Psychology and Behavioral Science International Journal (PBSIJ)

Research Article

Treating a Sexual Abuse Trauma with Eye Movement Desensitisation and Reprocessing Therapy in an Adult Community Mental Health Team Setting a Case Series

*¹Jonathan Hutchins and ²Clare Mason

¹Clinical Director Hutchins Psychology Services, UK

²Honorary Research Assistant, Hutchins Psychology Services, UK

Submission: August 08, 2017; Published: August 24, 2017

*Corresponding author: Jonathan Hutchins, Clinical Director Hutchins Psychology Services Ltd, 16 Chequers Street, St Albans, AL1 3YD, UK, Tel: 7725363481; Email: jonathan@hutchinspsychology.co.uk

How to cite this article: Jonathan H, Clare M. Treating a Sexual Abuse Trauma with Eye Movement Desensitisation and Reprocessing Therapy in an Adult Community Mental Health Team Setting a Case Series. Psychol Behav Sci Int J. 2017; 6(1): 555676. DOI: 10.19080/PBSIJ.2017.06.555676

Abstract

Introduction: Rape and sexual trauma are two of the most prevalent traumatic experiences that are linked to mental health problems.The challenge exists in treating these traumatic experiences. This study focuses on three case studies of treating sexual trauma using Eye Movement Desensitisation and Reprocessing Therapy.

Method: This was a case series case design using pre- and post-measures including the BDI, BAI, OQ.45 and IES-R with three different clients. A three month follow up was also completed.

Results: The therapy was effective at treating the sexual abuse traumatic experiences within a short number of sessions. Recovery was shown on all four outcome measures.

Discussion: Although this is a case series study, it provides some evidence of EMDR being an effective treatment for sexual abuse trauma.The additional advantages of EMDR are discussed including the strength of not having to talk about the trauma in-depth within the therapy.

Abbreviations: tfCBT: Trauma Focused Cognitive Behavioural Therapy; EMDR: Eye Movement Desensitization and Reprocessing Therapy; BDI: Beck Depression Inventory; BAI: Beck Anxiety Inventories

Introduction

Rape and sexual trauma are two of the most prevalent traumatic experiences that can happen in people's lives, both in terms of adverse childhood experiences Dube et al. [1] and adult experiences Elliott [2]. Often victims experience high levels of shame and self blame which can prevent them from accessing psychological therapy Patterson [3]. The experience of shame, combined with the natural fear of talking about atrauma, can also be significant impediments to psychological therapy. Currently the NICE guidelines for Post-Traumatic Stress Disorder (2005) and recent Meta analytical studies Bisson et al. [4]. Recommend both trauma focused Cognitive Behavioural Therapy (tfCBT) and Eye Movement Desensitization and Reprocessing Therapy (EMDR) in treating PTSD. Both tfCBT and EMDR utilise the theory that PTSD results from the inadequate processing of atraumatic event, due to the individual dissociating at the time.

This is thought to be because their experience of the event is overwhelming Shapir [5]; Ehlers and Clark 2000. Trauma- focused CBT requires the individual to describe the trauma in detail, reliving the experience with the therapist and aiming to find hotspots within the trauma memory which can then be addressed with cognitive therapy techniques Grey 2002. This approach can be very challenging, especially for victims of rape and sexual abuse trauma due to the significant levels of shame they may feel Kessler and Bieschke [6]. One particular advantage of EMDR in this area is that is does not require the victim to describe the trauma in-depth to the therapist. Some protocols actively encourage that the traumatic experience be blind to the therapist Blore [7]. This can be very helpful for the victim as it may significantly reduce the shame and self-blame associated with this experience Blore [7]. As a result, victims are more willing to engage in EMDR therapy, leading to more positive outcomes. This article highlights three case studies where this has occurred, within a UK National Health Service (NHS) community mental health team.

Method

Design

This is a case series design, based on EMDR intervention with three clients. The outcome measures used with all clients were the service standard within the locality in which the clients were seen, and included the Beck Depression Inventory (BDI) Beck Anxiety Inventories (BAI) Beck 1993 as well as the Outcome Questionnaire 45 item version (OQ.45) Lambert et al. 1996, a measure of an individual's functioning. The Impact of Events Scale Revised (IES-R) was used as the measure of Post-Traumatic Stress Disorder Creamer [8]. Where there were multiple traumas, clients were asked to describe and initially focus on the most dominant when completing the measures. Clients were then asked to complete the measure for each individual trauma, prior to it being treated. Therefore, in the case for client 2, six IES-R's were gathered, pre- and post-treatment as there were six sexual traumatic events to be treated. A three month follow up was also completed following the intervention.

Consent

All clients gave their verbal and written consent for the case study, Client Details:

Client 1 was a 60 year old man, referred by his GP to the local community mental health team for depression and cognitive behavioral therapy. On assessment with the clinical psychologist, he disclosed that he had been sexually abused by his uncle from the age of 7 to 11.He had experienced nightmares and flashbacks about the events for all of his life. He also reported a significant alcohol problem, consuming up to four pints of beer daily. Although there were considerable problems with the client's drinking, the treating clinician decided to fast track the client into trauma focused work, on the agreement that the client would not drink before the session. The clinician believed that if the trauma could be treated, the client’s avoidant behavior with alcohol may cease.

Client 2 was a 22year old woman already under the care of the community mental health team. She had previously been diagnosed with Borderline Personality Disorder, with difficulties regulating her emotions and interpersonal relationships. She was referred by the team psychiatrist due to high anxiety.On assessment with the clinical psychologist, she reported a complex sexual trauma history which included being sexually abused by her next door neighbor from the age of 10 to 15. In addition, she reported several experiences of being raped at her workplace between the ages of 16 and 19. She reported nightmares and flashbacks about these events which had occurred in several different places. The clinical psychologist accepted her for trauma focused therapy as, despite her previous diagnosis of BPD, she met the suitability criteria for trauma focused work in terms of being able to self-sooth and there were no risk behaviors present at the time of the intervention.

Client 3 was a 35 year old woman, referred by her GP to the Community Mental Health Team for treatment of anxiety and depression. She was assessed by the team clinical psychologist, at which point she disclosed that she had been raped by a coworker at a restaurant toilet when she was 19. She had regular intrusions about the event ever since.

Treatment

The participant was seen by a Clinical Psychologist who is an Accredited EMDR Europe Practitioner with over three years experience of using EMDR. The treating clinician was supervised by an EMDR Europe Accredited Consultant. Treatment followed the standard EMDR protocol Shapiro [5]. EMDR was chosen for several reasons including the client's desire to avoid talking about the traumatic events in depth, which would have been required in a tfCBT approach. It was thought that EMDR would be preferable given the multiple traumatic events to be addressed in a short time frame. Furthermore, EMDR has been shown to be a quick and effective treatment of PTSD and trauma and to be effective in complex trauma cases Shapiro [5].

In the case of client 2, multiple traumatic experiences were identified. Some of these were the same sexual traumatic event that had occurred repeatedly over several years. Following standard EMDR protocol, these cases were treated in a single event approach. It is thought that where the same event is repeated, in re-processing one trauma memory of the experience, they are all treated Shapiro [5]. Six discrete trauma memories and several composite memories were identified. Where a traumatic event was addressed within a single session, IES-R was recorded on a weekly basis, for a period of six sessions. Therefore, six pre- and post-IES-R’s were record for this case.

Results

The outcome measures for the three-session intervention are shown below. The intervention included one assessment session, including stabilization of the client, one EMDR processing session and one follow-up session. The client reported significant improvements at follow-up, both in terms of the memory no longer being disturbing to him and also in his relationships, where he felt closer to his children and wife (Table 1).

The outcome measures highlighted below, show significant gains in symptom reduction on both the Beck Anxiety and Depression scales. In addition, on measuring each individual traumatic experience using IES-R, there were significant reductions in PTSD symptoms one week after EMDR reprocessing treatment. At this point, each memory no longer met criteria for PTSD. These gains were maintained at follow-up (Table 2).

The outcome measures below highlight significant improvements following five sessions of EMDR, addressing the client's single event rape trauma. Significant improvements were shown on both Beck Depression and Anxiety Inventories. The IES-R measurements showed significant recovery from PTSD symptoms to the point that she would no longer meet PTSD criteria [9] (Table 3).

Discussion

The results in these three case studies suggest that EMDR was a highly effective and efficient treatment for sexual trauma, both in terms of childhood sexual abuse and adult rape. Reliable change is highlighted across all outcome measures used, to the point where the three clients no longer met the diagnostic criteria for PTSD as well as for anxiety and depression.

Limitations of the Study

This case series has a small sample size and therefore the findings cannot be generalized to a wider population.

Findings in Relation to other Research

Whilst this study is based on a small sample size, these case studies perhaps highlight how effective EMDR can be in routine community settings. The findings support other case studies on treatment carried out in America Shapiro [5]. Which also suggest EMDR is an effective treatment for rape. In addition, these findings support wider research demonstrating EMDR as an effective treatment for PTSD Bisson et al. [4]. What is particularly interesting to note here is how, in one case, EMDR was used to successfully treat multiple childhood sexual abuse traumas within one session per traumatic memory. This may offer a useful and efficient, treatment of childhood sexual abuse trauma. These results suggest that large scale, randomized, control trials and cohort studies are now required, to provide an enhanced evidence base so that more clients experiencing sexual trauma are able to access effective treatment, through EMDR.

Conclusion

Whilst this is a small sample case series design, the research findings highlight that EMDR is an efficient and effective treatment of both adult and childhood sexual abuse trauma. Large scale, randomized, control studies are required to further investigate the effectiveness and speed of treatment, so that other clients may be able to access EMDR when they experience sexual trauma.