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Treating Veterans with PTSD
Treating Veterans with PTSD

Section 7
Eye Movement Desensitization and Reprocessing

Question 7 | Test | Table of Contents |
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

In the last section, we gave an introduction that served as a review for treating clients with PTSD and that will help begin the discussion of treatment with your client.

In this section we will discuss the eye movement technique that can be used by your PTSD client as a quick distraction and a way to gain temporary relief from distressing thoughts. This may be a review for you if you have had studied eye movement techniques but it is a good technique to use with your PTSD clients.

Michelle, who was introduced in the previous section, was dealing with trauma after early physical and emotional abuse and faced a traumatic experience of being held at knifepoint. Michelle was still experiencing anxiety and panic attacks and she shared with me, "It’s as if your own mind attacks you. This sense of being viciously threatened by your own thoughts is terrifying- there is absolutely nowhere to hide. How do I deal with the panic attacks that seem to just creep up on me? How can I deal with them in the moment?"

I then went over the Eye Movement Technique with Michelle to help her gain temporary relief from PTSD related thoughts she had. The Eye Movement Technique is different from eye movement desensitization and reprocessing (EMDR) which is a far more comprehensive treatment strategy. We will cover EMDR later in this course.

Eye Movement Technique:
To begin with each step of the Eye Movement Technique, I say the sentences in bold out loud and continue each step until my client is ready to move on.

1. "Identify something that upsets you."
I stated to Michelle, "Think of something, whether it be a present situation or seeing a trigger or thinking about the trauma, that upsets you. Then rate the situation on the subjective units of distress (SUDs) scale. This scale rates how stressing a situation is for you. A rating of 0 means you feel relaxed with no distress. A rating of 10 means the most extreme distress that you have ever experienced." Once Michelle rates the situation, we move on to the next step.

2. "Imagine the upsetting event."
I then stated, "Add worry upon your upsetting situation by including ‘what-ifs’, ‘oh nos’, and so on. Think about the situation until it is about a 5 or 6 on the SUD scale. At this level, you may still experience fear, anxiety, or other similar uncomfortable states but you are able to think clearly." When Michelle has reached this level of anxiety, we move on.

3. "With your eyes open and your head still, watch as I move my hands."
I began moving my hand back and forth horizontally about two feet at a distance of about fourteen inches from her eyes. I stated to Michelle, "Pay attention to whether or not this reduces your discomfort."

4. "Where are your SUDs now?"
I asked Michelle to rerate the situation on the SUDs scale and stated, "It is characteristic that people drop to 4 or 4.5 on the scale. What happened to your images and thoughts?" It is typical that clients may say something like their emotions or thoughts are suppressed, blurred, blocked, shrunk, or even faded.

5. "If your thoughts and images altered somewhat and if your SUDs dropped a little, then this technique may be a useful skill to practice."
I then stated to Michelle, "If you do feel like this is a useful skill, this next step will put the skill under your control. Pick two spots in the room to focus on. Think about something that upsets you, again that is in the 5-6 range on the SUD scale. Once you get a clear image of it add worry to the image and bring yourself to the 5-6 range on the SUD scale. Complete roughly 25 cycles of eye movements and check for any alterations in your SUDs, images, and/or thoughts." Once Michelle tried it once on her own, I asked her how easy is it when she self-directed. Michelle, like most clients, found this process easier when therapist directed but with practice the self-directed becomes easier. We then continued to the next step to work on Michelle’s self-directed practice.

6. "You might be in situations when you cannot conveniently move your eyes back and forth."
I stated to Michelle, "In this situation, you can do the eye-movement technique with your eyes closed. It may even be helpful to have your hands over your eyes." I then had Michelle try this technique with her eyes closed. I continued, "Let your eyes close and get an image of a stressful event. Just like before, add the worrying thoughts until you reach a 5 or 6 on the SUDs range. Once you reach that level, try moving your eyes back and forth about 25 times. Notice what happened to your SUDs and what happened to your images and thoughts."

Michelle found the Eye Movement Technique helpful so I encouraged her to practice several times a day over a one to two week period in order to become a master of the skill. I stated to Michelle, "You can use this technique as an effective distraction from upsetting intrusions and as a rapid stress reducer."

Do you have a client who is experiencing panic attacks because of a traumatic experience who may benefit from using the Eye Movement Technique?

In this section we discussed the Eye Movement Technique that can be used by your PTSD client as a quick distraction and a way to gain temporary relief from distressing thoughts. The technique uses the SUD scale for your client to gauge their level of stress in different situations they identify. SUD stands for Subjective Units of Distress. For your client to use the technique in a self-directed manner, he or she can either pick two spots in the room to focus on and move his or her eyes back and forth about 25 times or he or she can close his or her eyes and move his or her eyes back and forth.

In the next section we will discuss the Feelings Dial and Containment Skills. Both of these techniques offer PTSD clients a way to manage intrusive thoughts, images, feelings, or sensations.

Source: Schiraldi 134-136 Naparstek 101

Peer-Reviewed Journal Article References:
Banbury, N. M. (2016). Case study: Play therapy and eye movement desensitization and reprocessing for pediatric single incident posttraumatic stress disorder and developmental regression. International Journal of Play Therapy, 25(3), 166–174. 

Jowett, S., Karatzias, T., Brown, M., Grieve, A., Paterson, D., & Walley, R. (2016). Eye movement desensitization and reprocessing (EMDR) for DSM–5 posttraumatic stress disorder (PTSD) in adults with intellectual disabilities: A case study review. Psychological Trauma: Theory, Research, Practice, and Policy, 8(6), 709–719.

Orbach, I., & Glaubman, H. (1979). Children's perception of death as a defensive process. Journal of Abnormal Psychology, 88(6), 671–674.

Sandler, I. N., Ma, Y., Tein, J.-Y., Ayers, T. S., Wolchik, S., Kennedy, C., & Millsap, R. (2010). Long-term effects of the family bereavement program on multiple indicators of grief in parentally bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 78(2), 131–143. 

Shapiro, R., & Brown, L. S. (2019). Eye movement desensitization and reprocessing therapy and related treatments for trauma: An innovative, integrative trauma treatment. Practice Innovations, 4(3), 139–155.

What are the two ways your client can self-direct the Eye Movement Technique (steps 5 and 6)? To select and enter your answer go to Test.

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