Eye Movement Desensitization and Reprocessing for postoperative pain management in adolescents

An experimental, randomised controlled trial. The Wong-Baker FACES Pain Rating Scale (WBFS) was first administered to all patients approximately 2 hours post-surgery, when each patient was reported to be conscious and alert. Participants also had their blood pressure and heart rate taken at this point. Participants were then taken to a private room, where they either underwent the EMDR or control condition activities. Following the administration of the WBFS, EMDR was administered to participants in the treatment group for 60 minutes. EMDR therapy EMDR therapy typically involves eight distinct phases: 1) Client history, 2) Preparation, 3) Assessment, 4) Desensitization, 5) Installation, 6) Body Scan, 7) Closure, and 8) Re-evaluation (Shapiro & Laliotis 2010). The first two stages are preparatory and primarily involve briefing the patient on the technique, as well as receiving relevant information regarding the patient’s history. The third stage (Assessment) centres around identifying negative and positive cognitions related to the trauma. It begins with identifying negative target memories for reprocessing, where participants are instructed to represent such memories as either a representative image or an associated negative cognition. In this experiment target cognitions comprised descriptions of negative beliefs associated with the surgery (e.g. ‘I am in danger’, or ‘It will be painful’) and/or negative images associated with the surgery (e.g. a visual representation of the surgical procedure). Participants were then instructed to form a positive cognition related to their target cognition/image. In this experiment participants were instructed to state how they would like to feel in words (e.g. ‘I am in control’ or ‘I am not in danger’) or using imagery (lying in bed, free of pain). During the fourth and fifth stages (Desensitization and Installation), the negative cognition/image is recreated in the participant’s mind, and the patient is asked to track the therapist’s fingers, which are constantly displaced across the patient’s line of vision (Shapiro 1989). The speed of the eye movements is gradually increased until it is as fast as is comfortable for the client to maintain accurate tracking. During this process the patient is told to report any information that they become aware of, and once tracking is finished they are told to ‘let it go’ or ‘blank it out’ (Smith & Yule 1999, p. 269). This process is repeated until no further improvements occur. The positive cognition is then installed by having patients think of the negative event and positive cognition in parallel, whilst completing a further set of eye movements. This is repeated until patients have internalized the positive cognition, as indicated by the Validity of Cognition (VOC) scale (see Shapiro et al. 2010). In the sixth stage (Body Scan), patients carry out a final set of eye movements, designed to target residual tension that occurs when participants are asked to again think of the original negative image/cognition. EMDR is only regarded as successful when participants can recall the initial image/cognition without experiencing body tension or pain. In the final two stages, Closure and Re-evaluation, participants are led through a range of relaxation exercises and debriefed. If participants require more than one session this is discussed in the final stage (Re-evaluation). In the current study patients all participated in only a single session. For a full overview of EMDR therapy, see Shapiro et al. (2010). a psychologist who had training in EMDR administered the EMDR.