Over the years Eye Movement Desensitization and Reprocessing (EMDR) therapy has become increasingly popular, evidence-based, therapy approach to resolving psychological distress. Initially used to relieve psychological distress related to clinical symptoms caused by traumatic experiences, its use has now spread to relieving psychological distress related to a number of different clinical symptoms that cause psychological distress and not only to clinical symptoms caused by traumatic experiences.
History of EMDR
According to Francine Shapiro (1989), sometime in 1987, she was walking in the park when she realized that eye movements appeared to decrease the negative emotion associated with her own distressing memories. Francine assumed that eye movements had a desensitizing effect, and when she experimented with this she found that others also had the same response to eye movements. It became apparent however that eye movements by themselves did not create comprehensive therapeutic effects and so she added other treatment elements, including a cognitive component, and developed a standard procedure that she called Eye Movement Desensitization (EMD). Over the following years, Francine continued to develop this treatment approach, incorporating feedback from clients and other clinicians who were using EMD. Consequently, sometime in 1991, she changed the name to Eye Movement Desensitization and Reprocessing (EMDR) to reflect the insights and cognitive changes that occurred during treatment, and to identify the information processing theory that she developed to explain the treatment effects (Shapiro, 1991).
Efficacy of EMDR
Even though criticized at first, over the years EMDR has got a broad base of published case reports and controlled research that supports it as an empirically validated treatment of trauma and other adverse life experiences.
According to the American Psychologist’s Association (APA), with a number of controlled studies of EMDR, EMDR is currently one of the most researched methods of psychotherapy used in the treatment of trauma. Its efficacy has been supported by a number of studies.
The Form of EMDR
At the moment EMDR is best described as a complex therapy approach that combines salient elements of the major therapeutic schools (e.g., cognitive, behavioral, psychodynamic, physiological, and interactional). Although the eye movement stimulation (and other forms of dual stimulation used in the approach) have garnered the most attention professionally and publicly, EMDR actually involves a much broader spectrum of interventions, which are organized into eight phases of therapy (Shapiro, 2001).
In the eight phases of EMDR therapy approach, attention is given to three time periods – the past, present, and future. During this, the attention is given to past disturbing memories and related events. And, also, to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions.
The following is a more detailed overview of the eight phases of EMDR therapy, according to Shapiro (2001).
Phase 1: The first phase is a history-taking session(s), where assessment of the a client’s readiness is performed, after which a treatment plan is starting to be developed. Within this phase, possible targets for EMDR processing are identified. These may include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.
Initial EMDR processing may be directed to childhood events rather than to adult-onset stressors or the identified critical incident if the client had a problematic childhood. By doing this, it is possible to generally gain insight into situations, which resolves emotional distress and starts to change the problematic behaviors. The length of treatment depends upon the number of traumas and the age of onset of clinical symptoms. Generally, those with single event adult onset trauma can be successfully treated in under 5 hours. In this regard, multiple trauma victims may require a longer treatment time.
Phase 2: During the second phase of treatment, the knowledge about different ways of handling emotional distress in raised. In this regard, the client may learn a variety of imagery and stress reduction techniques that can be used during and between sessions.
In general, the goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.
Phases 3-6: In phases three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying three things:
1. The vivid visual image related to the memory
2. A negative belief about self
3. Related emotions and body sensations.
In addition, during this stage, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones. The type and length of these sets are different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneously happens.
After each set of stimulation, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending on the client’s report, the clinician will choose the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.
When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session. At this time, the client may adjust the positive belief if necessary and then focus on it during the next set of distressing events.
Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses
When it comes to different stages of EMDR therapy described above, it should be noted that currently EMDR is often used as a part of integrative therapy approach. Hence, at times, the form of EMDR therapy may deviate from the one described by Shapiro (2001).
As it was previously noted, the EMDR integrates many psychological theories including psychodynamic, behavioral approaches, and cognitive behavioral theory. This makes EMDR possible to use as a part of integrative therapy approach. This type of approach is, therefore, possible to use with a wide variety of client and in a wide variety of situations.
In addition, numerous studies have shown the effectiveness of EMDR. Much of the EMDR research has studied clients suffering from PTSD, particularly veterans. However, studies proving the efficacy of EMDR have been conducted on clients struggling with addictions, excessive grief, developmental traumas, sexual dysfunction, and dissociative disorders, to name a few.
Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223.
Shapiro, F., (1991). Eye movement desensitization & reprocessing procedure: From EMD to EMD/R-a new treatment model for anxiety and related traumata. Behavior Therapist, 14, 133-135.
Shapiro, F., (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd edition). New York: Guilford Press.