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Eye Movement Desensitization and Reprocessing

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 The SAGE Encyclopedia of Theory
in Counseling and Psychotherapy
Eye Movement Desensitization
and Reprocessing Therapy

Contributors: Francine Shapiro & Roger Solomon

Editors: Edward S. Neukrug
Book Title: The SAGE Encyclopedia of Theory in Counseling and Psychotherapy
Chapter Title: "Eye Movement Desensitization and Reprocessing Therapy"
Pub. Date: 2015
Access Date: April 16, 2015
Publishing Company: SAGE Publications, Inc.
City: Thousand Oaks,
Print ISBN: 9781452274126
Online ISBN: 9781483346502
DOI: http://dx.doi.org/10.4135/9781483346502.n134
Print pages: 389-395
©2015 SAGE Publications, Inc. All Rights Reserved.
This PDF has been generated from SAGE knowledge. Please note that the pagination
of the online version will vary from the pagination of the print book.
Enc Thoery Contributo
©2015 SAGE Publications, Inc. All Rights Reserved. SAGE knowledge

http://dx.doi.org/10.4135/9781483346502.n134
Eye Movement Desensitization and Reprocessing (EMDR) therapy is an integrative
psychotherapeutic approach that emphasizes the role of the brain’s [p. 389 ↓ ]
information processing system. Mental health problems, excluding those caused by
lack of information, organic deficit, toxicity, or physical injury, are conceptualized as
the result of inadequately processed memories of disturbing or traumatic experiences.
These unprocessed memories contain the emotions, physical sensations, and
perspectives experienced at the time of the original disturbing event. EMDR comprises
eight phases and a three-pronged methodology to identify and process (1) memories
of past adverse life experiences that underlie present problems, (2) current situations
that elicit disturbance, and (3) needed skills that will provide positive memory templates
to guide the client’s future behavior. Using standardized procedures, which include
sets of eye movements or other forms of bilateral dual attention stimuli (tactile or
auditory), the client’s memories are accessed and processed to an adaptive resolution.
Stimulating the information processing system causes internal connections to form
as the problematic experience is appropriately integrated and resolved. During this
processing, insights automatically arise, along with positive emotions, beliefs, and
physical reactions, and the disturbing event becomes both a learning experience and
the foundation of resilience.

Historical Context
EMDR therapy originated in 1987, when, through self-observation, Francine Shapiro
noticed that thoughts became less disturbing after spontaneously generated eye
movements. On further experimentation, she determined that repeated eye movements
when focusing on a disturbing event resulted in a decrease in negative affect. Working
with both civilians and combat veterans, she developed a procedure, which she then
evaluated with trauma victims who volunteered for treatment. What was then called Eye
Movement Desensitization involved a repeated return to a targeted memory paired with
the eye movements, which were believed to trigger an inherent relaxation response.
In 1989, a randomized controlled trial demonstrating the efficacy of the procedure
for treating traumatic memories was published in the Journal of Traumatic Stress.
With its emphasis on apparent desensitization effects, Eye Movement Desensitization

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and Psychotherapy: Eye Movement Desensitization
and Reprocessing Therapy
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reflected a behavioral orientation. Further experimentation and observations of the

changes initiated by the eye movements resulted in an evolution of the methodology.
Procedures were developed that encouraged naturalistic associative reprocessing
of comprehensive memory networks by allowing the client’s attention to move
spontaneously to internal associations (e.g., other memories, insights) during the sets of
eye movements. In 1990, the therapy was renamed Eye Movement Desensitization and
Reprocessing to reflect the observation that the apparent desensitization was merely
a by-product of the reprocessing and that changes were simultaneously occurring
in the affective, somatic, and cognitive domains. At that time, it was also recognized
that many “everyday” disturbing life experiences (e.g., arguments, humiliations) can
have the same debilitating effects as full-blown trauma and set the groundwork for a
wide range of clinical problems. Clinicians were instructed to examine clients for these
kinds of experiences and to target them during EMDR therapy. Since then, substantial
research has confirmed the importance of everyday adverse life experiences as a basis
of pathology.

When the initial study was published in 1989, there were no empirically supported
treatments for posttraumatic stress disorder (PTSD). Therefore, the positive effects
reported in the one-session study resulted in years of controversy regarding the efficacy
of EMDR and the role of the repetitive eye movements in the therapy. The problem was
compounded by early studies evaluating the effects of the procedure with and without
eye movements that reported equivocal results. In 2000, these studies were determined
by the International Society for Traumatic Stress Studies Practice Guideline Taskforce
to be flawed because of insufficient treatment fidelity and/or length of treatment. Since
then, numerous randomized studies have evaluated the role of the eye movements
and reported positive results, including decreases in negative emotions, increased
recognition of true information, and other memory effects. A recent meta-analysis of the
eye movement research has demonstrated significant effects for the eye movements
in both clinical and laboratory studies. Clinical observation and research have also
indicated positive effects when substituting bilateral (back and forth) tones or taps for
the eye movements.

[p. 390 ↓ ] Subsequent to the publication of the original randomized study, Shapiro
continued to refine the procedures, and EMDR therapy was introduced as an eight-
phase treatment approach. A randomized study published in 1995 in the Journal of

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Counseling and Clinical Psychology reported 84% remission of PTSD after three
sessions. A humanitarian assistance program launched to treat victims of the Oklahoma
City bombing that same year obtained virtually identical results. Since then, research
has continued to demonstrate the effectiveness of EMDR therapy, and it is now widely
regarded as an empirically validated treatment for trauma. The efficacy of EMDR
therapy has been confirmed by more than 20 randomized controlled studies, and it has
been designated effective internationally in the practice guidelines of organizations
such as the American Psychiatric Association, the Department of Veterans Affairs
and Defense, and the World Health Organization (WHO). Although many clinicians
influenced by the early controversy believe that EMDR is a form of cognitive-behavioral
therapy, the WHO Practice Guidelines have made a clear distinction by indicating the
marked differences between the two therapies with respect to both conceptual basis
and clinical procedures.

Since EMDR therapy does not include the 30 to 100 hours of prescribed homework
characteristic of the other empirically validated trauma treatments, its therapeutic effects
can be achieved on consecutive days. This provides field teams the ability to use both
individual and group therapy protocols to efficiently treat appropriately screened and
stabilized trauma victims on-site after both natural and man-made disasters. The EMDR
Humanitarian Assistance Programs, which was recognized in 2011 with an award for
clinical excellence by the International Society of Traumatic Stress Studies, has been
assisting victims pro bono since 1995, both in the United States and internationally.

Randomized trials have confirmed that EMDR therapy is both effective and efficient.
For instance, three studies have reported that 84% to 100% of single-trauma victims no
longer had PTSD after the equivalent of three 90-minute sessions. Additional sessions
are needed for multiple traumas. For example, it has been found that 12 sessions
with combat veterans resulted in the elimination of PTSD diagnosis in 77.7% of the
cases. However, it is unnecessary to process each trauma individually because positive
treatment effects generalize to similar events. Numerous studies and case reports have
found EMDR therapy to be effective with a wide range of disorders. Different diagnoses
require customized EMDR therapy procedures, which incorporate the three-pronged
protocol of the past, the present, and the future. EMDR therapy can be integrated with
a specialized treatment framework appropriate for a wide range of populations. It is
applied with individual and group protocols.

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and Reprocessing Therapy
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Theoretical Underpinnings
EMDR therapy is guided by the Adaptive Information Processing (AIP) model, which
views unprocessed memories of adverse life experiences as the basis of pathology,
excluding that caused by organic factors (e.g., genetics, injury, toxicity). Memories
are physically encoded experiences that are stored in associative neural networks.
These networks provide an important basis for the person’s interpretation of new
experiences and significantly influence current perceptions, behaviors, and feelings.
Under normal circumstances, the information processing system integrates new
experiences with previous ones, gleaning the information that is useful and discarding
that which is not. This information, along with the appropriate emotional states, is stored
in interconnected memory networks that become available to guide the person’s future
actions. However, high levels of disturbance can disrupt the system and cause the
unprocessed memories to be stored with the perspectives, affects, and sensations that
were experienced at the time of the event. Distressing events can include not only major
traumas but also the more ubiquitous childhood experiences of rejection, abandonment,
humiliation, and household disruption. Such experiences become stored in a way that
does not allow them to connect to more adaptive information, therefore preventing
appropriate learning from taking place. Predictably, if a current situation triggers
memory networks of inappropriately stored information, the perceptions, emotions, and
physical sensations inherent in the unprocessed memory emerge automatically. When
this occurs, “the past becomes present.” These negative affects and perspectives shape
the individual’s responses and result in reduced [p. 391 ↓ ] self-esteem, self-efficacy
issues, relationship difficulties, and the overt symptoms of a wide variety of diagnoses.

The goals of EMDR therapy are to access and process the dysfunctionally stored
memories by stimulating the innate information processing system through the use of
standardized procedures and protocols. These procedures include the use of bilateral
dual attention stimulation, such as eye movement, taps, or tones. The AIP model posits
that successful EMDR treatment results in the emergence of the targeted memory from
its isolated state to become appropriately integrated with the wider comprehensive
memory networks that constitute the totality of the individual’s life experiences. The
memory is now stored in a new, adaptive form, capable of being recalled and verbalized

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and Reprocessing Therapy
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by clients without the negative affects, perspectives, and physical sensations that
characterized their previous psychological condition.

Various theories have been proposed to account for the rapid emergence of insight,
memory association, and decrease in disturbance observed during EMDR therapy.
One dominant hypothesis is that the eye movements link into the same processes
that occur during rapid eye movement sleep. Randomized trials studying the eye
movement component of EMDR therapy in isolation have supported this explanation.
Two other theories receiving research support are that the eye movements (1) stimulate
an automatic relaxation response by triggering the orienting response and (2) tax the
working memory, thereby decreasing the vividness of the accessed disturbing image,
resulting in a decrease in negative emotions.

Major Concepts
Three major concepts that underlie EMDR therapy theory and practice are (1) memory
networks and unprocessed memories, (2) information processing, and (3) associative
channels.

Memory Networks and Unprocessed

Memories
Memory networks are viewed as the underlying basis of pathology and mental health.
Distressing or traumatizing events can disrupt the brain’s information processing
mechanisms, which results in the experience becoming dysfunctionally stored in the
brain with the affects, perspectives, and physical sensations experienced at the time
of the event. These memories are stored in isolation, unable to link with more adaptive
information. Because learning cannot take place, they remain essentially unchanged
over time. As the perceptions of the present link to existing memory networks, various
components of the unprocessed memories can be experienced in the form of emotions,
physical sensations, and thoughts or beliefs. Unprocessed memories of trauma and
other adverse life experiences (i.e., the more ubiquitous life experiences such as

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humiliations, rejections, arguments, and childhood household dysfunction) are viewed

as the basis of pathology, excluding those caused by genetic defect, toxicity, or injury.

Information Processing
Processing is viewed as the forging of adaptive associations between networks of
information stored in the brain. In EMDR therapy, the disturbing memory is accessed
by eliciting image, beliefs, emotions, and physical sensations related to the memory.
The information processing system is activated through standardized procedures
that include dual attention bilateral stimulation (e.g., eye movements, tones, or taps),
resulting in adaptive information linking into the neurobiological network(s) holding the
dysfunctionally stored memories.

The unprocessed components or manifestations of memory (image, thoughts, sounds,

emotions, physical sensations, beliefs) transmute during processing to an adaptive
resolution. What is useful is stored, available to appropriately inform future responses.
Processed memories are posited to move from implicit and episodic memory systems
(e.g., vivid remembrance of what occurred) to full integration within semantic memory
systems (i.e., meaning has been extracted).

Associative Channels
Encoded memories are stored in networks with neural linkages to events with similar
information (e.g., senses, thoughts, emotions, body sensations, and beliefs). The
pattern of recovery observed in EMDR reprocessing sessions involves a rapid [p.
392 ↓ ] progression of intrapsychic connections as emotions, sensations, insights,
and memories surface and shift with each new set of dual attention stimulation.
Hence, EMDR therapy appears to open up associative channels and reveal the
interconnections of the memory networks. As processing continues, positive
associations arise as part of the learning process in the form of new linkages to relevant
memory networks.

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and Reprocessing Therapy
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Techniques
The generic therapeutic protocol underlying comprehensive EMDR treatment includes a
three-pronged approach following appropriate preparation. The client is first engaged in
processing (a) past experiences contributing to present dysfunction, (b) present triggers
that elicit disturbance, and (c) patterns of behavior for future positive functioning.
Protocols customized for different diagnoses (e.g., substance abuse, phobias, chronic
pain) all incorporate the eight-phases and three-pronged protocol. Guided by the AIP
model, EMDR therapy utilizes an eight-phase approach to address the full range of
clinical symptoms caused or exacerbated by negative experiences.

Phase 1: Client History

The clinician obtains background information, determines client suitability for EMDR
treatment, and identifies processing targets from events in the client’s life. The clinician
assesses client stability and the availability of positive memory networks necessary to
allow processing to take place. The clinician employs direct questioning and specific
techniques (e.g., Affect Scan, Floatback) to identify the earlier memories that are the
foundation of the client’s current symptoms.

Phase 2: Preparation
Clients deemed appropriate are prepared to process the targeted memory experiences.
The goals in this phase are to establish a therapeutic alliance, educate the client
about the symptom picture, explain the EMDR process and its effects, and teach self-
control techniques that foster stabilization. If needed, a variety of resource development
procedures that enhance adaptive functioning are used along with the therapeutic
relationship to increase access to positive memory networks.

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and Reprocessing Therapy
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Phase 3: Assessment
The memory to be targeted for processing is accessed and evaluated by identifying
the relevant components. This is achieved by eliciting the mental image, currently
held negative belief, desired positive belief, current emotion, physical sensations, and
baseline measurements of the level of current distress and believability of the desired
positive belief.

Phase 4: Desensitization
This is the first phase during which memory targets involving negative past experiences
and current disturbances are reprocessed. The goal is to neurophysiologically catalyze
a life-enhancing learning experience through processing the accessed memory, which
results in the emergence of insight and positive emotions, transforming the disturbing
event into a foundation of resilience. Standardized procedures, including sets of
bilateral dual attention stimuli, are utilized to help activate the information processing
system, and systematic feedback is obtained to carefully monitor and guide the client
to resolution. During sets of bilateral stimulation, the client maintains a dual awareness
of the external stimuli and an internal focus on what emerges in consciousness.
Simultaneous shifts in cognition, emotion, and physical sensation associated with the
memory reprocessing reveal the in-session treatment effects. Positive templates for
adaptive future behavior are also incorporated into memory.

Phase 5: Installation
The client’s most desired positive self-belief (initial or emergent) is identified and
enhanced to increase its connection with currently existing positive cognitive networks
and facilitate generalization effects between associated memories.

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Phase 6: Body Scan

The client identifies and processes any residual negative body sensations until they
disappear. [p. 393 ↓ ] Because dysfunctionally stored memories often manifest via
physical disturbance, processing is not considered complete until all negative somatic
responses disappear.

Phase 7: Closure
This phase shifts the focus away from the negative memory to neutral or positive
networks. It may incorporate methods to return clients to psychological equilibrium, if
needed, and ensure their stability between sessions. Clients are briefed about what to
expect between sessions and instructed to maintain a brief log of their psychological
experiences or state of mind to identify potential targets for future sessions.

Phase 8: Reevaluation
In the sessions following processing, an assessment is made of the client’s current
psychological state, the thoughts and feelings that may have emerged since the
previous treatment, and the level of integration within the larger social system. In
addition, the previous session’s target is accessed to evaluate the maintenance of
effects and any other associations that may have emerged. This information is used to
guide the direction of treatment.

Therapeutic Process
The following brief example describes a session of EMDR therapy with a single trauma:
a war veteran who experienced PTSD symptoms resulting from a marketplace bombing
incident in which people were killed. He specifically recalled a crying child near its dead
mother. On returning home, he could not hold his infant daughter, and when she cried,
he experienced flashbacks and panic. The memory was targeted for processing, the

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worst image being that of the crying child. The negative cognition was “I’m helpless,”
while the positive cognition was “I did the best I could.” The client’s emotions of sadness
and guilt were felt in the stomach. During processing, he recalled his activities during
this incident, such as calling first aid workers, bringing a blanket to a child, and trying
to be a comforting presence. With further processing, he stated that he had done all
he could to help the wounded and no longer felt any negative physical response in his
body. He then said, “It was a terrible situation, but it’s over now. I hope the child is being
taken care of.” He could then think of holding his own child with a feeling of love. Future
memory templates were encoded to anticipate comforting his child when she cried.

In summary, EMDR is an integrative psycho-therapeutic approach that conceptualizes

current mental health problems as emanating from past experiences that have been
maladaptively stored neurophysiologically as unprocessed memories. EMDR therapy
utilizes standardized procedures including bilateral dual attention stimuli to activate
the information processing system to bring the client to a robust level of mental health.
A three-pronged protocol is used that targets the (1) unprocessed memories of past
adverse life experiences underlying the clinical complaints, (2) current situations that
trigger disturbance, and (3) positive memory templates needed for future adaptive
behavior. Extensive research has validated this approach.

See alsoFoundational Therapies: Overview; Neurological and Psychophysiological

Therapies: Overview; Shapiro, Francine

FrancineShapiro RogerSolomon

http://dx.doi.org/10.4135/9781483346502.n134
Further Readings

Doering, S., Ohlmeier, M., de Jongh, A., Hofmann, A., & Bisping, V. (2013). Efficacy
of a trauma-focused treatment approach for dental phobia: A randomized clinical trial .
European Journal of Oral Sciences , 121, 584–593. doi:http://dx.doi.org/10.1111/
eos.12090

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and Psychotherapy: Eye Movement Desensitization
and Reprocessing Therapy
Enc Thoery Contributo
©2015 SAGE Publications, Inc. All Rights Reserved. SAGE knowledge

Lee, C. W., & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements
in processing emotional memories . Journal of Behavior Therapy and Experimental
Psychiatry , 22, 231–239. doi:http://dx.doi.org/10.1016/j. jbtep.2012.11.001

Marcus, S., Marquis, P., & Sakai, C. (1997). Controlled study of treatment of
PTSD using EMDR in an HMO setting . Psychotherapy , 34, 307–315. doi:http://
dx.doi.org/10.1037/h0087791

Oren, E., & Solomon, R. (2012). EMDR therapy: An overview of its development
and mechanisms of action . European Review of Applied Psychology , 62, 197–203.
doi:http://dx.doi.org/10.1016/j.erap.2012.08.005

Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles,

protocols, and procedures (2nd ed.). New York, NY: Guilford Press.

Shapiro, F. (2012). Getting past your past . New York, NY: Rodale.

Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR)
therapy in medicine: Addressing the psychological and physical symptoms stemming
from adverse life experiences . The Permanente Journal , 18, 71–77. doi:http://
dx.doi.org/10.7812/TPP/13-098

Shapiro, F., & Laliotis, D. (2011). EMDR and the adaptive information processing
model: Integrative treatment and case conceptualization . Clinical Social Work Journal ,
39, 91–200. doi:http://dx.doi.org/10.1007/s10615-010-0300-7

Solomon, R., & Shapiro, F. (2008). EMDR and the adaptive information processing
model: Potential mechanisms of change . Journal of EMDR Practice and Research , 4,
315–325. doi:http://dx.doi.org/10.1891/1933-3196.2.4.315

Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action . Journal of

Clinical Psychology , 58, 61–75. doi:http://dx.doi.org/10.1002/jclp.1129

Wilson, S., Becker, L. A., & Tinker, R. H. (1997). Fifteen-month follow-up of eye
movement desensitization and reprocessing (EMDR) treatment of post-traumatic stress

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and Psychotherapy: Eye Movement Desensitization
and Reprocessing Therapy
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©2015 SAGE Publications, Inc. All Rights Reserved. SAGE knowledge

disorder and psychological trauma . Journal of Counseling and Clinical Psychology , 65,
1047–1056. doi:http://dx.doi.org/10.1037/0022-006X.65.6.1047

World Health Organization. (2013). Guidelines for the management of conditions that
are specifically related to stress . Geneva, Switzerland: Author.

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and Reprocessing Therapy

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