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Although most would acknowledge that the intensity of a traumatic event contributes to
the impact on the individual, the participants’s mental processing skills must also be con-
sidered. For instance, a harmless event for an adult may be traumatic for a child. According
to the AIP model, these events are considered
small t
trauma, although the events needed
to diagnose PTSD such as accidents and natural disasters are considered
large T
traumas
(see Shapiro, 2001, 2002). As mentioned previously, if the adult’s neurological structure is
still affected by traces of an insufficiently processed traumatic childhood experience, an
apparently neutral current event can be experienced by the participant as anguishing and
elicit an intense anxiety reaction.
In addition to the role of events per se (abuse, accidents, separations, etc.), parental atti-
tudes must also be considered. Parental apprehension, strict parenting approaches, and rigidity
tend to influence children’s lives, thereby reducing their ability to explore independently
and to achieve self-confidence (Parker, 1981). Converting these parental attitudes into targets
through the identification of representative events will allow them to be processed through
the EMDR protocol.
The correlation between symptoms and previous negative or stressful experiences is par-
ticularly clear in panic disorders. In fact, with reference to the role of unpleasant events in
the etiology and maintenance of emotional disturbance, memory plays a mediating role
(Williams, 1996) between event and psychopathology. Therefore, working on negative and
damaging experiences is considered a key to accessing and changing dysfunctional knowl-
edge and behavior. Given EMDR’s proven effectiveness in this regard, one would expect it
to effectively address the traumatic etiological events related to panic disorders. However,
before using EMDR, therapists must take a thorough client history to identify and define
the experiences that have created a vulnerability to these symptoms. The first panic attack
is often the climax of a chain of stressful events, occurring once life circumstances are no
longer conducive to escaping into avoidance (Fava & Mangelli, 1999). Often panic attacks
occur during times of high stress, generated by problems at school or at work, loss of a
loved one, as well as after a surgery, an accident, or the birth of a child.
Because the feeling of powerlessness and loss of control typical of panic disorders con-
figure a cognitive and emotional schema often learned after experiencing disturbing events,
the great challenge in psychotherapy is to identify and to reconstruct other situations asso-
ciated with similar feelings of panic or distress (Fernandez, 2001). Moreover, the thera-
peutic goal is to identify the moment and the situation responsible for these dysfunctional
learning experiences. Often, this involves incidents of abuse, parental arguments, accidents,
and separations or losses.
Because these experiences have been dysfunctionally stored in the memory, information
is fragmented, stored as sensory impressions, and later experienced as anxiety and distress.
Evidence suggests that symptoms experienced during panic attacks (anxiety, extreme agi-
tation, exaggerated startle response, irrational thinking, and blocking beliefs, harrowing
emotions, eventual depersonalization and derealization experiences) become traumatic
experiences in their own right (McNally & Lukach, 1992). Therefore, it is necessary to
address the memories of particularly traumatic panic attacks, including the first, the worst,
the last, and a projected future event. EMDR is an integrative psychotherapy that uses an
8-phase treatment approach and standardized phobia protocol to address these issues
(Shapiro, 2001).
50 Clinical Case Studies