Phone

Therapies

eye movement desensitization and reprocessing (EMDR)
What Is It?
How Does It Work?
What You Can Expect
Health Benefits
How To Choose a Practitioner
Cautions


What Is It?

Eye movement desensitization and reprocessing (EMDR) is a complex approach to psychotherapy that combines elements from a number of therapeutic methods (psychodynamic, cognitive, behavioral, and Freudian-based therapies among them) in order to relieve physical and emotional complaints resulting from traumatic or upsetting experiences. It is based on the assumption that specific traumatic experiences from the past can continue to govern a person's responses in the present. These experiences can be large traumas that result in post traumatic stress disorder (PTSD), a condition characterized by, sleeplessness, anxiety, and phobias, or they can be smaller traumas that have a less dramatic but still negative impact on personality and behavior. EMDR works to bring these traumatic memories to a positive resolution.

EMDR arose from a chance observation made by clinical psychologist Francine Shapiro, Ph.D., now a senior research fellow at the Mental Research Institute in Palo Alto, CA. While out for a walk in a California park in 1987, Shapiro found herself experiencing some particularly distressing thoughts. She noticed that these thoughts faded, however, when her eyes spontaneously moved rapidly from side to side. The experience eventually led her to believe that rapid lateral eye movements, as well as other rhythmic movements (including alternate hand tapping on a surface or alternating audio tones in a client's ear), could be employed to help individuals release, "digest," and reprocess traumatic memories.

Shapiro decided to test her hypothesis by studying the effects of EMDR therapy on a group of Vietnam veterans, as well as on victims of physical and sexual abuse. All suffered from PTSD and had difficulty concentrating. After only a single, 60-minute session, Shapiro reported, those individuals who received treatment with rapid eye movements described a significant reduction in PTSD symptoms compared to members of a control group who were asked to recall the traumatic memory, but without the eye movements.

Today some studies have corroborated the success of Shapiro's method in treating trauma due to many causes, including loss of a loved one, sexual assault, accidents, combat trauma, and natural disasters. However, conflicting studies have also found equal success in PTSD groups where no rapid eye movements or other external stimulus were employed. Further studies are ongoing to determine the necessity of external stimuli in EMDR therapy for PTSD and lesser trauma (see Health Benefits, below).

How Does It Work?

Although no one knows exactly how EMDR works, and some dismiss it as "pseudoscience," Dr. Shapiro's work has been hailed by certain behavioral health practitioners as a breakthrough, particularly for PTSD sufferers. According to her hypothesis, humans have an information processing system in the brain. While memories of an ordinary event are processed completely and normally, memories of a traumatic event may be insufficiently processed and remain trapped in the processing system. Moreover, the initial emotions, perceptions, and physical feelings existing at the time of the trauma may also get trapped, and can be triggered by events in the present. The result can be a range of psychological problems, including anxiety and depression, difficulties relating to others, phobias, panic attacks, and more.

During EMDR therapy a client works with a specially trained therapist to target the disturbing memories while focusing on an external visual or audio stimulus. Dr. Shapiro suggests that this external stimulus releases memories that were "trapped" as a result of the trauma. The client is then able to go back and reprocess the information in a more positive, less distressing way (see How Does It Work, below).

Harvard assistant psychiatry professor Robert Stickgold has another theory on how the eye movements used in EMDR work to relieve trauma. He likens the memory reprocessing technique of EMDR to the processing of memories that occurs during the deep rapid eye movement (REM) stage of sleep--the stage when dreams take place. Research shows that memories often play themselves out during dreams in order to be processed and stored. Traumatic memories that are insufficiently processed can manifest themselves in recurrent dreams, and cause continuous distress. Stickgold suggests that by doing the rapid eye movements of EMDR, clients access troubling memories in a way similar to what occurs during REM sleep.

What You Can Expect

EMDR treatment always consists of eight phases, and each phase must be successfully completed before a memory can be effectively reprocessed. Often only a few sessions (usually running from 60 to 90 minutes) are needed to provide benefits, although a situation may require more sessions if there is a history of prolonged neglect or physical or sexual abuse early in life.

Initially, the therapist will take a client history to evaluate whether or not EMDR is appropriate. Determining factors include the ability to deal with severe disturbances, the amount of stress in the client's life, and any pre-existing medical conditions, such as heart or eye problems.

Subsequent phases focus on targeting and treating a specific traumatic memory and replacing any negative self-beliefs connected with it (such as "I am worthless") with positive beliefs (such as "I am a great person"). To help achieve this, the therapist moves a finger rapidly back and forth in front of the client's face to redirect eye movements that accompany the recalled trauma. Or, the therapist may use moving lights, alternating hand tapping on a surface, or alternating audio tones instead of the finger movements. This is done until the client no longer identifies with the negative beliefs. Rhythmic patterns may also be employed to release any bodily tension relating to the traumatic memory. Relaxation techniques are also often taught to combat any emotional disturbances that may occur between sessions.

The final phase of treatment re-evaluates the work of previous sessions to determine if progress has been maintained. Once this entire process has been successfully completed, the phases of therapy may be repeated to reprocess other traumatic memories.

Health Benefits

Since its creation as a therapeutic method, EMDR has been used primarily to treat post-traumatic stress disorder, and much of the research in the field has focused on this ailment. In 1999, the International Society of Traumatic Stress Studies and the American Psychological Association approved EMDR for treatment of PTSD. The therapy has been (and continues to be) extensively used to help survivors and rescue workers cope with the emotional trauma of the September 11th terrorist attacks.

Newer areas of application for EMDR include treating phobias, panic disorders, personality disorders, substance abuse, physical and sexual abuse, nightmares, insomnia, fibromyalgia, and public performance anxiety, all of which have a memory component. EMDR may also help to reduce related problems, such as negative self-esteem, behavioral problems, and difficulties relating to or trusting others, which have arisen as an indirect result of a traumatic event.

To be truly effective, Dr. Shapiro believes, EMDR should be used only within a comprehensive treatment plan designed by a licensed behavioral health clinician (see How to Choose a Practitioner, below).

How To Choose a Practitioner

EMDR is typically practiced by behavioral health practitioners (see the entry on Behavioral Health Practitioner in the WholeHealthMD Reference Library). But while there are thousands of professionals who have completed training workshops in EMDR, there is currently no national or state credentialing agency monitoring its practice.

For this reason it is important to check a practitioner's credentials carefully. The EMDR Institute in Pacific Grove, CA, and the EMDR International Association in Austin, TX, conduct EMDR training workshops for behavioral health practitioners who have a masters degree or higher in the mental health field and who are licensed or certified through a state or national board that authorizes independent practice. Contact one of these organizations for a referral to a to a EMDR therapist in your area.

Cautions

 EMDR may not be appropriate for individuals who are unable to deal with high levels of stress or disturbance, or for those with heart conditions or eye problems.  Talk with your obstetrician if you are pregnant and want to try EMDR.  You may experience occasional disturbing memories or emotions between sessions. A qualified EMDR therapist will prepare you for this and teach you how to deal with such situations. However, if these experiences become a pattern for you, be sure to discuss the problem with your therapist.  Although EMDR can relieve the distress caused by a traumatic memory, proponents of EMDR therapy stress that this technique should be used as a larger treatment approach, rather than as the sole method of therapy.



Date Published: 04/19/2005
Previous  |  Next
> Printer-friendly Version