Peter M. Barach, Ph.D.

EMDR

(Eye Movement Desensitization and Reprocessing)

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EMDR (Eye Movement Desensitization and Reprocessing) is a technique that has been developed in recent years to help people come to terms with overwhelming or traumatic experiences. It has also been used to help people deal with phobias and other anxieties. Its inventor is a psychologist, Francine Shapiro, Ph.D.


The theory behind EMDR

People who have had traumatic or overwhelming experiences sometimes tend to return to feelings, images, sounds, and body sensations that they connect with those experiences. For some people, there are times when they seem to relive past situations and feelings with the intensity they may have felt long ago. The experience of reliving past events may even become intrusive into daily life or sleep. For some people, it seems as if some experiences have become "locked" in the nervous system in vivid and disturbing ways.

EMDR aims to "unlock" the nervous system so that the brain can process the experiences and move on. The therapist helps the patient to identify upsetting images, beliefs, body sensations, and emotions that are connected with the disturbing experiences, then leads the client through a eye movement procedure that often helps the patient to begin coming to terms with the experience in a new way. The eye movement procedure seems to stimulate resources on both sides of the brain that often facilitate emotional healing. The patient remains in control of the process. Patient are also asked to identify some positive beliefs about themselves that they would like to have as a result of coming to terms with the experience, and EMDR often helps patients to own these positive beliefs.

EMDR is not like hypnosis in its methods, and most patients who have experienced both will report that it feels quite different from hypnosis. EMDR is a technique that fits well into many kinds of psychotherapy, but it is not designed to replace traditional therapy.


What happens during EMDR sessions?

The eye movement procedure takes place over a number of sessions. During the eye movement procedure, the patient is asked to bring the disturbing or traumatic incident to mind, and then is asked to track the therapist's fingers for a few seconds as one hand is moved rapidly from side to side in front of the patient's eyes. After pausing to discuss what has come up, the therapist repeats the process a number of times until the patient reaches a stage of having little or no discomfort about the original incident. This may take a number of sessions, especially if many disturbing incidents or feelings have occurred, or have come to mind over the course of EMDR.

Clients should not assume that everything remembered during EMDR is completely factual. Researchers and therapists have long known that human memory is not like a video recorder that plays back exactly what happened. Like any memory, remembered traumatic experiences may be factual to the last detail, or may mix fact and fantasy. Neither the therapist nor anyone else can tell if a memory is factual unless there is corroborative information available. Therefore, if you have any questions about whether a memory is factual, you are encouraged to do your own investigation and share your findings with your therapist.

Sometimes people will remember new incidents during EMDR that are previously unknown to them, or they may remember new details about a well-known memory. As stated above, these new memories should not be assumed to be 100% factual, although they may be.

The patient always has the ability to stop EMDR at any time, for any reason. There are also times when it makes sense for the therapist to put the procedure aside permanently or temporarily and continue therapy as usual.

For some people, the eye movement procedure causes mild eye discomfort or dizziness. If this happens, the therapist uses other techniques that alternately stimulate both sides of the brain, such as gently tapping on the backs of the patient's hands. These alternative techniques seem to work as well as Shapiro's original eye movement procedure.

It is common for people to experience strong emotions during and after EMDR sessions, so it is important for the patient to give the therapist accurate information about what is happening at these times. EMDR sessions should ideally be scheduled at times when the patient will not be going into a highly demanding situation right after the session. In addition, it is important that the patient not leave the therapist's office until s/he feels grounded and calm. Sometimes the patient will want to remain in the waiting room for a few minutes in order to make sure things feel settled before leaving. If upsetting feelings or images come to mind in between sessions, patients are asked to keep a log of this material to bring to the next session. The therapist is available by telephone if necessary.


Is EMDR effective?

Over 15,000 clinicians have been trained to use EMDR over the last ten years, and a number of people are conducting research programs to see if it is effective in dealing with various problems. So far, there is convincing evidence of its effectiveness for treating Posttraumatic Stress Disorder (PTSD). Several professional associations and government agencies have recognized EMDR as an effective treatment for PTSD, including the International Society for Traumatic Stress Studies. In addition, the Division of Clinical Psychology of the American Psychological Association, the Northern Ireland Department of Health, Social Services and Public Safety, the U.S. Department of Veterans Affairs and the Department of Defense, as well as governmental agencies in the U.K., Israel, and the Netherlands. Therapists have sometimes reported good results in using EMDR with people who have phobias, dissociative disorders, and other problems, but there are no controlled studies yet.


Are there potential risks in using EMDR?

There are no documented cases of harmful effects of EMDR. Like any treatment, it can be misused. Clients should not try to do EMDR at home, nor should they permit themselves to receive EMDR treatment from any therapist who has not received training in the procedure.

Is EMDR an experimental treatment?

EMDR is closely related to other treatment approaches that are widely used for treating people with a variety of diagnoses. It "integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies."

As noted earlier on this web page, many professional organizations in the mental health field, and several governmental bodies, have recognized EMDR as a validated and effective treatment for PTSD. In addition, a number of large managed care organizations (MCO's) have also acknowledged that it is a validated approach to treating PTSD and will cover it within their members' psychotherapy benefits. These MCO's include Aetna, CIGNA, Magellan, and Value Options. You should check with your therapist and your insurance company if you have questions about whether EMDR is a covered service.

Sampling of web links about EMDR

EMDR International Association

"What is EMDR?" (EMDR Institute, Inc.)

"What is Traumatic Stress?" (International Society for Traumatic Stress Studies