Eye Movement Desensitization and Reprocessing (EMDR)

Woman follows a doctor's finger with her eyes during EMDR treatment
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Eye Movement Desensitization and Reprocessing (EMDR) remains a controversial treatment technique despite the fact that it was developed by Francine Shapiro in 1987. It was initially used to treat trauma survivors, but it is now also used with phobias and other problems.

The treatment is fairly complex and includes elements from several different schools of therapy. There are eight stages to the treatment technique, and they draw from different approaches and orientations.

What is EMDR?

The most unusual part of the treatment involves the therapist waving his or her fingers back and forth in front of the client's eyes, and the client tracking the movements while focusing on a traumatic event. The act of tracking while concentrating seems to allow a different level of processing to occur. The client is often able to review the event more calmly or more completely than before.

EMDR also includes a strong cognitive-behavioral component. Clients are asked to come up with a negative belief about themselves which resulted from the trauma, and asked "What would you rather believe about yourself?" At various points, the client rates their level of emotions and the extent to which they believe this new belief.

How Does it Work?

How does it work? That's one of the mysteries. Shapiro proposes an "accelerated information processing theory" mechanism. In earlier writings she speculated on the relationship between the eye movements and the eye movements in REM sleep.

Another interesting theory has been presented online in the paper "An Orienting Reflex/External Inhibition Model of EMDR and Thought Field Therapy" by Nathan R. Denny, Ph.D. Denny speculates that both EMDR and "Thought Field Therapy" work by a common mechanism. He states that the eye movements elicit the orienting reflex and that this reflex is incompatible with the fight-or-flight response.

I asked Dr. Shapiro about this theory in her online forum An EMDR Discussion with Francine Shapiro. This forum on Behavior Online is a fascinating opportunity to discuss these issues with the psychologist who developed the technique. A portion of her reply:

The inhibition of a fight or flight mechanism is intriguing. However, as I stipulated in the text, hypotheses regarding potential effects of the eye movements alone are insufficient to account for the wide range of treatment effects. For that one has to look at an interaction of the all the various procedural elements. (Shapiro, 1997)

Suzanne Hurst and Natasha Milkewicz have written a review of the research in a paper entitled Eye Movement Desensitization and Reprocessing - A Controversial Treatment Technique. They conclude that EMDR deserves further research because of the surprisingly positive results from a number of studies. In their review they note that Shapiro has been criticized for insisting that all EMDR training be done by herself and a select group of people that she has trained. Her organization thus stands to profit from all of the training.

Some of the criticism has been muted since she published Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures in 1995.

This book explains the technique in detail so that researchers can fully examine it. Clinicians are still encouraged to receive training in this complex procedure.

I've been trained in EMDR and I use it at times in my practice. I have seen it work extremely well to relieve trauma symptoms in a short period of time, but it does not seem to work for everyone. We need more research and study to determine who this treatment works best for.

For complete information these books from the bookstore are suggested:

  • Francine Shapiro, Margot Silk Forrest. This book is written for a professional and lay audience.
  • Eye Movement Desensitization and Reprocessing : Basic Principles, Protocols, and Procedures, the definitive professional book on EMDR by Francine Shapiro.

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