Eye Movement Desensitization and Reprocessing EMDR www riverside

Eye Movement Desensitization and Reprocessing (EMDR) 動眼減敏重整療法 高雄市河堤診所 孫讚福醫師 www. riverside. tw 98. 12. 18

EMDR的誕生(1) w w w Francine Shapiro 心理學博士 1987年，發現EMD 1989年，EMD for PTSD 1991年，EMD EMDR 1995年，Shapiro出版Eye Movement Desensitization and Reprocessing Basic Principles, Protocols, and Procesures (2001年第二版) w 目前www. amazon. com 售有至少 48本EMDR 書籍 11/28/2020 4

EMDR 治療過那些人？ w Victims of Vietnam combat, rape, molestation, accident, catastrophic loss and natural disaster (以 上的病人族群，有做過 控制組研究) w PTSD, Panic disorder with/out agoraphobia, Specific phobia(spider phobia), Performance anxiety(public speaking, test), Eating disorder, Chronic pain, Couple therapy, Adjustment disorder, Dental Phobia, Dermatological Disorder 11/28/2020 6

Efficacy/Validation w American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines EMDR given the same status as CBT as an effective treatment of ameliorating symptoms of both acute and chronic PTSD. 11/28/2020 7

EMDR 的八階段治療流程 w w w w Client history Client preparation Assessment Desensitization Installation Body scan Closure Reevaluation 11/28/2020 8

Phase One: Client History(1) w 過去：導致痛苦或功能異常之記憶。 w 現在：啟動當下困擾之情境。 w 未來：需要何能力、技巧來因應未來。 ( Symptoms, Specific Internal picture / cognition / feeling, Duration, Initial course or incident, Past occurrences, Alternative Complaints, How presently affected, Parallels and connections in past and present history, Desired behavior, Skill needed) 11/28/2020 9

Phase Two: Client Preparation(2) Eight-step Safe Place Exercise Image (影像) Emotions and sensations (情緒與感受) Enhancement ( 強化影像或情緒 ) Eye Movement ( 4 -6次即可 ) Cue Word (自我暗示語) Self-cuing ( 自我暗示、練習 ) Cuing with disturbance ( 小困擾做試驗，治療師引導 ) w Self-cuing with disturbance (小困擾做試驗，自我引 導) w w w w 11/28/2020 12

Phase Three: Assessment(1) w What picture represents the incident? w What picture represents the worst past of the incident? w If no picture: when you think of the incident what do you get? w Negative cognition: what negative words go best with that picture that express your belief about yourself now? 11/28/2020 13

Phase Three: Assessment(2) w Positive cognition: when you bring up that picture (or incident) what would you like to believe about yourself now? w VOC (Validity of Cognition) : How true does that statement feels to you now on a scale of 1 to 7? w Emotion: when you bring up that picture (or incident) what emotion do you feel now? 11/28/2020 14

Phase Three: Assessment(3) w SUDs(Subjective Unit of Disturbance Scale) : On a scale of 0 to 10, how disturbing does the picture ( or incident) feel to you now? w Location of body sensation: Where in your body do you feel it? 11/28/2020 15

Phase Four: Desensitization w 影像、負面信念、身體感受 → EM (Eye Movement, hand tapping, alternating sound) w 陪同與肯定 w 深呼吸、中斷、休息、經驗分享(不分析) w 數次 EM後 w 評 SUDs(直到 0 -1) 11/28/2020 16

Phase Five: Installation w 評估正向認知之VOC (直到 6 -7) w 灌注正向認知 11/28/2020 17

發表個案報告 w Mindfulness Meditation Training Combined with Eye Movement Desensitization and Reprocessing in Psychotherapy of an Elder Patient. 合併內觀禪訓練 與動眼減敏重整療法治療一憂鬱症之老人(Chang Gung Medical Journal. June 2004) w Synergism Between Mindfulness Meditation Training and Eye Movement Desensitization and Reprocessing in Psychotherapy of Social Phobia 以內觀禪訓練強化動眼減敏重整療法對社交畏 懼症的療效 (CGMJ, Dec 2005) 11/28/2020 22