Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Guide to Making an Informed Choice

What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) is a complex, highly specialized therapy used to overcome the effects of traumatic or upsetting experiences. It was developed by psychologist Francine Shapiro, after she noticed her own stress reactions diminishing when her eyes swept back and forth as she walked through a park.

EMDR combines several therapeutic methods—psychodynamic, cognitive, behavioral, etc.—with eye movements or other forms of rhythmical stimulation, such as hand taps or sounds. It involves recalling a stressful past event and “reprogramming” the memory in the light of a positive, self-chosen belief.

Theories as to why EMDR works are still evolving. It has been most successful with single-incident trauma, but has expanded to effectively treat the emotional scars left by more common childhood events that keep people stuck in limiting behaviors.

How does EMDR therapy work?

Dr. Shapiro developed the adaptive information processing model to help explain the success of EMDR. At the time of a traumatic event, strong emotions interfere with our ability to completely process the experience. Impressions of the trauma get stored in our nervous system through the defense mechanisms we use to cope with the incident, such as dissociation, or “splitting off” from ourselves to handle the emotional pain. As a result, we are blocked from learning new ways of seeing the situation, and will re-experience the symptoms of the initial trauma when stressful events trigger us in the present. Thus, we can get trapped in recurring anxiety, depression, phobias, panic attacks, and the like.

On the EMDR Institute’s website, Shapiro uses the example of rape to illustrate how we can get stuck in trauma. “A rape survivor may ‘know’ that rapists are responsible for their crimes, but this information does not connect with her feeling that she is to blame for the attack. The memory is then dysfunctionally stored without appropriate associative connections and with many elements still unprocessed. When the individual thinks about the trauma, or when the memory is triggered by similar situations, the person may feel like she is reliving it, or may experience strong emotions and physical sensations.”

EMDR links the memory of trauma with present-oriented, adaptive information. Though the exact mechanism is unknown, it appears that the eye movements relieve the anxiety associated with the trauma so that the original event can be examined from a more detached perspective, somewhat like watching a movie of what happened. In this way cognitive reorganizing takes place, leading to spontaneous emotional and behavioral life changes.

What happens during EMDR therapy for single-incident emotional trauma?

The first EMDR session involves taking an initial client history, and is followed by one or more sessions where the therapist trains the client in self-care techniques, so that he or she can handle strong emotions that may arise during or between sessions. When the client is ready, he or she is asked to identify three things:

• a target, or visual image of a traumatic memory and the associated emotions and bodily sensations
• a negative belief about self related to the memory
• a preferred positive belief about self

The client is asked to rate the negative belief on a scale of how true he or she believes it to be, as well as the strength of the positive belief. The client is also asked to rate the intensity of physical sensations related to the mental image of the trauma. Once these self-assessments have been noted, the therapist has the client recall the target image, while leading the client through a series of rapid eye movements (or other tactile sensations) as he or she talks about the original event. This is known as dual processing, which enables the client to access positive ways of reframing the original trauma (reprocessing), and to release the body’s stored negative emotional charges around it (desensitization). The result is that the client can then recall the traumatic event without the anxiety once experienced.

After each set of eye movements, the client is asked to again rate the negative and positive self-beliefs. This provides concrete measures of how the relationship to the trauma is changing. What is unique about EMDR is how rapidly new beliefs about self and interpretations of the trauma replace old ones, as possibilities emerge that were never before considered. The insights gained are used as the starting points for the next set of eye movements, thus continually building a more functional cognitive relationship to the trauma. Therapists monitor their clients’ reports on the intensity of their symptoms between sessions to ensure that progress is being made.

What conditions are treated by EMDR?

EMDR has been most powerful in treating post-traumatic stress disorder (PTSD) and major trauma such as that experienced by combat veterans, survivors of natural disasters, and victims of violent crime. However, its uses also include “small t” traumas, as Shapiro calls them: events that happen in everyone’s lives, but which leave us with the inability to reprocess negative beliefs about ourselves. These include being teased in school, ridiculed by a parent, or getting lost as a child in a public place. EMDR is widely used to treat the following problems:

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EMDR is also currently being explored for treating chronic pain, asthma, and learning disabilities.

What are some reported benefits of EMDR?

• The main benefit of EMDR is the speed at which deep-seated problems can be resolved. Single sessions of EMDR have been shown to produce results, and Shapiro reported an average treatment time of five sessions to comprehensively treat PTSD (Shapiro, 1989 199-223). According to Carol Boulware, Ph.D., a practicing EMDR therapist in Los Angeles, one study showed that “EMDR was twice as effective in half the amount of time of standard traditional psychotherapeutic care.”
• Unlike many “talk” therapies, EMDR does not require the client to go into detail about the distressing events of the past. While communicating and establishing trust with the therapist is essential, what seems to be equally important to the process is the client registering the event and holding the recall within during the eye movement sessions and the reprocessing. There is no need to analyze the trauma for long periods of time.
• EMDR is a multi-faceted approach, not limited to cognitive, behavioral, or somatic methods, but a synthesis of all three and more. The fact that it simultaneously works on mind, body, and emotions may account for its success in taking mere intellectual understanding of the origins of a problem (e.g. “I know I have guilt over killing in the war”) to a holistic resolution involving a bodily release, where post-traumatic symptoms such as intrusive thoughts, nightmares, and anger outbursts clear up.
• Since all therapies in some way involve getting to the roots of psychological problems, it is a benefit of EMDR that the trauma that must be re-experienced during treatment is relatively short-lived. Cognitive reprocessing occurs simultaneously with memory recall.

What are some potential drawbacks of EMDR?

• EMDR was created for use as a trauma therapy and as such focuses on intensely stressful subjects. Pregnant women, or those with heart conditions or eye problems, should consult their health care practitioners before beginning EMDR therapy.
• Though EMDR has proved effective in studies with PTSD it has not been tested or proven effective in studies on phobias, panic disorder or stress related disorders.
• EMDR is a relatively new therapy and as such the verdict is still out as to its long-term effectiveness. There is a considerable divergence of opinion around the scientific validity of the research studies performed to measure EMDR results. Both sides of the debate are passionate about their claims, and present plenty of food for thought. However, the number of studies performed is prolific and makes a statement about EMDR’s impact. According to the Energy Healing Resources website, EMDR has had “more double-blind, placebo-controlled studies published in peer-reviewed journals than any other psychotherapy method” for the treatment of PTSD.

Are there research studies on the effectiveness of EMDR?

Yes. The EMDR Institute’s website provides a page of controlled research studies with brief synopses of the findings on their Research Overview and Efficacy pages. A site with even more results is Dr. David Baldwin’s Trauma Information Pages, which contain literally hundreds of journal articles citing research studies (see references and resources). See also the Energy Healing Resource’s Reference Page for more study citations.

How can I find an EMDR therapist?

EMDR is a highly specialized therapeutic modality that needs to be conducted by a licensed mental health professional who has taken specific training in this complex approach. Please refer to the references and resources below to find a qualified EMDR practitioner in your area.

The EMDR Institute suggests you ask the following questions of a prospective clinician:

• Have they received both levels of training;
• Was the training approved by EMDRIA;
• Have they kept informed of the latest protocols and developments;
• How many cases have they treated with your particular problem/disorder;
• What is their success rate.

As with choosing any therapist, it is important to interview the candidate to find out if they are a good fit. You should feel a sense of trust and rapport with the person, and would ideally want to meet with more than one therapist to compare styles and personalities.

"Reprinted with permission from http://www.helpguide.org/.