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a remission of panic disorder and agoraphobic behaviors symptoms. The 30 sessions
included 3 sessions of history taking and treatment planning; 3 sessions of preparation for
EMDR sessions; 15 EMDR processing sessions of etiological events, triggers, and future
behaviors; and 9 sessions reviewing results.
9 Follow-Up
Follow-up at 3 months, 6 months, and 1 year confirmed maintenance of the above effects.
Her posttreatment and follow-up diary not only reported no symptomatology but all of her
treatment goals were met as indicated by the following results:
Elimination of anxiety and panic attacks,
Elimination of avoidance behaviors,
Establishment of independent functioning through the ability to be alone and drive,
Resolution of agoraphobic symptoms,
Insight and understanding about symptoms and secondary gains, and
Establishment of a new self-perception, which included an adjustment of interpersonal
relationships, and return to normal daily life functioning.
10 Treatment Implications of the Case
In this case, several anguishing situations were effectively addressed by EMDR. It is
worth noting that the EMDR processing of a particular selected target—for instance, the
first panic attack—can spontaneously and directly associate with other related episodes.
Although sometimes the reasons for these connections are not immediately clear to the
therapist when they arise spontaneously during a set of eye movements, continued pro-
cessing generally reveals the logic and meaning in terms of the foundation of the disorder.
EMDR works on a multisensory level providing a simultaneous emotional desensitization,
change of physical sensations, and elicitation of client insights regarding event. The simul-
taneous shift in emotional and cognitive content allows the client to reestablish a more
appropriate contact with reality, thereby promoting new behaviors. Once this process is set
in motion, clients can take an appropriate emotional distance enabling them to gradually
accept the risk of facing their emotions and new situations.
In this particular case, Adriana began to recall and to connect all of the events that were
related to the panic attacks. Although this type of association is typical of therapeutic work
in general, it appears to occur more quickly during EMDR therapy. It seems that EMDR
provides direct access to the memory network and allows previous memories to be metab-
olized, thus contributing to therapeutic changes that go beyond the disappearance of the
originally presented complaint. In this instance, the EMDR treatment affected not only the
symptoms of panic and agoraphobia but reconstellated the family of origin power dynamic
and placed her upcoming marriage in a new perspective.
The sequence of treatment procedures demonstrated in the present case is very signifi-
cant. Unlike standard CBT treatments, therapist-assisted in vivo exposure was not needed
as part of the therapy. Standard CBT treatment of PDA would include in vivo exposure as
58 Clinical Case Studies