Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR) is a therapy developed in the late 1980s by California psychologist Francine Shapiro. It is used primarily in the treatment of patients who suffered a single traumatic event, such as rape, or are currently suffering from post-traumatic stress disorder (PTSD). Studies, including those conducted by the US Department of Veteran Affairs, have shown that EMDR reduces PTSD symptoms in over 50% of patients. In the the civilian population, 20 controlled outcome studies have put the figure at between 77-100%.
When we experience a traumatic event, our psychological coping mechanisms may not be equipped to handle the thoughts and feelings that result and the memory of the event will be corrupted. Later on, when we remember the event, we will again be unable to adequately process the thoughts and feelings that ensue. Most patients report post-traumatic stress symptoms of anxiety, insomnia and/or nightmares. It is not uncommon that they self-medicate with alcohol or drugs. The goal of EMDR is to help the patient properly process the memories and develop coping mechanisms that were absent during the event. The next time the person remembers the event, he or she will react in a healthier manner.
Although it integrates many successful elements of several therapeutic approaches, there are unique aspects of EMDR: In particular, the therapist leads a patient in a series of lateral eye movements while the patient focuses on various aspects of a disturbing memory. The left – right eye movements in EMDR are a form of “bilateral stimulation.” Other forms of bilateral stimulation used by EMDR therapists include alternating bilateral sound using headphones and alternating tactile simulation using a handheld device that vibrates or taps to the back of the patient’s hands.
The specialized therapist first reviews the patient’s history and assesses readiness for EMDR. Each session is generally between 60-90 minutes long, although shorter sessions can also be effective. During the preparation phase, the therapist works with the individual to identify a positive memory associated with feelings of safety or calm that can be used if distress associated with the traumatic memory is triggered. Then the target traumatic memory for the session is accessed with attention to image, negative belief, and body sensations. Repetitive 30-second dual-attention exercises are conducted in which the patient attends to a motor task while focusing on the target traumatic memory and then on any related negative thoughts, associations, and body sensations. The therapist then directs the patient to think of a preferred positive belief regarding the incident and to focus on this positive belief while continuing with the exercises. The exercises end when the patient reports, with confidence, comfortable feelings and a positive sense of self when recalling the target trauma. After reviewing the progress, the therapist and patient discuss scenarios or contexts that might trigger psychological distress. These triggers and positive images for appropriate future action are also targeted and processed. In addition, the therapist asks the client to keep a journal, noting any material related to the traumatic memory, and to focus on the previously identified positive safe or calm memory whenever psychological distress associated with the traumatic memory is triggered.
With every new session, the therapist will reevaluate the work done in the prior session. The therapist will also assess how well the patient managed on his or her own in between visits. At this point, the therapist will decide whether it is best to continue working on previous targets or continue to newer ones.
The underlying mechanism for how this process works to reduce trauma-related stress, anxiety, and depression is unknown. Researchers have theorized that the positive effect is due to adaptive information processing, the theoretical model behind EMDR. Dual-attention exercises disrupt the client’s stored memory of the trauma and allow for an alteration of beliefs, emotions, and other symptoms associated with the memory. Once recall of the trauma no longer elicits negative beliefs, emotions, or other maladaptive symptoms the memory shifts to a more adaptive set of beliefs, emotions, and mechanisms, overwriting the original memory of the trauma.
As a skeptic, I am always aware of the old “if it’s too good to be true it probably is” school of thought. That said, I have found EMDR to be an extremely effective therapy both in my own case as a survivor of violent childhood sexual abuse and in the lives of others I have observed in the last decade. (In reply to a New York Times blog about EMDR, 2012)
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