EMDR FOR PEOPLE WITH AUTISTIC SPECTRUM DISORDERS (ASD) PRESENTED BY - PowerPoint PPT Presentation

EMDR FOR PEOPLE WITH AUTISTIC SPECTRUM DISORDERS (ASD) PRESENTED BY CAROLINE VAN DIEST EMDR TRAINER, CONSULTANT AND CBT THERAPIST

LEARNING OBJECTIVES • Understanding ASD in relation to EMDR • Consider adaptation to protocol • Identify potential blocks or obstacles • Improve your confidence with working with this client group • Draw your attention to literature (or lack of literature and encourage research/publication)

WHAT DO WE MEAN BY AUTISTIC SPECTRUM DISORDERS? • Consider the common characteristics that you think of when you hear the term ASD • Who have you worked with, what did you need to attend to? • In pairs or threes discuss this with your neighbour (5 mins)

FABULOUS PEOPLE • William – TV programmes. - no friends, sibling rivalry and behavioural challenges, orientated by his own interests, misinterpret gifts • Andrew – repaired the tree to make the problem go away! • Gary – anger, ice road truckers, “you said you ’ d be reliable” • James – walking on the left, hoodies • Harry – OCD – contamination, curry and IT • Maxine – relationships, confusion, fear and anxiety • Katie – engaged, teacher and accountant, challenged by rules/rigidity, musical, minimal group of friends

Autism Asperger’s Social (Pragmatic) Communication Disorder (May 2013) Impairment in social interaction Impairment in social interaction Difficulties in social use of verbal and non verbal communication Impairment in communication Restricted repetitive stereotyped behaviour Restricted repetitive stereotyped behaviour Delay in developmental abnormal functioning No delay in general language development in May not see it in early development prior to age 3 childhood or cognitive ability, self help adaptive behaviour or curiosity Clinically significant impairment social, Functional limitations: social academic, occupational, other domains functioning occupational Not attributable to other medical or neurobiological condition. Not autism and not intellectual or developmental disability Autistic Spectrum Disorders: Now covering: NO LONGER DIAGNOSIS – PREVIOUS autistic/ Asperger/pervasive developmental ASPERGER’S LABEL = AUTISTIC SPECTRUM disorder not otherwise specified DISORDER

SO WHY DO WE NEED THERAPY? VULNERABILITY FACTORS EXPERIENCES

WHAT DOES THE RESEARCH SAY? • Ester Leuning 2015: EMDR with Autism: chapter 6: Hans-Japp Oppenheim, Hellen Hornsveld, Erik ten Broeke and Ad de Jongh: Praktijkboek Deel ll Toepasssingen voor nieuwe patientengropen en stoormissen • Donald Kosatka and Celia Ona: EMDR in patient with Asperger’s Disorder: Case report. Journal of EMDR Practice and Research Vo 8 number 1 pg 13-18 • Richard Dilly 2014: EMDR in the treatment of trauma with mild intellectual disabilities: a case study Advances in Mental Health and Intellectual Disabilities pg 63-71 • Rosanna Gilderthorp 2015: Is EMDR an effective treatment for people diagnosed with both intellectual disability and post traumatic stress disorder? Journal of Intellectual Disabilities vol 19/1 • Beth Barol and Andrew Seubert: 2010 Stepping Stones: EMDR treatment of individuals with intellectual and developmental disabilities and challenging behaviour. Journal of EMDR Practice and Research Vol 4 Number 4 pg 156-169 • L Mevissen, Lievegoed and A de Jongh: 2011 EMDR Treatment in People with Mild ID and PTSD : 4 Cases. Psychiatry Q 82: 43-57 • R L Brand Flu Congress Psychiatry, EMDR Children with ASD – Abstract only • Sherri Paulson 2014 : Edinburgh EMDR Conference: Using EMDR with individuals with Autism

LATEST RESEARCH • ELLA LOBREGT-VAN BUUREN, BRAM SIZOO, AD DE JONGH AND LIESBETH MEVISEEN • DUTCH EMDR CONFERENCE 31 ST MARCH 2017 • FiRST CONTROLLED STUDY OF EFFECTIVENESS OF EMDR WITH ADULTS WITH AUTiSTIC SPECTRUM DISORDER • RESULTS INDICATE SIGNIFICANT REDUCTION IN TRAUMA RELATED SYMPTOMS, PSYCHOPATHOLOGICAL SYMTPOMS AND AUTISM SYMPTOMS • PROVIDING 8 SESSIONS OF EMDR IN ADDITION TO TREATMENT AS USUAL

HOW AND WHY WE NEED TO MODIFY THE PROTOCOL

COMPLICATIONS FOR US COMMUNICATION, NON VERBAL LACK NON SHARING UNDERSTANDING VERBAL EXPECTATION AND INFORMATION FEEDBACK INSTRUCTION ABOUT EMOTION AND EXPERIENCES ABREATIONS LACKING ENQUIRY STOP SIGNAL AND TICS AND INQUISITVE AND INNER NATURE PROCESSES

COMPLICATIONS FOR US LACK OF IMAGINATION AND AROUSAL EYE FUTURE MOVEMENTS TEMPLATE AND DIFFICULT RESOURCES LACK OF BODY GETTING AN AWARENESS IMAGE FRUSTRATING TO SENSORY GO BACK TO OVERLOAD TARGET

THINKING PHASES….. • PHASE ONE: HISTORY TAKING • PHASE TWO: PREPARATION • PHASE THREE: ASSESSMENT • PHASE FOUR: DESENSITIZATION • PHASE FIVE: INSTALLATION • PHASE SIX: BODY SCAN • PHASE SEVEN: CLOSURE • PHASE EIGHT: RE-EVALUATION

PHASE ONE: HISTORY TAKING • THINKING TRAUMA HISTORY • TIME LINE • LACK OF SPONTANEOUS INFORMATION • LACK OF UNDERSTANDING AND REPORT OF TRAUMA – FACTUAL ACCOUNTS • DIFFICULT MEMORY - ANYONE ELSE WHO COULD CONTRIBUTE • FIXED STORY • TOO MUCH INFORMATION • LACK OF EMOTIONAL REGULATION WHEN TELLING THE STORY • THINKING TARGET SELECTION

PHASE TWO: PREPARTION • THERAPY ROOM/ENVIRONMENT – TICKING CLOCK • UNDERSTANDING EMOTIONS AND REGULATING AFFECT • PSYCHOLOGICAL EDUCATION RE: ANXIETY • SAFE PLACE • OTHER INTERESTS AND RITUALS OR ROUTINES • GROUNDING TECHNIQUES – PRACTICAL • TOOL BOX • EXPLAINING EMDR – ABSTRACT CONCEPT/TRIAL MAY BE NEEDED • TYPES OF BI LATERAL – SENSORY CONSIDERATIONS – EM MAY NOT BE PREFERRED, BUZZERS TOO MUCH, TOUCH DIFFICULT, NOISE TOO LOUD • STOP SIGNAL

PHASE THREE: ASSESSMENT • DIFFICULTY GETTING AN IMAGE: THINKING ABOUT DRAWINGS, DESCRIBING AS A DVD ON A SCREEN • PHOTO BOOK, CLIPPINGS, STORIES FROM OTHERS, SOCIAL STORIES, COMMIC STRIP CONVERSATIONS • NEGATIVE COGNITION – DOMAINS – CONCEPT OF HOW YOU FEEL NOW COULD BE DIFFICULT • POSITIVE COGNITION – ABSTRACT AND GENERAL CONCEPT DIFFICULT TO IDENTIFY AND RATE WITH VOC • SUDS: LIKERT SCALE DIFFICULT – VISUALLY REPRESENT IT, DESIGN A SCALE TOGETHER

PHASE FOUR: DESENSITIZATION • SPEED OF PROCESSING – TAXING WORKING MEMORY • EM’S OR TAPPING – MULTIPLE MAY BE OVERSTIMULATING • FEEDBACK – UNDERSTANDING EXPECTATIONS, INTERPRETING EXPERIENCES CAN BE DIFFICULT, FEEDBACK MAY BE DELAYED. • COGNITIVE INTERWEAVES – MORE DIRECTIVE, LESS SOCRATIC • GOING BACK TO THE TARGET MAY BE CONFUSING OR FRUSTRATING.

PHASE FIVE: INSTALLATION • THE THEN AND NOW QUESTION….. HARD TO COMPREHEND • OFTEN FEEDBACK IS, IT JUST IS DONE…. NOT BOTHERING ME… LIKERT SCALES • LACKING GENERALISATION

PHASE SIX: BODY SCAN • MAY HAVE MOVED ON – “ITS GONE” “WIPED OUT” “JUST IS” • UNAWARE OF BODY SENSATIONS

PHASE SEVEN: CLOSURE • IF YOU NOTICE ANYTHING… TOO MUCH OF AN AMBIGUOUS A STATEMENT • LACK OF GENERALISATION TO CONSIDER • MAY WANT TO TALK ABOUT EXPERIENCE • NOT UNDERSTAND IT WILL CONTINUE OR SEE IMPROVEMENT • “YOU’VE WORKED REALLY HARD” …. ABSTRACT CONCEPT

PHASE EIGHT: RE-EVALUATION • LACK OF GENERALISATION • LACK OF SPONTANEOUS INFORMATION- ASK PRACTICALS BASED ON ORIGINAL PROBLEM OR PRESENTATION (IE ARE YOU ABLE TO DRIVE THE CAR NOW WITHOUT CHECKING THE MIRROR MORE THAN 6 TIMES AT THE TRAFFIC LIGHTS?) • MEMORY IS DISMISSED EASY AND CLIENT MAY NOT WISH TO REVISIT IT IN ANY DETAIL

Any Questions?