Eye Movement Desensitization and Reprocessing
Eye movement desensitization and reprocessing (EMDR) is an integrative psychotherapy approach developed in 1987 by clinical psychologist Francine ShapiroOpens in new window.
EMDR is a method used to desensitize clients to distressing memories, feelings, and cognitions (thoughts) and to replace negative thoughts with positive ones (Rubin, 2003).
When a traumatic event occurs, it is often accompanied by strong negative feelings and dissociation. Recall of the traumatic event is thereafter linked with the strong negative emotionsOpens in new window that accompanied the actual event.
EMDR is a technique to reprocess the traumatic memory while disconnecting it from the associated negative emotions and thoughts.
EMDR contains elements of other therapies including psychodynamicOpens in new window, cognitive-behavioral (CBT)Opens in new window, interpersonalOpens in new window, experientialOpens in new window, and body-centeredOpens in new window therapies.
The key component in EMDR is the use of bilateral (two-sided) stimulation. The bilateral effect is provided by having the client visualize a distressing scene or memory while the therapist stimulates rapid back-and-forth eye movements, alternates right and left hand taps, or alternates sounds between the right and left ears. During the visualization, the client brings to mind thoughts and feelings related to the distressing memory (Rubin, 2003).
The term EMDR comes from the idea that eye movements (or other bilateral stimulation) while reprocessing a traumatic memory can lead to desensitization of the anxiety associated with the memory.
EMDR goals include anxiety reduction, elicitation of positive affect (emotion), changes in beliefs, insights, and behavioral shifts (Shapiro, 2002). A course of treatment may consist of 12 or more sessions over a period of several weeks, depending on the client’s needs and response to treatment. EMDR is usually administered on an outpatient basis (Bisson et al., 2007).
Since Dr. Shapiro’s (1989) first article on EMDR was published, over 30,000 mental health practitioners have been trained in EMDR. In the early 1990s, EMDR was depicted by the popular media and early proponents as a miracle cure for a wide range of problems.
The dramatic results of early EMDR studies were misinterpreted as implying that a single EMDR session could lead to long-lasting resolution of distress associated with traumatic memories in posttraumatic stress disorder (PTSD)Opens in new window and that clinicians could anticipate success rates as high as 80 or 90 percent.
PTSD may occur afer experiencing or witnessing military combat, domestic violence, sexual trauma, auto accidents, natural disasters, and other types of trauma. However, Shapiro acknowledged some of the media reports as hype and cautioned EMDR proponents not to make claims about miracle cures (Rubin, 2003).
EMDR has been used to treat many conditions, including PTSDOpens in new window, griefOpens in new window, eating disordersOpens in new window, phobiasOpens in new window, panic disorderOpens in new window, test anxietyOpens in new window, performance difficulties (e.g., work, sports, performing arts), conduct disordersOpens in new window, personality disordersOpens in new window, chemical dependencyOpens in new window, marital and relationship problems, dissociative disordersOpens in new window, and physical pain.
The most compelling evidence exists for the effectiveness of EMDR in treating PTSDOpens in new window. Some extreme claims have contributed to the controversy and skepticism surrounding the use of EMDR.
For example, Allan L. Botkin, Psy.D., claims that an offshoot of EMDR he calls induced after-death communicationOpens in new window can help resolve the deep sadnessOpens in new window associated with griefOpens in new window by helping bereaved individuals “experience what they believe is actual spiritual contact with the deceased” (Botkin, 2000, p. 181).
Theories about the mechanism of action responsible for the effects of EMDR include resetting of cells in the brain’s septum (which includes the hippocampusOpens in new window and amygdale), disconnection between the affective (emotion) and cognitive (thought) parts of the anterior cingulated cortex, and increase in the interaction between right and left brain hemispheres.
Evidence from electroencephalogram (EEG)Opens in new window studies suggest that brain stimulation during EMDR increases the power of a naturally occurring low-frequency rhythm in the amygdale of the brain, which processes fearOpens in new window.
When fearful memories are recorded (encoded), the memory is closely linked to the fearful emotion experienced during the traumatic event. This low-frequency rhythm produced by EMDR stimulation causes a mechanical change in fear memory, allowing the memory to be disconnected from the extreme emotions previously associated with the traumatic memory (Harper, 2009).
There has been a great deal of controversy about the effectiveness of EMDR. In a 2007 review of the research into treatment of PTSD, EMDROpens in new window was found to be as effective as trauma-focused CBTOpens in new window, both of which were more effective than stress managementOpens in new window, other therapies, or no treatment. Results may be affected by the populations being studied. For example, a study of Vietnam vets with PTSDOpens in new window showed EMDR to be less effective than a control group receiving no treatment (Bisson et al., 2007).
While EMDR appears to be a well-supported treatment for adults with PTSD resulting from a single trauma, there is less compelling evidence supporting the effectiveness of EMDR to treat PTSD in children, combat veterans, or individuals who have sustained multiple traumas (Rubin, 2003).
As not all individuals will benefit from EMDR, a variety of treatment approaches should be considered. Other treatment options may include alternative forms of trauma-focused treatment (e.g., CBT or exposure therapy) or psychotherapy augmented with medication (Bisson, 2007; Rubin, 2003).
More research is needed to establish the effectiveness of EMDR as a treatment for various populations and conditions, to see whether beneficial effects are maintained over time, and to explore and document any negative outcomes or side effects.
Side effects of EMDR may include unanticipated reactions, a temporary increase in distress (emotional or physical), or ongoing reexperiencing of traumatic material (e.g., in memories, dreams, or flashbacks) after the session has ended.
- Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. British Journal of Psychiatry, 190, 97 – 104.
- Borkin, A.L. (2000). The induction of after-death communications utilizing eye-movement desensitization and reprocessing: A new discovery. Journal of Near Death Studes, 18, 181 – 209.
- Harper, M. (2009). On the neural basis of EMDR therapy: Insights from qEEG studies. Traumatology, 15, 81 – 95.
- Rubin, A.A.R. (2003). Unanswered question about the empirical support for EMDR in the treatment of PTSD: A review of research. Traumatology, 9, 4 – 30.
- Shapiro, F. (2002). EMDR 12 years after its introduction: Past and future research. Journal of Clinical Psychology, 58, 1 – 22.