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Eye Movement Desensitization and Reprocessing (EMDR) and Related Approaches

Jamie Marich, Ph.D., LPCC-S, LICDC-CS, RMT, edited by C. E. Zupanick, Psy.D.

When EMDR was first introduced in 1989, many viewed it as a weird, fringe, too-good to-be-true therapy. After all, how could moving your eyes back and forth help you clear trauma? The other methods, such as alternating audio tones in your ears, or tapping with your hands back and forth, seemed equally weird. Nonetheless, EMDR is currently one of the most researched therapies for PTSD, and it now appears on the SAMHSA registry of evidence-based practices.

eyeWhat began as a chance discovery has evolved into a multi-phase protocol for treatment of traumatic experiences. The bilateral stimulation component (e.g., eye movements, audio tones, bilateral tapping) is believed to promote greater connectivity between the limbic/reptilian regions of the brain where traumatic memories are stuck, and the neocortex. The SAMHSA registry offers a solid, comprehensive summary of what happens in EMDR:

Treatment is provided by an EMDR therapist, who first reviews the client's history and assesses the client's readiness for EMDR. During the preparation phase, the therapist works with the client to identify a positive memory associated with feelings of safety or calm that can be used if psychological distress associated with the traumatic memory is triggered. The target traumatic memory for the treatment session is accessed with attention to image, negative belief, and body sensations. Repetitive 30-second dual-attention exercises are conducted in which the client attends to a motor task while focusing on the target traumatic memory and then on any related negative thoughts, associations, and body sensations. The most common motor task used in EMDR is side-to-side eye movements that follow the therapist's finger; however, alternating hand tapping or auditory tones delivered through headphones can be used. The exercises are repeated until the client reports no emotional distress. The EMDR therapist then asks the client to think of a preferred positive belief regarding the incident and to focus on this positive belief while continuing with the exercises. The exercises end when the client reports with confidence comfortable feelings and a positive sense of self when recalling the target trauma. The therapist and client review the client's progress and discuss scenarios or contexts that might trigger psychological distress. These triggers and positive images for appropriate future action are also targeted and processed. In addition, the therapist asks the client to keep a journal, noting any material related to the traumatic memory, and to focus on the previously identified positive safe or calm memory whenever psychological distress associated with the traumatic memory is triggered.

Most of the EMDR research is conducted with adults. However, many EMDR practitioners successfully use this intervention with children. Certain modifications are needed that take into account a child's developmental maturity.

A variety of therapeutic interventions have spun-off of EMDR. As of this writing, these other approaches have not yet achieved listing in SAMHSA registry. Still, many are growing in popularity due to the positive results of ongoing research, and/or feedback from clients. These interventions include Brainspotting, Progressive Counting, The Developmental Needs Meeting Strategy, and Lifespan Integration Therapy. Websites for information about all of these approaches are listed in the Resources Section at the end of this article. There are also self-help books about various EMDR-informed tapping and rapid eye movement solutions that many survivors of trauma have found helpful. Please seek professional assistance if you feel highly distressed or overwhelmed after attempting any self-help approach.