Research and EMDR: new perspectives

“EMDR is one of the psychotherapies that not only treat but also heal. Francine Shapiro passed away leaving us a gift for humanity. It is now up to us to be worthy of it.”  This is how Prof. Cyril Tarquinio set the scene at the 10th Metz Academic Meeting (MAM) in Metz, France,  at  which  clinicians,  doctoral  students,  and  scholars  meet  to  share  and  confront  their  thinking  about EMDR therapy practice and research. Research  has  demonstrated  the  effectiveness  of  EMDR  therapy  in  the  treatment  of  posttraumatic  stress disorder in a wide range of contexts and populations. Case studies and series, clinical reports, and a number of comparative research studies have described how EMDR therapy may be implemented successfully in the treatment of several other forms of psychopathology and mental  health  issues.  Yet,  many  questions  remain  following  Francine  Shapiro’s  passing.  What  do  we  know about EMDR therapy today, how does it work, how  and  when  should  it  be  applied,  and  to  whom, and  what  is  its  future?    For  two  days,  clinicians,  doctoral students, and researchers proposed their humble and partial answers to these questions. Twelve presentations were structured around three axes of reflection that were constantly intertwined: a Clinical axis, a Neurological axis, and an Epistemological axis.

CLINICAL AXIS
The MAM is above all a seminar composed of clinicians. What could be more natural, than to give the  floor  first  and  foremost  to  clinical  practice  in  the  field,  just  as  EMDR  therapy  emerged  from  a  clinical experience? The MAM invites us to open the doors of institutions and private practices to meet psychotherapists at the core of their practice. This is an opportunity to hear the expertise of different consultants as well as the innovations of some psychotherapists. Eva Zimmermann, from Switzerland, reminded us  that  the  desensitization  phase  of  the  standard  EMDR  protocol  (phase  4)  presents  several  clinical  choice  points  to  the  therapist.  It  appears  to  be  a  relatively simple phase for the therapist who stays out  of  the  way  to  accompany  the  desensitisation  and  reprocessing  process.  Despite  this  stance,  the  therapist must nevertheless remain active and present  while  the  patient  goes  through  different  stages, which are more or less emotionally intense. By maintaining this course and by their clinical  choices,  the  clinician  facilitates  change,  by  continuously adjusting to the complexity of the emerging material, to the affective intensity, or to  the  issues  that  are  specific  to  this  phase  of  the  treatment: dissociative phenomena, jumps between different  traumatic  targets,  or  even  looping  that  requires cognitive interweaves (statements or questions  aimed  at  eliciting  adaptive  information  that may then link with the dysfunctionally stored, trauma-related memories). Changes in the client may manifest through the client’s insights, a distancing of the negative material, a reprocessing at  the  emotional  or  sensory  level,  or  more  subtly  at  the  imaginary  level  or  even  without  externally  visible signs. Olivier Piedfort-Marin, also from Switzerland, argued  that  the  theory  of  structural  dissociation  of  the  personality  (TSDP)  (Van  der  Hart,  Nijenhuis,  &  Steele,  2006)  may  shed  light  on  the  processes  at  stake  in  EMDR  therapy.  TSDP  is  sometimes  the  object of a simplified and reductive understanding, summarised in the concepts of the Apparently Normal Part of the personality (ANP) and the Emotional Part of the personality (EP), to the detriment  of  an  understanding  of  the  mechanisms  at play in trauma-related dissociation. Piedfort-Marin reminded the audience of the following: Contrary  to  the  phenomenon  of  dissociation,  the  objective of psychotherapeutic treatment is the synthesis  of  the  patient’s  lived  experience,  both  in its different components (central synthesis) and over time (extended synthesis). Synthesis cannot be achieved without the realisation of the experience, which is itself distinguished in two  stages:  personification  and  presentification.  Personification  is  the  ability  of  the  individual  to  feel  that  they  have  lived  through  a  (traumatising)  event, to take personal ownership of the lived experience. Presentification is the ability of an individual to integrate that the (traumatising) event  has  taken  place  in  the  past  and  is  over,  that  they can act fully in the present moment and project themselves in the future. Piedfort-Marin proposed  a  new  understanding  of  EMDR  therapy’s  Adaptive Information Processing (AIP) model in the light  of  TSDP.  In  phase  4  in  particular,  the  client’s  associations  during  the  different  sets  of  bilateral  stimulation  (BLS),  involving  emotions,  cognitions,  sensations, and behaviours, enable a central synthesis. The three-pronged focus (past, present, future) subsequently promotes an extended synthesis.  Using  clinical  vignettes,  Piedfort-Marin  suggested  that  the  therapist’s  interventions,  such  as  cognitive  interweaves,  follow  the  same  process  of  synthesis,  first  suggesting  personification  and  then presentification, depending on where the client is  at.  As  Eva  Zimmermann  had  already  illustrated,  the  role  of  the  therapist  in  phase  4,  which  appears  so  “simple  and  minimalist,  even  withdrawn”,  then  appears essential. Clinical discussions were pursued regarding applications in specific clinical contexts. Cyril Tarquinio, from France, shed light on the application of  EMDR  therapy  in  oncology.  Cancer  involves  the  conceptualisation of a specific psychopathology, it implies more than the cumulation of reactive symptoms or disorders. Recent work shows associations between depressive mood and adverse childhood events (ACEs) and the evolution of cancer. Furthermore, cancer is a word synonymous with “death” in the collective imagination. It is a succession of  emotional  shocks  (diagnosis,  treatment,  relapse,  upheavals  in  daily  life  and  in  the  lives  of  loved  ones,  etc.) which not only generates psychotraumatological symptoms, but also feelings of vulnerability, despair, loss of control and autonomy. Life as a whole is then reshuffled, the cards are redistributed and priorities redefined. Because it is an illness that is  rarely  defined  in  time,  it  upsets  the  client  on  at  least  three  levels  in  terms  of  temporality,  identity,  and changes in values. EMDR therapy appears relevant in the approach it proposes: it not only reduces reactive symptoms (depressive, anxious, post-traumatic) but can repair fractures in terms of identity  and  temporality.  The  EMDR  therapist  can  thus  work  on  optimistic  projections,  remobilise  the  individual in their daily life and give hope of a way out of the unbearable powerlessness imposed by cancer. Moreover, the idea is to help the client grow from this ordeal  (post-traumatic  growth),  which  allows  them  to  access  a  new  understanding  of  their  world  and  of  themselves,  in  an  ultimately  spiritual  and  deeply  resilient dynamic. For her part, Dolores Mosquera, from Spain, described  the  application  of  EMDR  therapy  to  the  treatment of women who have experienced domestic violence. Domestic violence causes many upheavals, not only because of the disturbing emotions that are experienced,  but  also  and  in  particular,  because  of  the internalisation of inappropriate response models. In  other  words,  the  domestic  violence  survivor  then  more or less consciously repeats a dysfunctional behaviour that has been learned. To this may be added certain cultural beliefs that are unfortunately still  very  much  in  vogue  (“It  is  better  for  children  to  grow up in a family with a father and a mother, even if  ‘things  happen’  sometimes”  or  “If  a  man  controls  you,  it  is  because  he  loves  you”).  The  consequences  for the woman experiencing domestic violence are  numerous,  among  them:  blocking  of  emotions  (fear, shame, guilt, and sorrow for the partner), ambivalence  or  difficulties  to  protect  oneself  and  to  set  boundaries.  These  emotional  blocks  lead  to  inappropriate  responses  that  need  to  be  identified  in therapy. Identifying these difficulties in the client allows the therapist to define strategies for client’s stabilisation, the extent of her resources, but above all to assess whether sufficient adaptive information is  available.  When  there  are  many  distortions,  the  processing of the trauma often remains blocked (due  to  the  impossibility  of  connecting  to  adaptive  information that is missing). As these clients have  difficulties  in  feeling  safe  and  ensuring  their  own safety, a strong therapeutic alliance will be absolutely necessary. The EMDR treatment plan will also depend on the client’s degree of awareness, which is a key element of the treatment, and whether she  is  ready  to  leave  her  partner,  something  that  is  eminently  difficult  due  to  the  ambivalence  and  idealisation of women towards their partners.
Mosquera suggested the following steps:
1.  Explore  the  risk  factors  and  try  to  increase  the  client’s safety and protection as much as possible. Develop her social network and the ability to access it.

2.  If  the  victim  has  to  make  important  decisions,  help her to assess the pros and cons of the situation, including the level of risk posed by each decision.

3.  Assess  responsiveness  to  problems,  conflicts,  and unexpected events. Address as necessary.

4. General psycho-education on gender-based violence.

5. Psycho-education on the difficulties presented by  the  client,  including  the  link  between  her  life  history and the maladaptive learning of her current violent situation.

6.  Self-care,  improved  functioning  in  daily  life  for  the client and her children, if applicable.

7.  Work  on  boundaries  (emotional,  physical,  and  psychological).

8. Work on emotions and defences (including self-regulation, to avoid relapses caused by emotional dependency and idealisation).

9. Work on trauma.Mosquera  then  proposed  to  organise  to  target  memories  in  a  chronological  order,  or  if  they  are  too numerous and similar (as is often the case), to work on them in clusters as follows:

1.  Memories  of  situations  of  immediate  risk  for  the woman and her loved ones;

2. Targets related to memories of powerlessness, physical violence, and abuse;

3. Intrusive thoughts, cognitions or memories;

4.  Negative  early  childhood  experiences  related  to the problem presented in each case.

In order to circumvent the ambivalence and idealisation that clients may present and which impede  the  successful  application  of  the  standard  EMDR, Mosquera suggested that specific interventions be executed first by desensitising the experienced positive affects that are dysfunctionally  stored,  similarly  to  what  may  be  done in addiction therapy. After that, realisation is possible  and  classical  EMDR  treatment  may  prove  effective. If the MAM is a French and predominantly francophone  seminar  (although,  this  year,  three  of  the  twelve  presentations  were  made  in  English),  it  also invites us to look at the practice of therapists around  the  world.  Let’s  cross  the  Mediterranean  and go to Turkey. Berfin Bozkurt-Bayhan presented the  volunteer  work  performed  within  the  scope  of  EMDR-HAP (Humanitarian Assistance Programme) after the biggest mining disaster in Turkey, in which 301  miners  lost  their  lives  in  2014.  She  introduced  the EMDR Group Protocol (EMDR-GP) that was applied  to  children  who  lost  their  fathers  and  to  mothers  who  lost  their  husbands  (Korkmazlar,  et  al., 2020; Bozkurt-Bayhan, et al., 2022). EMDR-GP, administered 18 months after the disaster, is a group protocol which can be applied to participants  aged  older  than  6  years  and  includes  8 phases of the standard EMDR protocol. One of the details that makes this voluntary study interesting  is  that  the  field  study  was  not  carried  out for research purposes at first, but it was carried out on a volunteer basis. Therefore, a research design  was  created  after  the  group  intervention.  It  can  be  said  that  the  strength  of  this  study  was  the case presentation and the evaluation of the drawings of safe place, desensitization phase, and  resource  installation.  According  to  the  results  of this voluntary study, it was shown that SUD (Subjective Units of Disturbance) levels decreased significantly  during  the  intervention,  and  trauma-focused  scale  scores  decreased  significantly  one  year  after  the  intervention  for  both  children  and  mothers. It can be said that working with trauma is a  difficult  process,  especially  when  working  in  the  field. In the presentation, Bozkurt-Bayhan touched on the subtleties of intervening in the trauma field.  The  importance  of  exchanging  information  with  a  local  professional,  preparing  a  manual  that  allows for a structured intervention program before going into the field, and going to the field as a  team  within  the  framework  of  an  association  or  institution  was  emphasized.  In  addition,  attention  was drawn to the evaluation of the emotional state of  the  therapists,  the  planning  of  individual  EMDR  sessions if necessary, and the organisation of daily consultations during the field study. As working in  the  trauma  field  is  a  challenging  process,  it  was  recommended  that  the  working  time  in  the  field  be  4-5  days.  Finally,  it  was  emphasized  that  it  was  important  to  present  a  report  to  the  next  team  when finally leaving the field.Opening up to the world is also an opportunity for clinicians to be inspired by other practices and  to  to  share  their  experience  with  others.  This  is the case of Joanic Masson, from France, who presented how he combines EMDR psychotherapy with acupressure from Traditional Chinese Medicine (TCM), a medicine practice that is over 5000 years old.  Rather  than  performing  SBL  in  the  traditional  way, Masson stimulates different acupressure points chosen according to the disorders presented by the patient. For example, point 40 Stomach (Feng Long),  which  is  located  on  the  outside  of  the  thigh,  can  be  used  to  facilitate  the  regulation  of  sadness  and  the  release  of  the  throat,  in  accordance  with  Chinese nomenclature, which maps the body not only by organs and bones as does Western medicine, but to which it adds, among other things, the  meridians,  which  are  the  privileged  channels  through  which  energy  (Qi)  flows.  Each  meridian  is  associated with pairs of organs that have energetic, emotional,  psychological,  physiological  functions,  etc.  However,  Masson’s  presentation  went  further  than the presentation of a clinical practice. He proposed to compare the EMDR psychotherapy model  as  we  conceptualise  it  today  with  the  TCM  model.  Firstly,  because  EMDR  considers  the  need  to integrate all aspects of experience in treatment, since emotions cannot be dissociated from the body, which is a fundamental postulate of TCM. Secondly,  because  the  EMDR  therapist  in  phase  4  is in a state that can be called “focused mindfulness” where  they  observe  by  being  fully  present  to  and  mindful of the client (as brilliantly explained by Eva Zimmermann and Olivier Piedfort-Marin) and to themselves, and let the process happen. This implies that the process is self-organised spontaneously, perhaps sometimes unconsciously, in  a  way  that  is  similar  to  that  found  in  a  hypnotic  state  –  in  short  something  akin  to  letting  go.  This  “letting go” is in fact another fundamental concept of TCM, taken from Taoism: non-action (Wu Wei). In a  few  words,  non-action  is  in  no  way  inaction,  but  rather the ability to detach oneself from doing, from control, in order to let go. Paradoxically, it is thus an eminently  active  posture,  but  one  that  allows  the  body to do what it needs to do to regain its balance. This  understanding  by  Joanic  Masson  allows  us  a  beautiful transition. The challenge for EMDR today is not only to evolve in its clinical practice, but also in a new epistemological perspective.

EPISTEMOLOGICAL AXIS
By definition, epistemology is the study of scientific knowledge.  EMDR  is  today  a  true  epistemological  object, because it has been a revolution in the field of psychotherapy and psychopathology. This is the  context  in  which  Cyril  Tarquinio  set  the  MAM’s  first  presentation  of  MAM,  in  which  he  addressed  the  clinical,  theoretical,  and  moral  considerations  since the death of Francine Shapiro. EMDR therapy today  is  no  longer  limited  to  PTSD,  it  raises  many  questions  about  what  psychotherapy  is  and  how  to understand the processes involved. Firstly, because EMDR is still poorly understood. It is mainly explained through the AIP model, which is more of a working hypothesis for the clinician, although very relevant and useful, rather than a scientifically valid model. The only other models that allow us to understand the processes at play are in neurology, which  is  both  necessary  and  regrettable,  because  they limit the exercise of therapy to the use of bilateral  stimulations  or  the  exact  application  of  the standard EMDR protocol, which seems to be far removed from the complexities of clinical practice. We lack a psychological theory. At present, only the theory of structural dissociation of the personality, as proposed by Piedfort-Marin in his presentation, could address this lack. Today, we should no longer think of science as being off the ground with rigorous methodological designs that are too  refined  and  far  from  the  complexity  of  clinical  realities. Science without conscience is but the ruin of the soul, said Rabelais. The challenge today is to grasp all the numerous parameters that intervene in parallel and are in perpetual motion, and that we still have  difficulty  identifying  in  order  to  truly  grasp  what is at stake during EMDR practice. It is in this perspective that a research project, presented  by  Juliette  Machado,  from  France,  was  born  in  the  hope  of  being  part  of  this  dynamic,  the  DETECT-EMDR project (“The therapist’s dimension in the effectiveness of EMDR treatment of simple trauma: the forgotten dimension?”) It was a question of starting from this epistemological postulate but also from a clinical observation, that few  therapists  strictly  apply  the  standard  EMDR  protocol  in  their  daily  practice.  However,  it  is  clear  that they obtain results, even though academic research shows that it is the strict application that 22ESTD Newsletter   Volume 11 Number 3, December 2021 is  the  key!  It  follows  that  we  might  as  well  seize  this paradox. The challenge was to consider the practice  of  EMDR  as  a  professional  situation  and  to  study  it  as  such,  with  methodologies  borrowed  from study of clinical practice. Indeed, it is well known in the field of professional psychology that  workers  never  limit  themselves  to  their  job  description, they take more or less freedom to be  as  close  as  possible  to  what  they  need  to  do.  The same applies to therapists who adjust and adapt  to  the  complexity  of  their  clients,  which  can  lead  them  to  stray  far  from  the  guidelines  set  out  by Francine Shapiro. By filming all the sessions, these  two  conditions  were  compared:  a  group  of  therapists  who  were  asked  to  treat  their  patients  strictly  according  to  the  standard  protocol  (strict  group),  and  another  group  whose  only  instruction  was to treat their patients “as they usually do” (free group). Among the different analyses carried out,  let  us  retain  the  most  original  one:  subjecting  the therapist to the self-confrontation device, a device  borrowed  from  the  observational  analysis  of  work  activity.  The  therapist  is  invited  to  watch  the  video  of  their  practice  and  comment  on  what  they  see  themselves  doing.  Accompanied  by  the  researcher, the aim is to make the therapist’s practice more aware in order to approach what we call  the  “difficult  to  say”  (“at  that  moment  I  made  this  choice  for  my  patient,  but  I  don’t  know  why  I  did  it,  I  sensed  it  that  way”).  Preliminary  results  were  presented  and  already  point  to  interesting  observations: all therapists globally apply the protocol, including those who are free not to do so, although  the  latter  have  a  more  flexible  practice,  especially for phase 3. However, the protocol is always  present  as  a  red  wire  and  the  global  steps  are respected. It is in the application within the phases  that  differences  are  observed.  Moreover,  the way in which the protocol is experienced seems to differ from one group to another. The emotional commitment of the therapist is different according to the place they give to the technique in their work, but this observation seems to depend on the confidence  that  the  therapist  has  in  themselves,  but  also  on  the  psychopathological  complexity  of  the client and the type of target to treat. However, the protocol is very clear, and for both groups, how it interferes with the therapeutic relationship. The more  the  therapist  describes  themselves  as  close  to  their  technique,  the  less  they  feel  connected  to  their client, and vice versa. More detailed analyses are needed, but these observations invite us to open up the field of research in a different way and to  grasp  certain  dimensions  that  are  sometimes  put aside. For example, it is the sensory that takes precedence when approaching this “difficult to say”. Therapists feel a connection, without being able to explain why. The implications for research but also for the training of future therapists are promising. Where it will be possible to map, as far as possible, the  therapist’s  representational  universe  as  a  key  element in the effectiveness of EMDR.Jenny Ann Rydberg, from France, pursued this epistemological  questioning  when  describing  the  course  of  her  doctoral  thesis,  which  asks:  “What  would EMDR therapy be without its jargon?” Rydberg illustrated the evolution of a doctoral candidate’s  thinking  while  working  on  their  thesis,  from  initial  hypotheses  to  ever-changing  nuances  built  on  the  evolution  both  of  one’s  own  thinking  and relevant publications in the field (scientific publishing  is  not  put  on  hold  to  give  us  the  time  and opportunity to demonstrate and publish our original ideas!). The presentation addressed the question of EMDR therapy’s status as an integrative psychotherapy as well as the relevance of the ever-increasing number of EMDR special protocols, claiming to address the specific needs of different populations, outcome goals, and contexts. Rydberg then moved on to the most recent relevant developments in the field that attempt to address  the  issue  of  the  future  of  EMDR  therapy,  including presentations by Michael Hase and Peter Liebermann at the EMDR Europe conference in June 2021, and the November 2021 article by the Council of Scholars’ (Future of EMDR Therapy Project) “What  is  EMDR?”  article  published  in  the  Journal  of EMDR Practice and Research. These most recent developments seem to show that EMDR therapy is destined to be regarded as an integrative psychotherapy  approach;  formulated  in  a  manner  based on terminological, conceptual, theoretical, and  epistemological  clarifications;  situated  within a broad field of psychotherapies with common ancestors; where EMDR therapy consists of the characteristic and idiosyncratic assembly of certain elements common to several psychotherapies, with guidelines for adaptations under the form of  standard  variations.  It  remains  for  the  field  to  define  the  boundaries  of  what  constitutes  EMDR,  perhaps in the form of concentric circles.In  another  register,  but  one  that  has  proved  to  be  more  topical  than  ever,  Alix  Lavandier,  also  from  France,  continued  this  epistemological  reasoning  by addressing EMDR therapy in an integrative protocol,  the  TIM-E  protocol,  using  virtual  reality  in particular. In the Cronos CPTSD project (the TIM-E protocol: Understanding and functioning of  a  new  integrative  protocol  for  adults  suffering  from Complex Post Traumatic Stress Disorder), the  idea  is  to  start  from  a  clinical  observation,  the  difficulty of dealing with CPTSD, and to propose to understand  the  functioning  of  the  TIM-E  protocol,  which  has  provided  encouraging  initial  results  on  the symptoms of this disorder. The TIM-E protocol (Temporalist  Investigation  Model  &  Experiencing,  Dieu and ARCA, 2016) proposes that people focus on temporality by using time as the main variable.  The  TIM-E  model  is  inspired  by  and  uses  different already-existing models and concepts: the temporal perspective (Zimbardo, 1999), AIP, the  social  learning  model  (Bandura,  1980)  and  the  Good Life Model (Ward, 2002). The TIM-E protocol is  divided  into  9  individual  sessions  (with  virtual  reality with a temporal perspective, cognitive distancing exercises, exercises on basic needs), 9 group sessions (development of interpersonal skills,  construction  of  temporal  identity,  cognitive  distancing, work on erroneous cognitions) and EMDR sessions. The methodology of this doctoral research was designed in relation to other research already underway on EMDR therapy and should provide data, particularly on the temporal perspective, the therapeutic alliance, and psychological flexibility in the  management  of  CPTSD  using  EMDR.  The  aim  is  to  come  as  close  as  possible  to  what  is  done  in  current care practice. The interest of this research is  therefore  both  clinical  and  scientific:  Clinicians  are therefore confronted with many difficulties in  the  treatment  of  CPTSD  and  research  does  not  always reflect this clinical complexity. This work is intended  to  test  the  effect  of  the  TIM-  E  protocol  and also to understand how it works.

NEUROLOGICAL AXIS
Finally, let us finish this overview of the 10th MAM by taking a step back into clinical practice and allowing  scholars  to  meet  clinicians.  Ad  de  Jongh,  from the Netherlands, took us on a journey between past,  present  and  future.  After  a  brief  history  of  EMDR  therapy,  he  questioned  EMDR  therapy  on  several points, in particular: how does EMDR work? How can eye movements allow the emotional discharge of negatively encoded memories? He reminded participants of the teachings of Francine Shapiro. By targeting the memory of the event (thoughts,  sounds,  images,  sensations,  emotions,  beliefs, in short, everything that was encoded at  the  time  of  the  event)  and  by  stimulating  “the  information processing system”, this memory transmutes  along  the  processing  system  into  an  adapted memory network. As a result, this memory and the components of the memory change.Research seems to show that performing eye movements,  while  keeping  the  targeted  memory  in mind, works best to degrade the memory in question. The speed of the eye movements is of great importance. The more and faster the movements, the better for the client, but the movements do not have to be horizontal. According to De Jongh, this is a myth in EMDR therapy. Vertical movements would work better, he claimed. Shapiro, by the way, initially mentioned diagonal movements. In the studies presented by De Jongh, there is no difference in effect between horizontal or vertical  eye  movements.  It  would  follow  that  it  is  not  so  much  the  bilaterality  that  is  important  for  the  degradation  of  the  traumatic  memory,  but  the  fact  that  the  targeted  memory  is  kept  in  mind  and  sufficiently activated during the process, otherwise the eye movements would be useless. De Jongh also strongly  emphasised  that  eye  movements  are  not  the  only  effective  task.  Horizontal  or  vertical  eye  movements  work,  but  auditory  or  drawing  tasks also help to reduce the emotional load and thus the complete  processing  of  disturbing  memories.  Eye  movements  and  all  dual  attention  tasks  produce  comparable effects. According to De Jongh, all these  studies  indicate  that  it  is  better  to  use  the  term  “lateral  eye  movements”  and  not  “bilateral  stimulation”. Thus, it is the working memory hypothesis that he favours as the operating model of  EMDR.  The  evocation  of  a  memory  brings  the  memory back into short-term memory, and if a second task is requested during this recall, the emotional  charge  of  the  memory  will  diminish  and  it can then be reconsolidated in long-term memory in a different way. We must add that the working memory model does not  explain  everything  that  is  observed  in  EMDR  therapy  and  that  other  mechanisms  probably  also  play  a  role.  However,  the  working  memory  theory  helps  to  understand  why  EMDR  may  not  always  work,  for  example  where  the  emotional  charge  of  the  memory  is  too  low  or  the  simultaneous  task  is  not sufficient. After Tarquinio’s presentation on the application of EMDR  therapy  to  cancer  patients,  Sarah  Carletto,  from  Italy,  presented  clinical  and  neurobiological  evidence  of  EMDR  therapy  in  cancer  patients.  In  the  first  part,  she  discussed  the  studies  on  the  relationship between cancer and psychological distress. She drew attention to the fact that depression  and  anxiety  are  better  known  in  the  relationship between psychological distress and cancer, but that there are few studies on psychological  interventions  for  PTSD  in  medical  patients. According to the results of studies conducted  with  cancer  patients,  EMDR  can  be  a  potentially  effective  treatment  for  psychological  distress  in  cancer  patients.  In  the  second  part  of  the presentation, Carletto included neurobiological studies showing that the same brain structures play a role in non-oncologic PTSD and psycho-oncologic cases (in particular intrusive symptoms) (Carletto  &  Pagani,  2016).  In  the  latest  study  by  Carletto  et  al.  (2019),  it  was  shown  that  there  was  a significant decrease in depression and PTSD symptoms in cancer patients receiving EMDR therapy. Another important result is that activation was  observed  in  the  left  angular  gyrus  and  right  fusiform  gyrus  regions  in  patients  who  had  EMDR  therapy when compared with the treatment-as-usual (TAU) according to the EEG results. Therefore, activation of these regions with EMDR therapy facilitates the contextualisation and reprocessing of  the  traumatic  event  by  providing  the  activation  from the limbic regions involved in emotional states to the cortical regions. All these studies raise  new  research  questions  about  psychological  distress  in  cancer  patients.  Finally,  the  difficulty  of identifying the single traumatic stressor, the fact that the situation is an ongoing stressor, intrusive symptoms are future oriented, and the re-experiencing  criterion  that  is  associated  with  the  risk of recurrence of the symptoms are important factors  for  the  enrichment  of  clinical  studies  on  cancer.

CONCLUSION
“Documenting your outcomes and sharing it is ‘research.’ Research is not just about proving to  others.  It  is  a  way  to  guide  each  one  of  us  to  establish  the  best  practices.  It  is  about  staying  on  the right road”. Shapiro.The MAM hopes to contribute to this research, dynamic, engaging in discussions and bringing together neurology, epistemology and clinical practice. We look forward to seeing you in 2022 for MAM#11!

References
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