EYE MOVEMENT DESENSITIZATION AND REPROCESSING E.M.D.R.
WHAT IS E.M.D.R. ?
EMDR stands for Eye Movement Desensitization Reprocessing. It
works in the brain at the neurological level. It has been known
for sometime that when we dream we have corresponding periods of
Rapid Eye Movements (REM). While these Rapid Eye Movements are
still somewhat of a mystery, it is now known that they perform a
very important function. It is believed that EMDR triggers a
physiological process in the brain, one that involves the way you
process memory. The Rapid Eye Movements stimulate a part of the
brain stem that activates other areas of the brain controlling
memory, and speeds up the brains ability to process information.
When you dream, your brain is attempting to process information to
resolve problems that occur during the daytime waking state.
The average individual has a dream about every 90 minuets while
asleep. We usually do not even remember most of these dreams.
Most dreams are usually a rehashing of events which have occurred
thoughout the day. However, if the dream is recurrent, or the
theme of the dream is recurrent, or the dream is associated with
very intense emotions (nightmares), this can indicate some
significant stress and/or trauma. Dreams are part of the brain's
built in biological mechanism to help us resolve problems that we
are unable to resolve during the waking state. EMDR allows you to
do this while awake, when done with an EMDR trained therapist.
Eye Movement Desensitization and Reprocessing (EMDR) is an
interactional, standardized approach and method to therapy that
integrates into, and augments, a treatment plan. EMDR accelerates
the treatment of a wide range of pathologies and self esteem
issues related to both upsetting past events and present life
conditions. Controlled studies of victims of Vietnam combat, rape,
molestation, accident, catastrophic loss and natural disaster
indicate that the method is capable of a rapid desensitization of
traumatic memories, including a cognitive restructuring and a
significant reduction of client symptoms (e.g., emotional
distress, intrusive thoughts, flashbacks and nightmares. There are
more controlled studies to date on EMDR than on any other method
used in the treatment of trauma. A literature review indicated
only six other controlled clinical outcome studies (excluding
drugs) in the entire field of PTSD (Solomon, Gerrity, and Muff,
EMDR was developed by Francine Shapiro, Ph.D. in 1988, and to
date over 15,000 licensed mental health therapists in thirty eight
countries have been trained. Because a clinical background is
necessary for the effective application of EMDR, workshops are
limited to mental health professionals who are licensed or
certified to provide treatment. Training is considered mandatory
for appropriate use (Shapiro, 1991b). EMDR is a specialized
approach and method that requires supervised training for full
therapeutic effectiveness and client safety. Clients are at risk
if untrained clinicians attempt to use EMDR (Behavior Therapist,
HOW DOES IT WORK?
The client focuses on a past memory that is disturbing and words
or messages the person received that created trauma, lowered self-
esteem, created negative thinking, body illness etc. At the same
time you are focusing on the memory, you are performing eye
movements that allows the brain to covert the traumatic memories
into normal less disturbing memories. My experience working with
clients using this method has been the memory is not wiped away,
but it no longer creates the upsetting response it has in the
past. For example, you have many concious memories that you never
really think about, until someone brings them up and you recall
them. For example, if you are with an old friend, or at your
class reuion, etc. When you are traumatized, however, you tend to
go over, and over the same issues, with little or no resolution.
You may be hypervigilant to certain issues related to this
problem, and you may even have nightmares, etc. According to
(Leslie M. Drozd, Ph.D.) "when you are traumatized, information
processing stops. There is an over-excitation in the brain and a
resulting pathological change of neural elements." In plain
language there is an overload, and information processing is
blocked. Completing EMDR therapy with a trained EMDR therapist
will allow you to complete the processing of this information
which significantly reduces the Subjective level of Disturbance
(of intensity of the emotion) associated with the event. The
memory is still there, just as any other memory, but without the
disturbing emotional distress usually associated with it. In
studies conducted on EMDR, it appears the brain actually changes
after a memory is worked through with EMDR.
HOW DOES THIS EFFECT ME?
Well, when the information is stored in your brain, it is stored
in its anxiety-producing form with the original picture emotions,
sensations and negative self-assessments. And when you are in
similar situations, this anxiety producing picture and emotions is
retriggered. For instance, as a child you were told you were not
very smart, and probably wouldn't be very successful. So when you
go to learn something new that old message is still in your brain
along with any negative feelings that may accompany it. Your boss
wants you to learn a new program and you panic or become highly
anxious and you don't know why. It's because that old tape is
being triggered again and again.
So you see when (EMDR) is done properly, it may reactivate
unresolved issues or feelings that are best handled with a trained
therapist. EMDR has been used for a number of problems Post-
traumatic stress, anxiety disorders, phobias, low self-esteem
issues, and depression. I am not claiming this is the answer to
all your problems, but is a fast way to access unresolved issues.
I have had positive effects with clients I have worked with, who
poor self-esteem, low self-confidence, dysfunctional family
issues, and depression, etc.
WHAT ABOUT MY OWN CHANGES?
EMDR is not given to just anyone. It takes one or two sessions to
determine if the EMDR is the right tool for this individual.
Background questions, learned relaxation techniques, and a general
evaluation are necessary to determine if this is the right
technique to deal with a troubling memory. Then in the second or
third session the eye movement process is used which takes between
1-1.5 hours. There is usually a positive effect even after only
one session, however, 4 to 6 sessions are normally required to
complete the therapy effectivley. At the end of the sessions the
memory has lost most of its impact.
Since the initial efficacy study (Shapiro, 1989), positive
therapeutic results with EMDR have been reported with a wide
number of populations, including:
Combat veterans from Desert Storm, the Vietnam War, the Korean
War, and World War II who were formerly treatment resistant and
who no longer experience flashbacks, nightmares, and other PTSD
sequelae (Carlson, Chemtob, Rusnak, & Hedlund, in press; Daniels,
Lipke, Richardson, & Silver, 1992; Lipke & Botkin, 1992; Perry, in
press; Taber, in press; Thomas & Gafner, 1993; Viola & McCarthy,
1994; Young, in press).
Persons with phobias who revealed a rapid reduction of fear and/or
symptomatology (Doctor, 1994; Kleinknecht, 1993; Lohr, Tokin, &
Kleinknecht, in press-a, in press-b).
Sufferers of panic disorder who are recovering at a rate more
rapid than that achieved by other treatments (Goldstein, 1992;
Goldstein & Feske, 1994; O'Brien, 1993).
Crime victims and police officers who are no longer disturbed by
the after effects of violent assaults (Baker & McBride, 1991;
Kleinknecht, 1992; Page & Crino, 1993; Shapiro & Solomon, in
press; Solomon, 1995).
People relieved of excessive grief due to the loss of a loved one
or to line-of-duty deaths, such as engineers no longer devastated
with guilt because their train unavoidably killed pedestrians
(Puk, 1991a; Solomon, 1994, 1995; Solomon & Shapiro, in press).
Children healed of the symptoms caused by the trauma of assault or
natural disaster (Abruzzesse, 1994; Cocco & Sharpe, 1993;
Greenwald, 1994; Pellicer, 1993; Shapiro, 1991a).
Sexual assault victims who are now able to lead normal lives and
have intimate relationships. (Gould, 1994; Parnell, 1994; Puk,
1991a; Shapiro, 1989b, 1991a, 1994a; Wolpe & Abrams, 1991).
Accident and burn victims who were once emotionally or physically
debilitated and who are now able to resume productive lives
(McCann, 1992; Puk, 1992; Solomon & Kaufman, 1994).
Victims of sexual dysfunction who are now able to maintain healthy
sexual relationships (Levin, 1993; Wernik, 1993).
Clients at all stages of chemical dependency who now show stable
recovery and a decreased tendency to relapse (Kitchen, 1991;
Shapiro, Vogelmann-Sine, & Sine, 1994).
People with dissociative disorders who progress at a rate more
rapid than that achieved by traditional treatment (Fine, 1994;
Lazrove, 1994; Marquis & Puk, 1994; Paulsen, in press; Paulsen,
Vogelmann-Sine, Lazrove, & Young, 1993; Puk, 1994; Rouanzoin,
1994; Young, 1994).
Clients with a wide variety of PTSD and other diagnoses who
experience substantial benefit from EMDR (Cohn, 1993; Fensterheim,
1994a; Figley & Carbonell, 1995; Forbes, Creamer, & Rycroft, 1994;
Marquis, 1991; Puk, 1991b, 1994; Spates & Burnette, in press;
Spector & Huthwaite, 1993; Vaughan, Wiese, Gold, & Tarrier, 1994;
The following controlled EMDR studies have been completed:
Boudewyns, Stwertka, Hyer, Albrecht, and Sperr (1993). A pilot
study randomly assigned 20 chronic inpatient veterans to EMDR,
exposure, and group therapy conditions and found significant
positive results from EMDR for self-reported distress levels and
therapist assessment. No changes were found in standardized and
physiological measures, a result attributed by the authors to
insufficient treatment time considering the secondary gains of the
subjects who were receiving compensation. Results were considered
positive enough to warrant further extensive study, which has been
funded by the VA. Preliminary reports of the data (Boudewyns,
Hyer, Peralme, Touze, & Kiel, 1994) indicate that EMDR is superior
to a group therapy control.
Jensen (1994). A controlled study of the EMDR treatment of 25
Vietnam combat veterans suffering from PTSD, as compared to a non-
treatment control group, found small but statistically significant
differences after two sessions for in-session distress levels, as
measured on the SUD Scale, but no differences on the Structured
Interview for Post-traumatic Stress Disorder (SI-PTSD), VOC, GAS,
and Mississippi Scale for Combat-Related PTSD (M-PTSD; Jensen,
1994). This study was done by two psychology interns who had not
completed formal EMDR training. Furthermore, the interns reported
low fidelity checks of adherence to the EMDR protocol and skill of
application, which indicated their inability to make effective use
of the method to resolve the therapeutic issues of their subjects.
Levin, Grainger, Allen-Byrd, and Fulcher (1994). A controlled
study of 45 Hurricane Andrew (Florida) survivors found significant
differences in scores on the SUD and Impact of Event scales,
indicating a superiority of EMDR treatment to supportive crisis
counseling and non-treatment controls at l-month and 3-month
Pitman et al. (1993). In a controlled component analysis study of
17 chronic outpatient veterans, using a crossover design, subjects
were randomly divided into two EMDR groups, one using eye movement
and a control group that used a combination of forced eye
fixation, hand taps, and hand waving. Six sessions were
administered for a single memory in each condition. Both groups
showed significant decreases in self-reported distress, intrusion,
and avoidance symptoms. SCL-90-R changed in the eye movement
condition only, while the Clinician Administered PTSD Scale
(CAPS), Mississippi Scale for PTSD, and State Anxiety remained
unchanged in both.
Renfrey and Spates (1994). A controlled component study of 23 PTSD
subjects compared EMDR with eye movements initiated by tracking a
clinician's finger, EMDR with eye movements engendered by tracking
a light bar, and EMDR using fixed visual attention. All three
conditions produced positive changes on the CAPS, SCL-90-R, Impact
of Event Scale, and SUD and VOC scales.
Shapiro (1989a). The initial controlled study of 22 rape,
molestation, and combat victims compared EMDR and a modified
flooding procedure that was used as a placebo to control for
exposure to the memory and to the attention of the researcher.
Positive treatment effects were obtained for the treatment and
delayed treatment conditions on SUDs and behavioral measures,
which were independently corroborated at 1- and 3-month follow-up
Vaughan, Armstrong, et al. (1994). In a controlled comparative
study, 36 subjects with PTSD were randomly assigned to treatments
of (1) imaginal exposure, (2) applied muscle relaxation, and (3)
EMDR. Treatment consisted of four sessions, with 60 and 40 minutes
of additional daily homework over a 2- to 3-week period for the
image exposure and muscle relaxation groups, respectively, and no
additional homework for the EMDR group. All treatments led to
significant decreases in PTSD symptoms for subjects in the
treatment groups as compared to those on a waiting list, with a
greater reduction in the EMDR group, particularly with respect to
D. Wilson, Covi, Foster, and Silver (1991). In a controlled study,
18 subjects suffering from PTSD were randomly assigned to eye
movement, hand tap, and exposure-only groups. Significant
differences were found using physiological measures (including
galvanic skin response, skin temperature, and heart rate) and the
SUD Scale. The results revealed, with the eye movement condition
only, a one-session desensitization of subject distress and an
automatically elicited and seemingly compelled relaxation
response, which arose during the eye movement sets and which
appears to support a conditioning model.
S. Wilson, Becker, and Tinker (in press). A controlled study
randomly assigned 80 trauma subjects (37 diagnosed with PTSD) to
treatment or delayed-treatment EMDR conditions and to one of five
trained clinicians. Substantial results were found at 30 and 90
days and 12 months post treatment on the State-Trait Anxiety
Inventory, PTSD-Interview, Impact of Event Scale, SCL-90-R, and
the SUD and VOC scales. Effects were equally large whether or not
the subject was diagnosed with PTSD. Non-randomized studies
involving PTSD symptomatology (not noted in Table 1) include:
An analysis of an inpatient veterans' PTSD program (n = 100)
compared EMDR, biofeedback, and relaxation training and found EMDR
to be vastly superior to the other methods on seven of eight
measures (Silver, Brooks, & Obenchain, 1995).
A study of Hurricane Andrew survivors found significant
differences on the Impact of Event Scale and SUD scales in a
comparison of EMDR and non-treatment conditions (Grainger, Levin,
Allen-Byrd & Fulcher, 1994).
A study of 60 railroad personnel, suffering from high-impact
critical incidents, compared a peer counseling debriefing session
alone to a debriefing session that included approximately 20
minutes of EMDR (Solomon & Kaufman, 1994). The addition of EMDR
produced substantially better scores on the Impact of Event Scale
at 2- and 10-month follow-ups.
Of 445 respondents to a survey of trained clinicians who had
treated over 10,000 clients, 76% reported greater positive effects
with EMDR than with other methods they had used. Only 4% found
fewer positive effects with EMDR (Lipke, 1992b, 1994).
FOR MORE INFORMATION CONTACT:
EMDR Institute, Inc.
PO Box 51010
Pacific Grove, CA 93950-6010 USA
Tel: 408-372-3900 Fax: 408-647-9881
Internet Address: http://www.emdr.com