What is EMDR?

Events are traumatic when they overwhelm the coping capacities of the person. Traumatic events threaten the physical integrity or life of a person and induce feelings of helplessness, terror or horror in survivors. After exposure to a traumatic event most survivors show some symptoms such as intrusive re-experiencing, anxiety, sleep disturbances, nightmares, and depression. Because stimuli that are reminiscent of the traumatic event tend to make these symptoms worse, people often start trying to avoid being exposed to these kind of reminders. In some people these initial symptoms may fade over a period of weeks, but in many people the passage of time will not lessen their symptoms and they will develop a Posttraumatic Stress Disorder.

Not everyone who experiences a specific event will develop a Posttraumatic Stress Disorder. Because children have fewer coping capacities they are more easily traumatized than are adults. Adults who were traumatized or experienced other adverse life events as children (such as death, incarceration, serious illness or substance abuse of a parent) are more easily retraumatized by overwhelming adult experiences.

People need to make sense of what happened to them as part of recovery. When traumatic events are shared environmental or man-made disasters they are usually remembered and talked about. When traumatic events involve betrayal by a parent, family member or trusted adult (such as a teacher or a religious leader), it may not be possible to talk about the experience and there will be a tendency to have psychogenic amnesia or other dissociative symptoms such as experiences of numbing or disorientation when stressed by cues that share some similarity with the original traumatic events.

Recovery from trauma involves working through the impact and meaning of the traumatic experience. Specific types of psychotherapy have been shown to be especially helpful for trauma recovery. These include EMDR (Eye Movement Desensitization and Reprocessing) and Prolonged Imaginal Exposure (which is a specialize type of Cognitive Behavioral Therapy). Some prescription medications can be helpful for managing symptoms of Posttraumatic Stress Disorder. Alcohol, caffein, tobacco, and illegal street-drugs will not help and will generally make symptoms worse. While some trauma survivors do not get referred for needed treatment for long periods of time, the good news is that specific treatments are highly effective and that with treatment most survivors can make a full recovery.

EMDR therapy has been the subject of more controlled research than all other treatments for posttraumatic stress disorder (PTSD) combined. A total of 30 controlled studies have been completed in University, Veterans Administration, HMO and other settings. A number of meta-analyses have evaluated these controlled studies and compared EMDR therapy's effects with those of prolonged imaginal exposure and other methods.

EMDR therapy has been found to be more rapid, efficient or comprehensive in treating symptoms caused by trauma than behavior therapy, biofeedback, active listening or standard cognitive and analytic treatments.

As a result of the extensive research evidence, EMDR therapy is recognized as an evidence supported method of treatment for Posttraumatic Stress Disorder by the American Psychiatric Association, the US Department of Defense, the US Veterans Administration, the International Society for Traumatic Stress Studies and government agencies in countries around the world.

EMDR therapy has been shown to be helpful in resolving symptoms caused by traumatic events including intrusive thoughts, panic, phobias, depression, painful sensations, and emotional distress including excessive guilt, anger, grief and fear, recurring nightmares and behavioral symptoms as avoiding formerly enjoyable activities.

Adult, adolescent, and child survivors of single incident traumas, multiple traumas, and of childhood abuse have responded positively to EMDR therapy. Victims of crime, combat veterans, and survivors of disasters have all benefited from EMDR therapy.

It is important to understand that EMDR therapy is not a panacea. While EMDR therapy has helped alleviate a wide range of trauma based symptoms for millions of people around the world, not every person and not every symptom is amenable to treatment with EMDR therapy. An appropriately trained mental health professional will gather information over one or more sessions to determine whether a person is a good candidate for EMDR therapy. Then it may take one or more "reprocessing" sessions to determine whether a person will respond positively to EMDR therapy.

How long will treatment take?
Studies show that symptoms related to a single traumatic incident can often be resolved in a total of three to six sessions. This includes sessions for history taking, treatment planning, preparation, reprocessing sessions and reevaluation. Treatment for survivors of multiple traumas will take longer. Survivors of prolonged trauma such as combat trauma and persistent childhood neglect and abuse have also been shown to benefit from EMDR therapy, but to achieve comprehensive improvements, more lengthy treatment is needed.

EMDR "reprocessing" is offered only within the safety of an established therapeutic relationship and after gathering enough information to develop a specific treatment plan. Your EMDR psychotherapist can often give you an estimate of the anticipated length of treatment after the first two or three visits.

Not enough is yet known about the brain's response to psychological trauma or about EMDR to be certain how EMDR works. Indeed very little is known about the specifics of how any of the research-supported forms of psychotherapy work.

Current theory suggests EMDR therapy’s known effects may result from an interaction of several factors including focusing on specific memories, cognitive restructuring and self-regulation methods properly integrated with the structured use of alternating sensory stimulation. However there is evidence that EMDR therapy’s known treatment effects cannot be adequately explained by any of the older psychological theories which contributed some elements to EMDR therapy procedures (such as Systematic Desensitization, Exposure-Flooding, Cognitive Behavioral theory).

The Adaptive Information Processing model developed by Dr. Shapiro proposes that EMDR therapy stimulates an intrinsic human capacity for adapting to and learning from new and stressful life experiences which normally operates during the rapid eye movement (dreaming) phase of sleep. Research shows consolidation of emotional learning takes place during REM, also known as paradoxical sleep. Some theorists propose that EMDR therapy may catalyze this innate capacity to resolve disturbance by focusing on a traumatic memory while deliberately engaging eye movements and may tap into some of the same neurological processes active in REM sleep.

These REM-like effects may be enhanced by the investigatory response (also referred to as the orienting response) first described by Pavlov. The investigatory response produces an spontaneous and involuntary decrease in sympathetic arousal (fight, flight and freeze responses) and an increase in parasympathetic tone (calming) in response to neutral stimuli such as the bilateral eye movements used in EMDR therapy. Others link these beneficial effects on arousal to a shift from a dorsal vagal activation (older, more primitive branch of the vagal system) to ventral vagal activation (a newer mammalian system) as describe by Porges.

Another leading theory proposes that some of the distinctive benefits of psychotherapy with EMDR therapy result from the neurological effects of dual attention to the memory and to current (alternating) sensory stimuli. These theorists propose that attending to certain types of sensory stimuli at the same time as a memory triggers an increase in the prefrontal orbital cortex where higher executive functions reside leading to greater mindfulness and a more detached point of view.

Other theories include the working memory hypothesis which proposes that rapid bilateral eye movements are so distracting as to disrupt the short term memory systems holding the sensory and emotional elements of memory. This leads to a rapid decrease in the vividness and emotionality of old memories. Others have proposed that the rapid bilateral eye movements have tonic effects on the integrative capacities of the thalamus — the sensory switchboard for the brain. This tonic effect is proposed to promote increased intra- and inter-hemispheric coordination leading to new insights and new, positive connections to old memories.

A great deal of attention has focused on the effects of EMDR therapy in resolving symptoms resulting from traumatic experiences. There is also emerging evidence that an EMDR therapy procedure known as Resource Development and Installation (or RDI) may enhance the positive emotions, thoughts and behaviors associated with positive memories. Dr. Leeds helped pioneer the development of RDI and has published papers on its use.

When clinically indicated, RDI procedures are used by many EMDR therapy trained clinicians working with traumatized individuals to enhance coping skills and emotional balance before starting work on reprocessing disturbing memories. Preliminary research suggests psychotherapy combining a focus on enhancing resources with RDI and resolving reactions to current stressors with EMDR may be helpful in overcoming maladaptive behaviors such as angry outbursts, self-injury, substance abuse, and compulsive sexual behaviors.

RDI procedures are also used with EMDR therapy to assist athletes and business executives to achieve peak performance in pursuing their personal and professional goals.

Who can provide EMDR treatment?
Only mental health professionals eligible to be licensed to practice psychotherapy are accepted for training by EMDR International Association approved training programs.

Finding an EMDR trained mental health professional
I provide EMDR therapy in Santa Rosa. Due to the volume of requests, except for my own patients and their families, I do not provide specific referrals to other EMDR trained clinicians.

It is relatively easy to locate EMDR therapy trained mental health professionals through two searchable public directories.

The EMDR International Association maintains a searchable public directory listing the qualifications of its EMDR trained members.

The first level in the EMDRIA listings are for members who have completed EMDRIA approved training in EMDR therapy.
The second level of credentialing is EMDRIA Certified in EMDR.
The highest level of credentialing EMDRIA offers is Approved Consultant.

A video introduction to EMDR Therapy
A 10 minute video from the EMDR International Association that explains EMDR therapy.

Sonoma Psychotherapy Training Institute
For more information on EMDR therapy and to see a list of published research articles and books on EMDR therapy visit the Sonoma Psychotherapy Training Institute web site.

EMDR International Association
For general information on EMDR and referral to EMDRIA Certified clinicians and Approved Consultants visit the EMDR International Association web site.

The Evidence on E.M.D.R.
This question and answer format blog on the New York Times site provides commentary from the developer of EMDR therapy, Dr. Francine Shapiro. There are links to other commentaries by Dr. Shapiro on the Times site.