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Eye movement desensitization and reprocessing EMDR 

There are two perspectives on EMDR therapy.

One was advanced by the method's creator, with a theory that eye movement provides

neurological and psychological effects that enhance the processing of  traumatic

memories. The other perspective is that eye movement is an epiphenomenon, 

unnecessary, and that EMDR is simply a form of desensitization.

EMDR integrates elements of imaginal exposure, cognitive therapy, psychodynamic

and somatic therapies. It also uses the unique and somewhat controversial element of 

 bilateral stimulation (e.g. moving the eyes back and forth). According to Francine

Shapiro's theory, when a traumatic or distressing experience occurs, it may

overwhelm usual ways of coping and the memory of the event is inadequately

 processed; the memory is dysfunctionally stored in an isolated memory network.

When this memory network is activated, the individual may re-experience aspects of the original event, often resulting in inappropriate overreactions. This explains why

 people who have experienced or witnessed a traumatic incident may have recurring

sensory flashbacks, thoughts, beliefs, or dreams. An unprocessed memory of a

traumatic event can retain high levels of sensory and emotional intensity, even though

many years may have passed.

EMDR uses a structured eight-phase approach and addresses the past, present, and

future aspects of the dysfunctionally stored memory. During the processing phases of 

EMDR, the client attends to the disturbing memory in multiple brief sets of about 15– 

30 seconds, while simultaneously focusing on the dual attention stimulus (e.g.,

therapist-directed lateral eye movement, alternate hand-tapping, or bilateral auditorytones). Following each set of such dual attention, the client is asked what associative

information was elicited during the procedure. This new material usually becomes the

focus of the next set. This process of alternating dual attention and personal

association is repeated many times during the session.

The theory is that EMDR works directly with memory networks and enhances

information processing by forging associations between the distressing memory and

more adaptive information contained in other  semantic memory networks. It is

thought that the distressing memory is transformed when new connections are forged

with more positive and realistic information. This results in a transformation of the

emotional, sensory, and cognitive components of the memory so that, when it is

accessed, the individual is no longer distressed. Instead he/she recalls the incidentwith a new perspective, new insight, resolution of the cognitive distortions,

elimination of emotional distress, and relief of related physiological arousal.

When the distressing or traumatic event is an isolated incident, the symptoms can

often be cleared with one to three EMDR sessions. But when multiple traumatic

events contribute to a health problem—such as physical, sexual, or emotional abuse,

 parental neglect, severe illness, accident, injury, or health-related trauma that result in

chronic impairment to health and well-being—the time to heal may be longer.

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Therapy process

1. Phase I: In the first sessions, the patient's history and an overall treatment

 plan are discussed. During this process the therapist identifies and clarifies

 potential targets for EMDR. Target refers to a disturbing issue, event, feeling,

or memory for use as an initial focus for EMDR. Maladaptive beliefs are alsoidentified.

2. Phase II: Before beginning EMDR for the first time, it is recommended that

the client identify a safe place, an image or memory that elicits comfortable

feelings and a positive sense of self. This safe place can be used later to bring

closure to an incomplete session or to help a client tolerate a particularly

upsetting session.

3. Phase III: In developing a target for EMDR, prior to beginning the eye

movement, a snapshot image is identified that represents the target and the

disturbance associated with it. Using that image is a way to help the client

focus on the target, a negative cognition (NC) is identified – a negative

statement about the self that feels especially true when the client focuses on

the target image. A positive cognition (PC) is also identified – a positive self-

statement that is preferable to the negative cognition.

4. Phase IV: The therapist asks the patient to focus simultaneously on the image,

the negative cognition, and the disturbing emotion or body sensation. Then the

therapist usually asks the client to follow a moving object with his or her eyes;

the object moves alternately from side to side so that the client's eyes also

move back and forth. After a set of eye movements, the client is asked to

report briefly on what has come up; this may be a thought, a feeling, a

 physical sensation, an image, a memory, or a change in any one of the above.

In the initial instructions to the client, the therapist asks him or her to focus onthis thought, and begins a new set of eye movements. Under certain

conditions, however, the therapist directs the client to focus on the original

target memory or on some other image, thought, feeling, fantasy, physical

sensation, or memory. From time to time the therapist may query the client

about her or his current level of distress. The desensitization phase ends when

the SUDS (Subjective Units of Disturbance Scale) has reached 0 or 1. [1]

5. Phase V: The "Installation Phase": the therapist asks the client about the

 positive cognition, if it's still valid. After Phase IV, the view of the client on

the event/ the initial snapshot image may have changed dramatically. Another 

PC may be needed. Then the client is asked to "hold together" the snapshot

and the (new) PC. Also the therapist asks, "How valid does the PC feel, on ascale from 1 to 7?" New sets of eye movement are issued.

6. Phase VI: The body scan: the therapist asks if anywhere in the client's body

any pain, stress or discomfort is felt. If so, the client is asked to concentrate on

the sore knee or whatever may arise and new sets are issued.

7. Phase VII: Debriefing. The therapist gives appropriate info and support.

8. Phase VIII: Re-evaluation: At the beginning of the next session, the client

reviews the week, discussing any new sensations or experiences. The level of 

disturbance arising from the experiences targeted in the previous session is

assessed. An objective of this phase is to ensure the processing of all relevant

historical events.

he following basic terms are described in Shapiro's 2001 text[1]

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Information Processing

During information processing, a physiologically-based system sorts new

(perceptual) information, makes connections between new information and

other information already stored in associated memory networks, encodes the

material, and stores it in memory.

Adaptive ResolutionWhen information processing is complete, learning takes place, and

information is stored in memory with appropriate emotion. The new

information is therefore available to guide future action.

Dysfunctionally Stored Information

When information processing is incomplete, the information is not connected

to more adaptive information, and it is stored in a memory network with a

high negative emotional charge. It can cause reactivity and can be the cause of 

various symptoms.

Reprocessing

During reprocessing in EMDR, new associative links are forged between

dysfunctionally stored information and adaptive information, resulting incomplete information processing and adaptive resolution.

Memory Networks

 Neurobiological associations of related memories, sensations, images,

thoughts, and emotions.

Target Memory

The memory of a distressing or traumatic event, which still causes current

distress, and which has been selected to be targeted during EMDR treatment.

Memory Components

All components of the target memory are accessed during Phase Three to

ensure that the memory network is fully activated. These components include

the image, cognitions, emotions, and body sensations.

VOC (Validity of cognition) scale

VOC ratings are used in EMDR to measure baseline validity of the positive

cognition during Phase Three, and to assess progress being made, where 1 =

not true, and 7 = completely true.

SUD (Subjective units of disturbance) scale

SUD ratings are used in EMDR, exposure therapies, and other treatments to

measure baseline emotional or physical pain and also to assess progress being

made. This is a personal measurement of distress, where 0 = no distress, and

10 = worst distress possible.

InterweaveA specific strategy used by the clinician to assist processing if the client

appears to be having difficulty accessing more adaptive information. Ideally,

the interweave contains needed information that would have been available

except for blockage of inner pathways by trauma responses.

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Mechanism

The theory underlying EMDR treatment is that it works by helping the sufferer 

 process distressing memories more fully which reduces the distress. EMDR is based

on a theoretical information processing model which posits that symptoms arise when

events are inadequately processed, and can be eradicated when the memory is fully processed. It is an integrative therapy, synthesizing elements of many traditional

 psychological orientations, such as psychodynamic, cognitive behavioral,

experiential, physiological, and interpersonal therapies.

EMDR's most unique aspect is an unusual component of bilateral stimulation of the

 brain, such as eye movement, bilateral sound, or bilateral tactile stimulation coupled

with cognitions, visualized images and body sensation. EMDR also utilizes dual

attention awareness to allow the individual to vacillate between the traumatic material

and the safety of the present moment. This prevents retraumatization from exposure to

the disturbing memory. As EMDR is an integrative therapy which combines elements

of cognitive behavioral and psychodynamic therapies to desensitize traumatic

memories, some individuals have criticized EMDR and consider the use of eye

movement to be an unnecessary component of treatment. However, recent studies

have examined the effects of eye movement and have found that eye movement in

EMDR decreases the vividness and/or negative emotions associated with

autobiographical memories, enhance the retrieval of episodic memories, increase

cognitive flexibility,[14] and correlate with decreases in heart rate, skin conductance,

and an increased finger temperature. These physiological changes associated with

EMDR are consistent with earlier research on physiological changes associated with

EMDR. Also recent studies that have removed eye movement from the method have

found the procedure less effective.

There is no definitive explanation as to how EMDR works. There is some empirical

support for three explanations regarding how an external stimulus such as eye

movement can facilitate the processing of traumatic memories.

The first hypothesis views PTSD as a failure by the individual to process episodic

memory; the bilateral eye movement involved in EMDR facilitate interaction between

the brain's hemispheres, which then improves the processing of trauma-related

memories. This hypothesis is supported by a study that tested the effects of eye

movement on the ability to retrieve episodic memory. The study found better recall

following a horizontal eye movement task compared to that following no eyemovement or a vertical eye movement task.

A second hypothesis suggests that eye movement facilitates processing of trauma

memories by activating a neurobiological state similar to REM sleep wherein

associative links to episodic memories are formed and these memories are then

integrated into general semantic networks. Stickgold proposed that PTSD occurs

when an event is sufficiently arousing to prevent its transfer from encoding from an

episodic memory to a semantic memory. As a result of high arousal levels,

associations between the traumatic event and other related events fail to develop. He

argues that the attentional redirecting in EMDR induces a neurobiological state

similar to REM sleep. He then reviews the research that suggests that REM sleepenhances processing of episodic memory through the preferential activation of weak 

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associative and semantic links. Thus in EMDR trauma-related information that is

closely associated with a target event is weakened and ancillary information loosely

related to the event is strengthened, allowing the integration of trauma-related

material with other loosely associated events in the person’s life. Support for this

argument comes from a study that found that, compared to eye fixation, eye

movement promoted attentional flexibility and increased preparedness to processmetaphorical material.

A third hypothesis links the eye movement in EMDR with the orienting response. 

MacCulloch and Feldman argued that eye movement triggers the investigation

component of the orienting response, which can either produce avoidance behaviour 

or inhibit avoidance responses. Inhibiting avoidance behaviour includes reducing both

negative somatic responses and cognitive changes that would allow fresh

investigatory behaviour to commence. MacCulloch and Feldman proposed that

initially when danger is identified there is a negative affect response. However a

second part of the orienting response is to scan for further danger, and this

investigatory reflex seems to accompany a positive physical response. In the authors’opinion, eye movement induces this investigatory reflex and produces a relaxation

response. A relaxation response was, in fact, found in a study that investigated the

autonomic responses of participants when they were engaged in an eye movement

task as part of EMDR treatment and when participants focused on negative memories

while engaging in eye movement [23]. However there is not a differential effect of 

eye movement on a relaxation response when participants focused on positive

memories. This supports the hypothesis that eye movement is an orienting response

mechanism rather than a simple relaxation mechanism. In addition, recent research

that has examined the physiological correlates of eye movement in EMDR has found

that a clear orienting response pattern of psycho-physiological de-arousal occurs when

eye movement begins, and this de-arousal is characteristic of the physiological

changes that occur when an orienting response is elicited.