EMDR Summarized
Eye Movement Desensitization and Reprocessing
Dr. Francine Shapiro’s Therapeutic Approach
Summarized by Murriel Schulte, Ph. D., Dallas, TX
“From 0 to 10, with 10 being high, how would you rate your current level of distress?” With his rating, the client is asked to keep the most distressing picture of his presenting event or memory in mind; then, to identify where the feeling lodges in his body; and lastly, to identify his associated negative cognitions that go with the problem–such as “I’m helpless,” or “It’s my fault.” Continuing with his images, feelings, and thoughts, he is kept grounded in the present through the clinician’s interactions with him. The eye movement stimulation (or possibly an alternate form, auditory or tactile, of left-right lateral stimulation) is then introduced. He is intermittently asked for his rating of his distress on a scale of 0-10–the Subjective Unit of Disturbance Scale (SUDS) while he is processing the trauma, until the point when his memories have lost their disturbing power.
This recursive procedure is maintained until he has desensitized his difficult memories and until positive self-cognitions have replaced his negative self-cognitions. When his negative images are dissipated, he is asked to rate the believability of his alternative positive cognitions on a scale of 1(completely untrue) to 7(completely true)–the Validity of Cognition Scale (VOC). From having spoken of his negative cognitions initially, he now speaks of what he would rather believe about himself, his positive cognitions.
In the EMDR process, something creative happens; with an almost surprising acceleration, images, memories, associations, thoughts, and emotions are often brought forth rapidly into a client’s mind. In reliving events, the client may emote in rage, grief, or fright. After EMDR therapy, he is not simply desensitized or less anxious; his thinking has changed. In the course of one or more sessions, the former memory has lost its power. The EMDR process posits that trauma teaches maladaptive lessons that can be unlearned. The speed of change and the lasting resolution with EMDR is reported to be the most appealing aspects to clinicians of this psychotherapy.
The founder of EMDR, Francine Shapiro, Ph.D., is the executive director of the EMDR Institute, Inc., and a Senior Research Fellow at the Mental Research Institute, Palo Alto, California. She was awarded the 1993 Distinguished Scientific Achievement in Psychology Award presented by the California Psychological Association. She is the author of three books: Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures (1995), EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma (1997), and the forthcoming EMDR and the Paradigm Prism (American Psychological Press). Training in EMDR techniques through the EMDR Institute is mandatory for clinicians. According to Dr. Shapiro, it is a specialized approach and method that requires supervised training for full therapeutic effectiveness and client safety. To date, 30,000 clinicians have been trained throughout the world. Level I EMDR training centers on how to desensitize traumatic memories, anxieties, and phobias, and to install positive belief structures. EMDR has applications to natural disasters, family therapy, Post-traumatic stress disorder (PTSD), children and adult survivors of abuse, adult children of alcoholics and for the personal use for the therapist to process vicarious imagery overflow from traumatized patients. Level II Training has applications for Dissociative identity disorder, Axis II diagnoses and other major disorders.
According to Bessel A. van der Kolk, M. D., “The speed at which change occurs during EMDR contradicts the traditional notion of time as essential for psychological healing. Shapiro has integrated elements from many different schools of psychotherapy into her protocols, making EMDR applicable to a variety of clinical populations and accessible to clinicians from different orientations.”
Early inspiration for EMDR was in 1987, when, as a graduate student, Dr. Shapiro discovered the technique as she was walking in a park. She had been troubled by some old memories and disturbing thoughts. Her painful memories seemed to dissolve as she moved her eyes rapidly back and forth. She was amazed by her own discovery, gathered volunteers to experiment with this process, and then, organized formal research to test this discovery.
In 1988, she approached Joseph Wolpe, the originator of systematic desensitization, to teach him her method and to ask him to publish her paper in the journal he edited, The Journal of Behavior Therapy and Experimental Psychology. He experimented with EMDR and published her article and one of his own case studies using EMDR in the journal. He stated that with EMDR treatment for PTSD “there is often a marked decrease in anxiety after one session, and practically no tendency to relapse.”
In 1989, she published her research, “Eye movement desensitization: A new treatment for post-traumatic stress disorder,” which was then followed in adding ‘reprocess-ing’ in the 1991 article, “Eye movement desensitization and reprocessing procedure: From EMD to EMD/R: A new Treatment Model for Anxiety and Related Trauma.” From these original studies, a great deal of other research has followed, until, to date, there have been more controlled treatment outcome studies on EMDR than on any other method used in the treatment of PTSD.
One controlled study by Wilson, Becker, and Tinker (1995), evidenced the effects of three 90-minute EMDR treatment sessions on traumatic memories, working with 80 participants. These subjects revealed decreases in their presenting complaints, and in addition, reported increases in positive cognitions. The general functioning of these participants improved, with less depression, fewer somatic complaints, and improvement in self-esteem. These positive effects were maintained at a 90-day follow-up.
In 1998, a meta-analysis of 61 studies compared the efficacy of several treatments of PTSD–drug therapies, behavior therapy, EMDR, relaxation training, hypnotherapy, and dynamic therapy–found that behavior therapy and EMDR were most effective. By self-report assessment, EMDR was the most effective treatment. Treatment effects were maintained at a 15-week follow-up.
The meta-analysis reviewed the theoretical bases for all treatments and summarized that EMDR maintains these treatment components: “imaginal exposure with concomitant lateralized movements, along with coping statements.” The provisions for how EMDR works is unclear. It is unknown as to “what changes occur in what part of the brain, how oscillatory movements are involved in those changes, how that leads to ‘reprocessing’ of the trauma, and how such reprocessing results in decreased PTSD symptoms. . . . Clarification of the mechanism by which symptoms change and the active ingredients in EMDR is now critical, given its apparent efficacy. Without such clarification, the acceptability of EMDR within the professional community is likely to remain controversial.”
Wilson, S. A., Becker, L. A., and Tinker, R. H. (1995). Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized individuals. Journal of Consulting and ClinicalPsychology; 63, 928-937.
Van Etten, M. L., and Taylor, S. (1998). Comparative efficacy of treatments for Post-traumatic Stress Disorder: A meta-analysis. Clinical Psychology and Psychotherapy; 5, 126-144.
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