Here at Turning Point Centers, Utah’s drug rehab program, we’re proud to have 2 EMDR providers on staff. EMDR stands for Eye Movement Desensitization and Reprocessing. Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that was developed to resolve symptoms resulting from disturbing and unresolved life experiences. It uses a structured approach to address past, present, and future aspects of disturbing memories. The approach was developed by Francine Shapiro to resolve the development of trauma-related disorders as resulting from exposure to a traumatic or distressing event, such as rape or military combat. Clinical trials have been conducted to assess EMDR’s efficacy in the treatment of post-traumatic stress disorder (PTSD). In some studies it has been shown to be equivalent to cognitive behavioral therapy and exposure therapies, and more effective than some alternative treatments.

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 movements, 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 movements to be an unnecessary component of treatment. However, recent studies have examined the effects of eye movements and have found that eye movements in EMDR decrease the vividness and/or negative emotions associated with autobiographical memories enhance the retrieval of episodic memories increase cognitive flexibility, 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.

Effectiveness: Conclusions from international scientific committees
Based on the evidence of controlled research both the practice guidelines of the American Psychiatric Association and the Department of Veterans Affairs and Defense have placed EMDR in the highest category of effectiveness and research support in the treatment of trauma. This status is reflected in a number of international guidelines where EMDR is a recommended treatment for trauma.

Effectiveness: EMDR compared to typical treatments
EMDR has been demonstrated to have significant advantages over usual treatment for PTSD, and improvement was maintained at a six month follow-up. EMDR has been shown to be effective on measures of trauma, depression and anxiety in women and men who have been sexually abused as children.

Effectiveness: EMDR compared to medication
To date EMDR has only been compared directly to medication in one study. Van der Kolk et al. found EMDR to be more effective than fluoxetine, an SSRI in treating trauma, especially six months post-treatment. The study also suggests a role for SSRIs as a reliable first-line intervention.

Source(s):

Shapiro, Francine (1995). Eye movement desensitization and reprocessing: basic principles, protocols, and procedures. New York: Guilford Press. pp. 398.

Shapiro, F. & Maxfield, L. (2002). “Eye movement desensitization and reprocessing (EMDR): Information processing in the treatment of trauma”, Journal of Clinical Psychology, 58, 933-948.

Herbert, Lilienfield et al. “Science and Pseudoscience in the development of eye movement and reprocessing: Implications for Clinical Psychology”, Clinical Psychology Review, Vol.20, No.8, pp945-971, 2000 PMID1098395

Traumatology, Vol. 9, No. 3 (September 2003) 169. EMDR: Why the Controversy? Charlotte Sikes and Victoria Sikes

Kuiken, D., et al. (2001), “Eye movement desensitization reprocessing facilitates attentional orienting”, Imagination, Cognition & Personality, 21(1): p. 3-20.

Elofsson, U. O. E., von Schèele, B., Theorell, T., & Söndergaard, H. P. (2008). “Physiological correlates of eye movement desensitization and reprocessing”, Journal of Anxiety Disorders, 22:622-634. doi:10.1016/j.janxdis.2007.05.012

Sack, M., Lempa, W., Steinmetz, A. Lamprecht, F., Hofmann, A. (in press). “Alterations in autonomic tone during trauma exposure using Eye Movement Desensitization and Reprocessing (EMDR) – results of a preliminary investigation”, Journal of Anxiety Disorders (2007), doi:10.1016/j.janxdis.2008.01.007

Wilson, D., Silver, S. M., 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.

Lee, C. W., & Drummond, P.D. (in press). “Effects of Eye Movement versus Therapist Instructions on the Processing of Distressing Memories”, Journal of Anxiety Disorders, (2007)doi:10.1016/J.janxdis.2007.08.007

Australian Centre for Posttraumatic Mental Health. (2007), Australian guidelines for the treatment of adults with acute stress disorder and post traumatic stress disorder, Melbourne, Victoria: ACPTMH., http://www.acpmh.unimelb.edu.au/resources/resources-guidelines.html#.

National Institute for Clinical Excellence (2005), Post traumatic stress disorder (PTSD): The management of adults and children in primary and secondary care, London: NICE Guidelines, http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=10966.

Dutch National Steering Committee Guidelines Mental Health and Care., Guidelines for the diagnosis treatment and management of adult clients with an anxiety disorder, Utrecht, Netherlands: The Dutch Institute for Healthcare Improvement (CBO)

Foa, E.B.; Keane, T.M.; Friedman, M.J. (2000), Effective treatments for PTST: Practice guidelines of the International Society for Traumatic Stress Studies, New York: Guilford Press

Bleich, A.; Kolter, M.; Kutz, E.; Shaley, A. (2002), A position paper of the (Israeli) National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victime in the hospital and the community, Jerusalem, Israel.

United Kingdom Department of Health (2001), Treatment choice in psychological therapies and counseling evidence based on clinical practice guideline, London: Author, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007323.

Marcus, S., P. Marquis, and C. Sakai, Three- and 6-Month Follow-Up of EMDR Treatment of PTSD in an HMO Setting. International Journal of Stress Management, 2004. 11(3): p. 195-208.

Edmond, T., L. Sloan, and D. McCarty, Sexual Abuse Survivors’ Perceptions of the Effectiveness of EMDR and Eclectic Therapy. Research on Social Work Practice, 2004. 14(4): p. 259-272.

Edmond, T., A. Rubin, and K. Wambach, The effectiveness of EMDR with adult female survivors of childhood sexual abuse. Social Work Research, 1999. 23(2): p. 103-116.

Van der Kolk BA, Spinazzola J, Blaustein ME, et al. (2007). “A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance”. The Journal of clinical psychiatry 68 (1): 37–46. PMID 17284128.