EMDR – Eye Movement Desensitization and Reprocessing is a form of therapy used to treat multiple aspects of trauma. It is a structured therapy that encourages the patient to briefly focus on the traumatic memory while simultaneously experiencing bilateral stimulation (usually eye movements), which is typically associated with a reduction in the intensity of the emotion that always accompanies the traumatic memory.
Eye Movement Desensitization and Reprocessing (EMDR) therapy was initially developed in 1987 by Francine Shapiro for the treatment of post-traumatic stress disorder (PTSD), guided by the Adaptive Information Processing model (AIP).
EMDR is an individual therapy usually administered once or twice a week, totaling 6-12 sessions, although some patients need fewer sessions.
Unlike other therapy methods, sessions can be conducted on consecutive days.
The Adaptive Information Processing (AIP) model considers PTSD symptoms and other traumatic disorders (excluding those with physical or chemical causes) as results of very intense past experiences that continue to cause distress due to inadequate processing of the memory and defective (unintegrated) storage in memory. These unprocessed memories are understood to contain the emotions, thoughts, beliefs, and physical sensations that occurred at the time of the event. Therefore, when memories that have remained unprocessed (or improperly integrated) are triggered, these disturbing stored elements are re-experienced, causing PTSD symptoms and/or other disorders.
In conclusion, unlike other forms of therapy that focus on directly modifying emotions, thoughts, and responses resulting from traumatic experiences, EMDR therapy focuses directly on the moment of the trauma, aiming to change how the traumatic memory is stored in the brain, thereby reducing and eliminating problematic symptoms through desensitization and reprocessing.
Clinical observations suggest that during EMDR therapy, an accelerated learning process is facilitated and stimulated by the standardized EMDR procedures, which incorporate the use of eye movements and other forms of left-right rhythmic (bilateral) stimulation (e.g., tones or taps). Thus, while clients briefly focus on the traumatic memory and simultaneously experience bilateral stimulation (BLS), the associated intensity and emotion are greatly reduced (Shapiro, 2017).
EMDR follows an eight-phase approach:
1. History Taking and Treatment Planning: The therapist gathers information about the client’s history and identifies the target memories causing distress.
2. Preparation: The therapist explains the EMDR process and helps the client develop coping mechanisms and relaxation techniques (defining a “safe place”).
3. Assessment: The client identifies negative beliefs associated with the target memories and selects positive beliefs to replace them. The third phase of EMDR, assessment, activates the memory targeted in the session by identifying and evaluating each memory component: image, cognition, affect, and bodily sensation, using two Likert scales with 7 and 10 steps, respectively.
During EMDR therapy sessions, two scales are used to evaluate changes in emotion and cognition: the Subjective Units of Disturbance (SUD) scale (10 steps) and the Validity of Cognition (VOC) scale (7 steps). These scales are used repeatedly during the various stages to subjectively assess the degree of desensitization and reprocessing (APA, 2023).
4. Desensitization, Reprocessing, and Verification of New Associative Channels: This phase involves recalling the target memory while simultaneously engaging in bilateral stimulation (e.g., eye movements, taps, or sounds). The goal is to process the memory, reducing its emotional intensity.
5. Installation: Positive beliefs are reinforced, replacing negative beliefs associated with the target memory.
6. Body Scan: The client checks for any remaining physical tension or discomfort related to the targeted memory.
7. Closure: The therapist helps the client return to a state of balance and offers coping strategies for dealing with any residual distress.
8. Reevaluation: In subsequent sessions, the therapist and client evaluate progress and address any remaining issues.
Phases 4-5-6 are accompanied by BLS (Bilateral Stimulation). Experimentally, it has been found that bilateral stimulation, such as lateral eye movements, mimics the natural processing that occurs during REM (Rapid Eye Movement) sleep, hypothesizing that this bilateral stimulation facilitates the integration of traumatic memories, helping patients reprocess them in a way that reduces their emotional load (EMDR Manual, 2023).
However, although EMDR has demonstrated its effectiveness in treating trauma-related conditions, its exact mechanisms are not fully understood, and research on its efficacy is still ongoing. The therapy has expanded beyond eye movements to include other forms of bilateral stimulation (tactile and/or auditory). It is important to note that EMDR needs to be used by certified and trained psychotherapists in both other forms of therapy and EMDR (Shapiro, 2017).
The core principle of EMDR is bilateral stimulation, but considering that even now, many years after the method’s empirical discovery (by observation), there is no consistent explanation of its mechanisms, we might question whether it is truly effective in desensitizing and reprocessing traumatic images. The answer can be found in a meta-analysis by Lee & Cuijpers (2013), published in the Journal of Behavioral Therapy and Experimental Psychiatry, 44(2):231-9., which concludes: “The contribution of eye movements in processing traumatic memories – Meta-analysis of studies published in the last 23 years (849 subjects): the effect is significantly superior in reducing negative emotions and image intensity, compared to a group without eye movements” (Lee & Cuijpers, 2013) (EMDR Training Manual – 2023).
Thus, the meta-analysis included:
– 15 clinical studies comparing the effects of EMDR therapy with and without eye movements to those of EMDR without eye movements.
– 11 laboratory studies (in a non-therapeutic context): the effects of eye movements while the person thinks about a traumatic memory vs. the same procedure without eye movements.
“Conclusions of the study conducted on 849 participants: The effect size in the case of the added effect of eye movements in studies considering EMDR treatment was moderate and significant (Cohen’s d index = 0.41). For the second group of laboratory studies, the effect size was large and significant (d = 0.74). The largest difference in effect size was calculated for the intensity (vividness) values of mental images in non-therapeutic context studies (d = 0.91). The data showed that treatment fidelity acted as a moderating variable on the effect of eye movements in therapeutic context studies” (EMDR Training Manual 2023).
There are several theories attempting to explain the mechanism by which BLS – Bilateral Stimulation significantly enhances the effects of EMDR therapy, being considered a key component. BLS involves the use of lateral eye movements, taps, or sounds that alternate between the left and right sides of the body, alternately exciting the two hemispheres of the brain, the left hemisphere, and the right hemisphere. Although, as mentioned above, the exact mechanisms of how BLS works in the context of EMDR are not fully understood, some theories suggest certain therapeutic effects:
– Memory Processing: Processing painful (traumatic) memories, allowing them to be integrated in a way that reduces their emotional intensity, using BLS simultaneously. Bilateral stimulation engages both hemispheres of the brain and may mimic the natural processing that occurs during REM (Rapid Eye Movement) sleep.
– Dual Attention: The use of BLS requires patients to keep the targeted traumatic memory in mind while simultaneously focusing on external bilateral stimulation. This dual attention may help patients address and process traumatic memories without being overwhelmed by them through possible abreactions, providing a graded and structured way to engage with the “material” of the trauma. On one hand, the patient is “in the painful memory” (while being in a state of relaxation), and on the other, “here and now,” creating a bridge for proper memory integration.
– Cognitive Reorganization: BLS may contribute to cognitive reorganization by helping patients link the traumatic memory with more adaptive and positive beliefs. As the traumatic memory is processed, positive beliefs are simultaneously reinforced, leading to a change in the individual’s emotional response and reducing the power of negative beliefs associated with the trauma.
– Arousal Regulation: The rhythmic and repetitive nature of bilateral stimulation can help regulate arousal levels. For individuals with trauma-related conditions, managing increased arousal is crucial during therapeutic processes. BLS is believed to have a calming effect, allowing individuals to remain focused on the traumatic memory without being overwhelmed by emotional distress.
It is important to note that, although BLS is an important component, a tool of EMDR, the overall effectiveness of EMDR cannot be based solely on this aspect. It can also be stated that what plays a significant role in the success of therapy is the EMDR process in the totality of its eight phases, along with the therapeutic relationship established between the patient and the therapist. Therefore, research is being conducted, some ongoing, to better understand the specific mechanisms of action associated with EMDR and its components.
From a therapeutic perspective, EMDR (Eye Movement Desensitization and Reprocessing) is indicated as a method of treatment, or as an adjunctive treatment, for adults, children, adolescents, and even couples, across a wide range of conditions and disorders. A non-exhaustive list of these includes: childhood-onset fluency disorder (stuttering), ADHD, tic disorders, major depressive disorder, persistent depressive disorder (dysthymia), separation anxiety disorder, selective mutism, specific phobias, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), hoarding disorder (Diogenes syndrome), dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder, somatization disorder and related disorders, anxiety, conversion disorder (functional neurological symptom disorder), eating disorders (including pica, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa), rumination, sleep disorders (insomnia, hypersomnia, non-REM sleep arousal disorders, confusional arousals), erectile disorders, conduct disorders, oppositional defiant disorder, intermittent explosive disorder, addictions and substance use disorders, antisocial personality disorder, borderline personality disorder, voyeuristic disorder, exhibitionistic disorder, reactive attachment disorder, disinhibited social engagement disorder, acute stress disorder, post-traumatic stress disorders (PTSD), and adjustment disorders.
References:
Francine Shapiro, Florence Kaslow, Louise Maxfield – Handbook of EMDR and family therapy processes, John Wiley & Sons, Inc., Hoboken, New Jersey, 2007
Francine Shapiro, PhD – Eye Movement Desensitization and Reprocessing (EMDR) – Therapy Basic Principles, Protocols, and Procedures, THIRD EDITION, Kindle Edition, THE GUILFORD PRESS, New York – London, 2017
Hello everyone, I am Gabriel Dulcu, clinical psychologist, member of the Romanian College of Psychologists, UK accredited hypnotherapist, graduate of the Past Life Regression Academy UK, member of the UK General Hypnotherapy Register, EMDR (Eye Movement Desensitisation and Reprocessing) therapist for adults, member of the EMDR European Association, integrative psychotherapist in training. On a personal level I am a perpetual student of spirituality, esotericism, Ancient Wisdom, psychology, neuroscience and neuro-hacking, writer, publicist, editor and translator. Besides that, I have had a rich professional activity in Telecommunications, IT and computer design, being a former top manager in the field.
I am here to help you, if you need it, in solving those problems you are facing, that are weighing you down, to facilitate the use of your enormous potential and inner resources, to move forward in your journey, onto inner peace and harmony.
EMDR – Eye Movement Desensitization and Reprocessing is a form of therapy used to treat multiple aspects of trauma. It is a structured therapy that encourages the patient to briefly focus on the traumatic memory while simultaneously experiencing bilateral stimulation (usually eye movements), which is typically associated with a reduction in the intensity of the emotion that always accompanies the traumatic memory.
Eye Movement Desensitization and Reprocessing (EMDR) therapy was initially developed in 1987 by Francine Shapiro for the treatment of post-traumatic stress disorder (PTSD), guided by the Adaptive Information Processing model (AIP).
EMDR is an individual therapy usually administered once or twice a week, totaling 6-12 sessions, although some patients need fewer sessions.
Unlike other therapy methods, sessions can be conducted on consecutive days.
The Adaptive Information Processing (AIP) model considers PTSD symptoms and other traumatic disorders (excluding those with physical or chemical causes) as results of very intense past experiences that continue to cause distress due to inadequate processing of the memory and defective (unintegrated) storage in memory. These unprocessed memories are understood to contain the emotions, thoughts, beliefs, and physical sensations that occurred at the time of the event. Therefore, when memories that have remained unprocessed (or improperly integrated) are triggered, these disturbing stored elements are re-experienced, causing PTSD symptoms and/or other disorders.
In conclusion, unlike other forms of therapy that focus on directly modifying emotions, thoughts, and responses resulting from traumatic experiences, EMDR therapy focuses directly on the moment of the trauma, aiming to change how the traumatic memory is stored in the brain, thereby reducing and eliminating problematic symptoms through desensitization and reprocessing.
Clinical observations suggest that during EMDR therapy, an accelerated learning process is facilitated and stimulated by the standardized EMDR procedures, which incorporate the use of eye movements and other forms of left-right rhythmic (bilateral) stimulation (e.g., tones or taps). Thus, while clients briefly focus on the traumatic memory and simultaneously experience bilateral stimulation (BLS), the associated intensity and emotion are greatly reduced (Shapiro, 2017).
EMDR follows an eight-phase approach:
1. History Taking and Treatment Planning: The therapist gathers information about the client’s history and identifies the target memories causing distress.
2. Preparation: The therapist explains the EMDR process and helps the client develop coping mechanisms and relaxation techniques (defining a “safe place”).
3. Assessment: The client identifies negative beliefs associated with the target memories and selects positive beliefs to replace them. The third phase of EMDR, assessment, activates the memory targeted in the session by identifying and evaluating each memory component: image, cognition, affect, and bodily sensation, using two Likert scales with 7 and 10 steps, respectively.
During EMDR therapy sessions, two scales are used to evaluate changes in emotion and cognition: the Subjective Units of Disturbance (SUD) scale (10 steps) and the Validity of Cognition (VOC) scale (7 steps). These scales are used repeatedly during the various stages to subjectively assess the degree of desensitization and reprocessing (APA, 2023).
4. Desensitization, Reprocessing, and Verification of New Associative Channels: This phase involves recalling the target memory while simultaneously engaging in bilateral stimulation (e.g., eye movements, taps, or sounds). The goal is to process the memory, reducing its emotional intensity.
5. Installation: Positive beliefs are reinforced, replacing negative beliefs associated with the target memory.
6. Body Scan: The client checks for any remaining physical tension or discomfort related to the targeted memory.
7. Closure: The therapist helps the client return to a state of balance and offers coping strategies for dealing with any residual distress.
8. Reevaluation: In subsequent sessions, the therapist and client evaluate progress and address any remaining issues.
Phases 4-5-6 are accompanied by BLS (Bilateral Stimulation). Experimentally, it has been found that bilateral stimulation, such as lateral eye movements, mimics the natural processing that occurs during REM (Rapid Eye Movement) sleep, hypothesizing that this bilateral stimulation facilitates the integration of traumatic memories, helping patients reprocess them in a way that reduces their emotional load (EMDR Manual, 2023).
However, although EMDR has demonstrated its effectiveness in treating trauma-related conditions, its exact mechanisms are not fully understood, and research on its efficacy is still ongoing. The therapy has expanded beyond eye movements to include other forms of bilateral stimulation (tactile and/or auditory). It is important to note that EMDR needs to be used by certified and trained psychotherapists in both other forms of therapy and EMDR (Shapiro, 2017).
The core principle of EMDR is bilateral stimulation, but considering that even now, many years after the method’s empirical discovery (by observation), there is no consistent explanation of its mechanisms, we might question whether it is truly effective in desensitizing and reprocessing traumatic images. The answer can be found in a meta-analysis by Lee & Cuijpers (2013), published in the Journal of Behavioral Therapy and Experimental Psychiatry, 44(2):231-9., which concludes: “The contribution of eye movements in processing traumatic memories – Meta-analysis of studies published in the last 23 years (849 subjects): the effect is significantly superior in reducing negative emotions and image intensity, compared to a group without eye movements” (Lee & Cuijpers, 2013) (EMDR Training Manual – 2023).
Thus, the meta-analysis included:
– 15 clinical studies comparing the effects of EMDR therapy with and without eye movements to those of EMDR without eye movements.
– 11 laboratory studies (in a non-therapeutic context): the effects of eye movements while the person thinks about a traumatic memory vs. the same procedure without eye movements.
“Conclusions of the study conducted on 849 participants: The effect size in the case of the added effect of eye movements in studies considering EMDR treatment was moderate and significant (Cohen’s d index = 0.41). For the second group of laboratory studies, the effect size was large and significant (d = 0.74). The largest difference in effect size was calculated for the intensity (vividness) values of mental images in non-therapeutic context studies (d = 0.91). The data showed that treatment fidelity acted as a moderating variable on the effect of eye movements in therapeutic context studies” (EMDR Training Manual 2023).
There are several theories attempting to explain the mechanism by which BLS – Bilateral Stimulation significantly enhances the effects of EMDR therapy, being considered a key component. BLS involves the use of lateral eye movements, taps, or sounds that alternate between the left and right sides of the body, alternately exciting the two hemispheres of the brain, the left hemisphere, and the right hemisphere. Although, as mentioned above, the exact mechanisms of how BLS works in the context of EMDR are not fully understood, some theories suggest certain therapeutic effects:
– Memory Processing: Processing painful (traumatic) memories, allowing them to be integrated in a way that reduces their emotional intensity, using BLS simultaneously. Bilateral stimulation engages both hemispheres of the brain and may mimic the natural processing that occurs during REM (Rapid Eye Movement) sleep.
– Dual Attention: The use of BLS requires patients to keep the targeted traumatic memory in mind while simultaneously focusing on external bilateral stimulation. This dual attention may help patients address and process traumatic memories without being overwhelmed by them through possible abreactions, providing a graded and structured way to engage with the “material” of the trauma. On one hand, the patient is “in the painful memory” (while being in a state of relaxation), and on the other, “here and now,” creating a bridge for proper memory integration.
– Cognitive Reorganization: BLS may contribute to cognitive reorganization by helping patients link the traumatic memory with more adaptive and positive beliefs. As the traumatic memory is processed, positive beliefs are simultaneously reinforced, leading to a change in the individual’s emotional response and reducing the power of negative beliefs associated with the trauma.
– Arousal Regulation: The rhythmic and repetitive nature of bilateral stimulation can help regulate arousal levels. For individuals with trauma-related conditions, managing increased arousal is crucial during therapeutic processes. BLS is believed to have a calming effect, allowing individuals to remain focused on the traumatic memory without being overwhelmed by emotional distress.
It is important to note that, although BLS is an important component, a tool of EMDR, the overall effectiveness of EMDR cannot be based solely on this aspect. It can also be stated that what plays a significant role in the success of therapy is the EMDR process in the totality of its eight phases, along with the therapeutic relationship established between the patient and the therapist. Therefore, research is being conducted, some ongoing, to better understand the specific mechanisms of action associated with EMDR and its components.
From a therapeutic perspective, EMDR (Eye Movement Desensitization and Reprocessing) is indicated as a method of treatment, or as an adjunctive treatment, for adults, children, adolescents, and even couples, across a wide range of conditions and disorders. A non-exhaustive list of these includes: childhood-onset fluency disorder (stuttering), ADHD, tic disorders, major depressive disorder, persistent depressive disorder (dysthymia), separation anxiety disorder, selective mutism, specific phobias, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), hoarding disorder (Diogenes syndrome), dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder, somatization disorder and related disorders, anxiety, conversion disorder (functional neurological symptom disorder), eating disorders (including pica, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa), rumination, sleep disorders (insomnia, hypersomnia, non-REM sleep arousal disorders, confusional arousals), erectile disorders, conduct disorders, oppositional defiant disorder, intermittent explosive disorder, addictions and substance use disorders, antisocial personality disorder, borderline personality disorder, voyeuristic disorder, exhibitionistic disorder, reactive attachment disorder, disinhibited social engagement disorder, acute stress disorder, post-traumatic stress disorders (PTSD), and adjustment disorders.
References:
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Hello everyone, I am Gabriel Dulcu, clinical psychologist, member of the Romanian College of Psychologists, UK accredited hypnotherapist, graduate of the Past Life Regression Academy UK, member of the UK General Hypnotherapy Register, EMDR (Eye Movement Desensitisation and Reprocessing) therapist for adults, member of the EMDR European Association, integrative psychotherapist in training. On a personal level I am a perpetual student of spirituality, esotericism, Ancient Wisdom, psychology, neuroscience and neuro-hacking, writer, publicist, editor and translator. Besides that, I have had a rich professional activity in Telecommunications, IT and computer design, being a former top manager in the field.
I am here to help you, if you need it, in solving those problems you are facing, that are weighing you down, to facilitate the use of your enormous potential and inner resources, to move forward in your journey, onto inner peace and harmony.
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