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EMDR and combat-related trauma

EMDR and combat-related trauma

The importance of cultural competence in trauma therapy?

I’ve always had a keen interest in working with the uniformed services and, for 8 years, led a task force on behalf of the European Society for Traumatic Stress Studies for their members who worked with this group. The emergency services – such as police officers, paramedics, firefighters – and military personnel and veterans are often exposed to acute, complex and cumulative trauma as part of their occupational role and I believe it is society’s moral duty to provide them with the best support for achieving resilience and recovery.

My PhD focused on veterans and their experience of and attitudes towards mental health issues and treatment. In my clinical practice, I often worked with serving military personnel and veterans who had experienced combat trauma. One of the most effective therapies I found was EMDR (eye movement desensitisation and reprocessing) and, used properly it literally transformed lives.

So, I am sure I am not alone in feeling dismay on discovering that the latest guidelines from NICE suggest that EMDR is not effective in people with military combat-related trauma “in marked contrast to all other included trauma types for which benefits were observed”.

In my humble opinion, this lack of benefits is less about the effectiveness of therapy and more about the culture.

How can a therapy that is so effective with healing so many types of psychological trauma, including historical sexual abuse, not work for another specific type of trauma? After all the premise of EMDR is that it uses the brain’s natural adaptive processing system.

Could it be that we’re ignoring a vital ingredient in therapy – the need for cultural sensitivity?

In 2017, I was asked to contribute a chapter to a seminal EMDR text – Cultural competence and Healing Culturally Based Trauma with EMDR Therapy. My chapter “People like me don’t get mentally ill: Social Identity Theory, EMDR and the Uniformed Services” clearly set out obstacles to treatment efficacy in different phases of EMDR therapy that clinicians should be aware of and avoid.

Like any therapy, EMDR will not be effective if we cannot get the client to engage fully in all stages of the process.

These new guidelines will undoubtedly be received with great disappointment by the many therapists who currently successfully use EMDR with combat trauma – and the very many people who have had their lives changed by successful EMDR therapy.