EMDR (Eye Movement Desensitization and Reprocessing)
by Clay Watkins, LMFT
What is EMDR?
Eye movement desensitization and reprocessing (EMDR), though it has been in use for decades, is a relatively unknown therapeutic technique that has been shown to help relieve the often horrific effects of traumatic memories. It is primarily used to access, neutralize, and bring to adaptive resolution the upsetting memories at the root of recurring psychological disturbances (Greenwald, 1994). Though there exist both supporters and critics of the treatment, voluminous clinical and anecdotal evidence of EMDR-induced recoveries, particularly from long-term sufferers of post-traumatic stress symptoms, has made the therapeutic community stand up and take notice, and has motivated many to consider EMDR for further study.
History of EMDR
Francine Shapiro, an unknown clinical psychology graduate student from Palo Alto, California, discovered the therapeutic affects of rhythmic alternating bilateral eye movement in 1987 while walking through a park in California, preoccupied with old memories and disturbing thoughts. She discovered that as her eyes moved rapidly back and forth, her memories seemed to dissolve spontaneously. Amazed by the phenomenon, she experimented with 70 volunteers, obtained similar results, and organized a formal research study one year later (Butler, 1993).
In this study, which became her doctoral thesis, 22 survivors of rape, childhood abuse, and war were given one 60-minute EMDR session. All of these participants reported that their memories had lost most of their devastating charge and that their irrational, negative self-attributions and presenting complaints had greatly improved. This effect was maintained at a three-month and a three-year follow-up. A control group that simply called up a memory without using the eye movement showed no relief at all (Shapiro, 1989a; as cited in Greenwald, 1994).
She later founded the EMDR Institute that conducts research and trains licensed mental health professionals in the use of EMDR.
Since its inception in 1995, EMDRIA , an international association of therapists trained to conduct EMDR, has grown to tens of thousands of members, though the collective number of clinicians trained in EMDR worldwide extends into the hundreds of thousands.
EMDR has gained notable endorsements in the last few years. The American Psychological Association, the nation’s primary professional organization for psychologists, has determined that EMDR is an effective treatment for civilian post-traumatic stress disorder, and in 2004 the US Department of Veterans Affairs and Department of Defense (2004) placed EMDR in the "A" category as “strongly recommended” for the treatment of trauma (VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress) . Kaiser Permanente, one of the nation’s biggest HMOs, uses the technique to treat patients at mental health clinics in Northern California.
EMDR’s increasing acceptance is part of a larger trend in psychotherapy. Conventional talk therapy, which can be a lengthy process, has been augmented or supplanted by techniques that emphasize problem solving, such as cognitive behavioral therapy, which tries to change abnormal reactions to ordinary stresses. Such experiential techniques, which seem to help patients more quickly, have been inspired by new insights into brain chemistry and how the mind deals with trauma.
In recent years psychotherapy has been significantly influenced by research into the brain and how it processes information. EMDR appears to provide a crucial link between cognition and the emotional shift that may be necessary for behavioral change to occur. Dr. Bessel A. van der Kolk, professor of psychiatry at Boston University renowned in the field of Posttraumatic Stress Disorder (PTSD) research, says "We thought that if people can talk about something, they will feel better ‘ but we’ve discovered just talking doesn’t necessarily change your life.”
EMDR was first used on patients suffering from PTSD: Vietnam veterans; victims of rape, incest or child abuse; and survivors of natural disasters or traumatic events, like car accidents, earthquakes, the shooting at Columbine High School and the Oklahoma City bombing. And when terrorists attacked the Pentagon and the World Trade Center on 9/11, EMDR therapists traveled to Washington and New York to counsel survivors, victims’ families, and rescue and recovery workers. The number of people helped worldwide by EMDR now extends into the tens of millions.
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What does EMDR treatment look like?
Clients are first asked to visualize the traumatic event as vividly as possible. While retaining this image in mind, they are told to supply a statement that epitomizes their reaction to it (e.g., "I am about to die"). Clients are then asked to rate their anxiety on a Subjective Units of Distress (SUDs) scale, which ranges from 0 to 10, with 0 being no anxiety and 10 being extreme terror. In addition, they are told to provide a competing positive statement that represents their desired reaction to the image (e.g., "I can make it"), and to rate their degree of belief in this statement on a 0 to 8 Validity of Cognition scale. Following these initial steps, clients are asked to visually track the therapist's finger as it sweeps rhythmically from right to left in sets of 12 to 24 strokes, alternated at a speed of two strokes per second. The finger motion is carried out for 12 to 14 inches in front of the client's eyes. Following each set of 12 to 24 strokes, clients are asked to "blank out" the visual image and inhale deeply, and are then asked for a revised SUDs rating. This process is repeated until clients' SUDs ratings fall to 2 or lower and their Validity of Cognition ratings rise to 6 or higher.
Application and styles of treatment
The traditional focus of EMDR treatment has been the resolution of emotional distress arising from traumatic childhood experiences or the recovery from the effects of critical incidents, such as automobile accidents, assault, natural disasters, and combat trauma . Included in the list of other problems treated with EMDR, however, are phobias, anxiety and panic attacks, substance abuse, impulse control, anger, chronic pain , and somatization disorders. Shapiro asserts EMDR can also be useful in the treatment of generalized anxiety, paranoid schizophrenia, learning disabilities, eating disorders, and even pathological jealousy (Beere 1992; Marquis 1991; Shapiro 1989b).
Therapists who use the technique say it helps people come to terms with their experience without being re-traumatized. "EMDR is much more accurate than conventional therapy," says Steven V. Marcus, a psychologist at Kaiser Hospital in Santa Clara. In an often-cited study funded by Kaiser and published in the journal Psychotherapy in 1997, Marcus randomly assigned 67 PTSD sufferers to either EMDR or standard treatment. At the end of three sessions, 50 % of the EMDR participants no longer met the criteria for PTSD, compared to 20% receiving standard therapies. After treatment, 77 % of the EMDR group no longer met the PTSD criteria, compared to 50 % of those receiving standard therapy. "With EMDR," says Marcus, "you can pinpoint a specific trauma and target that like a laser beam."
A unique aspect of EMDR is that it appears to act faster on PTSD symptoms than traditional forms of talk therapy, with reported cases where complete elimination of symptoms was reported after only one session Puffer, Greenwald, and Elrod (1998) . How many sessions are required, however, may depend on the type and magnitude of the trauma affecting the victim. A 1999 review of several EMDR studies by Louise Maxfield of Lakehead University, Canada compared the effectiveness of EMDR in seven civilian studies to that in five studies using combat veteran participants. She concluded that particularly with combat veterans who experienced multiple traumas, a full regimen of EMDR treatments (12 sessions) was significantly more effective than treatment using only two or three sessions.
EMDR integrates aspects from several styles of therapy including psychodynamic, cognitive, and client-centered therapies "Integral EMDR" (Shapiro & Forrest, 1997) . It can also be used adjunctively to assist therapy of virtually every therapeutic orientation.
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Explanations of why EMDR works
Dr. Shapiro, when interviewed regarding why EMDR works, responded by reflecting on the hypothesis that eye movement might be linked to what occurs in REM (rapid eye movement) sleep. It has, in addition, been theorized by others that REM sleep cycles may provide a reprocessing function for traumatic memories, essentially moving a traumatic memory to a less trauma-based location in the brain. The REM cycles of survivors of trauma are often disrupted and it may be that the deliberate rehearsal of rapid eye movement reproduces the normal reprocessing of the memory that occurs during REM sleep, allowing the person to access the memory without the retraumatizing affect.
Bergmann, (1998) hypothesized that EMDR corrects the marked asymmetry in lateralization of the brain caused by trauma. This correction of lateralization appears to facilitate for the traumatized client a more realistic differentiation between real and perceived threat. Feeling less threat, the client becomes less hypervigilent, allowing rational cognitions to be processed more easily. He speculates that EMDR processing stimulates higher brain functioning, overriding the input from the highly excitable and overreacting limbic structures. The limbic system is an ancient structure considered to be responsible for our initial appraisal of potential threat from the environment. Click here.
for a look at brain scans that show positive affects associated with EMDR treatment.
Bergmann also asserts that eye movement, per se, is less important than rhythmic alternating bilateral hemispheric stimulation of the brain. This bilateral stimulation can be equally achieved through other means such as taps to the right and left hands or knees, and sounds alternating ear-to-ear. Further, Bergmann speculates that the bilateral stimulation produced by EMDR may act as a pacemaker, inducing correct inter-hemispheric activity in the brain. Briefly stated, bilateral eye movements and other rhythmic alternating bilateral hemispheric stimulation of the brain appear to balance the brain, helping it return to pre-trauma levels of cognitive function.
Controlled studies on EMDR effectiveness
EMDR is one of the most researched topics in psychology in the last two decades. To view a list and descriptions of controlled studies on the effectiveness of EMDR treatment click here.
Benefits of EMDR treatment
- Short-term benefits of EMDR frequently include the immediate relief of emotional distress and the elimination of the debilitating affect of unresolved past trauma.
- Longer-term benefits of EMDR therapy often include the restoration of each client's natural state of emotional functioning. This return to normalcy can bring with it a greater sense of personal power, more rewarding relationships and a more peaceful life.
Situations wherein EMDR is not appropriate
EMDR is contraindicated if the clinician has not been fully trained in implementing EMDR techniques and in how to respond to the variety of emotional reactions clients may have to EMDR. EMDR is also contraindicated for clients who:
- are abusing drugs or alcohol
- are taking psychotropic medications that prevent the client from accessing memories
- are actively psychotic
- are especially labile or emotionally fragile
- are mandated to attend treatment sessions, whether the mandate is from the court or a parent
- are experiencing dissociative symptoms
- are too young to understand the process or to focus long enough for a resolution to occur (for a discussion of the advantages and disadvantages of EMDR treatment in children, click here .)
- have secondary gain issues. Individuals with impending legal procedures should obtain their lawyer's approval before proceeding with EMDR.
Cautions of EMDR treatment
- With clients with epilepsy, brain injury, vertigo, dizziness, nausea or eye problems, visual forms of bilateral hemispheric stimulation should not be used. In these cases alternate methods such as tapping the client’s knees or hands, or the use of auditory stimulation may be effective.
- Even controlled rehearsal may cause victims to feel re-victimized. Any mental or physical rehearsal event should include a phase that focuses on defusing emotional reactions, restoring control in the present, and returning victims to a state of calm.
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Clay Watkins is a licensed marriage and family therapist specializing in the use of EMDR in the treatment of PTSD, childhood or adult trauma, anxiety, panic and phobias, with offices located in San Luis Obispo, Arroyo Grande, and Santa Maria, California.
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Our director, Clay Watkins, LMFT, is a licensed Marriage and Family Therapist. He provides individual, couples and family counseling. He specializes in anxiety-related difficulties including panic attacks, post-traumatic stress (PTSD) and phobias. He has advanced training and a decade of experience utilizing