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Eye Movement Desensitization and Reprocessing (EMDR)
Please note new information dealing with EMDR treatment
Post-traumatic stress disorder, like any other psychological trauma, is difficult to diagnose, and often, even more difficult to treat. But a team of psychotherapists at the North Chicago VA Medical Center's PTSD Treatment Clinic is finding that a somewhat physical procedure may indeed offer some success. Physically, Eye Movement Desensitization and Reprocessing (EMDR) is as simple as a therapist waving a hand in front of a patient's face, but it is what happens at the psychological level that is much more complicated and controversial. EMDR is currently endorsed under the VA/DoD Clinical Practice Guidelines for the Management of Post-Traumatic Stress Disorder as a treatment of "significant benefit."
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 health care or mental health treatment, but agreed to participate in a research study in order to receive treatment. The benefits reported following EMDR include:
- Feeling less troubled by trauma memories and reminders while awake and in their dreams (PTSD intrusive reexperiencing 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 health care. 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 awareness
(9) at an intensity and pace that the survivor feels is helpful, not overwhelming
(10) guided by an active and involved therapist