1. EMDR with traumatized
children
3.October 2012
1
Maire Riis
Crisis Program for Children and Youth
Laste ja Noorte Kriisiprogramm MTÜ
maire@lastekriis.ee

2. Crisis Program for Children and Youth
 since 1994 (ferry “Estonia” disaster)
 Supporting children and families traumatized by
the death of the close family member
 Working in individual and group settings
 With other childhood traumas
 Acute crisis intervention
 Teaching
2

3. Trauma in Childhood has long effects
Adverse Childhood Experience Study (ACE)
(n=17,000) (Felitti, et al., 1998)
Divorce
Not just emotional distress
Death of parent
4 or more ACE 
Yelling
more likely cancer, heart disease,
Neglect
more likely drugs, alcohol, suicide
Parent using alcohol / drugs
Parent with mental health problem
(e.g.bipolar, PTSD)
7 or more ACE 
Sexual abuse even if no drinking, smoking, overeating
Physical punishment 360% higher heart disease than 0
Domestic violence
Verbal abuse + witnessing violence > sexual abuse
without verbal abuse & witnessing violence
(Teicher et al. (2006). Sticks, Stones, and Hurtful Words: Relative Effects of
Various Forms of Childhood Maltreatment)

4. Eye movement desensitization and
reprocessing (EMDR) overview
 Trauma-focused psychoterapeutic approach
 originated by Francine Shapiro (first study 1989)
 Integrative psychotherapeutic model
 elements of many psychotherapeutic schools as
psychodynamic, cognitive behavioural, client-centered, body-
centered
 Treatment follows structured protocol
 Often limited amount of sessions
 Length of treatment depends on complexity of clinical
picture
 Originally developed for adults but is easily adjusted for
children 4

5. EMDR for whom
 Adults and children – for both
 Adjust according to the developmental level of the child !
 Painful memories from
 Traumatizing experiences
 After disasters and terror attacks
 Traumatic memories after bereavement
 Other disturbing memories that have not been
processed
 Recent research has also revealed that other, less dramatic
life experiences can cause even more symptoms of PTSD than
major traumas (F.Shapiro, 2012)
 Individual- and group setting
 Good results for children groups while adding drawing 5
 F.Shapiro, in press, 2012

6. International treatment guidelines
Effective Treatments for PTSD
 The European Network of Traumatic Stress Studies - TENTS (2010)
 International Society for Traumatic Stress Studies – ISTSS (2009)
 EMDR and cognitive behavioral therapy (CBT) equivalent efficacy
– Level A rating
 American Psychiatric Association – APA (2004)
 Department of Veterans Affairs & Department of Defense (2010)
 NICE - National Institute for Clinical Excellence,UK(2005)
 National Institute of Health and Medical Research, France (2004)
 National Board of Health and Welfare, Sweden (2010)
www.emdr-europe.org 6

7. Research
 Many randomized controlled trials for EMDR during 20
years
 The first-line psychological treatment for chronic PTSD should
be trauma-focused CBT or EMDR” (Bisson et al, 2007)
 “EMDR is an effective treatment for PTSD, and equally
effective as exposure-based therapies” (Spates, et al, 2009).
 For children fewer studies – Level B rating (ISTSS)
 Rodenburg, G., Benjamin, A., de Roos, C., Meijer, A.N., &
Stams, G.J, (November 2009). Efficacy of EMDR with children:
A meta-analysis. In Clinical Psychology Review Issue 7 599 –
606.
 More studies need to be completed for EMDR adapted for use
with children and adolescents.
7
http://consults.blogs.nytimes.com/references-on-e-m-d-r/

8. EMDR approach
 Adaptive Information Processing Model:
 The cornerstone of the EMDR approach:
memory networks are the basis of clinical
symptoms and of mental health
 The goal is to let the brain’s information
processing system make new internal
connections as the client focuses on the
thoughts, emotions, memories and other
associations that are freely made during the
sets of bilateral stimulation.
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9. EMDR as a therapeutic method
 Treatment focuses on how trauma affects present
functioning
 Processing includes working on one trauma memory
at a time
 Bilateral stimulation accompanies the client’s
processing
 Therapist guides client through the process
 Children reprocess their traumas more quickly
 Parents are involved in the process
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10. An eight phase approach
Phase 4 – 6 unique to EMDR treatment
1. History taking phase
2. Preparation phase
3. Assessment phase
4. Desensitization phase
5. Installation phase
6. Body scan phase
7. Closure phase
8. Re-evaluation phase
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11. What happens during EMDR?
Traumatic memory EMDR Memory
Less disturbing
Associated with disturbing Image
Image Positive Cognition
Cognitions Appropriate Affect
Affect without disturbing
Physical Sensations Physical Sensations
(fragmented, not integrated)
The past is present The past is past
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12. What does EMDR session look like
Phase 3 Assessment: (in connection to the memory)
 Memory:
 Father and grandmother fighting
 Worst part of the memory (image):
 I get scared, ´cause I don´t see my dad anymore
 Negative thoughts about oneself I can´t stand it
(for child: mixed-up thoughts):
(a “way out”)
 Positive thoughts
(for child: good thoughts about yourself) I can handle it
 Emotions and body sensations:
(for child: feeling-detector)
 I feel depressed, sad
 in my head, heart and stomach 12
Certain scales are added to measure disturbance...

13. Phase 4: Desensitization
 The information processing system of the brain is
stimulated so the memory can be transformed into an
adaptive learning experience.
 Reprocessing (appropriate for the age) using bilateral
stimulation until memory feels completely neutral:
 Eye movements (fingers, puppet)
 Tapping
 Tones
 After processing linking neutral memory to a psotive
statement a positive sense of self can emerge
 It´s not my fault, I am strong
 It doesn´t bother me anymore
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14. EMDR and children in Europe
 EMDR is being used in Europe to help children and
adolescents with a wide range of anxiety-related
problems, including single trauma, phobias,
nightmares, school-related anxieties, bullying,
medical problems, enuresis, social anxieties and
fears, attachment problems, sexual and physical
abuse, bonding, bereavement and depression.
(J.Morris-Smith, 2007)
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J.Morris-Smith, 2007. EMDR and children: Europe leads the way, Therapy for today, Vol8, 3.

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