Group Trauma Processing: A group model using EMDR, EMDR 2.0 and Flash
Hi everyone. In 2023 I presented at the Royal Australian and New Zealand College of Psychiatrist (RANZCP) State conference and the topic was group trauma processing. Community members have asked me about what I said and therefore this is a summary of that talk.
In the Effective Treatments for PTSD published by the International Society for traumatic Stress Studies the authors state that “trauma focused psychological treatments have the strongest empirical support and remain the first line treatment” for PTSD. In the book, Christopher Edwards notes that treatment gains from EMDR are substantial and stable. He refers to studies indicating a loss of PTSD diagnosis from 48-95%.
It is very difficult to find people in South Australia to treat patients using EMDR and CPT. Therefore other options need to be explored.
There are a number of group protocols including the EMDR Integrative Group Treatment Protocol (IGTP) for adults developed by Ignacio Jarero and Lucina Atigas and the EMDR Group-Traumatic Episode Protocol (G-TEP developed by Elan Shapiro. Dr Amanda Roberts has also developed an innovative EMDR group protocol.
There has been an increased interest in EMDR group protocols in recent years and there have been a number of presentations at the EMDR International Association (EMDRIA) conferences over the last few years. Dr Andrew Leeds was the keynote speaker at the 2023 EMDR Association of Australia (EMDRAA) conference and he predicted that soon most EMDR will be administered in a group setting.
For some time now I have been using a group processing model as part of the mindfulness and somatic trauma reprocessing (MASTR) program. The protocol incorporates the standard protocol, EMDR 2.0 (Matthijssen, S.J.M.A., et al., (2021). The effect of EMDR versus EMDR 2.0 on the emotionality and vividness of aversive memories in a non-clinical sample. European Journal of Psychotraumatology, V 12(1)) and Flash (Mansfield, P.E., Engel, Lewis, et al., (2021) Flash technique in a scalable low-intensity group intervention for COVID-19-related stress in health care providers. Journal of EMDR Practice and Research, V 15, p.127-139). EMDR 2.0 and Flash are ideally suited to group work. The standard protocol can be easily modified to use in a group setting.
The MASTR program group protocol has a number of key features. It is a cohesive, manual and structured treatment program comprising of an individual session and then 8 group sessions. It preserves all 8 phases of the standard EMDR protocol with minor alterations due to the group format. The 3 pronged EMDR approach is maintained for the past, present and future. There is more extensive stabilisation and resourcing. It acknowledges that processing is based on mindfulness. It incorporates recent developments in processing that are particularly useful in the group setting including Flash and EMDR 2.0. It includes Graham Taylor’s extended EMDR processing to accommodate different processing speeds. This allows people to process multiple targets in phase 4. It has the capacity to address present symptoms, recent and past trauma, attachment issues, relationship issues and dysfunctional behaviours.
The MASTR program group processing protocol adheres to a number of important principles. It is trauma sensitive and therefore choice is central. Participants don’t talk about their trauma experiences and therefore vicarious traumatisation is avoided. Participants often share positive experiences and therefore there may be vicarious healing. There are 6 processing sessions and each is part of a 2 hour session. If people become overwhelmed, they can either ring a support person or send me a private message. General interweaves are used but they are based upon knowing the group participants negative and positive cognitions.
The standard protocol includes each of the 8 phases. Flash is used both as a stabilizing practice and is a processing practice.
Group processing has a number of advantages. It provides a sense of community and support. It is an efficient and effective way of processing trauma. It is very useful where the demand for trauma therapy exceeds the supply of evidence-based treatments. It provides many of the benefits of individual processing therapy combined with the benefits of group therapy. It avoids vicarious traumatisation whilst vicarious healing often occurs. Many people say they could not approach the trauma alone but they can in a group setting. It makes processing therapy more accessible and therefore it addresses a lack of distributive justice. It is more affordable than traditional processing therapy.
SUMMARY
I have included a group processing protocol in the MASTR program. It appears to be effective and efficient. The results as monitored with the PCL-5 and the K10 are very encouraging. This group protocol has the potential to treat people affected by trauma that might otherwise have difficulty accessing treatment.
