By Elizabeth Lee, MEd, CPsych
Jun 22, 2021
Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychotherapy method that was developed by psychologist Dr. Francine Shapiro and has demonstrated success in helping some individuals heal from the emotional distress that stem from painful and traumatic life experiences.
Our brains have a natural system that digests our experiences and integrates them into memory networks, which enable us to make sense of new information (Shapiro, 2001). However, a distressing incident can overwhelm healthy functioning of this system, preventing the traumatic information from being effectively processed by our brain and causing the traumatic memories to get “stuck” (Shapiro 1995, 2001, 2006). When traumatic memories get stuck, individuals may experience distress that, in turn, can trigger the “fight-flight-freeze” responses well as a series of upsetting emotions, images, and bodily sensations (Shapiro, 2001). Additionally, individuals can start having negative beliefs about themselves that are related to and maintained by the unprocessed traumatic incidents, such as “I won’t survive” (Shapiro, 2001; Soloman & Shapiro, 2008).
The “fight-flight-freeze” response is a response we are biologically wired to produce when we feel threatened. This automatic response was helpful when our ancestors needed to spring to action (eg. A lion is about to attack and we need to flee or fight) or needed a moment to decide which option offered the best chance of survival (freeze when a lion is stalking us to decide the best course of action) (Roelofs, 2017). However, when this response is activated by a threat in our mind- when we remember a traumatic memory- the “fight-flight-freeze” response hinders us instead of helping us since the threat is no longer real.
EMDR involves a series of experiential activities designed to help “unstuck” the brain’s system, allowing disturbing memories to be fully processed so that when negative incidents are remembered, although unpleasant, there’s no longer an overwhelmingly distressing experience. EMDR also consists of strengthening positive beliefs to ultimately replace the negative beliefs that are intertwined with and maintained by traumatic memories. For example, when recalling a painful memory, instead of believing “I’m unlovable” we believe and feel “I’m loveable.”
What are the eye movements about?
EMDR involves bilateral stimulation such as eye movements, alternating hand-tapping, or alternating sounds as a way to help clients effectively process their emotionally disturbing memories.
Dr. Shapiro noticed in 1989 that her emotional distress related to disturbing thoughts disappeared when she rapidly and spontaneously moved her eyes. She later conducted a controlled study and found that eye movements are associated to desensitizing traumatic memories (Shapiro, 1989).
Several randomized research studies have found that such eye movements have an effect on: emotional arousal, image vividness, retrieval, distancing, and memory association (Andrade et al, 1997; Barrowcliff et al., 2004; Christman et al., 2003). Lee et al. (2013)’s meta-analysis found that the eye movements reduced the vividness and emotion associated with unpleasant autobiographical memories.
What does EMDR consist of?
A trained EMDR therapist would first assess whether or not EMDR would be an appropriate intervention for a client before introducing this type of psychotherapy. After discussion and with clients’ agreeance, EMDR trained therapists guide clients through the phases of EMDR therapy in a controlled and standardized way, called the Adaptive Information Processing Model (Shapiro, 2007). This includes:
- History and treatment planning: the therapist collects some information about the client’s distressing memories then works collaboratively with clients to create a treatment plan consisting of which specific incidents to work on as well as the associated negative beliefs and the positive beliefs.
- Preparation: therapists teach clients skills to cope with emotional disturbance related to distressful memories that might be experienced outside of psychotherapy sessions.
- Assessing incident(s): this involves a negative image, bodily sensations, and negative beliefs such as “I’m not good enough”, “it’s my fault” as well as positive beliefs, which might be “I’m enough”, “I did my best”, etc.
- Processing the memory: clients focus on a traumatic memory while engaging in bilateral stimulation (eye movement, alternating taps, listening to tones), to lessen the distress of the trauma memory, and notice physical sensations in the body.
- Strengthening positive beliefs: clients focus on a memory while engaging in bilateral stimulation (eye movement, alternating taps, listening to tones), to strengthen the positive belief.
- Closure: when the targeted memory is not fully processed in a session, clients are encouraged to use specific techniques that have been taught during the Preparation stage to develop safety between sessions.
- Evaluating treatment outcomes: therapist and client discuss the effects of EMDR and if there are other incidents or negative beliefs to work on.
Is EMDR effective?
Several research studies found that EMDR was effective in:
- Reducing post-traumatic stress disorder (PTSD), depressive and anxiety symptoms for survivors of life-threatening cardiac events after a 4-week treatment (Arabia et al., 2011).
- Reducing PTSD, anxiety, and depressive symptoms for cancer patients (Capezzani et al., 2013).
- Reducing distressing emotions for people who experienced disturbing life events and don’t meet the criteria for PTSD (Cvetek, 2008).
- Reducing clinical symptoms for adult female survivors of childhood sexual abuse (Edmond et al., 1999).
- Reducing PTSD symptoms for individuals who suffered sexual assault (Rothbaum, 1997).
EMDR has been compared to other psychotherapy approaches and meta-analysis research studies found:
- EMDR therapy is as effective as trauma-focused Cognitive Behavioral Therapy (CBT) for adults with chronic PTSD (Bisson et al., 2013).
- EMDR therapy is equally effective to exposure and other cognitive behavioral treatments for reducing PTSD symptoms (Bradley et al., 2005).
EMDR has been endorsed as an evidence-based psychotherapy model by various organizations, including: The International Society for Traumatic Stress Studies, The Cochrane Database of Systemic Reviews, and the World Health Organization.
Can my therapist provide me EMDR psychotherapy?
EMDR is a specific psychotherapy method and should only be provided by mental health clinicians who have been properly trained to provide EMDR to their clients. The EMDR International Association (EMDRIA) provides EMDR training to individuals who are required to meet certain eligibility requirements.
Where can I learn more about EMDR?
For a more in-depth outline of the EMDR experience, please visit: emdria.org
To learn more about the theory and research on EMDR, please visit emdr.com
EMDR Trained Psychologists
Andrade, J., Kavanagh, D., & Baddeley, A. (1997). Eye-movements and visual imagery: A working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36, 209-223.
Arabia, E., Manca, M.L., & Solomon, R.M. (2011). EMDR for survivors of life-threatening cardiac events: Results of a pilot study. Journal of EMDR Practice and Research, 5, 2-13.
Barrowcliff, A.L., Gray, N.S., Freeman, T.C.A., MacCulloch, & M.J.(2004). Eye-movements reduce the vividness, emotional valence and electrodermal arousal associated with negative autobiographical memories. Journal of Forensic Psychiatry and Psychology, 15, 325-345.
Bisson, J., Roberts, N.P., Andrew, M., Cooper, R. & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, 2013, DOI: 10. 1002/14651858.CD003388.pub4
Bradley, R., Green, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimenstional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227.
Capezzani, L., Ostacoli, L., Cavallo, M., Carletto, S., Fernandez, I., Solomon, R., Pagani, M., & Cantelmi, T. (2013). EMDR and CBT for cancer patients: Comparative study of effects on PTSD, anxiety, and depression. Journal of EMDR Practice and Research, 7, 134-143.
Christman, S.D., Garvey, K.J., Propper, R.E., & Phaneuf, K.A. (2003). Bilateral eye movements enhance the retrieval of episodic memories. Neuropsychology. 17, 221-229.
Cvetek, R. (2008). EMDR treatment of distressful experiences that fail to meet the criteria for PTSD. Journal of EMDR practice and Research, 2, 2-14.
Edmond, T., Rubin, A., & Wambach, K. (1999). The effectiveness of EMDR with adult female survivors of childhood sexual abuse. Social Work Research, 23, 103-116.
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.
Roelofs, K. (2017). Freeze for action: Neurobiological mechanisms in animal and human freezing. Phil. Trans.R. Soc. B.372:20160206. http://dx.doi.org/10.1098/rstb.2016.0206
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 desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress Studies, 2, 199-223.
Shapiro, F.(1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York: Guilford Press.
Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd ed.). New York: Guilford Press.
Shapiro, F. (2006). New notes on adaptive information processing. Hamden, CT: EMDR Humanitarian Assistance Programs.
Shapiro F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice and Research, 1, 68-87.
Solomon, R.M. & Shapiro, F. (2008) EMDR and the adaptive information processing model: Potential mechanisms of change. Journal of EMDR Practice and Research, 2, 315-325