EMDR with OCD

1. EMDR with OCD John Marr

2. Hello • John Marr (EMDR Practitioner) • Trained in • Humanistic Therapy • CBT • EMDR • Worked as • Social Worker • University and College Lecturer • Therapist (Charity)

3. Today • Basic information • Confusion Ex/RP or CBT • My Research (a background) • Adapted Protocol 1 • Adapted Protocol 2

4. In the Beginning • World Health Organisation (WHO) has actually ranked OCD in the top ten of the most disabling illnesses of any kind, in terms of lost earnings and diminished quality of life. • Obsessive Compulsive Disorder (OCD) is the 4th most common mental health disorder.

5. In the Beginning • There was confusion world wide during peer review. • All clients reported receiving CBT therapy in the past • Peer reviewers argued CBT is not a treatment for OCD • Had to agree to use term Ex/RP to publish • Criticism of UK term CBT Generically

6. Most recommended • Although Ex/RP Therapy can be highly effective for around 50% of people who complete Ex/RP treatment there are a number of recognized drawbacks (Psychological Medicine. 40. pp2013 – 2023) • One of the biggest problems with Ex/RP is the relapse rate which is high (57.3%) and which hasn't improved in past 20 years. • World Health Organization; Global Burden of Disease 2000, Draft 21-08-06; Maher et al. 2010

7. My experience • 4 clients • All Male • Aged between 18 and 28 • Untreated OCD • All referred for CBT in past • All told CBT not appropriate within 2 sessions • All left for years

8. What to Do? • Continue with EX/RP therapy (CBT) • Medicate • Do Nothing • Discover the causal link • Be Innovative

9. Traumatic Phobia • The Clients • Background • Traumatic Phobia • OPTC (Recent thinking) • Obsessive Post-Traumatic Compulsions • Conventional Therapy had not worked

10. Innovation • Use a combination of the Phobia Protocol and Mental Video Playback • A standard Phobia Protocol with exceptions • Mental Video Playback replaces EX/RP • EMDR reprocess the response to the mental exposure

11. Adaptions • During the history taking identify the OCD Triggers • Electric Plugs • Taps • Touching People • Water • Locking Doors • Infection • ETC

12. Practicum • Break into pairs (30 min) • Each Identify a safe OCD Issue • Door locking • Tap Checking • Removing plugs • Shaking Hands • Hand washing • etc.

13. Process • Each Trigger is dealt with as a separate OCD event • Process each Trigger • Ensure client able to completer a full video without experiencing anxiety before moving on

14. OCD Protocol • In this OCD Protocol, targets are desensitized in the following sequence, • starting with the current triggers (OCD compulsions and obsessions); • followed by past related disturbing memories (if any);

15. and then by • the future template (imagining successful future action). • In the OCD Video Playback Protocol, each current target is fully processed using standard EMDR procedures.

16. Phase one: Client History • As with standard EMDR, a full client history is taken, thus providing the therapist with insight into the client’s issues.

17. Phase two: Preparation • The client is prepared as in the standard EMDR protocol with a calm place, and with the addition of an imaginal nurturing figure, strength figure, or a protection figure if needed • The stop signal is taught; this inclusion should be understood as a necessity by both client and therapist. • A dry run of the therapy is conducted, using a minor issue with little subjective distress. The Subjective Units of Disturbance (SUD; Shapiro, 1995) scale is introduced at this point to measure the subjective disturbance, where 0 is no disturbance or neutral and 10 is the highest disturbance that they could imagine. • Triggers:

18. Phase Three: Video playback procedure to identify triggers. • The following procedure is used separately for each trigger (i.e., each OCD event). • The therapist says, “Play the mental videotape of the circumstances of this OCD event. When you begin to experience anxiety similar to the anxiety that you experienced during the actual event, let me know. ”

19. Phase Three: Video playback procedure to identify triggers. • The standard EMDR protocol for phase 3 is then applied, with the client asked to identify the various components. These include: a representative image, Emotion, the SUD score; and the body location of the emotion.

20. Practicum • Using History taking techniques Identify Triggers. • Door locking. • Close door, key in lock • Count clicks key makes as it enters lock • Turn Key • Count clicks • Check door handle 10 times each hand

21. Adaptions SUD (Personal Choice) VOC (Personal Choice) PC (I Don’t Identify, will arise during processing) NC (Personal Choice) Touchstone (Will present during processing)

22. Practicum • Play video until anxiety • Ask about the • Image • Emotion • Bodily Sensation • Use EMDR to process • Return to Video and continue playing.

23. Practicum • Either use the case study provided or a case of your own. Use the mental video playback technique with the presenting triggers. • 50 Minutes

24. Group feedback • How did you find the mental video playback to use. • Did any issues arise • Did the client find it easy to visualise

25. 40 35 30 Client 1 25 Client 2 20 Client 3 15 Client 4 10 5 0 Delayed Positive Cognition

26. 40 35 30 Client 1 25 Client 2 20 Client 3 15 Client 4 10 5 0

27. 40 35 30 25 20 15 10 5 0 40 35 30 25 20 15 10 5 0 1 2 3 4