Index

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

AIP model, 15, 54

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

prevalence, 191, 191

reprocessing, 193, 196

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

Atonement, 202, 204

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

secondary gain, 123–124, 124

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

Closure, 175, 227–230

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

symptoms, 9, 9

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

prevention, 92–93, 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

limits, 56, 240

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

EMDR, 43, 48

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

drop-out rates, 42, 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

Informed consent, 56, 106–111

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

guilt, 200–201, 202–204

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

Labeling issues, 4–5, 6

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

assessment, 143–144, 184–185

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

treatment, 182–183, 184

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 career, 72, 125–126

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

amputation, 193, 196

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

Resilience, 10, 245–254

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

Suicidal ideation, 85–86, 203

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

case study, 143–144, 184–190

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