Understanding Eye Movement Desensitization and Reprocessing (EMDR)

In the latter part of the 1980s, psychotherapist Francine Shapiro observed that when her patients were directed to use lateral eye movements when discussing disturbing thoughts or memories, their emotional reactions to these unsettling thoughts were reduced. Shapiro began to experiment with individuals who had experienced traumatic events using lateral eye movements to reduce the emotional response to the memories of these events. Eventually she refined her techniques to the point of developing Eye Movement Desensitization and Reprocessing Therapy (EMDR). The technique has developed a minor following among therapists, and it is used for treatment of a number of different issues even though there is some controversy surrounding it.

What Is EMDR?

EMDR is a form of therapy where the clients in the therapy sessions reflect on particular aspects of traumatic experiences or emotionally upsetting events while following the hand motions of the therapist with their eyes. In the most common application of the technique, the therapist moves their fingers back on forth (left to right then right to left) in the visual field of the client during this procedure, and the client follows the movement with their eyes without moving their head. The technique capitalizes on saccadic eye movements, which are rather quick and jerky eye movements that redirect an individual’s line of sight in order to fix their vision and a moving object. According to Dr. Shapiro and her followers, by inducing these movements while having the individual reflect on trauma, emotional experiences, and other issues, it helps the person reprocess the experience and eliminate the emotional reaction to the experience.

The eye processing aspect of EMDR is only one aspect of the full treatment. EMDR liberally borrows from other aspects of Cognitive Behavioral Therapy and uses a number of other empirically validated procedures in addition to the eye movement aspect of the treatment. These procedures existed far before the development of EMDR by Shapiro and include:

• Concentrating on the bond between the therapist and client: The working bond between the therapist and client is known as the therapeutic alliance. The therapeutic alliance was identified as a very strong factor that contributes to successful therapy treatment outcomes long before the development of EMDR. Proponents of EMDR make special efforts to develop a strong working alliance between themselves and their clients.
• Assignments and homework: The majority of Cognitive Behavioral Therapy practices, behavioral therapies, and even cognitive therapies have engaged in the practice of giving clients assignments to complete during the sessions and homework assignments to develop the skills these individuals learn in their sessions. The use of in-session assignments and assigning homework in various forms of psychotherapy and counseling predates the development of EMDR by many years.
• The use of exposure therapy: A major component used in EMDR is exposure therapy. Individuals in EMDR sessions are instructed to reflect on various aspects of their traumatic experiences that are associated with the most powerful negative emotions. These individuals are instructed to visualize aspects of the traumatic experience, and try and hear the sounds that occurred during the traumatic experience. Individuals are instructed to expose themselves to anxiety-producing, emotionally laden, and stressful stimuli while at the same time inducing feelings of relaxation and harmony within themselves. Clients are often trained in various forms of progressive muscle relaxation and diaphragmatic breathing before engaging in actual exposure techniques. During the eye movement processing aspect of EMDR, individuals are instructed to perform various aspects associated with exposure therapy.
• Cognitive restructuring: The technique of cognitive restructuring comes from Cognitive Behavioral Therapy and remains one of the most popular approaches to treatment. Cognitive restructuring is a technique that helps individuals to reconceptualize their beliefs, thoughts, and attitudes in a more realistic and functional manner. Cognitive Behavioral Therapy operates on the idea that many aspects of dysfunctional behavior and even psychopathology are based on irrational beliefs and unrealistic expectations that people have of themselves, other people, and various aspects of the world in general, including the future. By changing these irrational thoughts and beliefs, individuals are freer to also change their actions in accordance with reality and a functional manner.

A great deal of time is spent during EMDR sessions in getting clients to develop different attitudes regarding the traumatic experience and to develop different value systems regarding their beliefs of the effects of the trauma on them while performing the eye processing technique. This is simply just another manifestation of an older method of cognitive restructuring and not unique to EMDR.

EMDR Protocol

Being proficient at all the facets of EMDR requires therapists who use this technique to have intensive training in psychotherapy, including Cognitive Behavioral Therapy and behavioral therapy. The typical treatment process includes eight stages:

1. Gathering history and background of the client for the preparation of the treatment plan
2. The preparation for treatment and the development of a solid therapeutic alliance
3. Assessing and preparing the formal treatment by selecting aspects of the client’s experiences that will be addressed
4. Using the eye movement desensitization
5. Installing new perceptions associated with the trauma (cognitive restructuring)
6. The body scan phase (the use of progressive relaxation and diaphragmatic breathing)
7. Closure (using more relaxation techniques)
8. Evaluating the treatment progress

The therapist and the client will move back and forth between stages to make sure the client is comfortable and the treatment progresses as planned. They will often go back and address any new issues that need to be addressed.

Effectiveness

There are a number of issues that have been explored regarding the effectiveness of EMDR. This technique has a number of very devoted followers who claim that is effective for a number of issues, including prominent stress-related disorders, depression, substance use disorders, anxiety disorders, personality disorders, etc. Individuals attempting to become a certified in this technique must be licensed therapists and undergo specific training. Research performed by strong proponents of the technique is often very positive; however, there are number of issues with the technique.

According to scholarly sources, such as the book Science and Pseudoscience in Clinical Psychology, one major issue with EMDR is that even though Dr. Shapiro reported that lateral eye movements were associated with a decrease in emotional distress, not every therapist using the EMDR technique incorporates the eye movement component. Some therapists may use sound, tap their finger on the desk, or another method to engage the client instead of the eye movement component. This is problematic for the theory regarding how EMDR is supposed to work.

The next issue is that there is research that has established that using EMDR is significantly more effective than getting no treatment at all. However, because EMDR uses a number of already established techniques from Cognitive Behavioral Therapy and behavioral therapy, this type of research does little to establish the fact that the eye movement component of EMDR adds something significant to these already established techniques.

Finally, there are a number of studies, including a 2012 article in Scientific American, that indicate that the eye movement component of EMDR most likely adds little to the treatment effectiveness of the other behavioral and cognitive behavioral techniques used in the method. A number of meta-analytic studies have also indicated that the eye movement component of EMDR adds nothing to the cognitive behavioral and exposure aspects of the treatment. (Meta-analysis is a statistical technique that combines a number of similar studies in order to determine the overall results from numerous studies.)

It should be pointed out that EMDR uses valid techniques for the treatment of trauma and stress-related disorders, anxiety disorders, and other psychological disorders, and a 2013 report in the Cochrane Review indicated that EMDR was generally equivalent to other forms of therapy in the treatment of trauma-related issues. This is most likely due to EMDR’s use of empirically validated principles and not due to the eye movement component of the treatment. Thus, individuals being treated with EMDR should be expected to have similar success rates to other forms of therapy for similar types of issues; however, EMDR treatment is often more expensive than equivalent forms of cognitive therapy, Cognitive Behavioral Therapy, and other interventions.

Nonetheless, while the eye movement component in EMDR may not add anything substantial to traditional forms of exposure therapy, Cognitive Behavioral Therapy, and the therapeutic alliance, it should also be noted that EMDR therapists spent a great deal of time relating to their clients, preparing them for change, and using established therapeutic techniques. Thus, some individuals may find this treatment preferable to more traditional forms of these interventions.