EMDR : A highly effective treatment for trauma and anxiety-based problems. EMDR (Eye Movement Desensitization and Reprocessing) is a therapeutic method originated and developed by Dr Francine Shapiro in 1987.
EMDR is effective in treating individuals who have experienced psychological difficulties arising from traumatic experiences, such as assault, road-traffic accidents, war trauma, torture, natural or man-made disasters, sexual abuse and childhood neglect. EMDR is also increasingly used to treat complaints which are not necessarily trauma-based such as panic disorder, phobias, performance anxiety, self-esteem issues and other anxiety-related disorders.
EMDR is a complex method of psychotherapy which integrates many of the successful elements of a range of therapeutic approaches in combination with eye movements or other forms of alternative dual-attention stimulation, such as alternative audio tones or alternative hand tapping, which appear to stimulate the brain's information processing system. Therapists who have trained in EMDR find it is very much more effective than exclusively verbally based therapies. EMDR incorporates aspects of all the major therapeutic methods, whether cognitive, psychoanalytic, behavioural, systemic or experiential but also most importantly it processes somatically stored memory.
What does an EMDR session look like
Once a full history has been taken and some preparatory relaxation and resource imagery exercises have been developed, the therapist helps the client to identify possible targets for EMDR. Such targets could be comprised of a big "T" trauma (such as a disaster, a rape etc) or small "t" trauma (such as lying and getting someone into trouble at school or jealousy of a sibling in the past, which still disturbs the person in the present).
When focusing on a particular memory the EMDR method evokes all aspects of the traumatic memory – visual, emotional, cognitive and most importantly physical. The client is asked to simply follow the hand of the therapist moving rapidly back and forth in front of his or her face.
During EMDR treatment the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on the therapist's fingers or to alternative sounds. EMDR appears to facilitate the accessing of the traumatic memory network and the information is adaptively processed with new associations being made between the disturbing memory and more adaptive memories or information, leading to more complete information processing and alleviation of emotional and physiological distress.
So, a client may concentrate on the worst part of a road traffic accident being an image of the car about to impact, the negative belief of "I'm completely helpless" and the disturbing sensation of fear manifest as a constriction in the throat and chest. After a set of eye movements the client reports other aspects of the accident and after a further set of eye movements the client may spontaneously move to thinking of an earlier, thematically-related, trauma, or may move to other situations where he or she felt helpless in the past. These may be early childhood events. The therapist merely facilitates the client in finding their own adaptive resolution without interfering with the process.
So in doing the eye movements the client seems to spontaneously free-associate through a whole network of related memories, sensations and emotions. It is as if the eye movements (or alternative sounds or touch) facilitate access to all the channels of association to the traumatic memory targeted during the treatment. As these different channels are accessed, the client appears to rapidly link up with more appropriate information which leads to a more functional and less dysfunctional storage. So for instance the client no longer feels helpless and has access to a more adaptive understanding of the traumatic memory. This new perspective can then replace the neurological imprint of terror and fear with a feeling of empowerment in the present and/or the sense of safety in the present.
EMDR leads to the emergence into consciousness of associatively linked memories to the trauma or emotional pain and the assumption is that if there is a recent trauma this cannot be fully processed until the earlier events with which it resonates have been processed. What seems to happen is that the processing involves tracking back through chains of linked emotional and sensory memories and in particular the physical or bodily aspects of these, and ultimately finding a more functional and adaptive resolution of the anxiety symptoms related to the targeted event.
How does EMDR work
Although there are many hypotheses the fact is we still do not know how EMDR produces its impressive results. Dr Robert Stickgold¹ has put forward a theory that the eye movements or other forms of bilateral stimulation elicit a physiological response which plays a major role in reorganising memory in the brain and activates the associations linking up memories that are associated with each other through common emotions.
There have also been suggestions that EMDR stimulation reinforces the activity of the para-sympathetic nervous system.² EMDR is a process which involves dual-attention stimuli where the client stays focused on the present while re-experiencing emotions that belong to the past and this appears to trigger a reorganising of the traumatic memory in the brain. EMDR is rapidly being recognised through an increasing number of scientific studies to be an effective treatment for Post Traumatic Stress Disorder and for other anxiety-related disorders.
Organisations that have recognised EMDR as a highly effective treatment are:
- The American Psychological Association
- The Department of Health UK
- The Department of Health Israel
- The Department of Health Northern Ireland
Guidelines for the treatment of Post Traumatic Stress Disorder produced by the National Institute of Clinical Excellence are currently suggesting that EMDR and CBT are the treatments of choice for clients suffering from Post Traumatic Stress Disorder.
Although EMDR as a psychotherapy sounds deceptively simple it is a very powerful technique. It involves a very specialized approach and method that requires supervised training for full therapeutic effectiveness and client safety. Clients are at risk if untrained clinicians attempt to use EMDR. A clinical background is necessary to undertake the EMDR Basic, Intermediate and Advanced Training and these trainings are limited to mental health professionals who are qualified to provide treatment in the mental health field.
References: Stickgold, R. (2002), 'A Putative Neurobiological Mechanism', Journal of Clinical Psychology 58: 61-75.
Wilson, D., Silver, S., Covi, W. & Foster, S. (1996), 'Eye Movement Desensitization and Reprocessing: Effectiveness and Autonomic Correlates', Journal of Behavior Therapy and Experimental Psychiatry 27 (3): 219-229.
Chambless, D. et al (1998), 'Update on Empirically Validated Therapies, II', The Clinical Psychologist 51 (1): 3-16.
United Kingdom Department of Health, (2001), The Evidence Based Clinical Practice Guideline.
Bleich, A. et al (2002), 'Guidelines for the Assessment and Professional Intervention with Terror Victims in the Hospital and in the Community', a position paper of the National Council for Mental Health, Ministry of Health, Israel.
CREST (2003), 'The Management of Posttraumatic Stress Disorder in Adults' (Belfast, Northern Ireland, Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety).
By Alexandra Richman
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