Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR) is practiced by more than 100,000 clinicians across the world and millions of people have been treated successfully. Dr. Francine Shapiro began to EMDR in 1987 after she noticed that certain eye movements seemed to alleviate negative thoughts about previous traumatic events. In 1989, Dr. Shapiro published the first controlled study on the treatment of Posttraumatic Stress Disorder (PTSD) with EMDR. Over the last 30 years, extensive research has demonstrated the effectiveness of EMDR in the treatment of PTSD.
The American Psychiatric Association, the Department of Veterans Affairs & Department of Defense, the Substance Abuse & Mental Health Services Administration, and the World Health Organization all recognize EMDR as an effective treatment for trauma. Some preliminary studies have indicated that EMDR might also be effective for phobias, panic, body image issues, anxiety, and depression, but more research is needed in these areas.
Dr. Shapiro developed a theory to explain and predict the effects of EMDR called the Adaptive Information Processing model (AIP). This model states that we have an information processing system in our brain that usually processes experiences in an adaptive way so that learning takes place. This information processing system consists of memory networks that are organized around the earliest related event and contain related thoughts, images, emotions, and sensations.
Some events are so overwhelming that our brain cannot process the memories properly, and they are stored in an unprocessed form. As a result, when these memories are reactivated, the emotions, thoughts, and physical sensations that were present when the original traumatic event occurred are experienced all over again. AIP suggests that unprocessed memories cause current dysfunctional reactions.
Processing the memory during EMDR links the memory to adaptive information stored in the memory network. Learning then takes place as maladaptive information is discarded and adaptive information is stored. The client can then use this newly learned information to inform future experiences and choices.
There are multiple elements of EMDR that may contribute to its effectiveness, including exposure to the traumatic memory, and mindfulness. One unique element of EMDR is the side-to-side eye motion called bilateral stimulation (BLS). BLS has been found to enhance memory processing by decreasing memory vividness and emotionality.
Treatment with EMDR consists of eight phases:
History Taking: The therapist gets to know the client and they collaboratively identify targets for treatment, including past memories, current triggers, and future goals.
Preparation: The client is introduced to the basic mechanics of EMDR and is taught skills to manage distressing emotions.
Assessment: The therapist helps the client identify the distressing memory, the image of the worst moment of that memory, the client’s negative belief about themself in that moment, and the emotions and physical sensations associated with the memory. The client will also identify a positive cognition that they would like to believe about themself in relation to the target memory.
Desensitization: The therapist guides the client to think about the image of the worst moment of the target memory and their negative belief while engaging in BLS in approximately 30-second increments. The client is then asked to just notice any changes that occur in the memory, physical sensations, or emotions. These changes become the focus of the next set of BLS. This process is repeated until the memory becomes less distressing.
Installation: BLS is used to strengthen the client’s positive belief about themself.
Body Scan: The therapist and client identify and treat any physical sensations associated with the distressing memory.
Closure: If the targeted memory was not fully processed in the session, specific techniques are used to regulate emotions and ensure safety until the next session.
Reevaluation: At the start of the next session, the therapist evaluates the client’s current emotional state, maintenance of treatment effects, and any new material that came up between sessions that may need to be processed.
Many clients prefer EMDR to other evidence-based treatments for trauma because they do not have to go into detail about the memories of disturbing events. Also, other types of treatment require extensive time outside of the therapy session for “homework.” There is no homework involved in EMDR, and in comparison to other treatment models the treatment dropout rate is minimal. This treatment modality is currently offered at Aspire Psychology by Dr. Erin Fettes.
Additional Resources:
Getting Past Your Past, by Dr. Francine Shapiro
