Wednesday, February 15, 2012

EMDR: An Evidence-Based Treatment for Trauma

Eye Movement Desensitization and Reprocessing (EMDR) was discovered quite by accident in 1987 by Francine Shapiro, PhD.  She went for a walk  in the park and noticed that by the end of the walk she was no longer upset about something that had been bothering her.  When she thought about what had happened, she realized that she had engaged in spontaneous rapid eye movements while contemplating the problem and hypothesized that this had helped her to process and resolve her distress.  She later realized that most people do not spontaneously engage in these eye movements when awake, so she experimented with having people follow her fingers back and forth while focusing on their problems and discovered that it resolved their problems as well. 

In 1988, Dr. Shapiro graduated from using EMDR with "mundane problems" to experimenting with the "highly-charged memories" of people with post traumatic stress disorder (PTSD).*  She had similarly promising results using EMDR with this population.  At the time, PTSD was a fairly new diagnosis (it was first introduced in 1980) and there was no rigorous research about treatment effectiveness, other than studies that came out at about the same time evaluating cognitive behavioral therapy (CBT) as a  PTSD treatment .

There is now a substantial body of research that demonstrates the effectiveness of EMDR for the treatment of PTSD.**  In fact, only CBT and exposure therapy (and to a lesser degree stress inoculation therapy), have as much research supporting their use as a treatment for people suffering from PTSD. Despite this, some clinicians continue to mistakenly believe that EMDR is not evidence-based. 

Other clinicians mistakenly believe EMDR is just another exposure therapy.  EMDR uses brief exposure to the traumatic event, combined with bilateral stimulation (eye movements, tones, vibrations or tapping) and sensory, cognitive, affective and somatic components, to facilitate  adaptive information processing (AIP) and reconsolidation of the traumatic experience.

There are several theories about the role of the bilateral stimulation (BLS). One theory is that focusing on a distressing memory and a neutral visual, auditory or tactile stimulus at the same time helps to keep one foot in the present and one foot in the past to prevent retraumatization and facilitate adaptive reprocessing. Another theory is that the sensory stimulation may help process disturbing events in a mechanism similar  to dream sleep, also known as REM (rapid eye movement) sleep.  A third theory is that the bilateral stimulation activates both hemispheres of the brain to link right brain intuitive, sensory information with left brain logical, sequential, language-based information. Studies have been conducted about each of these theories and research continues to be done to answer our questions about how EMDR works.

What questions do you have about EMDR? What experience have you had with EMDR therapy, as a client and/or as a therapist?  What are your impressions about its effectiveness? Please share your comments and questions below. 

*See the recent article by Francine Shapiro in the Huffington Post online  where she talks about this:

**See for citations and a brief summary of practice guidelines for PTSD treatment from the International Society for Traumatic Stress Studies (ISTSS), the American Psychiatric Association, the American Psychological Association, Cochrane Database of Systematic Reviews,  Department of Veteran's Affairs & Department of Defense (VA/DoD), and the Substance Abuse and Mental Health Services Association (SAMHSA)


  1. Thanks so much for sharing some of the history behind the development of EMDR. It was most interesting.

    I am currently trying out EMDR as a client (and my plan will be to subsequently train in it as a clinician) although not for the treatment of a specific trauma.

    My experience of it to date is that I go into it not quite knowing what to expect. In other words, we will start out with a particular image/memory and see where things go...

    One journey led me to the painful discovery that my mother had been depressed when I was born - something that I had not known beforehand. I am still wrestling with this information...

    On the one hand, knowledge is power because now that I know this, I can rewrite the "unwanted" or "unloveable" script that I have deep inside that I was mostly unaware of... On the other hand, I am now feeling the pain and sadness that I felt as an infant with a depressed mother...

    In short, this is a rather painful process. My hope is that I will emerge from this not only understanding myself more but also feeling better...

    1. Dear Dalia,

      I am so impressed with the work you are doing in therapy. I believe it will serve you well both personally and professionally.

      In my experience with EMDR, as both a therapist and a client, I have witnessed amazing transformations. I believe that rewriting the "unloveable" script that you refer to will yield powerful results that will enable you to pursue your dreams unencumbered.

      I have learned through my own healing that we are only able to help our clients as far as we are able to travel on our own paths. Before I did my own grief work, I was less able to help my clients to grieve. I tended to try to soften the blow instead of helping them to feel the pain they needed to feel in order to fully heal. Now I know that there is no getting around the pain. EMDR helps us to move through the pain, instead of staying stuck in it. But we have to feel it before we can release it and move on.

      It takes a lot of courage and a leap of faith to go through this process. I respect your courage and determination and wish you all the best.


    2. Thanks so much for your support, Andrea

      And as I'm thinking about what you are saying about helping clients grieve... I think I can identify with this.

      I never realized that my inability to be aware of/recognize/acknowledge/feel all of my pain could prevent me from being as helpful as I could be...

      One element that definitely adds to the stress of the EMDR journey is the fact that I have no idea of what will come up. - Is this typical for all clients?

      It also makes future sessions feel a bit scary... It means that it is possible that I may discover additional painful forgotten information about my childhood.

      For me, the EMDR seems to have opened the pandora box of pain, as opposed to have moved me through pain... but I guess with time, I will get to the other side :)

    3. Dear Dalia,

      Unfortunately, opening pandora's box of pain is necessary before you can get to the other side. And yes, it can be very scary not knowing what else might come up. Some clients decide not to pursue EMDR because of this fear.

      When EMDR is for treatment of a single incident adult-onset traumatic experience, it is much more straightforward. When EMDR treatment is for more complex childhood issues of insecure attachment, then it is much more involved and uncertain. That is why I admire your determination to follow this journey wherever it takes you, despite the pain.


  2. I am a patient that has been doing EMDR with my therapist. When my therapist first introduced me to the idea of EMDR, she told me about the eye movements, the tapping and other stuff about how it might help with my problems. To be honest, my first reaction was to think that my therapist had just flipped and perhaps she needed therapy for herself. But I decided I would try it and see what happened.

    So I allowed her to do it. At first it was a little awkward because I just felt silly and a little nervous about it. When she did it, I would actually feel as though I was the age I was when it happened and it was a bit scary in the beginning. But my therapist and I took it one step at a time--she stopped it, she got me to come back so I knew I was in the office and then slowly we did it again. Until we finished what we called “ the picture”.

    How did my therapist know that I needed EMDR? One example was when I saw someone’s shoe and it gave me a horrible feeling and I didn’t know why. Another example was words people would say which would trigger me. A third example was when I smelled a certain scent and would have a flashback. Each of these times my therapist did EMDR and it worked! The shoe, words and scent all stopped bothering me and I had no more flashbacks or horrible feelings from those terrible memories.

    After you do the EMDR you actually remember a lot of the things that happened that you only saw in flashbacks before. It is very scary if you try to conquer them on your own. But less scary if you conquer them through EMDR. With a good therapist that you can trust. I’m not saying that it’s easy to do EMDR if you have had a life of abuse. You relive it and it is kind of sad that it went on. But it gives you so much knowledge of why you were feeling the feeling that you had.

    I am only a regular person who was abused for pretty much most of my life. I really had no say in the matter. It hurts that the abuse happened at such a young age and continued on up to older ages. It hurts when you think about how and why people could be so mean. It made me suicidal at times before doing EMDR. But through my experience this truly does work. I am now back to work part time and moving on. Do I have a setback once in a while? Yes, I’m only human. But it’s not nearly as bad as it was.

    To the therapists out there who work with others who were abused: I commend you; it’s not an easy job. The patience my therapist had with me and still does is unbelievable at times. I would give up and she would hold on for me. So to all you therapists all I can say is three words. “Patience” it takes a lot. “Caring” you can’t be in this field if you don’t care for people. “Stubbornness” if my therapist wasn’t stubborn and strict at times I don’t think I would be here. It wasn’t a mean stubbornness or strictness but it was direct to the point and made me think it’s time to wake up.

    And about EMDR, on a scale of 1-10 (1 being don’t do it and 10 being do it all the way) I say 10 without a doubt.

    1. Dear Anonymous,

      Thanks for sharing your perspective on EMDR therapy. I believe it will give hope to survivors of childhood abuse who are still suffering and help them find the courage to get help.

      With gratitude,

  3. Dear Andrea
    I hope it does give hope to survivors of childhood abuse that are still suffering. I hope they all are able to get help. My goal since childhood was Peace on earth wouldn't it be wonderful if this crazy mixed of world could have peace on earth. Or at least if one person who has been abused could have peace inside forever.

    1. Dear Anonymous,

      Peace on earth would be wonderful. Inner peace for one child abuse survivor at a time is attainable with EMDR. I have witnessed powerful transformations.

      FYI: The EMDR Humanitarian Assistance Program(HAP)has the mission to end the cycle of violence in families, communities and countries throughout the world. HAP provides low cost EMDR training to non-profit mental health professionals who are helping people to overcome trauma. Then those therapists use EMDR to help their clients to heal, which decreases the violence in the world. It is a lot like your goal to work towards peace on earth.

      Thanks for writing.