Journal Article Review: Eye Movement Desensitization and Reprocessing (EMDR)
- Clinical Services Team
- Nov 11
- 6 min read
Updated: 9 hours ago
WCF Clinical Team
Background
In 1987, American psychologist and psychotherapist Francine Shapiro discovered the desensitization effects of spontaneous eye movements, and develops procedures using application of eye movement.
By 1989, Shapiro had begun controlled studies of EMD for PTSD – positioning eye movement’s impact on de-arousal, and linking this to REM sleep.
In 1990, EMD became EMDR – shifts beyond reduction/elimination of distress, to emotional shifts in understanding the meaning of experiences.
The Key Underpinnings
'Adaptive information processing’ model – recognises that the brain stores typical memories and traumatic memories differently.
Trauma is stored in the body – EMDR addresses the physiological storage of memory and how it informs experience.
Trauma is about integration/storage of memories, not the intensity of an event. i.e. a collection of ‘small t’ traumas can be comparable to the impact of ‘big T’ traumas (those events needed typically to diagnose PTSD).
A bit about Memory and the Brain
When an experience is successfully processed (whether positive or negative), it is adaptively stored, integrating with other, similar experiences about self and others
During sleep, we process and consolidate memories from the hippocampus to the neocortex (think.. filing cabinet). At night when we dream, REM sleep (rapid eye movement) causes the memories to be processed by the rest of the brain, and sorted into their relevant memory networks.
Disruptions to the information processing system due to high arousal states from adverse life experiences, result in memories that are inadequately processed and maladaptively stored. i.e. the memory is ‘stuck’ in the amygdala/hippocampus and when triggers occur, feel like they are happening in the present.
When unconsciously experiencing a past memory as if it were happening in the present, the person therefore has maladaptive conclusions to interpret the present - These inadequately processed memories have stored components – images, thoughts, emotions, beliefs, physical sensations
EMDR (the reprocessing stage) allows for relevant connections to be made between memories, and the previously disturbing memories are neutralized and integrated with other similar experiences. What is useful is stored, available to inform future experiences, and what is no longer adaptive is discarded (e.g. feelings, beliefs, negative images)
The Model
EMDR is a memory-based approach focussing on the reprocessing of experience. It integrates past, present, and future.
EMDR is used to address the adverse life experiences that contribute to problems in daily living
EMDR accesses a target memory (acting as a portal to associated memory network of similar dysfunctionally stored experiences) – and reprocesses its components – integrating them into adaptive memory networks.
Adaptive memory networks consist of associated memories that are processed and integrated. Also included negative experiences that are resolved, i.e. the information is congruent with the emotional response and are no longer disturbing.
Bilateral Stimulation (BLS)
BLS is just one component of EMDR. Includes eye movements, tactile taps, auditory tones
Reprocessing occurs when dual attention on a past memory, combined with BLS, activates and associated process that allows relevant connections to be made.
BLS helps induce a reduction in arousal (slowing down an overactive amygdala) and allows linkages to adaptive memory networks to spontaneously occur.
BLS mimics the synchronisation of cortical activity that occurs in REM sleep.
Do I need to talk about the Trauma?
The “Processing” part of EMDR does not mean talking about a traumatic experience. “Processing” means setting up a learning state that will allow experiences that are causing problems to be “digested” and stored appropriately in your brain. That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future.
EMDR focusses on the body sensation and the self-belief, rather than the memory itself (e.g. following an assault, the underpinning irrational self-belief may be ‘I am unlovable’).
The individual then formulates a positive belief that he would like to have about themself (“I am a worthwhile and good person in control of my life.”). All the physical sensations and emotions that accompany the memory are identified. The individual then goes over the memory while focusing on an external stimulus that creates bilateral (side to side) eye movement. After each set of bilateral movements, the individual is asked how they feel (often using SUDS). This process continues until the memory is no longer disturbing.
The individual is processing the trauma with both hemispheres of the brain stimulated.
SUDS (subjective units of disturbance) and VOC (validity of cognition)
SUDS and VOC are used in EMDR to measure the goal being achieved – for the client’s distress to decrease (ultimately to a 0) and their positive believe/perception/cognition to increase.
Resourcing
There are 8 stages to EMDR therapy (below), but very importantly before beginning any type of reprocessing, is ensuring that stabilization occurs and time has been spent resourcing. This could go across several sessions before any processing begins, and involves accessing a person’s internal resources, strengths, positive memories, etc.
Using BLS - soothing the nervous system to strengthen a resource or memory being activated.
E.g. using BLS to install a safe place, nurturing figure, protective figure, a container…
This process uses sensor data to later refer back to the resource, during the processing stage in order to impact levels of distress in that moment.
Evidence/Efficacy
EMDR is recognised by the World Health Organisation as an evidence based treatment. It requires specialised training for practitioners to be able to use the therapy modality. It is recognised under Medicare in Australia.
The Role of EMDR Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences
Research shows that adverse life experiences contribute to both psychological and biomedical pathology. It’s benefits include not involving detailed descriptions of the event, nor challenging beliefs, nor extended exposure or homework for the client.
Studies found that EMDR is more rapid and more effective treatment than TF-CBT n minimising symptoms relating to trauma. Control trials also show rapid decreases of negative emotions and/or vividness of disturbing images, and relief from somatic complaints.
A Randomized clinical trial of EMDR, Fluoxetine, and pill placebo in the treatment of PTSD: treatment effects and long-term maintenance
This study had 88 participants with diagnosed PSTD and compared the results of 8 weeks treatment with the above, following up after 6 months
Results found the EMDR was more effective than the SSRI treatment in sustained reductions in PTSD and depression symptoms. At the 6 month follow up, 75% of adult onset PTSD and 33% of child onset trauma subjects receiving EMDR, achieved an asymptomatic end-state functioning compared with none of the SSRI group.
The results concluded that SSRIs are reliable for first-line intervention to symptom relief, though EMDR treatment is more effective ongoing. However, further research is needed into the impact of longer term intervention.
An Integrative EMDR and Family Therapy Model for Treating Attachment Trauma in Children: A Case Series
This case series study investigated the effectiveness of an integrative eye movement desensitization and reprocessing (EMDR) and family therapy model - for improving traumatic stress, attachment relationships, and behaviours in children with a history of attachment trauma; specifically, adopted children with a history of maltreatment and foster or orphanage care
22 child participants completed treatment in 6–24 months. Mean treatment length was 12.7 months. Statistical analysis demonstrated significant improvement in scores on children's traumatic stress symptoms, behaviours, and attachment relationships by the end of treatment.
Efficacy of EMDR Therapy for Children With PTSD: A Review of the Literature
This literature review examined 15 that tested the efficacy of EMDR therapy for the treatment of children and adolescents with these symptoms. All studies found that EMDR therapy produced significant reductions in PTSD symptoms at posttreatment and also in other trauma-related symptoms, when measured.
References
EMDR Institute Basic training course – weekend one booklet and training slides
The Role of EMDR Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences, Francine Shapiro, The Permanente Journal, Winter 2014
A Randomized clinical trial of EMDR, Fluoxetine, and pill placebo in the treatment of PTSD: treatment effects and long-term maintenance, Van Der Kolk et al. Clin Psychiatry 68:0, 2007
An Integrative EMDR and Family Therapy Model for Treating Attachment Trauma in Children: A Case Series, Armstrong et al. 2018 - https://connect.springerpub.com/content/sgremdr/12/4/196.full.pdf
Efficacy of EMDR Therapy for Children With PTSD: A Review of the Literature, Beer 2018 - https://www.emdr-es.org/Content/PDF/noviembre2023/Efficacy%20of%20EMDR%20Therapy%20for%20Children%20With%20PTSD.pdf
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