Supervisor & Author: Dr. Michael Nazir
Abstract
This report presents the application of eye movement desensitization and reprocessing (EMDR) therapy to a person that exhibited symptoms of post-traumatic stress disorder (PTSD) stemming from previous experiences of domestic violence. This study aimed to assess the potential of EMDR therapy to minimize PTSD manifestations, anxiety, and depression in women who have been victims of domestic violence. Trials were employed to evaluate the symptoms of the patient during the initial assessment, after some EMDR sessions, as well as at 6-month follow-ups. The findings indicated that following ten active sessions of EMDR, the patient showed no symptoms of PTSD, and her indications of depression and negative thoughts were no longer present. Consequently, EMDR proved to be the effective therapy for PTSD symptoms related to domestic violence, with sustained results observed at the 6-month follow-up.
Introduction
Intimate partner violence (IPV), or domestic violence, is a significant public well-being concern that encompasses a range of harmful behaviors occurring within intimate relationships. These behaviors include physical aggression, sexual coercion, psychological abuse, and controlling actions. IPV is widely recognized as a violation of human rights and poses a global health issue, particularly affecting women [1]. It is a pressing challenge that disproportionately burdens women, with men being the primary perpetrators [2, 3]. Research conducted by Tjaden and Thoennes (2000) indicates that probably 25% of women reported experiencing partner violence at some point [4]. IPV encompasses various elements, such as physical or sexual violence, the combination of physical or sexual violence, as well as psychological and emotional abuse. During the COVID-19 pandemic, the prevalence of domestic violence has increased up to 48% [5]. Post-Traumatic Stress Disorder (PTSD) is a prominent psychological outcome of IPV, with an average prevalence of 64% observed among abused women. It is characterized by different clinical manifestations, comprising intrusive and distressing thoughts, emotions, and hallucinations that are tethered to the traumatic experience, avoidance behaviors, and trauma-induced hyperarousal symptoms in response to direct or indirect exposure to the trauma. Such traumatic encounters may involve actual or perceived threats to one’s life, severe bodily harm, or sexual assault. As mentioned earlier, the symptoms can significantly impair an individual’s quality of life.
The trauma-focused cognitive behavior therapy (CBT) and eye movement desensitization and reprocessing (EMDR) therapy are considered to be the most effective therapies to treat PTSD, according to the report of the World Health Organization (in 2013) [6, 7]. The findings of a meta-analysis revealed that EMDR was found to be more effective than CBT in decreasing post-traumatic signs and anxiety. Nonetheless, no significant difference was observed in reducing depression. [8]. The EMDR is a structured psychotherapy treatment developed by Shapiro (2001) with eight phases to resolve symptoms stemming from distressing and unprocessed life experiences [9]. Unfortunately, still, it is a debate. Limited studies are available to provide conclusive evidence regarding the efficacy of the treatment. In this respect, the current study aimed to explore the potential of EMDR in alleviating the symptoms of PTSD in a woman who has been suffering from domestic violence for years.
Case presentation
A 32-year-old woman, Jane, complained that she was encountering nightmares and flashbacks and experiencing feelings of isolation, irritability, and guilt. Furthermore, she was unable to sleep. During interview sessions, it was observed that she had endured severe physical and emotional abuse from her partner over an extended period. As a result, she was experiencing distressing symptoms, including nightmares, flashbacks, avoidance behaviors, and feelings of guilt and shame.
After an initial assessment, PTSD symptoms were diagnosed by thoroughly assessing the woman’s symptoms and history of traumatic experiences. The data collection procedure included a wide range of methods, including questionnaires during interviews, observation of body movements, and clinical assessments of the patient (Jane). The PDS is a self-administered survey used for a definite diagnosis of PTSD and a continuous evaluation of the severity of symptoms. It consists of 17 items that align with the 17 PTSD symptoms outlined in the DSM-IV. Additionally, it included additional questions to evaluate the impact on daily functioning, perceived life threat, duration of symptoms, onset timing, and a checklist of past traumatic experiences. The therapist used standardized measures of PTSD symptoms to establish a baseline level.
For Jane’s symptoms of PTSD, the physiotherapist recommended ten sessions of EMDR therapy. The EMDR therapy sessions followed a standardized protocol involving eight phase series comprising history taking, preparation, assessment, desensitization, installation, and closure. EMDR Phase I involved gathering a history and formulating a therapy done in the study by administrating the Adapted ADIS-C PTSD section. In Phase II, the patient was organized to deal with her trauma. Skill and resource development were deemed unnecessary, so they were not implemented [9]. The introduction of EMDR took place in the first treatment phase, followed by sessions III to VII that involved reprocessing stressful memory. Phase III focused on recalling the patient’s traumatic memory and concentrating on several facets, including the most painful image, intrusive self-perceptions related to the idea, associated emotions, and bodily sensations. A crucial aspect of the procedure involved engaging the participant in a working-memory-demanding task that often requires the therapist’s finger movements, during which the participant focused on the trauma memory. Emotional and somatic characteristics of remembrance were accessed after addressing the image and negative perceptions. The therapist guided the patient to follow their fingers and encouraged them to freely report any emotional, cognitive, somatic, or imagistic involvements that arose. When internal troubles reached a zero on the Subjective Unit of Disturbance scale (SUDs), an adaptive and positive self-statement was fully believed and rated on a Validity of Cognition scale (VoC). Phase VII was conducted to close the session and prepare the patient for the time between treatment phases. It mainly involved re-evaluation and integration [10, 11].
Throughout the therapy sessions, the therapist also used qualitative methods, such as observation and interviewing, to gather data on the woman’s experiences and progress. The therapist also used standardized measures of PTSD symptoms to track the woman’s progress throughout the treatment. Finally, a follow-up assessment was made to evaluate the long-term effects of the EMDR therapy. This included a repeat administration of standardized measures of PTSD symptoms and qualitative data on the woman’s experiences and overall well-being.
The therapist also provided education about PTSD and its symptoms and coping strategies to manage distress during therapy sessions. Throughout several EMDR sessions, the therapist and Jane targeted specific traumatic memories related to her domestic violence experience. For example, they used bilateral stimulation, including eye movements, tapping, or auditory tones, while recalling the memories to facilitate processing traumatic material. The therapist also provided support and validation during the sessions to help Jane feel safe and understood.
After 10 EMDR therapy sessions, Jane reported a significant reduction in PTSD symptoms. She reported fewer nightmares and flashbacks and less avoidance behavior. She also reported feelings of less shame and guilt related to the traumatic experiences. Furthermore, Jane reported a decrease in signs of anxiety and depression. After the treatment, the therapist and Jane discussed strategies to maintain her progress and prevent relapse. The therapist recommended continued use of coping skills and self-care techniques, such as mindfulness and relaxation exercises. The therapist also provided resources for support groups and community services for survivors of domestic violence. Six months after completing EMDR therapy, the therapist conducted a follow-up assessment. Jane reported sustained improvement in her PTSD symptoms and a higher quality of life. She also reported a sense of empowerment and increased self-esteem.
Discussion
Domestic violence is a common cause of PTSD, making it difficult to treat due to the ongoing trauma experienced by the victim. According to the study, 61% of women in Latin America and 42% of females in South Africa reported physical violence by their partners. A survey report analysis revealed that 12% of women with IPV (intimate partner violence) had PTSD [1]. Another study by Rao in 2020 revealed that domestic violence is shown to be increased by 48% in India [5].
EMDR, a psychological intervention technique, has effectively addressed emotional trauma and unpleasant life experiences [12]. For example, in PTSD children, adolescents, and adults, 77% of EMDR therapy reduced anxiety and post-traumatic symptoms. On the other hand, CBT therapy reduced chronic pain and stress only in one patient [8]. A randomized controlled trial examined 24 studies, seven of which found EMDR therapy more effective than trauma-focused cognitive-behavioral therapy. In addition, eight studies reported various other memory effects, such as working memory or past traumatic memory.
Additionally, 12 subjects indicated a rapid reduction in negative emotions and vividness of disturbing images. Evaluations have also documented that EMDR therapy can alleviate somatic complaints, with no significant difference observed in the depression between CBT and EMDR [9]. The mild to borderline intellectually disabled PTSD patients experienced a decrease in symptomatology after four sessions of EMDR, with sustained improvement at a six-week follow-up [10]. However, our patient reported improvement after completing six months of EMDR therapy. The varying time duration in progress may depend on the patient’s condition or trauma they experienced in their past.
A study showed the importance of left and right-hand movement in EMDR treatment [7]. This study implies bilateral stimulation, including eye movements, tapping, or auditory tones in EMDR treatment to treat patients conditions suffered from PTSD. Shapiro’s study mentioned the importance of clapping taps, tones, and bilateral eye movements in EMDR therapy [9]. On the other hand, Mevissen et al. signified using fingers with stickers, buzzer vibrations, auditory tones (using headphones or speakers), and tapping on the patient’s knee or hands in EMDR treatment [10]. Consistent with Mivissen et al. and Shapiro’s recommendations, the patient in our study was treated with figures, and bilateral stimulation, including eye movements, tapping, or auditory tones and the treatment received success.
These reports and the current study have indicated that EMDR can be applied to patients with stress-related disorders and those suffering from a wide range of physical conditions. However, varied duration effects and underlying factors influencing treatment efficacy should be addressed.
Conclusions
The study’s outcomes revealed that EMDR could effectively treat PTSD in women caused by domestic violence. The effect of EMDR therapy was successful in reducing Jane’s symptoms of PTSD and improving her overall mental health and well-being. However, a large sample size and a randomized controlled design study are required to validate the study results.
References
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