EMDR vs Brainspotting

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Eye Movement Desensitization and Reprocessing (EMDR) and Brainspotting (BSP) are both effective therapeutic procedures used to help treat clients who are suffering from an acute stress syndrome or have experienced a traumatic situation(s) and/or are suffering from PTSD. They can also be effective in alleviating symptoms caused by anxiety and depression. It’s important that we treat these symptoms with effective treatments because it’s been proven that the presence of PTSD is positively correlated with higher levels of health-related problems, lower levels of functioning, and is more often a persistent and chronic disorders, according to an article published in the Mediterranean Journal of Clinical Psychology (Hildebrand et al, 2017). Both EMDR and BPS have been referred to as “power therapies” because they work on unlocking creativity and process through past trauma.

How are EMDR and Brainspotting similar?

Both use therapeutic modalities to help reprocess information that is stored in the amygdala- the part of the brain that is accessed verbally. They’re both developed around a client’s line of vision with the idea that the position of a client’s eyes or where the client’s gaze is directed can unlock some deeper insights that have not yet been recognized. Both help the client approach things from a different perspective and ultimately helping the client’s healing process exponentially.

How are EMDR and Brainspotting different?

Most of EMDR is performed visually using rapid eye movements to tap into the part of the brain where nonverbal information is stored, while BSP is focused on a single fixed gaze position, called the brainspot that corresponds with a specific emotional response or situation. EMDR follows a specific protocol and guidelines on how a therapist should respond. BSP is a little more flexible and focuses more on the attunement of the therapist with the client, rather than a set procedure.

Which one is more effective?

Brainspotting has been proven to be more flexible than any EMDR method. This adaptability gives the therapist more flexibility in their approach, allowing for the therapist to customize to the client’s individual needs, yielding faster and deeper results. EMDR has been found to be over stimulating by some, limiting who can benefit from its use. While BSP requires very little conversation by the client, making the technique a little more appealing for such clients that have a hard time opening up to therapists.

When would someone be diagnosed with Acute Stress Disorder or PTSD?

The DSM-5 criteria used in the diagnostic assessment process are listed below for both disorders. Please do not self-diagnosis yourself. It is important that a professional mental health clinician evaluate your symptoms and the severity of your distress and impairment to determine an accurate diagnosis. The criteria for both Acute Stress Disorder and PTSD have been pulled from the most recent DSM-5 publication (American Psychiatric Association, 2013).

Acute Stress Disorder Diagnostic Criteria:

Criterion A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:

  • Directly experiencing the traumatic event(s).
  • Witnessing, in person, the events(s) as it occurred to others.
  • Learning that the traumatic events(s) occurred to a close family member or close friend. Note: In
    cases of actual or threatened by death of a family member or friend, the events(s) must have been
    violent or accidental.
  • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: This does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related.

Criterion B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:

Intrusion symptoms:

  • Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
  • Recurrent distressing dreams in which the content and/or affect of the dream are related to the events(s). Note: In children older than 6, there may be frightening dreams without recognizable content.
  • Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). Note: In children, trauma-specific reenactment may occur in play.
  • Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic events.

Negative Mood:

  • Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Dissociative Symptoms:

  • An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing.)
  • Inability to remember an important aspect of the traumatic events(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).

Avoidance symptoms:

  • Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
  • Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Arousal symptoms:

  • Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep)
  • Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
  • Hyper vigilance
  • Problems with concentration
  • Exaggerated startle response

Criterion C. The duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.

Criterion D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion E. The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or other medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder.

Posttraumatic Stress Disorder (PTSD) Criteria:

All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:

Criterion A: Stressor (one required)
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B: Intrusion Symptoms (one required)
The traumatic event is persistently re-experienced in the following way(s):

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C: Avoidance (one required)
Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related external reminders

Criterion D: Negative Alterations in Cognitions and Mood (two required) Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E: Alterations in Arousal and Reactivity- Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F: Duration (required) – Symptoms last for more than 1 month.

Criterion G: Functional Significance (required) – Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H: Exclusion (required) – Symptoms are not due to medication, substance use, or other illness.
Two specifications:

  • Dissociative Specification:  In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
    Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
    Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).
  • Delayed Specification: Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.
References:

American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.

Hildebrand, A., Grand, D., Stemmler, M. (2017). Brainspotting – the efficacy of a new therapy approach for the treatment of Posttraumatic Stress Disorder in comparison to Eye Movement Desensitization and Reprocessing. Mediterranean Journal Of Clinical Psychology MJCP. 5 (1). Retrieved from
http://cab.unime.it/journals/index.php/MJCP/article/viewFile/1376/pdf_2

About Kasia Ciszewski 4 Articles
Kasia Ciszewski, LPCA provides counseling services to adults & couples. Specializes in anxiety, grief, depression & life transitions counseling.

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