Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories.
Francine Shapiro’s Adaptive Information Processing model posits that EMDR therapy facilitates the accessing and processing of traumatic memories and other adverse life experience to bring these to an adaptive resolution. After successful treatment with EMDR therapy, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced.
During EMDR therapy the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus.
Therapist directed lateral eye movements are the most commonly used external stimulus but a variety of other stimuli including hand-tapping and audio stimulation are often used.
Shapiro hypothesizes that EMDR therapy facilitates the accessing of the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.
EMDR therapy uses a three pronged protocol:
1. the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information;
2. the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized;
3. imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning.
In plain English
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference.
It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma.
When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes.
Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.
More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions.
There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense.
Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the ”everyday’ memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 25 years.
EMDR therapy is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings.
In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.
For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, ”I survived it and I am strong.”
Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes. The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution, all without speaking in detail or doing homework used in other therapies.
EMDR therapy combines different elements to maximize treatment effects. A full description of the theory, sequence of treatment, and research on protocols and active mechanisms can be found in F. Shapiro (2001) Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd edition) New York: Guilford Press.
EMDR therapy involves attention to three time periods: the past, present, and future. Focus is given to past disturbing memories and related events. Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions.
With EMDR therapy, these items are addressed using an eight-phase treatment approach.
Phase 1: The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These 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. Clients generally gain insight on their situations, the emotional distress resolves and they start to change their behaviors. The length of treatment depends upon the number of traumas and the age of PTSD onset. Generally, those with single event adult onset trauma can be successfully treated in under 5 hours. Multiple trauma victims may require a longer treatment time.
Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A 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, 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 is 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 upon 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.
What Is Eye Movement Desensitization and Reprocessing (EMDR) Therapy?
EMDR is a unique, nontraditional form of psychotherapy designed to diminish the traumatic event itself and focus more on the disturbing emotions and symptoms that result from the event. Treatment includes a hand motion technique used by the therapist to guide the client’s eye movements from side to side, similar to watching a pendulum swing.
EMDR is a controversial intervention, because it is unclear exactly how it works, with some psychologists claiming it does not work. Some studies have shown, however, that EMDR is effective for treating certain mental-health conditions.
When it’s used
EMDR was originally developed to treat the symptoms of post traumatic stress disorder, anxiety, and phobias. Some therapists also use EMDR to treat depression, eating disorders, schizophrenia, sexual disfunction, and stress caused by chronic disease.
What to Expect
In the early stages of therapy, you will discuss your problems and symptoms with your therapist, but you won’t necessarily have to reveal all the details of your traumatic experience.
Instead, your therapist will help you focus on related negative thoughts and feelings that you are still experiencing, and decide which of these beliefs are still relevant and which ones you would like to replace with positive thoughts and beliefs. You will learn techniques to help you deal with disturbing feelings.
Your therapist will then guide you through a process known as desensitization. While keeping the memory of a painful or traumatic event in mind, you will follow the therapist’s back-and-forth finger movements with your eyes. The purpose of this technique is to help you fully process your negative feelings and begin to recognize that you no longer need to hold on to some of them.
Future sessions are devoted to reinforcing and strengthening positive feelings and beliefs until you get to a point where you can bring up memories of the traumatic event without experiencing the negativity that brought you to therapy in the first place.
How It Works
The goal of EMDR is to fully process past experiences and sort out the emotions attached to those experiences. Negative thoughts and feelings that are no longer useful are replaced with positive thoughts and feelings that will encourage healthier behavior and social interactions. Ultimately, clients learn to handle stressful situations themselves.
EMDR therapy occurs in eight phases:
1) History and treatment planning
2) Preparation, to establish trust and explain the treatment in-depth
3) Assessment, to establish negative feelings and identify positive replacements
4) Desensitization, which includes the eye movement technique
5) Installation, to strengthen positive replacements
6) Body scan, to see if the client is now able to bring up memories of trauma without experiencing negative feelings that are no longer relevant, or if reprocessing is necessary
7) Closure, which occurs at the end of every session
8) Re-evaluation, which occurs at the beginning of every session
What to Look for in an EMDR Therapist
Look for a licensed, experienced therapist, social worker, professional counselor or other mental-health professional with additional training and certification in EMDR. The EMDR International Association is one source of credentialing. In addition, it is important to find a therapist with whom you feel comfortable working.
History of EMDR
In 1987, Francine Shapiro was walking in the park when she realized that eye movements appeared to decrease the negative emotion associated with her own distressing memories. She 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 Shapiro added other treatment elements, including a cognitive component, and developed a standard procedure that she called Eye Movement Desensitization (EMD).
Shapiro then conducted a case study and a controlled study to test the effectiveness of EMD. In the controlled study, she randomly assigned 22 individuals with traumatic memories to two conditions: half received EMD, and half received the same therapeutic procedure with imagery and detailed description replacing the eye movements.
She reported that EMD resulted in significant decreases in ratings of subjective distress and significant increases of confidence in a positive belief. Participants in the EMD condition reported significantly larger changes than those in the imagery condition.
Shapiro wrote ”a single session of the procedure was sufficient to desensitize subjects’ traumatic memories, as well as dramatically alter their cognitive assessments.”
Unfortunately, Shapiro has often been erroneously cited as claiming that “EMDR can cure [posttraumatic stress disorder] PTSD in one session (F. Shapiro, 1989). Shapiro never made this statement; what she actually wrote was that the EMD procedure ”serves to desensitize the anxiety not to eliminate all PTSD related symptomatology and complications, nor to provide coping strategies for the victims, and reported an average treatment time of five sessions to comprehensively treat PTSD.
1989 was the first year that controlled studies investigating the treatment of PTSD were published. Besides Shapiros article, three other studies were published.
The Brom et al. study compared the results of psychodynamic therapy, hypnotherapy, and desensitization and provided an average of 16 sessions. It found clinically significant treatment effects for 60% of the civilian participants, with no differences between the conditions.
The Cooper and Clum study compared flooding to standard care in a Veterans Administration Hospital. They reported moderate clinical effects after 6-14 sessions, with a 30% patient drop-out rate. The Keane et al.(1989) study compared flooding to a waitlist control for veteran participants and reported moderate clinical effects after 14-16 sessions.
Shapiro continued to develop this treatment approach, incorporating feedback from clients and other clinicians who were using EMD. 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.
Because EMDR therapy was an effective treatment, achieving results very quickly for many clients, Shapiro felt an ethical obligation to teach other clinicians so that individuals suffering from PTSD could find relief. However, EMDR was still experimental since it had not received independent confirmation through other controlled studies. She attempted to resolve this ethical dilemma by teaching EMDR only to licensed clinicians, and by ensuring that everyone who learned the approach was trained by the EMDR Institute in the same model. That way safeguards would be in place, clinicians would be taught to inform clients of its status, and a feedback system would allow everyone that was trained to get the most up to date information. In 1995, after other controlled studies had been published, the label “experimental and the training restrictions were removed and a textbook of procedures was published.
Shapiro has been severely criticized by some for her method of dissemination, because she initially restricted training and because she taught an experimental procedure. However, these critics ignore the APA ethics code mandated responsibilities of an innovator to determine training practices and the fact that even as late as 1998, there were no treatments for PTSD that were designated as well established and empirically validated. At that time, independent reviewers for the Clinical Psychology Division of the American Psychological Association identified three treatments with ”probable efficacy.” These were EMDR, exposure therapy, and stress inoculation therapy.
Since the initial studies were published in 1989, hundreds of case studies have been published, and there have been numerous controlled outcome studies. These studies have demonstrated EMDR’s effectiveness in PTSD treatment and EMDR is now recognized as efficacious in the treatment of PTSD.
A professional association, independent from Shapiro and the EMDR Institute was founded in 1995 to establish standards for training and practice. The EMDR International Association (EMDRIA) declares that its primary objective is ”to establish, maintain and promote the highest standards of excellence and integrity in Eye Movement Desensitization and Reprocessing (EMDR) practice, research and education.”
Information about EMDRIA is available at http://www.emdr.org.
Despite its demonstrated effectiveness, similar to most new approaches in psychotherapy, EMDR has been surrounded by controversy. While some critics have labeled EMDR a ”pseudoscience” others have commented that these conclusions are based on misinterpretations of the literature [see “Confusion, Misinformation, and Charges of “Pseudoscience”]. Another area of debate is the role of eye movements in EMDR [See Eye Movements and Alternate Dual Attention Stimuli and What has research determined about EMDR’s eye movement component?
Shapiro developed an information processing theory to explain and predict the treatment effects seen with EMDR therapy. This theoretical model also describes the development of personality, psychological problems and mental disorders. The following is a simplified description of Shapiro’s theory.
All humans are understood to have a physiologically based information processing system. This can be compared to other body systems, such as digestion in which the body extracts nutrients for health and survival. The information processing system processes the multiple elements of our experiences and stores memories in an accessible and useful form. Memories are linked in networks that contain related thoughts, images, emotions, and sensations.
Learning occurs when new associations are forged with material already stored in memory.
When a traumatic or very negative event occurs, information processing may be incomplete, perhaps because strong negative feelings or dissociation interfere with information processing. This prevents the forging of connections with more adaptive information that is held in other memory networks.
For example, a rape survivor may ”know’ that rapists are responsible for their crimes, but this information does not connect with her feeling that she is to blame for the attack. The memory is then dysfunctionally stored without appropriate associative connections and with many elements still unprocessed. When the individual thinks about the trauma, or when the memory is triggered by similar situations, the person may feel like she is reliving it, or may experience strong emotions and physical sensations. A prime example is the intrusive thoughts, emotional disturbance, and negative self-referencing beliefs of posttraumatic stress disorder (PTSD).
It is not only major traumatic events, or ”large-T Traumas” that can cause psychological disturbance. Sometimes a relatively minor event from childhood, such as being teased by one’s peers or disparaged by one’s parent, may not be adequately processed. Such ”small-t traumas” can result in personality problems and become the basis of current dysfunctional reactions.
Shapiro proposes that EMDR can assist to successfully alleviate clinical complaints by processing the components of the contributing distressing memories. These can be memories of either small-t or large-T traumas. Information processing is thought to occur when the targeted memory is linked with other more adaptive information. Learning then takes place, and the experience is stored with appropriate emotions, able to appropriately guide the person in the future. A variety of neurobiological contributors have been proposed.
The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma
FRANCINE SHAPIRO, PHD AND MARGOT SILK FORREST
IN THE EIGHTEEN YEARS since this book was written, many things have changed, and Eye Movement Desensitization and Reprocessing, or EMDR, therapy is now widely accepted as a research supported, effective treatment for trauma and other adverse life experiences. Yet the primary guiding principles of EMDR therapy have remained the same. It is worthwhile here to review those principles and to answer some questions.
Trauma Comes in Many Forms
Most of us are used to thinking of trauma only as those big events that appear in the newspapers. War veterans, survivors of natural catastrophes and terrorist attacks, these are the sufferers of trauma in the popular imagination. But, in fact, by dictionary definition, trauma is any event that has had a lasting negative effect.
We all know people who have lost jobs, loved ones, even possessions and who have truly suffered as a result. When you lose your peace of mind, or if you never had it, there can be serious physical and psychological consequences no matter what the cause. Regardless of the “triggers,” the causes are generally found in earlier life experiences. We call these experiences traumas.
Trauma Can Be Healed
Anxiety, stress, guilt, rage, and fear, regardless of the cause, are extremely unhealthy if they are long lasting. Fortunately, the body uses a process similar to digestion in order to resolve upsetting experiences. Just as the digestive system extracts nutrients from the food we eat, so the mind’s information processing system, when functioning properly, extracts useful information from our experiences. What we learn from this information allows us to move forward.
When the memories of upsetting experiences are processed, the related emotions, beliefs, body responses, and thoughts are transformed, becoming healthy and adaptive.
Sometimes, though, negative experiences remain in memory unresolved, leaving a residue of emotion to dominate our daily lives.
The system becomes “stuck”, as if it was choking on trauma, and often requires assistance in order to get moving smoothly again. This is where EMDR therapy comes in.
Therapy for the Body, Therapy for the Mind
Most people think that therapy involves only talking about problems. However, one aspect of EMDR therapy is that you do not have to talk in detail about a trauma for it to be digested by your own information processing system. Basically this involves what some have called bottom-up instead of top-down processing.
In other words, rather than trying to talk through the problem, the processing occurs on a physiological level and allows new associations, insights, and emotions to emerge spontaneously.
EMDR therapy involves a very specific set of procedures to help this “digestive” function in the brain, which neurobiologists refer to as information processing.
EMDR therapy is guided by the Adaptive Information Processing model, which identifies negative life experiences stored in the brain as central to mental health problems.
A number of neurobiologists and memory researchers point out that major traumas and other disturbing life experiences are stored in the wrong form of memory. Instead of being stored in memory where they can be remembered without pain, they are stored in memory where they hold the emotions and body sensations that were part of the initial event. Because these memories are not able to connect with other, more helpful information, they remain isolated from other life experiences in our memory networks.
For example, even though we can look at things rationally where other people are concerned, and know they aren’t to blame for certain things, we can’t view ourselves in the same way. We may recognize that a victim of rape should not be blamed for the actions of the rapist, yet, placed in the same circumstance ourselves, feel somehow at fault.
Basically, no matter how intelligent or spiritual or experienced or educated we are, the memories can simply be stored in the wrong form of memory. We didn’t cause it, we are suffering from it.
The memory system is in the brain, and the brain is part of the body. Most of us recognize that if our body is cut it will begin to heal unless there is a block, such as a splinter. We are willing to enter into surgery because we know our body will close and heal the wounds, just as it’s supposed to do. But for some reason, we don’t think of “mental problems” in the same way.
Traumatic memories are located in the brain, and since the brain is part of the body, it can and should heal in the same way. Although we expect the physical bruises of crime victims to heal in a matter of weeks, we believe that healing psychological wounds may take years. This is not necessarily so. In reality, the brain can heal at the same rate as the rest of the body.
In many ways EMDR therapy is like having your arm set by a doctor. Both conditions are physical and both need assistance to prepare, align, and stimulate the body’s own healing mechanism. EMDR therapists are trained to work with the information processing system in order to access the troubling experiences. Once accessed, these experiences need to be addressed to bring the client to full health.
Who Needs EMDR Therapy?
EMDR therapy has been used with combat veterans, firefighters, policemen, emergency service workers, and missionaries, all trained to help others and to “tough it out.” They came for help because they realized that they did not need to treat the mind differently from the body. We all need help sometimes, and sometimes it’s hard to find the right kind of help.
But there are many forms of therapy, so saying, “I tried therapy and it doesn’t work” is like saying, “I tasted a fruit and didn’t like it, so I’m not going to eat any fruit.” There are hundreds of thousands of licensed mental health clinicians in the United States alone. There are hundreds of techniques and many different types of therapies. Psychodynamic therapists alone may follow the principles and practices of many different, well respected therapists, such as Freud, Jung, Horney, Adler, or a dozen others.
Therapists who practice Cognitive Behavioral Therapy (CBT) may be more focused on behavior or cognition and may draw from a variety of techniques, depending on their own training and life experience.
EMDR is a distinct form of therapy and has principles and practices that are different from these and other approaches. While EMDR integrates aspects of other therapies, it also gives the client a different experience. The purpose of this book is to provide examples of those experiences so that you and your loved ones can be sure you are receiving EMDR therapy, and not someone’s distorted version of it.
Unfortunately, what has changed in the years since EMDR was first published is that more people are affected by trauma than ever before. These may be both what we can call large “T” and small “t” events. Large “T” traumas are those experiences that are necessary to diagnose posttraumatic stress disorder (PTSD). Large “T” events are technically called Criterion A events and include natural disasters, combat, accidents, catastrophic illnesses, and the loss of a loved one. However, while these kinds of events are necessary to officially diagnose PTSD for many people, research now supports the Adaptive Information Processing model guiding EMDR therapy and indicates that general adverse life experiences can result in even more PTSD symptoms than major trauma can.
Small “t” events are those more prevalent experiences that make us feel unsafe, unloved, or without control or hope. These can be humiliations, failures, or losses of any kind. For children, the events can include being bullied or excluded or even falling off their bicycle. Events that can seem unimportant to an adult can be devastating to children and can have lasting effects. In fact, a Kaiser Permanente study that evaluated 9,508 participants reported that adverse childhood experiences were associated with a wide range of mental health disorders and several leading causes of death in adults. Given the current state of the world, pressures and uncertainties have compounded the daily problems that many adults face, and many more people are in need of help than ever before. Fortunately, help is available to a greater degree than ever before.
When this book was first published, there were 20,000 clinicians trained in EMDR and about one million people had been treated. EMDR was as well supported by research as any other treatment approach, but unknown in many circles, and suspect in others. Today, hundreds of thousands of clinicians have been trained worldwide, and millions of people have been successfully treated.
Does EMDR Work?
EMDR is recognized as an effective trauma therapy by numerous organizations worldwide. For instance, in 2009, the International Society for Traumatic Stress Studies‘ declared that EMDR therapy’s effectiveness was supported by research. In 2002, the Israeli National Council of Mental Health designated EMDR as one of three preferred trauma treatments for terrorist victims. In 2010, the U.S. Department of Defense and Department of Veteran Affairs issued new guidelines putting EMDR into the category of therapies with the highest level of evidence and recommending it for treatment of PTSD.
Most recently, in 2013, the World Health Organization reported that trauma focused CBT and EMDR are the only psychotherapies recommended for children, adolescents, and adults with PTSD. The report also noted the differences between the two forms of treatment: “Like CBT with a trauma focus, EMDR 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.” These differences will be evident in the cases described throughout this book.
The many organizations recommending EMDR therapy based their decisions on the large number of research studies that support it as an effective and long-lasting treatment. Research has shown that about five hours of EMDR treatment eliminates PTSD in 84 to 100 percent of civilians with a single trauma experience, including rape, accident, or disaster. When civilians experience multiple traumas, more treatment is needed. Research indicates that about eight to twelve hours of treatment can result in 77 to 80 percent elimination of multiple-trauma PTSD in civilians. A study funded by Kaiser Permanente reported that 80 percent of multiple-trauma victims and 100 percent of single-trauma victims had PTSD eliminated in an average of six fifty-minute sessions. However, it should not be assumed that all symptoms can be handled for everyone in that amount of time. Everyone is different in their biological, psychological, and environmental makeup. Nevertheless, these research studies offer clinicians and clients a guide as to what to expect in clinical practice.
Given the uncertainties of our time, with many men and women facing combat, we are thankful that EMDR is a treatment that works well with soldiers. A randomized study that evaluated a full course of EMDR treatment with combat veterans reported that after twelve sessions, 78 percent of the Vietnam combat veterans in the study no longer had PTSD. The fact that there were zero dropouts, unlike studies of other treatments that generally have about a 30 percent dropout rate, can be attributed to several factors: (1) EMDR therapy results in a rapid decrease in emotional disturbance that occurs even in the first session, (2) there is no need to talk about the memory in detail, and (3) it eliminates fear, anger, guilt, and sleep problems. A 2007 study of sixty-three active duty personnel with PTSD reported that after trauma treatment, the emotional disturbance was basically “eliminated and a new more positive perspective had developed.” The average treatment time was four EMDR sessions, eight sessions if they had been wounded in action.
Positive research reports include a field study of a Veterans Administration (VA) program and several articles reporting positive treatment effects with veterans from World War II, the Korean War, and Desert Storm and current active military personnel. Overall, these results mean that no matter how long their symptoms have lasted, veterans and their families can be healed of the ravages of pain. Chapter 3 describes a case in detail.
These results also mean that those who serve in daily combat on our city streets such as the emergency service workers, firefighters, police, and others can also be healed. Regardless of how tough a person might be, the bottom line is that the memories of disturbing experiences can be stored in the wrong form of memory. The intrusive thoughts, dreams, disturbing emotions, and sensations are all products of a physical problem that can be helped without resorting to drugs or alcohol to mask the pain. In fact, a National Institute of Mental Health (NIMH) study reported that EMDR was superior to Prozac in treating trauma. After people were taken off the medication, their symptoms returned, while those treated with EMDR therapy kept getting better. These findings emphasize why the World Health Organization did not recommend any drugs for the treatment of PTSD. They also underscore the Adaptive Information Processing model principle that targeting and reprocessing the trauma is preferable to merely treating the symptoms.
What Is the Difference Between EMDR Therapy and Exposure Therapy?
There are several cognitive behavioral therapies for PTSD that use exposure; however, the one most commonly recommended for PTSD is prolonged exposure (PE). The therapist asks the client to hold the disturbing experience in mind, identify and “feel the feelings” that arise, and describe it all to the clinician in detail for an hour to ninety minutes at a time, saying things like “I feel the pain; I see the blood.” The client is not allowed to let the mind move away from the experience, because that is considered “avoidance” and is thought to make people worse. The session is audio taped and the client is expected to listen to it each night until the next session. In addition, the client is also supposed to go to physical locations they find disturbing as a result of the trauma experience. This might be the area where the client was raped, or the location of the car accident. They are instructed to stay in the area for about one hour each day, until the disturbance goes away.
In contrast, EMDR therapists ask clients to concentrate on a disturbing part of the memory, and then let their minds move to “whatever comes up” during sets of eye movements or other forms of bilateral stimulation. The client may spend only a short period of time on the disturbing memory itself. While there may be a certain amount of distress, there is generally a decline at the end of the first session, and new insights and understandings tend to emerge. A Harvard researcher has proposed that the same neurobiological processes that occur during rapid eye movement (REM) or dream sleep cause this tendency. REM state is known for processing experiences, learning skills, and reducing emotional disturbance.
It is easy to recognize the similarities between REM and EMDR, as EMDR therapy produces the same effects. In fact, one of the guiding principles of EMDR therapy involves stimulating the natural information processing tendencies of the brain, while also not restricting or dictating the client’s reactions. The EMDR clinician is trained to help guide the processing according to consistent procedures and protocols. All of these characteristics of EMDR therapy are explored in the chapters of this book.
How Important Are the Eye Movements?
EMDR is not simply “eye movement therapy.” It is a complex approach to psychotherapy that is listed in psychology encyclopedias along with psychodynamic therapy, cognitive therapy, family therapy, and so forth. It combines aspects and procedures that are found in the different therapies in order to address the whole person. That is, rather than concentrating on any one specific part of the clinical picture, EMDR therapy addresses the emotions, thoughts, physical sensations, attitudes, behaviors, and more. In doing so, people are then able to feel joy and love, to bond, connect, and feel good about themselves. All the procedures and protocols are combined to achieve comprehensive success as defined by a decrease in symptoms and an enhanced ability to function in life. Of course, I want to underscore that all forms of psychotherapy have their place. However, each form of therapy offers people a different experience, during which they may achieve different goals. Whether or not you have had previous therapy, reading this book will show you specifically what EMDR has to offer.
Unfortunately, in 1987 I included the words “eye movement” in the name of the therapy. However, in 1990, after EMDR had already achieved name recognition, I discovered that other forms of stimulation could also achieve success. When blind people came in for treatment and could not move their eyes, we found that hand taps and audio tones could work as well. Many neurobiologists have argued that the taps and tones work on the same principle as the eye movement, by causing an “orienting” or “interest” response in the brain that fosters the processing. Others say that the different stimuli affect the “visuospatial template of working memory.” Still others have supported the notion I discuss in Chapter 6 of this book, that EMDR links into the same processes that occur during REM or dream sleep.
Basically, there are several research-supported theories for why EMDR therapy works, and there is a strong likelihood that all are correct and come into play at different times in the therapy process. However, there is not enough known in the area of brain physiology and neurobiology to know for sure. That is the case for any form of therapy. We know something works because we can observe the outcomes, but we don’t know why it works. No one can explain on a neurobiological level why, for example, family therapy works. We don’t even know exactly why most medications work.
For many years, the eye movement component was considered controversial because of research that was considered flawed in the 2000 International Society for the Study of Traumatic Stress Practice Guidelines. At this point, however, more than thirty randomized controlled studies have supported the effects of the eye movements, and a meta-analysis published in 2013 has confirmed the effects, such as decreases in negative emotions and imagery. The eye movements also promote the connection with new associations necessary for information processing to occur. Moreover, numerous randomized studies have demonstrated effects such as increased memory retrieval and recognition of true information.
Again, though, EMDR is much more than eye movements. It is a combination of standardized procedures and protocols guided by certain principles. Anyone who uses only eye movements is not using EMDR.
When Should EMDR Be Used?
EMDR practice is guided by the Adaptive Information Processing model. Just like psychodynamic and behavior therapies, EMDR’s principles are separate from particular neurobiological mechanisms. The purpose of any psychotherapy model is to explain clinical effects, predict successful outcomes with certain types of problems, and guide clinical practice. In accordance with its information processing model, EMDR therapy addresses the experiences that have contributed to the problems. While some problems may have a biological foundation, such as certain forms of depression, most others are based on or influenced by experiences. For instance, in Chapter 4, the impact of an extremely insensitive statement by an authority figure appeared to have had a lasting and devastating effect on a woman until she received therapy.
While most of the EMDR research has concentrated on PTSD, many other uses have been described in clinical journals. One published article reported that five of seven people who came into therapy believing there was something horribly wrong with their appearance discovered that it was based upon the emotional impact of an inappropriate insult. They were successfully treated with EMDR within three sessions.
Our views of ourselves are based on our previous experiences. Anyone who feels unlovable, useless, a failure, or guilty can find out in a short time if they can be helped by EMDR therapy. Whether these kinds of problems involve you or a loved one, help may be just a few weeks away.
It is important to remember that good therapy is an interaction between client, therapist, and method. If you don’t find the right therapist, you will not receive good therapy. It is important for people to be informed, and for consumers to make sure that the therapist they choose has experience and special training in their particular complaint. For instance, if you are struggling with alcohol or drug problems, you should see an EMDR therapist specially trained in the field of substance abuse. Therapists will know when and how to use EMDR if they have appropriate experience and training. In other words, EMDR should always be integrated into the wisdom of field.
In addition to being qualified to address your particular problems, it is also important that you make sure that your therapist has been well trained in EMDR. Make sure that the therapist has finished a program certified by the EMDR International Association, the EMDR Europe Association, EMDR Iberoamérica, or EMDR Asian and, preferably, is a member so that he or she is keeping up with all the latest developments. Also investigate whether your therapist is using EMDR as a “technique” or as an “approach.” In other words, some clinicians may be using EMDR only if they feel that something is “stuck,” instead of using it systematically to address the entire clinical picture.
To receive the most thorough EMDR therapy, your clinician should teach you a selfcontrol technique, such as the “safe place” exercise, before beginning any direct processing with eye movements or other stimulation. This and other techniques will help you to deal with your feelings and emotions while therapy is taking place.
The clinician should also take a thorough history in order to identify the (1) earlier events that set the foundation for the problem, (2) the present situations that cause the disturbance, and (3) the skills and behaviors necessary for the future. You may not know what the earlier events are, but a skilled clinician will help you identify them by using a variety of techniques she or he would have learned in the EMDR training and from my professional textbook. If your clinician has not taken a certified training and read the text, this person would not be a good choice as an EMDR clinician.
EMDR therapy is not a good choice for everyone. If you are not willing to be in touch with your feelings and don’t want to learn the techniques to help you do so, or if you have a problem that is purely biological, EMDR is not for you. Those problems that are purely caused by imbalances that only medications can address will not be changed by EMDR. However, some forms of depression are caused by experiences that have left the person feeling helpless and hopeless. An example of this is described in Chapter 12. Given how long it takes for medications to take effect, trying a few sessions of EMDR may indicate that the medication is unnecessary.
The amount of EMDR therapy you will need depends upon many factors, including your readiness to deal with emotions and your personal history. Those people with long histories of childhood abuse will not be treated completely in only a few sessions. While the PTSD research indicates that three EMDR sessions will complete treatment on a single trauma, more traumas need more treatment. It may not be important to address each traumatic experience, especially since the positive treatment effects can generalize to similar events, but more therapy will be necessary.
We also need to be aware of the difference between reducing the obvious suffering of a particular disorder and coming into full health. Comprehensive EMDR treatment involves addressing those experiences that contributed to both problems and achievement. At the end of therapy, success would be defined by a person who can love, bond, feel secure, and find joy in living.
Why I Wrote the Book
The chapters in this book describe real people who wanted their stories told in order to help others find their way. In addition to chapters that cover the evolution and structure of EMDR therapy, each of the chapters describes a different type of problem and shows what caused it, and how it was treated. These are not the only types of problems that can be dealt with by EMDR treatment, but millions of people are struggling needlessly with these kinds of common symptoms. The goal is to give you a good understanding of who can be helped, where problems come from, and what EMDR treatment looks like. In addition, Chapter 12 of this book deals with the frontiers of EMDR therapy, and its “global reach.” This includes a description of the work done by the nonprofit Trauma Recovery/EMDR Humanitarian Assistance Programs (HAP) to help underserved populations in the U.S. and around the world.
The basic belief that many of us hold is that violence begets violence, and trauma begets more suffering. We believe that unhealed traumas cascade into the next generation, whether from one family member to the next, or through the anger that fuels much of the ethnopolitical warfare throughout the globe.
If, after receiving EMDR therapy, you believe it has helped you, please consider helping to make the treatment available to suffering people worldwide.
My hope in writing this book is that people will recognize themselves or a loved one in its pages, and see that help is available. I also want this book to illustrate what good EMDR therapy looks like so that clients can be informed consumers and make sure their own treatment stays on track. Most clients should be ready for processing within a few sessions. It doesn’t take months or years to see if EMDR therapy is appropriate for you or a loved one. Maybe things you think can’t change, actually can. It may not take that long to find out.
The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma
by Francine Shapiro , P.Hd and Margot Silk Forrest
get it at Amazon.com