Unlocking the Power of EMDR Group Therapy with Group Traumatic Episode Protocol
(G-TEP)
Regina Morrow Robinson Ed.S., LMFT, LMHC
Safa Kemal Kaptan Ph.D.
Eye Movement Desensitization Reprocessing (EMDR) Therapy has expanded into EMDR Group Therapy. EMDR Integrative Group Treatment Protocol (IGTP) was first documented in 1998 in response to a natural disaster as both a prevention and early intervention application. Different EMDR group protocols are now utilized in countries around the world highlighting the cultural and diverse applicability (Kaptan 2021, Nickerson 2023).
Among them, EMDR Group Traumatic Episode Protocol (G-TEP) was developed in response to disasters (Shapiro, 2023). Applications of G-TEP have since expanded beyond disaster response to addressing many other trauma-based struggles and settings. First Responders and others who experience exposure to high stress professionally (Adler-Tapia et all 2023, Farrell et al., 2023), patients struggling with serious or chronic health issues (Moench & Billsten, 2021, Roberts, 2018), university counseling centers, and refugees (Bizouerne, C. et al., 2023, Kaplan 2021, Yurtsever et al., 2018) are some of those benefiting from G-TEP. It is also being utilized with couples, families and children which are currently experiencing an overwhelming on-going journey.
The design of G-TEP includes features to increase containment and safety. Specifically, it acknowledges and tackles the fragmented nature of recent overwhelming experiences, as outlined by Foa & Riggs (1994), Van der Kolk (1996), and Shapiro (2018). This is accomplished through the introduction of the “Trauma Episode,” which encompasses the event itself and its on-going, or lack of safety aftermath.
Originally integrated into the individual EMDR Recent Traumatic Episode Protocol, the Trauma Episode aspect focuses on the ongoing period marked by a lack of safety. By addressing both the onset of the traumatic event and its consequences extending from the past into the present and future, this approach aids in mitigating issues such as time distortion and the avoidance of future actions.
What sets this conceptualization apart is its applicability to a group setting, allowing the G-TEP protocol to be effectively utilized in an ongoing group where participants may have different yet similar journeys that continue to unfold.
Enabling the activation and expansion of the internal adaptive information processing system, this approach empowers participants to mindfully observe their internal thoughts, emotions, and bodily sensations during the sets of bilateral stimulation. A sense of control is fostered through self-bilateral stimulation, empowering participants to self-select specific fragments of their experiences to address.
In situations of overwhelming struggles, a common experience is a loss of control. To address this, the approach emphasizes privacy and minimizes the risk of secondary re-traumatization to both group members and therapists. Participants are encouraged to share positive resources, while the sharing of disturbing experiences is discouraged. The G-TEP method is designed to prevent the spread of disturbance across individuals, fostering the exchange of resilience, connection, and collective healing within the group.
G-TEP incorporates a scripted protocol and prominent step by step G-TEP worksheet which invites drawing and/or writing. The worksheet establishes three resources before trauma confrontation. It acts as a metacommunication with a visual representation of the trauma episode enveloped within present, past and future resources. The bottom of the worksheet provides a visual reminder of the past that is separate from the present.
There are six steps.
Step 1 includes a screening process and a stress management skill building exercise; the 4 Elements. Group members are invited to share their resource calm safe place from the four elements exercise. Participants are encouraged to use it outside of group.
Step 2 acknowledges the onset of the difficult time.
Step 3 group members are asked to recall a positive memory and it is strengthened. Sharing is again invited.
Step 4 there is a list of positive thoughts listed, activating the direction of growth the group members desire. Group members select the thoughts that make some sense to them.
Step 5 trauma targets are selected to process, one at a time, by scanning the whole episode, past, present, and future. Once the first memory fragment (target) is selected, it is drawn, or a word/symbol is added to the worksheet. Each fragment receives nine brief sets of 15-20 seconds bilateral stimulation. The subjective level of disturbance scale (SUD 0-10) is measured at the start and after every three sets. Once nine sets are completed, another scan of the episode is performed. A new target is self-selected and the same process repeats. How much time is set aside for G-TEP, and the group’s capacity determine the number of targets addressed. Children, for instance, typically address one fragment.
Step 6 group members are asked to think about the entire episode and check the Episode SUD level. Additionally, they are invited to select a positive thought they now have and want to take away with them. Sharing of what they wish to take away is invited.
This valuable information along with feedback and observations, informs the therapist if the group member will benefit from more G-TEP or other interventions. All G-TEP sessions include a closure to ensure that each member is presently oriented and stable. This often includes rehearsing four Elements exercise from Step 1.
There are many advantages to G-TEP. It is cost and time effective, an efficient use for resources, has built in screening, is simple to learn, there is less avoidance of care because members are not required or asked to share out loud their trauma or disturbance (Farrell et al., 2022). Members process internally while in connection with others also in healing. It is culturally adaptable and interpreter friendly. Each session is conducted in the same manner which permits group members to increase their depth of work due to the familiarity over repeated sessions. It is one way to overcome barriers to treatment for a family as they can all participate together; in the same session with the same therapists (Rowland & Asovski 2023). It is possible to build a repeatable sustainable group program combining G-TEP with other EMDR group protocols, psychoeducation, or additional group programs.
While this is a brief introduction to EMDR Group Traumatic Episode Protocol, to learn more about G-TEP and other Group EMDR protocols click on EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond .
References
Adler-Tapia, R. Silveria, D., DeFrates, J. (2023), Using Group EMDR with Emergency Responders including Law Enforcement Professionals, Firefighters, Emergency Medical Professionals, and Emergency Communications Dispatchers, In R. Morrow Robinson, S. Kemal Kaptan (Eds), EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. New York, NY. Springer Publishing Company.
Archuletta, C., Grandjean, V. (2023), Health-Medical Challenges and Grief: Group EMDR Therapy for Patients and Caregivers, In R. Morrow Robinson, S. Kemal Kaptan (Eds), EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. New York, NY. Springer Publishing Company.
Bizouerne, C., Dozio, E., Dlasso, E., Letzelter, A., Abuzeid, A., Le Roch, K., & Farrell, D. (2023). Randomized controlled trial: Comparing the effectiveness of brief group cognitive behavioural therapy and group eye movement desensitisation and reprocessing interventions for PTSD in internally displaced persons, administered by paraprofessionals in Northern Iraq. European Journal of Trauma & Dissociation, 7(4), 100362.
Farrell D, Moran J, Zat Z, Miller PW, Knibbs L, Papanikolopoulos P, Prattos T, McGowan I, McLaughlin D, Barron I, Mattheß C and Kiernan MD (2023). Group early intervention eye movement desensitization and reprocessing therapy as a video-conference psychotherapy with frontline/emergency workers in response to the COVID-19 pandemic in the treatment of post-traumatic stress disorder and moral injury—An RCT study. Front. Psychol. 14:1129912. doi: 10.3389/fpsyg.2023.1129912
Farrell, D (2022) EMDR in COVID-19 as a Video Conferencing Psychotherapy Using Blind 2 Therapist (B2Tr) EMDRIA Session 332 presentation 2022.9.17
Foa, E.B., & Riggs, D.S. (1994). Posttraumatic stress disorder and rape.
Gomez, A. (2023), The Journey of the Butterfly: G-TEP with Children (C-GTEP) In R. Morrow Robinson, S. Kemal Kaptan (Eds), EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. New York, NY. Springer Publishing Company.
Hemmerde, M., (2023), Umsetzbarkeit und Evaluation der gruppentherapeutischen EMDR-Methode G-TEP in der ambulanten Psychotherapie. (Zeitschrift für EMDR Nr. 8 Juni 2023 (Evaluation of the effectiveness on various symptoms independent of diagnoses of the Group-Traumatic Episode Protocol. A randomised pilot study)
Kaptan, S. K., Dursun, B. O., Knowles, M., Husain, N., & Varese, F. (2021). Group eye movement desensitization and reprocessing interventions in adults and children: A systematic review of randomized and nonrandomized trials. Clinical Psychology & Psychotherapy.
Moench, J., & Billsten, O. (2021). Randomized controlled trial: Self-care traumatic episode protocol (STEP), computerized EMDR treatment of COVID-19 related stress. Journal of EMDR Practice and Research. DOI: 10.1891/EMDR-D-20-00047
Morrow Robinson, R. Kemal Kaptan, S. (Eds.) (2023). EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. New York, NY. Springer Publishing Company.
DOI: 10.1891/9780826152954
Nickerson, M. (2023), The Power of Groups and Checklist for Cultural Competence as a Practioner of Group EMDR Therapy, In R. Morrow Robinson, S. Kemal Kaptan (Eds), EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. New York, NY. Springer Publishing Company.
Shapiro, E. (2023), The EMDR Group Traumatic Episode Protocol (G-TEP), In R. Morrow Robinson, S. Kemal Kaptan (Eds), EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. New York, NY. Springer Publishing Company.
Shapiro, E., (2012) EMDR and early psychological interventions following trauma, European Journal of Applied Psychology (ERAP). 62(4), 24251.https://doi.org/10.1016/j.erap.2012.09.003.
Shapiro, F (2018). Eye Movement Desentization and Reprocessing (EMDR): Basic Principles, Protocols, and procedures (3rd, 319-323). Gilford Press.
Roberts, A. K. P. (2018). The effects of the EMDR Group Traumatic Episode Protocol with cancer survivors. Journal of EMDR Practice and Research, 12(3), 105-117.
Rowland Petrie, C., Asovski, G. (2023), All Ages and Stages: Group EMDR Therapy for Children, Adolescents and Famillies, In R. Morrow Robinson, S. Kemal Kaptan (Eds), EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. New York, NY. Springer Publishing Company.
van der Kolk BA, Pelcovitz D., Roth, S. et al. Dissociation, somatization, and affect dysregualtion: the complexity of adpativion of trauma. The American Journal of Psychiatry. 1996 Jul;153. DOI: 10.1176/ajp.153.7.83
Yurtsever, A., Konuk, E. (2023), Group EMDR Therapy with Forcibly Displaced Groups; Refugees and Asylum Seekers, In R. Morrow Robinson, S. Kemal Kaptan (Eds), EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. New York, NY. Springer Publishing Company.
Yurtsever, A., Konuk, E., Akyüz, T., Zat, Z., Tükel, F., Çetinkaya, M., … & Shapiro, E. (2018). An eye movement desensitization and reprocessing (EMDR) group intervention for Syrian refugees with post-traumatic stress symptoms: Results of a randomized controlled trial. Frontiers in psychology, 9, 493.