EMDR therapy (Eye Movement Desensitisation and Reprocessing) is a powerful and relatively new form of psychotherapy that is challenging everything we believe or have assumed about emotions and the nature of change. Where years ago it was accepted that psychotherapy often took a long time, depending on the nature of the problem (and even then outcomes were less than wonderful), therapists and clients are finding that problems that were resistant to years of psychotherapy are being resolved in a very short amount of time. Sometimes, within a few sessions.
The EMI approach (Eye Movement Integration) is a similar concept which is used in combination with EMDR when appropriate. EMI therapy is particularly effective when tackling some of the more stubborn aspects of trauma.
Both EMDR and EMI are generally combined with aspects of hypnotherapy to generate even better outcomes. This is sometimes referred to as Hypno EMDR.
Changing States in partnership with Neuro Innovations has undertaken research and development to innovate new EMDR / EMI software to facilitate even greater levels of change. This approach partially automates EMDR / EMI techniques to ensure replicable treatments. More about EMDR / EMI Software…
A Few EMDR Therapy Case Histories
Tom was a professional who freelanced, and was quite successful at what he did, but he was terrified of making a mistake in public and drawing attention to himself. As a result, he avoided eating in restaurants with his colleagues. During EMDR therapy Tom thought about this fear and noticed the thoughts, emotions and physical sensations he was having. The therapist began to move her hand from side to side in a horizontal direction and asked
Tom to follow with his eyes and simply notice what was “coming up”, and to report this whenever the therapist stopped. Without conversation, the therapist began moving her hand, and again Tom followed with his eyes and reported what he noticed. The session continued like this for 60 to 90 minutes until Tom was experiencing only positive feelings and thoughts. At the next week’s session he reported that he had had lunch out with his co-workers every day and only experienced the slightest anxiety.
Ellen entered therapy complaining of lifelong depression. As a child she was abused emotionally, physically and verbally. Her mother was so incredibly sadistic that it was difficult to listen to her stories. If Ellen had been in traditional psychotherapy it may have taken ten or more years to make significant progress. When she began EMDR she began to notice differences in her self-esteem, behaviour and outlook after only two sessions. Ellen worked through many of her worst traumatic memories and ten months later she felt she was ready to stop therapy. She felt and acted like a new person.
So what is EMDR, how was it developed?
Prior to EMDR being labelled as EMDR there were a number of eye movement trauma techniques that evolved from research in the 60s that were in use by the NLP movement. The co-founder of NLP, John Grinder, taught one of those techniques to an administrator that was working at his training centre for use with her traumatised friend. This same technique evolved into the NLP approach known as Eye Movement Integration. The administrator was Francine Shapiro who later claimed to have “invented” EMDR without reference to any past research or technique.
Anyway, the story goes that in 1987, psychologist Dr. Francine Shapiro was walking through the park and thinking about something that was troubling her. She accidentally noticed that her eyes were darting back and forth. When she returned to her thoughts she noticed that they weren’t as disturbing. This intrigued her and she tested it out on herself by thinking of something disturbing, then thinking of it again while purposely moving her eyes back and forth. The results were the same.
Dr. Shapiro began testing this scientifically, first with Vietnam war veterans suffering from PTSD (Post Traumatic Stress Disorder). Some of these men had been in traditional therapy for 15 to 20 years and yet they continued to have nightmares and flashbacks that felt as if they were reliving the horrors of war. PTSD had completely incapacitated some of these men, but when they received EMDR treatment, many found that years of PTSD symptoms disappeared within a few sessions. These incredible results were repeated when EMDR was tested with rape victims and victims of other types of trauma. What is remarkable is that during her research, Shapiro found that not only does EMDR desensitize painful memories but people spontaneously began to view themselves and the event in a healthier and more positive way. So, “I’m worthless” became, “I’m a good and lovable person and deserving of love and respect”.
How does EMDR work?
Exactly how EMDR works is not really known. We do know from memory and brain research that painful or traumatic experiences are stored in a different part of the brain than pleasant or neutral ones. Normally, if we’re troubled by something, we think about it, talk about it, perhaps dream about it and eventually we are able to come to some sort of adaptive resolution. (We find a way to come to terms with it in a healthy way, enabling us to put it behind us.) Something happens that interrupts this process when we experience a trauma or a very painful event. Instead, the traumatic material gets ‘stuck’ in the brain and remains in its original form, with the same thoughts, feelings, bodily sensation, smells and sounds. It’s as though it is sealed off from the healthy, functioning brain. That’s why it’s not uncommon for a person who’s had years of traditional talk therapy to find that they still hurt and haven’t changed as much as they had hoped. This is because the dysfunctionally stored material still has not been processed.
What researchers think is that EMDR in some way is able to ‘nudge’ that material so that it neurologically reconnects with the healthy brain and then is reprocessed and integrated at an accelerated speed. The most popular theory is that when the eyes move back and forth it creates brain activity similar to that which occurs during REM (rapid eye movement) sleep. It’s during this REM phase (when we dream) that we resolve conflicts, process information and consolidate learning and memory. More simply put, information processing takes place. By creating similar brain activity, while thinking about the painful event, it appears that EMDR is able to help the brain finally process the ‘stuck’ material, enabling the person to arrive at an adaptive resolution. The painful event or trauma becomes an unfortunate memory but is no longer produces the emotional pain that it did before.
What’s wonderful is that over the past ten years many accomplished therapists have found that EMDR is helpful in treating many other problems besides PTSD. Some of these include other anxiety disorders, depression, sexual abuse issues, work related problems and low self-esteem. Furthermore, some EMDR therapists have found that EMDR can enhance the performance of athletes, performing artists and writers.
It is important to understand that EMDR is not merely a technique using eye movements, but a complex, integrative method that utilises very precise protocols. Nor is it a “miracle cure” as some have been led to believe. Most long term problems are not cured in three sessions, however treatment is generally much shorter than traditional talk therapies, which is an advantage in the age of managed, solution driven care. EMDR has changed the face of psychotherapy and continues to do so. As scientists learn more about the brain, using new and sophisticated methods such as brain imaging, we may gain a deeper understanding of how the brain and EMDR works.
Originally, EMDR was used to resolve the after-effects of psychological trauma: assaults, natural disasters, traumatic grief, and other acutely painful situations. It was seen to work with unusual speed, and to achieve a degree of relief that was uncommon, to say the least. In recent years, however, it has been seen that EMDR can do wonders with a wider range of psychological disturbances than had originally been thought. EMDR works with a wide range of problems. This surprising clinical finding, validated increasingly by research, is part of what is forcing us to change our thinking about mental health, as we work with EMDR in clinical settings.
Put simply, we have found that a psychotherapy that seems focused on trauma-resolution actually helps with, and can heal, a wide range of problems not previously thought to be trauma-related, such as substance abuse disorders, a variety of kinds of depression, bipolar disorder, a wide range of anxiety disorders, and so on. Many times we cannot know if the use of EMDR will help or not until we try it. Often it does. Our understanding of why this is so is currently limited. But this is not particularly a problem. There is very little that happens in psychotherapy that we can fully explain. It’s simply far more important to understand that EMDR can help than it is to know why or how.
Certain issues are now considered routine for EMDR based treatment, due the historical success they have had in dealing with these problems. Here are some of the routinely treated clinical problems with which EMDR has been employed with considerable success:
EMDR is used in conjunction with clinical hypnotherapy, NLP self help techniques and cognitive / behavioural methods as provided by Changing States as defined by the needs of the individual. EMDR is not suitable for those with a detached retina or glaucoma.
“EMDR (Eye Movement Desensitization and Reprocessing) therapy has emerged as a procedure to be reckoned with in psychology…. Almost a million people have been treated …. Also, further research appears to support the remarkable claims made for EMDR therapy.”The Washington Post, July 21, 1995.
“Where traditional therapies may take years, EMDR takes only a few sessions.”The Stars and Stripes, February 12, 1995
“New type of psychotherapy seen as boon to traumatic disorders.”The New York Times, October 26, 1997.
Research Studies (PTSD and EMDR Therapy)
EMDR is the most thoroughly researched psychotherapy method for the treatment of symptoms of Posttraumatic Stress Disorder (PTSD). Below is the logic that supports the position that EMDR therapy is the best psychotherapy for the treatment of symptoms of PTSD.
1. Numerous controlled studies show EMDR is as effective as cognitive-behavior therapy.
Marcus, S. V., Marquis, P., & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307-315.
Lee, C., Gavriel, H., Drummond, P., Richards, J. & Greenwald, R. (2002). Treatment of post-traumatic stress disorder: A comparison of stress inoculation training with prolonged exposure and eye movement desensitization and reprocessing. Journal of Clinical Psychology, 58, 1071-1089.
Power, K. G., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., Swanson, V., & Karatzias, A. (in press). A controlled comparison of eye movement desensitisation and reprocessing versus exposure plus cognitive restructuring, versus waiting list in the treatment of posttraumatic stress disorder. Journal of Clinical Psychology and Psychotherapy.
Ironson, G., B. Freund, B., Strauss, J. L. & Williams J. (2002). Comparison of two treatments for traumatic stress: A community-based study of EMDR and prolonged exposure. Journal of Clinical Psychology. 58(1): 113-128.
Sprang, G. (2001). The use of eye movement desensitization and reprocessing (EMDR) in the treatment of traumatic stress and complicated mourning: Psychological and behavioral outcomes. Research on Social Work Practice, 11, 300-320.
2. The only published outlier is Devilly.
Devilly, G. J., & Spence, S. H. (1999). The relative efficacy and treatment distress of EMDR and a cognitive behavioral trauma treatment protocol in the amelioration of post traumatic stress disorder. Journal of Anxiety Disorders, 13 (1-2), 131-157.
3. The Maxfield & Hyer meta-analysis shows the importance of study rigor –which disqualifies Devilly’s study.
Maxfield, L. & Hyer, L. (2002). The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology. 58(1): 23-41.
4. Van Etten & Taylor meta-analysis assesses exposure and EMDR equally effective, but EMDR as more efficient.
Van Etten, M. L. & Taylor, S. (1998) Comparative efficacy of treatments for posttraumatic stress disorder: A meta-analysis. Clinical Psychology & Psychotherapy, 5, 126-144.
5. Chemtob et al found that EMDR reduces disturbance in children. Chemtob, C. M., Nakashima, J. & Carlson, J. G. (2002).
Brief treatment for elementary school children with disaster-related posttraumatic stress disorder: A field study. Journal of Clinical Psychology. 58(1): 99-112.
6. The International Society for Traumatic Stress Studies guidelines assess EMDR as effective with a A/B rating. The additional studies that would now bring it up to an A rating (See Lee; Ironson; Power).
Chemtob, C. M., Tolin, D. F., van der Kolk, B. A., & Pitman, R. K. (2000) Eye movement desensitization and reprocessing in E. A. Foa, T. M. Keane & M. J. Friedman (Eds.) Effective treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press.
7. As noted in Keane and Barlow, exposure/CBT and EMDR are equivalently effective. However, EMDR has been found to be more efficient (Lee; Ironson; Power; van Etten).
Keane, T. M. & Barlow, D. H. Posttraumatic stress disorder. In: Barlow, D. H. (Ed.) (2001). Anxiety and its disorders: the nature and treatment of anxiety and panic. New York: Guilford Publications.
8. Wilson et al. study and follow-up indicates that the benefits of EMDR therapy are substantial and long lasting.
Wilson, S. A., Becker, L. A., & Tinker, R. H. (1995). Eye movement desensitization and reprocessing (EMDR) therapy treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology, 63, 928-937
Wilson, S. A., Becker, L. A., & Tinker, R. H. (1997). 15-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for psychological trauma. Journal of Consulting and Clinical Psychology, 65 (6), 1047-1056.
9. There are numerous instances in the literature in which misconceptions about EMDR have been developed and maintained. Perkins & Rouanzoin have attempted to sort out the confusion.
Perkins, B. R. & Rouanzoin, C. C. (2002). A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points of confusion. Journal of Clinical Psychology. 58(1): 77-97.
10. The American Psychological Association has approved the EMDR Institute as a CEU provider because EMDR has been shown to be effective for trauma–as noted in the ISTSS guidelines.
11. The United Kingdom Department of Health (2001) has also listed EMDR as an efficacious treatment for PTSD. (Source unknown).
United Kingdom Department of Health. (2001). Treatment choice in psychological therapies and counselling evidence based clinical practice guideline. (Source unknown).