Eye Movement Desensitization and Reprocessing Therapy

Eye Movement Desensitization and Reprocessing Therapy (EMDR) is a therapeutic approach for treating traumatic memories. According to the theory, life disrupting symptoms emerge from inadequate processing of disturbing experiences (trauma) that has been stored in “state specific dysfunctional form” (Solomon, Shapiro, 2008, page 315). EMDR therapy employs “dual stimulation” by directing the client to focus attention on two experiential areas: internal elements (specific images, emotions, body sensations, and thoughts) and an external stimulus (rapid eye movement) (Ecker, Ticic, and Hulley, 2012).

Dual stimulation originally was achieved through rapid eye movement, however, EMDR therapist may also use other forms of dual stimulation such as tactical or audible stimulations. Some researchers hypothesize that the “attention on two experiential areas at once” creates the dynamics necessary for accessing dysfunctional memories. Therapists assist clients give attention to “a cluster of linked internal elements (specific images, emotions, body sensations, and thoughts) and an external physical stimulus that guides a bilateral oscillation of perceptual attention (whether through eye movements, audio tones, or physical taps)” (2012).

EMDR theorists posits that he practice of dual stimulation allows past memories to surface where patients spontaneously integrate through reconsolidate traumatic memories through dynamic linkage to adaptive memory networks. Basically, unresolved trauma is consolidated into coherent narratives which ultimately resolves the patients symptoms. While there is contradicting research, a large body of evidence supports the effectiveness of Eye Movement Desensitization and Reprocessing therapy.

The Therapeutic Process of Eye Movement Desensitization and Reprocessing Therapy

EMDR therapy is much more than simply moving the eyes. While many therapist may experiment with the process, the treating a patient effectively requires also guiding the client through “processing to resolution.” This requires the practitioner to have a familiarity with the “vast array of advanced interventions as well as creativity and skill” (Greenwald, 1996).

Therapists may use EMDR in a variety of ways:

• EMDR Psychotherapy
  
  EMDR psychotherapy is a comprehensive application of EMDR that treats the whole person, working past the original developmental trauma symptoms, and assisting the client in growth in other relational and behavioral domains.
• EMDR Treatment Protocols
  
  EMDR treatment protocols are accessible, affordable and effective. This is the standard application of EMDR therapy to target formative past trauma experiences. EMDR treatment protocols is a stand alone treatment for Post Traumatic Stress Disorder (PTSD). The treatment protocols have a goal of complete reprocessing of disturbing and dysfunctional memories.
• EMDR-Derived Techniques
  
  This refers to treatment that uses EMDR techniques in conjunction with other therapy styles (such as cognitive behavioral therapy).

Eight Phases of EMDR Therapy

We have a tendency to look at steps or phases as a sequential map for a process. However, the phases in EMDR may actually be stages of treatment that can take place over a period of time, overlapping with other phases in the treatment process. Any therapy is a dynamic process that adapts as new information comes to light during a session. Perhaps, history taking, preparation and assessment occur as part of every session. Reevaluation is also an essential on-going process of thearpy.

1. History-Taking
2. Preparation
3. Assessment
4. Desensitization
5. Installation
6. Body Scan
7. Closure
8. Revaluation

History of EMDR

Psychologist Francine Shapiro (1948-2019) initially developed EMDR in 1987 to treat post-traumatic stress disorder (PTSD). In 1987, during a walk in a park, Shapiro noticed that “rapid eye movements produced a dramatic relief from her distress” (Van der Kolk, 2015, Kindle location 4,676). Originally, Shapiro referred to the therapy style as Eye Movement Desensitization or EMD. In 1991, she changed the name to EMDR “to reflect the paradigm shift from the initial formulation of a simple desensitization technique to a reprocessing of memories” (Laliotis, et al., 2021).

Shapiro began publishing articles on EMDR therapy most notably beginning in 1989 and she continued to publish research on EMDR throughout the remainder of her life. throughout her life. Shapiro early on recognized that her theory and procedures did not evolve from a theoretical basis. Rather, they emerged from personal observations. Shapiro advised that Eye Movement Desensitization and Reprocessing Therapy is not a “panacea” (1993, p. 420). Basically, She was pointedly reminding that rapid eye movement alone does not cure the symptoms but that the “dual stimulation” of rapid eye movement in conjunction with therapy led to effective reprocessing of dysfunctional information stored in memory.

She explained that “treating trauma is like removing a quilt from a mattress; only then are you able to observe thee other problems that must be addressed” (P. 420). EMDR, then, just exposes underlying memories related to trauma, making them available for reprocessing and further therapeutic work.

Initial Lacking of Theoretical Explanation

While initially, the theoretical basis for EMDR was lacking, clinical trials were positive, suggesting that EMDR therapy was effective in treating trauma. In 1995 Shapiro, referred to the accelerated information processing model as the theoretical mechanisms behind the effectiveness of EMDR. She later in 2001 renamed it the adaptive informational processing model.

Early research on Eye Movement Desensitization and Reprocessing Therapy had varying findings and controversial opinions.​ Much of the opposing research, however, were not replicating the procedures outlines by Shapiro, or were treating patients for illnesses outside of the targeted and researched areas.

The Cleveland Clinic published on their website that while “there’s some controversy surrounding why EMDR works…that controversy doesn’t extend to whether or not EMDR does work. Dozens of controlled trials and research studies have analyzed EMDR and shown that it’s effective” (2022).

Theoretical Explanation of Eye Movement Desensitization and Reprocessing Therapy

Bruce Ecker, Robin Ticic, Robin, and Laurel Hulley wrote that “the cornerstone of EMDR’s conceptual model is what Shapiro terms the brain’s Adaptive Information Processing System, which is understood as always striving for survival and adaptive mental health.” They continue, “in that context, EMDR is understood as functioning to update the client’s memory network by bringing about a genuine resolution of negative emotional experiences rather than engaging in counteractive managing of symptoms.” (2012, Page 142).

Bessel Vander Kolk explains that “EMDR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past” (2015). Some researchers speculate that the dual stimulation may create a sense of safety that eases access to dangerous memories.

The underlying theoretical explanation for why EMDR works is that dual stimulation assists patients retrieve dysregulated and fragmented memories, and reprocess them in a functional way. As the therapy style began to mature, Shapiro hypothesized that the adaptive process model was a key factor for the effectiveness of EMDR.

Adaptive Information Processing Model

Shapiro wrote that “the heart of EMDR involves the transmutation of these dysfunctional stored experiences into an adaptive resolution that promotes psychological health” (2008). A theoretical understanding of how the brain processes and stores memories, provides hints to how EMDR helps clients achieve adaptive resolution.

Shapiro explains that the Adaptive Information Processing Model posits “the existence of an information processing system that assimilates new experiences into already existing memory networks.” Trauma interrupts normal assimilation of new experiences and they become frozen in their “own neural network, unable to connect with other memory networks that hold adaptive information” (p. 316).

The adaptive information processing model holds that “negative behaviors and personality characteristics” are the result of difunctionally stored information. Van der Kolk wrote that irrational thoughts are the residues of traumatic incidents. These thoughts, he explains, that were present during, or shortly after traumas occurred are “reactivated under stressful conditions.” Van der Kolk adds, “trauma interferes with the proper functioning of brain areas that manage and interpret experience” (2015).

Multiple Memory Networks

Brain science now knows that memories are not a simple library system where entire episodes are stored in one spot. Robert Stickgold, Robert Stickgold, Ph.D., Harvard Medical School Professor of Psychiatry, explains “there are different memory systems that store information in different formats and in different parts of the brain.” Each sensory modality (visual, auditory, tactile, and olfactory) imprint the memory in their region of the brain before passing the information on to conscious perception.

In the sematic memory network, we ascribe meaning to the information by integrating the new information from sensory modalities with old information (concepts, words, beliefs). This process makes new information usable.

For long term memories to form, Stickgold explains, the hippocampal complex is required (2002, pp. 63-64). The hippocampus doesn’t store specific details of the memory but something akin to a brief outline and an index pointing to locations where specific details are stored. Recalling a memory, then, is a process of reconstructing the event by pulling stored information from different memory systems. Context surrounding reconstruction strongly influences this process.

Van der Kolk also wrote about this process. He explains that “memories evolve and change. Immediately after a memory is laid down, it undergoes a lengthy process of integration and reinterpretation—a process that automatically happens in the mind/brain without any input from the conscious self. When the process is complete, the experience is integrated with other life events and stops having a life of its own” (2015, Kindle location 4,766).

Complex Systems of Memory Storage and Retrieval

We can see with the complexity of the process of storage and retrieval the memory processes can easily dysfunction. The Adaptive Information Process Model suggests that trauma interferes with this process. EMDR, however, allows memories to resurface, in a safe environment, where the client may reprocess the memory (integrate and store) in a psychologically healthy manner that consequently may heal the symptoms of dysfunction.

Van der Kolk says, “people may be able to heal from trauma without talking about it. EMDR enables them to observe their experiences in a new way, without verbal give-and-take with another person.” He further describes “the most remarkable feature of EMDR is its apparent capacity to activate a series of unsought and seemingly unrelated sensations, emotions, images, and thoughts in conjunction with the original memory. This way of reassembling old information into new packages may be just the way we integrate ordinary, nontraumatic day-to-day experiences” (2015).

REM and EMDR

Shapiro suggested that the “eye movements of EMDR are functionally analogous to the eye movements of Rapid Eye Movement (REM) sleep” (Kuiken, et al,. 2001). Research supports Shapiro’s speculation. Research suggests that that phasic events of REM and EMDR (e.g., transient inhibition of the diaphragmatic and skeletal musculature, transient activation of middle ear and periorbital musculature, and the rapid eye movement) are regulated by the same neural mechanisms (p. 5).

Greenwald explains, “implicit in the hypothesis relating EMDR to REM sleep is the notion that dreaming is itself a therapeutic process, in which exposure to disturbing material (dream content) during REM sleep is curative” (1995).

Stickgold explains that brain activity is dramatically different during REM sleep and non-REM sleep. The limbic and sensory cortices are “preferentially activated in REM sleep” (2002, p. 68). The cortical shifts during REM sleep have a profound influence on memory processes. The shift allows for association with weaker associative links, testing for new valuable insights between experiences and older memories. Stickgold explains that “blocking hippocampal outflow during REM will help prevent sematic associations from falling back into more predictable, over-learned patterns and will favor the formation of new associative links necessary for understanding the meaning of events in our lives” (p. 69).

If, as hypothesized, EMDR helps shift cortical processing of old information, then the theoretical foundation underlying this therapy is strong, even if Shapiro didn’t understand the theoretical basis behind her relief of tension and anxiety during her historical walk in the park.

Is Eye Movement Desensitization and Reprocessing Therapy Effective?

Studies largely support the effectiveness of EMDR in treatment of PTSD. In one study, “the patients on EMDR did substantially better than those on either Prozac or the placebo: After eight EMDR sessions one in four were completely cured (their PTSD scores had dropped to negligible levels), compared with one in ten of the Prozac group. But the real difference occurred over time: When we interviewed our subjects eight months later, 60 percent of those who had received EMDR scored as being completely cured” (Van der Kolk, Bessel, 2015).

EMDR is considered a credible therapy by the World Health Organization, International Society for Traumatic Stress Studies, American Psychiatric Society, VA and DoD, National Institute of health and Care Excellence, and the High Commission for Refugees, to only name a few (Farrell & Rydberg, 2022).

As of 2019, “there were more than 30 published random control trials on the treatment of adults and children with PTSD symptoms.” Many meta-analysis of these studies “reported that EMDR therapy is an efficacious treatment for PTSD and it is recommended in numerous treatment guidelines” (Laliotis, 2021).

What Is a Typical EMDR Session Like?

A typical desensitization EMDR session can last up to 90 minutes. Your therapist asks the client to follow their fingers back and forth with their eyes. While their eyes are bouncing back and forth, the EMDR therapist will ask the client to recall a disturbing event.

What Does EMDR Treat?

Physicians and Therapists sometimes use EMDR to treat other psychological ailments. Such as:

• Panic attacks
• Depression
• Eating disorders
• Addictions
• Anxiety, such as discomfort with public speaking or dental procedures

A Few Words by Psychology Fanatic

Therapists have used EMDR for over 40 years to treat trauma and related illnesses. Research shows it is effective. And, perhaps, it may be right for you.

References:

Civilotti, C., Margola, D., Zaccagnino, M., Cussino, M., Callerame, C., Vicini, A., & Fernandez, I. (2021). Eye Movement Desensitization and Reprocessing in Child and Adolescent Psychology: a Narrative Review. Current Treatment Options in Psychiatry, 8(3), 95-109.

Doğan, Ceren Kurtay; Yaşar, Alişan Burak; Gündoğmuş, İbrahim (2021). Effects of the EMDR Couple Protocol on Relationship Satisfaction, Depression, and Anxiety Symptoms. Journal of EMDR Practice and Research, 15(4), 218-230.

Ecker, Bruce; Ticic, Robin; Hulley, Laurel (2012). Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation. Routledge; 1st edition.

Farrell, D., & Rydberg, J. (2022). The Future of EMDR Therapy and of the Journal of EMDR Practice and Research. Journal of EMDR Practice and Research, 16(1), 2-3.

Greenwald, Ricky (1995). Eye Movement Desensitization and Reprocessing (EMDR): A New Kind of Dreamwork?. Dreaming, 5(1), 51-55.

Greenwald, Ricky (1996). The Information Gap in the EMDR Controversy. Professional Psychology: Research and Practice, 27(1), 67-72.

Hase, M., & Brisch, K. (2022). The Therapeutic Relationship in EMDR Therapy. Frontiers in Psychology, 13.

Kuiken, D., Bears, M., Miall, D., & Smith, L. (2001). Eye Movement Desensitization Reprocessing Facilitates Attentional Orienting. “Imagination, Cognition and Personality”, 21(1), 3-20.

Laliotis, D., Luber, M., Oren, U., Shapiro, E., Ichii, M., Hase, M., Rosa, L., Alter-Reid, K., & Jammes, J. (2021). What Is EMDR Therapy? Past, Present, and Future Directions. Journal of EMDR Practice and Research, 15(4), 186-201.

Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology,58(1), 61-75.

Van Minnen, M., Markus, W., & Blaauw, E. (2020). Addiction-Focused EMDR Therapy in Gambling Disorder: A Multiple Baseline Study. Journal of EMDR Practice and Research, 14(1), 46-59.

Cleveland Clinic (2022). EMDR Therapy. Published 3-29-2022. Accessed 7-17-2023.

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