Eye Movement Desensitization and Reprocessing was developed for the treatment of post-traumatic stress disorders (PTSD) caused by experiencing stressful events, such as violence or participation in hostilities.
From the beginning, Eye Movement Desensitization and Reprocessing (EMDR) was rooted on practice. The author of this approach, Dr. Shapiro, a researcher at “Mental Research Institute” in Palo Alto, California, USA, says that she quite accidentally discovered a positive effect of eye movement on stressful thoughts and memories. While walking in the park in 1987, Fransine noticed the hard thoughts suddenly became less overwhelming when she spontaneously moved her eyes alternatively to the right and to the left.
She developed a standardized method and created EMDR on the basis of this approach. It aims to combine fragments of traumatic memories and process them.
Important dates:
1989 - the first year that controlled studies investigating the treatment of PTSD were published
1991 - EMDR was developed as a method
1995 - Conceptualisation of 8 phases of EMDR. Quality check conducted by a professional association
1991-1997 - Publication of 17 control studies
1997-1999 - First recognition (APA American Psychological Association, ISTSS International Society for Traumatic Stress Studies)
Since 2000, research outside the classical PTSD
2013 - WHO declared EMDR as an effective treatment for children and adolescents with PTSD
Description
The therapeutic approach in EMDR method is divided into 8 therapeutic steps or phases (table 1). It allows to detect a complex psychological trauma and to gradually process it in a systematic way without destabilizing patients excessively and without compromising their ability to function in their everyday lives or in the hospital. In EMDR therapy, it is supposed that allowing the information processing system of the brain can make the internal connections needed to resolve the disturbance. So, the person only needs to focus briefly on the disturbing memory as the internal associations are made (Shapiro, 2018).
Two things that set EMDR apart from almost all other forms of therapy are 1) how quickly it works and 2) the use of “bilateral stimulation”, typically in the form of side to side hand movements. But meta-analysis show that EMDR is not better than exposure therapies for anxiety and trauma, the efficacy is approximately similar.
Strong therapeutic relationship is also one of the key factors in effective EMDR method. The therapist in the full sense of "being on the side of the victim" supports and understands the patient. The professional position of the therapist removes the mutual use of each other. The therapeutic relationship should be shaped on the basis of authenticity and increased openness, which allows you to focus and quickly process mental trauma.
EMDR integrates elements of many effective psychotherapies to maximise treatment effects. These include:
• Psychodynamic therapy
• Cognitive behavioural therapy
• Interpersonal therapy
• Experiential therapy
• Body Centred Therapies therapy
Overview of eight-phase in EMDR therapy treatment (Shapiro, 2012)
Phase
Purpose
Procedures
1. History taking
Obtain background information
Identify suitability for EMDR treatment
Identify processing targets from events in client’s life according to standardized three-pronged protocol
Standard history-taking questionnaires and diagnostic psychometrics
Review of selection criteria
Questions and techniques to identify 1) past events that have laid the groundwork for the pathology, 2) current triggers, and 3) future needs
2. Preparation
Prepare appropriate clients for EMDR processing of targets
Education regarding the symptom picture
Metaphors and techniques that foster stabilization and a sense of personal control
3. Assessment
Access the target for EMDR processing by stimulating primary aspects of the memory
Elicit the image, negative belief currently held, desired positive belief, current emotion, and physical sensation and baseline measures
4. Desensitization
Process experiences toward an adaptive resolution (no distress)
Standardized protocols incorporating eye movements (taps or tones) that allow the spontaneous emergence of insights, emotions, physical sensations, and other memories
5. Installation
Increase connections to positive cognitive networks
Enhance the validity of the desired positive belief and fully integrate the positive effects within the memory network
6. Body Scan
Complete processing of any residual disturbance associated with the target
Concentration on and processing of any residual physical sensations
7. Closure
Ensure client stability at the completion of an EMDR session and between sessions
Use of guided imagery or self-control techniques if needed
Briefing regarding expectations and behavioral reports between sessions
8. Reassessment
Ensure maintenance of therapeutic outcomes and stability of client
Evaluation of treatment effects
Evaluation of integration within larger social system
Nevertheless a new up-to-date study about brief intervention involving Tetris computer game play for the prevention of intrusive memories after trauma appeared in 2017. The hypothesis of this study was based on memory consolidation theory - cognitive tasks with high visuospatial demands during the time window of trauma memory consolidation may reduce the occurrence of subsequent intrusive visual memories of trauma. The main outcome was that a simple behavioral task with high visuospatial demand - playing Tetris computer game in current study - can be effective in reduction of intrusive memories of trauma over 1 week. This brief intervention opens up new possibilities for tackling a core clinical symptom of PTSD ( Iyadurai, 2017).
Indications
EMDR therapy is recognized as a best practice for the treatment of PTSD by the U.S. Departments of Veterans Affairs and Defense, the International Society for Traumatic Stress Studies, the World Health Organization, the U.K. National Institute for Health and Care Excellence (NICE), the Australian National Health and Medical Research Council, the Association of the Scientific Medical Societies in Germany, and other health care associations/institutes around the world. Clinicians have also successfully used EMDR as a treatment component in the management of:
• Depression
• Anxiety disorders
• Personality disorders
• Complicated grief
• Dissociative disorders
• Pain disorders
• Body dysmorphic disorders
• Eating disorders
• Sexual or Physical abuse
• Disturbing memories
• Phobias
• Addictions
Efficacy
EMDR was associated with reductions in PTSD symptoms, depression and/or anxiety both post-treatment and at follow-up compared with all other alternative therapies (cognitive behavior therapy, individual/group therapy and fluoxetine) and control treatment (pill placebo, active listening, EMDR delayed treatment, and treatment as usual) (Chen et al., 2018 and Wilson et al., 2018).
EMDR is equivalent to exposure and other cognitive behavioral treatments and all “are highly efficacious in reducing PTSD symptoms (Bradley et al., 2005).
EMDR could be a viable and effective treatment for reducing depressive symptoms and improving the quality of life of patients with recurrent depression (Ostacoli,et al., 2018).
EMDR therapy significantly improved PTSD (Carletto et al., 2016), and significantly reduced symptoms of PTSD (Chen et al., 2014, 2015; Acarturk et al., 2016; Carletto et al., 2016), and other trauma symptoms (ter Heide et al., 2016).
License/Certification: documentation of independent license as a mental health professional, license to practice independently.
Notarized documentation supporting the following statements:
- at least two years experience in your field of license?
- at least 50 EMDR sessions with at least 25 clients?
20 hours of consultation by an EMDRIA Approved Consultant in EMDR. At least 10 of these hours must be obtained through individual, EMDR-focused consultation. The remaining 10 hours may be obtained through small group consultation. Consultation groups cannot exceed more than 8 participants at a time. Consultants-in-Training can provide up to 15 hours of consultation; the remaining 5 hours must be with an Approved Consultant.
Letter(s) of recommendation from one or more EMDRIA Approved Consultant(s) in EMDR, regarding your utilization of EMDR with clients.
Two letters of recommendation regarding your professional utilization of EMDR (if possible), ethics in practice, and professional character. These can be obtained from colleagues or peers.
Certificates of completion of 12 hours of EMDRIA Credits (continuing education in EMDR).
If your Certification Application is approved, your EMDRIA Certification status will be granted for a two year period.
Comment from an expert and a quote from a famous psychotherapist
“Eye Movement Desensitization and Reprocessing, or EMDR, is a form of therapy that focuses on memory and the brain. Every different form of therapy has a different model, a different way of conceptualizing cases and different procedures. For instance, in cognitive behavior therapy (CBT), pathology is based on inappropriate beliefs and behaviors. In psychodynamic therapy, it’s intra-psychic conflicts. In EMDR therapy, pathology is based on unprocessed memories that are stored intact—so if someone has some irrational beliefs or negative behavior, that’s not the cause but rather the symptom.”
Francine Shapiro
“EMDR quickly opens new windows on reality, allowing people to see solutions within themselves that they never knew were there. And it’s a therapy where the client is very much in charge, which can be particularly meaningful when people are recovering from having their power taken away by abuse and violation.”
Laura S. Brown, Ph.D., Past Recipient of the American Psychological Association Award for Distinguished Professional Contributions to Public Service
Comment from a trainee with some kind of experience (duration of the training, personal thoughts)
“Our department specializes on PTSD treatment. After completion of my EMDR course I definitely can say that it is one of the most complex structured type of psychotherapy. It contains specific features that allow me to work out all the symptoms of PTSD comprehensively. Satisfaction of patients after EMDR is very high. I do believe, this approach has a big future. “
Iryna Frankova, Ukraine
Research possibilities
EMDR Research Foundation offers a great number of research possibilities, grants, awards etc. which could be reached on the official site https://emdrresearchfoundation.org/
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