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the sets of eye movements. For Adriana, these statements were particularly meaningful
because she could connect them to other similar events (other panic-related episodes and
subsequent avoidance situations). Therefore, the associative link between the positive belief
and the memory of the disturbing event is strengthened so that when the traumatic event is
recalled, it is linked to the new positive belief (e.g., “I can handle these situations”). The
positive belief may also generalize to other similar situations that have occurred in the
client’s life and may change the client’s attitude toward present and future life events. This
phase, focusing on the installation of the positive self-assessment, is a crucial step toward
a positive therapeutic outcome.
After installation, the client is instructed to recall the original event while simultaneously
focusing on the words associated with the positive cognition (e.g., “I can handle the situa-
tion”) and mentally scanning her entire body from the top down. The purpose of this phase
(
body scan
) is to identify any residual tension. After processing the first panic attack,
Adriana still had some tension in her arms and legs, which was resolved with additional
sets of eye movements. After each processing session, the
closure
phase prepared Adriana
for the processing that may continue in the following hours or days. She was encouraged
to keep a log of thoughts, dreams, and memories that emerged between sessions. The
re-
evaluation
phase took place at the beginning of each subsequent session. Adriana was
asked to recall the previously processed traumatic event and to evaluate her response. This
determines whether reprocessing effects have been maintained. In this phase, new possible
targets, memories, or situations to be reprocessed with the EMDR protocol may emerge.
The reprocessing of the first panic attack led Adriana to identify her mother’s facial
expression as another important target. In fact, when she spoke about her disorder, Adriana
often related it to her mother’s usual attitude. She linked her urge to return home immedi-
ately (when she went out) to the distress always conveyed by her mother, which was related
to her need to know that all the family was together at home and safe, as if in a nest. Adriana
reported identifying with her mother’s states of mind and believed that this explained the
lack of self-confidence and permanent state of alert she had been experiencing since the
onset of her disorder.
The image representing this attitude of the mother, the negative and positive cognitions,
the emotion, the SUD level, and body location were identified. In fact, each target was
treated in the same way as the first panic attack according to the standard EMDR protocol
(Shapiro, 2001). The image associated with Adriana’s issue with her mother was her
mother’s (typical) expression of fear and concern. Her negative cognition was “I am pow-
erless” and the preferred positive cognition was “I can handle the situation.” This was not
very believable to Adriana as she reported her VOC to be 1. The emotion associated with
this target was anguish. Adriana felt significantly distressed as she recalled this target mem-
ory, as indicated by an SUD level of 8, and felt discomfort in her chest and throat.
After reprocessing this target, Adriana was able to recall that typical expression of her
mother without distress. She noted that the image was very distant and differentiated from
her. This was reflected in expressions such as “I am myself,” “I can choose what I want,”
“I am different from my mother,” “I must not take her literally,” “I can hold only onto the
things I need,” and “I am not alone after all.” Although Adriana felt that her mother’s
image was with her, she no longer believed that her mother needed help and viewed her
as stable.
Fernandez, Faretta / Panic Disorder and EMDR Treatment
53