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.
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.
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.
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.
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