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What is 'EMDR Therapy?

The following is a revised version (2021) of an article that was written for the Australian Psychological Society (APS) in 2014. The original was requested of Sigmund Burzynski, co-authored and largely written by me (Dr Darra J Murphy), with input from Dr Francine Shapiro.
 
The original is available to APS members (only) on the Evidence- based and Quality Information for Psychologists (EQIP) website, but is now well out-of-date. You can read the revised article here, or click on the button above to download it as a Word File.

OVERVIEW

​What is ‘EMDR Therapy’? The shortest answer is that EMDR Therapy is:

 

Eye Movement Desensitisation (EMD) & Reprocessing Therapy (R).

 

Dr Francine Shapiro (18 August 1948 - 16 June 2019), a clinical psychologist in the USA, was the originator and developer of EMDR Therapy. She first discovered the effects of eye movements on memory in 1987. Eye Movement Desensitisation (EMD) was introduced to the world in 1989, with the publication of a randomized controlled trial evaluating its effects with trauma victims – the Mendocino study (Shapiro, 1989). 

 

From EMD to EMDR Therapy

 

Perhaps the most common and persistent misunderstanding is that ‘EMDR’ is simply a treatment technique involving the use of eye movements. That is certainly how it began. EMD was used to address the impact of a single traumatic experience, or post-traumatic stress disorder (PTSD). Although it became obvious early on that the bilateral stimulation (BLS) associated with the eye movements brought up distant associations, the early ‘procedure’ explicitly avoided any further ‘free association’ beyond the memory in question. It limited attention to the single memory being targeted.

 

What also became obvious early on, however, was that the ‘reprocessing’ of a single memory often led to more generalised effects, through spontaneous emergence of more distant associations and other memories. Gradually, the EMD procedure was changed to permit ‘reprocessing’ of other associated memories. EMD evolved into EMDR, as other target memories and sequences of memories emerged.

 

It also became clear that PTSD was often more ‘complex’ than that related to a single event. Psychological trauma often began early in life. As a result of recognising the reality of 'Complex PTSD', reprocessing a traumatic memory to a more adaptive resolution was considerably enhanced by adopting a ‘trauma-informed’ approach. This involves more careful assessment, stabilisation and uncovering before any 'EMDR'. Having said all that, it has taken until 2018 for 'Complex PTSD' to be listed in the ICD-11. It is still not listed in the DSM.

What finally emerged was the eight-phased approach of EMDR Therapy, a highly structured approach to psychotherapy (Method), based on a clear conceptual framework (Model) and an emerging clarity in relation to the underlying physiology of why it works as well as it does (Mechanism). There is a growing literature in relation to all aspects of this integrative approach to psychotherapy (Shapiro, 2014b).

Why EMDR Therapy and not just ‘EMDR’?

Using the acronym ‘EMDR’ in isolation is a problem, as it fails to distinguish the overall approach of EMDR Therapy (Phases 1-8) from the procedures associated with reprocessing a disturbing memory, or EMDR treatment (Phases 2-7). This fosters confusion between the overall ‘system’ of therapy, based on all eight Phases (which articulates with many other therapies) and the ‘procedures’ that are unique to it.

EMDR Therapy does not begin with EMDR treatment. It begins with case conceptualisation through the prism of the Adaptive Information Processing (AIP) model elaborated by Dr Shapiro. In particular, this includes assessment of the client’s capacity for self-regulation, followed by whatever stabilisation and psychoeducation are required, before any reprocessing of disturbing memories is attempted.

Whilst it is true, therefore, that ‘EMDR’ began as a 'treatment procedure' (EMD), it is now much more than an expanded version of EMD. It is a complex and structured approach to psychotherapy, with an emphasis on adverse life experiences and the manner in which they are encoded in memory (Shapiro, 1995). As far back asthe 2nd edition of her ‘Basic Principles, Protocols and Procedures’ she wrote that, if she had her time over again, she would have simply called it ‘Reprocessing therapy’ (Shapiro, 2001).

There are now 36 randomised controlled trials that demonstrate the clinical efficacy of EMDR Therapy in the treatment of trauma (cf. link to Research Overview, below). Its efficacy in the treatment of Post Traumatic Stress Disorder (PTSD) is well-established (Bisson, 2007). Evidence is also accumulating for its efficacy across a broad range of trauma-related psychopathology and its potential clinical application is now considered to be even broader still (Shapiro, 2014a). 

 

The aim of EMDR Therapy is to replace the 'perpetual re-experiencing' of traumatic events with a 'learning experience' that becomes a source of resilience. Divested of their affective load, traumatic memories are ‘reprocessed’ (reconsolidated) as semantic memory and thus become a neutral component of the client’s ‘narrative’, or life story. Desensitisation and more adaptive resolution are experienced as outcomes of reprocessing / re-consolidating a memory held in 'state-specific' form.

PRINCIPLES

​In Shapiro’s conceptual framework, all human beings are physiologically geared towards healing and the restoration of an energy efficient ‘resting’ state. The role of the therapist, therefore, is to facilitate a psychological process that has a naturalistic physiological basis (Shapiro, 2001). 

 

​​Model:        Adaptive Information Processing (AIP)

 

​​The AIP model forms the basis of understanding developmental and clinical phenomena, guides case conceptualisation and treatment planning and predicts positive outcomes. The model holds that:

 

  • disturbing memories are stored physiologically, in 'state-specific’ form, as they were experienced and perceived at the time of an adverse (traumatic) life experience or stressful event;

 

  • without further processing and integration into wider memory networks, dysfunction may occur when the memories of disturbing events are triggered and the encoded emotions, beliefs and physical sensations emerge along with their associated patterns of autonomic arousal and network activation;

 

  • excluding situations caused by inadequate information, or organic deficits, incompletely processed memories are the basis of mental illness.​

 

Memory

 

In Shapiro’s AIP model, therefore, mental illness is viewed primarily as a disorder of memory (Shapiro, 2001). The hypothesis that adverse (traumatic) life experiences and their imprint in memory lie at the heart of mental illness was the original basis of psychoanalysis (Breuer & Freud, 1893). This has been empirically validated (Felitti et al. 1998, Heim et al. 2004, Mol et al. 2005, Afifi et al. 2012).

 

The brain is not simply recording what is happening, through activation of our senses. It is building a memorial map of the world and then using this map to predict what it is likely to encounter and navigate through it. In a resting state, information is initially processed into memory in weak (episodic) form. It may then be consolidated into strong (stable) episodic form and finally reconsolidated into semantic (explicit, narrative) or procedural (implicit, behavioural) form (Stickgold, 2002).

 

Perceptions of current situations link into networks of stored memories in order to be interpreted. So, if a network contains an incompletely processed memory, the current perceptions are informed by the emotions, sensations, thoughts/beliefs associated with the earlier event and the ‘past becomes present’.

 

This is the basis of PTSD and may well be the basis of many other forms of psychopathology (Shapiro, 2014a; Solomon & Shapiro, 2008). Adaptive resolution (reprocessing) of 'traumatic' memories requires the forging of links between disturbing memories and more adaptive memory networks.

 

Mechanism:          Memory Consolidation and Reconsolidation

 

One theory of mechanism is that attention to the key elements of a disturbing memory, along with bilateral physical stimulation (particularly eye movements), stimulates an ‘orienting’ response (Stickgold, 2002). This appears to facilitate the rapid reprocessing of information, such as may occur naturally during the Rapid Eye Movement (REM) phase of sleep, calling up more distant associations.

 

Disruptions of information processing arise as a consequence of the nature and level of the disturbances that occur at the time an adverse life experience is first encoded in memory. Precisely because of the real or perceived threat (or actual injury), such experiences are invariably associated with a high level of autonomic arousal.

 

Encoded thus at the outset, in ‘state-specific form’, these memories may persist in this form and resist integration (Bergmann, 2010). In the AIP model, the incompletely processed memories of these past adverse life experiences result in disorders of cognition (thinking), emotion (feeling) and action (behaviour) in the present.

 

Resting State Networks

Recent developments in neuroscience have also highlighted the importance of ‘Resting State Networks’ (Menon, 2012 & 2015, Chamberlin, 2015, 2019). Three major and widely distributed neural networks represent distinctly different patterns of brain activation and are associated with different degrees and forms of autonomic arousal:

 

  • the Default Mode Network (DMN), associated with being, or doing;

  • the Central Executive Network (CEN), associated with problem solving;

  • the Salience Network (SN), which controls dynamic switching between them.

Essentially, the DMN is internally focussed and the CEN is externally focussed. Under ‘resting’ circumstances, the DMN and CEN are ‘anti-correlated’ and the SN controls the mix of activation required in our responses to stimuli. Thus the Orienting response is associated with a dominant SN, a seamless shifting of attention and rapid network switching between the DMN and CEN.

This switching occurs at speeds of 14-20 msec. At this level of arousal, new information is seamlessly integrated, often unconsciously. These different patterns of activation also correlate with developments in our understanding of stress responses and ‘polyvagal theory’ (Porges, 2001).

Stress Responses

Beyond the normal shifting of attention associated with the ‘orienting’ response, more primitive responses include:

  • a Startle response (Active Freeze), that alerts us to a potential threat;

  • a Fight-Flight response (Action), that effects a response to a perceived threat;

  • a Fright-Faint response (Passive Freeze), or psychic numbing, when Fight-Flight is ineffective.

When something is challenging, it may be associated with activation of the amygdala and a startle response, with selective activation of the DMN (in less than 20 msec). Much of the time, this will be followed by activation of the ventral vagus (recognition of a ‘false alarm’) and restoration of the dominance of the SN (in 500msec). If not, it may persist in memory as a heightened startle response that resists integration. Nonetheless, this level of hyper-arousal lies within a certain ‘window of tolerance’.

 

If, however, the challenge is perceived as a threat, preferencing of the DMN may be associated with activation of the locus coeruleus (LC), over-riding the amygdala and the ventral vagus and launching the Fight-Flight response (within another 20 msec. In these circumstances, the hyper-arousal is clearly outside the window of tolerance and it may take minutes or hours to restore ‘equanimity’. Such experiences may induce or re-enforce an episodic memory of threat that is then difficult to integrate.

 

Finally, if our Fight-Flight response is ineffective and we are overwhelmed, defeated, or injured), this may lead to activation of a Fright-Faint response (dorsal vagus). This is associated with repression of the Fight-Flight response and preparation for death. This may lead to numbness and avoidance of anything that may trigger the memory of this ‘near-death’ experience and a return of the repressed Fight-Flight associated with it (i.e. a panic attack). Not only are such experiences outside the window of tolerance, but they may be difficult to identify as a consequence of the repression.

 

In summary, stressful experiences may ‘up-regulate’ our stress responses and this ‘sensitisation’ may be captured in memory. This may then inhibit the physiological pathways that are necessary to ‘down-regulate’. Thereafter, we may be more easily ‘triggered’ by events in the present, when the disturbing memories are activated. This is consistent with the basic tenets of psychoanalysis as well as classical conditioning (Pavlov) and operant conditioning (Skinner).

 

​EMDR Therapy demonstrates that these memories can be identified and processed to a more adaptive level of resolution, more easily and quickly than has hitherto been recognised. Desensitisation to sensory information in the present that can trigger these associations is both the goal and the outcome of EMDR treatment.

 

 

COMPONENTS

 

​EMDR Therapy involves 8 distinct phases.

Method:        The Eight Phases of EMDR Therapy (& their primary purposes)

1.         History                           (Case conceptualisation)

2.         Preparation                       (Stabilisation, resourcing, psychoeducation)

3.         Assessment                       (Setting up a ‘Target’ memory for reprocessing)

4.         Desensitisation                (Reprocessing / reconsolidating a target memory)

5.         Installation                        (Cognitive enhancement)

6.         Body Scan                         (Somatic enhancement / Embodiment)

7.         Closure                              (Re-stabilisation at the end of a session)

8.         Re-evaluation                   (Review processing & treatment direction)

​​

(Note: EMDR treatment = Phases 3-6)

Phase 1.         History                    (Case conceptualisation)

 

EMDR Therapy begins with the AIP model firmly in mind. Case conceptualisation involves history taking and psychometric assessment, with a focus on current issues and past events that may have increased the client’s vulnerability to stress. Unless the client indicates a problem that may be addressed through education, or a contemporary trauma, the therapist will explain the AIP model and the need to look for past experiential contributors to the presenting problem.

 

Particular attention is given to adverse life experiences in childhood (e.g. adoption, attachment security, illness, injury, family of origin issues, schooling, relationships etc;), alongside  a careful assessment of the client’s current stressors (triggers) and resources (including their own capacity for self-regulation). Direct questioning and EMDR Therapy techniques are used to trace current dysfunction to past experience.

The overall aim is to gain a clear picture of the client’s clinical landscape, so that appropriate sequences of target memories can be identified and a treatment plan developed to respond comprehensively to the presenting problem. 

Standard Protocol

 

In the 'standard protocol' of EMDR Therapy, past experiences are processed first, followed by present triggers. Finally, future templates are set to encourage in vivo activation of behavioural changes. In more complex cases, this may need to be adjusted and augmented, in order to maintain client stability in the present.

 

Phase 2.         Preparation           (Stabilisation, resourcing, psychoeducation)

 

Adequate preparation involves the development of a stable therapeutic relationship and may also require instruction in self-care and affect regulation. This is achieved through standard cognitive-behavioural approaches, as well as relaxation training, breathing and guided imagery techniques. Adaptive memory networks may need to be accessed and targeted for re-enforcement, before any attempt is made to reprocess and reconsolidate disturbing memories.

 

Preparation therefore involves adequate stabilisation (testing and strengthening the client’s capacity for self-regulation), as well as instruction in the AIP model and the methodology of EMDR Therapy, before disturbing memories are even identified let alone reprocessed (EMDR treatment). Clients may have multiple adverse life experiences, beginning at an early age and extending over long periods of time.

 

Although the memories of early adverse life experiences are often easily accessed, in more complex cases such memories may be 'forgotten' (repressed, dissociated) and may only emerge as the processing of what is remembered proceeds. A prolonged period of preparation may be required in such cases, with a clear focus on maintaining client stability in the present. The need for psychotropic medication may also need to be considered in this phase.

 

Phase 3.         Assessment          (Setting up a ‘Target’ memory)

 

The primary goal in this phase is to identify the key elements of a memory which has been selected for further processing (reprocessing). The target memory may be any adverse event or life experience, having regard for the 'standard protocol' as described above.

 

Primary aspects of an individual target memory (T) include an image (I), cognitions (C), emotions (E) and sensations (S), often referred to under the acronym TICES. These elements are identified in a standardised manner, designed to contain the affect that is invariably triggered by recalling such memories.

 

First, an image is sought that represents the worst part (or moment) of the memory. Next, a negative cognition (NC) is sought to express an irrational, exaggerated, inaccurate or false belief about the self that has been ascribed to the event (not one which is simply ‘pessimistic’). This is then offset by seeking a desired positive cognition (PC) to oppose to the NC (i.e. one that is rational, factual, accurate or ‘true’ and not simply ‘optimistic’).

 

Baseline measurements are then made before any attempt is made to reprocess a target memory. A 'validity of cognition’ (VoC) scale is used to assess the strength of the PC with the image in mind (1 feels completely false, 7 feels completely true). Clients are then asked to identify their emotions, when the image and the NC are held in mind and to rate the level of disturbance they feel on a 'subjective units of disturbance' (SUD) scale of 0-10 (where 0 feels calm, or neutral and 10 feels the worst imaginable). Notice that the emphasis is more on the feeling state than the ‘belief’.

 

It should be noted here that 'negative' refers to inaccurate, irrational or exaggerated (false) conclusions about the self and not simply to those which are pessimistic, whilst positive refers to 'accurate, rational (true) conclusions and not simply those which are optimistic. In complex cases, new targets may emerge with processing and further excursions back into the preparation phase may be required.

​​

Phase 4.         Desensitisation    (Reprocessing / reconsolidating a memory)

 

Having selected the target memory for reprocessing, the client is instructed to bring back the memory, to focus on the image, the Negative Cognition (NC) and the sensations in their body. This is how the memory is activated. The therapist instructs the client to ‘let whatever happens happen’ and to ‘just notice’ whatever comes up.

 

The therapist then administers sets of bi-lateral stimulation (BLS), usually eye movements, although auditory stimulation or taps may be used. At the end of each set, the client is asked to report on whatever they notice (any images, thoughts, emotions, sensations). Based on their response and guided by standardised procedures, the therapist determines the next focus of attention, asks the client to focus on it and ‘let whatever happens happen’ again during the next set of BLS.

 

Shapiro has written that: “The instruction to 'let whatever happens happen' and to 'just notice' the trauma and attendant disturbance, were initially included in order to reduce demand characteristics. … This cultivation of a stabilised observer stance in EMDR is inherent in a variety of Eastern meditative practices (Kabat-Zinn, 1990; Krystal et al. in press) and appears similar to the 'mindfulness' of dialectical behaviour therapy (Linehan, 1993) and the 'radical acceptance' of acceptance and commitment therapy (Hayes, Wilson & Strosahl, 1999).” (Shapiro, 2001).

 

​What is most frequently observed during this phase is the forging of associative links between the memory of the stressful life experience and more adaptive memory networks, as new thoughts, insights, emotions and memories spontaneously emerge. Standardised procedures are used to guide the clients’ focus through various aspects of the memory network, until the affect associated with the memory is completely dissipated ('metabolised').

Stressful memories are thus 're-processed', physiologically, to an adaptive resolution. This is generally defined as a reduction in the SUD to 0 (i.e. no disturbance associated with the memory), unless it is deemed ‘ecologically’ appropriate for this to be otherwise. Precisely how much affect is revealed and processed during this phase, in any particular therapy session, depends on the complexity of the client’s adverse life experiences.

 

Phase 5.         Installation            (Cognitive enhancement)

 

Only when the disturbing affect associated with the Target Memory is fully metabolised (SUD = 0, as defined above), does the therapist proceed to this next phase. The goal in this phase is to strengthen the Positive Cognition (PC), by linking it to the original target memory. As the client will have come more fully into the present at this point, at least in relation to this particular experience, the therapist first checks the suitability of the original PC.

 

The client may choose to proceed with this or to choose another PC that is now more suitable (or 'attainable'). The therapist will continue to administer sets of bilateral stimulation until there is an increase in the Validity of Cognition (VoC) to 7 (completely true), when the memory and the chosen PC are held in mind.

 

Phase 6.         Body Scan             (Somatic enhancement / Embodiment)

 

Once satisfied that Phases 4 and 5 have been completed (SUD = 0, VoC = 7), the therapist will check again that there is no residual disturbance in the body. Asking the client to hold the memory and the PC in mind, the therapist instructs the client to scan from their head to their toes for body sensations. Any residual disturbance requires the administration of further sets of BLS, until the disturbance has resolved. Pleasant body sensations may be enhanced with slow sets of BLS.

 

Phase 7.         Closure                   (Re-stabilisation at the end of a session)

 

Typically, processing is considered to be complete when there is a reduction in the SUDS to 0 (no disturbance associated with the memory), an increase in the VoC to 7 (PC felt to be completely true, when the memory and it are paired and held in mind) and a clear body scan (no disturbing body sensations). Anything less may require re-stabilisation at the end of a therapy session.

 

The client may be instructed to use one or more of their stabilisation skills to settle themselves before leaving the room. Clients will also be instructed that processing may continue between sessions and to use a TICES log to note any disturbance, including additional (potential Target) memories that come up between sessions.

 

​Phase 8.         Re-evaluation       (Review processing & treatment direction)

 

Subsequent treatment sessions begin with a re-evaluation of any memory targeted in the previous session.  An incompletely processed memory will require further re-processing (Phase 4-6). An assessment may also be made of the degree to which the processing has resulted in any 'generalisation effect' (i.e. resulted in the automatic processing of associated memories and a general improvement in well-being). A new target will then be selected for processing, or if all target memories have been processed, the therapist will proceed to install 'future templates'.

 

​Overall, as previously described, EMDR Therapy involves a ‘standard (three-pronged) protocol’ for addressing dysfunction which involves targeting:

 

  1. Past events (which act as experiential contributors to current dysfunctions);

  2. Present triggers (that activate disturbances of mood, thinking or behaviour);

  3. Future goals (desired outcomes, which may require education and the incorporation of new skills to optimise function).

 

​​In complex cases (e.g. Dissociative Disorders), identifying the need for additional stabilisation is paramount, before any processing is attempted. This may be difficult at the outset of therapy, which is why completion of an approved training in EMDR Therapy is a basic requirement for the safe practice of this approach to psychotherapy. Advanced training is required to deal with the most complex cases.

​​

 

 

APPLICATIONS & EFFICACY

 

​​Post Traumatic Stress Disorder (PTSD)

EMDR Therapy is widely recognised as having good evidence for its clinical efficacy in the treatment of  PTSD. It is currently recommended by (but not limited to):

International Treatment Guidelines (PTSD)

​2000    International Society for Traumatic Stress Studies

2002    Israeli National Council for Mental Health

2003    Northern Ireland Department of Health

2004    American Psychiatric Association

2004    US Departments of Veteran Affairs & Defense

2005    UK National Institute of Clinical Excellence

2007    Australian National Health and Medical Research Council

2012    Australian Psychological Society

2013    World Health Organisation (WHO)

2014    German Federal Joint Committee (GB-A)

2020    Medicare Australia (Focussed Psychological Strategies)

In its recognition of EMDR Therapy for stress-related disorders, the WHO identified trauma-focused CBT and EMDR Therapy as the only psychotherapies recommended for children, adolescents and adults with PTSD, stating:

 

"Like CBT with a trauma focus, EMDR Therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.”  (WHO, 2013)

 

This highlights the inherent safety of EMDR Therapy, when a 'fidelity' to all 8 phases of the approach is practiced. With adequate preparation, EMDR Therapy carries less risk of re-experiencing of the trauma (due to less exposure) and less likelihood of re-enforcing its impact. In addition, all of the therapeutic work is done within the affect-regulating presence of the therapist.

For PTSD, research has indicated rapid treatment effects in numerous randomized trials. For instance, randomized trials have indicated that 84-90% of single-trauma victims no longer have PTSD within three 90-minute sessions (Rothbaum, 1997; Wilson, Becker & Tinker, 1995, 1997) and 100% of single-trauma victims and 77% of multiple trauma victims no longer have PTSD in a mean of 5.4 hours of treatment (Marcus et al., 1997, 2004).

 

It should be noted, however, that loss of a PTSD diagnosis is relatively easy to achieve. A 'cure' (a more complete relief from distress), however, is also attainable with at least eight 90-minute sessions of EMDR Therapy (van der Kolk, 2008).​

Other applications

 

In addition to the randomised controlled trials that demonstrate the clinical efficacy of EMDR Therapy in the treatment of stress-related disorders, there is a vast emerging literature in relation to other clinical applications. More than 20 randomised trials and a large meta-analysis (Lee et al, 2013) have demonstrated the positive effects of eye movements.

 

Many clients do not meet current diagnostic criteria for PTSD. However, elements of what are defined as characteristics of PTSD are recognisable in a great many cases of psychological distress:

 

Avoidance                                                  (distressing memories, thoughts, feelings)

Heightened arousal                                  (aggressive, reckless, hyper-vigilant)

Re-experiencing                                        (prolonged psychological distress)

Negative thoughts, moods, feelings    (blaming, estrangement)

 

Whilst there is now a whole category of Trauma and Stressor-Related Disorders in the DSM-5 (which includes Acute Stress Disorder, Adjustment Disorders, Reactive Attachment Disorder, as well as PTSD), psychiatric diagnosis is still based largely on symptomatology. This is also true of the ICD-11 (WHO, 2018).

 

However, in the USA, the elaboration of a Research Documentation Criteria Matrix (RDoC Matrix) by the National Institute for Mental Health (NIMH) may herald a shift away from this approach in the near future (NIMH, 2013).

 

 

 

SUMMARY & CONCLUSIONS

In summary, EMDR Therapy is steadily gaining recognition as an effective approach to persistent disturbance associated with the impact of adverse life experiences and how they are held in memory. The goals of EMDR Therapy may be summarised as:

 

-           maximum treatment effects whilst maintaining client safety;

-           adaptive resolution of presenting problems;

-           incorporation of new skills and behaviours;

-           optimisation of client function (cognitive, emotional and somatic).

 

EMDR Therapy recognises that information is stored in memory physiologically and retrieved along with associated patterns of response. As perceptions in the present link to existing memory networks, various components of incompletely processed memories are experienced physiologically (images, emotions, physical sensations, thoughts/beliefs). The information processing system, like other body systems, is inherently homeostatic and geared towards health unless somehow ‘blocked’.

 

As the information processing system is activated, disturbing memories are integrated and transformed into a learning experience, which can become the foundation of increased resilience (Shapiro, 2001).  Whilst underlying biological mechanisms are still under investigation, as with any other form of psychotherapy, research indicates that the bi-lateral physical stimulation (and most particularly eye movements) does indeed change brain function.

 

One theory holds that the BLS taxes working memory and stimulates an 'orienting' response, so that episodic memories of distress are reconsolidated as semantic (narrative) memory and become part of a client’s life story. This occurs naturally to some degree during the rapid eye movement (REM) phase of sleep and may explain why eye movements appear to be so effective in stimulating the processing.

EMDR Therapy is consistent with biomedicine and the physiological principles of regulation and homeostasis. It is already known that the impact of early stressful / adverse childhood experiences (ACEs) have an equivalent or greater negative effect than events which meet the current clinical criteria in the DSM-5 for the diagnosis of PTSD (Mol et al., 2005).

In conclusion, EMDR Therapy is widely recognised for the treatment of PTSD and other trauma-related disorders (cf. link to ‘Evaluated Clinical Applications’, below). in 2014, Shapiro also drew the attention of the medical profession to the importance of processing the impact of all adverse life experiences (Shapiro, 2014a), as these have significant implications for health in general and are highly amenable to treatment (cf. link to Research Overview, below)

REFERENCES

 

Afifi, T.O., Mota, N.P., Dasiewicz, P.,   MacMillan, H.L.  & Sareen, J. (2012). Physical punishment and mental disorders: Results from a nationally representative US sample. Pediatrics, 130.

 

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. p.265-327.

 

Bisson, J. & Andrew, M. (2013). Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews. Online at http://summaries.cochrane.org/CD003388

 

Bergmann, U. (2010). EMDR’s Neurobiological Mechanisms of Action: A Survey of 20 Years of Searching. Journal of EMDR Practice and Research. Volume 4, Number 1: 22-42.

 

Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258.

 

Heim, Plotsky & Nemeroff (2004). Importance of studying the contributions of early adverse experience to neurobiological findings in depression. Neuropsychopharmacology, 29, 641–648.

 

Lee, C.W. & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy & Experimental Psychiatry, 44, 231-239.

 

Marcus, S., Marquis, P. & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting.  Psychotherapy, 34, 307-315.

 

Marcus, S., Marquis, P. & Sakai, C. (2004). Three- and 6-month follow-up of EMDR treatment of PTSD in an HMO setting.  International Journal of Stress Management, 11, 195-208.

 

Mol, S. S. L., Arntz, A., Metsemakers, J. F. M., Dinant, G., Vilters-Van Montfort, P. A. P., & Knottnerus, A. (2005). Symptoms of post-traumatic stress disorder after non-traumatic events: Evidence from an open population study. British Journal of Psychiatry, 186, 494–499.

 

Rothbaum, B. (1997). A controlled study of eye movement desensitization and reprocessing in the treatment of post-traumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317-334.

 

Shapiro, F. (1989). Efficacy of the eye movement desensitisation procedure in the treatment of traumatic memories. J Trauma Stress. Apr;2(2): 199-223.

 

Shapiro, F. (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. 1st ed. New York: Guilford Press.

 

Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing. Basic Principles, Protocols and Procedures. 2nd ed. New York, NY: The Guildford Press.

 

Shapiro, F. (2017). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols and Procedures. 3rd ed. New York, NY: The Guildford Press.

 

Shapiro, F (Editor) et al: EMDR as an Integrative Approach to Psychotherapy. American Psychological Association (2002).

 

Shapiro, F. (2014a). The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms stemming from Adverse Life Experiences. Perm J 2014 Winter; 18(1):71-77.

 

Shapiro, F. (2014b). EMDR Institute Training Manuals. EMDR Institute Inc., Watsonville, California.

 

Stickgold, R. (2002). EMDR: A Putative Neurobiological Mechanism of Action. Journal of Clinical Psychology, Vol. 58(1), 61-75.

 

Stickgold, R. (2008). Sleep-Dependent Memory Processing and EMDR Action. Journal of EMDR Practice and Research, Volume 2, Number 4: 289-299.

 

Wilson, S., Becker, L.A., & Tinker, R.H. (1995). Eye movement desensitization and reprocessing (EMDR): Treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology, 63, 928-937.

 

Wilson, S., Becker, L.A., & Tinker, R.H. (1997). Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment of post-traumatic stress disorder and psychological trauma. Journal of Consulting and Clinical Psychology, 65, 1047-1056.

World Health Organization. (2013). Guidelines for the management of conditions that are specifically related to stress. Geneva, WHO: p.1.

 

RECOMMENDED READING

 

Adler-Tapia, R; Settle, C: EMDR and The Art of Psychotherapy With Children. Springer Publishing Company (2008).

 

Bergmann, U: Neurobiological Foundations for EMDR practice. Springer Publishing Company (2010).

 

Forgash, F; Copeley, M (Editors): Healing the Heart of Trauma and Dissociation with EMDR and Ego State Therapy. Springer Publishing Company (2008).

 

Knipe, J: EMDR Toolbox. Theory and Treatment of Complex PTSD and Dissociation. Springer Publishing Company (2015).

Leeds, A: A Guide to the Standard EMDR Protocols for Clinicians, Supervisors, and Consultants. Springer Publishing Company (2009).

 

Luber, M (Editor): EMDR Scripted Protocols. Springer Publishing Company (2009).

 

Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols and Procedures. 3rd ed. New York, NY: The Guildford Press.

 

Shapiro, F (Editor) et al: EMDR as an Integrative Approach to Psychotherapy. American Psychological Association (2002).

 

Shapiro, F: Getting Past Your Past. Take Control of Your Life with Self-help Techniques from EMDR Therapy. Rodale Books (2012).

 

Shapiro, R (Editor): EMDR Solutions. Pathways to Healing. W.W. Norton& Company (2005).​

 

 

FURTHER INFORMATION       

Evaluated Clinical Applications        

http://www.emdr.com/clinical-applications/

 

Research Overview               

https://www.emdr.com/research-overview/

 

RDoc Matrix

https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/about-rdoc.shtml