Expanding the Healing Power of EMDR Therapy with the
EMDR Integrative Group Treatment Protocol for Ongoing Traumatic Stress
BIgnacio Jarero and Nicolle Mainthow
Eye Movement Desensitization and Reprocessing (EMDR) therapy (Shapiro, 2018) protocol for individual treatment in a group format has been modified to Integrative Group Treatment Protocol for Ongoing Traumatic Stress (EMDR-IGTP-OTS).
EMDR History
It is the direct descendant of the first EMDR therapy protocol in a group format, the EMDR Integrative Group Treatment Protocol (EMDR-IGTP; Jarero et al., 2006; Jarero et al., 2008). The EMDR-IGTP was developed in 1998 in response to Hurricane Paulina, which devastated Mexico’s Guerrero and Oaxaca coasts. After years of implementation of the EMDR-IGTP to address and alleviate the suffering of those impacted by natural and man-made disasters globally (Brown et al., 2017; Maslovaric et al., 2017), the EMDR-IGTP-OTS was developed as an adaptation of the original EMDR-IGTP to address recent, present, or past prolonged adverse experiences and ongoing traumatic stress situations (Jarero et al, 2018; Osorio et al, 2018). A remote, online version of the EMDR-IGTP-OTS-R was developed in response to the COVID-19 pandemic (Pérez et al., 2020).
As of October 2024, EMDR-IGTP and the EMDR-IGTP-OTS have 47 peer-reviewed published articles that demonstrate the efficacy, feasibility, and safety of the protocols in treating post-traumatic stress disorder (PTSD) symptoms (Jarero, 2024).
EMDR-IGTP-OTS Model
The EMDR-IGTP-OTS administers the eight phases of the EMDR therapy standard protocol, as well as incorporating aspects of art therapy (drawings and symbols). It employs the EMDR Butterfly Hug method (BH; Artigas & Jarero, 2014) for self-administered bilateral stimulation to facilitate the reprocessing of the individual’s traumatic material in a group setting.
Objectives of EMDR-IGTP-OTS
- To be a component of a symptom trajectory-based stepped-care approach for trauma-oriented treatment.
- To treat individual prolonged adverse experiences in a group setting.
- To reprocess pathogenic memories.
- To reduce or eliminate posttraumatic symptoms (e.g., PTSD, anxiety, and depression).
- To bring to conscious awareness those aspects of the adverse experiences that were dissociated.
- To facilitate the expression of painful emotions or shameful behaviors.
- To condense the different aspects of the pathogenic memories into representative and more manageable images.
- To increase the patient’s perception of mastery over the distressing components of the adverse experiences.
- The Emotional Protection Team offers the patients support and empathy.
- To identify those who need further assistance as part of a symptom trajectory-based stepped-care approach.
- To normalize reactions: The patients can see that their reactions are normal since other patients have similar reactions.
Advantages of EMDR-IGTP-OTS
- The group setting allows for the group administration of individual EMDR treatment, ensuring that many children, adolescents, and adults can be treated simultaneously. This is highly valuable in settings where resources are limited.
- The group setting reduces the stigma associated with mental health services, normalizes psychosocial support, and creates a sense of belonging, offering emotional support to participants.
- The structured worksheet promotes a sense of containment of the pathogenic memories.
- The highly manualized treatment protocol facilitates treatment adherence.
- Treatment can be delivered online or in-person in non-private settings, such as under a mango tree, in shelters, in open-air clinics, and so forth.
- Patients in the group do not have to verbalize or write information about the adverse experiences, preventing the other participants and clinicians from Secondary Traumatic Stress (STS) or Vicarious Trauma.
- The protocol is suitable for large-scale, post-traumatic situations and chaotic conditions, as well as for small groups (e.g., families).
- All treatment and pathogenic memories’ exposure take place in the affect-regulating presence of the Emotional Protection Team.
- The protocol is designed to be a structured and time-limited treatment intervention, easily taught to new and experienced EMDR clinicians.
- EMDR clinicians can be assisted by specially trained allied professionals (e.g., medical doctors, social workers, nurses), particularly where the availability of EMDR clinicians is limited.
- The pathogenic memories are not visualized mentally as in the standard EMDR protocol but instead are represented concretely in the participants’ drawings or symbols.
- The protocol can be provided on subsequent days, two or three times a day, and there is no need for homework between sessions. This reduces the risk of discontinuation of treatment and research attrition.
- The protocol is culturally sensitive and reduces cultural resistance, even to members of reticent cultures resistant to therapeutic treatment (e.g., military, first responders) because the protocol is minimally intrusive and respects privacy, does not require creating a narrative of the adverse experiences, does not require verbal or written disclosure of details, prolonged re-living of the traumatic experiences, or homework.
- The protocol is cost-effective because people are treated more quickly, with fewer therapists, and involving larger community segments, allowing for equitable care.
- Allows EMDR Therapy treatment to be more affordable and accessible to everyone, regardless of socioeconomic status.
Eight phases of EMDR-IGTP-OTS
Eight phases of the EMDR therapy standard protocol (Shapiro, 2018), with appropriate adjustments to accommodate the group format.
Phase 1: Those implementing the group gather basic demographic information of each participant and obtain a brief background of the recent event or adverse experience to be reprocessed in the group format.
Phase 2: The EMDR Butterfly Hug method, self-soothing exercise, and Subjective Units of Disturbance Scale (SUDS) are taught. Using an analogy, psychoeducation is provided to explain the Adaptive Information Processing (AIP) theoretical model (Shapiro, 2018). Verbal informed consent is obtained, and required materials are distributed.
Phase 3: The worst part of the adverse experience is identified through a specific directive that encompasses the entire traumatic stress clinical spectrum.
Phase 4: The traumatic material is reprocessed through drawings/symbols and the self-administration of the EMDR Butterfly Hug method.
Phase 5: A future vision is depicted with the application of the EMDR Butterfly Hug method. This phase allows usto identify adaptive or non-adaptive drawings and cognitions that are helpful in the evaluation of the participant at the end of the group protocol.
Phase 6: A body scan is implemented to reprocess any remnants of disturbing material somatically held.
Phase 7: The session is concluded with a self-soothing exercise taught in Phase 2.
Phase 8: At the end of all the group interventions, the EMDR clinicians will identify participants who need additional time to complete the reprocessing of any residual material from the previous group sessions.
Some Examples of populations treated with the EMDR-IGTP-OTS and the EMDR-IGTP
Disaster survivors (Trentini et al., 2018), children during ongoing war trauma (Zaghrout-Hodali et al., 2008), Caregivers of patients with dementia (Passoni et al., 2018), Women survivors of domestic violence (Harris et al., 2018), Refugee minors (Hurn, R., & Barron, I. 2018; Perilli et al., 2019; Molero et al.,2019); Children’s survivors of a terrorist attack (Brennstuhl et al., 2019), Healthcare professionals working with COVID-19 patients (Fogliato et al., 2022; Faretta et al., 20222), and Adolescents with multiple adverse childhood experiences (Roque-Lopez et al., 2021) women survivors of domestic violence.
For the full populations and references you can visit https://tinyurl.com/263byfe2
To learn more about the EMDR-IGTP-OTS visit: www.scalingupemdr.com
References
Artigas, L., & Jarero, I. (2014). The Butterfly Hug. In M. Luber (Ed.). Implementing EMDR Early Mental Health Interventions for Man-Made and Natural Disasters (pp. 127-130). New York, NY: Springer.
Brown, R.C., Witt, A., Fegert, J.M., Keller, F., Rassenhofer, M., and Plener, P.L. (2017). Psychosocial interventions for children and adolescents after man-made and natural disasters: a meta-analysis and systematic review. Psychological Medicine, Page 1 of 13. Cambridge University Press 2017. DOI:10.1017/S0033291717000496
Elisa Fogliato, Roberta Invernizzi1, Giada Maslovaric, Isabel Fernandez, Vittorio Rigamonti, Antonio Lora, Enrico Frisone, Marco Pagani (2022). Promoting Mental Health in Healthcare Workers in Hospitals through Psychological Group Support with EMDR during the Coronavirus Pandemic 2019: An Observational Study. Frontiers in Psychology. 12:794178. doi: 10.3389/fpsyg.2021.794178
Faretta, E., Garau, M.I., Gallina, E., Pagani, M., and Fernandez, I (2022). Supporting
Healthcare Workers in Times of COVID-19 with Eye Movement Desensitization and Reprocessing Online: A pilot study. Frontiers in Psychology. 13:964407. doi: 10.3389/fpsyg.2022.964407
Harris, H., Urdaneta, V., Triana, V., Vo, C.S., Walden, D., Myers, D. (2018). A Pilot Study with Spanish-Speaking Latina Survivors of Domestic Violence Comparing EMDR & TF-CBT Group Interventions. Open Journal of Social Sciences, 6, 203- 222.
Hurn, R., & Barron, I. (2018). The EMDR Integrative Group Treatment Protocol in a Psychosocial Program for Refugee Children: A Qualitative Pilot Study. Journal of EMDR Practice and Research, 12(4), 208-223Jarero, Ignacio. (2024). EMDR protocols, ASSYST treatment interventions, and EMDR Butterfly Hug method for early intervention and prolonged adverse experiences. Technical Report. Research Gate. https://tinyurl.com/28oboroz
Jarero, I., Artigas, L., & Hartung, J. (2006). EMDR integrative treatment protocol: A post-disaster trauma intervention for children & adults. Traumatology, 12(2), 121–129. Sage Publications. https://tinyurl.com/24zsfptb
Jarero, I., Artigas, L., & Montero, M. (2008). The EMDR integrative group treatment protocol: Application with child victims of a mass disaster. Journal of EMDR Practice and Research, 2(2), 97–105. DOI: 10.1891/1933-3196.2.2.97
Jarero, I., Givaudan, M., Osorio, A. (2018). Randomized Controlled Trial on the Provision of the EMDR Integrative Group Treatment Protocol Adapted for Ongoing Traumatic Stress to Female Patients with Cancer-Related Posttraumatic Stress Disorder. Journal of EMDR Practice and Research, 12(3), 94- 104.
Marie-Jo Brennstuhl, Fanny Bassan, Anne-Marie Fayard, Mathieu Fisselbrand, Amandine Guth, Maud Hassler, Karen Lebourg, Rachel Pavisse, Lydia Peter, Adeline Thiriet, Pascale Tarquinio, Jenny Ann Rydberg, Cyril Tarquinio. (2019). Immediate treatment following the November 13 attacks: Use of an EMDR emergency protocol. European Jour
Maslovaric, G., Zaccagnino, M., Mezzaluna, C., Perilli, S., Trivellato, D., Longo, V., and Civilotti, C. (2017). The Effectiveness of Eye Movement Desensitization and Reprocessing Integrative Group Protocol with Adolescent Survivors of the Central Italy Earthquake. Frontiers in Psychology. 8:1826. DOI: 10.3389/fpsyg.2017.01826
Molero, R.J., Jarero, I., Givaudan, M. (2019). Longitudinal Multisite Randomized Controlled Trial on the Provision of the EMDR Integrative Group Treatment Protocol for Ongoing Traumatic Stress to Refugee Minors in Valencia, Spain. American Journal of Applied Psychology, 8(4),77-88. doi: 10.11648/j.ajap.20190804.12
Osorio, A., Pérez, M.C., Tirado, S.G., Jarero, I., Givaudan, M. (2018). Randomized Controlled Trial on the EMDR Integrative Group Treatment Protocol for Ongoing Traumatic Stress with Adolescents and Young Adults Patients with Cancer. American Journal of Applied Psychology, 7(4), 50-56. doi: 10.11648/j.ajap.20180704.11
Passoni, S., Curinga, T., Toraldo, A., Berlingeri, M., Fernandez, I., Bottini, G. (2018). Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) applied to caregivers of patients with dementia. Frontiers in Psychology, Vol. 9. Article 967. DOI: 10.3389/fpsyg.2018.00967
Pérez, M.C., Estévez, M.E., Becker, Y., Osorio, A., Jarero, I., & Givaudan, M. (2020). Multisite Randomized Controlled Trial on the Provision of the EMDR Integrative Group Treatment Protocol for Ongoing Traumatic Stress Remote to Healthcare Professionals Working in Hospitals During the Covid-19 Pandemic. Psychology and Behavioral Science International Journal. 15(4):1-12. ID:555920. DOI: 10.19080/PBSIJ.2020.15.555920 https://tinyurl.com/yhqsm9ee
Perilli, S., Giuliani, A., Pagani, M., Mazzoni, G.P., Maslovari, G., Maccarrone, B., Morales, D. (2019). EMDR Group Treatment of Children Refugees -A Field Study. Journal of EMDR Practice and Research, 13(3),143-155.
Shapiro, F. (2018). Eye movement desensitization and reprocessing. Basic principles, protocols, and procedures (Third edition). Guilford Press.
Susana Roque-Lopez, Elkin Llanes-Anaya, María Jesús Alvarez-López, Megan Everts, Daniel Fernández, Richard J. Davidson, Perla Kaliman (2021). Mental health benefits of a 1-week intensive multimodal group program for adolescents with multiple adverse childhood experiences. Child Abuse & Neglect, 122, 1-11. https://tinyurl.com/yjj3zcv4
Trentini, C., Lauriola, M., Giuliani, A., Maslovaric, G., Tambelli, R., Fernandez. I., and Pagani, M. (2018). Dealing with the Aftermath of Mass Disasters: A Field Study on the Application of EMDR Integrative Group Treatment Protocol with Child Survivors of the 2016 Italy Earthquakes. Front. Psychol. 9:862. doi: 10.3389/fpsyg.2018.00862
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