex Hooijschuur -The Netherlands ~ a.hooijschuur@home.nl
Others: Noeline Nakasujji, Professor of Psychiatry | Patricia Villacensio from Spain
Zambia
Contacts: Sue Gibbons ~ suegibbonsnow@yahoo.co.uk
Jack McCarthy ~ jackmcc5@aol.com | Geraldine Wateridge
Zimbabwe
Contacts: Anne Dewailly ~ dewailly.anne@gmail.com | Aquila Vera ~ aquievee@gmail.com
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A S I A
EMDR Asia Association: An association of Asian National EMDR Associations https://emdrasia.org
Contacts: Tri Iswardani danisadatun301@gmail.com | Sushma Mehrotra ~ mehrotrasushma@gmail.com
Matthew Woo ~ matthew.woo.sg@gmail.com
Afghanistan
Contacts: Mohibullah Israr ~ mohib.israr123@gmail.com | Bashir A. Sarwari ~ basarwari@gmail.com
Australia
Association: EMDR Association of Australia http://emdraa.org
Contacts: Phil Nottingham ~ admin@emdraa.org
Bangladesh
Contacts: Shamim Karim ~ shamim.karim@gmail.com | Shaheen Islam ~ shaheen.islam8@gmail.com
Mahjabeen Haque ~ mahjabeenhaquedu@gmail.com
Cambodia
Association: EMDR Cambodia Association http://emdrcambodia.org
Facebook: https://www.facebook.com/EMDRCambodia-240952806003977
Contacts: Sophearith Phul ~ psy.psprith@gmail.com | Om Platkin ~ plaktintom@emdrcambodia.org
Nil Ean ~ nilean@yahoo.com | Bunna Phoen ~ bunnapsyeng@gmail.com
China Mainland
Association: China EMDR ~ emdrchina@163.com
Contact Jinsong Zhang ~ zhangsk@yeah.net
Chinese Taiwan
Association: Chinese Taiwan EMDR Association [TEMDRA] ~ http://www.temdra.org.tw
Facebook ≈ https://www.facebook.com/taiwanemdr
Contacts: Chen-Jung Hu ~ janetnfmm@gmil.com or dorothyhcj@gmail.com | Pe-Li Wu ~ t05017@ntu.edu.tw
Hong Kong SAR
Association: The EMDR Association of Hong Kong https://emdr.hk
Contact: Atara Sivan ~ email@hkemdr.org
India
Association: EMDR India www.emdrindia.org
Facebook: https://www.facebook.com/emdr.india
Contacts: Mrinalini Purandare ~ mdpurandare@yahoo.co.in | Parul Tank ~ parultank@gmail.com
Sushma Mehrotra ~ mehrotrasushma@gmail.com | Chintan Naik ~ chintanik3014@gmail.com
Dushyant Bhadlikar ~ dushyantbhadlikar@gmail.com ~ emdrindia@gmail.com
Indonesia
Association: EMDR Indonesia
Contact: Tri Swasono Hadi ~ tri_hadi@yahoo.com | Jackie Viemilawati ~ jacquijegeg@yahoo.com
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Japan
Association: Japan EMDR Association ≈ http://www.emdr.jp
Contact: Masaya Ichii ~ msyichii@emdr.jp
Korea
Association: Korean EMDR Association [KEMDRA] ≈ http://www.emdrkorea.com
Contacts: Seok Hyeon Kim ~ shkim1219@hanyang.ac.kr | Daeho Kim ~ dkim9289@hanyang.ac.kr
Nam Hee Kim ~ daehokimmd@gmail.com
Myanmar
Contact: Sithu Pe Thein ~ drsithupethein@gmail.com
Nepal
Contacts: Prathama Raghavan ~ prathama.raghavan@gmail.com | Anil Bilas ~ bilas2bilas@yahoo.com
New Zealand
Association: EMDR New Zealand Association ≈ https://www.emdr.org.nz
Contacts: Astrid Katzur ~ astrid.katzur@xtra.co.nz | Irene Begg ~ Irene@talkinheadz.co.nz
Pakistan
Association: EMDR Pakistan Association ≈ https://emdrpakistan.wordpress.com
Facebook https://www.facebook.com/groups/emdrpakistan
Contacts: Mowadat Hussain Rana ~ mhrana786@gmail.com
Rashid Qayyum ~ rashidqayyum@hotmail.com | Khadija Tahir ~ ktahir67@gmail.com
Philippines
Association: EMDR Philippines
Facebook https://www.facebook.com/EMDR-Philippines-570890159608387/?fref=ts
Contact: Lourdes Medina ~ lcm50us@yahoo.com
Singapore
Association: EMDR Singaporehttp://emdr.sg
Contacts: Vera Handojo ~ vera.handojo@gmail.com | Matthew Woo ~ matthew.woo.sg@gmail.com
Linda Wan Koh ~ lindawankoh@gmail.com
Sri Lanka
Association: Sri Lanka EMDR Association (SEA) www.emdrsrilanka.org
Contacts: Sr. Janet Nethisinghe ~ jnethisinghe@yahoo.ca | Indira Weerasinghe ~ indiraw65@gmail.com
Thailand
Association: EMDR Thailand ≈ https://emdrthailand.org
Contacts: Parichawan Chandarasiri ~ parichawan@yahoo.com | Sombat Tapanya ~ sombat.tapanya@gmail.com
Vietnam
Contact: Dr. Carl Sternberg ~ pv.carl@gmail.com ( Ho Chi Minh City )
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E U R O P E
EMDR Europe Association
An association of European National EMDR Associations ≈ www.emdr-europe.org
President: Isabel Fernandez ~ isabelf@emdritalia.it
Executive Assistant: Valentina Martini ~ valentinamartini@emdritalia.it
Albania
Association ≈ https://www.emdralbania.org
President: Besarta Taci ~ besa.taci@libero.it
Austria
Association: EMDR-Netzwerk Osterreich ≈ http://www.emdr-netzwerk.at
President: Eva Muenker-Kramer ~ muenker-kramer@emdr-institut.at
Azerbaijan
Facebook https://www.facebook.com/emdra.az
President: Suleyman Mammad-zade ~ emdra.az@gmail.com
Belgium
Association: EMDR-Belgium ≈ http://www.emdr-belgium.be
President: Freek Dhooghe ~ freek.dhooge@gmail.com
Bosnia & Hercegovina
Association ≈ www.emdr.ba
President: Mevludin Hasanovic ~ hameaz@gmail.com
Cyprus
Contact: Demetrious Photini-Ipsmiller ~ phofidemetriou@hotmail.com
Denmark
Association: EMDR Danmark ≈ http://www.emdr.dk
President: Birgit Schulz ~ birgit schulz@me.com
Finland
Association: Suomen EMDR-Yhdistys ≈ http://www.emdr.fi
President: Markus Heinimaa ~ markus.heinimaa@utu.fi ~ emdrsuomi@gmail.com
France
Association: Association EMDR France http://www.emdr-france.org
Administrator: Pascal Hotte ~ contact@etudehotte.fr
Contact: Françoise Le Bonniec ~ contact@emdr-france.org
Georgia
President: Ketevan Pilauri emdrgeorgia@gmail.com
Germany
EMDRIA Deutschland e.V. http://www.emdria.de
President: Michael Hase ~ m.hase@emdria.de
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Greece
Association: EMDR Greece http://www.emdr-hellas.gr
Contacts: Anna Maria Kyriakopoulou ~ amkyriakopoulou@yahoo.com
Domna Ventouratou ~ vent@travmatotherapeia.com | Vassiliki Sfyri ~ emdr.hellas@gmail.com
Hungary
Contact: Judit Havelka ~ havelka.judit@gmail.com ~ info@emdr.hu
Iceland
Association: EMDR Iceland https://emdr.is
President: Gyða Eyjólfsdóttir ~ gyda@emdrstofan.is
Ireland
Association: EMDR-All Ireland website-under construction
President: Gus Murray ~ gusmurray18@gmail.com
Israel
Association: EMDR-IS http://www.emdr.org.il
Facebook ≈ https://www.facebook.com/EMDR.IS?fref=ts&ref=br_tf
Chairman: Ehud “Udi” Oren ~ udioren@emdr.co.il | Contact: Dafna Kalkstein ~ dafna@emdr.co.il
Italy
Association: EMDR Italia https://emdr.it
President: Isabel Fernandez ~ isabelf@emdritalia.it | Contact: segreteria@emdritalia.it
Lithuania
Facebook https://www.facebook.com/EmdrEuropeAssociation/posts/lithuania-the-first-group-
that-completed-the-basic-standard-training-in-vilnius-/1718255038213810
President: Paulina Zelviene ~ P.zelviene@gmail.com
Luxembourg
Association: EMDR Luxembourg http://www.emdrluxembourg.com
President: Deborah Egan-Klein ~ debeganklein@hotmail.com
Malta
President: Joan Camilleri ~ dtjoancamilleri@gmail.com
Netherlands
Association: Vereniging EMDR Nederland http://www.emdr.nl
President: Carlijn de Roos ~ cderoos@planet.nl ~ vereniging@emdr.nl
Norway
Association: EMDR Norge http://www.emdrnorge.no
President: Janne E. Amundsen ~ janne@janneamundsen.no
Poland
Association: PTT EMDR http://www.emdr.org.pl
Facebook ≈ https://www.facebook.com/groups/391190417630323/?ref=br_tfemdr.org.pl
Contact: Marzena Oledzka ~ moledzka@wp.pl
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Portugal
Association: EMDR Portugal http://www.emdrportugal.com
Facebook https://www.facebook.com/Associacao-EMDR- Portugal-1506930796286984/?fref=ts
President: Ana Cristina Santos (anacristinasantos) ~ psicologia@hotmail.com ~ emdrportugal@gmail.com
presidencia.emdrportugal@gmail.com
Romania
Association: EMDR Romania http://www.emdr-romania.org/index.php/en
Russia
Association: EMDR Russia http://www.emdrrus.com http://www.emdr-association.ru
President: Julia Lokkvova ~ lokkova@gmail.com
Serbia
Association: EMDR Serbia http://www.emdr-se-europe.org
President: Vesna Bogdanovic ~ vesnabgd1@gmail.com
Slovakia
Contact: Daniel Ralaus ~ ralaus@hotmail.com
Spain
Association: Asociación EMDR-España www.emdr-es.org
President: Francisca Garcia Guerrero ~ francisgar@emdr-es.org ~ infor@emdr-es.org
Sweden
Association: EMDR Sverige http://www.emdr.se
President: Raili Hulstrand ~ raili@emdr.se ~ info@emdr.se
Switzerland
Association: EMDR Switzerland http://www.emdr-ch.org http://www.emdr-ch.org/vorstand.html
Contacts: Olivier Piedfort-Marin ~ olivier.irpt@gmail.com
Anita Enkelmann ~ info@emdr-ch.org
Turkey
Association: EMDR Derneği http://www.emdr-tr.org
Contacts: Emre Konuk ~ konuk@dbe.com.tr ~ destek@emdr-tr.org
Ukraine
Association: EMDR Ukraine http://www.emdr.com.ua
Contacts: Olga Ryschkovska ~ rysch@add.lviv.ua
Oksana Nakonechna ~ bezmezhna@gmail.com
United Kingdom
Association: EMDR UK http://www.emdrassociation.org.uk
President: Michael O’Connor ~ m.o’connor@emdrassociation.org.uk
Contact: Dawn Damni ~ info@emdrassociation.org.uk
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I B E R O M É R I C A
EMDR Iberoamérica
An association of South & Central America National EMDR Associations www.emdriberoamerica.org
Argentina
Association: EMDR Iberoamérica Argentina http://www.emdribargentina.org.ar
Contact: Susana Balsamo ~ susanabalsamo@yahoo.com.ar
Brazil
Association: EMDR Brasil http://www.emdr.org.br
Contact: Ana Lúcia Gomes Castello ~ presidencia@emdr.org.br
Chile
Association: EMDR Chile http://www.emdrchile.cl
Columbia
Association: EMDR-IBA Colombia http://emdrcolombia.com
Contact: Chiquinquira Blandón
Costa Rica
Association: EMDR Costa Rica http://emdrcostarica.wordpress.com
Cuba
Contact: Alexis Lorenzo Ruiz ~ alexis.lorenzo@psico.uh.cu
Ecuador
Association: EMDR Iberoamérica Ecuador http://emdrecuador.org
Guatemala
Association: EMDR Guatemala http://emdrguatemala.org
Contact: Ligia Barascout ~ ligiabps@yahoo.com
Haiti
Association: Association EMDR Haiti
Contact: Myrtho Marra Chilosi ~ chilosi.myrtho@gmail.com
Honduras
Contact: Victor Aguilar ~ psicovictor11@gmail.com
Mexico
Association: EMDR Mexico http://www.emdrmexico.org
Contact ~ contacto@amamecip.org
Nicaragua
Contact: Rolando Mena EMDRIBA ~ ccasic-@hotmail.com
Panama
Association: EMDR Panama http://emdribapanama.org
Puerto Rico
Association: EMDR Iberoamérica Puerto Rico
Contact: Neriluz Maldonado ~ neriluz.maldonado@gmail.com
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Uruguay
Association: EMDR Uruguayhttp://emdruruguay.org.uy
Venezuela
Contact: Deglya Camero de Salazar ( WhatsApp +58 412 6032147 )
M I D D L E E A S T & N O R T H A F R I C A
Algeria
Association ~ emdr.algerie@gmail.com
Facebook ≈ https://www.facebook.com/groups/122478674494378
Contact: Mohamed Chakali ~ chakmed@yahoo.com
Egypt
Association: EMDR Egypt Association
Contact: Osama Refaat ~ osama.doctor@gmail.com
Iraq
Contact: Mona Zaghrout ~ monazag12@yahoo.com ~ mzaghrout@ej-ymca.org
Jordan
EMDR Association Jordan (in process of being formed)
Contact: Yousef Muslem ~ clinicalpsyy@yahoo.com
Lebanon
Association: EMDR Lebanon Association ≈ http://www.emdrlebanon.org
Facebook https://www.facebook.com/emdrleb
President of EMDR Lebanon: Lina Ibrahim ~ lina_f_ibrahim@hotmail.com or lina.ibrahim@emdrlebanon.org
Libya
Contact: Anwar Younis ~ anwaryounis7777@gmail.com
Palestine
Contact: Mona Zaghrout ~ monazag12@yahoo.com ~ mzaghrout@ej-ymca.org
Tunisia
Contact: Eleuch Ahmed ≈ www.psychotrauma-Tunisie.org
N O R T H A M E R I C A
Canada
Association: EMDR Canada http://www.emdrcanada.org
President: Dell Cucharme ~ info@emdrcanada.org
United States
Association: EMDR International Association ≈ http://emdria.org
Executive Director: Michael Bowers ~ exec@edmria.com
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Related EMDR Trauma Aid/Humanitarian Assistance Programs
A S I A
Japan ~ Association: JEMDRA-HAPhttp://hap.emdr.jp
E U R O P E
Trauma Aid Europe Association: Trauma Aid Europe http://www.emdr-europe.org
France Association: Trauma Aid France https://www.trauma-aid-france.org/page/866956-l-association
Germany – Association: Trauma Aid ≈ http://www.trauma-aid.org
Spain Association: HAP-España ≈ http://www.emdr-es.org
Switzerland – Association: Trauma Aid/HAP Switzerland ≈ http://www.hap-schweiz.ch
Turkey – Association: EMDR-HAP Turkey ≈ www.emdr-tr.org
Contact: Senel Karaman ~ senelkaraman@gmail.com
United Kingdom – Association: HAP UK ≈ https://www.traumaaiduk.org
Facebook: Trauma Aid UK ~ facebook.com@tramaaiduk
Twitter: Trauma Aid UK ~ traumaaiduk@twitter.com
I B E R O M É R I C A
Iberoamerica EMDR Iberoamerica ≈ http://emdriberoamerica.org/progamaayudahumanitaria.html
Argentina
Association: EMDR Iberoamérica Argentina ~ pah@emdribargentina.org.ar
Contact: Jimena Cavarra ~ pah@emdribargentina.org.ar
Mexico
Asociacion Mexicana para Ayuda Mental en Crisis A.C. ≈ http://www.amamecrisis.com.mx/emdr-mexico
N O R T H A M E R I C A
United States
Trauma Recovery’s EMDR Humanitarian Assistance Program [EMDR-HAP] ≈ http://www.emdrhap.org
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Other Related Humanitarian Response Groups
N O R T H A M E R I C A
United States
Association: EMDR Community Response Networks
Contact: CRN Leadership Team ~ CRN.emdr.us@gmail.com
Association: EMDR Disaster Network of Therapists https://emdrdisaster.net
Contacts: Deany Laliotis ~ info@deanylaliotis.com | Dan Merlis ~ emdrdisaster@gmail.com
Association: Trauma Recovery network/Trauma Recovery: EMDR Humanitarian Assistance Programs
https://www.emdrhap.org/content/trauma-recovery-network
Contact: Trauma Recovery/HAP (203) 288-4450
The Francine Shapiro Library
Francine Shapiro Library’s EMDR Bibliography https://emdria.omeka.net
EMDR Journals and E-Journals
The Journal of EMDR Practice and Research The official publication of the EMDR International
Association http://www.springerpub.com/emdr
EMDR-IS Electronic Journal http://www.emdr.org.il
EMDR Research Foundation www.emdrresearchfoundation.org
Related Traumatology Information
American Red Cross www.redcross.org
The Institute of Family Studies https://aifs.gov.au/cfca/topics/web-resources-trauma-grief-and-loss
David Baldwin’s Trauma Pages http://www.trauma-pages.com
Children and War http://www.childrenandwar.org
European Federation of Psychologists Associations Task Force on Disaster Psychology [EFPA]
http://www.disaster.efpa.eu
European Society for Traumatic Stress Studies http://www.estss.org
Give an Hour www.giveanhour.org
International Society for the Study of Trauma and Dissociation https://www.isst-d.org
The International Critical Incident Stress Foundation http://www.icisf.org
National Center for PTSD http://www.ptsd.va.gov
National Institute of Mental Health http://www.nimh.nih.gov/health/topics/post-traumatic-stress-
disorder-ptsd/index.shtml
Wounded Warrior Project www.woundedwarriorproject.org
Appendix
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© 2020 All rights reserved.
© 2020 All rights reserved.