by Linda Stevenson, LPC
American Day Treatment Center

In 1987 while taking a walk, Francine Shapiro noticed that the disturbing thoughts she was having suddenly disappeared.  She also realized that while she had been thinking those thoughts her eyes had started moving spontaneously back and forth in an upward diagonal.  She then experimented by concentrating on other disturbing thoughts and memories and deliberately made the same eye movement.  She found that these thoughts disappeared or lost their strength.  This was the beginning of EMD --Eye Movement Desensitization, which was enlarged later to EMDR.

EMDR has become an effective tool in the treatment of psychological trauma by stimulating problematic thoughts, feelings and memories, and activating the information processing mechanism so that information can flow along its natural course to resolution.

The EMDR literature states that past physical traumas (such as rape or combat experiences) and past emotional traumas (such as humiliation or disappointment) can have lasting negative effects.  These can result in emotions, beliefs and physical sensations that arise in the body and mind and lead to unhappiness and inappropriate behaviors in the present.  In information processing terms, trauma is information that is dysfunctionally stored in the wrong form of memory, i.e. body vs. narrative.  Dysfunctionally stored memory has within it the perceptions and thoughts that were present at the original event as opposed to adequate learning when memory is stored, with appropriate emotions that facilitate growth and understanding.  The clinician identifies the dysfunctionally stored material, stimulates the person's present perceptions and assists in reprocessing these.  Dual attention, through either eye movements, tapping on the client's palms, or snapping fingers next to the client's ears are stimuli used to activate the client's information processing system to achieve treatment effects.

After her walk, Shapiro worked with seventy people over a six-month period and developed a standard procedure that succeeded in reducing anxiety.  EMD was actually renamed EMDR (Eye Movement Desensitization Reprocessing) when the orientation changed from the idea of desensitization to the information processing.  Information processing theory suggests that there is a system in all of us that is physiologically geared to process information to a state where negative emotions are relieved.  Learning takes place as information is appropriately integrated.  The system can become unbalanced because of trauma or stress. EMDR techniques demonstrate that once the information is appropriately activated and processed cognitive restructuring occurs.  Adaptive reprocessing is occurring on a neurophysiologic level.  This process works faster than traditional therapy because it affects the associative neurophysiologic networks.
    
The treatment involves 7 steps:

1. Client History :  The clinician takes a thorough personal history; identifies the clients 10 most disturbing memories/thoughts and assesses the clients patterns of reaction.
   
   
2. Preparation:  The clinician establishes a therapeutic relationship; explains the process in detail and addresses the client's concerns.  The clinician determines the target memory and baseline measure of the client's reactions and processes.  The clinician has the patient describe the disturbing image and traumatic memory along with the negative thoughts and beliefs he has about the situation.  An example of such a negative cognition might be "I'm worthless". The client is then asked to create a safe place in her imagination that can be used for a temporary rest during processing or as an aid in closing down the disturbance in order to end the session. It can also be used to deal with disturbing material that arises between sessions.
   
   
3. Assessment: The client is asked to recall the memory and the negative cognition and rate the anxiety on a scale from 0 - 10 called the Subjective Unit of Disturbance. The client is then asked to verbalize a positive belief that she would like to have about herself and to rate how true this feels on the 7 point Validity of Cognitive Scale.

   The clinician will then demonstrate the eye movements, tapping or snapping and ask the client to follow these to give feedback about comfort levels.  The clinician can experiment with different speeds and directions.

   
   
4. Desensitization:  When something traumatic happens the information processing can break down. The perceptions of the trauma are stuck in our nervous system in the same form as originally experienced.  It is important to note that the process will not desensitize a person's negative feelings if they are appropriate to the situation.

   The clinician will initiate sets of 24 movements.  At the end of the last set the clinician says "rest/let it go/blank it out/take a deep breath".  This refocusing period interrupts the intensity of the focus and gives the client permission to reorient and prepare to verbalize the new perception.  When the client appears ready she is asked "What do you get now?" or "What came up for you?"  This helps the clinician to get a  "read-out" from the client on any aspects of the event that have shifted and on the current state of the target material.  These in between intervals allow the client time and opportunity to describe internal experiences in words and to understand the changes, move or shifts in her thinking. 

   
   
5. Installation :  The client is asked to evaluate the positive cognition that she chose during the assessment phase (i.e., I am capable.)  "As you think of these words on the Validity of Cognition Scale how do they feel from 1 (false) to 7 (true)?".
   
   
6. Body Scan:   The adaptive processing model that guides EMDR suggest that dysfunctional material may have discernible physical sensations that correspond to cognitive processes. The clinician says "Close your eyes and keep in mind the original memory and positive cognition.  Then bring your attention to the different parts of your body starting with your head and working downward. Tell me any place you find tensions, tightness or an unusual sensation."  The clinician will take the client's feedback and focus on that in the next set.
   
   
7. Closure:  The clinician will use a guided visualization to return the client to a state of relaxation.  She will assess for any dissociation that might be preventing the client from returning to the here and now.  To aid in debriefing, the client will be reminded that further disturbances are part of the process.  She will be asked to  keep a daily log of memories, dreams and thoughts that come up, to bring to the next session.  At the beginning of each therapy session after the first, the therapist will check to assess if the positive results (i.e., the low SUD, and the positive VOC) and the decreased body tension have been maintained.

EMDR has been used on varied populations of people including those suffering from symptoms of PTSD, anxiety, sexual abuse, phobias, depression and grief. There are many ideas about the mechanism of the treatment.  One theory suggests that through evolution a reflex developed that allows mammals to observe danger. The resulting excitation motivates the animal to fight or flight. The eye movements in EMDR trigger associated mechanisms that inhibit this response resulting in rapid psychological reorientation, and a sense of calm.   Another theory is that neurononal bursts of rapid eye movement (like a low voltage current) might cause an inhibition in the location where the memory is stored.  This might reverse the neural pathology in a way similar to what happens in REM sleep.

Although reactions can be locked in the nervous system, it seems that whatever has been learned can be changed.  Certainly it is the belief of not only EMDR but all psychotherapies that traumatic life events, destructive and dysfunctional thoughts can be successfully reprocessed.

For more information about EMDR I suggest EMDR Basic Principals and Procedures by Francine Shapiro or contact the EMDR Institute at www.emdr.com.

###