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EMDR in the Context of General
Medical Practice in the UK: 4 case reports
Editorial note: This interesting article describes the
use of EMDR in a very time-pressured general practice surgery. The description
of the use of EMDR is unorthodox and must be considered anecdotal, especially
the second case report. If readers have any comments on the descriptions given,
please contact the editor. All responses to this article will be published on
the emails to the editor page.
Abtract: Some
EMDR cases that the author has conducted have taken long sessions outside of
normal surgery hours, but a few have reached a successful conclusion within
or nearly within the seven and a half minutes allocated to a GP consultation.
Four such cases are reported here.
Introduction
I have been interested in EMDR for about one of my 17 years as a Principal General
Medical Practitioner (GP). I have used EMDR on 29 cases since completing my Level
1 in September 1998. I have written this article is to draw attention to the contribution
EMDR can make to a GP's therapeutic facilities.Most of my patients have been with me for several years and obviously I know them and their backgrounds which enables the explanation of EMDR's theoretical conceptualisation to be explained in the context of already established rapport. My experience shows that it is vital for a therapeutic response to get a "gut" negative cognition (NC), positive cognition (PC), and respective Subjective Units of Distress (SUD) and Validity of Cognition (VoC) scores, based on a feeling of mutual confidence - 'rushing in' can lead into a brick wall, so to speak. Some cases have taken several long sessions outside surgery time, but a few have reached a successful conclusion within or nearly within the seven and half minutes allocated to a GP consultation. It is some of these examples I describe here: MIGRAINES:
My first patient who introduced me to the effectiveness of EMDR was a 35 year
old company secretary who had had many migraine attacks over the years, both premenstrual
(PMT) and otherwise. A charming lady who, with a low opinion of her abilities
though they are perfectly adequate, always excused herself for taking up the doctor's
valuable time when she came for another supply of Imigran (Sumatriptan) tablets.
Because of the expense of these tablets and a dissatisfaction at not getting to the root of her problem I asked her if she was upset about anything. She then said that she had been reprimanded by her employer some months previously and this had bought on a panic attack. After this her migraines had got worse. We then targeted the scene of the reprimand, and I heard for the first time the frequently quoted EMDR remark that the 'the scene was going away into the distance, like a picture getting smaller'. She then left the surgery and went on holiday. I met her three weeks later and she had had only one PMT migraine, and thanked my "magic hands". Her husband, seen independently, corroborated her remarks. I met her again recently to ask permission to relate her story and she confirmed that she gets only the occasional PMT migraine. GUILT FEELINGS:
A 48 year old lady came for analgesics for a bad headache. Her 84 year old mother
had just died after a long dementing illness (the mother had become increasing
difficult to manage whilst living with daughter and son in law). The mother had
died suddenly whilst eating lunch, her head falling forward into her food. The
daughter, my patient, who had physical problems herself having undergone a mastectomy
and radiotherapy for breast cancer in the previous 2 years, now felt very guilty
about her previous irritation and half formed wishes that her mother would die.
Neither SUDs ratings were taken nor PC established, but after 45 seconds of eye movements the headache suddenly cleared, and she said spontaneously, "My mother had some very happy times with us before she died". I have seen her since and the headaches have become much less. Apparently if they occur she gets her husband to help with eye movements, and the feelings of guilt go. Guilt feelings might imply an implicit NC and PC, as this EMDR session worked so well without the preliminary exploration, rather like Francine Shapiro's famous walk. (Shapiro 1995). I met her again recently when she came to the surgery for more medication for her breast cancer prophylaxis. She told me that every time she gets a headache she focuses her mind on "Nothing" while her husband or daughter does hand tapping. The headaches ease satisfactorily after about 90 secs. She has told her fellow office secretaries and they are using EMDR for their headaches, using thoughts and feelings about their holidays as positive cognitions. My patient felt that it was important to focus the mind on something while doing EMDR. This illustrates the ease of EMDR as a self help exercise, and is probably safe when used for presumably tension type headaches. Obviously more complex cases require a therapist. ANXIETY:
I saw a 74 year old man with a long history of agoraphobia and inability to use
lifts. He came to get more pain killers and to discuss his recent radiotherapy
for prostate cancer. During the consultation, he described intermittent attacks
of free floating anxiety, with a "churning knot" in the stomach, which
was actually present as we talked. Apparently they occurred usually when he was
alone. When asked to concentrate on the sensation, he gave a SUD rating of 6.
The PC identified was "I am lucky", meaning I still have fair health,
a nice house, a good wife and pleasant grandchildren although he rated the VoC
at 3 when the anxiety was present. We did four sets of hand tapping of about a minute each resulting in the churning disappearing. I then installed the PC. He was very surprised and found it hard to describe what he felt was happening, but it was very positive, and we planned to reassess him in a weeks time. I met him again as planned and he told me that he had been woken by the anxiety and the familiar "knot" in his stomach in the early hours of the morning after my first session with him. The following night he had taken 50 mg Dothiepin, and had felt unusually well ever since. He then told me that he had once got stuck in a lift, late one Friday evening, and dates the start of his lift phobia from that time. He wondered if his improvement had been a mixture of EMDR and Dothiepin, but until the mechanism of EMDR is known we can only speculate. UNREQUITED LOVE:
A 25 year old man came to see me. He was in tears and had suicidal thoughts. His
girlfriend of five years had left him five weeks earlier. Over the year prior
to this she had been constantly prevaricating, one day saying she wanted to be
with him, the next going off with other men. My patient was unable to shake off
the feelings of love he had for her in spite of her behaviour. Both his own parents
and his girlfriend's had been very critical and unhelpful. We chose for the safe place exercise the patient's car in which he had been in the habit of going for long drives to help settle his feelings. After three sets of about 2 minutes each, the NC of "I am worthless" changed to a tremendous feeling of peace. After a short pause, we then turned to the scene of the break up of the relationship. After three sets his description of the image of his girlfriend's behaviour was described as "tatty". The patient had come to ask for antidepressant medication..... he calmly left the surgery without it. I saw him later and he joked about his ex-girlfriend's behaviour and accepted my criticism of her with a smile. CONCLUSIONS:
OK, this is scarcely how to use EMDR in an 'official' way but it does give an
idea of how useful EMDR just might be in those clinics that have extreme time
pressures placed upon them. In some ways this is exactly the sort of quick and
effective intervention that Doctors look for in tablets. The difference is that
if EMDR can produce the rapid results we hear about, we are going to hear less
about the side-effects the poor patient has to endure on a regular basis.
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