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To illustrate, it was decided to target Adriana’s first panic attack for EMDR treatment
because it was the most disturbing event in the history of her disorder. She viewed it as an
event that was influencing her ability to function daily. As she described it,
I was discharged from the hospital . . . . A few days later . . . I went out for some shopping . . . .
While I was driving near my house, I was suddenly caught by an incredible agitation. I felt I
couldn’t breathe, as if I had a cramp, but I could do nothing . . . everything was blocked . . . my
body tingled . . . my head was spinning. I was very scared of dying. Terror. I couldn’t
breathe . . . . I don’t know how, but I succeeded to return home, I laid on the couch, but these
feelings did not go away. On the contrary, they got worse.
For Adriana, the most anguishing memory in this case was the image related to being in the
car, still trying to breathe but unable to inhale air. She felt a pain in her chest, her heart
accelerated, and she felt “a terrible feeling of death.”
Adriana, guided by her therapist, linked the image of this scene, to a negative self-belief
“I cannot control the situation.” The positive statement, that is, what she would rather think
about herself (“I can handle the situation”) did not feel very true to Adriana (VOC = 2 of 7).
The emotion linked to this memory (SUD = 10 of 10) was terror, and the distress was
noticed in the arms, chest, and legs.
During the fourth phase of EMDR treatment (
desensitization
), eye movements or other
forms of bilateral stimulation are used while the client focuses on the image, negative cog-
nition, and bodily sensations. This enables the dual focus of attention, whereby the client
concentrates on her inner experience associated with the traumatic memory while also
attending to the external bilateral stimulation administered by the therapist. The therapist
guides the client through several sets of eye movements until the SUD level has decreased
to a value of 0 or 1 (e.g., when the reaction is appropriate to the present circumstances).
After each set of eye movements, the therapist asks the client, “What do you notice now?”
to facilitate the verbalization of any new associations that might emerge.
After 10 sets of eye movements, Adriana noted that her distress had substantially
reduced. The scene of the first panic attack had faded and other memories, associations, and
sensations began to emerge. The positive associations that emerged over time were increas-
ingly adaptive and provided evidence that Adriana was starting to distance herself emo-
tionally from the situation. This was evident by such statements as “looking at this scene
does not bother me” or “I can handle these situations.” After further sets of eye movements,
Adriana gradually produced several meaningful memories and associations. For instance,
she reported seeing herself handling that situation because she managed to reach home in
spite of her feelings. In fact she noted, “All things considered, I never lost control . . .”
During the next phase of treatment (
installation
), the positive belief is strengthened after
the client no longer feels the distress related to the targeted traumatic memory. This is
obtained in practice by associating the positive cognition (“I can handle these situations”)
with the traumatic experience and adding eye movements. Installation is considered com-
plete when the client considers her positive statements totally true (VOC = 7).
For Adriana, the positive statements included “I can trust my ability to manage emotions”
or “I can handle these situations.” The clinician instructed Adriana to mentally recall the
distressing event (first panic attack) and to associate it with the positive statement during
52 Clinical Case Studies