How to treat psychological trauma with your eyes. Why is the ADHD (eye movement desensitization and reprocessing) technique good for the client?

DPDG Desensitization and Recycling of Psychological Traumas by Eye Movements (Shapiro) - method, technique, description, algorithm, training, self-application.

Method that is applicable for independent use.

This technique is related to " PSYCHOLOGICAL HELP "/" PSYCHOLOGICAL WORKING ".
I cannot say something specific about the explicit and obvious results from this method. It seems that this is one of those methods that only works sometimes and only for a few. And I entered it into this magazine because out of dozens of methods and techniques that were once seriously tested on myself, this technique (unlike dozens of other "dummies" from NLP, esotericism and psychology) really showed very clearly a couple of times (out of several dozens of approaches) a clear distinct result. True, these results were not as something "enchanting", but as insight, as a change in point of view, as new knowledge. And if suddenly this method works for you (even 1 time out of 20), then you can move mountains in this life, correctly and patiently applying this method to your goals, tasks, internal blocks, obstacles, etc. What exactly to apply and for what - is in the articles of this LJ.

DPDG - Desensitization and processing by eye movements
The method itself became popular thanks to Francine Shapiro, and it is she who is credited with its discovery and name. Although before her it was the same with the popularizer of NLP Steve Andreas.

In the description here, the method is positioned as for working with a therapist.But it can be quite simple to learn (learn) and easy to use on your own - for psychological help to oneself (and others) . You can buy a flashlight or a pointer with a laser, and follow the point with your eyes while walking along the wall. You can throw the ball from hand to hand and follow it with your eyes. You can, as in the picture below, my client did - glue or tape a ping-pong ball to a stick (about 80 cm), and then, moving this stick from side to side, follow the ball with your eyes. Or, for lovers of mysticism: instead of a ball at the end, you can adapt a candle (second picture below). You can also come up with all sorts of suitable options. It is possible without any auxiliary items at all. Skill comes with practice.

Now about the method.
(I compile information here from different sources)

Desensitization of psychotrauma using eye movement (DPDG)

Eye movement desensitization and reprocessing (EMA)

Every person at least once in his life has heard the old proverb - "the morning is wiser than the evening." And of course, any person knows that after a full sleep, all the problems and troubles that the night before put a heavy burden on the consciousness, are perceived in the morning not so dramatically. Why it happens? What does the human nervous system do so special during sleep, which makes it possible to “process” numerous, including negative, impressions of the day?

Neurophysiologists have an answer to this question. A person's sleep consists of several stages, one of which is accompanied by rapid movements of the eyeballs (by the way, it is during this phase that the sleeper sees dreams). At this stage of sleep, the processing of that information (and primarily complex, negative, and sometimes traumatic) that a person received during the day takes place.

And what happens if this information-processing system of the brain for some reason fails, is blocked? In these cases, negative information seems to “freeze”, gets stuck in the neural networks of the brain, its processing does not take place and it begins to injure a person, causing anxiety, obsessive thoughts, unpleasant physical sensations, in a word - neuroses.

Method

The method is based on the use of natural biological methods of information processing that the human nervous system possesses. Over the years of its existence, the method has proven to be highly effective in the treatment of psychotraumas.

The discovery of the method was preceded by a dramatic story related to the discovery of an oncological disease in the philologist Francine Shapiro, who at that time was successfully completing her doctoral dissertation on poetry by Thomas Hardy. The fatal diagnosis became a borderline in her life. She focused entirely on finding remedies for the disease and its devastating psychological effects. Shapiro enrolled in a doctorate in clinical psychology and unexpectedly discovered an original method that she initially used to reduce anxiety and stabilize her own emotional state. Then she began to experiment with other people, achieving positive results. Since Shapiro focused on reducing anxiety in accordance with a behavioral model, and the main component of the technique was controlled eye movement, she called the new procedure "Eye Movement Desensitization" or FDG for short. Shapiro, having recovered from cancer, by 1989 modified her method and began to teach it to clinicians. Through her research, she concluded that the optimal procedure using eye movements involves the simultaneous desensitization and cognitive restructuring of traumatic memories.

Quote:
The basis of the method is that the phase of the so-called "REM sleep" is reproduced in reality, during which information is processed in the nervous system. This is a very effective method of working with psychological trauma and psychological assistance, since the natural mechanism for processing psychotraumas existing in the human psyche is used. The effect comes on very quickly and is highly persistent.

What is the essence of the method?

The essence of the DPDG method is to activate a blocked brain system responsible for this important information processing. In other words, with the help of a therapist (or independently), the client does in a psychotherapeutic session what his information-processing system of the brain did not do at night.

The method is based on a model of accelerated information processing, according to which all people have a special psychophysiological mechanism, called the information processing system, which ensures the maintenance of mental balance (Shapiro, 1995). When this adaptive system is activated, any information is processed, including emotional information, associated with stress and problems of survival.

These processes normally occur in humans at the stage of sleep, accompanied by rapid eye movements (REM sleep phase).

If for some reason the information processing system is blocked, processing and neutralization of the traumatic experience does not occur. At the same time, negative information seems to “freeze” and freeze for a long time in the part of the neural network occupied by it in its original (due to traumatic experience) form.Neural structures that store dysfunctional material unchanged are isolated from other parts of the cerebral cortex. Therefore, adaptive ( psychotherapeutic) the information cannot link to the stuck and isolated information about the traumatic event, which means that no new learning occurs.Under the influence of various external and internal factors, one way or another reminiscent of trauma, restimulation (activation) of an isolated neural network occurs, which leads to the release of information stored in it: visual images, sounds, physical sensations, taste, smell, affect and ideas and beliefs associated with a traumatic event. At the same time, the subject not only vividly imagines his picture, but re-experiences the whole gamut of negative emotions and uncomfortable physical sensations.

Thus, the lack of adequate processing leads to the fact that the whole complex of negative experiences associated with trauma continues to be provoked by current events, which can manifest itself in the form of nightmares, obsessive thoughts, avoidant behavior, autonomic disturbances, etc.

The essence of the method is artificial revitalization the process of accelerated processing and neutralization of traumatic memories, as well as any other negative information blocked in the neural networks of the brain. It is assumed that eye movements or alternative forms of stimulation(alternate tapping on the palms of the hands or clicks of the fingers in one ear or the other), used during the DPDG procedure, trigger processes similar to those occurring in a dream, in the phase of rapid movement of the eyeballs.

The method provides quick access to isolated traumatic material, which undergoes accelerated processing. Memories with a high negative emotional charge turn into a more neutral form, and the corresponding perceptions and beliefs of patients acquire an adaptive character.

During the DPDG procedure, when the patient is asked to recall a traumatic memory, the psychotherapist (or the person himself, if he practices on his own) establishes a connection between consciousness and the part of the brain that stores information about the trauma (i.e. directs conscious attention to an image, or feeling, or a memory, etc. that is associated with a trauma). Eye movements activate the information processing system and restore its balance. With each new series of eye movements, traumatic information moves, and in an accelerated manner, further along the corresponding neurophysiological pathways until a positive resolution of this information is achieved.

One of the key assumptions in DPDG is that the activation of processing of traumatic memories will naturally direct those memories to the adaptive information required for positive resolution. Thus, the model of accelerated information processing is characterized by the idea of ​​psychological self-healing.

* Shapiro (1995) frankly admits that the accelerated information processing model is only a working hypothesis that helps to understand exactly how the RPDG works. It is assumed that in the future this model may be revised based on clinical and laboratory observations. As a result of numerous studies of DPDH, it has now been established that eye movements are only one form of bilateral stimulation and are not an integral part of treatment.

Indications for using the method
Francine Shapiro called her technique the Eye Movement Injury Desensitization and Treatment Technique (OMA). The word “desensitization” can be translated as “desensitization”. Psychotherapists around the world today, in addition to classical methods, use it in their work with those who have experienced emotional trauma, sexual abuse, the horrors of war, became a victim of a terrorist attack, natural disaster, and saw the death of other people. Situations like this are beyond the ordinary human experience. If such a traumatic event happened at a time when a person was especially vulnerable, his psyche cannot cope with this experience on its own. Months and even years later, obsessive thoughts and painful memories may haunt him. Their images are so vivid that every time a person feels the realism of what is happening: he does not just remember, but again and again experiences the same horror, pain, fear and helplessness. The DPDG technique can improve the condition in just a few sessions. It also helps in the treatment of various phobias, addictions, depression, anorexia and even schizophrenia at the initial stage of this disease.

Contraindications a little: severe mental conditions, some diseases of the heart and eyes, insufficient blood circulation in the brain, intraocular pressure, pregnancy (?), any conditions in which stress must be avoided.

How is the session going

First, the client, together with the therapist (or independently), finds earliest and most intense (!! about "intensive" - ​​different schools of psychology and psychologists // psychotherapists may have very different opinions and approaches to this indication. Some suggest starting with the least intense) a traumatic memory that may well turn out to be source, root the problem with which the client sought psychotherapeutic help.

The therapist then asks the client to focus on this negative memory.

Customer remembers and at the same time monitors directions of movement of the therapist's hand. It is clear that at the same time the client's eyeballs move, involving more and more new areas of the brain in the processing of traumatic material, which is quickly "grinded" at the same time, losing its painful force. And what is important - painful memories do not just lose their emotional color and significance, they automatically begin to be perceived from a different angle of view, unfold in the mind “on the shelves”, becoming part of the valuable life baggage.

During the procedure, the specialist controls the emotional state and is a reliable "guide" for negative memories. In addition, there is a psychosomatic assessment of the influence of emotions and the elimination of negative sensations.

Emotions are processed to a gradual weakening, while there is a kind of training that helps to use them in the future.

Recycling negative beliefs during exercise allows positive, confidence-inspiring emotions and beliefs to form new images, leading to more appropriate behaviors.

After each session, the person's sensory experience is revised, and a variety of reports of images, thoughts, or bodily sensations are produced as the topic under discussion and the person's original request are corrected.

Applicability

This technique is applicable both to current traumatic conditions, and to conditions from the past.

The use of the "fresh trail" technique, immediately after a traumatic event (for example, after an experienced catastrophe) allows clients to quickly return to their normal state and eliminate the impact of psychological trauma on their future life.

With psychological assistance in working with chronic conditions, it is necessary to achieve associations with them, since often such conditions are encapsulated. For example, a person may completely forget a traumatic event and the first manifestation of a condition caused by that event. This often manifests itself as the disappearance of segments of memories. The man says: "I was told that there was an event, but I do not remember anything." And the fact that the old state is dissociated does not exclude its influence on a person's life, on his key strategies of behavior.

Another application of the technique is as an addition to any others, in cases where a negative state interferes with work or for crushing generalized negative states.

This technique is also applicable to relieve unaccountable and constant anxiety caused by the expectation of a significant event or being in a dangerous, in the person's opinion, situation. "

There is now a lot of basic and additional information on this topic on the net and in the books of Shapiro and NLP. Whoever needs it will find)

The essence.
Working out the "problem"
1. Select the problem that you would like to work through (if you find the source / root of the problem, then this is generally good!).
2. Rate it on a 10-point scale ("0" - does not bother at all, "10" - the most severe anxiety / suboptimality)
3. What picture, emotion, feeling, sensation, conviction (about yourself, about others, about the world, about life, etc.) is there, when you think about this problem, perceive and / or experience it?
4. Keeping your attention on this problem / on the image of the problem (picture, emotion, feeling, sensation, thought), start moving your eyes. 22-24 times per scheme.
!! In the original original of the DPDG technique, it is proposed to work only with visual picture the problem / situation being worked on. But it makes sense to use and consistently work through the rest of the components of the problem - audio, emotions, feelings, bodily sensations, thoughts.
!! Different consultants may technically conduct and / or recommend this technique in different ways. Choose what suits you best.
The main options are:
- think about a problem / perceive a problem (a picture of a problem, a picture of a memory, a feeling, etc.) only between rounds oculomotor movements;
- thinking about a problem (or, for example, asking a question you want an answer to) and moving your eyes - simultaneously;
- keep a picture of a problem (or a picture of a memory) in imagination in front of and move your eyes;
- an imaginary picture move together with eyes, while paying special attention to areas of movement where the picture gets stuck or disappears.

5.
6. Give your eyes some rest.
7. Take multiple sets.
8.
- what do you think about your trouble now.
Now rate the level of anxiety on a 10-point scale.
9. Bring the assessment to an acceptable level for yourself, going through the entire cycle again as much as necessary (or maybe even stretching this study over several days).

In the same way, a positive self-determination that is beneficial to you is "built in".
1. What would you like to have instead of Problems?
2. What picture, emotion, feeling, sensation, belief (about yourself, about others, about the world, about life, etc.) is there when you think about this new, positive self-determination, perceive and / or experience it?
3. Assess your compliance now with this new positive self-determination ("0" - I do not correspond at all, "10" - I correspond absolutely at 100%)
4. Keeping your attention on this new self-determination / on the image of the new self-determination (picture, emotion, feeling, sensation), start moving your eyes. 22-24 times per scheme.

5. After finishing the series, throw everything out of your head and take a deep breath - exhale.
6. Give your eyes some rest.
7. Take multiple sets.
8. Then go back to the image and explore:
- what are you currently experiencing about this image,
- what do you think about your new image / self-determination now.
Now rate the level of compliance on a 10-point scale.
9. Bring your grade to an acceptable level for you

, going through the whole cycle again as much as needed (or maybe even stretching this study for several days).

"Clean up" possible remaining aspects
Investigate if there are any suboptimalities, doubts, etc. on the worked out "theme". If any are found, work them out according to the DPDG procedure.

This technique of working out / psychological assistance is recommended for application both to current traumatic conditions, and to conditions from the past and from the future.

Important note!

Unfortunately, in most cases, the usual version of the method of dpdg does not give almost any intelligible results to adults from its use. And when I see some Kovalev moving his fingers in front of the video camera for a couple of minutes in his video proudly declares to the audience, "Now breathe in, breathe out, your problem is solved!" - I am at least puzzled by this.

But the chances of working out the problems (even with such a dubious method) can still be slightly improved. Now a few words about this.

Here's the thing. If some experience of life has not been processed and / or cannot be processed in any way (including something about the future, for example), then there is some reason (or several reasons) that is inside this experience, but you still haven't recognized it and / or haven't taken it seriously. For example, in some situation in the past, which still cannot let go of a person, the underlying reason may be that in this situation there was an unexpected destruction of some important personal belief for a person, or his important personal value, or some important expectation or surprise, or something else like that ( * ). The reasons may be different, you need to look for your own. This reason - why the situation // experience "got stuck" and could not fit in as a simple life experience - needs to be found. It needs to be realized. Freeze as freeze frame. And then work with her. This will be more correct. Well, even better, it is to go deeper along the chain of reasons further.
The same applies to states about future "foreseeable" situations.

(* ) And on the basis of this, at that moment, a person could make some fateful conclusion or decision, for example. But this is the next "chain".

There is also an additional idea for this method, which is to try to work in turn with each of the eyes. This can be especially tried on material that does not "want" to be worked through at all. To do this, you need to alternately close your eyes with your hand, a bandage, or just close your eyes. And after such work, see if any of the parties brings improvement, and if so, which one. And then he will focus more on this side in working out the topic taken.

By the way, observations from practice:
- such eye movements can be used to cheer up, get out of the "dullness", wake up, activate the cerebral hemispheres, etc .;
- if he wants to yawn during this practice, then yawn to your health, do not suppress;
- it makes sense in several approaches to stretch the eye muscles at the extreme points of the range well straight all the way(unless, of course, for medical reasons you have no contraindications).
- answers to questions or a problem may not come immediately, but after a while.

Domoratsky Vladimir Antonovich

Doctor of Medicine, professor, psychotherapist, psychiatrist, sexologist. A full member and leader of the modality "Ericksonian psychotherapy and Ericksonian hypnosis" of the All-Russian Professional Psychotherapeutic League (APL), an official international class teacher of the APPL, a full member of the Russian Scientific Sexological Society, Vice-President of the National Self-Regulatory Organization "Union of Psychotherapists and Psychologists". Conducts long-term training programs on Ericksonian hypnosis in the League, as well as training seminars on psychotherapy with eye movements (MAP), short-term strategic psychotherapy, psychotherapy of sexual dysfunctions and marital disharmony, psychotherapy of psychosomatic disorders in Moscow, Minsk, Kiev, Chisinau, Krasnokostnodar, , Novosibirsk and other cities.

The main directions of scientific activity: studying the mechanisms of formation and clinical features of neurotic and sexual disorders. Development and improvement of approaches to the prevention and treatment of neurotic and psychosomatic disorders, sexual disharmony and sexual dysfunctions with an emphasis on methods of their psychotherapeutic correction.

Member of the editorial boards of the journals Psychiatry, Psychotherapy and Clinical Psychology (Minsk), Psychotherapy (Moscow), Theory and Practice of Psychotherapy (Montreal, Canada). Author and co-author of over 240 scientific publications, including 12 books.

As a practicing specialist, he conducts therapy for persons with neurotic and psychosomatic disorders, addictions, sexual disharmony and dysfunctions.

Eye movement desensitization and reprocessing (EMA)- one of the most effective methods of short-term therapy, while being quite easy to use, safe and versatile in use. DPDG works with children and adults, in the context of both the past, present and future, can be supplemented by other techniques, has a wide range of applications.

Duration of the training course: 40 academic hours.

Occupation mode: 2 seminars for 2 days (10 academic hours per day).

The target audience: practicing psychologists, psychotherapists, sexologists, psychiatrists, senior students of psychological faculties and medical universities.

At the seminars, you will be able to master the basic skills of EMDR for effective use in your own practice and self-help, learn about the peculiarities of applying the method in various situations and the possibilities of its combination with other approaches.

Dates of the seminars:

• October 13-14, 2018
• December 8-9, 2018

Time: 10.00-18.00

Course program

• The history of the creation and development of DPDG.
• The mechanisms of the therapeutic effect of the method.
• The main stages of the standard DPDG procedure.
• Dealing with individual negative memories.
• Techniques to ensure the safety of the client.
• Application of stimulating strategies for blocked processing of dysfunctional material.
• Features of work in the event of a response.
• DPDG in work with acute psychotraumas and distant traumatic events. Post-traumatic stress management (PTSD) protocols.
• Use of DPDH in children.
• General strategy of work in the DPDG model; psychotherapy (work with the past, present and future).
• Protocol for dealing with PTSD.
• Therapy of specific (isolated) and social phobias.
• Dealing with self-doubt and low self-esteem.
• DPDG in the treatment of anxiety disorders.
• Recommendations for the use of DPDG.
• How to present DPDG to clients?
• Bilateral stimulation as a self-help method.

At the second seminar, modern approaches to the use of DPDG in various situations are discussed and more complex work strategies are given:

• Risk factors when using DPDH.
• Concepts about complex trauma and features of its symptoms.
• The practice of using different variants of the "Safe place" technique.
• Use of the "lifeline" in DPDG.
• "Scan of Affect" technique.
• Technique "Connecting to resources".
• Fear Management Technique.
• "Blind" psychotherapeutic protocol (work without publicizing the problem).
• Picture protocol for DPDH for adults.
• Negative (nightmare) dream editor.
• Techniques for working with DPDG in a group format.
• Dealing with trauma violence.
• DPDG in the treatment of psychogenic sexual dysfunctions.
• DPDG in the treatment of dissociative disorders.
• Dealing with acute grief (loss syndrome).
• New protocols for working with cancer patients.
• Protocols for working with chemical dependencies.
• The use of DPDG in patients with somatic pathology.
• Combined use of DPDG and Ericksonian psychotherapy techniques.
• Supervision.

Forms of work: lectures; demonstration of practical work with various kinds of problems of participants using DPDG; work in pairs; supervision.

* The workshop leader conducts many demonstrations of practical work with various kinds of problems for participants using the techniques in question. * All participants receive electronic text versions of presentations, including protocols of work with various problems.

Additional Information

The method is based on a model of accelerated information processing, according to which a person has a special psychophysiological mechanism, called the adaptive information processing system, which ensures the maintenance of mental balance (F. Shapiro, 1995). When it is activated, any information is processed, including those related to stress and survival problems. These processes normally occur in all people at the stage of sleep, accompanied by rapid eye movements (REM sleep phase). If for some reason the information processing system is blocked, processing and neutralization of the traumatic experience does not occur. At the same time, negative information seems to “freeze” and freeze for a long time in the part of the neural network occupied by it in its original (due to traumatic experience) form. Neural structures that store dysfunctional material unchanged are isolated from other parts of the cerebral cortex. Therefore, adaptive (psychotherapeutic) information cannot connect with stuck and isolated information about a traumatic event, which means that new learning does not occur. Under the influence of various external and internal factors reminiscent of trauma, restimulation (activation) of an isolated neural network occurs, which leads to the release of information stored in it: images, sounds, sensations, taste, smell, affect and beliefs associated with the traumatic event. At the same time, the subject not only vividly imagines his picture, but re-experiences the whole gamut of negative emotions and physical discomfort. Thus, the lack of adequate processing leads to the fact that the whole complex of negative experiences associated with trauma continues to be provoked by current events, which can manifest itself in the form of nightmares, obsessive thoughts, avoidant behavior, autonomic disturbances, etc.

The essence of the method is to artificially activate the process of accelerated processing and neutralization of traumatic memories, as well as any other negative information blocked in the neural networks of the brain. It is assumed that eye movements or alternative forms of bilateral stimulation trigger processes similar to those occurring in sleep, in the phase of rapid movement of the eyeballs. The method provides quick access to isolated traumatic material, which undergoes accelerated processing. Memories with a high negative emotional charge turn into a more neutral form, and the corresponding perceptions and beliefs of patients acquire an adaptive character. With DPDH, rapid changes occur, which distinguishes the method from most other forms of psychotherapy. F. Shapiro (1995) explains this by the fact that the method allows direct access to dysfunctional material stored in memory.

Being, in fact, an integrative method, DPDG is well combined with other areas of psychotherapy. At the same time, it can be used as a very effective way of processing psychotraumas of any severity. In 2010, one of the pioneers of Geshalt therapy in France (since 1970) Serge Ginger published an unexpected article “EMDR: an Integrative Approach”, in which he urged colleagues to integrate the “revolutionary EMDR method” into their practice. He cited interesting statistics on his clients: 42% of clients had 1-2 sessions of EMDR therapy. The condition improved in 28% of them. 47% of clients completed 3-6 sessions. 84% of them showed a significant improvement. 10% of clients went through more than 7 sessions, 90% of them could see an improvement in their condition! Ginger notes overlaps and similarities between EMDR and other psychotherapeutic approaches. For example, as in Gestalt therapy, EMDR supports the client in expressing emotions while dealing with trauma (including bodily manifestations), while providing a safe framework through therapeutic alliance and empathy. The method seeks to complete the "unfinished gestalt" in the client's past. EMDR deals with “polarities” such as those simultaneously present: - the need for safety and the need for independence; caring for the feelings of others and defending oneself; negative self-image (“negative self-belief”) and the desired image that the person wants to achieve (“positive self-belief”). The method addresses both intrapersonal phenomena and the relationship of a person with the outside world, similar to how work takes place on the “border of contact” between a person and the environment, in “here and now”. EMDR also conducts regular body sensing assessments (“body scans”). Ginger emphasizes that the protocols and special techniques of information restructuring used in EMDR integrate well into gestalt therapy and other psychotherapeutic approaches, bringing there a neurophysiological dimension.

Indications for the use of the method:

• post-traumatic stress disorder (PTSD) among veterans of local wars and civilians (including traumas of sexual violence, the consequences of attacks, accidents, fires, man-made disasters and natural disasters); obsessive compulsive disorder; panic disorder; psychogenic sexual dysfunction;
• dissociative disorders (if the psychotherapist has special skills);
• dependence on psychoactive substances;
• chronic somatic diseases and associated psychological trauma;
• cases of acute grief (bereavement syndrome);
• psychosomatic disorders, in the history of which a psychotrauma has been identified, which presumably has a connection with the current pathology (this traumatic episode is being processed);
• marital and industrial conflicts;
• problems associated with increased anxiety, self-doubt, low self-esteem, etc.

Contraindications for the use of DPDG are few. These include: psychotic states, epilepsy, inability to tolerate high levels of anxiety (both during sessions and in the intervals between them).

Forms of work:

• lectures
• demonstration of practical work with various kinds of problems of participants using DPDG
• work in pairs
• supervision

Pre-registration in the group is required!

Contacts: training leader of the CPLP
Anna Rudolfovna Neroda

1987. Going through a difficult period in life (cancer, divorce from her husband), the American psychologist Francine Shapiro experienced real suffering: she was tormented by obsessive fears and nightmares. One day, while walking in the park, she noticed that quick movements of her eyes from left to right relieved her condition. She continued research that confirmed that the method helps with post-traumatic stress. Shapiro defended her thesis on DPDG, and in 2002 she received the Sigmund Freud Prize, the most prestigious award in the field of psychotherapy.

Definition

DPDG is a psychotherapeutic technique that is used in the treatment of emotional trauma. It is designed primarily for the treatment of PTSD, addiction syndrome or bereavement depression. At the moment of trauma (accident, terrorist attack, natural disaster, physical or mental violence), the human brain remembers all the details related to this event. Memories of them continue to haunt him, throwing him out of balance. The DPDG method helps to improve the client's condition by identifying the feelings and images associated with the painful experience of trauma, and to change the perception of this event.

Operating principle

The DPDG method is based on the neurological concept of psychological trauma and can accelerate word healing. A traumatic event blocks the processes of self-regulation of the psyche: images, sounds or bodily sensations associated with a painful experience seem to "get stuck" in it, so that a person experiences horror, pain, fear and helplessness over and over again. Eye movement helps to synchronize the rhythms of the cerebral hemispheres. And eye movements from side to side cause alternate activation of the hemispheres and synchronous processing of information. Natural self-regulation processes are restored, and the brain shuts down on its own.

Progress

After explaining the plan of action to the client, the therapist invites him to think about something good first. Next, a "target" is selected: some event from the past that haunts him, or the current situation that serves as a subject of concern (phobias or anxiety attacks). By focusing on the painful situation, the client focuses on the therapist's hand moving from left to right. During each session, he must follow 15 such rhythmic movements, wide and precise (the span is about 1 m). In the pauses between exercises, you can talk about this event and evaluate the intensity of the emotion experienced about it. Classes are held until the client notices a decrease in the severity of the experience. During the procedure, the specialist also helps to form new, positive images instead of those associated with the trauma. The memory of the trauma does not disappear, but it stops hurting the person.

Indications for use

For those who experience severe post-traumatic stress (after a terrorist attack, violence or disaster), as well as in the case when an event in the past left a painful memory. This technique can also help with disorders such as drug addiction, anorexia, or depression. Contraindications: severe mental conditions, some diseases of the heart and eyes.

How long? What is the price?

DPDH is more often used in combination with other methods and helps to reduce the severity of the experience and speed up the healing process. DPDG is not used at the first meeting with the client: first, it is necessary to get an idea of ​​the history of the disease and the nature of the symptoms. Sometimes one DPDG session is enough. A session lasts 1 hour and costs from 1500 rubles

(Eye Movement Desensitization and Reprocessing therapy, EMDR) was developed by an American Francine Shapiro and is very successfully used in the treatment of PTSD. In 1987, while walking, she noticed that eye movements reduced stressful memories.

The method is based on the idea that any traumatic information is unconsciously processed and absorbed by the brain during sleep- v REM sleep(other names: rapid eye movement sleep, REM sleep, REM from rapid eye movement). It is during this phase of sleep that we dream. Severe trauma disrupts the natural process of information processing, which leads to repeated nightmares with awakenings and, of course, to distortions of REM sleep. Treatment with repeated series of eye movements unblocks and accelerates the processing of traumatic experiences.

Performed from 1-2 to 6-16 sessions of treatment lasting 1-1.5 hours. The average frequency is 1-2 times a week.

Standard desensitization and recycling procedure eye movements contains 8 stages.

1) Safety assessment

Psychotherapist analyzes the entire clinical picture and highlights the goals of treatment... Use the DPDH method only in those patients who are able to cope with the possible high levels of anxiety during the session. For this reason, the psychotherapist first helps to cope with current problems and only then tackles long-standing trauma. At the end, the future is also worked out by creating and fixing in the patient's imagination " positive example»Behavior.

At this stage, patients also teach to reduce stress levels by using:

• imaginations safe place,
• technicians luminous flux(presentation of a healing ray of light that enters the body),
• independent using eye movements or neuromuscular relaxation.

2) Preparation

Establish productive trusting relationship with the patient, explain the essence of the method of desensitization and processing by eye movements. Figure out what types of eye movements of those offered are the most comfortable for the patient. The appearance of pain in the eyes when performing movements requires an immediate cessation of treatment with the consultation of an ophthalmologist to clarify possible contraindications to loads on the oculomotor muscles.

For testing the psychotherapist shows 2 touching fingers of his hand at a distance of 30-35 cm from the patient's face, and then, with gradual acceleration, moves the fingers left and right to the edge of the visual field. The optimal distance to the fingers, the height of the hand, the speed of movement are selected (maximum is required, but without discomfort). If the patient is unable to keep track of the fingers or a malfunction occurs (stop, involuntary eye movements), it is usually sufficient for the patient to press their fingers against their closed eyes. Check the effectiveness of other eye movements - in a circle, diagonal, figure eight. Vertical eye movements (up and down) soothe and reduce anxiety, dizziness and nausea.

One eye movement is a full cycle back and forth. In the technique of desensitization and processing with eye movements, series of 24 movements, the number of which can be increased to 36 or more.

If eye movements are impossible or uncomfortable, use alternative stimulation methods:

• alternately tapping on the patient's knees and palms facing upward,
• alternately doctor snapping fingers near the ears.

To reduce anxiety, the patient is taught technique "Safe place"... It is suggested to remember a calm place where he felt completely safe, and to focus on this image. The image is enhanced by the suggestion of the psychotherapist, as well as 4-6 series of eye movements. In the future, if necessary, the patient can on one's own return to safety in imagination.

It is also explained to the patient that he can interrupt the procedure at any time by raising your hand or giving another prearranged signal. This serves as an additional factor for patient safety.

3) Determination of the subject of influence

The psychotherapist defines target of impact... In PTSD, the goals of exposure can be a traumatic event, nightmares, and other experiences.

After choosing the target of exposure, the patient is offered pick an image that reflects the most unpleasant part traumatic event, and then asked to express in words painful self-images(in the present tense and in his own name), for example: “ I am nothing», « i did something bad», « i can't trust myself», « i don't deserve respect" and etc.

Next, you need to define positive presentation- what the patient wants to be at the present time, when he recalls the traumatic situation: “ I am good the way I am», « i can trust myself», « i control myself», « i did the best i could», « i can handle it". This positive idea is used later, in the 5th stage (installation). A positive self-presentation makes it easier to re-evaluate events correctly and contributes to a more adequate attitude towards them. The patient is invited to intuitively assess the adequacy of such self-presentation by a 7-point (SSP). If 1 (minimum) point is scored, meaning “ complete disagreement with the true self-image”, The psychotherapist must weigh the realistic wishes of the patient.

After that, the patient aloud calls negative emotions that arise when he focuses on trauma and painful ideas about himself, and also evaluates the level of anxiety by Subjective Anxiety Scale(SHS) from 0 (complete rest) to 10 points (maximum anxiety).

4) Desensitization

The goal is to reduce the patient's anxiety level.

At this stage, the patient should follow the movements of your fingers with your eyes psychotherapist, while remembering the most unpleasant part of the traumatic event and at the same time repeating to himself (not aloud) painful ideas such as “ I am nothing», « i did something bad". After each series of eye movements, the patient is told: “ Now rest. Inhale and exhale. Let everything go as it goes". Then they ask if there are any changes in visual images, thoughts, emotions and physical sensations (these are indicators of internal processing of psychotrauma).

Usually, the alternation of these series of eye movements with rest leads to a decrease in emotional and physical stress, and memories become more comfortable. The goal of the desensitization stage is to reduce the patient's level of anxiety during recollection of trauma to a minimum level of 0 or 1 on the SBR (Subjective Anxiety Scale).

During treatment with desensitization and processing by eye movements, it is possible short-term amplification of negative emotions or reaction (abreaction). However, the response is slightly different than with hypnosis because the patient persists double focus(on psychotrauma and on a sense of security in the present) as opposed to total immersion in hypnosis. During the DPDG session, registration occurs 4-5 times faster than in trance... If the response has begun, the therapist increases the number of eye movements to 36 or more in order to complete the response as possible during the current series.

If, after 2 consecutive series of eye movements, the patient does not feel any changes in thoughts and emotions, it is necessary change the direction of eye movements... The ineffectiveness of changing 2-3 directions of eye movement indicates blocked processing (additional strategies.

Additional strategies for blocked processing:

1) Change in direction, duration, speed, or span eye movements. It is more optimal to combine these techniques.

2) During the selection of eye movements, the patient is asked focus only on sensations in the body(without the image of psychotrauma and positive self-presentation).

3) Stimulating the patient express suppressed emotions openly and move freely. In parallel, eye movements are carried out.

4) Pressure by the patient (finger, hand) in the place of discomfort, while negative sensations decrease or associative images appear, which are influenced in the future.

5) Focusing on another aspect of the event(think about another image of psychotrauma, change the brightness of the performance, repaint it in black and white). Or focus on the most disturbing sound stimulus.

6) Cognitive intertwining- combine the thoughts and feelings of the patient with the psychotherapist's auxiliary information. Various cognitive intertwining options are possible:

1. the therapist explains to the patient correct understanding of past events and his role. The patient thinks about what was said during a series of eye movements.
2. redefining the traumatic situation through addressing significant persons for the patient... For example, a participant in the hostilities felt guilty for the fact that his best friend in battle did not follow the command of the commander to duck and was killed, while the patient himself ducked and remained alive. The psychotherapist advised to think about what the patient would order to do if the patient's 16-year-old son was in the friend's place. After answering "duck!" and a series of eye movements, the feeling of guilt was significantly reduced, and the working out of the situation was completed.
3. usage suitable analogies(metaphors) in the form of parables, stories or real life examples. The psychotherapist draws parallels with the patient's situation and provides hidden clues to solve the problem. This can be done both during a series of eye movements, or before it with a suggestion to ponder during the series.
4. Socratic dialogue(named after the ancient Greek philosopher Socrates). During the conversation, the therapist consistently asks questions, leading the patient to a certain logical conclusion. After the suggestion to ponder, a series of eye movements are performed.

During the processing of the main psychotrauma in the patient's mind, additional negative memories... They should be made the subject of focus on the next series of eye movements. During the treatment of PTSD in combatants, it is necessary to process all associative material (combat episodes, memories, sounds, sensations, etc.).

When all associations are revised, you should return to the initial goal(psychotrauma) to perform an additional series of eye movements. If within 2-3 episodes no new memories appear, and the level of anxiety according to the SSS is not higher than 1 point out of 10 (ideally 0 points), then proceed to the next (5th) stage - installation.

5) Installation

The goal is to enhance and consolidate the patient's self-esteem by linking positive self-image with trauma.

After desensitization (stage 4), the patient is asked to remember his positive presentation(as he wanted to see himself in the 3rd stage) and ask if it works now. Many patients refine or even change the self-concept that is meaningful to them.

Then the patient is offered think about trauma taking into account the voiced positive self-image and answer how much it corresponds to the truth. The patient is asked to recall the trauma from the position of a positive self-image, while the psychotherapist spends the number of eye movements series necessary to consolidate the effect.

If the consolidation was crowned with complete success (7 points on a subjective 7-point The scale of correspondence of representations), then go to the stage of scanning the body (6th stage). If, due to incomplete processing of additional memories and negative beliefs, the desired (maximum) level of consolidation cannot be achieved, then the treatment of DPDH is postponed to the next session, and this one is completed (7th stage - completion).

6) Body scan

The goal is to eliminate residual discomfort in the body.

If the fixation at the installation stage was successful (6-7 points on a subjective 7-point scale), scan is performed. The patient is asked to close his eyes and, presenting trauma and positive self-image, mentally walk all parts of your body from head to toe.

Any places of discomfort or unusual sensations should be reported. If discomfort is found somewhere, it is worked through with new series of eye movements. If there are no sensations at all, then a series of eye movements are performed. When pleasant sensations arise, they are enhanced with an additional series of DPDG. Sometimes you have to go back several stages to work through new negative memories that have surfaced.

7) Completion

The goal is the patient's achievement of emotional balance, regardless of the completion of the processing of psychotrauma.

For this, the therapist uses hypnosis or the Safe Place technique(described in the 2nd stage). If processing is not completed, then after the session, an unconscious continuation of processing is likely. In such cases, the patient is advised to write down (remember) disturbing thoughts, memories and dreams. They can become new targets for exposure to DPDG sessions.

8〉 Revaluation

The goal is to test the effect of the previous treatment session.

Reevaluation is carried out before each new desensitization and processing session with eye movements. The psychotherapist evaluates the patient's response to previously revised targets... It is possible to rework new goals only after complete reworking and assimilation of the previous ones.

Features of the DPDG method in the treatment of combatants

Many veterans of military conflicts suffer from excruciating feelings of self-blame in connection with their actions during hostilities. Need to explain to the patient:

1. if the patient was really as bad a person as he thinks, then would not suffer so much... Conscience does not torment bad people for decades.
2. suffering already will not help the victims in any way, but will greatly interfere with the full life of the survivors.
3. the painful symptoms of PTSD are the result of trauma being trapped in the neural networks of the brain, and treatment will help to get rid of the "stuck" of the negative... It is important to pay attention to the fact that the acquired combat experience will be retained in memory, because the treatment is aimed only at getting rid of suffering and anxiety, and not at the loss of memory for military events. Treatment will help to live a more fulfilling life, give more opportunities to honor the memory of the victims and help former colleagues in difficult times.

Beyond self-blame, a big problem is outbursts of uncontrollable anger... They can lead to family breakdown and problems with the law. Treatment with a psychotherapist will help you better control your behavior. Additionally patients are educated:

• technique "Safe place",
• relaxation exercises,
• self-use of eye movements to calm down.

Treatment of PTSD patients with DPDH is highly effective and can completely eliminate unpleasant symptoms. It is possible to combine DPDG with other psychotherapeutic techniques, as well as with medications.

Using the DPDG method in the treatment of sexual dysfunctions

Minimum 11% former combatants need sexological help. In the presence of PTSD, this level is even higher, but most of them, for various reasons, do not go to a sexologist. Most common the following problems:

• anxious anticipation of sexual failure (psychogenic erectile dysfunction),
• the consequences of alcohol abuse,
• problems in relationships with people due to symptoms of PTSD.

Against the background of sexual failures, such people increase jealousy, a outbursts of anger are becoming more destructive and unpredictable. Based on the foregoing, the treatment of sexual dysfunctions should be included in the rehabilitation program for people with PTSD, which will allow them to increase self-esteem, achieve psychological comfort and harmonize relationships in marriage.

You can help patients who:

• can't forget their failures in bed,
• received negative information about their potency,
• have false beliefs about sexuality,
• remember any events that cause anxiety and fear of intercourse.

2-6 sessions are carried out with a frequency of 1-2 per week. The duration of each is 1-1.5 hours.