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Eye Movement Desensitization and Reprocessing

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Cover of the book EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma by Francine Shapiro, published 1997
Cover of the book EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma by Francine Shapiro, published 1997

Eye Movement Desensitization and Reprocessing (EMDR) is a tool with a controversial working mechanism used in certain forms of psychotherapy that intends to relieve the symptoms of post-traumatic stress disorder (PTSD), Complex Post Traumatic Stress Disorder (C-PTSD), and other mental health problems using (in its original form) only eye movements similar to those which occur naturally in REM sleep (original theory).

Later developments have removed the focus on the eyes and used a number of other bilateral stimuli such as sound and touch, or dual attention stimuli to bring about the effect. Its use has also been extended to include a wide range of conditions.

Contents

[edit] About the founder

EMDR was developed by American psychologist Francine Shapiro, PhD in 1987 after she observed, during a walk in a park, that moving her eyes seemed to reduce the stress of disturbing memories. Based on these initial observations she conducted further research and published a paper in 1989 describing beneficial results in a number of case studies. Shapiro attended San Diego's Professional School for Psychological Studies, a now-defunct, then-unaccredited school. Dr. Shapiro has been given an award for Distinguished Scientific Achievement in Psychology by the California Psychological Association and in 2002 the International Sigmund Freud Award for Psychotherapy presented by the City of Vienna in conjunction with the World Council for Psychotherapy.

Dr. Shapiro is a Senior Research Fellow at the Mental Research Institute and an Executive Director of the EMDR Institute in California. See Bibliography below.

[edit] Description of therapy

The therapy originally consisted of the patient being guided by the therapist in moving their eyes in a systematic way while recalling disturbing memories. The therapist identifies and utilizes this resource to facilitate ego strengthening and more complete reprocessing of the target.

When a traumatic experience of any type takes place, it overwhelms temporarily, or even permanently, the usual ways of coping. The traumatic events, and the unique responses to them, are stored in what can be thought as memory networks. [1][2] These can become frozen in time due to the protective mechanism of dissociation as well as from the action of protective body/neurological responses. When any element of the trauma is triggered, the entire traumatic reaction, or some part of it, may recur again and again.

This explains why people who have had a traumatic accident, loss, or illness, or who have witnessed or experienced some other type of trauma, such as abuse or violence, may have recurring sensory flashbacks, thoughts, beliefs, or dreams. Post-traumatic reactions remain connected to the traumatic events even though subjects are not consciously aware of them while the reactions are taking place. Since the traumatic reactions cannot be fully processed due to blocked or frozen mind pathways, the traumatic reaction can remain pretty much the same in intensity and quality. This can be the case even though many years may have passed and many intervening healing events may have taken place. EMDR therapy seems to help traumatized people re-enter frozen memory and informational pathways, reprocess past memories as well as recent related events, and prepare for situations that may occur in the future. Because past, present, and future are connected in our information systems in many complex ways, positive changes spread or generalize throughout the system so that benefits are maximized in a short time period.

The eye movements used in EMDR are believed to impact two different types of networks, which facilitate multifaceted reprocessing. First, they seem to stimulate the memory network where the trauma is stored. The eye movements may also activate the informational networks that can restore a traumatized person’s ability to process an event fully. When both networks operate simultaneously during the eye movement sets, it appears that the traumatic information is rapidly processed. Traumatic reactions such as fear, panic, despair, and grief are replaced by more positive ones that emerge from a new place of balance and completion.

When the trauma appears to be an isolated incident, the traumatic symptom can be cleared within one or two sessions of using this efficient therapy. But when multiple traumatic events contribute to a health problem, such as physical, sexual, or emotional abuse, parental neglect, severe illness, accident, injury, or health-related trauma that result in chronic impairment to health and well-being, the time to heal may be longer. [3]

[edit] Therapy process

  • Phase I: In the first session the patient's history and an overall treatment plan are discussed. During this process the therapist identifies and clarifies potential TARGETS for EMDR. Target refers to a disturbing issue, event, feeling, or memory for use as an initial focus for EMDR. Maladaptive beliefs are also identified.
  • Phase II: Before beginning EMDR for the first time, it is recommended that the client identify a SAFE PLACE, an image or memory that elicits comfortable feelings and a positive sense of self. This safe place can be used later to bring closure to an incomplete session or to help a client tolerate a particularly upsetting session.
  • Phase III: In developing a target for EMDR, prior to beginning the eye movements, a snapshot image is identified that represents the target and the disturbance associated with it. Using that image is a way to help the client focus on the target, a NEGATIVE COGNITION (NC) is identified - a negative statement about the self that feels especially true when the client focuses on the target image. A POSITIVE COGNITION (PC) is also identified - a positive self-statement that is preferable to the negative cognition.
  • Phase IV: The therapist asks the patient to focus simultaneously on the image, the negative cognition, and the disturbing emotion or body sensation. Then the therapist usually asks the client to follow a moving object with his eyes; the object moves alternately from side to side so that the client's eyes also move back and forth. After a number of eye movements or a set of eye movements, the client is asked to report briefly on what has come up: This may be a thought, a feeling, a physical sensation, an image, a memory, or a change in any one of the above. In the initial instructions to the client, the therapist asks him or her to focus on whatever has just come up, and begins a new set of eye movements. Under certain conditions, however, the therapist directs the client to focus on the original target memory or on some other image, thought, feeling, fantasy, physical sensation, or memory. From time to time the therapist may query the client about his current level of distress. The desensitization phase ends when the SUDS (Subjective Units of Disturbance Scale) has reached 0 or 1.

[4]

[edit] Vocabulary of terms

Clinical target image: An image that represents the symptom, or past disturbing experiences related to the symptom, selected for EMDR processing.

Conflict-free image: An image that represents a time of wholeness and completely positive feelings. Inner conflict, anxiety, stress, discomfort, and health symptoms are absent. Ideally, this is a time of activity built into one’s regular routine. Examples include playing a musical instrument, gardening, hiking, meditation, playing with grandchildren. This type of image can be used with any of the energy methods.

Interweave: New information added to speed up blocked processing. Ideally, the interweave contains needed information that would have been available except for blockage of inner pathways by trauma responses. Types of interweaves include:

Cognitive interweave: New cognitive, adult perspective added by the therapist in the form of questions or statements designed to help the client find missing information.
Counterbalancing interweave: Added when someone is looping or overwhelmed by traumatic feelings. Designed to facilitate complete processing by adding new information that is “counter” or opposite to the activated stated or feelings.
Developmental learning interweave: Important information designed to help people learn to better mange inner or interpersonal boundaries, regulate powerful emotions, and hold positive attachments to self and others.
Resource interweave: Important information revealed by associations during EMDR or in life experiences. The therapist identifies and utilizes this resource to facilitate ego strengthening and more complete reprocessing of the target.
Re-nurturing interweave: Resource interweave offered to repair past experiences of parenting that were abusive, incomplete, or damaging to facilitate reprocessing.
Safety interweave: New information that adds to the safe place image and introduced as a positive target image or used during processing of clinical targets to increase sense of safety and stability.
Temporal resource interweave: New information that helps us realize that instinctual reactions at the time of a stressful event are useful and that important learning has taken place as a result of the traumatic experience.

Looping: When EMDR processing seems stuck. The client may be repeating similar associations, feelings, thoughts, or images and is not progressing.

Positive target image: A sensory image used to represent an experience that evokes only positive feelings when symptoms are not present ( e.g., pain-free interlude).

Protocol: A recipe or step-by-step formula for dealing with specific types of symptoms. For example, there are special EMDR protocols for depression, dissociative disorders, illness and somatic disorders, and phobias.

Reprocessing (also processing) : Rapid free association of information between trauma memory networks and informational networks during eye movement sets which results in the reduction of distress, as measured by SUD, and a “metabolizing” of the trauma.

SUD (Subjective units of disturbance scale) : This is a personal scaling of distress (from zero to 10) activated by a clinical target image chosen for reprocessing. Used in EMDR (and TFT) to measure baseline emotional or physical pain and also to asses progress being made.

Target: A goal for reprocessing related to past trauma or distressing events believed to contribute to current symptoms. Can be a full or partial memory, dream image, sensory fragment (feeling in the body, image, sound or voice, ect.), or current awareness.

Protocol for ego strengthening in EMDR:

    1. Use the safe place at the beginning and end of every EMDR session.
    2. Expand the safe place concept.
    3. Begin with a conflict-free target image for stabilization.
    4. Utilize the positive thoughts and beliefs that accompany conflict-free imagery.
    5. Link conflict-free imagery with cognitive interweaves.
    6. Install other positive imagery as needed for additional resource interweaves.
    7. Expand the positive template.[5]

[edit] Later developments

Later developments have removed the focus on the eyes and used a number of other bilateral stimuli such as sound and touch, or dual attention stimuli to bring about the effect. Its use has also been extended to include a wide range of conditions. The technique has been doubted compared to other treatments through meta-analysis and some claim that it is non-falsifiable.[6]

EMDR has been used on children to treat a variety of conditions.[7] It has been used in the treatment of children who have experienced trauma and complex trauma.[8] It is often cited as a component in the treatment of Complex Post Traumatic Stress Disorder (Briere & Scott, 2006), emotional dysregulation, and in the treatment of children exposed to chronic early maltreatment that is related to Attachment disorder. It is recognised by the UK National Institute for Health & Clinical Excellence (NICE) Guidelines as a treatment for PTSD.

Future research will hopefully be directed to two other critical needs. First, research should explore the degree to which successful trauma treatment decreases the amount of high- risk and perpetrator behavior ( Freenwald, 1999; Scheck et al., 1999; Shapiro, 1995, 2001a, in press) and deters further victimization. Second, research should explore the degree to which neurobiological changes and cognitive deficits correlated with traumatization ( Perry. 1997; Perry, Pollard, Blakley, Baker, & Vigilante, 1995; Schore, 1994, 1997, 2001; Seigel, 1999; van der Kolk, McFarlane, & Weisaeth, 1996) can be reversed with the judicious application of EMDR within a multidimensional treatment ( Schore, Seigel, Shapiro, & van der Kolk, 1998).

Full article: EMDR 12 Years after Its Introduction: Past and Future Research Francine Shapiro; Mental Research Institute, Palo Alto, CA Journal of Clinical Psychology, Vol. 58(1), 1-22 (2002) © 2002 John Wiley & Sons, Inc.

[edit] Other applications of EMDR

Although controlled research has concentrated on the application of EMDR to PTSD, a number of studies have investigated EMDR’s efficacy with other anxiety disorders as well as numerous reports of diverse clinical applications.

Case reports have been published on the application of EMDR to the treatment of (a) personality disorders ( Fensterheim, 1996a; Korn & Leeds, in press; Manfield, 1998), (b) dissociative disorders ( Fine & Berkowitz, 2001; Lazrove & Fine, 1996; Paulsen, 1995; Twombly, 2000), ( c ) a variety of anxiety disorders ( De Jongh & Ten Broeke, 1998; De Jongh, Ten Broeke, & Renssen, 1999; Goldstein & Feske, 1994; Lovett, 199; Nadler, 1996; Shapiro & Forrest, 1997) and (d) somatoform disorders ( Brown, Mcgoldrick, & Buchanan, 1997; Grant & Threlfo, 2002). However, controlled research is needed to evaluate the efficacy of these applications.

In designing the research the entire EMDR protocol should be evaluated within the context of the potential special needs of the particular population. For instance, Brown et al. (1997) evaluated the application of EMDR in seven consecutive cases of Body Dysmorphic Disorder (BDD), which has been reported to necessitate 8 to 20 sessions of cognitive behavior therapy with varying success rates ( Neziroglu, McKay, Todaro, & Yaryura-Tobias, 1996; Beale et al., 1996; Wilhelm, Otto, Lohr, & Deckersbach, 1999). In contrast, Brown et al. reported the elimination of BDD in five of the seven consecutive cases in one to three sessions of EMDR through the processing of the etiological memory. Shile this result indicates the EMDR holds promise for the treatment of this disorder, future controlled research should include a greater number of sessions in order to evaluate the more comprehensive clinical picture.

EMDR can work on a multitude of problems that are less complex than PTSD. One of these is uncomplicated depression. The EMDR Casebook by Philip Manfield, PH.D. has documented several case studies in which EMDR was used. In the case about uncomplicated depression, Manfield was able to help his client, George, resolve several childhood issues that have plagued his adult life. Moreover, EMDR can work for diseases such as postpartum depression. By having the client target a distinctive memory and work through it with a series of eye movements, the client is then able to achieve a positive cognition.[9]

There have been studies of using EMDR without eye movement by Dr. Edmund Hume to use the "...taps to hands, right and left, sounds alternating ear-to-ear, and even alternating movements by the patient can work instead. The key seems to be the alternating stimulation of the two sides of the brain." They used this treatment on the blind patients by using toones and hand-shaping instead of fingers wagging. Shapiro now called the treatment Reprocessing Therapy. She admits that eye movement is not necessary desensitization processing.[10]

EMDR has been used on children to treat a variety of conditions (Tinker & Wilson, 1999, and Greenwall, 1999). It has been used in the treatment of children who have experienced trauma and complex trauma (Tinker & Wilson, 1999; Greenwald, 1999). It is often cited as a component in the treatment of Complex Post Traumatic Stress Disorder (Briere & Scott, 2006), emotional dysregulation, and in the treatment of children exposed to chronic early maltreatment that is related to Attachment disorder. It is recognised by the UK National Institute for Health & Clinical Excellence (NICE) Guidelines as a treatment for PTSD.

Full article: EMDR 12 Years after Its Introduction: Past and Future Research Francine Shapiro; Mental Research Institute, Palo Alto, CA Journal of Clinical Psychology, Vol. 58(1), 1-22 (2002) © 2002 John Wiley & Sons, Inc.

[edit] Controversy

Researching the working mechanisms of EMDR has created a good deal of controversy since its inception. The long-term effects are still under study, with evidence of a deterioration in gains and relative inefficacy compared to well-practiced cognitive behavior therapy (e.g., Devilly & Spence, 1999[11]; Taylor et al., 2004). The technique has been doubted compared to other treatments through meta-analysis and Devilly claims that, through a lack of specificity and conceptual underpinnings, the theory leading to the practice is now non-falsifiable (e.g., Devilly, 2002[12]).

[edit] See also

[edit] Bibliography

  • EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma . NY: Basic Book, 1997. ISBN 0-465-04301-1
  • EMDR as an Integrative Psychotherapy Approach: Experts of Diverise Orientations Explore the Paradigm Prism. American Psychological Associations Book, 2002. ISBN 1-55798-922-2
  • EMDR: Eye Movement Desensitization of Reprocessing: Basic Principles, Protocols and Procedures. NY: Guilfor Press, 2001. ISBN 1-57230-672-6

[edit] References

  1. ↑ Devilly, G.J., & Spence, S.H. (1999). The relative efficacy and treatment distress of EMDR and a cognitive behavioral trauma treatment protocol in the amelioration of post traumatic stress disorder. Journal of Anxiety Disorders, 13, 131–157.
  2. ↑ Devilly, G.J. (2002). Eye Movement Desensitization and Reprocessing: A chronology of its development and scientific standing. Scientific Review of Mental Health Practice, 1, 113-138.
  3. ↑ Shapiro, F. (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. New York: The Guilford Press.
  4. ↑ Tinker, R., & Wilson S., (1999) Through the eyes of a child: EMDR with children. NY: Norton.
  5. ↑ Greenwald, R., (1999). Eye movement desensitization and reprocessing in child and adolescent psychotherapy. NY: Norton.
  6. ↑ Briere, J., and Scott, C., (2006) Principles of Trauma Therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks, CA: Sage.
  7. ↑ De Jong, A., Ten Broeke E. & Renssen M E., (1999) Treatment of Specific Phobias with Eye Movement Desensitisation and Reprocessing (EMDR): Protocol, Empirical Status and Conceptual Issues. Journal of Anxiety disorders, Vol 13, No. 1-2, pp69-85.
  8. ↑ Manfield, Philip. (2003). EMDR Casebook. NY: W.W. Norton & Company, Inc.
  9. ↑ Phillips, Maggie., (2000). Finding the Energy to Heal: How EMDR, hypnosis, TFT, imagery, and body focused therapy can help restore the mind body health. NY:Nortonn.com
  10. ↑  [13]
  11. ↑  [14]

[edit] External links

[edit] Supporting EMDR

[edit] Skeptical of EMDR

[edit] Other

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