Early EMDR Intervention (EEI)

A Summary, a Theoretical Model, and the Recent Traumatic

Episode Protocol (R-TEP)

Elan Shapiro
Ramat Yishay, Israel
Brurit Laub
Machon Magid, Hebrew University, Israel

This article examines existing early EMDR intervention (EEI) procedures, presents a conceptual model,
and proposes a new comprehensive protocol: the Recent-Traumatic Episode protocol (R-TEP). A review
of research and important professional issues regarding application and parameters are presented. The
commonly used EEI protocols and procedures are summarized, with the inclusion of descriptive case
examples from the Lebanon war and a review of related research. Then a theoretical model is presented
in which traumatic information processing is conceptualized as expanding from a narrow focus on the
sensory image (perceptual level) to a wider focus on the event/episode (experiential level) and finally
to a broad focus on the theme/identity (meaning level). The relationship of this model to the Recent-
Traumatic Episode protocol is articulated and case examples are presented. Theoretical speculations are
discussed relating to attention regulation and the Adaptive Information Processing (AIP) model. Further
research is encouraged.

Keywords: EMDR; early EMDR intervention; recent trauma; Adaptive Information Processing model;
posttraumatic stress disorder (PTSD); prevention of PTSD

Every story has a beginning, a middle, and an end—but not necessarily in that order.
—(attributed to Jean Luc Goddard)
Every trauma has a past, a present, and a future—but not necessarily in that order.
—(Authors)

he first section of this article focuses on the is- Professional Questions

T sues related to early EMDR intervention (EEI).
The ethical issues arising from early interven-
tion after a recent traumatic event are discussed and
Early EMDR (eye movement desensitization and re-
processing) intervention following a traumatic event
raises a number of professional questions. There are
questions about the appropriateness and utility of EEI
are addressed. This is followed by a summary of early concerns about the risk of pathologizing a normal
EMDR interventions, including several case examples response to an abnormal situation and ethical issues
illustrating their application and a brief review of re- about the therapeutic contract when intervening
lated research. with EMDR soon after a critical incident. It should

Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 79

© 2008 Springer Publishing Company DOI: 10.1891/1933-3196.2.2.79
be remembered that most of the clients seen follow- Natural recovery following disasters may also be
ing a recent trauma would not have sought or been painfully prolonged, lasting as many as 18 months
offered treatment otherwise. However, some may (Norris et al., 2002). Thus despite reassurance that a
also have previous trauma and mental health histo- majority of people exposed to traumas will recover,
ries. This has implications regarding the therapy con- there are still a large number who become impaired
tract. Clinicians are cautioned to attend to a general with clinically significant symptoms and many
risk of cutting corners such as insufficient history tak- more with subclinical symptoms. These findings
ing/intake and insufficient rapport and preparation. support the notion of early intervention. Therefore
In particular, there are specific risks concerning brief, if there is a possibility of avoiding the development of
emergency EMDR interventions such as a lack of PTSD, or of relieving excessive suffering, by means of
containment and a possibility of opening up other a relatively simple procedure such as early interven-
clinical issues. With EMDR we know where we start tion with EMDR, this is well worth exploring.
but not where we will go, and intense emotions are
frequently evoked. In addition, follow-up may be Overview of Existing Early EMDR
neglected. The self-healing, minimal intervention Intervention (EEI) Protocols
philosophy of EMDR could come into conflict with The memory of a recent trauma differs from that of a
a temptation to rush into early EMDR interventions. more distant trauma in that it tends to be more frag-
However, EMDR clearly has much to offer for aiding mented, disorganized, and less integrated into a coher-
recovery following trauma. Consequently, the way in ent narrative or sequence of events. Consequently, it
which early EMDR intervention is conducted needs may not be adequately represented or generalized by
to be carefully considered. any single image from the event (F. Shapiro, 2001). Fur-
While working with victims of the Lebanon war ther, according to the model presented in this article, it
in the summer of 2006, in which large civilian popu- may not yet be organized into a theme cluster. There-
lations came under missile attack, the authors with fore, when working within several weeks and possibly
other EMDR practitioners in Israel felt an urgent need months following a traumatic event, it is necessary to
to consider early intervention with EMDR. The main modify treatment procedures to address these factors.
early EMDR intervention (EEI) protocols were exam- The main protocols proposed for early interven-
ined and compared to discern what characterizes and tion are the EMD (eye movement desensitization)
distinguishes them, what is their appropriate applica- protocol and the Recent Event protocol (F. Shapiro,
tion, and how the professional concerns raised above 2001). Table 1 places these protocols, as well as other
can be addressed. EMDR relevant early intervention procedures, along
a timeline from 2 days following a traumatic event to
Why Early EMDR Intervention? 3 months and more following the diagnostic indica-
According to the National Institute for Clinical Excel- tions for acute stress disorder (ASD), acute PTSD,
lence (N.I.C.E.) U.K. Clinical Guidelines (2005) for and chronic PTSD (American Psychiatric Association
treatment of posttraumatic stress disorder (PTSD), [APA], 1994). Note that these categories are only ap-
the probability of developing PTSD following a trau- proximate and that in practice there is a continuum
matic event is 8% to 13% for men and 20% to 30% with overlap.
for women, with an annual prevalence of 1.5% to 3%.
Eye Movement Desensitization (EMD)
Many recover without treatment within months/
years of an event, with 45% to 80% showing natural The EMD protocol, as its name suggests, differs from
remission at 9 months. Generally 33% will remain the standard EMDR protocol in that it focuses on the
symptomatic for 3 years or longer with an increased desensitization of the intrusive sensory image, return-
risk of secondary problems. ing to it and frequently checking Subjective Units of

TABLE 1. Principal Early EMDR Intervention (EEI) Protocols

Time After “T” 2 Days…> 2 Weeks…> 1 Month…> 3 Months…>
Diagnosis ASR ASD Acute PTSD Chronic PTSD
Main Protocols ERP EMD RE protocols Standard protocol
Other Protocols EMDR-ER; Kutz protocol Group (EMDR-IGTP); Kutz Group (EMDR-IGTP)

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Shapiro and Laub
 THEME Processing
[Standard Protocol]
LEVEL
Meaning/
Assumptive world

EPISODE Processing
IMAGE EVENT
EV
VENT Processing
V g (R-TEP)
Processing [RE]
[EMD]
PERCEPTUAL LEVEL: Experiential/
Layers of meaning
ISSUE
Transitional ISSUES: Internal to identity
NARROW WIDE FOCUS external to internal identity
FOCUS on event WIDEST FOCUS
on intrusive
WIDER FOCUS On themes,
on multiple targets
image
of the episode
schemas

IMPLICIT MEMORY EXPLICIT MEMORY

FIGURE 1. Early EMDR interventions (EEI): The widening focus of image-event-episode-

theme processing.

Disturbance (SUD) level (where 0 = no disturbance

CASE: USING THE EMD PROTOCOL
and 10 = worst disturbance possible). This process
IN THE LEBANON WAR
thereby limits associative chains. EMD is conceptu-
alized by the authors as a protocol primarily utilized Miriam, a mother of three, was exposed to a traumatic
for treating intrusive symptoms of ASD, usually in- event during the war. Previously well functioning, she
trusive pictures, sounds, smells, and other repetitive asked for professional help because she was still suffer-
sensations, referred to here as “sensory images,” ad- ing from nightmares and sleep disturbances several weeks
dressing stuck processing at the perceptual level, as later. The traumatic event was a fall of a missile in the
illustrated in Figure 1. house yard when the family was on its way to the shel-
EMD is described in the Military & Post-Disaster Re- ter. Miriam’s leg was injured from shrapnel and she fell
sponse Manual (F. Shapiro, 2004) as follows: down. The daughter, who was hand in hand with her, was
thrown from the blast to another place. Some minutes
Sensory disturbance interfering with . . . func-
later they met and both parent and daughter went down
tioning can be addressed with EMD that focuses
to the shelter.
directly and repeatedly on the target (e.g., intru-
In the assessment phase of EMD, Miriam identified the
sive image, explosion, smell).
intrusive image of her daughter suddenly disappearing, to-
After each set (12–24 movements), client is told gether with a sensation of terror and the thought that she
“Blank it (the picture) out, and take a deep breath.” is dead. The session started with the 4 Elements exercise
The client is then asked to bring up the picture and for stress management (E. Shapiro, 2007) followed by the
words again, to concentrate on the sensations gener- EMD protocol, with a distancing metaphor of viewing as
ated, and to provide an SUD level rating from “0” to on a TV screen. Miriam started with SUD = 10. The SUD
“10.” At the times the SUD levels are taken, clients are level was checked after every set and it went down gradu-
occasionally asked such questions as “Did the picture ally to 3. In the third set the image started to disappear from
change?” or “What do you get now/Does anything time to time, in the fourth she recalled other details of the
else come up?” Their answers are used as a barometer event and the picture got larger on the TV screen. On the
of change since they often reveal new insights, percep- fifth set she didn’t need the distancing any more: “I went
tions, or alterations of the picture (e.g., “The picture back there without the TV screen and it was OK. I remain
seems further away”; “I didn’t do anything wrong”). If relaxed, I am part of it.” In the sixth set many details were
an answer reveals that a new associated limiting belief elicited, some of which she had not previously remem-
has arisen, this belief is often included with the origi- bered. Miriam continued processing the event chronologi-
nal statement during the next set (p. 2). cally, from the moment she was hurt onward. In the last set

Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 81

Early EMDR Intervention
she described with a smile the gathering of the neighbors in Obtain a narrative history
the shelter nurturing each other: “The event is not in the Identify each target
center any more.” Finally she ended with a future Resource Image, NC, PC, VoC, emotion, SUD, location
Connection (Laub, 2001) in which she imagined preparing Desensitize most disturbing target
her older daughter’s wedding in the house yard (the loca- Desensitize remaining targets in chronological
tion of the trauma) where she was watering the bombed order
tree (which had started to grow). Have client visualize the entire sequence of the
event with eyes closed and desensitize it as
disturbance arises. Repeat until the entire
Recent Event (RE) Protocols event can be visualized from start to finish
without disturbance
Recent Event (RE) protocols conceptualize the trau- Have client visualize the event from start to fin-
matic event as a fragmented experience, which has not ish with eyes open and install positive cogni-
yet consolidated so that no single image can represent tion (p. 5)
the entire event. It is therefore necessary to process a
number of targets, which are aspects or parts of the
Recent Traumatic Event (RTE) Protocol
event, in order to facilitate integration and consolida-
tion (F. Shapiro, 2001). There are several versions of The Recent Traumatic Event (RTE) protocol was
the RE protocol: the extended Protocol for Recent based on Roger Solomon’s critical incident work-
Traumatic Events developed by Francine Shapiro shops (E. Shapiro, 2003). It essentially modified the
(2001), a version of it in the Military & Post-Disaster protocol for recent traumatic events to structure it
Response Manual (F. Shapiro, 2004), and the Recent along parallel lines to the eight phases of the stan-
Traumatic Event protocol (RTE), a modified version dard EMDR protocol where possible. This familiar
based on Roger Solomon’s workshops (E. Shapiro, structure was adopted to facilitate rapid teaching and
2003). The authors of the current article conceptual- assimilation of the protocol to EMDR-trained practi-
ize these similar protocols as having a wider focus, tioners in emergency situations who are unfamiliar
usually utilized for treating ASD and acute PTSD fo- with it while also reminding them to attend to the
cusing on various aspects of the single traumatic event good practice guidelines of the eight phases. This pro-
that are disturbing, predominantly at the experiential tocol was made available to EMDR practitioners dur-
level (emotion, somatic sensations), in addition to the ing the Lebanon war.
intrusive sensory images.
The extended Protocol for Recent Traumatic
Events (F. Shapiro, 2001) instructs the client to obtain CASE: WORKING WITH THE RTE PROTOCOL
a narrative history, target the most disturbing aspect IN THE LEBANON WAR
of the memory, and then identify targets reported
from the remainder of the narrative in chronologi- Rachel, a religious woman, was a single parent with three
cal order. The client is asked to mentally visualize children. Two months after the war she suffered from high
the entire sequence of the event with eyes closed to anxiety and stress. The session began with the 4 Elements
identify remaining disturbing targets for processing. exercise for stress management (E. Shapiro, 2007), fol-
Each target is given the standard EMDR procedure lowed by the EMD protocol with a distancing metaphor
except for body scan. This is repeated until the entire of a TV screen. She chose one intrusive image, in which
event can be visualized from start to finish without the blast from a missile damaged the windows of her flat.
disturbance. Her SUD score decreased gradually from 10 to 3. How-
The Recent Trauma protocol is outlined in the ever, at the end of the session, she recalled other traumatic
Military & Post-Disaster Response Manual (F. Shapiro, events from the 2 weeks in the bombed city and the SUD
2004) as follows: went up. The EMD protocol was therefore not sufficient to
complete the processing. At the second meeting the RTE
Recent traumatic events often have not had the protocol was employed that processed several targets from
time to consolidate. Therefore, it is necessary to the 2-week-long traumatic event and included video visu-
target each aspect of the traumatic (“T”) event alization to identify residual disturbances. She finished the
separately. Each aspect of the event needs to be session with SUD = 1 and PC: “God is guarding me and
assessed for its own image, negative cognition, I am protected,” which expressed her renewed faith and
positive cognition, VoC, emotions, SUDs, and confidence.
body sensations.

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Shapiro and Laub
Emergency Room Protocols hospital setting, sometimes in the ER, although more
usually some days or weeks later to patients with acute
Three Emergency Room (ER) protocols are described stress syndrome who present with unusual responses
here: the Emergency Response protocol (ERP; Quinn, following terrorist attacks or motor vehicle accidents
2007), the EMDR-ER (Guedalia & Yoeli, 2003), and (Kutz, 2006).
Kutz’s (in press) Modified Abridged EMDR protocol.
The authors of the current article consider these ER Group EMDR Protocols
interventions as augmenting stabilization (phase II)
and promoting initial processing. Group EMDR protocols were included in Table 1
as they have been applied in emergency disaster
situations in which there are many victims and few
Emergency Response Protocol (ERP)
practitioners available so that individual intervention
In his Emergency Response protocol (ERP), Quinn is limited. The EMDR Integrative Group Treatment
(2007) reported positive results with the use of bilateral protocol (EMDR-IGTP; Jarero, Artigas, & Montero,
stimulation (BLS) combined with supportive positive this issue) was originally designed for working with
cognitions (e.g., “it’s over, you are safe now”). The children and was modified later for use with adults.
ERP protocol was provided in the hospital emergency It utilizes the Butterfly Hug as a form of self BLS ini-
room following terrorist attacks to victims who were tiated by Artigas, together with drawings for group
presenting with extreme responses and who were un- processing. Working mostly with small groups of chil-
able to communicate because of severe distress. dren and an emotional support team of mental health
The ERP is outlined in the Military & Post-Disaster personnel, EMDR-IGTP begins with a preparation
Response Manual (F. Shapiro, 2004) as follows: phase to establish rapport and trust, which includes
a safe place exercise. The children are asked to think
Overwhelming affect presenting as dissociation about disturbing aspects of the event, to draw it, and
or hallucinations within hours of the event then to perform the Butterfly Hug. This process is
can be directly targeted. repeated three more times, with the child each time
Bilateral stimulation is applied with positive drawing another picture that they rate using an SUD
cognitions until the client is able to produce a Scale. At the end they are asked to draw a positive
narrative. picture together with a word or a phrase, which is in-
For high but not overwhelming affect, BLS can be stalled with the Butterfly Hug.
used in short sets to take off the edge. Psychoeduca- The authors of the current article regard the group
tion may then be sufficient (p. 2). procedures as valuable in certain disaster circum-
stances where individual interventions are not feasible
or restricted and for screening for persons who will
EMDR-ER
require further individual attention. They may be ben-
Guedalia and Yoeli (2003) developed another protocol eficial as a means of gaining more control over anxiet-
to be used in the emergency room following their ex- ies and getting in contact with coping resources.
perience with suicide bombing victims. This protocol,
which they called EMDR-ER, was used with patients Research on Early Treatment Interventions
still on gurneys, who were unable to move on to the
ambulatory staging area and who displayed difficulty Very few randomized controlled treatment studies
in functioning. The focus in this protocol was on in- have been reported for early intervention following
stallation of positive cognitions and for the therapist trauma (Bisson, 2006; Bryant, 2000). Bisson described
to assist in creating a narrative of the traumatic event nine trials of early psychological intervention and
so that the patient had a “speech-full” coherent ac- three trials of early pharmacological intervention. He
count with generally appropriate affect. The goal was concluded that there is emerging but limited evidence
to get the patient up and out of the emergency room. of clinically important effects with trauma-focused
cognitive behavioral therapy (CBT), administered 1–3
months following a trauma. There is no convincing
The Kutz Modified Abridged EMDR Protocol
evidence of the effectiveness of pharmacological in-
The Kutz protocol is viewed as a variant of the EMD terventions or of debriefing. It is noted, however, that
protocol. Kutz described it as a single session “modi- there is a methodological difficulty in demonstrating
fied abridged EMDR protocol,” with Alternating Bi- effectiveness because of the high percentage of spon-
lateral Stimulation (ABS). It is usually provided in a taneous recovery expected after trauma.

Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 83

Early EMDR Intervention
EMDR with the EMDR-Israel Association. They contacted
people who had been admitted to hospital emergency
There have been no randomized controlled studies
rooms suffering from extreme stress responses after
with early EMDR intervention; however, there are
missile attacks during the 2006 Lebanon war. Those
some nonrandomized controlled studies. Victims of
who still had symptoms several weeks later were
Hurricane Andrew were given one session of EMDR
offered a single session of EMD and follow-up. The
two and a half months following the disaster. De-
sample was small and all participants in this sample
spite the limitations of the study in disaster condi-
were exposed to repeated shelling and multiple trau-
tions, the results were promising, showing significant
matic events for more than 4 weeks. The results were
improvements in the EMDR group as compared to
inconclusive for various reasons, but it seems that
the waiting-list controls (Grainger, Levin, Allen-Byrd,
treatment was helpful in the short term on a num-
Doctor, & Lee, 1997).
ber of measures. There was some erosion of gains at a
A study was conducted on the use of EMDR fol-
3-month follow-up (Kutz, 2006).
lowing the 9/11 terrorist attacks in New York in 2001
(Colelli & Patterson, this issue; Silver, Rogers, Knipe,
EMDR Integrative Group Treatment
& Colelli, 2005). Again, due to research difficulties
Protocol (EMDR-IGTP)
in disaster situations, the researchers used an analog
wait-list control group to compare symptom levels The EMDR Integrative Group Treatment protocol
after treatment of the “early group” (2–10 weeks fol- (EMDR-IGTP; Jarero et al., this issue) was originally
lowing trauma), as well as of a “late group” (30–48 developed for the survivors of Hurricane Pauline in
weeks after). The treatment consisted of an average Acapulco, Mexico, in 1997. This protocol utilizes the
of four to five sessions of EMDR. The results showed “Butterfly Hug” as a form of self BLS, together with
significant positive gains on a number of outcome drawings for group processing. Field study reports
measures in both treatment groups. It is interesting to from various parts of the world lend support to the
note that those who sought treatment at the later date benefits of using EMDR-IGTP in mass disaster situ-
presented with higher levels of distress than those who ations ( Jarero, Artigas, & Hartung, 2006). The group
were treated in the first few weeks. Silver et al. con- protocol was used with children in Turkey after the
cluded that “EMDR is a useful treatment intervention 1999 earthquake (Korkmazlar-Oral & Pamuk, 2002),
both in the immediate aftermath of disaster as well as with children in Thailand who survived the December
later” (p. 29). 2004 tsunami (Birnbaum, 2007), as well as with groups
Ad de Jongh (2005) has reported encouraging re- of Kosovar-Albanian refugee children in Germany
sults with very early EMDR interventions (several (Wilson, Tinker, Hofmann, Becker, & Marshall, 2000).
days after the incident) with crime victims in the Neth- In a nonrandomized study, 236 schoolchildren with
erlands. Quantitative data is currently being collected. PTSD symptoms after witnessing a plane crash-
ing into a building in Milan received EMDR-IGTP
Single-Session Modified Abridged 30 days after the incident. Nearly all the children were
EMDR Protocol reported to be functioning normally at 4 months
follow-up (Fernandez, Gallinari, & Lorenzetti, 2004).
Ilan Kutz (in press) has provided initial data from In a modification (Laub, in press), EMDR-IGTP was
multiple case studies using what he calls a single- combined with the 4 Elements stress management ex-
session “modified abridged EMDR protocol,” with ercise (E. Shapiro, 2007) and employed with groups of
BLS applied to patients with ASD following road ac- distressed children following ongoing missile attacks
cidents and terrorist attacks. He found that 77% of in Israel (Bar-Sade, 2007).
the 86 patients showed immediate or marked relief
of their intrusive and other distress symptoms. Most Considerations When Using
of the responders were victims of a single traumatic Early EMDR Intervention
event.
There appear to be at least three main issues to con-
sider when intervening with EMDR soon after a criti-
Recent Event Protocols and EMD
cal traumatic incident. First, the nature of the recent
There are no published studies relating to the use of trauma memory itself: fragmented, not integrated.
EMDR Recent Event protocols or EMD protocol in its Second, the nature of the situation: stressful for cli-
application for early intervention. A pilot study evalu- ent and therapist, sense of urgency/emergency, risk
ating EMD was initiated by Ilan Kutz, in collaboration of high arousal with re-experiencing/flooding and the

84 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008

Shapiro and Laub
need to contain and keep the client safe. Third, the
A Theoretical Model
nature of the therapeutic context: professional issues
involving the therapy contract, and scope of the in- In the first section of this article, the major EEI pro-
tervention, which can be limited to the trauma or ex- tocols were analyzed and compared to discern what
tended to other clinical issues. characterizes and distinguishes them (see Table 2).
Existing EEI protocols give guidelines and sug- It was observed that the EMD protocol tended to
gestions relating to the first issue of the fragmentary narrowly focus on intrusive sensory images, which
nature of the recent trauma memory. While EEI pro- primarily addressed stuck processing at the percep-
tocols provide a good basis for approaching this issue, tual level, involving physical survival issues (safety,
the authors suggest that they are incomplete. Clinical control). Whereas the RE protocols focused more
experience showed that they could fall short of en- widely on the various parts of the event, addressing
compassing all the levels at which processing could stuck processing primarily at the experiential level
become stuck. They omit a systematic targeting of of the event, also usually involving survival issues
disturbances subsequent to the traumatic event itself. of safety and control, external to identity. When the
It was not always clear when to use which EEI proto- standard EMDR protocol was extrapolated on this
col or whether to comply with the standard protocol. continuum, it was seen to focus broadly on events
The second and third issues were not adequately related to themes at the meaning level, addressing
addressed. The fact that the client may be easily trig- additional issues of psychological survival relating to
gered into re-experiencing intense emotional states identity.
requires including additional measures within the It is noted that while the primary focus at each level
protocols for stabilization and regulation to contain (perceptual, experiential, meaning) was usually on a
and keep them safe when working soon after trau- particular modality, it is evident that all the modali-
matic incidents. In the stressful circumstances usually ties (sensory, emotional, somatic, and cognitive) are
associated with EEI, the therapeutic context and goals simultaneously present at each level to some extent,
could be overlooked. EMDR phases I and II (history with one or more being dominant.
and preparation) could easily be neglected and the While the standard EMDR protocol uses a three-
therapeutic contract left vague and unclear. pronged approach to address past, present, and future
Another aspect concerns therapist issues and com- aspects of the event, the EMD and RE protocols can
mon difficulties faced by therapists working in be understood as one-pronged approaches relating
emergency situations. These challenges include over- primarily to the (recent) past image or event. What
identification with the victim and fear of causing harm has been missing is a two-pronged approach for re-
and can lead on the one hand to collusion with the cli- cent events relating to the past and to the present.
ent in avoidance of relating to the trauma and on the This need is fulfilled by the R-TEP, which is intro-
other hand to burnout or compassion fatigue (Lahad, duced in this article. The R-TEP is placed in Table 2 in
2000). Unclear procedures can contribute to therapist the column that was “missing” from the existing pro-
confusion, hesitancy, and avoidance in these circum- tocols, illustrating how it provides the missing links
stances. There is a need for a clear and comprehensive bridging the transition from RE protocol to standard
model and set of guidelines in the first aid toolbox of protocol.
the EMDR practitioner to assist in approaching the It is suggested that the focus of these interventions
prospect of EEI with more confidence. expand from a narrow focus on the intrusive sensory
A broader conceptualization of the traumatic time image in an Image Processing protocol to a wide focus
frame or episode consisting of multiple events/targets on the parts of an event in an Event Processing pro-
seems to be necessary, as well as an effective means of tocol, to a wider focus on a series of events in an Epi-
identifying these unprocessed targets. These observa- sode Processing protocol, to a broad (widest) focus on
tions and conclusions lead to the development of a a series of episodes in a Theme Processing protocol.
new model and protocol: the Recent Traumatic Epi- Figure 1 illustrates this expanding task focus and rein-
sode protocol (R-TEP). forces a need for an approach that encompasses the
It should be noted that it was the attempt to collect narrow as well as the wider focuses.
empirical data using the EMD protocol that inspired In the first section of the article, it was concluded
this article and the development of the R-TEP. This that the existing EEI protocols were not comprehen-
underlines the importance of gathering data about the sive enough. It was not clear when to use which EEI
usefulness of these protocols in order to improve them. protocol or whether to stay within the standard pro-
However, research is needed to test their effectiveness. tocol. There was also insufficient attention paid to the

Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 85

Early EMDR Intervention
 86
TABLE 2. Early EMDR Interventions (EEI)—Protocols Comparison Table
EMD Protocol Recent Event Protocol R-TEP Standard Protocol
IMAGE Processing EVENT Processing EPISODE Processing THEME Processing
STUCK PROCESSING LEVEL PERCEPTUAL Sensory image EXPERIENTIAL Event Experiential/layers of meaning MEANING
Episode (time period from the Theme, schema,
original event to the present) assumptive world
Life pattern
FOCUS NARROW FOCUS on intrusive WIDE FOCUS on disturbing WIDER FOCUS on disturbing WIDEST FOCUS on disturbing
sensory image aspects of the event aspects of the entire episode aspects of a theme, schema
ISSUES Physical SURVIVAL Physical SURVIVAL TRANSITIONAL: from Psychological SURVIVAL
Safety/Control Safety/Control/Guilt Physical to Psychological Appropriate Responsibility for
External to IDENTITY External to IDENTITY SURVIVAL from External to past events, Safety in the
Internal IDENTITY present, new Choices in the
future. Internal to IDENTITY
GOAL Adaptive absorption & Consolidation of fragmented, Integration of unprocessed parts Integration of unprocessed
integration of image within unprocessed experiences, of the episode (the event, events into an adaptive theme
event integration of event experiences after the event,
Desensitization and the changing meaning of
the original event)
MEANS Repeated targeting of intrusive Processing disturbing aspects of Processing disturbing aspects Reprocessing of disturbing
sensory image the event. Using “video” of the episode. Process using memories associated with the
(sequential) to identify targets “Google Search” (non- theme
sequential) to identify targets
Limited associative processing No regulation of associations Option of regulating associative Full associative processing
processing
1-pronged protocol Extended 1-pronged protocol 2-pronged protocol 3-pronged protocol

Shapiro and Laub

Journal of EMDR Practice and Research, Volume 2, Number 2, 2008
therapeutic context of early intervention and to the The Recent Traumatic Episode
consequences of the traumatic event. Protocol (R-TEP)
This article describes the new protocol, the R-TEP,
which is presented here in manualized form for prac- Symptoms of ASD or acute PTSD characteristically
tical application. Case examples are given and its main show a lack of differentiation of past and present at
features are discussed. The development of this pro- some level. In the current conceptualization of the
tocol evolved together with a conceptual model. This model proposed here, the sequence of experiences that
process went hand in hand with theoretical specula- has unfolded since the original event is considered part
tions relating to the Adaptive Information Processing of the continuing traumatic episode, which extends into
(AIP) model (F. Shapiro, 2001) as well as the possible the present time. Within this episode there may be mul-
role of attention regulation. tiple targets that require processing and integration.

TABLE 3. Recent Traumatic Episode Protocol (R-TEP)

Main Features of the R-TEP
Target selection:
1) Episode-wide focus = period from the traumatic event to the present
2) Use of “Google Search” metaphor to identify multiple targets within the episode (sensory images/events/other
experiences)
Containment (safety):
1) Eight-phase structure parallel to standard protocol
2) Episode narrative with DAS for grounding
3) Regulation of associations, option of limiting associations to the image/event/episode
A
PHASE 1: HISTORY
Obtain as much client history/information as possible in the circumstances; from others if necessary. If possible administer
the Impact of Events Scale (IES-R).
PHASE II: PREPARATION
Start with stabilization and resources such as a safe/calm place exercise, resource connection, and/or the 4 Elements
exercise.
B
PHASES III and IV: EPISODE PROCESSING (multitarget processing)
These phases include assessment and processing of multiple targets identified from the event, experiences after the event,
and the changing meaning of the original event.
1. Episode Narrative with Dual Attention Stimuli (DAS):
Episode narrative is running the movie of the episode while telling the story out loud with DAS (dual attention stimuli).
This helps to ground and contain affect while the client begins the processing. Using a distancing metaphor, e.g., T.V.
screen, gives additional containment if needed.
Say: “I am going to ask you to view the whole episode, from the beginning until today, as on T.V. Imagine that you are watching the
episode on a screen with a remote control that can make the screen smaller, further away, lower the volume or even stop it—and tell the
story out loud.”
Use continuous DAS during the episode narrative.
2. Episode “Google Search” (GS) with DAS:
Say: “Now, without talking out loud this time, return to scan the whole episode, like ‘Google Search’ in the computer, for any excessive
disturbance, in no particular order. Just notice what comes up as you search the whole episode from the original event until today and
stop at what is still disturbing you and we will use it as a target for EMDR.”
Target each point of disturbance: (sensory images/events/other disturbing experiences).
(continued)

Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 87

Early EMDR Intervention
TABLE 3. (continued )
Option: If the target is an intrusive sensory image use the EMD protocol for desensitizing this image. It is usually a short
procedure. Then return to GS for additional targets.
Process each target: Using as much of the standard protocol assessment as is appropriate (use clinical judgment): Image,
NC, PC, VoC, Emotion, SUD, Body sensation.
Say: Focus on the image, the words (NC…..), the feelings and body sensations.”
Do a set of DAS.
After each set say: “Take a deep breath. …What do you get now?”............................................
I- If the association is about the episode:
Say: “Go with that” … and continue with DAS, as with standard EMDR processing—as long as the association is related to
the episode.
II- If the association is not related to the episode then return to focus on the target event.
Say: “Go back to the target, what do you get now?”...................................
Continue the processing until the SUD drops to ecological level.
Goal of episode multitarget processing:
To integrate the disturbing images/events/other experiences within the episode so that processing can proceed.
Continue with the “Episode Google Search” to find other targets of disturbance and then process each one, as above.
Checking the episode SUD (E-SUD)
When no more targets emerge with GS check the SUD for the entire episode.
Say: “When you think of the whole episode until today, how disturbing is it to you on a scale of 0 to 10?”…..If it is not ecological,
then check with GS for remaining pockets of disturbance to be processed. This may indicate a need for a higher meaning
level of processing, addressing negative themes/world assumptions.
When SUD is ecological proceed to Installation of Episode PC.
C
PHASE V: INSTALLATION of EPISODE POSITIVE COGNITION (E-PC)
Say: “When you look at the whole episode now, how would you like to think about it? What have you learned from it?” (obtain a PC
for the whole episode)
Check the VOC. Say: “When you think of the whole episode until today and say the words (PC) how true does it feel to you on a scale
of 1 to 7?”……
“Episode installation” with DAS
Say: “Think of the PC and run the movie of the whole episode again starting from the beginning until today.”
Install with sets of DAS.
Goal of episode processing: To integrate the whole traumatic episode within a positive theme cluster, completing transi-
tion from external physical survival to adaptive internal identity theme.
D
PHASE VI: EPISODE BODY SCAN
Say: “When you think of that episode and your positive cognition (state PC), notice what is going on in your body, if there is any body
sensation, let me know.”
Use sets of DAS as in the standard protocol.
PHASE VII: CLOSURE
The protocol may take several sessions, so ensure a strong closure (return to safe/calm place, resource connection, and/or
4 Elements exercise).
PHASE VIII: FOLLOW-UP
Obtain feedback from previous work and check Episode SUD. If not ecological, use G-Search to identify any residual tar-
gets which may require additional processing.
If possible administer the Impact of Events Scale (IES-R) again.

88 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008

Shapiro and Laub
 The R-TEP (Table 3) incorporates the EMD and The reason for the initial distancing and the un-
RE protocols within its overall unifying approach and usual application of DAS during the relating of
expanding focus, making the whole episode (from the the story stems from clinical experience. In recent
event until today) the strategic focus. trauma processing the client is likely to exhibit very
high SUD levels and be readily flooded. The therapist
Main Features of the R-TEP can therefore facilitate containment by maintaining
at least partial attention to present safety by means of
Stabilization. The R-TEP attempts to retain the
a distancing metaphor and grounding effects of the
structure of the eight phases of the standard EMDR
DAS.
protocol. In phase I, client history/information is
obtained as much as possible in the circumstances “Google Search” (GS) Metaphor. The “Google
and from others if necessary. Screening for complex Search” (GS) is a modified mechanism for target se-
PTSD is advised. In phase II (preparation), attention lection and a strategy for checking for residual distur-
is given to stabilization, which is essential when work- bance. Clients are asked, without talking, to search
ing with recent trauma. Following the war experience, their memory of the entire episode (not necessarily
the safe/calm place exercise was sometimes difficult in a sequential way) for the parts that are still dis-
to achieve or insufficient, and additional stabilization turbing them. This contemporary metaphor for a
methods were needed, such as the 4 Elements exercise “mental search engine” applied with the mechanics
for stress management (E. Shapiro, 2007). It comprises of DAS seems to deliver more appropriate targets
various self-soothing, stress management exercises for for processing, which may not have been reported if
client use: Earth (grounding), Air (breathing), Water asked for in the usual way. These targets can then
(producing saliva), and Fire (safe place and/or other be processed with the standard protocol (applied
resource imagery). They are presented in a package flexibly). The term “Google Search” was proposed
that can be easily remembered, together with a brace- playfully initially. However, it became apparent
let or sticker, which acts as an anchor or cue reminder that this mechanism employs the same information
for frequent practicing. While working with recent processing “language” of EMDR, perhaps mimick-
trauma in the protocol, additional containment mea- ing natural associative processes. The GS implies
sures are usually indicated, such as the option of using simultaneous scanning and categorizing, which are
a distancing metaphor. manifestations of the ability of the mind to differen-
Focusing on the Episode. RE protocols focus on the tiate and integrate in complex ways via its associa-
parts of a single traumatic event, whereas the R-TEP tive networks. GS can also be used in other ways, like
focuses on a series of events or experiences, which “resource GS” for targeting resources, or “Googling
comprise the entire episode. The episode concept is back” (similar to “float back”), or “Googling forward”
extended to include the consequences of the trau- (future projection).
matic event/s until today. This perspective makes it a Regulation of Associative Chains. The option of
“two-pronged” protocol (past to present), as opposed limiting the associative chains to the image, event, or
to the RE, which could be described as an extended episode helps contain and regulate the processing ac-
“one-pronged” (past focus) protocol. cording to the level at which it is stuck. The possibil-
Episode Narrative With DAS. The client is asked ity of keeping the associations focused on the episode
to run the “movie” of the episode while telling the by frequently returning to the target when clients
story out loud during dual attention stimulus (DAS). depart to other issues provides the therapist with a
DAS is employed (for grounding and present orien- possible mechanism of containment. This is an exten-
tation) while the client is instructed both to “watch sion of the idea in the EMD protocol of going back
the movie” (for distancing) and to tell the story out to target after each set. This regulation is regarded
loud. Apart from the importance of the narrative for as a clinical choice point, in which the strategy is to
assessment of the episode history, telling the story focus more narrowly on the recent event and epi-
of the recent traumatic event seems to be more sode at first and only to widen the focus if this is not
containing and also facilitates initial processing and sufficient for releasing spontaneous processing. The
integration (see the case of Sarah below). Prior to regulation of associations corresponds with the idea
this the client is discouraged from going into detail of a narrow focus that gets wider as one moves from
about the event to avoid triggering high arousal the processing of image to event/episode and then
prematurely. to theme. It is speculated that in recent traumatic

Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 89

Early EMDR Intervention
events/episodes the unprocessed associations are Case Examples
not yet integrated within a theme cluster. Therefore
processing with R-TEP can prevent the traumatic SARAH: A CASE ILLUSTRATING THE
episode from being integrated into a negative clus- ADVANTAGES OF EPISODE NARRATIVE
ter. Processing with the R-TEP can be of benefit even WITH DAS
after longer than three months, when thematic issues
may be prominent, because the focused processing of Sarah was a young woman whose 2-week-old baby had
the episode can weaken linkage to negative themes died 2 months previously of a heart attack. Although ordi-
and strengthen links to positive theme clusters (see narily well functioning, she seemed so easily flooded that
case of Dina below). she was even unable to find a safe place without crying im-
mediately. It took two extra sessions to achieve preliminary
A Bridge From Episode to Theme. The transition from stabilization.
physical to psychological survival issues parallels the Sarah was asked to “Google” for any resource that helped
evolving layers of meaning from external to internal her feel calmer. She came up with a friend whose voice and
identity themes or world assumptions. Immediately fol- words helped her most. After installing this as a resource
lowing trauma, issues usually concern safety, control, she was more prepared to begin processing the trauma and
and guilt (as a retroactive attempt to restore control). was asked to tell the story by running the movie (distanc-
Later issues may involve responsibility (self-blame, ing) while talking out loud with DAS.
inferiority). Eventually, adaptive processing results in The surprising thing was that she could tell the whole
positive themes such as accepting appropriate respon- story in minute detail (for the first time she said) with ap-
sibility for past events, experiencing a sense of safety in propriate affect; tearful with occasional brief heavy tears,
the present, and having new choices in the future. but not overwhelmed as she had been when even attempt-
R-TEP processing consolidates fragmented unpro- ing the safe place exercise. After about 30 minutes her face
cessed images, moments, and experiences within the changed, the fear was gone, and she could look the thera-
episode that includes the event, experiences after the pist in the eye for the first time properly and was much
event, and the changing meaning of the event. In this calmer. Processing had taken place, although no specific
perspective the R-TEP can be seen as a bridge be- targets were selected. She also arrived at a spontaneous
tween the episode and theme processing levels (see positive cognition (PC) “I am confident we did everything
Figure 2). we could.” Over the next few sessions, she went on to

THEME processing
Stuck level: Meaning

EPISODE processing Stuck level:

experiential/layers of meaning
Identity issues
Issues: transitional from external to internal to identity

IMAGE processing EVENT processing R-TEP

Stuck level:
Stuck level: Perceptual experiential BROAD FOCUS
On themes,
schemas,
life patterns,
3-pronged:
WIDE FOCUS on the episode Past-Present-Future
[series of images/events from the trauma until today]
2-pronged: Past-Present

FIGURE 2. R-TEP (Recent Traumatic Episode protocol): Part/whole levels of processing and a bridge
from episode to theme in early EMDR interventions (EEI).

90 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008

Shapiro and Laub
successfully process selected targets from the episode using to tell my grandchildren, how I was nearly eaten by a lion
“Google Search.” but managed to overcome it and defeat the lion” (theme:
meaning level).
During the processing he realized what probably had
triggered the delayed symptoms: He was arranging the
RON: A CASE ILLUSTRATING THE USE
specimens he had collected chronologically and just got up
OF THE RECENT TRAUMATIC EPISODE
to the day of the trauma.
PROTOCOL (R-TEP)
At the next session Ron reported that the main symptoms
Ron was an entomologist on a field trip in Africa with had reduced substantially but that he was less focused than
friends. One night while he was sleeping alone in his tent usual (e.g., he got on the wrong train twice). Follow-up on
he was suddenly awakened by a roaring lion close to his the work done the previous time, which he referred to as
head. For 15 minutes he was certain he was going to die “a close call,” seemed much further away, with an SUD of
and thought his friends had already been eaten by the lion 0–1.
or lions, or that they had run away abandoning him. He Following the R-TEP procedure, GS was employed for
experienced absolute terror (it is said a lion’s roar can be any residual disturbance. He soon stopped this time at the
heard 5 miles away and has been described as “blood cur- sound of the lion’s roar and the sensation in his body. This
dling”). Showing active resourcefulness, lighting his torch was surprising because he had already worked on this mo-
and shouting at the lion to go away, he eventually ventured ment previously, but then the focus was on the imagined
out to see what had happened to his two friends. They were image of the lion’s head and accompanying thoughts. This
sleeping in the vehicle, and he joined them inside it. They intrusive audio and somatic sensation had an SUD level of
were all unharmed. 7–8. Image processing was used here and the SUD dropped
Ron had some acute stress response symptoms for a few dramatically to 0, with additional somatic release after a
days. They went away gradually and he managed to finish few sets.
his trip. After coming back, apart from some irritability, Had it not been for the GS strategy of checking for fur-
he did not seem to have any obvious symptoms until al- ther disturbance this unprocessed fragment may have been
most 3 months later when he started getting flashbacks, missed. One would have thought that he had finished pro-
intrusive thoughts and images, and disturbed sleep. Quite cessing the experience because it had reached an ecologi-
agitated and worried that he was getting PTSD, he asked cally reasonable SUD level. It indicates the importance of
for help. using the GS for further identification of targets for process-
A brief intake revealed a person with strengths; the safe ing even when the SUD level is low.
place and preparation phase went smoothly. Ron first In this vein there were yet more lessons to learn. Con-
gave the episode narrative (telling the story out loud with tinuing with GS (according to the R-TEP protocol) for the
DAS), which was rather mechanical and emotionless. entire episode, Ron next stopped at an incident that had
Then he proceeded with GS, searching the whole episode occurred the following day, when the jeep was stuck in
from the day it occurred until today, to identify anything the mud for 7 hours trying to cross a stream. During this
that was still excessively disturbing. The first target he time he apparently experienced a mild anxiety attack. This
chose with GS was the image of the lion’s head drooling event was fully processed with the basic protocol: Image
over him (which he imagined). Assessment: Image–the li- = sitting in the back of the jeep, no air; NC = “I am help-
on’s head drooling over him; NC (Negative Cognition) = “I less”; PC = “I can be patient and cope”; VOC = 3; Emo-
am helpless, going to die”; PC (Positive Cognition) = “It tion = shame; SUD = 4–5; Body = chest. The processing
was an adventure I survived, it’s over”; VOC (Validity of revealed interesting connections to a theme: “I must never
Cognition) = 2–3; Emotion = Fear; SUD = 8, Body sensa- be helpless . . . I always have to be active in stressful situa-
tion = in chest. tions . . . this is how my mother survived in Auschwitz, by
After only a few sets there was already a positive shift, active coping. . . losing control does not necessarily mean
which just got stronger and stronger. The lion shrunk and death”—which were noted but not pursued much further.
then receded and disappeared (image: perceptual level), As this was not part of our treatment “contract,” associa-
with a tremendous body release, emptying and cleansing tions were limited here and he was instructed to return to
from his chest, ending up feeling light and relieved (sensa- the original target. This processing was a growth experi-
tion/affect: experiential level). The SUD reduced to 2, he ence leading to a more philosophical perspective of flow-
felt empowered and able to see it as a story, an adventure ing and trusting, coping with setbacks, and looking upon
belonging to the past (VOC = 6.5). “I overcame my fear of them as adventures. Further GS revealed no more distur-
dying and rose above it. It became an adventure, a story bance. Episode SUD = 0. Episode PC: = “I can flow and

Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 91

Early EMDR Intervention
cope,” VOC = 6. Ron even began contemplating future Aspects of the orienting response feature promi-
trips to Africa. nently among the various theoretical explanations
for the underlying basis of EMDR treatment effects
(F. Shapiro, 2001). The orienting response involves
DINA: A CASE ILLUSTRATING NEED FOR directing attention to a new stimulus. One of its
ADDRESSING THEMES OR MEANING functions may be to facilitate reality testing. The DAS
LEVELS FOR COMPLETING EPISODE in EMDR with “one foot in the present” (external re-
PROCESSING ality) and “one foot in the past” (internal recollection
of the traumatic event) (F. Shapiro, 2001, p. 325) may
Dina, a young woman, was standing at the bus stop on her
free attention from preoccupation with the (implicit)
way to work when two cars collided near her and one of
memory of past danger to enable the recovery of flex-
them ran into her, throwing her into the air. She sustained
ible, adaptive attention regulation.
moderate injuries requiring several operations. Several
Recent research has shown that the parts of the
months after the accident, she received EMDR treatment
brain involved in attention regulation may be identical
for PTSD symptoms. She responded reasonably well to
to the parts involved with eye movements (Corbetta
treatment, which enabled her to commence her univer-
et al., 1998; Moore & Armstrong, 2003; Pierrot-De-
sity studies. However, various strange lingering symptoms
seilligny, Milea, & Muri, 2004). These fascinating find-
were exacerbated after the Lebanon war, in which she was
ings are of particular interest for EMDR and should
exposed to missiles falling near her home.
be explored further, suggesting as they do relevance
Her therapist processed these later events and then de-
to mechanisms occurring in EMDR. From the atten-
cided to check the previous work with a GS for residual
tion perspective, the R-TEP can also be viewed as a
disturbance despite this being 18 months after the original
strategy for restoring adaptive attention regulation
accident. She stopped very soon and identified a disturbing
and appropriate reality testing.
thought: “On my way to the bus stop that morning I didn’t
know that in 5 minutes something would happen which
Theoretical Speculations
was going to change my life, what kind of world is this!”
This world assumption belief was targeted and processed. Reflecting on theoretical aspects of the R-TEP suggests
She came to a resolution acknowledging her vulnerability a possible organizational principle of the AIP model
but also that she was not helpless and had coping strengths. (F. Shapiro, 2001), which aims toward integration. It is
Continuing with GS, revisiting the accident and subsequent manifested in two aspects, which work together. One
experiences of the episode (up to the present) revealed is the capacity of the brain to integrate part/whole
further targets for processing that were not previously relations in hierarchical order (for example, sensory
identified. image —> event —> episode —> theme —> identity).
Accordingly, information transmitted via the four mo-
dalities (sensory, emotional, somatic, and cognitive)
Discussion is processed at increasing levels of complexity, from
a simple processing level (perceptual), to a complex
The Role of Attention Regulation
one (experiential), to a more complex one (meaning),
During a traumatic experience, our information ab- perhaps matching the evolution of the brain. This also
sorption and processing system may be flooded by appears to correspond with the transition from im-
a chaos of threatening stimuli, triggering alarm. The plicit memory to explicit memory (F. Shapiro, 2006;
emergency response imperative may monopolize Stickgold, 2002).
attention. The emotional brain has the attention de- The second aspect of the organizing principle is the
fault. However, this can become maladaptive when capacity to integrate opposites (parts) into a new whole
hyperaroused, and selective attention becomes cap- via a dialectical movement (Laub & Weiner, 2008). In
tured and/or dysregulated. Overloaded, our percep- adaptive processing there is a dialectical movement
tual sensory system may block or lock the incoming between problems (negative associative chains) and
information: Overwhelmed attention mechanisms resources (positive associative chains) during process-
either block access to the threatening information ing (Laub, 2001; Laub & Weiner, 2008). Perhaps the
(denial, dissociation) or zoom into some conspicu- dialectical movement is the primary vehicle by means
ous aspects and lock onto them obsessively (repeti- of which part/whole components of information are
tion, intrusive symptoms), becoming stuck rigidly in processed in an adaptive way. It is interesting to con-
a time warp. sider dual attention from this perspective.

92 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008

Shapiro and Laub
Tentative Hypotheses Concerning unfold associatively during processing, according to a
the AIP Model hidden order of a theme. The standard protocol at-
tends to the perceptual, experiential, and meaning
The AIP system moves toward completion. Comple-
levels of information, which consist of the four mo-
tion means the containment of negative and positive
dalities: sensory, emotional, somatic, and cognitive
experiences into an adaptive and harmonious whole.
(thoughts and later beliefs).
An organizing principle of the AIP system is mani-
Although the four modalities are present simulta-
fested in the capacity to form hierarchical part/whole
neously at each level (perceptual, experiential, and
relations by differentiation and integration processes
meaning), one or two modalities are more salient:
directed toward completion.
sensory at the perceptual level (image), emotional
The part–whole components of information pro-
and somatic at the experiential level (event/episode),
cessing that we address in our model are: the sensory
and cognitive at the meaning level (theme/identity).
image —> event —> episode —> theme —> identity.
This is a further example of the hierarchical order of
Many sensory images are organized into one event.
the organizing principle.
Many events are organized into one episode. Many
In summary, following trauma, multidimensional
episodes are organized into one theme. Many themes
traumatic information (four modalities) in unorga-
are organized into identity.
nized part–whole relations enters the brain to be pro-
The processing of different “parts” facilitated by
cessed. This information may be stored negatively
the dialectical movement between negative and posi-
(dysfunctionally) by being associatively connected
tive associative chains leads to adaptive completion.
to previous negative stored memories organized in
When a “part” is stuck, the AIP is disrupted and cannot
negative theme clusters. The goal of the AIP system is
move toward the next “whole,” thus failing to reach
to move the traumatic information, through differen-
completion. For example, intrusive, unprocessed im-
tiation and integration processes, to connect associa-
ages can disrupt the completion of the adaptive pro-
tively with positive (functional) stored memories (the
cessing of an event. An unprocessed event/episode
dialectical movement) in order to reach completion.
can disrupt the completion of the adaptive processing
Completion is manifested by associative chains of mul-
of a theme.
tidimensional adaptive information in well-organized
The AIP can be disrupted by blocking or locking
part–whole relations where the negative informa-
the attention regulation that is needed for adaptive
tion is embedded and contained in positive (adap-
processing. Both blocking and locking obstruct the
tive) memory networks. The ultimate completion
AIP from moving, either by blocking access to the in-
is momentarily experienced as a pure here and now
formation or by locking repetitively onto a part.
sense of wholeness.
In PTSD, AIP is disrupted and fails to restore it-
self because there is chronic linking of associative
chains to negative stored memories and a lack of Conclusion and Suggestions for
linking to positive stored memories. The dialec- Further Study
tical movement is therefore blocked. Successful The R-TEP incorporates the wisdom of existing pro-
processing of recent trauma can facilitate the AIP tocols (EMD, RE, and the standard protocol) in a
to restore itself (which usually happens spontane- modified form with some new aspects.
ously). It is possible that recent trauma processing
with clients who were at risk for PTSD may reduce
Professional Concerns About Premature
the possibility of linking the traumatic memory to
Intervention
similar negative stored memories, thus preventing
PTSD development. In recent trauma processing, Concerns about premature intervention are ade-
regulating the associative chains by limiting them quately addressed in this protocol by following the
to episode-related associations may be sufficient for familiar, good practice, eight-phase structure simi-
adaptive processing since the trauma is not yet inte- lar to the standard protocol. Additional procedural
grated into clusters of themes. elements of the R-TEP are designed to promote
Following the model, it is insightful to briefly note safety and confidence for the clinician and client.
some things about the standard protocol as the master For example, the episode narrative with DAS, with
integrator. The standard protocol relates to the vari- its grounding of safety in the present and the op-
ous part–whole elements: the theme, the event, the tion of regulating associative chains during process-
most disturbing image, many events (episodes), which ing (choosing to focus only on the image or event

Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 93

Early EMDR Intervention
or episode) and not necessarily opening up other is stuck rather than in terms of the time that has
clinical issues, provides additional ways of contain- passed. In a way all current disturbances relating to
ing. The systematic and comprehensive structure of past, type I, single incident, and life-changing trau-
the R-TEP protocol makes it easier for a clinician to matic experiences, could be described as “unfinished”
consider early EMDR intervention. Common sense traumatic episodes, with the memory stuck at the
suggests that intervention in the days and weeks after implicit memory state. Therefore this protocol could
a critical incident should mostly be appropriate when possibly be applied to nonrecent traumatic episodes
there are unusual responses (excessive), delay or ap- as well. The role of time after the event needs to be
parent failure to recover, and chronic sleep distur- investigated: At what point can it still be called a re-
bances. The effectiveness of such interventions needs cent event? How is it differentiated from a nonrecent
to be empirically tested. However, the bolder pros- event? Perhaps a distinction can be made between
pect of utilizing R-TEP as a convenient prophylactic processing (recent event) as opposed to reprocessing
screening procedure, as a means of checking for and (nonrecent event)?
enhancing adaptive processing following significant Further study is needed to confirm the face-valid
traumatic experiences, is a further possibility that speculations about the widening focus of trauma
remains to be investigated. processing and levels at which it can become stuck.
In this view the focus of the processing starts from
Thinking in Terms of the Episode an orienting sensory reception of threatening infor-
mation (perceptual level), expands to an emotional
The episode is conceptualized as the period from the and somatic survival response (experiential level),
trauma to the present, requiring processing and inte- and proceeds to a broad cognitive focus on the life
gration, which has a beginning, a middle, but no end pattern themes of identity and world assumptions
yet. One can think of it as a two-pronged protocol (meaning level).
addressing recent past to present. The cases of Ron
and Dina suggest that processing trauma by focusing Prevention of PTSD
only on the event itself using EMD or RE protocols
may not necessarily be sufficient and that adopting a The exciting prospect that early EMDR interven-
wider episode focus with a scanning strategy to seek tions, such as the R-TEP, may contribute to the pre-
out additional targets of unprocessed disturbance vention of the development of PTSD is an important
may be advised. This can be tested by re-evaluating subject for further research.
subjects treated with EMD or RE, using GS to re-
veal the existence of any unfinished processing of the Summary
episode.
The R-TEP evolved from an urgent need in the field,
clinical experience, and new conceptualizations con-
GS With DAS
cerning memory consolidation following recent
GS is a mechanism suggested for identifying unre- trauma. Three main issues were identified concerning
solved fragments of the traumatic episode for pro- EEI after a critical traumatic incident: the nature of
cessing. Clinical observation suggests that it may the fragmented memory, the nature of the stress-
have advantages for revealing targets for process- ful situation for client and therapist, and the nature
ing, which may not have been reported if asked of the therapy contract. Existing EEI protocols only
for in the usual way, and also as a means of check- gave partial answers to these issues. The R-TEP was
ing more thoroughly for remaining pockets of dis- therefore developed to provide a more systematic and
turbance. However, this needs to be studied and comprehensive approach to EEI, which incorporates
tested. and extends the existing procedures within an adapted
eight-phase structure borrowed from the standard
protocol. It bridges the gaps left by these previous
Widening Focus and Level
protocols, facilitating a transition from the RE to the
of Trauma Processing
standard protocols.
Although this article is primarily concerned with Theoretical speculations were made relating to the
early intervention, it may be more useful in practice Adaptive Information Processing (AIP) model as well
to think in terms of the level at which the processing as the possible role of attention regulation.

94 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008

Shapiro and Laub
 The R-TEP attempts to offer a clear and com- Kutz, I. (2006). Early EMDR intervention. Plenary presenta-
prehensive protocol for the first aid tool box of the tion, EMDR Europe Association Conference, Istanbul.
EMDR practitioner, which will assist in addressing all Kutz, I. (in press). The effect of a single session EMDR on acute
three of the above issues so that the prospect of EEI stress syndromes: A multiple case study (submitted for
may be approached with more confidence. publication).
Lahad, M. (2000). Darkness over the abyss: Supervising cri-
The ideas expressed in this article are still tentative
sis intervention teams following disaster. Traumatology,
and developing and await further research. It is im- 6(1–4), 273–294.
portant to study the effectiveness and applications of Laub, B. (2001). The healing power of resource connection
the R-TEP, its implications for preventing PTSD, and in the EMDR protocol. EMDRIA Newsletter, special edi-
the suggested theoretical model. tion, 21–27.
It is hoped that it will stimulate discussion and Laub, B. (in press). Group EMDR protocol—An inte-
further interest in this area. Comments and feedback gration of the IGTP and the 4 Elements exercise.
from the reader’s experience with this protocol are In M. Luber (Ed.), Eye movement desensitization and
welcomed. reprocessing (EMDR): Scripted protocols. New York:
Springer.
Laub, B., & Weiner, N. (2008). The pyramid model—
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Journal of EMDR Practice and Research, Volume 2, Number 2, 2008 95

Early EMDR Intervention
 at the annual meeting of the International Society for the Correspondence regarding this article should be di-
Study of Traumatic Stress, San Antonio, TX. rected to Elan Shapiro, POB 187, Ramat Yishay, 30095,
Israel. E-mail: [email protected], or Brurit Laub,
Acknowledgments. The authors wish to thank Roger Solo-
12 Hadar St., Rehovot, 76466, Israel. E-mail: brurit@
mon and Marilyn Luber for their helpful comments and
zahav.net.il
suggestions in the writing of this article.

96 Journal of EMDR Practice and Research, Volume 2, Number 2, 2008

Shapiro and Laub