Eye Movement Desensitization and Reprocessing (EMDR)
Overview
Eye Movement Desensitization and Reprocessing (EMDR) therapy is an approach that aims to help individuals cope with distressing memories. EMDR comprises eight phases where clients work with a licensed mental health professional to process and reframe traumatic experiences.[1] This modality is unique compared to other therapies because the client is guided through bilateral stimulation in the form of eye movements to process the traumatic experience. While EMDR has been used to primarily address conditions like post-traumatic stress disorder (PTSD), its applications have expanded to other psychiatric conditions.
History and Development
Eye Movement Desensitization and Reprocessing therapy was introduced in 1989 by American Psychologist Francine Shapiro.[2] Shapiro discovered that a person’s specific eye movements while walking in the park and simultaneously recalling distressing memories reduced associated negative emotions.[3] To determine its effectiveness on others, Shapiro (1989) conducted a study to assess the impact of Eye Movement Desensitization (EMD) on patients with PTSD.[4] The study included 22 participants who experienced traumatic incidents during the Vietnam War.[5] The participants’ symptoms reported included low self-esteem, intrusive thoughts, flashbacks, and relationship problems.[6] After one month of EMD therapy, eight participants had their symptoms of flashbacks, nightmares, daily headaches, and insomnia eliminated.[7] EMD was changed to EMDR in 1991 to reflect the cognitive changes during treatment.
In 1995, the EMDR International Association was founded to establish standards for training and practice. Its primary objective is “establishing, maintaining, and promoting the highest standards of excellence and integrity in EMDR practice, research, and education.[8]
Foundation
Shapiro developed the theory of Adaptive Information Processing (AIP) to offer insights into the observed outcomes of EMDR therapy.[9] The AIP model states that the human brain typically can effectively process stress-inducing information.[10] However, maladaptive storage of traumatic memories hinders the rational processing of information.[11] For example, these traumatic memories may resurface with such intensity that they feel as if the traumatic event is happening presently. Additionally, negative self-worth, such as thinking “I am not good enough,” can be a symptom of unprocessed past life experiences that still influence an individual’s emotions and perspective.[12]
Techniques of EMDR
EMDR typically consists of the following eight phases:[13]
Phase 1 - History and Treatment Planning: The client’s readiness for EMDR is assessed by a trained licensed mental health professional (e.g., therapist) using the client’s comprehensive history, dysfunctional behaviors, symptoms, specific characteristics, any secondary gains from what the client is experiencing. Additionally, two scales are used:
Validity of Cognition Scale (VOC): This measures how true each of the new positive beliefs that were introduced feel to them. This scale is measured on range of 1 (totally false) to 7 (totally true).[14]
Subjective Units of Disturbance Scale (SUDS): When the client names an emotion they are feeling, the clinician will ask how disturbing does it feel right now on a scale of 0 (no disturbance) to 10 (worst possible disturbance).[15]
Note: during later stages, the VOC and SUD are repeated to measure how well a client is responding to treatment. Lastly, in Phase 1, a treatment plan is created.
Phase 2 - Preparation: The client and therapist build a therapeutic relationship and establish reasonable expectations. Then as part of the therapeutic process, the client is encouraged to utilize metaphors when explaining their traumatic memories and stop signals to indicate moments of distress during therapy sessions.
Phase 3 - Assessment: The process involves pinpointing the relevant memory and guiding the client to identify the least distressing image associated with it. The client is assisted in addressing and challenging the negative beliefs connected to the memory, offering a new perspective on the event. Additionally, positive beliefs are introduced related to the target memory to counterbalance the emotional impact.
Phase 4 - Desensitization: The therapist will guide the client in performing eye movements and deep breaths while recalling the target memory. The therapist will adapt the direction, pace, and type of stimulation based on the client’s response.
Phase 5- Installation: There is an increase in the strength of the positive cognition associated with the traumatic memory until the VOC scale is seven or above.
Phase 6 - Body Scan: The client is asked to recognize any somatic responses (e.g., muscular tension and temperature fluctuations) by body scanning when revisiting the traumatic event. If any such responses are identified, those will serve as the focal point for additional processing and exploration.
Phase 7 - Closure: The client is guided on what to anticipate between sessions, encouraged to track any problems they experience and use coping strategies like deep breathing and grounding techniques.
Phase 8 - Reevaluation: A comprehensive review occurs to ensure the treatment produces the best possible outcomes for the client and address any additional areas that may require attention.
Efficacy and Limitations
Although EMDR is evidence-based and professionally supported, it generates more controversy than other therapeutic approaches. The debate arises from the use of bilateral stimulation in the therapy, and the factors contributing to its success remain uncertain.[16] To test the efficacy of this modality, Van Der Kolk (2021) evaluated the long-term effectiveness of EMDR compared to traditional pharmacotherapy interventions.[17] The results indicated that SSRIs were more reliable for initial treatment, while EMDR demonstrated greater efficacy in symptom reduction.[18]
Taylor et al. (2023) conducted a study of the effectiveness of three distinct treatments for PTSD examined in a cohort of 60 participants, including prolonged exposure, relaxation training, and EMDR.[19] Although the findings indicated a similarity in the benefits and overall efficacy of the three treatments, notable differences were observed.[20] Specifically, exposure therapy was the most effective, demonstrating a reduction in re-experiencing and avoidance symptoms and a quicker response in diminishing avoidance upon treatment completion.[21] However, Maxfield and Hyer (2001) note that the effectiveness of EMDR varies across different studies, primarily due to methodological disparities.[22]
If you would like to explore if EMDR might benefit you, please reach out to a licensed psychologist or therapist for an appointment to learn more about your options.
Contributed by: Kelly Valentin
Editor: Jennifer (Ghahari) Smith, Ph.D.
references
1 Menon, S. B., & Jayan, C. (2010). Eye Movement Desensitization and Reprocessing: A Conceptual framework. https://doi.org/10.4103/0253-7176.78512
2 Maxfield, L. (2019). A Clinician’s guide to the Efficacy of EMDR therapy. https://doi.org/10.1891/1933-3196.13.4.239
3 Shapiro, F., & Forrest, M. S. (1997). EMDR: the breakthrough therapy for overcoming anxiety, stress, and trauma. https://doi.org/10.5860/choice.35-0593
4 Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. https://doi.org/10.1002/jts.2490020207
5 Ibid.
6 Ibid.
7 Ibid.
8 EMDR International Association. (2023, October 20). EMDR International Association Home | EMDR Practitioners. https://www.emdria.org/
9 Hill, M. D. (2020). Adaptive Information Processing Theory: origins, principles, applications, and evidence. https://doi.org/10.1080/26408066.2020.1748155
10 Hase, M., Balmaceda, U. M., Ostacoli, L., Liebermann, P., & Hofmann, A. (2017). The AIP model of EMDR therapy and pathogenic memories. https://doi.org/10.3389/fpsyg.2017.01578
11 Hill, M. D. (2020). Adaptive Information Processing Theory: origins, principles, applications, and evidence. Journal of Evidence-based Social Work. https://doi.org/10.1080/26408066.2020.1748155
12 Solomon, R., & Shapiro, F. (2008). EMDR and the Adaptive Information Processing ModelPotential Mechanisms of Change. https://doi.org/10.1891/1933-3196.2.4.315
13 Menon, S. B., & Jayan, C. (2010). Eye Movement Desensitization and Reprocessing: A Conceptual framework. https://doi.org/10.4103/0253-7176.78512
14 Hendriks, E. E. (2014). Exploring eye movement desensitization and reprocessing (EMDR) as a technique for therapeutic intervention of adolescents experiencing trauma. https://www.semanticscholar.org/paper/Exploring-eye-movement-desensitization-and-(EMDR)-a-Hendriks/92332befc93eece325551df3e9bda00d52b354d2
15 Šalkevičius, J., Miškinytė, A., & Navickas, L. (2019). Cloud based Virtual Reality Exposure Therapy service for public speaking anxiety. Information, 10(2), 62. https://doi.org/10.3390/info10020062
16 Landín-Romero, R., Moreno‐Alcázar, A., Pagani, M., & Amann, B. L. (2018). How does eye movement desensitization and reprocessing therapy work? A systematic review on suggested mechanisms of action. https://doi.org/10.3389/fpsyg.2018.01395
17 Van Der Kolk, B. A. (2021, February 4). A randomized clinical trial of Eye Movement Desensitization and Reprocessing (EMDR), Fluoxetine, and pill placebo in the Treatment of Posttraumatic Stress Disorder: Treatment Effects and Long-Term Maintenance.https://www.psychiatrist.com/jcp/randomized-clinical-trial-eye-movement-desensitization
18 Ibid.
19 Taylor, S., Thordarson, D. S., Maxfield, L., Fedoroff, I. C., Lovell, K., & Ogrodniczuk, J. S. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71(2), 330–338. https://doi.org/10.1037/0022-006x.71.2.330
20 Ibid.
21 Ibid.
22 Maxfield, L. (2019). A Clinician’s guide to the Efficacy of EMDR therapy. https://doi.org/10.1891/1933-3196.13.4.239