Dr James Alexander, PhD- Psychologist

Eye Movement Desensitization and Reprocessing (EMDR) therapy was devised by American psychologist, Dr Francine Shapiro. It is an approach which entails a desensitization process aimed at reducing the level of physiological arousal associated with the traumatic event, in combination with cognitive restructuring. EMDR therapy has undergone more empirical testing than any other approach in the psychological treatment of trauma; and it has more evidence supporting its efficacy than any other psychological treatment of trauma, including CBT.

According to the World Health Organization (2013), Guidelines for the management of conditions that are specifically related to stress:-
 
Trauma-focused cognitive behavioral therapy (CBT) and EMDR are the only psychotherapies recommended for children, adolescents and adults with posttraumatic stress disorder (PTSD).  No pharmaceuticals are recommended. 

“Eye movement desensitization and reprocessing (EMDR): This therapy is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements. 

Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.”  (p.1)

During EMDR therapy, the client is guided to deliberately bring into conscious awareness the sensory memory, their thoughts, and the accompanying emotions and bodily sensations. Clients need to be willing to experience the emotions and body sensations that accompany the recall of a distressing memory and associated thoughts. Then by following the moving fingers of the therapist, the client's eyes move rapidly for a brief period of around 30 seconds or so.This produces a distinctive and naturally occurring pattern of electrical activity in the brain (similar to what the brain is doing while we dream), which causes the stored trauma memory to change and move. This process can at times occur very quickly, and at other times at a slower rate requiring many more sessions of eye movements. The exact mechanism in the brain which causes the stored trauma memory to change has not yet been confirmed, but the regions of thebrain involved with sensory storage, emotional activation and reasoning all become more active with changed patterns of nerve cell firing, leading to resolution.

During the eye movement, the therapist talks very little and rarely offers suggestions. The client is instructed to not try and change any aspect of the memory, but is asked to just notice their emotions, bodily sensations and thoughts. At the end of each set of eye movements, the client is then asked to report their present experience. It may be that the sensory memory becomes less detailed or vivid, and clients often report that the memory has become quite distant. Commonly, the emotional or bodily sensations reduce in intensity quite quickly, and at other times it may take longer. The goal isto arrive at no emotional or physical distress relating to the memory.

The EMDR therapy process is complete when a new, more positive perspective about the incident feels true, even when the old memory is recalled. The entire process with any one memory may take as little as ten minutes, or as long as a full session- at times, more than one session on a resilient memory is required. Where there are several different experiences underlying the client's difficulties, it usually takes a series of sessions to fully resolve them- six to as many as twenty sessions may be needed.

EMDR therapy is not suitable for all clients. Some people will need additional help in managing and reducing emotional arousal before the process can be attempted, if at all. Whilst EMDR therapy looks and sounds simple, there are many important procedural steps for the therapist to follow before the eye movements are commenced. It takes over 50 hours of closely supervised instruction to fully train already experienced psychologists and mental health workers to become EMDR therapists. There have been over 100,000 professionals trained in this approach around the world over the last 20 years, and millions of people have benefited from it as clients. EMDR therapy incorporates much of the best that psychology has developed over the last hundred years, and continues to evolve in response to rigorous scientific research and observations about what works best in addressing human problems.

(acknowledgments to Graham Taylor & Chris Lee for some of the above material)

EMDR therapy is endorsed as an evidence based therapy by:

• The Australian Centre for Posttraumatic Mental Health (approved by the National Health and Medical Research Council) - 2007
  

• The American Psychiatric Association - 2004 
• The US Department of Veterans Affairs and Department of Defense - 2004
• The Northern Ireland Department of Health - 2003
  
• The Dutch Guidelines of Mental Health Care - 2003 
• The Israel National Council for Mental Health - 2002
  
• The Clinical Division of the American Psychological Association - 1998.
• The World health Organisation - 2013
  

see a brief You Tube interview with neurologist Dr Robert Scaer, a brain/trauma specialist, on the neurological effects of EMDR.

http://www.youtube.com/watch?v=xhUTEaNmCJg

Read some of the evidence demonstrating the effects of EMDR, presented by its originator, Dr Francine Shapiro who answers dozens of questions put to her about this unique psychotherapy.

http://consults.blogs.nytimes.com/2012/03/02/the-evidence-on-e-m-d-r/

and

http://consults.blogs.nytimes.com/2012/03/16/expert-answers-on-e-m-d-r/

Watch an informative interview with Dr Francine Shapiro about EMDR by clicking on the following link.

https://www.youtube.com/watch?v=8GUd5hhnkVE

See Chapter 16 of The Hidden Psychology of Pain for more discussion on EMDR therapy, and click on the EMDR Institute website below for more information and to locate a practitioner in your part of the world.