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Eye movement desensitization and reprocessing (EMDR) is a psychotherapy developed by Francine Shapiro that emphasizes disturbing stored memories as the cause of psychopathology.^[1][2] EMDR is used for individuals who have been victimized by severe traumatic events and have not resolved these experiences.^[3] This psychotherapy is designed as an exposure therapy. According to Shapiro, when a traumatic or distressing experience occurs, it may overwhelm usual cognitive and neurological coping mechanisms. The memory and associated stimuli of the event are inadequately processed, and are dysfunctionally stored in an isolated memory network.^[4] The goal of EMDR therapy is to process these distressing memories, reducing their lingering influence and allowing clients to develop more adaptive coping mechanisms. EMDR incorporates aspects of many major orientations: psychodynamic, behavioral, cognitive, experiential, hypnotic and systems theory. This is done by having clients imagine certain events while following the therapist's hand movement.^[5] Stages of this process are explained later in this article. The use of EMDR was originally developed to treat adults suffering from PTSD, however, the use of EMDR has been implemented for children.^[6]

Development

EMDR was first developed by Francine Shapiro upon noticing that certain eye movements reduced the intensity of disturbing thought, She then conducted a scientific study in 1998. The success rate of that first study using trauma victims was posted in the Journal of Traumatic experience. ^[7] Shapiro noted that when she was experiencing a disturbing thought her eyes were involuntarily moving rapidly. She noticed further that when she brought her eye movements under voluntary control while thinking a traumatic thought, anxiety was reduced.^[8] Shapiro developed EMDR therapy for post-traumatic stress disorder. She speculated that traumatic events "upset the excitatory/inhibitatory balance in the brain, causing a pathological change in the neural elements".^[8] EMDR is now recommended as an effective treatment for trauma in the Practice Guidelines of the American Psychiatric Association.^[9]

Approach

EMDR uses a structured eight-phase approach to address the past, present, and future aspects of a traumatic or distressing memory that has been dysfunctionally stored. The therapy process and procedures are according to Shapiro.^[10]

During the processing phases of EMDR, the client focuses on the disturbing memory in multiple brief sets of about 15–30 seconds. Simultaneously, the client focuses on the dual attention stimulus, which consist on focusing on the trauma, while the clinicians initiates lateral eye movement.^[11] Following each set, the client is asked what associative information was elicited during the procedure. This new material usually becomes the focus of the next set. This process of personal association is repeated many times during the session.^[12]

Although EMDR is established as an evidence-based treatment for PTSD there are two main perspectives on EMDR therapy. First, Shapiro^[13] proposed that although a number of different processes underlie EMDR, the eye movements add to the therapy's effectiveness by evoking neurological and physiological changes that may aid in the processing of the trauma memories being treated. The other perspective is that the eye movements are an unnecessary epiphenomenon, and that EMDR is simply a form of desensitization.

EMDR treatment consists of 8 phases and each phase has its precise intentions.^[14][15]

Phase I History and Treatment Planning

The therapist will conduct an initial evaluation of the client’s history and develop a general plan for treatment.

Phase II Preparation

During this phase the therapist discusses the methods and theory behind EMDR further in detail. He or she will also assess whether the client is ready or stable enough to begin delving deeper into the emotions. If need be the therapist will teach the client the coping skills necessary to advance further into the treatment plan. It is important that during this phase the client develop trust in the therapist. The client will also learn how to manage challenging feelings effectively when in between sessions.

Phase III Assessment

During phase 3, the therapist will ask the client to visualize an image which represents the disturbing event. Along with it the client will describe a thought or negative cognition (NC) associated with the image. The client will be asked to develop a positive cognition (PC) to be associated with the same image that is desired in place of the negative one. The client is asked how strongly he or she believes in the negative and positive cognitions to be true. The client is also asked to identify where in the body he or she is sensing discomfort.

Phase IV Desensitization

At this time, when the client is focused on the negative cognition as well as the disturbing image together, the therapist begins the bilateral gestures and requests the client to follow the gestures with their eyes. This process continues until the client no longer feels as strongly about the negative cognition with the image.

Phase V Installation Phase

At this time the therapist will ask the client to focus on the positive cognition developed in phase 3. The therapist will continue with the gestures and the client is to continue following with the eyes while focusing on the new and positive thought. When the client feels he or she is coertain the positive cognition has replaced the negative the istallation phase is complete.^[16][17]

References