Effective Use of EMDRSarah Brothwell, Rachel Pickel, Ashley Walczak

What is EMDR?

Eye Movement Desensitization and Reprocessing is a therapeutic treatment that uses eye movements, sounds or pulsations to stimulate the brain.

Using theses sensory experiences in conjunction with focusing on a traumatic memory can create changes in the brain that help a client overcome symptoms of depression, anger and anxiety among other conditions.

EMDR combines aspects of behavioral, psychodynamic and cognitive therapy.

History of EMDR

In 1987, Francine Shapiro was walking in the park when she realized that eye movements appeared to decrease the negative emotions associated with her own distressing memories, leading her to believe that eye movements have a desensitizing effect.

In her first controlled study to test effectiveness, participants in the EMDR conditions reported larger changes than those in the imagery condition.

Evolution of EMDR

In 1989, studies investigating the treatment of PTSD were becoming more popular. During this time Shapiro published two studies demonstrating the efficacy of EMDR.

Shapiro, F (1989). Eye Movement Desensitization: A new treatment for Post-traumatic Stress Disorder. Journal of Behavior Therapy in Experimental Psychology, 20,211-217.

Shapiro, F (1989). Efficacy of the Eye Movement Desensitization Procedure in the Treatment of Traumatic Memories. Journal of Traumatic Stress, 2, 199-223.

Theoretical Model According to Shapiro, the Information Processing System incorporates the multiple elements of our experiences and stores memories in an accessible and useful form.

When a traumatic or very negative event occurs, information processing may be incomplete leaving the memory dysfunctionally stored without appropriate associative connections and elements still unprocessed.

When an individual thinks about a traumatic experience or a memory is triggered, he or she may feel that they are reliving it.

Shapiro proposed that EMDR can alleviate emotions associated with the trauma by processing the components of the distressing memories and linking them with more adaptive information.

Goals of Treatment

To completely process traumatic experiences that are creating problems in the present.

To leave the client with emotions, understandings and perspectives that will lead to healthy functioning.

Treatment is not complete until EMDR therapy has focused on the past memories that are contributing to the problem the present situations that are disturbing and what skills the client may need for the future

Stages of Therapy http://www.youtube.com/watch?v=bqbFIj5vwmA

Stage 1: History Taking

Usually takes place during the first two sessions of therapy

Entails the development of a treatment plan, discussion of the specific problem, and behaviors and symptoms stemming from the problem

Specific targets are defined to use EMDR on

Stage 2: Client Preparation

1-4 sessions

Primary goal of preparation is to establish a relationship of trust

Relaxation techniques are taught to clients to rapidly deal with emotional disturbances when they arise

Stages of Therapy Cont.

Stage 3: Assessment: Person selects a specific scene from the target experience that best represents the memory.

The client chooses a statement that expresses a negative self-belief associated with the memory.

The person identifies negative emotions and physical sensations associated with the memory and then rates that disturbance using Subjective Unites of Disturbance.

Stages of Therapy Cont.

Stage 4: Desensitization

Focuses on the clients disturbing emotions and sensations.

The therapist leads the person in sets of eye movements or other forms of stimulation with appropriate shifts and changes of focus until the SUD scale levels are to zero.

This phase deals with all of the persons responses as the targeted event changes and its disturbing elements are dissolved.

Stages of Therapy Cont. Stage 5: Installation

The goal is to concentrate on and increase the strengths of the positive belief that the person has identified to replace the person’s original negative belief.

Stage 6: Body Scan

The therapist asks client to bring the targeted event to mind and see if he or she has any physical sensations in response to the event.

If so, then those sensations are targeted to be reprocessed.

Stages of Therapy Cont. Stage 7: Closure

The therapist assures that the client leaves feeling better than at the beginning of the session.

If not the therapist will assist the person in using relaxation techniques to regain a sense of equilibrium before leaving.

Stage 8: Re-evaluation

Is done at the beginning of subsequent sessions

The therapist makes sure that positive results have been maintained, identifies any new areas that need treatment and continues reprocessing additional targets.

Overview of TraumaCauses of trauma: human action, such as domestic violence, abuse, neglect, assault or war. Noninterpersonal traumas including life threatening illness, accidents, and natural disasters.

Types of trauma: An experience of a single traumatic event are said to be a Type I trauma. The experience multiple/enduring traumatic events, are said to be Type II trauma.

Reactions to trauma: Acute stress disorder, Post-traumatic stress disorder, depression, generalized anxiety disorder, childhood traumatic grief, specific phobias, and separation anxiety.

ResearchSilver, S.M., Rogers, S., Knipe, J., & Colleli, G. (2005). EMDR therapy following the 9/11 terrorist attacks: A community-based intervention project in New York City. International Journal of Stress Management, 12 (1), 29-42.

This article addresses questions regarding the effectiveness of EMDR as a treatment for individuals traumatized by mass terror attacks and the effectives of EMDR in regard to the time elapsed between traumatic event and treatment.

Results indicated a 50-61% decrease in scores on measures of PTSD symptoms and even greater improvements on self-report based measures after 4-5 treatment sessions.

Results also indicate that the sooner treatment begins after a traumatic event the more effective treatment will be.

ResearchVan der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. W., Hopper, E. K., Korn, D. L., & Simpson, W. B. (2007). A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term maintenance. Journal Of Clinical Psychiatry, 68(1), 37-46. doi:10.4088/JCP.v68n0105.

This study indicates that the short-term use of EMDR may not be sufficient on its own to treat clients who have experience prolonged childhood trauma. Clients who experienced childhood trauma may need more intensive, longer-term EMDR treatment to experience permanent symptom remission.

This study also identifies the benefits of pharmacological intervention, which may be helpful for those who have experienced significant childhood trauma.

EMDR may not be as effective in treating adults who have experienced childhood trauma, because of the time that has elapsed since the trauma occurred.

Research Davidson, P.R., & Parker, K.C.H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69 (2), 305–316.

Results from a meta-analysis of 34 studies indicated that EMDR is effective when compared to no therapy at all and non-specific therapies (e.g. applied relaxation, biofeedback, active listening, rapid induction).

Results also indicate that EMDR was no more effective than other exposure based treatments (e.g. in vivo exposure, CBT).

Also, the authors did not support the necessity of the eye movement component, nor for the training of therapists by the EMDR Institute.

Research

Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, 13 (2), 97-107.

This study investigated whether EMDR is another form of exposure based therapy or if its effectiveness is related to dual-focus of attention.

Dual-focus is being able to maintain an optimal balance between a focus on the traumatic material and a sense of not being part of the trauma.

This article rejects the idea that EMDR is simply another exposure based therapy.

Additional Uses of EMDR

Treatment of MigrainesKonuk, E., Epözdemir, H., Atçeken, Ş., Aydin, Y., & Yurtsever, A. (2011). EMDR Treatment of Migraine. Journal Of EMDR Practice & Research, 5(4), 167-176.

Treatment of Chronic PainMazzola, A., Calcagno, M., Goicochea, M., Pueyrredòn, H., Leston, J., & Salvat, F. (2009). EMDR in the Treatment of Chronic Pain. Journal Of EMDR Practice & Research, 3(2), 66-79. doi:10.1891/1933-3196.3.2.66

Treatment of Phantom Limb Pain Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2008). EMDR in the Treatment of Chronic Phantom Limb Pain. Pain Medicine, 9(1), 76-82. doi:10.1111/j.1526-4637.2007.00299.x

Additional Uses of EMDR

Improvements in Attachment Style: Wesselmann, D., & Potter, A. E. (2009). Change in Adult Attachment Status Following Treatment With EMDR: Three Case Studies. Journal Of EMDR Practice & Research, 3(3), 178-191. doi:10.1891/1933-3196.3.3.178

Treating Eating Disorders: Bloomgarden, A., & Calogero, R. M. (2008). A Randomized Experimental Test of the Efficacy of EMDR Treatment on Negative Body Image in Eating Disorder Inpatients. Eating Disorders, 16(5), 418-427. doi:10.1080/10640260802370598

Additional Information

EMDR.com

EMDRnetwork.org

EMDRinaction.com

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