1441 – Inclusion of eye movement de-sensitisation and reprocessing (EMDR) therapy as a separate Focussed Psychological Therapy under Medicare's Better Access to Psychology Scheme

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EMDR therapy requires strict adherence to an 8-phase protocol, including history taking, preparation, assessment, de-sensitisation, installation, body scan, closure and re-evaluation (Shapiro 1995). Diaphragmatic breathing or distress tolerance skills are covered in the preparation phase. Target memories are then assessed and an appropriate memory selected for de-sensitisation. The associated negative and desired positive beliefs are identified, as well as emotions and body sensations that are present with these target memories. De-sensitisation begins with the consumer’s attention being directed to the negative memory (their negative belief) and body sensations. Bilateral stimulation is provided by way of saccadic eye movements.

Processing continues until the reported distress has reduced to 0 or 1 on a subjective unit of distress scale (SUDS); the preferred belief statement (positive memory) is then integrated with the now de-sensitised memory with saccadic eye movements, until the positive statement is rated as true (as measured on a seven-point scale, with 1=completely untrue; and 7=completely true).

During the final phase of treatment, a body scan is implemented where the consumer holds the target memory and positive belief in their mind while scanning their body for any negative sensations. If negative body sensations are reported, saccadic eye movements are continued until there are no longer any negative body sensations. Each session concludes with debriefing and specific closure procedures.

Follow-up sessions affirm that the person's memory (while still present) no longer causes disturbing emotions. Resolution of the traumatic memory allows the patient to reduce avoidance and anxiety symptoms.

Post-traumatic stress disorder (PTSD) arises when a person experiences a traumatic event and then develops symptoms that persist for at least a month following the incident (American Psychiatric Association, 2000). Traumatic events range from military trauma, to car accidents, natural disasters, robberies, hostage situations, home invasions, street violence, childhood sexual assault, domestic violence, rape and workplace abuse.

PTSD diagnosis is broken into 4 distinct symptom categories, each varying on a continuum of severity. Re-experiencing symptoms include flashbacks, nightmares (and general sleep disturbance) and any type of intrusive memories. Avoidance symptoms include efforts to avoid thinking of the trauma, numbing of general responsiveness, dissociation and restrictive range of affect. There are alterations in mood and cognitions accompanied by alterations in arousal and reactivity symptoms - for example, exaggerated startle response, hyper-vigilance, increased anger and risky behaviours (American Psychiatric Association, 2013, Asmundson et al., 2000; King, Leskin, King, & Weathers, 1998).

Secondary or co-morbid disorders are highly prevalent when a disturbing / traumatic event is experienced (McGuire, Lee & Drummond, 2014)

- As high as 40% of PTSD sufferers have a co-morbid substance abuse disorder;
- 30-50% of PTSD sufferers also have a depressive disorder; and
- 20-50% of PTSD sufferers also have chronic pain.
 

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