FHE Health has begun providing intensive EMDR (“Eye Movement Desensitization Reprocessing”) as part of its specialized inpatient treatment program for first responders. The Shatterproof Intensive EMDR Program includes one EMDR resourcing group session, an intensive EMDR workbook for customizing individual goals, and two 1-1.5-hour intensive EMDR individual sessions.
EMDR is a highly effective therapy for PTSD and trauma-related mental health issues and has high success rates with first responders. More than 30 years of research support its use as a gold standard in trauma treatment.
Annalee Moody, MA, NCC, LMHC, CFRC, directs the intensive EMDR program and was instrumental in designing it. In a recent interview, she talked about its benefits for first responders and why intensive EMDR is more effective than outpatient for the Shatterproof population. What follow are highlights from that conversation.
Factors That Can Make PTSD in First Responders Hard to Treat
We asked Moody what factors can make PTSD notoriously hard to treat in the first responder population. She began with some context. First responders and veterans have a much higher propensity for developing PTSD because they are regularly and repeatedly exposed to trauma, Moody said.
On top of that, two factors in particular pose obstacles in treating first responder PTSD, according to Moody: “treatment non-compliance due to a lack of self-care resources and a lack of education about what PTSD is.”
Moody explained that the pressures of the job and the nature of their work often make compliance difficult for first responders: “Once they start a treatment protocol, they’re non-compliant because of shift work, doing overtime, or little time to attend to basic needs.”
Meanwhile, many first responders also lack “consistent access to time and resources to take care of themselves and continue treatment.”
Distinctive Components of Intensive EMDR in an Inpatient Context
What about intensive EMDR in an inpatient context is so distinctive?
“This is a whole program in an inpatient context, so we’re doing lots of EMDR therapy,” Moody said. “We’re also doing longer sessions, which means more actual reprocessing.” Here Moody gave the example of how, in an outpatient, one-hour session, the client might do 7-10 minutes of reprocessing with the therapist, whereas in a 90-minute, inpatient session, they would get 30-40 minutes of reprocessing.
Patients in the intensive EMDR program are “getting longer time and longer sets,” Moody said, “and because they’re in an inpatient treatment program, we have the ability to go deeper into their trauma faster—because it’s a safe, stable, and substance-free environment and we have our eyes on them to ensure their safety.”
What’s Accomplished in a Longer EMDR Session?
“In an outpatient context, you usually spend about 20 minutes catching up on what the client did the week before and how they’re doing,” Moody said. “In an inpatient context, you spend much less time on the checking in and much more of the session is spent reprocessing.”
The Role of the Workbook?
The workbook helps patients prepare for the group and individual sessions, by educating them about EMDR and helping them acclimate to the process. It also helps them “learn about their attachment styles, their trauma, their communication styles, and allows them to make connections and connect the dots in order to do the trauma reprocessing.”
Completed homework gives a helpful “snapshot” to the therapist about how to facilitate EMDR to address the individual’s needs and goals. Examples of “homework” might include “a dream log and ways to track progress, conceptually organize, and help manage everything that comes up in therapy.”
How the Group Sessions Work
There is such a thing as group EMDR, which sometimes is used after a traumatic incident witnessed by a group, Moody said. She explained that the intensive group sessions at FHE serve a different purpose, more of an educational one: “They educate patients about what EMDR is and how trauma impacts the brain and how EMDR works. The group sessions fulfill a resourcing role and help the patients develop their resources as a group.”
The group therapist might introduce a new resource that can support the reprocessing that the patients are doing in their individual EMDR sessions, Moody said. She gave the example of “a metaphorical container” that patients can use when distressing thoughts and emotions arise. Rather than suppressing or denying their experience, they instead can put those troubling sensations into the container.
Another resource the group therapist might impart: a calm scene— “not a happy place,” Moody clarified, “because many of those in treatment are dealing with severe depression and may not have felt happy in years, but a calm scene they can go to in their mind.”
The Importance of Goal Setting in Intensive EMDR
Individual goal setting plays an important part in intensive EMDR. Moody said the workbook, which is “in three parts (before, during, and after the EMDR)” is meant to support this process.
“As far as goal setting, it’s super important for first responders especially, because many don’t know how to set fair expectations for themselves,” Moody said. This is why the emphasis is on starting with smaller, more manageable goals. Her analogy: “If someone had the goal of running a marathon, we’d encourage a 5K.”
In the case of goal setting with EMDR, the workbook includes worksheets with prompts to help patients begin to articulate their treatment goals. These can include:
- Learning about EMDR and how it works
- Asking someone who has done EMDR to share their experience with it
- Trying EMDR in order to reprocess one or more major incidents of trauma
Ultimately, the goals of EMDR are to reduce the disturbance level of the trauma, eliminate the somatic response to it, and replace the negative cognition with a healthier one, Moody said.
How Does Intensive EMDR Expedite the Healing Process?
“EMDR can be difficult, because you’re reexperiencing on some level some of the trauma,” Moody said. “Outpatient EMDR is like ripping off a Bandaid one hair at a time versus ripping it off all at once, which is more efficient, faster, and more tolerable … A lot of first responders are all in and would rather rip that Bandaid off.”
Another way in which intensive EMDR expedites the healing process is that it overrides the problem of non-compliance that more commonly occurs with outpatient EMDR, Moody said. Because of this difficulty, “it’s much better for first responders to get in for inpatient treatment, so they can achieve a more global positive effect to the brain during and after EMDR.” This is especially true with “a highly prioritized” and “very well-resourced” program like ours, Moody added.
Other innovative aspects of the inpatient treatment experience at FHE Health work in tandem with EMDR to restore brain health and facilitate healing at a deeper, more comprehensive level. Neuroscience-based treatments therapeutically and non-invasively target areas of dysfunction in the brain. Integral breathwork works with the same parts of the brain that EMDR addresses. Medications like prazosin, prescribed for hypertension and nightmares, can reduce PTSD symptoms. Group and individual therapies provide another layer of trauma treatment, as does trauma-informed yoga.
Interested in learning more about intensive EMDR? Contact FHE Health today for more information.