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EMDR (Eye Movement Desensitization and Reprocessing) Therapy
By: Lisa M. Salvi, Ph.D, LCSW

What is EMDR Therapy?
EMDR (Eye Movement Desensitization and Reprocessing) Therapy is an extensively researched psychotherapy method and comprehensive treatment that provides efficient and rapid treatment of trauma and many types of psychological stress. EMDR has been found effective by the American Psychiatric Association (American Psychiatric Association, 2004); the International Society for Traumatic Stress Studies (Foa,E.B., Keane, T.M., Friedman, M.J. & Coheng, J.A., 2009); the Department of Defense (Department of Veterans Affairs & Department of Defense, 2004); and the World Health Organization (World Health Organization, 2013). It is also considered evidence- based treatment for anxiety and depression symptoms and is widely used for other treatment issues, including: phobias and panic attacks (De Jongh, A., Ten Broeke, E., & Renssen, M.R., 1999); complicated grief (Gattinara, 2009); substance abuse and other addictive behaviors (Abel & O’Brien, 2010); obsessive compulsive disorder (Bohm, K, & Voderholzer, U, 2010) and adults with a history of abuse and/or neglect (Parnell, 1999). EMDR can be used with children as young as three years old, adolescents and adults across the lifespan.

How did it start?
EMDR Therapy was originated and developed by Dr. Francine Shapiro in 1987. While walking through the park one day after receiving rather upsetting news at a doctor's appointment, she noticed that her eyes were going back and forth, and as they were, the level of distress she experienced was decreasing. Although it began as a spontaneous observation, she began to experiment with voluntary eye movements, while recalling other upsetting events in her life. With repetition of the procedure, the memory became less distressing. In 1989, she conducted a research study with combat veterans and victims of sexual assault and found that EMDR significantly reduced the symptoms of posttraumatic stress of participants in this study. Other research studies followed, which also found significant results for the effectiveness of EMDR. To date, over 20 randomized controlled treatment outcome studies of PTSD show that EMDR therapy is an effective treatment modality for ameliorating posttraumatic stress symptoms (Bisson, J., Roberts, N.P., Andrew, M., Cooper, R. & Lewis, C., 2013).

Why does it help?
Although EMDR was originally seen by other therapists as merely a technique, it is actually a comprehensive treatment approach with a theoretical framework of how healing occurs. It is based on the belief that current difficulties and emotional symptoms have been caused by previous upsetting life experiences, ranging from what we refer to as ”Big T” traumatic events such as combat stress, assaults and natural disasters, to “little t” distressing childhood events that have accumulated and affect a person’s self-image and emotional well-being. While perhaps one upsetting event with a bully (considered a “little t” trauma) may not have a lasting impact, many experiences of being bullied will accumulate and lead to distortions in self-image, negative beliefs about self, emotional distress, etc.

EMDR clinicians believe that we are all born with an innate ability to process upsetting events that occur in our lives on a daily basis, which we refer to as the “Adaptive Information Processing System”. We all have this system which has been with us since birth, that helps us think problems through and process or “digest” them. In essence, we are all innately hardwired towards healing, both psychologically as well as physically. If we get a scrape or cut, our body knows what to do to heal itself and automatically begins the process. However, if a wound is deeper, some external intervention may be needed to facilitate healing, such as stitches, splints, or in severe cases, surgery.

The theory behind EMDR is that this natural healing system is disrupted when we have more intensely disturbing or traumatic events that occur. During these times, our brain is flooded with stress hormones that affect how it works. Neurophysiological evidence now suggests that our brain stores traumatic memories differently than other memories. Traumatic memories are stored in original, unprocessed form, often with dissociated sensory fragments. Since the memory has not been processed, it becomes “stuck” or frozen and stored in its original state. This means that any situation or event that is somehow reminiscent of the original trauma will cause other elements of the experience to be relived.  These symptoms can be experienced as flashbacks, intrusive thoughts or images of the traumatic event, or nightmares. Those who have endured a traumatic event will often go to great lengths to avoid reminders relating to the event in an effort to keep these symptoms at bay. Other related but less commonly known symptoms of trauma can include: anxiety, irritability, lack of energy, hypervigilance, inability to concentrate, depression, and feelings of being numb or disconnected from others. Sometimes people may begin to rely on drug or alcohol use as a means of dealing with the intensity of the emotions and reminders of the event. EMDR therapy can help by activating the traumatic memory and moving it through to adaptive resolution so that it does not have the same intense emotional and physiological reaction when reminders of the trauma are experienced.

How does it work?
In EMDR therapy, a client would be asked to recall a distressing event from the past and hold different aspects of the memory in mind. These components of memory may include the visual image that represents the worst part of the experience, the emotion that arises as they reflect on it, the negative belief they have about themselves and the bodily sensations that accompany the memory. After answering questions about the event that are meant to activate the components of memory, a client then tracks the therapist's fingers (or lights on a bar) that move from left to right in front of their eyes. Although eye movements are one form of “bilateral stimulation”, others that may be used include auditory tones listened through headphones, or tactile buzzers that alternate, vibrating in each hand. Unlike other forms of therapy, the goal of EMDR isn’t to desensitize the traumatic memory, but rather to help the brain integrate the fragmented components that have been stored in their “undigested” form. As the processing of the event continues, clients typically feel less emotional intensity about the event, while accessing positive shifts in their perspective as they access adaptive memory networks that were not available to them during the trauma. Thus, a firefighter who previously struggled with feelings of guilt and responsibility due to being unable to rescue a child in a fire may realize that they did the best they could in that situation.

Why does it work?
There are several hypotheses of what makes EMDR so effective. As with many issues that involve the brain, we do not have a definitive answer. One hypothesis is that forms of bilateral stimulation increase the “communication” and collaboration of the left and right hemispheres of the brain. Another, which is receiving more support from neurobiological studies, is that the process mimics that of REM sleep, in which our eyes go from left to right while we are in an unconscious state. Scientists have discovered that during the REM sleep state, there is a part of our brain that is typically “offline” during conscious awake states, and that this part of the brain allows us to see events from a different perspective and helps us to problem-solve, even during sleep. Brain scans have shown through imaging studies that this part of the brain becomes activated during EMDR, and is believed to help people shift perspectives and see events from a different “angle” when recalling past memories. Thus, EMDR therapy can help people access parts of a traumatic memory that may have been dissociated, activate it through the use of bilateral stimulation, and help process it through to adaptive resolution so it no longer has the same emotional or physiological intensity as it used to.

For more information on EMDR: visit emdr.com or emdria.org.

REFERENCES
Abel N.J. & O’Brien., J.M. (2010). EMDR treatment of comorbid PTSD and alcohol dependence: A case example. Journal of EMDR Practice and Research, 4, 50-59.

American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder.  Arlington, VA:  American Psychiatric Association Practice Guidelines.

Bisson, J.I., Roberts, N.P., Andrew, M., Cooper, R. & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults (Review). Cochrane Database of Systematic Reviews 2013, DOI:  10, 1002/14651858.CD03388.pub4

Bohm, K, & Voderholzer, U, (2010). Use of EMDR in the treatment of obsessive-compulsive disorders:  A case series.  Verhaltenstherapie, 20, 175-181.

DeJongh, A., Ten Broeke, E., & Renssen, M.R. (1999). Treatment of specific phobias with eye movement desensitization and reprocessing (EMDR):  Protocol, empirical status, and conceptual issues. Journal of Anxiety Disorders, 13, 69-85.

Department of Veterans Affairs & Department of Defense (2004). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress.  Washington, DC:  Veterans Health Administration. Department of Veterans Affairs and Health Affairs, Department of Defense. Office of Quality and Performance publication 10Q-CPG/PTSD-04.

Foa, E.B., Keane, T.M., Friedman, M.J. & Cohen, J.A., (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies. New York:  Guilford Press.

Gattinara, P.C. (2009). Working with EMDR in chronic incapacitation diseases:  The experience of a neuromuscular diseases center.  Journal of EMDR Practice and Research, 3, 169-177.

Parnell, L. (1999). EMDR in the treatment of adults abused as children. New York:  Norton.

World Health Organization (2013). Guidelines for the management of conditions that are specifically related to stress. Geneva, WHO.

Dr. Salvi is a certified EMDR therapist and an EMDRIA approved consultant. She is the coordinator of the Westchester County Trauma Recovery Network. She is a member of the EMDRIA regional group. She teaches at the NYU Silver School of Social Work Postgraduate Center for Child and Family Certification Program and facilitates training at the Big Oak Psychotherapy Training Institute.

Dr. Salvi’s website is lisasalviphd.com

Statements contained in the authored articles on the Westchester County Psychological Association (WCPA) website are the personal views of the authors and do not constitute WCPA policy unless so indicated. The information in the articles on the WCPA website is for educational purposes only. The information contained in the articles is not intended for diagnosis, psychological advice or medical advice.  It is not intended to be treatment and is not a replacement for psychotherapy. If you are in need of psychological treatment, you can utilize our clinician database which can be accessed by clicking on the link, "Find a Psychologist." WCPA and its directors and employees are not liable for any damages resulting from the utilization of information contained in articles posted on the WCPA website.

 

 

 


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