eye movement and desensitization reprocessing therapy

eye movement and desensitization reprocessing therapy (EMDR), psychotherapy technique using visual bilateral stimulation—such as watching a light or an object move in a rhythmic pattern that triggers activity in both sides of the brain—to reduce distress associated with traumatic memories and life experiences. Eye movement and desensitization reprocessing (EMDR) therapy was conceptualized by American psychologist Francine Shapiro in the late 1980s. The approach uses an eight-stage process primarily to treat disorders linked to trauma, such as post-traumatic stress disorder (PTSD). EMDR therapy is effective for many patients; however, the technique is controversial, owing to uncertainty surrounding its underlying mechanisms.

EMDR is informed by the adaptive information processing model, which posits that PTSD and related disorders are derived from inadequate processing of traumatic memories. As a result, thoughts, emotions, and sensations from the time of the traumatic event are experienced when the memory is triggered. EMDR focuses directly on reprocessing the memory to alleviate the negative symptoms.

Phases

EMDR therapy is organized into eight phases, which are typically conducted over the course of 6 to 12 sessions; some patients feel noticeable improvements after only several sessions. Sessions are usually held once or twice a week, each lasting from 50 to 90 minutes. In phase I, the therapist completes preliminary tasks, including taking the patient’s history, administering appropriate assessments, and identifying traumatic memories, triggers, and goals. The groundwork continues in phase II, where the therapist explains the EMDR process and provides the patient with techniques to deal with potential negative impacts associated with confronting traumatic memories.

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In phase III, the therapist identifies and assesses the traumatic memory before establishing a positive cognition to be used to replace the negative emotions. The patient begins to engage in bilateral stimulation exercises. In phase IV, the stimulation is repeated until the patient no longer reports experiencing distress from their memory. The focus then switches, in phase V, to positive cognition and its reinforcement. Following the installation of the positive thought, phase VI is used to address any residual physical responses to the traumatic memory; physical responses are resolved through further bilateral stimulation exercises, which may include tactile stimuli (e.g., alternately tapping the sides of the head).

In phase VII, the patient is returned to a state of emotional equilibrium—regardless of whether the traumatic memory was successfully reprocessed or not—and is given instructions on how to maintain safety and emotional security between sessions. The following sessions then begin with phase VIII, in which the therapist reviews the patient’s psychological state and the strength of their treatment responses and develops further steps necessary to achieve the patient’s goals.

Mechanisms

Although EMDR therapy can benefit patients, the underlying reasons for how and why it does are largely unknown and highly debated. Causal explanations typically fall into one of three main categories. One category, psychological models, points to the therapy’s interaction with the mind as the reason for its success. For example, some researchers use classical conditioning theory to argue that EMDR establishes a positive learned response to replace the negative reaction, while others draw on the finite capacity of working memory and argue that overloading it with stimuli decreases emotion attached to a traumatic memory.

The second category contains neurobiological models that look to physical responses as the root cause of the success of EMDR therapy. Certain researchers have theorized that bilateral eye movements stimulate associative memory processing through communication between the brain’s hemispheres. By contrast, others suggest that the therapy aids activation in the thalamus to provide improved integration of sensory and other information with memories.

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Finally, psychophysiological models combine both physical and mental processes in their explanations. For example, decreases in heart rate and changes in breathing patterns are consistent with relaxation attributed to bilateral stimulation. In addition, saccadic eye movements (fast intermittent eye movements that redirect gaze), which occur during bilateral stimulation, may serve a similar desensitization function as eye movements known to occur during REM sleep, which are thought to reduce dream-associated anxiety.

History and controversy

The basis for EMDR therapy reportedly came to Shapiro while she was walking in a park in 1987. She discovered that her traumatic memories lost their distressing nature when her eyes engaged in saccadic movements, hypothesizing that the motions helped alleviate her negative reactions. Shapiro tested her hypothesis on a group of volunteers who had been diagnosed with PTSD; she published her findings in 1989 in a landmark paper.

In the following decade EMDR therapy experienced both development and criticism. Multiple studies found evidence in support of EMDR, and in 1995 Shapiro established a formal manual for the therapy’s implementation. Meanwhile, other researchers compared EMDR to mesmerism and questioned the addition of eye movements to exposure therapy. Despite the lack of evidence for a scientific basis for EMDR therapy, a growing body of research supported its positive effects. As a result, the therapy began to gain approval by numerous psychological organizations, including the American Psychological Association, which in 1998 made a conditional recommendation for EMDR therapy for persons affected by PTSD.

Nonetheless, EMDR still faces controversy as a therapeutic technique. Shapiro’s claim about the therapy’s spontaneous discovery has come under scrutiny. Combined with the fact that it is nearly impossible to perceive one’s own saccadic eye movements, Shapiro had conducted prior research on the role of eye movements in neuro-linguistic programming, a pseudoscientific theory. Furthermore, the role of eye movements in influencing the outcome of EMDR therapy is heavily debated. Although described as the “crucial component” by Shapiro in her initial paper, there have been mixed findings on the significance of eye movements; other bilateral stimuli appear to be just as effective. Experts have further criticized EMDR for its significant overlap with other therapeutic techniques, particularly trauma-focused cognitive behavioral therapy (TF-CBT).