In today ‘s article we will refer to a study that will show us how to treat non-traumatic fear of flying through the Eye Movement Desensitization Reprocessing (EMDR) approach (Shapiro, 2000) in a Single Session (Newgent et al. , 2016).
What is the purpose of the study?
The purpose of the study is to show how EMDR treatment can adapt to the client’s needs and also be applied through a Single Session. In this case the treatment of the non-traumatic fear of flying is carried out directly in flight .
How does the traditional EMDR process go?
The traditional EMDR process proceeds through eight stages of treatment (Parnell, 1999; Shapiro, 2000):
- First stage: customer history . The consultant builds the hypothesis about the etiology of the problem and establishes the adequacy of the EMDR treatment.
- Second stage: client preparation . The counselor explains to the client how the treatment works and helps him to create an image of a “safe place” which can be used, for example, as a place of mental rest when the retreatment will be prolonged or in incomplete sessions.
- Third stage: evaluation . The consultant collects information relating to the problem presented by the client, the identification of the traumatic memory, the beliefs (positive and negative) associated with the image of the trauma and the emotions related to the experience. This includes rating positive and negative beliefs through the Validity of Cognition (VOC) scale and rating subjective distress intensity through the Subjective Units of Distress Scale (SUDS) .
- Fourth stage: desensitization . The client is asked to recall the traumatic event and the associated disturbing thoughts, feelings, and emotions. At this point, a series of auditory and tactile stimulations and eye movements will be introduced to create bilateral brain stimulation.
- Fifth stage: installation . The client is asked to recall the traumatic memory and to relate positive beliefs that fit the scene. The VOC scale is used to determine if treatment can move to the next stage.
- Sixth stage: body scan . The counselor will ask the client to report any bodily sensations during the incident review. Bilateral stimulations are used to reinforce a positive feeling or to work through a negative feeling.
- Seventh stage: closing . Resolution is achieved in this stage when the memory no longer triggers any negative emotional, cognitive, behavioral, or somatic response effects. If these responses are present, the counselor performs a debriefing, which may consist of relaxation techniques to assist the client until the next session.
- Eighth stage: reassessment . During the eighth stage, the client is asked about any other intrusive memories (Shapiro, 2000). If no significant intrusive memories have occurred, the client can begin focusing on the next target, memory, or incident, thus starting the EMDR process again or ending the one started.
How does a Single Session EMDR proceed?
In the example shown here of Single Session/Eye Movement Desensitization Reprocessing (EMDR) a rapid method of physiological and psychological desensitization of the symptoms associated with the non-traumatic fear of flying is proposed. According to Shapiro (2000), desensitization refers to one of the treatment effects in which memories and cues previously experienced as disturbing reach a resolution and are no longer experienced as disturbing. Furthermore, information processing, in this approach, refers to the physiological tendency of the brain to move towards a positive emotional and cognitive schema, such as occurs in the case of the healing self-response to injury (Shapiro, 2000). Finally, retreatment during in-flight EMDR treatment for nontraumatic fear of flying becomes more rapid.
When Jennifer R. started treatment she was 34 years old, single and afraid of flying. She stated in the session that prior to the EMDR treatment she had only flown ten times and that she had attempted to overcome the problem, using positive self-talk and reframing, calling the turbulence “irregular clouds.” The woman had not been afraid of flying before 1988 and she was unable to recall any triggers for the etiology of her fear of her.
In the summer of 1999, Jennifer showed signs of fear during a business flight with her professor and EMDR consultant. The consultant noticed that before the plane took off, the woman was digging her nails into her hands, leaving deep marks on herself. Her face was ashen and her breathing particularly labored, rapid and difficult, finally tears began to flow down her face at the thought of crashing.
After noticing the distress, the counselor offered to help and discussed possible treatment options with her. Jennifer trusted him, so she agreed that she would need help during the flight and she agreed to EMDR treatment for immediate relief.
Jennifer reported having a relatively normal childhood and no developmental problems . In 1986 there had been only a brief depressive episode during a general transition phase in her life. At the time of therapy she was in graduate school to become a counselor herself. Aside from the normal stressors of a college degree, she reported no other problems at that time in her life, other than taking two asthma medications.
Treatment and evaluation of progress
Due to the circumstances, standard EMDR treatment protocols were modified to meet the needs of the situation. The consultant did not spend time creating the safe space before starting the process. He also considered all ethical and legal issues related to conducting EMDR with a female student and being in a public place. However, the EMDR process did not require the client to share personal information or to relive the trauma. Confidentiality was also not an issue as the treatment would take place in a row of seats where they would be alone. Jennifer due to the anguish she was experiencing, she had no reservations about participating in the process.
First, the counselor gave Jennifer a brief explanation of the EMDR process: he gave her brief instructions, set a stop sign, and the distance and direction of eye movement, prompting a metaphor: think of the experience as if you were looking at it. on video. Next, he focused on Jennifer’s unsettling emotions and sensations, measuring them with the VOC and SUDS scales. Jennifer’s negative belief was the fear of not having any control while she was in flight.
In the setup phase whose goal is to “install” and increase the strength of the positive belief the person identified as replacing the original negative belief, the counselor helped Jennifer connect the desired positive belief “Everything will be okay” with the original experience .
Next, the counselor asked Jennifer to scan her body for tension. The woman reported minimal symptoms, so no retreatment was needed. At the end of the flight, the counselor made sure Jennifer was feeling well and less anxious than at the beginning of the EMDR process. The closure of the intervention and that of the revaluation was established .The goal of the re-evaluation is to ensure that the client maintains low subjective noise units, high VOCs and no body strain. Additionally, the counselor explores any new areas or goals in need of treatment (Shapiro & Forrest, 1997). After one EMDR session Jennifer had a VOC score of 4 and 6 after two post-treatment flights. Initially, her SUDS score was 8. After two post-treatment flights, Jennifer’s SUDS score was 0.
The consultant followed Jennifer’s progress over the next 21 months. The follow-up was initially done in person as Jennifer and the counselor saw each other regularly at the university. After Jennifer graduated, the counselor checked in on her periodically through email. Jennifer reported that the Single Session of in-flight EMDR treatment had been effective for her. Following EMDR therapy, she reported flying 24 separate times with no recurrence of symptoms.
To conclude, the purpose of the article is to provide an example of the application of EMDR therapy through a Single Session . This adaptation highlights how this form of therapy could be used with clients who, for example, do not benefit from more traditional approaches or in particular situations of emergency or need of the client .
Team Psychotherapist of the Italian Center
for Single Session Therapy
Newgent, RA, Paladino, DA, Reynolds CA (2006). Single Session Treatment of Nontraumatic Fear of Flying With EyeMovement Desensitization Reprocessing. Pre- and Post-September 11, Clinical case studies , 25 -35.
Parnell, L. (1999). EMDR in the treatment of adults abused as children. New York: Norton.
Senior, J. (2001). Eye movement desensitisation [sic] and reprocessing: A matter for serious consideration? The Psychologist, 14, 361-363.
Shapiro, F. (2000). Eye movement desensitization and reprocessing: Level I training manual. Pacific Grove, CA: EMDR Institute.