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A Brief Description of EMDR Therapy

Eye Movements

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For Physicians, Psychiatrists, and Neurobiological Researchers

EMDR has been given a high effectiveness rating for the treatment of trauma in the recent American Psychiatric Association Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines, 2004.

As noted on the Home Page, health departments of numerous countries have designated EMDR as a first line treatment for PTSD: http://www.EMDRHAP.org/researchandresources.htm

EMDR's theory and practice attends to somatic, as well as emotional and cognitive factors of the clinical condition. EMDR is an integrative form of psychotherapy, which includes aspects of, but is distinct from, psychodynamic and cognitive behavioral therapies. For instance, Albert Ray, MD, past president of the American Academy of Pain Medicine, indicates that EMDR benefits patients with chronic pain in ways different from, and potentially surpassing those, found in current CBT treatment.

Ray, A. L. & Zbik, A. (2001). Cognitive behavioral therapies and beyond. In C. D. Tollison, J. R. Satterhwaite, & J. W. Tollison (Eds.) Practical Pain Management (3rd ed.; pp. 189-208). Philadelphia: Lippincott.
For instance, the following articles have reported substantial decreases or complete elimination of phantom limb pain in patients after EMDR treatment.
Russell, M. (2008). Treating traumatic amputation-related phantom limb pain: a case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services. Clinical Case Studies, 7, 136-153.
Schneider, J., Hofmann, A., Rost, C., and Shapiro, F. (2008). EMDR in the treatment of chronic phantom limb pain. Pain Medicine, 9, 76-82. doi: 10.1111/j.1526-4637.2007.00299.x
Schneider, J., Hofmann, A., Rost, C., and Shapiro, F. (2007). EMDR and phantom limb pain: Case study, theoretical implications, and treatment guidelines. Journal of EMDR Science and Practice, 1, 31-45.
Wilensky, M. (2006). Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain. Journal of Brief Therapy, 5, 31-44.

An information processing model is used to explain EMDR's clinical effects. This model is not linked to any specific neurobiological mechanism since the field of neurobiology is as yet unable to determine the neurobiological concomitants of any form of psychotherapy, nor many medications. However, since EMDR achieves clinical effects without the need for homework, or the prolonged focus used in exposure therapies, attention has been paid to the possible neurobiological processes that might be evoked.

Harvard researcher, Robert Stickgold, MD, has explained how EMDR may directly tap into the processes of Rapid Eye Movement (REM) sleep:

Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology, 58, 61-75.

Numerous investigations have examined the neurobiological aspects of the eye movement component.

Andrade, J., Kavanagh, D., & Baddeley, A. (1997). Eye-movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36, 209-223.
Tested the working memory theory. Eye movements were superior to control conditions in reducing image vividness and emotionality.
Barrowcliff, A.L., Gray, Freeman, N.S., Freeman, T.C.A., & MacCulloch, M.J. (2004). Eye-movements reduce the vividness, emotional valence and electrodermal arousal associated with negative autobiographical memories. Journal of Forensic Psychiatry and Psychology, 15, 325-345.
Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing image vividness and emotionality.
Barrowcliff, A.L., Gray, N.S., MacCulloch, S., Freeman, T. C.A., & MacCulloch, M.J. (2003). Horizontal rhythmical eye-movements consistently diminish the arousal provoked by auditory stimuli. British Journal of Clinical Psychology, 42, 289-302.
Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing arousal provoked by auditory stimuli.
Christman, S. D., Garvey, K. J., Propper, R. E., & Phaneuf, K. A. (2003). Bilateral eye movements enhance the retrieval of episodic memories. Neuropsychology, 17, 221-229.
Tested cortical activation theories. Results provide indirect support for the orienting response/REM theories suggested by Stickgold (2002). Saccadic eye movements, but not tracking eye movements were superior to control conditions in episodic retrieval.
Gunter, R. A., & Bodner, G.E. (2008). How eye movements affect unpleasant memories: Support for a working memory account. Behavioral Research and Therapy, 46, 913-931.
Three studies were done with cumulatively support a working-memory account of the eye movements benefits in which the central executive is taxed when a person performs a distractor task while attempting to hold a memory in mind.
Kavanagh, D. J., Freese, S., Andrade, J., & May, J. (2001). Effects of visuospatial tasks on desensitization to emotive memories. British Journal of Clinical Psychology, 40, 267-280.
Tested the working memory theory. Eye movements were superior to control conditions in reducing within-session image vividness and emotionality. There was no difference one-week post.
Kuiken, D., Bears, M., Miall, D., & Smith, L. (2001-2002). Eye movement desensitization reprocessing facilitates attentional orienting. Imagination, Cognition and Personality, 21, (1), 3-20.
Tested the orienting response theory related to REM-type mechanisms. Indicated that the eye movement condition was correlated with increased attentional flexibility. Eye movements were superior to control conditions.
Lee, C.W. &; Drummond, P.D. (2008). Effects of eye movement versus therapist instructions on the processing of distressing memories. Journal of Anxiety Disorders, 22, 801-808.

";There was no significant effect of therapist's instruction on the outcome measures. There was a significant reduction in distress for eye movement at post treatment and at followup.....The results were consistent with other evidence that the mechanism of change in EMDR is not the same as traditional exposure.";

Maxfield, L., Melnyk, W.T. & Hayman, C.A.G. (2008). A working memory explanation for the effects of eye movements in EMDR. Journal of Practice and Research, 2, 247-261.

In two experiments participants focused on negative memories while engaging in three dual-attention eye movements tasks of increasing complexity. Results support a working memory explanation for the effects of eye movement dual-attention tasks on autobiographical memory.

Parker, A., Buckley, S., & Dagnall, N.(2009). Reduced misinformation effects following saccadic bilateral eye movements. Brain and Cognition, 69, 89-97.

Bilateral saccadic eye movements were compared to vertical and no eye movements. "It was found that bilateral eye movements increased true memory for the event, increased recollection, and decreased the magnitude of the misinformation effect." This study supports hypotheses regarding effects of interhemispheric activation and episodic memory.

Sharpley, C. F. Montgomery, I. M., & Scalzo, L. A. (1996). Comparative efficacy of EMDR and alternative procedures in reducing the vividness of mental images. Scandinavian Journal of Behaviour Therapy, 25, 37-42.
Results suggest support for the working memory theory. Eye movements were superior to control conditions in reducing image vividness.
Van den Hout, M., Muris, P., Salemink, E., & Kindt, M. (2001). Autobiographical memories become less vivid and emotional after eye movements. British Journal of Clinical Psychology, 40, 121-130.
Tested their theory that eye movements change the somatic perceptions accompanying retrieval, leading to decreased affect, and therefore decreasing vividness. Eye movements were superior to control conditions in reducing image vividness. Unlike control conditions, eye movements also decreased emotionality.

Additional Neurobiological Indicators

Bossini, L., Fagiolini, C., & Castrogiovanni, P. (2007). Neuroanatomical changes after EMDR in Posttraumatic Stress Disorder. Journal of Neuropsychiatry and Neuroscience, 19, 457-458.

Kowal, J.A. (2005). QEEG analysis of treating PTSD and bulimia nervosa Journal of Neurotherapy, 9 (Part 4), 114-115.

Lamprecht F, Kohnke C, Lempa W, Sack M, Matzke M, Munte T. (2004). Event-related potentials and EMDR Treatment of post-traumatic stress disorder. Neuroscience Research, 49, 267-272.

Lansing, K., Amen, D.G., Hanks, C. & Rudy, L. (in press). High resolution brain SPECT imaging and EMDR in police officers with PTSD. Journal of Neuropsychiatry and Clinical Neurosciences.

Levin, P., Lazrove, S., & van der Kolk, B. A. (1999). What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder (PTSD) by eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders, 13, 159-172.

Oh, D.H. & Choi, J. (2004). Changes in the regional cerebral perfusion after eye movement desensitization and reprocessing: A SPECT study of two cases. Journal of EMDR Practice and Research, 1,24-30.

Pagani, M. et al. (2007). Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nuclear Medicine Communications, 28, 757-765.

Richardson, R., Williams, S.R., Hepenstall, S., Sgregory, L., McKie & Corrigan, F. (2009). A single case fMRI study EMDR treatment of a patient with posttraumatic stress disorder. Journal of EMDR Practice and Research, 3, 10-23.

Sack, M., Lempa, W., & Lemprecht, W. (2007). Assessment of psychophysiological stress reactions during a traumatic reminder in patients treated with EMDR. Journal of EMDR Practice and Research, 1, 15-23.

Sack, M., Nickel, L., Lempa, W., & Lemprecht, F. (2003). Psychophysiological regulations in patients suffering from PTSD: Changes after EMDR treatment. Journal of Psychotraumatology and Psychological Medicine, 1, 47-57. (German)

van der Kolk, B., Burbridge, J. and Suzuki, J. (1997). The psychobiology of traumatic memory: Clinical implications of neuroimaging studies. Annals of the New York Academy of Sciences, 821, 99-113.


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