An Example of The Use of EMDR for Treatment of Fears of Flying
by Ronald M. Doctor, Ph.D.
Typologies for the Fear of Flying: Implications for Flight Personnel and Therapists (Doctor & Seif, 2007) in which we describe the various types of fearful fliers we have encountered in clinical practice. This supplements and enriches the information contained in this paper. I would also prefer that my deep appreciation and enthusiasm for EMDR not be seen as a “sales pitch.” Reader scepticism is healthy as much as experience is essential.
EMDR is not a therapy by itself, not a panacea, not a different form of systematic desensitization nor a variation of the exposure or cognitive therapies. It is also not hypnosis nor placebo effects. All of these possibilities have been eliminated by empirical research. At least in the beginning, EMDR is probably best viewed as a procedure that can be used within almost any form of relationship-based therapy (by this, I would include dentistry, hypnosis, physical therapies, etc. ). As a procedure, it has parameters that guide its application in terms of (1) the therapeutic goal, (2) the state of the client, and (3) the therapist’s ability to integrate the EMDR methodology into their approach and into a broad conceptual framework that includes psycho-neurophysiology. Let’s look at each of these briefly.
Therapeutic goals in any therapy are to relieve symptoms, reduce dysfunctional behavior or aversive affect and to nurture well-being in the client. At its theoretical base, EMDR sees many disorders as arising ultimately from traumatic experience (big “T” and/or little “t”) which, as we know it, tends to disrupt and create imbalance in the naturally adaptive resources that serve to resolve these traumas, restrict maturational and developmental progress and lock-in negative belief patterns about self and the surrounding world. Symptoms can be the direct result of trauma but most often trauma creates dysfunctional internal conditions as a result of which disorders eventually develop. The therapeutic use of EMDR is, therefore, based on a trauma treatment model. I do want to mention that not all EMDR applications are directed at trauma. For example, there is considerable work in applying it to enhance human performance in sports and social situations, applications with children, addiction control, ADHD, learning facilitation, belief modification, grief work, chronic pain reduction and so on. But most readers will want to use EMDR in their offices to resolve the effects of trauma and to facilitate development of more adaptive behaviour and positive self-beliefs.
The traumatic origins of much of psychopathology forces us to re-conceptualize assessment procedures and interviews and to go beyond the mind/body duality we explicitly or implicitly live with in our own professions. So, let’s say that I see a terrified client who is being forced to fly with his new boss to Asia. He flew for many years but eventually quit flying some six years after a particularly turbulent flight and is now essentially forced into a 10 hour trip to Korea in two days. Here is our question. Is it most effective for us to conceptualize this person’s fear of flying as merely a conditioned response to turbulence (where fears seem to have developed) or are there other associative pathways? In general, our clients do not come to us with ready-made analyses and solutions. But, when using EMDR, “understanding” emerges from within the process that is set in motion by the application of EMDR. Both the therapist speculations and any and all theories they prefer, must be set aside to allow the accelerated adaptive process set in motion by the EMDR to emerge and to seek a resolution on its own. In this sense, what we call EMDR can be viewed as a guided self-healing process that the therapist simply sets in motion. With this in mind, I might start (as I did with this fellow) by focusing on the most fearful event the client had encountered in flying (panic while flying in turbulence) and set up all the elements for EMDR (such as being aware of body sensations aroused by the incident, negative self-statements when looking back on the incident, emotions, and representations or images of the incident). Once these elements were present we started a process of “bilateral stimulation” -in this case- eye movement, back and forth across the body median. For this client, processing began quickly. Tears started to come, along with sharp sensations in the body and the deep pain and images of a mother left behind as he made his way into a new life in a distant land emerged spontaneously. Neither the client nor I foresaw this early trauma in this first and only session. Would we evidently have seen these connections? Probably so, in time, but in-depth understanding often takes considerable time. Soon emotions diminished as a result of the EMDR processing- starting and stopping as new material emerged- and a resolution was reached. This was not catharsis driven resolution but an actual shift that had occurred as a result of the EMDR intervention. This deep emotionally traumatic event was processed to an adaptive resolution. We could then begin to install positive self-belief statements to replace the negative ones that had persisted for so long. The next day, a 10-hour flight that would have been sheer terror before turned into a journey filled with enjoyment and considerable sleep. Months later, at a chance encounter in a shopping mall, we met again and he embraced me. I learned that he had settled into this country, married his beloved girl- friend and was now flying to Korea twice a month and had been doing so for the past two years. He was now Vice President of the large electronics company that originally brought him to Korea.
Not all clients are ready to process. We estimate that between 10 and 30% of clients are not initially responsive to these procedures. Often preparations (safe place, relaxation, affect modulation skills, etc.) are needed before starting EMDR. Dissociation and personality disorders must also be assessed as part of preparation and will require considerable containment training to help the client modulate and tolerate emotional arousal. EMDR is far from being aspirin or Tylenol for the psyche. Clearly it is a substantive process that taps into the fundamental aspects of neuro-psychological base to our lives. As such it carries great respect for its power from those who use it. Brain scans confirm that actual structural and functional improvements occur in the brain as a result of EMDR treatment (Van der Kolk, l998) so we know that emotional, psychological and neuro-physiological changes occur in this process.
Finally, therapists must somehow integrate this new theoretical and procedural resource into their practice before appreciating the full range of applications that will become available to them. Fortunately, both Pavlov and Freud advocated trauma models of psychopathology so behaviourists and psycho-analytically based therapists and all those in- between can feel comfortable with its inclusion in their work.
It terms of the fear of flying, trauma and traumatic experience looms up as a potential source both in the development of fear of flying and for the maintenance of these reactions over time. Flying involves potential trauma in the form of turbulence, crowds, forced social confinement, claustrophobia, heights, germs, darkness, deep water, changes in body sensations and many other stimuli encountered in even ordinary flights. There is also the personal history of trauma many fliers bring to the air plane Experiences such as family losses, abuse, fears of being away from a “safe place,” addictions, fears about destination events, and so on, can be factors that can create arousal and emotions that quickly become attached to air travel and form a trauma base for air travel. Likewise, horrific images often seen on the news or in movies of death, terrorist attacks, crashes and so on, can serve as implicit conditioned stimuli that elicit fear in air travel.
Let me address some of the research effectiveness questions briefly. APA Division 12 has placed EMDR and two other methods on a list of effective treatments for civilian PTSD populations. Even though the EMDR studies utilized only three sessions and the other methods many more, these three methods are on the list because they meet the criteria for empirically proven effectiveness (Chamblis et al., 1998). Meta-analyses (Van Etten & Taylor, l998; Davidson, & Parker, 2001; Maxfield & Hyer, 2002), comparing empirical results of treatments for PTSD, have concluded that EMDR is the most effective psychological and chemical treatment for PTSD. Likewise, contemporary reviews (Allen, Keller & Console, l999; Feske, l998) present a positive picture of the EMDR research results. These are articles worth reading for the therapist interested in EMDR. I would also recommend Francine Shapiro’s book (2001) as a thorough explanation of theory and procedures but caution readers to obtain adequate and extensive supervision in EMDR while working with clients.
Most contemporary psychologists sense and believe that we are on the verge of a new era in psychotherapy that will take us away from the mainly verbal, conceptual therapies we have practised for generations and into applications that directly access and affect neuro-psychological processes. Recent brain studies have identified cortical and sub-cortical areas responsible for triggering arousal reactions to sensory perceptions and for storing traumatic memory-experience; so we must look for new interventions- such as EMDR- to access and repair these imbalances. It is an exciting time and EMDR has brought psychology and psychotherapy to the doorway of this new era.
Allen, J.G., Keller, M.W. & Console, D.A. (1999) EMDR: A closer look [Video manual]. New York: Guildford Press.
Chamblis, D.L., Baker, M.J., Baucom, D.H., Beutler, L.E., Calhoun, K.S., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D.A.F., Bennett Johnson, S., McCurry, S., Mueser, K.T., Pope, K.S., Sanderson, W.C., Shoham, V., Stickle, T., Williams, D.A.& Woody, S.R. (1998) Update on empirically validated therapies, II, The Clinical Psychologist, 51, 3-16.
Davidson, P.R. & Parker, K.C.H. (2201) Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.
Doctor, R.M. & Seif, M.N. (2007) Typologies for the fear of flying: Implications for flight personnel and therapists. Paper presented at the Third World Conference on the Fear of Flying, Montreal, Canada.
Feske, U. (1998) Eye movement desensitization and reprocessing treatment for posttraumatic stress disorder. Clinical Psychology: Science and Practice, 5, 171-181.
Maxfield, L. and Hyer, L.A. (2002) The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology, 58, 23-41.
Shapiro, F. (2001) Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. (2nd ed.) New York: Guildford Press.
van Etten, M. & Taylor, S. (1998) Comparative efficacy of treatments for posttraumatic stress disorder: a meta-analysis. Clinical Psychology & Psychotherapy, 5, 126-144.
van der Kolk, B. (1998) The neurophysiology of EMDR treatment. Paper presented at the EMDRIA International Conference, Baltimore, Maryland.
This paper is dedicated to the Navy pilot who, during WWII, stayed with his crippled plane in order to guide it past the school yard where I and many other children were playing at recess, and lost his life in trying to eject far too late.
by Ronald M. Doctor, Ph.D.
Director, Freedom to Fly, Los Angeles
EMDR: Third World Conference on Fear of Flying (WCFF/3).
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