Final Exam - EMDR Refresher (EMDRIA) - The EMDR Center of Canada

Protective factors in the vulnerability to enduring posttraumatic reactions can be grouped into two categories. They are the ability:

1. To make use of external resources and engage in coping behaviors during and after the experience.
2. To make use of self-capacities for restabilization and self-regulation of internal functioning in the aftermath of the threat *

True

False

“The loss of the witnessing self” is associated with suppression in which brain region? *

a. The amygdala

b. The Hippocampus

c. The left prefrontal cortex

d. None of the above

e. All of the above

When a caregiver shows inconsistent and unpredictable behaviors and the infant displays contradictory urges to both approach and avoid caregiver concurrently, this is likely to represent… *

a. Insecure avoidant attachment

b. Secure attachment

c. Disorganized attachment

d. Insecure Resistant attachment

A dissociative disorder may develop when there has been severe neglect or emotional abuse, even in the absence of overt physical or sexual abuse. *

True

False

In the model of Structural Dissociation, dissociation is viewed as existing on a continuum from normal to pathological. *

True

False

Secondary structural dissociation with one predominant Apparently Normal Part of the Personality and more than one Emotional Part of the Personality is associated with which of the following sets of diagnoses? *

a. Acute stress disorder, posttraumatic stress disorder, Depersonalization disorder.

b. Dissociative identity disorder

c. Complex PTSD, DDNOS, trauma-related borderline personality disorder, unspecified dissociative disorder.

d. None of the above

e. All of the above.

A study in an outpatient clinic with a sample of 82, showed that 29% of clients met criteria for one of the dissociative disorders. *

True

False

According to Shapiro, The Dissociative Experiences Scale (DES-II) should be administered during Phase One, as an initial screening for dissociation. Further exploration may be warranted. *

True

False

Because all the items in the Dissociative Experiences Scale (DES-II) reflect psychopathology and it contains validity scales, it is a strong diagnostic tool on which clinicians should rely. *

True

False

EMDR Therapy is generally recognized as an effective treatment for PTSD and ASD, and most researchers recognize an important role for the effects of bilateral stimulation. *

True

False

In EMDR therapy, pathology is viewed in terms of maladaptive memory networks which have not been fully reprocessed and continue to be held in a state-specific form giving rise to maladaptive perceptions, behaviors, beliefs and attitudes. *

True

False

Case formulation in EMDR therapy is based on which of the following? *

a. The patient’s symptoms.

b. Events hypothesized to cause these symptoms.

c. Triggers that evoke symptoms.

d. Hypotheses about underlying adaptive and maladaptive memory networks.

e. Medications prescribed for the patient.

f. All but “d”.

g. All but “e”.

Case conceptualization in EMDR therapy depends on having an accurate DSM diagnosis. *

True

False

An understanding of clients’ attachment organization: *

a. Can be easily and quickly obtained by administering the Adult Attachment Inventory (AAI).

b. Should not be attempted as it is likely to be inaccurate or destabilizing.

c. Can be enhanced by using some of the questions from the AAI.

d. Is not relevant to the actual effects or administration of EMDR therapy.

e. None of the above.

f. All of the above.

Case conceptualization in EMDR therapy is founded on which of the following theoretical models? *

a. Systematic Desensitization, Psychodynamic Therapy, and Rogerian Therapy

b. The Adaptive Information Processing model, Attachment Theory and the Theory of Structural Dissociation of the Personality

c. The role of the therapeutic alliance.

d. None of the above

e. All of the above.

It is essential that the clinician clearly inform the client of the possibility for emotional disturbance during and after EMDR processing sessions. *

True

False

Generally, a specific written informed consent is not required for EMDR therapy, and clinicians can just document in the medical record the information on treatment options, risks and benefits that were discussed. *

True

False

Because eye movements tend to make memories less intense and vivid, in cases with legal (forensic) issues EMDR should not be offered until the legal issues are resolved. *

True

False

During reprocessing, bilateral eye movements should be offered… *

a. Starting and stopping at the center of the field of vision

b. Seated directly in front of the client so their face can be easily observed.

c. As fast as can be tolerated.

d. Only if the client likes them better than taps or tones.

e. a and c

f. None of the above.

g. All of the above.

Client responses to the calm place that suggest a need for more advanced EMDR skills and more complex treatment plans include all the following except… *

a. Negative associations within that scene or to another disturbing scene.

b. Not being able to think of a Calm Place.

c. Simple, positive shifts in state and an absence of any negative associations

d. Images with both positive and negative associations.

e. None of the above.

Before ending the exercise, the calm place exercise asks the client to mentally rehearse thinking of an annoying or stressful situation and then reconnecting with the calm place. If the client can do so, the clinician offers further bilateral stimulation. *

True

False

Which of the following is found in The Procedural script for Resource Development and Installation? *

a. Mastery, Relational and Symbolic sources for resources.

b. SUD ratings of the recent incident (trigger) before and after selecting, delineating, and installing the one or more resources.

c. Checking if the client’s ability to cope with the stressful situation has improved in a subsequent session.

d. Asking for an image that represents each resource.

e. None of the above.

f. All of the above.

Procedures to reduce the states of depersonalization and derealization include which of the following? *

a. Noticing and naming objects in the room.

b. Relaxing the postural muscles by curling up.

c. Tossing a beanbag.

d. A and C only

e. All of the above.

In the Calm Place exercise and in Resource Development and Installation, it is best to use which of the following? *

a. Sets of 6 to 12 back and forth eye movements slower than for standard reprocessing.

b. Sets of 6 to 12 back and forth eye movements faster than for standard reprocessing.

c. Sets of 24 to 30 back and forth eye movements the same speed as standard reprocessing.

d. None of the above

The history taking phase (phase 1) precedes the preparation phase (phase 2) and should be completed before client preparation and stabilization are started. *

True

False

During history taking the general intention is to take only brief summary statements and just enough material to understand the context without allowing clients to delve into a prolonged narrative. *

True

False

Research indicates patients with psychosis are poor candidates for EMDR therapy for trauma symptoms. *

True

False

For every significant patient symptom, clinicians should strive to find out: *

a. “When did that begin?”

b. “What kinds of stressful events were going on in your life or with your family at about that time?”

c. “How did that symptom change over time.”

d. “What stressors were associated with changes in the symptom?”

e. None of the above.

f. All of the above.

When selecting an image during Assessment Phase, the clinician should ask: *

a. What picture best represents the experience to you?

b. What picture would you like to believe when you think about the experience?

c. What picture represents the worst part of the experience as you think about it now?

d. Both A and C

e. Both B and C

Which of the following statements is true of the Negative Cognition (NC)? *

a. The Negative Cognition is a clear description of the traumatic event.

b. The Negative Cognition is a negative self-statement associated with the event

c. The Negative Cognition is often stated as an emotion such as, “I am afraid”

d. All of the above

e. None of the above

The NCs “I am defective” and “I am invisible” are in the theme of defectiveness-shame because they are a result of taking on excessive responsibility. *

True

False

The sentence “I am not helpless anymore" is acceptable as a PC. *

True

False

What is the Validity of Cognition scale range (VOC)? *

a. From 1-10

b. From 0-10

c. From 0-7

d. From 1-7

When assessing the VoC in Phase 3, all the following are true except: *

a. The patient needs to be accessing and referencing the selected target memory network.

b. The patient needs to be thinking about the words of the PC.

c. The patient must understand the direction of the rating scale.

d. The rating should be a cognitive rating, not a felt or “gut level” rating.

e. None of the above.

In the Assessment phase, when identifying the “Emotion” all the following are true except: *

a. We are seeking to identify the emotion the person felt at the time of the original experience.

b. The patient naming more than one emotion is fine.

c. Only one emotion is fine. There is no need to prompt for more emotions.

d. The named emotion provides baseline information to help assess later possible changes in patient reports.

e. None of the above

The letter “D” in “SUD scale” stands for: *

a. Disturbance

b. Depression

c. Duration

d. Distress

In the Assessment phase, when identifying the “Location” it is best to prompt for more than one location and to take time to ask about the characteristics of the sensation to confirm the client’s report. *

True

False

In the Assessment phase, identifying negative and positive cognitions can be stressful for clients and time-consuming. Therefore, clinicians should exercise clinical judgment and skip the identification of the NC and PC when needed to preserve time for reprocessing. *

True

False

During the Assessment Phase, the clinician should ask the client to hold in mind the original experience, the negative cognition, and the emotion and ask where they feel it in their body. *

True

False

During the Desensitization phase, as the patient moves down channels of association, you assess treatment effects from evidence of adaptive shifts in: *

a. Brief patient verbal reports between sets of bilateral eye movement—or bilateral auditory or kinesthetic stimulation.

b. Your observations of non-verbal indications of adaptive emotional and psychophysiological change.

c. By occasionally returning to refocus on the target and check on how the patient’s perception of the memory of the incident has changed.

d. None of the above.

e. All of the above.

All the following are true about channels of association except: *

a. Continue sets of BLS down a channel without returning to target for the entire session if need be until the patient reports positive material.

b. How often you need to return to target and identify another channel varies.

c. Return to target if the patient’s associations become so remote from the original target that your clinical judgment suggests reprocessing of the selected target may no longer be occurring.

d. None of the above

In the Desensitization Phase, when returning to target, be sure to repeat the Negative Cognition, the details of the image, the original emotions, original location of physical sensations so that you can obtain a valid SUD rating. *

True

False

In the Installation Phase, after each set of bilateral stimulation, ask the patient “What do you notice now?” *

True

False

Compared to the Desensitization Phase, in the Installation phase, fewer complete movements and a slower speed of BLS should be used. *

True

False

Procedures for closing an incomplete session include all of the following, except: *

a. Offer acknowledgment and encouragement for the patient’s work in the session.

b. Return to target, ask for information about the selected target memory and check the SUD.

c. Assess the patient’s need for structured containment or stabilization procedures.

d. Preserve time for patients who need assistance with mentalization.

e. When the patient is in a stable state, review the standard briefing statement.

f. None of the above.

Clients with developmental neglect and trauma who present with DESNOS (Complex PTSD) can often be treated with EMDR therapy using the Inverted Protocol (Hofmann, 2004, 2005, 2010). *

True

False

Which of the following statements are unacceptable as a Negative Cognition? *

a. I am a failure.

b. I cannot trust anyone.

c. I cannot succeed.

d. I feel hurt.

e. I should have known better.

f. All are acceptable.

During the Desensitization (Phase 4), after a set of bilateral stimulation, you should say which of the following? *

a. “What do you feel now?

b. “What do you notice about the picture now?”

c. “Did the fear change?”

d. “What sensations do you notice now?”

e. “What emotions do you notice now?”

f. None of the above

The primary purpose of the Resource Development and Installation procedure is to do which of the following? *

a. To make memories of positive experiences more vivid.

b. To make memories of negative experiences less vivid.

c. To enhance emotional and behavioral coping skills with regard to current triggers.

d. All the above.

e. None of the above

During the Desensitization (Phase 4), when using bilateral eye movements, if the patient reports the same disturbing content without change after two consecutive sets of bilateral stimulation, the first intervention is to do which of the following? *

a. Ask “What do you notice about the original picture?”

b. Check the SUD level.

c. Change the direction, height, speed or width of the eye movements.

d. Ask, “What keeps the material from changing?”

e. None of the above.

Which of the following are not essential foundations of case conceptualization in EMDR therapy: *

a. The Adaptive Information Processing model

b. Theory of structural Dissociation of the Personality

c. Attachment theory

d. Principles of Classical Conditioning

e. None of the above.

When resuming reprocessing after an incomplete desensitization, which of the following is not true: *

a. The primary aim is to resume reprocessing.

b. You check the feedback from the client’s log

c. It is necessary to redo the Assessment phase

d. You “return to target” to resume reprocessing

In the three-pronged approach, nightmares are considered to be targets in which prong: *

a. The first prong.

b. The second prong.

c. The third prong.

d. Nightmares should not be targeted.

Which of the following are true when using EMDR therapy with children? *

a. Reprocessing treatment effects tend to be more rapid than in adults

b. Reprocessing treatment effects are often slower than in adults

c. Clinicians should explain EMDR therapy only to parents

d. Clinicians should explain EMDR therapy only to parents

When responding to prolonged intense emotional responses: *

a. EMDR therapy should be viewed as an exposure extinction-based treatment

b. Clinician should try to abbreviate the client’s movement through the emerging material

c. EMDR therapy is more effective when reprocessing trauma in a detached manner

d. None of the above.

When the client is under-accessing a maladaptive memory, clinician can: *

a. Change direction or speed of bilateral stimulation

b. Return to target and remind the client of visual or other sensory threat cues from the memory

c. Inquire about unacted impulses

d. Inquire about unspoken words

e. All of the above.

Potential causes of ineffective reprocessing include: *

a. Under accessing the maladaptive memory network

b. Over accessing the maladaptive memory network

c. There is a need to shift focus to a different earlier maladaptive memory network

d. There is a need for an interweave to address lack of spontaneous synthesis between maladaptive and adaptive memory networks

e. All of the above.

The cognitive interweave is a strategy that is used during reprocessing: *

a. To address more complex and difficult to treat trauma

b. To restore effective reprocessing by introducing certain material rather than depending on the client to provide all of it

c. When the client remains at a high level of disturbance after successive sets of bilateral stimulation.

d. A and C only

e. All of the above

Which of the following is the first step in the Recent Event Protocol? *

a. Target the most disturbing aspect of the memory

b. Obtain a narrative history of the event, noting the most disturbing moments

c. Process present stimuli

d. Incorporate positive future templates for each trigger

e. None of the above

Which of the following are true of working with military personnel and veterans: *

a. Several modifications need to be made to the standard EMDR therapy protocol

b. It is important to develop cultural competence on the effect of military values and training.

c. It is best to avoid the use of interweaves

d. All of the above

e. None of the above

When using the Recent Event Protocol, the clinician should consider skipping the body scan if there are residual sensations that may be linked to other salient aspects of the experience. *

True

False

Which of the following statements is not true? *

a. Interweaves that shift the locus of responsibility can lead to the emergence of appropriate resentment toward a perpetrator.

b. Negative cognitions that may alert you to the need for a safety interweave are those that reflect the external perception of danger.

c. Clinicians should try to suppress the emergence of client’s defensive action urges.

d. Deliberately stimulating an adaptive memory network with an interweave should stay as close as possible to spontaneous reprocessing.

Which of the following statements are true about responsibility interweaves? *

a. Responsibility interweaves externalize responsibility and seek memory networks with adaptive adult perspectives

b. Responsibility interweaves address a sense of perceived helplessness or lack of choice.

c. An example of a negative cognition (NC) that reflects the potential need for a responsibility interweave is “I am helpless”

d. None of the above.

Which of the following are elements of case conceptualization in the AIP model? *

a. Attachment theory

b. The theory of structural dissociation of the personality

c. The mental model of the client’s difficulties leads to a set of hypotheses about the causes of the client’s symptoms

d. All of the above

e. None of the above

The Adaptive Information Processing Model is a neurophysiological model. *

True

False

The macro level of the re-evaluation phase includes which of the following: *

a. Focus on the specific impact of the previous session on the emotions, SUD and VoC

b. Assessing for changes in dreams, coping behaviors, and self-perception

c. Reassessing the negative cognition to see if it still fits

d. All of the above

e. None of the above

In the subsequent session following an incomplete desensitization, it is essential to recheck the SUD level before resuming reprocessing. *

True

False

Positive dreams can be strengthened using RDI. *

True

False

Which of the following is not true when providing EMDR therapy with children? *

a. Behavioral modification is sometimes needed to motivate children to engage in successful EMDR therapy sessions

b. Psychoeducation to normalize emotions and physical sensations is essential before starting reprocessing.

c. As a rule, the parent should never be present when providing EMDR therapy to a child

d. Children reprocess through their behaviors and creative play during BLS

Which of the following is true about negative cognitions and/or positive cognitions in children? *

a. NC’s and PC’s are much the same as in adults

b. Younger children generally show strong affective responses to NC’s

c. The NC and PC may be a feeling word

d. None of the above

A client is working on a target memory of a motor vehicle crash and has had the same, unchanging fear and anxiety in the last few sets of DAS/BLS. NC is “I am going to die.” PC is “It’s over, I survived.” Which of the following would be an appropriate interweave: *

a. If the same thing happened to your child, whom would you hold as responsible?

b. Where are you now?

c. You’re not to blame. That shouldn’t have happened to you.

d. None of the above.

The best interweaves are generally brief, lasting 15 to 30 seconds and often involve a single question. *

True

False

When moving down channels of association, the clinician is assessing for shifts in which of the following: *

a. Client’s verbal reports

b. Client’s non-verbal (emotional or psychophysiological) changes

c. All of the above

d. None of the above

When treating panic disorder with agoraphobia: *

a. It is best to start EMDR therapy focusing on core maladaptive childhood memories

b. Maladaptive memory networks may include preverbal material for which the clients have no clear memory

c. It should be treated the same as panic disorder without agoraphobia

d. None of the above

The inverted protocol is primarily used in work with which of the following issues: *

a. OCD

b. Addictions

c. Complex PTSD

d. None of the above

In the CIPOS procedure, the acronym ‘CIPOS’ stands for: *

a. Current Information Processing of Stimuli

b. Constant Installation of Present Orientation and Safety

c. Confirming Information Prior to Orienting Safety

d. None of the above

Which of the following are true about EMD: *

a. It is the former name of EMDR, but is otherwise no different than standard EMDR therapy.

b. It was developed in recent years when certain clients did not respond to standard EMDR therapy.

c. In the Desensitization phase, clinicians bring clients’ attention back to target after each set of BLS.

d. All of the above

e. None of the above

An EMDR protocol used to address addictions is: *

a. CravEx

b. DeTur

c. Feeling-State Theory

d. All of the above

e. None of the above

Which of the following is true about the Standard Future Template? *

a. It is intended to be used for disturbances related to the future with a high SUD rating

b. It is intended to be used for disturbances related to the future with a low to moderate SUD rating

c. It does not contain a negative cognition

Which of the following is true when working with DID? *

a. The clinician can proceed with Standard EMDR Protocol as with PTSD

b. The clinician should postpone history taking in lieu of extended preparation.

c. The clinician should not proceed with strategies such as CIPOS or Loving Eyes Procedure

d. All of the above

e. None of the above.

Which of the following are true about the Theory of Structural Dissociation of the Personality? *

a. Secondary structural dissociation includes disorders such as DESNOS and DDNOS

b. In Primary Structural Dissociation, there is one Apparently Normal Part of the Personality and one Emotional Part of the Personality

c. It is comprised of three levels of division of the personality defined as Primary, Secondary and Tertiary

d. All of the above

e. None of the above

Which of the following statements are true about Janet’s phase-oriented model for trauma treatment: *

a. Phase one focuses on stabilization and the development of self-capacities

b. Phase two focuses on extended stabilization

c. Phase three focuses on trauma reprocessing

d. All are false

Which of the following statements are true about the positive template: *

a. It combines mental rehearsal of new skills with potential challenges

b. It improves self confidence

c. It does not contain a negative cognition (NC)

d. All of the above

e. None of the above.

When using the positive template, which of the following are not included in the procedures for addressing minor disturbances: *

a. Clinician should repeat key descriptors of previously installed resources

b. Clinician should ask client to notice what they feel while holding the resource(s) in mind

c. Clinician should apply short sets of BLS

d. Clinician should ask client to do a body scan and offer sets of BLS until any residual disturbance is resolved

e. None of the above

Complex PTSD/DESNOS, Borderline Personality Disorder and Dissociative Disorder NOS, are all examples of: *

a. Primary Structural Dissociation

b. Secondary Structural Dissociation

c. Tertiary Structural Dissociation

d. None of the Above

The DeTUR protocol was developed by: *

a. Michael Hase

b. AJ Popky

c. Robert Miller

d. None of the above

Which of the following is not part of the DeTUR protocol *

a. Development of a Positive Treatment Goal

b. Anchoring the Positive State

c. Rating the SUD

d. Desensitizing each trigger

In which phase of treatment is the CIPOS procedure used: *

a. The preparation phase.

b. The desensitization phase.

c. Both of the above

d. None of the above

Which of the following is true about the ACE study: *

a. Findings indicated that substance abuse is highly correlated to a trauma history

b. Findings indicated that there is no correlation between substance abuse and a trauma history

c. The study was done by Michael Hase in 2003

d. None of the above

When using the inverted protocol, target sequencing begins with which of the following: *

a. Upcoming Triggers

b. Installation of “Future Self”

c. Present triggers

d. Past trauma experiences

In Janet’s Phase 3, which of the following is true: *

a. The focus moves to increasing self-esteem and self-respect and increasing healthy connections.

b. Re-evaluate current triggers and anticipatory fears. Consider new goals.

c. Psychoeducation, modeling and visualization to prepare for new challenges.

d. Both B and C

e. All of the above.

Tertiary Structural Dissociation includes one Apparently Normal Part of the personality (ANP) and several Emotional Parts of the Personality (EP). *

True

False

The Feeling-state theory of impulse-control disorders states that these disorders develop when intense positive feelings become linked with specific behaviors. *

True

False

A clinician is working with a client who has been diagnosed with Panic Disorder with Agoraphobia. Current target is a recent panic attack. During the most recent reevaluation, client reports that he continues to experience panic episodes that last for more than an hour in between sessions, and that he has an inability to tolerate anxiety when alone. When the clinician resumes reprocessing on the most recent panic episode, an early childhood memory of parental separation emerges. The clinician should: *

a. Continue reprocessing on the earlier memory

b. Contain current target and begin new target on worst panic episode

c. Prune the association to the early childhood memory by returning to target

d. None of the above.

When using the Standard Future Template with a client and the client reports a SUD of 7, the clinician should: *

a. Use the Positive Template instead

b. Proceed with the Standard Future Template

c. Use an Affect, Somatic or Defensive Urge Bridge to identify unresolved memories before continuing with the Standard Future Template

d. None of the above.

A clinician is beginning work with a client diagnosed with severe DDNOS. Client would like to begin the EMDR right away, however, the clinician should: *

a. Focus on stabilization

b. Develop the therapeutic alliance

c. Begin EMDR with first traumatic experience related to the client’s most significant symptom

d. Both A and B

e. None of the above.

Comprehensive Refresher on EMDR Therapy

Final Exam – EMDR Refresher (EMDRIA)

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