EMDR is a structured form of psychotherapy that is designed to reduce distress associated with traumatic memories or adverse life events. Dr Francine Shapiro is credited as being the originator and developer of EMDR.
Dr Francine Shapiro is credited as being the originator and developer of EMDR. In 1987 Shapiro observed that when thinking about a disturbing event, her eyes started spontaneously moving back and forth. When she made these eye movements deliberately while concentrating on a variety of disturbing thoughts and memories, she found that the thoughts and images disappeared and lost their emotional charge. This personal experience kickstarted Shapiro's development of and research into what is now known as EMDR therapy.
EMDR is best known as a trauma therapy designed to treat PTSD, but also has a number of
applications including:
The Adaptive Information Processing (AIP) Model is the underlying explanatory model of EMDR therapy. The AIP posits that:
It is thought that EMDR removes the 'blockages' that have been caused by trauma, allowing the brain's natural healing process to resume. An example used to explain the AIP Model is the natural ability of the human finger to heal after a cut. However, if there is a splinter in the finger, the natural healing process is blocked. EMDR aims to remove the splinter (metaphorically) so that the normal healing processes of the brain can continue.
The validity and reliability of EMDR has been established by rigorous research (see below), however, it is important to acknowledge that we cannot fully understand how and why EMDR therapy works in the brain.
EMDR can be brief focused treatment or part of a longer psychotherapy program. A thorough and comprehensive assessment of your presenting concerns, existing resources/skills (e.g., in distress tolerance and emotion regulation), and potential counterindications is required prior to commencing EMDR. Your therapist will discuss the best treatment approach/es for you and will advise on when or if EMDR may be suitable and appropriate to engage in.
Please note that when commencing EMDR, multiple sessions will be dedicated to “stabilisation” and assessment. The stabilisation phase involves establishing internal resources/skills to be used throughout treatment and creating safety within the therapeutic relationship.
Eye movements, similar to those during REM sleep, will be recreated simply by asking you to watch the therapist's finger moving backwards and forwards across your visual field. Sometimes, other types of bilateral stimulation are used. The eye movements will last for a short while and then stop. You will then be asked to report back on the experiences you have had during each of these sets of eye movements. Experiences during a session may include changes in thoughts, images and feelings.
It is believed that the bilateral (alternating from one side to the other) stimulation burdens the working memory while someone is connecting to and reprocessing a distressing memory. Something about the taxation of the working memory is theorised to contribute to the reduction in distress associated with the painful memories aka the 'sting' being taken out. A meta-analysis of studies comparing EMDR with and without eye movements found an incremental benefit from the eye movements themselves (Lee & Cuijpers, 2013).
With repeated sets of eye movements, the memory tends to change in such a way that it loses its painful intensity and simply becomes a neutral memory of an event in the past. Other associated memories may also heal at the same time. This linking of related memories can lead to a significant improvement in many aspects of your life.
Since Francine Shapiro's initial pilot research in 1989, the results of more than 30 randomised control trials (RCTs) investigating the effectiveness of EMDR Therapy for the treatment of PTSD have been published, providing evidence for EMDR as an effective trauma therapy (de Jongh et al., 2019). Results from several meta-analyses have reported EMDR Therapy to be an efficient and effective treatment for PTSD (Maxfield & Hyer, 2002; Rodenburg et al., 2009; Sack, Lempa & Lamprecht, 2001; Spector & Reed, 1999; van Etten & Taylor, 1998).
Both the World Health Organisation (WHO) and the UK's National Institute for Health and Care Excellence (NICE) recommend EMDR as a treatment for PTSD. The WHO's 2013 guidelines recommend trauma-focused CBT and EMDR as the psychotherapies of choice for PTSD in children, adolescents and adults.
NICE's 2018 guideline recommends EMDR for adults with PTSD from three months after the trauma; it notes that the evidence for using EMDR between one and three months post-trauma is limited, and that there is insufficient evidence for its use within the first month.
All therapies have limitations. It is important to note that EMDR studies have been criticised by some for having poor methodology (Cusack et al., 2016). To date, EMDR Therapy has not been shown to be more effective than other evidence-based PTSD treatments, and as it is still a relatively new therapy it is hard to draw long-term conclusions about its effectiveness.
There is also only emerging evidence for EMDR Therapy for presenting issues other than PTSD, as it is still in the early stages and more research is required (Matthijssen et al., 2020).
EMDR is not appropriate for everyone. You need to be aware of, and willing to experience, the strong feelings and thoughts associated with trauma, which sometimes occurs during sessions. EMDR Therapy is considered with caution for those vulnerable to dissociation or with dissociative disorders. It is important that the clinician is specially trained to deliver EMDR for those with dissociation, and a more extensive stabilisation phase is required.
The timing of EMDR Therapy is also important. EMDR Therapy can actually have an adverse effect if delivered too soon after the distressing event i.e. when the person is in shock. However, this is true for all trauma therapies. Supportive therapy, rather than processing therapies, is more appropriate in the immediate aftermath of a traumatic or distressing event.
It is with these considerations in mind that your therapist with conduct a comprehensive assessment with you prior to commencing EMDR Therapy.
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