Eye movement desensitization and reprocessing (EMDR) is a
fairly new, nontraditional type of psychotherapy. It's growing in popularity, and
some of the reported results of such treatment are really remarkable, which looks
suspicion on the global scale of the approved therapies, especially, when
compared with the traditional therapy outcomes.
Some EMDR proponents have called it a “miracle cure” and
“paradigm shift,” and ABC's 20/20 proclaimed it an “exciting
breakthrough” in the treatment of anxiety. More than 60,000 clinicians have
undergone formal training in EMDR, and the EMDR International Association
(EMDRIA), a group of mental health professionals dedicated to promoting the
technique, boasts more than 4,000 members. The organization estimates that this
procedure has been administered to approximately two million clients. Moreover,
in some American cities, psychotherapists proudly list their certifications in
EMDR on their Yellow Pages advertisements.
However, while research continues, EMDR still remains
controversial among some health care professionals. At first glance, EMDR
appears to approach psychological issues in an unusual way. It does not rely on
talk therapy or medications. Instead, EMDR uses a patient's own rapid, rhythmic
eye movements. These eye movements dampen the power of emotionally charged
memories of past traumatic events.
Overcoming Depression with EMDR
EMDR was developed by California psychologist Frances
Shapiro, PhD, in the late 1980s as a treatment for post-traumatic stress disorder, but research has found it helpful
with other conditions, including depression. “The most typical candidate [for
EMDR] is an individual who has suffered a significant trauma in his or her life
that continues to intrude on the present and negatively impacts their
functioning in some way,” says Ted W. Raddell, PhD, counseling psychologist at
the Cleveland Clinic Foundation and Beachwood Family Health and Surgery Center
in Ohio.
Typical individuals who might find relief from EMDR for
their depression include those who have experienced a major trauma such as
physical or sexual abuse in childhood; a serious accident; a natural disaster
such as a hurricane, flood, or earthquake; or an unnatural event like 9/11 or
witnessing a murder. Researchers have also found EMDR effective for treatment
of prolonged stress that may be causing depression, such as growing up with alcoholism, surviving ongoing or
multiple affairs, or living in poverty or with mental illness in the family.
Theoretical
Assumptions
Shapiro (1995) developed
the Accelerated Information Processing model to describe and predict EMDR’s
effect. More recently, Shapiro
(2001) expanded this into the Adaptive Information Processing (AIP)
model to broaden its applicability.
She hypothesizes that humans have an inherent information
processing system that generally processes the multiple elements of experiences
to an adaptive state where learning takes place. She conceptualizes memory as
being stored in linked networks that are organized around the earliest related
event and its associated affect. Memory networks are understood to contain
related thoughts, images, emotions, and sensations. The AIP model hypothesizes
that if the information related to a distressing or traumatic experience is not
fully processed, the initial perceptions, emotions, and distorted thoughts will
be stored as they were experienced at the time of the event.
Shapiro argues that such unprocessed experiences become
the basis of current dysfunctional reactions and are the cause of many mental
disorders. She proposes that EMDR successfully alleviates mental disorders by
processing the components of the distressing memory. These effects are thought
to occur when the targeted memory is linked with other more adaptive
information. When this occurs, learning takes place, and the experience is
stored with appropriate emotions able to guide the person in the future.
How EMDR Is Done
“When a traumatic event occurs, it can get frozen in the
memory systems of the brain with the original images, beliefs about oneself,
emotions, and body sensations,” Raddell explains. “This is why when a trauma
gets triggered by everyday circumstances, the individual can experience
tremendous anxiety, almost as if they are reliving the experience all over
again. EMDR seems to unfreeze this stuck or stored material so the brain can
integrate it and desensitization occurs.”
The EMDR approach involves eight phases that generally
start with the therapist taking a thorough client history, establishing a
rapport with the patient, and explaining the procedure over the span of a few
sessions before actual treatment begins. During the treatment itself, the
patient focuses on the traumatic event and accompanying sensations while also
following the therapist’s fingers with his or her eyes as the fingers are moved
back and forth. (The fingers are most often used, but some therapists use
auditory tones or tapping instead.) This is then repeated numerous times until
the patient does not feel distress when thinking about the upsetting memory.
“Research over the past decade suggests that it is the
dual attention processing that seems to be most critical in activating this
healing mechanism within the person’s brain,” says Raddell. “In other words,
the eye movements are not the most significant component, but rather it is the
client’s brain that is doing the healing as EMDR taps into an adaptive process
that allows one to integrate the stuck material in a more natural form.”
Is EMDR hypnosis?
No. During the EMDR session, the client is awake and
alert and in control at all times. The healing that takes place with EMDR is
much faster than with hypnotherapy. Like hypnosis, EMDR seems to work with the
unconscious mind, bringing into consciousness the repressed thoughts and
feelings that must be experienced again in order to release their energetic
hold on the person.
Treatment
Description
EMDR therapy combines different elements to maximize
treatment effects.
EMDR 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 is to produce rapid and effective change while
the client maintains equilibrium during and between sessions.
Phases 3-6:
In the phases three to six, a target is identified and processed using
EMDR 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.
How many sessions
will it take?
The number of sessions depends upon the specific problem
and client history. However, repeated controlled studies have shown that a
single trauma can be processed within 3 sessions in 80-90% of the participants.
While every disturbing event need not be processed, the amount of therapy will
depend upon the complexity of the history. In a controlled study, 80% of
multiple civilian trauma victims no longer had PTSD after approximately 6 hours
of treatment. A study of combat veterans reported that after 12 sessions 77% no
longer had post-traumatic stress disorder.
EMDR Treatment Results
Patients who have had EMDR treatment can still remember
the traumatic event, but either feel less disturbed by it or experience no
distress at all. Some describe it as more like a typical memory while others
say it’s less distinct or feels farther away. Research suggests the EMDR
process changes how and where the events are stored in the brain and may be
similar to the subconscious processing that occurs during REM sleep.
Raddell points out that while EMDR has been proven to be
successful, no single depression therapy works for every person. If you're
still experiencing signs and symptoms
of depression after EMDR treatment, it’s always a good idea to try
other doctors and therapies until you find the right method or combination of
methods.
Official
Guidelines
Guidelines issued by more than one professional
organization have recently boosted the credibility of EMDR. These guidelines
define who may benefit from the treatment. For example:
* The American Psychiatric Association (APA) has noted
that EMDR is effective for treating symptoms of acute and chronic PTSD.
According to the APA, EMDR may be particularly useful for people who have
trouble talking about the traumatic events they've experienced. The APA
guidelines note that other research is needed to tell whether improvements from
EMDR can be sustained over time.
* The Department of Veterans Affairs and the Department
of Defense have jointly issued clinical practice guidelines. These guidelines
"strongly recommended" EDMR for the treatment of PTSD in both
military and non-military populations. They also note that this approach has
been as effective as other psychological treatments in some studies, and less
effective in others.
Sources and
Additional Information:
