A
Acute combat-related PTSD, reprocessing, case study, 155–156
Acute Stress Disorder
early treatment, 95–96
Eye Movement Desensitization, 170
case study, 171–176
Acute stress injuries, EMDR
research, 176–177
treatment considerations, 176–177
Acute Stress Reactions, 94–101
defined, 8
Acute war stress injury
client preparation, case study, 101–105
EMDR assessment, case study, 142–143
Adaptive associations, neural networks, 14
Adaptive outcomes, 10
Adaptive resources
military-related, 79
post-military, 79
Adaptive Stress Reactions, defined, 10
Adverse childhood experiences, EMDR, 27
Affirmation
interpersonal violence, 199
traumatic grief, 199
Agency, 150
Aggression, 221–224
reprocessing, 222–224
client education, 111
EMDR assessment, 132–133
history taking, 61
hypothesized mechanism of action, 12–14
Military Sexual Trauma, 216
psychopathology, 12
reprocessing, 152–153
target memories, 131–133
treatment planning, 61
American Psychiatric Association, EMDR evidence-based treatment research results, 39–41
Amputation, 190–197
Body Scan, 196
client history, 192–193
desensitization, 193–195
EMDR treatment, traumatic leg amputation case study, 192–196
medical discharge, 192
treatment issues, 191–192
Anger, 221–224
reprocessing, 222–224
Assessment, 261
assessing suitability, 79–82
example script, 17
goal, 16
intake assessment, 61–62
medically unexplained symptoms, 184–185
objectives, 16–17
traumatic grief, 207–208
Association, 18
Associative memory process, 14
Attrition
childhood trauma, 28–29
EMDR, 48
Auditory sounds, bilateral stimulation, 112
B
Baseline measures, ecological validity, 158–159
Battlemind resiliency training program, 26
Behavioral model, 15
Bilateral stimulation, 12, 13, 152
auditory sounds, 112
combining, 113
eye movements, 112
kinesthetic vibrations, 112–113
stimulation, 13
taps, 112–113
therapist response after stopping, 154
Blocked processing, reprocessing, 149
Blocking belief, 260
Body Scan
amputation, 196
case study, 166–167
example script, 19
goal, 19
objectives, 19
protocol, 166
Brain, information processing systems, 11
Brake and gas pedal metaphor, 115
Brief Intervention Focusing Protocol
post-traumatic growth, 247–249
resilience, 247–249
C
Childhood trauma, 27–28
attrition, 28–29
EMDR, 46
pre-military history, 46
Chronic pain, EMDR research, 196–197
Chronic war stress injury, client preparation, case study, 105–110
Client demographics, 72
Client expectation, reprocessing, 149
Client history
goal, 16
objectives, 16
Client preparation, 171–172, 260
acute war stress injury, case study, 101–105
ambivalent military client, 122–130
chronic war stress injury, case study, 105–110
coerced client, 122–123
fear of absolution, 129
fear of forgetting fallen heroes, 127
fear of losing control, 127–128
fear of losing edge, 126–127
fear of losing it, 127
fear of revealing embarrassing, shameful, or unlawful material, 128–129
goal, 16
interfering with deployment, promotion, and career, 125–126
medically unexplained symptoms, 184
military client treatment concerns, 121–130
objectives, 16
Client stabilization, 86–88, 96, 97–99
case studies, 101–110
Emergency Response Procedure, 96, 97
case studies, 101–110
Eye Movement Desensitization, 96.97–99
case studies, 101–110
Resource Development and Installation, 99–101
case studies, 101–110
stability checklist, 84
Client-therapist introduction, 55
Clinical intake, 55–71
Clinical Practice Guideline for the Management of Post-Traumatic Stress, DOD, 38–39
example script, 19–20
goal, 19
objectives, 19
time management, 227
Cluster memories
chronological ordering of combat experiences, 68
earliest-worst-recent reprocessing sequence, 64–65
participant cluster, 65
starting with current vs. past, 66
starting with least vs. most disturbing, 66
starting with worst memory first, 65–66
Cognitive Behavioral model, 15
Cognitive model, 15
Cognitive Processing Therapy, 108
drop-out rates, 42
Combat Operational Stress Reaction
defined, 8
Combat Operation Stress Control, 94–101
early treatment, 95–96
recommended interventions, 95–101
Combat/Tactical Breathing, 118–119
Co-morbidity, 32
EMDR, 45
Co-morbid substance use disorder, 219–221
informed consent, 219
treatment planning, 219–220
Compassion stress injury, 160, 249–254
EMDR
case study prevention protocol, 251–252
treatment, 252–253
healer occupational hazards, 250
impairment indicators, 250
prevalence, 250–251
resources, 254
silencing response, 250
treatment, 92–93
Comprehensive reprocessing, 90–91
Comprehensive Soldier Fitness (CSF) program, 26
Confidentiality, 237–241
breaching privilege, 238
civilian therapists, 239–240
disclosures on need-to-know basis, 241
mandatory reporting, 238
military personnel issues, 238–239
military population importance, 57–58
multiple relationships, 238
therapist considerations of managing in military populations, 59
therapist’s duty to advise, 240–241
Control, 150
interviewing, 60
Cost-effectiveness
Virtual Reality Therapy, 43
D
Dangerousness to self or others, assessment, 84–85
Department of Defense
Clinical Practice Guideline for the Management of Post-Traumatic Stress, 38–39
EMDR funded research, 25
war stress injury funded research, 25–26
Department of Veterans Affairs
1993-1999: EMDR research, 21–23
clinical trials, 21–23
combat PTSD with treatment fidelity, 23–24
reasons for lack of EMDR reserarch, 24–25
Deployment history
cycle, 74–78
identifying EMDR specific deployment-related past contributors, 76
non-war-related, 75
Desensitization, 148–149, 173–175
goal, 17–18
medically unexplained symptoms, 185–186
reprocessing, compared, 148–149
target memory, 18
De-Tur Protocol, 220–221
Diet history, 73–74
Disability compensation, EMDR, 48
Dissociation
reprocessing, 119–121
grounding activities, 120–121
screening, 82
Domestic violence survivor, EMDR treatment, case study, 212–215
Drop-out rates
Cognitive Processing Therapy, 42
EMDR, 48
Prolonged Exposure, 42
Dual-focused attention, 12–13, 151
Dualism, 7
E
EMDR, 11
access, 15
acute stress and trauma military treatment results, 32–34
Acute Stress Disorder, 170
case study, 171–176
acute stress injuries
research, 176–177
treatment considerations, 176–177
advantages, 41
adverse childhood experiences, 27
AIP model, 11
psychopathology, 12
assessment (see Assessment)
attrition, 48
benefit to military clients and armed services, 47
childhood trauma, 46
chronic pain research, 196–197
chronic war and traumatic stress treatment in military settings reports, 34–37
client role expectations, 111–112
metaphor, 114–115
co-morbidity, 45
comparative theoretical approaches, 15
compassion stress injury
case study prevention protocol, 251–252
treatment, 252–253
consecutive sessions, 47
contraindications, 79–82
cost-effectiveness, 43, 45–46, 48
cost savings, 48
credibility among practitioners, 49
credibility with military culture, 50
demonstrating, 112–113
disability compensation, 48
early intervention, 94–101
research summary, 34
efficacy, 39
non-war-related trauma, 27–28
ethical issues, 242–244
therapist competence, 243–244
treatment planning, 243
flexibility for military populations, 44
amount of exposure and self-disclosure, 44
decreased compassion stress and fatigue, 44
treatment option flexibility, 44–45
follow-up session, 234
functional brain imaging studies, 13
holistic framework, 16
hypothesized mechanism of action, 12–14
initial timing, 56–59
integration into primary care, 48
medically unexplained symptoms research, 183
move, 15
neuropsychological therapeutic frame credibility, 49
neuro-scientific research, 29–31
phantom-limb pain research, 196–197
potentially rapid treatment course, 46–47
practicality for military populations, 41–43
prepping for, 96
primary substance use or other addictive disorder, 220–221
PTSD, Vietnam veterans, 21, 23–24
rationale for military use, 38–50
readiness for reprocessing, 79–82
re-assess, 15
reduced demand characteristics, 42–43
reduced time demands on military clients, 41–42
REM sleep, recent research, 224–225
reprocessing, causes of, 156–157
research meta-analysis, 22
research studies, 21–37
Resource Development and Installation, compared, 118
sexual trauma, 27–28
single treatment protocol efficiency, 45–46
stabilization interventions, 96–101
standard protocol, 16–17
goals, 16–17
objectives, 16–17
phases, 16–17
stimulate, 15
terminating therapy, 234
terrorism
acute trauma, 29
chronic trauma, 29
theory, 11
importance, 14–15
therapist role expectations, 111–112
three-pronged protocol, 144–145
treatment summary, 144–145
traumatic brain injury, 197
underlying experiences, 12
unfunded research on military effectiveness, 31–32
Emergency Response Procedure, client stabilization, 96, 97
case studies, 101–110
Emotions, target memories, 138
Ethical issues, 237–244
EMDR, 242–244
therapist competence, 243–244
treatment planning, 243
Eye movement
bilateral stimulation, 112
role, 13–14
F
Family of origin history, 73
Feeder memories, 68–69
affect scan, 69
asking, 69
float back, 69
First meeting, 55–71
Flashback experience, 222
Functional assessment, 83
G
Gestalt model, 15
Guilt
interpersonal violence, 200–201, 202–204
cognitive interweaves, 202
useful metaphors and approaches, 202
Kubany’s guilt typology, 202–204
sources, 202–204
traumatic grief, 200–201
Gulf War, medically unexplained symptoms, 7
Gulf War Illness, 7
H
History taking, 72–74, 171, 260
AIP model, 61
elements, 60–61
identifying current contributors, 69
identifying future contributors, 69–70
identifying past contributors, 63–68
medically unexplained symptoms, 184
traumatic grief, 205–206
Hobbies, 73
Homicidal ideation, 85–86
Humanistic model, 15
Hypervigilance, 13
I
Image, target memories, 133–134
Information processing systems, brain, 11
co-morbid substance use disorder, 219
specific to EMDR treatment, 110–111
treatment options, 107–110
Installation, 162–163
example script, 18–19
goal, 18
medically unexplained symptoms, 188–190
objectives, 18
protocol, 162–163
Intake assessment, 61–62
Interpersonal violence
affirmation, 199
clinical considerations, 200
cognitive interweave on killing, 266
EMDR treatment, case study, 212–215
cognitive interweaves, 202
useful metaphors and approaches, 202
psychological impact of killing, 201–204
reevaluation, 214–215
reprocessing, 213–214
shame, 200–201
support, 199
timing of presentation, 198–199
understanding, 199
Interviewing
control, 60
strategies, 59–63
K
Kinesthetic vibrations, bilateral stimulation, 112–113
L
Lateralization, 13
Legal history, 74
Lifestyle history, 73–74
Looping, 18
M
Malingering, 241–242
Marital history, 72–73
Medical discharge, amputation, 192
Medical history, 77
Medically unexplained symptoms, 4, 5
case study, 143–144
causality, 5–6
desensitization, 185–186
EMDR treatment research, 183
Gulf War, 7
history of, 6–7
history taking, 184
installation, 188–190
overview, 5–6
preparation, 184
reevaluation, 187–188
symptoms, 6
case study, 184–190
war stress injury, 5–6
Medications, 108–109
Medico-legal issues, 237–244
Memory clusters, see Cluster memories
Mental health care
barriers to seeking, 58–59
military career ramifications, 58–59
stigma, 58–59
Military mental health, referral resources, 255–258
Military Sexual Trauma, 216–218
AIP model, 216
Military stress injury, 3–4
Military unit risk factors, assessing, 85
Mind-body unitary theory, 7
Misconduct stress behaviors, 10, 128–129
Modern industrialized warfare, accumulative toxic psychosomatic effects, 5–6
Modified EMDR, 170
Moral symptoms, 9
Myoclonic jerks, 35
N
Negative cognition, target memories, 135–136
Neural networks
adaptive associations, 14
maladaptive, 151–152
Neurobiological model, 15
Neurobiological studies, 29–31
Neuroimaging studies, 29–31
Neuropsychiatric conditions, 5
causality, 5
diagnoses, 5
Neuropsychiatric symptoms, 4
contemporary diagnoses, 6
symptoms, 6
World War II, prevalence, 6–7, 7
P
Participating-witnessing atrocity, 204
Perceptual disturbance, target memories, 139
Performance enhancement, 91–92
Phantom-limb pain, 34, 190–197
EMDR research, 196–197
reprocessing, 163–166
Popky’s De-Tur Protocol, 220–221
Positive cognition, target memories, 136–138
Positive war stress reactions, 78–79
Post-deployment history, 76–78
Post-traumatic growth, 78–79, 245–254
Brief Intervention Focusing Protocol, 247–249
contemporary approach, 245
defined, 10
EMDR applications, 246–249
Resource Development and Installation, 247
Post-Traumatic Stress
defined, 8
vs. PTSD, 8
Pre-deployment history, 74–75
Pre-military adaptive resources, 78
Pre-military traumatic stress injuries, EMDR treatment, 181–182
case study, 181–182
recruit training setting, 181–182
Presenting complaint, 63–64
Primary symptom reduction, 88–90, 170–171
Prolonged Exposure, 107–108
drop-out rates, 42
Psychological testing, traumatic grief, 206
Psychosomatic complaints, incidence, 7
PTSD
EMDR, Vietnam veterans, 21, 23–24
EMDR assessment, case study, 143–144
reprocessing, 155–156
reprocessing, case study, 163–166
R
Recent Events protocol, 170–171
Recreational activities, 73
Reevaluation, 175–176, 230–234
between-session changes, 231–232
conducting, 231–232
goal, 20
interpersonal violence, 214–215
medically unexplained symptoms, 187–188
objective, 20
target memories, 232–234
complete session, 233
incomplete session, 233
transitioning from welcoming to, 231
transitioning to reprocessing, 232–234
traumatic grief, 211–212
Referral question, 56–59
Relaxation activities, 73
Religious history, 73
Reprocessing
acute combat-related PTSD, case study, 155–156
aggression, 222–224
AIP model, 152–153
anger, 222–224
blocked processing, 149
blocked reprocessing, 157, 161
returning to target memory, 157
causes, 156–157
client expectation, 149
client-therapist role expectation, 149–150
closing complete session, 228
closing incomplete session, 228–230
cognitive interweave, 263–266
types, 263–266
coping strategies, 116–117
debriefing, 230
desensitization, compared, 148–149
dissociation, 119–121
grounding activities, 120–121
instilling client sense of agency and control, 150
interpersonal violence, 213–214
interventions for over-and under-responses to, 262
language of change, 154
maladaptive neural network, 151–152
managing intense emotional reprocessing, 159–160
metaphor, 115
over-responding, 161
phantom-limb pain, cse study, 163–166
phases, 116–117
PTSD, case study, 163–166
reaffirming therapist presence, 150–151, 152
safety checklist, 148–149
standard protocol, 148–155, 162–168
SUDS rating, 157–158
target assessment, 62
therapeutic alliance, 150–151
therapist-related factors that interfere with, 261
therapist response after soliciting client self-report, 154
traumatic grief, 208–211
troubleshooting guide, 259–266
under-responding, 161
when therapist should stop, 227–228
Brief Intervention Focusing Protocol, 247–249
building, 91–92
contemporary approach, 245
EMDR applications, 246–249
Resource Development and Installation, 247
Resource Development and Installation, 117–118
client stabilization, 99–101
case studies, 101–110
EMDR, compared, 118
post-traumatic growth, 247
resilience, 247
Responsibility, 265
S
Safety checklist, reprocessing, 148–149
Secondary gain, 77–78
client preparation, 123–124, 124
Self-absorption, 13
Sensory memories, target memories, 134
Sexual trauma, see Military Sexual Trauma
Shame
interpersonal violence, 200–201
traumatic grief, 200–201
Sleep dysfunction, EMDR treatment, 224–226
Social history, 73
Spiritual history, 73
Spiritual symptoms, 9
Stop signal, 115
Stress injury, 1
Substance use disorder co-morbidity, 219–221
Substance use disorders, 219
EMDR De-Tur Protocol, 220–221
Substance use history, 77
SUDS rating
ecological validity, 158–159
reprocessing, 157–158
target memories, 139
Support
interpersonal violence, 199
traumatic grief, 199
Survivor guilt, 203
Symptom history, 63–64
dimensionalizing, 64
Symptoms, Signs, and Ill-Defined Conditions (SSID), 4
T
Taps, bilateral stimulation, 112–113
Target memories
AIP model, 131–133
chronological ordering of combat experiences, 68
cluster memories
participant cluster, 65
starting with worst memory first, 65–66
considered desensitized, 158
desensitization, 18
emotions, 138
identifying core components, 131–141
image, 133–134
military client censorship, 134
negative cognition, 135–136
optimal number, 70–71
perceptual disturbance, 139
physical sensation, 139–141
positive cognition, 136–138
reevaluation, 232–234
complete session, 233
incomplete session, 233
returning, 18
sensory memories, 134
starting with current vs. past, 66
starting with least vs. most disturbing, 66
starting with worst memory first, 65–66
SUDS, 139
Validity of Cognition, 138
Terrorism, EMDR
acute trauma, 29
chronic trauma, 29
Therapeutic alliance, 56–57, 259
clinical skills enhancing, 55
enhancing, 94
establishing client-centered military culture, 55–56
reprocessing, 150–151
Therapeutic frame establishment, 113–114
Three-pronged protocol, 17, 20
TICES log, 230230
TICES strategies, 262
Time management, closure, 227
Touchstone event, 12
Traumatic brain injury
EMDR, 197
phantom-limb pain, 197
Traumatic grief
affirmation, 199
assessment, 207–208
clinical considerations, 200
guilt, 200–201
history taking, 205–206
psychological testing, 206
reevaluation, 211–212
reprocessing, 208–211
reversing the flow, 212
shame, 200–201
support, 199
timing of presentation, 198–199
treatment plan, 204–205
acute traumatic grief reaction, 204
case study, 205–212
chronic traumatic grief reaction, 204–205
understanding, 199
Traumatic stress injuries, psychoeducation, 105–106
Treatment, see also Treatment planning
acute war stress injury, case study, 142–143
AIP model, 132–133
altering script or sequence, 141–142
amputation, 192–196
domestic violence survivor, case study, 212–215
first meeting, 55–71
interpersonal violence
case study, 212–215
medically unexplained symptoms, 184
potentially rapid treatment course, 46–47
primary diagnosis not targeting substance use disorder, 219–221
PTSD, case study, 143–144
single treatment protocol efficiency and cost-effectiveness, 45–46
sleep dysfunction, 224–226
summary statement, 141
traumatic leg amputation case study, 192–196
treatment options, informed consent, 107–110
treatment session flow considerations, 146
treatment session length, 115–116
treatment session pace, 115–116
Treatment planning
AIP model, 61
elements, 60–61
goals, 86–93
identifying current contributors, 69
identifying future contributors, 69–70
identifying past contributors, 63–68
intervention choice, 86–93
key factors, 86
practical considerations, 71–86
primer, 62–63
three-pronged protocol, 63
traumatic grief, 204–205
acute traumatic grief reaction, 204
case study, 205–212
chronic traumatic grief reaction, 204–205
Trust, 59
therapist’s earning, 56–57
U
Understanding
interpersonal violence, 199
traumatic grief, 199
Unlawful behaviors, 128–129
V
Validity of Cognition, target memories, 138
Virtual Reality Therapy, 108
cost-effectiveness, 43
W
War, history of, 3
Warrior class, 3–10
society’s pact with, 3
War stress injury
incidence, 7.7
medically unexplained symptoms, 5–6