EMDR is a psychotherapy technique designed to relieve the distress associated with disturbing memories. Short for Eye Movement Desensitization and Reprocessing, it involves recalling a specific troublesome experience while following a side-to-side visual stimulus delivered by the therapist. The resulting lateral eye movements are thought to help reduce the emotional charge of the memory so that the experience can be safely discussed, digested, and stripped of the power to trigger anxiety and avoidance.
Despite numerous studies showing that the technique works for some patients, it has been highly controversial ever since it was introduced in 1987. No universally accepted theory has been put forth to explain how lateral eye movements are integral to the treatment. Further, the evidence is not clear that EMDR is superior to classic forms of exposure therapy, in which patients recall traumatic memories in the safe environment created by a therapist; repeated exposure to the aversive memory in the safe context diminishes fear and avoidance of the memory and any situation that might trigger it.
EMDR was initially developed as an individual treatment for people with post-traumatic stress disorder (PTSD), but it has since been applied in the treatment of many other conditions. For example, it is used by some therapists to treat anxiety disorders, including panic and phobias, depression, dissociative disorders, eating disorders, obsessive-compulsive disorders, and some personality disorders.
To be a candidate for EMDR therapy, patients must be able to tolerate some emotional discomfort and not shut down emotionally or become too easily overwhelmed by feelings. Patients must be able to call on cognitive and emotional resources to reprocess their memories successfully.
Expect a course of treatment that consists of six to 12 sessions, typically delivered one or two times a week, although some people may need fewer sessions. Studies suggest that a single distressing memory can be processed within three sessions.
After taking the patient’s history and explaining the procedure, the therapist helps the patient decide which past experiences will be the subject of treatment. The therapist then activates a disturbing memory by asking the patient to visualize or experience thoughts, feelings, or body sensations related to the event. Once a memory is activated, standard protocol calls for the therapist to assess the level of negative feelings and thoughts regarding the event as well as positive beliefs about oneself the patient wishes to bolster, and then to administer the bilateral visual stimulation.
Patients can expect to experience some level of emotional and physical discomfort while recalling distressing memories. Throughout the procedure, as new feelings and thoughts emerge and are discussed, the therapist samples the level and nature of emotional and cognitive distress and any somatic distress. Sessions end when the patient feels manageably calm, with instructions on how to handle disturbing thoughts and feelings between sessions. Subsequent sessions always begin with an assessment of memories that may have emerged since the previous treatment.
EMDR is based on the so-called Adaptive Information Processing (AIP) model and is said to directly target the way a distressing memory is stored in the brain. The assumption is that past disturbing experiences continue to cause distress because they were not adequately processed, and when such memories are triggered in the present, they contain all the same emotions, thoughts, and physical sensations as the initial experience.
Despite evidence that the technique works, no conclusive explanation for how it does so has ever been put forth. In fact, studies have even questioned whether eye movements are necessary for the procedure, suggesting that the real work of desensitization to traumatic memories is accomplished through recalling, confronting, and reprocessing aversive memories under the guidance of a skilled therapist—exposure therapy.
Nevertheless, a new theory may be emerging. Years of research conducted on the visual system have persuaded neuroscientist Andrew Haberman of Stanford University that the lateral movement of the eyes is necessary—and explanatory. Such movement mimics optic flow, he says, and that calms down the fear system, temporarily diminishing the sense of threat that traumatic memories hold.
The eyes are a part of the central nervous system, the only part outside the cranium. In a study reported in Current Biology, he found that the eyes cue the brain to be alert or relaxed—that is, they adjust the inner state.
In a brain imaging study reported in the Journal of Neuroscience, a team of Dutch researchers found that lateral eye movements suppress the amygdala, one of the primary threat detection centers in the brain. The eye movements activate a dorsal frontoparietal network and transiently deactivate the amygdala. The downregulation of amygdala activity engages a ventromedial prefrontal pathway known to be involved in the cognitive regulation of emotion. Twenty-four hours later, those who underwent reactivation of aversive memories with lateral eye movements had less fear of recalling such memories.
The lateral eye movements of EMDR are akin to those that occur naturally during walking when the eye senses movement via the lateral streaming of visual imagery, so-called optic flow. Huberman observes. “It makes sense from an evolutionary perspective. We’ve always been confronted with threats—animal threats, interpersonal threats. Forward movement is the way you suppress the fear response.” The visual system, he notes, “is a steering wheel and brake of the nervous system. The brain will follow the visual system in many ways.”
There are several distinct reasons why EMDR is controversial. The first is that its origin story is strangely unscientific. Its originator, a psychologist named Francine Shapiro, noted that a distressing thought that came to mind dissipated as she was walking through a park, something millions of people do every day; wouldn’t someone have noticed such an effect before? Shapiro attributed her relief to the lateral movements of her eyes as she made her way through the park.
The early history of the procedure continued to violate the protocols of science. Believing the technique could be useful for treating post-traumatic stress disorder, Shapiro taught the technique to others—for a fee and only after they signed an agreement prohibiting them from teaching it to others. Making the technique proprietary prevents open and unbiased testing of its effectiveness.
Many contend that the technique is too akin to voodoo. Waving a finger back and forth for a patient’s eyes to follow not only resembles the distraction of a magic trick maneuver but seems to defy the seriousness of memories so intrusive they plague people for years, often distort their lives, and drive many to suicide.
Further, unlike all other evidence-based treatments, the procedure does not address the beliefs, emotions, or even the details of the traumatic experience thought to support the persistence of a distressing memory.
Moreover, Shapiro’s explanation of why it works shifted many times before her death. Initially, she claimed that traumatic memories are “locked” in a “neurochemical envelope” in the nervous system. But that is not how memory functions, and the explanation did little to assuage skepticism that such a simple maneuver could relieve profound struggles.
It has also not helped the credibility of the procedure that some therapists offer it as a treatment for almost all mental health problems.
As with any form of therapy, it is important to seek a therapist with whom it is possible to establish clarity of communication and a sense of good fit. In addition, experience counts, so it is advisable to seek a therapist who has had extensive training and experience using EMDR to treat patients presenting with mental health concerns such as yours.
You might ask a prospective therapist such questions as:
- How often have you dealt with problems such as mine before?
- How do you know whether a patient is a good candidate for EMDR?
- How does EMDR work?
- What is a typical plan of treatment, and how long is a typical course of therapy?
- How do you measure progress?
Good as EMDR may be, it is just one tool. Any good therapist has more than one tool available. It is advisable to seek a therapist who is skilled as well in other therapy techniques, such as cognitive and behavioral therapy, exposure therapy, and more.