Eye movement desensitization and reprocessing (emdr)

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anthony

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Eye Movement Desensitization and Reprocessing (EMDR)is a traumatic memory processing therapy only, that incorporates a dual stimulation by using either bilateral eye movements, tones or taps. EMDR does not include techniques for trauma maintenance, however; latest research does fundamentally establish EMDR as a Cognitive Behavioral Therapy (CBT) model, as its methods for effect still utilize fundamental procedures to change the patients cognition in conjunction with imaginative exposure therapy techniques, thus a CBT model is still being utilized, regardless the branding name used or Shapiro's pseudo-science theory, "Adaptive Information Processing Model". EMDR is still quite unique from established CBT methods, in that it achieves trauma processing faster with usually less emotional stigma.

Origins

EMDR was developed by Dr Francine Shapiro beginning 1987. With her own trauma, she realized that eye movements decreased negative emotion associated with her memories. She assumed that the eye movements had a desensitizing effect, and experiments begun. It was later discovered that it was not just the eye movements, so a cognitive component was added, and she named it Eye Movement Desensitization (EMD).

In 1989, after a trial consisting 22 patients with trauma produced significantly positive results, Shapiro published her first studies based on her findings. In 1991 she changed the name to EMDR to reflect cognitive changes that took affect as well as her information processing theory she developed. In 1995 after further studies had been performed, the experimental label associated to EMDR was lifted and it became an acknowledged treatment method. Once the experimental label was lifted, the EMDR International Association was formed, independent of Shapiro herself, which controls the working foundation for the treatment of EMDR. This association has official branches in most countries today.

Success & Failure

EMDR, like all therapies, has had its controversial aspects, however; the only pertinence that should be noted today is that EMDR has been recognized as a tier-1 treatment option along side cognitive therapy, exposure therapy and stress-inoculation training for the treatment of Posttraumatic Stress Disorder (PTSD). These are now the only four techniques recognized as level-A trauma treatment processes by all major influencial organizations, including American Psychiatric Association (APA), National Institute of Mental Health (NIMH), Department of Veterans Affairs (DVA), International Society for Traumatic Stress Studies (ISTSS), near most major health departments (Internationally) and the list is extensively long. To cut a long story short, it is empirically globally endorsed today for the treatment of trauma.

The largest aspect that patients miss with EMDR, is that EMDR is only a trauma treatment option, so with PTSD, EMDR alone is insufficient to provide longevity results, management techniques, social re-engaging and other exposure based necessities essential to resume life to its fullest capacity. Because present and future events are traumatic in themselves, EMDR alone lacks these essential life teaching components that the sufferer requires to handle such events and not become re-traumatized to the event of debilitating levels again. PTSD has always been linear based, and this is targeted at the worst end of the PTSD spectrum. If used in conjunction with other CBT methods, EMDR is extremely efficacious.

US Department of Defense (DOD)

Whilst noted in peer reviews in relation to the DOD dragging their feet with implementing EMDR within VA facilities, DVA do send soldiers external for EMDR treatment, however; qualified physicians are also in demand. EMDR experts believe EMDR should be the first choice solution, however; so does every other therapy association. The DOD invest millions in other methods, constantly trying to find a treatment option for the majority vs. the minority. Some fruitless, some beneficial.

Whilst EMDR associations may feel that EMDR is the solution for treatment of combat PTSD, it is also well documented that combat PTSD is one of the most resistant strains of PTSD for psychotherapy and pharmacology, along with complex trauma PTSD. EMDR is not a viable full spectrum solution for a highly resistant type of PTSD, hence why the DOD keep looking further, regardless what a biased association may feel.

Branching Out

There are physicians making claims that EMDR is effective for treating other disorders. Whilst EMDR can treat other disorders, it only treats the traumatic memories associated that provide a symptom/s from within other disorders, such as schizophrenia, body dysmorphic disorder, dissociative disorders, personality disorders and more. Shapiro herself cites, "there is currently no research on EMDR's use with schizophrenia. However, individuals with schizophrenia may have experienced distressing life experiences or traumas that exacerbate their symptoms." EMDR itself does not treat schizophrenia or any other disorder, it only treats trauma / distressing life experiences.

Studies have been conducted on panic disorders, and EMDR failed in comparison to in vivo exposure methods. The EMDR Institute clearly state that EMDR is only effective for the treatment of traumatic memories. There is no research outside of this that indicates any other effective use for EMDR, and instead, persons should be cautious approaching any professional claiming outside of this.

These rogue physicians who try to make a name for themselves are the ones who typically bring controversy towards any treatment option, in this case, EMDR.

Structure

EMDR is delivered in eight phased stages to treat a trauma, being:
  • Phase 1 - Patient assessment, treatment plan, clients appropriateness / readiness, history, etc.
  • Phase 2 - Patient is taught relaxation and grounding techniques, coping strategies for emotional distress, as well as overall stability is assessed.
  • Phase 3 - Trauma targets are identified and assessed.
  • Phase 4 - Desensitization of responses to trauma.
  • Phase 5 - Installation of positive beliefs to replace existing negative beliefs.
  • Phase 6 - Body scan for tension points against the targeted topic.
  • Phase 7 - Closure, the patient journals any new material, thoughts, etc, that arise during the following week.
  • Phase 8 - Re-evaluation of prior work, progress achieved.
Procedure

Think of the EMDR process like this, all achieved as self thought within your mind, not spoken out loud; the client focuses their attention on disturbing aspect/s of a distressful or traumatic memory, ie. image, cognition, emotion, sensation, or any combination thereof and simultaneously concentrate on alternating, external bilateral stimulation (tracking a light or finger). Clients are instructed to "just be aware of" any associations that may arise. After brief bilateral stimulation, a here-and-now self-report is solicited. If subjects report any change from their previous association, they are asked to attend to the new internal stimuli along with further bilateral stimulation. Typically this continues until self-reports become adaptive with corresponding reduction in emotional distress when the targeted, initial, memory is reassessed.

Put basically, the process attempts to bring together fragmented aspects of trauma to connect with past, present and future thoughts. When trauma occurs, the trauma could be stored in part 'w' of the brain, yet the emotion for that trauma got stored in part 'x' of the brain, a sensation that triggers you got stored in part 'y' of the brain, then a new thought could be introduced which is now stored in part 'z' of the brain. The EMDR process attempts to connect all these parts so the brain can process the traumatic memory, then associate a more positive thought to it for future use.

This procedure has also been packaged to use lights, sounds and other means of external stimulation. Physicians have also "re-packaged" EMDR with their own twists, some good, some not so good, though this is no different to any other therapy available.

Bilateral Stimuli

One area of uncertainty with EMDR currently is the bilateral stimulation. This is why EMDR has been shifted more as a CBT model now vs. its original pseudo-science foundation. What can be ascertained, and is covered further in the biology below, is that studies performed to date have shown the treatment works with and without the bilateral stimuli. Studies also have shown that the results are slightly better with bilateral stimuli, yet empirically founded statements require further research.

Finding a Licensed Physician

There are only two locations in which you want to use to find an EMDR physician globally, being:
  1. http://www.emdr.com/clinic.htm (EMDR Institutes licensed registry), and
  2. Link Removed (International EMDR Applicable Association)
You should also ask these standard questions of your EMDR practitioner first, being:
  1. Have they received both levels of training?
  2. Was the training approved by EMDRIA (country relevant EMDR organization)?
  3. Have they kept informed of the latest protocols and developments?
  4. How many cases have they treated with your particular disorder / trauma?
  5. What is their success rate?
Comparisons

The only direct comparison that can be made to EMDR is the collective tier-1 therapy types mentioned previously, all of which show little effective difference for the treatment of PTSD trauma. Whilst EMDR by itself can not fully treat PTSD, most practitioners use the term EMDR, though incorporate other CBT umbrella therapies in combination to provide a full spectrum treatment option. This approach provides the patient the necessary skill-set to self-manage future stressors and symptom outbreaks effectively.

If you look at what's typically referred to as CBT, comprising cognitive, exposure and stress-inoculation training, these three types of therapy are package for PTSD treatment. EMDR falls under the CBT umbrella as another type, so therefor if you swapped out cognitive therapy for EMDR, you would then have an all-inclusive EMDR package, even though it comprises three types of therapy, as a full spectrum PTSD treatment. This is typically how practitioners apply treatment.

Biology

Biology is one area that EMDR research still lacks due to its infancy upon the therapy scene. So far studies have demonstrated that there was an increase in bilateral activity of the anterior cyngulate, which moderates the experience of real versus perceived threat, and there appeared to be an increase in pre-frontal lobe metabolism. An increase in frontal lobe functioning may indicate improvement in the ability to make sense of incoming sensory stimulation. What is demonstrated though, is that EMDR actually does have a neurobiology effect within the correct areas of the brain in relation to trauma. Whilst studies lack compared to other CBT neurobiology results, in comparison, the areas are correct that EMDR targets.

A theory by Bergmann in 2000 towards how the bilateral stimulation effects the process, is that the cerebellum receives input and is activated from virtually every sensory system, including vestibular, proprioceptive, visual, auditory, tactile, and somatosensory. Accordingly, it is has been suggested that EMDR stimulation (visual, auditory and tactile) constitutes a constant and marked stimulation of the cerebellum.

There is one known negative to the biology of EMDR, and that is a minor risk of cognitive impairment. From reading above on how EMDR rapidly connects fragments of trauma, the risk of instigating this beyond the brains natural ability to piece trauma together, brings the inherit risk that a more disturbing memory could suddenly be associated that was either lost or unknown, overwhelming and possibly causing mild to severe cognitive impairment (aka. treatment makes you much worse). A common risk with complex and combat PTSD patients. The EMDR Institute admits that EMDR lacks neurological assessment to date, and that many aspects, both positive and negative, are purely speculative and theory based. There have also been claims of brain damage after the fact with EMDR. This could be severe cognitive impairment with long duration results, it could be permanent brain damage itself. As the EMDR Institute outlined, speculative and theory, a lot to yet be determined.

CBT models effectively only go as fast as the brain allows them to with therapy, being the brains built-in safety mechanism of self protection, where EMDR attempts to force the brain whether it wants to remember or not. So the plus with EMDR being more rapid in treatment brings the biological negative, that a risk is introduced. If screening is effectively carried out, then the treating physician should not treat those with amnesia based trauma or anyone suspected of such trauma.

Studies & Trials

The inherit issues with all studies duly applies to EMDR as well, being that the majority of studies have excluded severe and complex cases from participation, so whilst EMDR is placed equally with other proven trauma models, it is also placed equally alongside their similar failings within the area of statistical validation.

When EMDR has been used on the more severe and complex cases, the duration has significantly lengthened for treatment, the dropout rate has increased and the success rate decreased swiftly.

No different from other trauma therapies, the severe and complex ranges of trauma are extremely difficult to treat vs. the more average to lower threshold symptom level sufferers, being the majority of cases and target base for all treatment options.
 
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Tiffany1

“There have also been claims of brain damage after the fact with EMDR. This could be severe cognitive impairment with long duration results, it could be permanent brain damage itself. As the EMDR Institute outlined, speculative and theory, a lot to yet be determined. CBT models effectively only go as fast as the brain allows them to with therapy, being the brains built-in safety mechanism of self protection, where EMDR attempts to force the brain whether it wants to remember or not.”

Please provide any support for the two claims made above: 1) Risk of brain damage (which indicates a perhaps-permanent physical injury to the brain itself) and 2) that EMDR “forces” the recollection of traumatic memories.
 
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Theresa1

I had a very traumatic childhood and over the years have tried a few different therapies, non-directive talk therapy, cbt, mindfulness and have done a lot of reading and listened to many podcasts.
Late last year I saw a psychologist who specialised in EMDR and I found it to be amazingly helpful. After a lot of sessions (over 10) I have worked through a lot of my trauma and I feel like a different person. My constant feelings of hypervigilance and feelings of worthlessness have practically disappeared. I feel free, like a weight has been lifted. I still work on some issues myself, I journal stuff and then whilst tapping on my sides I say over and over, “let it go, let it go, I don’t need it”.. the tapping takes a while, I sometimes have to tap for 20 mins before I feel a sense of release, and sometimes I feel better a few days later, I think after a good sleep.
Just wanted people to know that this therapy can be very powerful.
But you have to find a good therapist, I tried another therapist and she was hopeless. I think I was fortunate to find a psychologist who had done EMDR for a long time and knew that you have to tap through the pain.
 
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Julie1

I have Severe PTSD, I can tell you that Emdr works great but you have to be careful, very careful how much you process at one time, the brain can overload too much and you do suffer because of it. I did. Anyway because my ptsd is attached to Borderline personality disorder it is much harder for to get well. But I can honestly say I am much better because of it. I waited 20 years, over 20 years to get help and that made it (10 x) harder to get better. Please don’t wait, get help! I am making it, I am alive and mostly well thanks to a lot of people but for me hypnosis and Emdr are the way to go good luck and take care, Julie
 
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Catherine McLean

Hi Theresa,

I to had a long history of Childhood sexual abuse. I was also adopted. My feelings of hypervigilance and worthlessness controlled me. My attraction to abusive men and several failed relationships kept enforcing my feelings.
One day at work I went to bring a patient for testing and began having my ” “slideshow” of Trauma when I was 14. I had completely blocked these events until this day. I was then diagnosed with complex PTSD.
I was launched into coming to terms with my abuse. I had been in and out of therapy most of my life but never worked with EMDR.
Dec 20th was the day that changed my life. As difficult a process, I too feel like a different person. Free from the anvil I had been dragging around all my life. A freedom I cant explain. I can focus better at work. I see life differently,.
I just wanted to share my experience for anyone who may be looking for some answers.

Best of luck,
Catherine
 

Satuma

New Here
Is your Borderline resolving with EMDR? Mine is (rooted in complex trauma). I’ve done it for almost two years and it will probably take at least another year… but it is a life saver for me.
 
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