Eye Movement Desensitization and Reprocessing (EMDR) is a relatively
new clinical treatment that has been scientifically evaluated primarily
with trauma survivors. EMDR's originator, Dr. Francine Shapiro,
describes the procedure in detail in a recent book, and advises
that therapists use EMDR only after completing an authorized advanced
training in EMDR. When considering the possibility that EMDR may
be helpful for you or someone you know, an important first step
is to speak with therapist(s) who have had advanced EMDR training
and are experienced in selecting clients and successfully conducting
EMDR. For information on qualified EMDR therapists, contact the
International EMDR Network (P.O. Box 51038, Pacific Grove, California
93950).
EMDR is widely used by psychotherapists with adult trauma
survivors, including war veterans, abuse and rape survivors, and
accident and disaster survivors. EMDR also is used with traumatized
children and with adults suffering from severe anxiety or depression.
Briefly, in EMDR a qualified therapist guides the client in vividly
but safely recalling distressing past experiences ("desensitization")
and gaining new understanding ("reprocessing") of the
events, the bodily and emotional feelings, and the thoughts and
self-images associated with them. The "eye movement" aspect
of EMDR involves the client moving his/her eyes in a back-and-forth
("saccadic") manner while recalling the event(s).
EMDR has shown evidence of therapeutic effectiveness in several
recent scientific studies. After receiving between one and twelve
sessions of EMDR, many (but not all) adolescents and adult clients
have reported a variety of benefits. EMDR recipients in these studies
have included adult and adolescent child and domestic abuse survivors,
combat veterans, rape and violent assault survivors, victims of
life-threatening accidents and disasters, and individuals with severe
panic attacks or depression. Some of these individuals were seeking
help from the VA, from their HMO medical plan, or from mental health
specialists at clinics or counseling centers, while others were
not actively seeking healthcare or mental health treatment, but
agreed to participate in a research study in order to receive treatment.
• Feeling less troubled by trauma memories
and reminders while awake and in their dreams (PTSD intrusive
re-experiencing symptoms)
• Feeling able to cope with trauma memories and reminders
without simply trying to avoid troubling thoughts, conversations,
people, activities, or places (PTSD avoidance symptoms)
• Feeling more able to enjoy pleasurable activities and
to be emotionally involved in relationships, as well as feeling
that there is a future to look forward to (PTSD numbing and detachment
symptoms)
• Feeling less tense, stressed, irritable or angry, easily
startled, and on-guard, and more able to sleep restfully, concentrate
on activities, and deal with pressure and conflict (PTSD hyperarousal
/ hypervigilance symptoms)
• Feeling less anxious, worried, fearful or phobic, and
prone to panic attacks
• Feeling less depressed (down and blue, hopeless, worthless,
emotionally drained, or suicidal)
• Feeling an increased sense of self-esteem and self-confidence
A few studies have checked to see how participants were doing several
months or more than a year after completing EMDR, generally finding
that the benefits persisted over these time periods.
However, EMDR is not a certain cure, nor always effective. In even
the most successful studies approximately 25-33% of participants
report no clear benefit. EMDR's most consistent benefit is helping
clients to feel better about themselves because they feel less troubled
by and more able to cope with trauma memories. EMDR is less likely
to actually change how much bodily arousal and mental hypervigilance
trauma survivors experience -- although such changes do occur at
times.
EMDR also is not always the best treatment to deal with PTSD or
related psychological problems. One study with Vietnam military
veterans diagnosed with PTSD showed EMDR to be no better than other
widely used forms of counseling. Another study with spider phobic
children showed EMDR to be less helpful than an "in vivo exposure"
treatment in which the children gradually and safely saw and touched
a variety of real or artificial spiders.
EMDR involves carefully but intensively confronting very frightening
or disturbing memories. Some clients report that the eye movement
feature of EMDR helped them to rapidly feel less terrified, intimidated,
or hopeless while undergoing this therapeutic "exposure"
to sources of fear, anxiety, or depression. However, several studies
suggest that "direct therapeutic exposure" by vividly
and safely confronting stressors without eye movements is equally
as effective as EMDR. These studies, with combat veterans or civilian
trauma survivors diagnosed with PTSD, and with adults with phobias
or panic disorder, raise the question of whether eye movements are
essential to the positive results that can occur following EMDR.
That question remains unanswered.
If you or someone you know are considering undergoing EMDR, you
should be aware, however, that PTSD is a complex and devastating
disorder. No single procedure can "cure" PTSD. The best
treatment plan is based upon a thorough professional assessment,
and may include individual therapies such as EMDR or therapeutic
exposure, but also a range of other appropriate services such as
group and family therapy, addiction care, medication, stress and
anger management, vocational therapy, and healthcare. EMDR, like
any other therapy, should be done with these basic guidelines:
1. with a goal of helping the survivor make
sense of confusing disturbing experiences
2. with an emphasis on gaining self-esteem and personal empowerment
3. vividly and without avoiding any aspect of the experience,
however stressful
4. guided by the survivor's desire for healing, not as a test
of strength or stamina
5. with an emphasis upon helping the survivor find realistic new
hope and optimism
6. free from pressure, demands, manipulation, or criticism from
the therapist
7. with a goal of helping the survivor develop accurate and realistic
self-understanding
8. guided by the survivor's bodily and emotional feelings and
awarenesses
9. at an intensity and pace that the survivor feels is helpful,
not overwhelming
• Lee Hyer and Jeffrey M. Brandsma, "EMDR Minus Eye Movements
Equals Good Psychotherapy," Journal of Traumatic Stress 10(3):
515-522 (July 1997).
• Francine Shapiro, Eye Movement Desensitization and Reprocessing:
Basic Principles, Protocols, and Procedures (Guilford Press, 1995,
ISBN 0-89862-960-8)
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