Eye Movement Desensitization and Reprocessing

Description of the Strategy

Since its introduction in 1989, eye movement desensitization and reprocessing (EMDR) has undergone numerous empirical investigations. Now a widely accepted treatment, EMDR is considered an integrative psychotherapy due to its blending of aspects from different orientations. Therapists from diverse [Page 297]orientations recognize a variety of elements, including nondirective or “free” association, attention to negative beliefs and learning, concentration on physiological sensation, and a client-directed stance.

Since the process of EMDR does expose clients to anxiety-provoking stimuli, some have considered it another form of exposure therapy and have suggested that this would account for its effectiveness. However, since exposure therapy incorporates a habituation and extinction model, positive treatment outcomes are thought to require prolonged, uninterrupted, and undistracted exposure in order for it to be effective. By contrast, EMDR uses very brief (20 to 50 seconds), repeated, client-directed exposures. Also, while exposure therapy prohibits the client from reducing his or her anxiety by “changing the scene” or moving too quickly through a traumatic memory, an integral component of EMDR is nondirective or “free” associating to whatever enters the client's consciousness. Thus, the structure of EMDR directly contradicts the elements that exposure theories purport are necessary for positive outcomes.

Initially, EMDR was known as eye movement desensitization (EMD), as it was assumed that the desensitization of anxiety was the primary result of this approach. However, it was quickly discovered that while targeting a disturbing experience, clients would begin to rapidly associate to earlier, related events. The subsequent changes in distress were accompanied by a reduction of negative attributions and an increase in insight and sense of self-worth. Furthermore, decreasing the disturbance associated with these earlier events was also found to decrease the level of disturbance connected to the present stimulus. It was posited that this decreased disturbance was related to learning that had occurred. Thus, the term reprocessing was added, and the informationprocessing model was developed.

The adaptive information processing (AIP) model is based upon the associative nature of memory and perception and describes pathology as resulting from insufficiently processed events that are dysfunctionally stored in implicit (nondeclarative) rather than explicit (narrative) memory systems. When a person experiences strong negative affect or dissociation as a result of a traumatic event, information processing is impaired and the memory is fundamentally stored with the initial perceptions, physical sensations, emotions, and distorted thoughts as they were at the time of the experience. Because this traumatic memory network becomes isolated, associative linking with related memories is inhibited and no new learning occurs. A variety of internal and external cues can then trigger the unresolved experience, often leading to nightmares, flashbacks, and intrusive recollections, as observed in individuals diagnosed with posttraumatic stress disorder (PTSD). Since the reexperiencing of this dysfunctionally stored information in future similar events can eventually lead to habitual response patterns, or personality traits, it is reasonable to expect that the resultant disorders would respond well to treatment designed to reprocess this information.

The EMDR protocol is designed to fully access and process the memory components (image, affect, cognitions, sensations), resulting in rapid treatment outcomes consistent with an adaptive resolution. That is, what is useful is learned, stored with appropriate affect, and able to successfully guide the person in the future. Each of the integrative procedures are viewed as contributing to treatment effects; however, some elements introduced in EMDR protocols in 1989 may particularly shed light on possible mechanisms of action: (a) brief client-directed exposure, (b) nondirective “free” association, (c) mindfulness, and (d) eye movements and other dual-attention stimulation.

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