EmpathicPivot

Shapiro (2018) presents the notion of “dysfunctionally stored” (p. 4) traumatic memories that have not been properly or “adaptively processed” (p. 4) so still have some of the physiological responses, feelings and thoughts attached to them, as happened at the time of the event. According to Shapiro (2018) it is these memories—such as the “nightmares, flashbacks, intrusive thoughts, and high levels of arousal” (p. 4) of PTSD—that are identified and adaptively processed to neutralise their impact.

EMDR requires the person to use directed eye movements while holding traumatic memories in mind to reduce their impact (Shapiro, 2018).

The Adaptive Information Processing (AIP) model attempts to explain the rapid change seen in memory reprocessing in EMDR (Hase & Brisch, 2022). AIP explains how memories, either normal and adaptive or traumatic and maladaptive, are stored in the brain (Hill, 2020). 

In AIP the memories of traumatic events that happened in a person’s life cause pathologies that affect emotions, thoughts and behaviour as well as identity (Shapiro, 2018). The person reacts to present-day triggers that elicit emotions, thoughts and behaviours that are linked to the earlier life event (Shapiro, 2018). AIP is based on a “neurobiological model of information processing and memory creation” (Hill, 2020, p. 320) which is still under “clinical investigation” (Hill, 2020, p. 320).

Shapiro (2018) acknowledges the compatibility of EMDR with “most of the known psychological orientations” (p. 19) in terms of both theory and some interventions, including the psychodynamic model with childhood memories, behaviour therapy with dysfunctional responses and behaviours and cognitive therapy with adaptive and maladaptive thinking.

EMDR serves a population of people that have been affected by trauma through strengths-based, person-centred and trauma informed approaches with a strong emphasis on the therapeutic relationship (Hase & Brisch, 2022).

In their review of EMDR, Navarro et al. (2018) outline the eight phases of EMDR as:

Phase 1 – reviewing the person’s history including identifying traumatic events for treatment and evaluating their link to current mood, thoughts or behaviours;

Phase 2 – testing of bilateral stimulation – such as eye movement;

Phase 3 – “accessing the traumatic memory” (p. 103), identifying an image and negative cognition associated with it, identifying an alternative positive cognition, identifying the emotion and level of physical discomfort when recalling the trauma and negative cognition.

Phase 4 – desensitisation – recalling the traumatic image, negative cognition, emotion and physical discomfort at the same time and beginning directed eye movements until “the traumatic image no longer causes discomfort” (p. 104);

Phase 5 – linking the positive cognition with the traumatic image through bilateral stimulation;

Phase 6 – scanning the body to establish if any negative feeling or sensations arise when recalling the traumatic image;

Phase 7 – debriefing the person on the possibility of post-session thoughts, memories or dreams that might emerge and what actions to take;

Phase 8 – re-evaluating the work from the last session to see if the memory has been adaptively processed.

To act as a facilitator who guides the client through the processes by maintaining adherence to procedures, developing a therapeutic alliance, strengthening the person’s positive internal resources, and prompting the client’s insights and associations during bilateral stimulation (Shapiro, 2018).

To be an active participant who reports their internal experiences and allows the associated thoughts, images, and emotions to emerge, without trying to control them, during bilateral stimulation (Shapiro, 2018).

Evidence exists for EMDR being used for treatment of PTSD including for children, veterans, first responders and refugees, and there is also some evidence for its use for vicarious trauma such as for clinicians, acute trauma, cultural-based intergenerational trauma of disadvantaged peoples, dissociation, generalised anxiety, phobias, OCD, panic attacks, agoraphobia, body dysmorphia, eating disorders, depression, couples therapy, relationships, loneliness and BPD (Hall, 2020).

Improved self-concept, greater social functioning, reduced depression, reduced intrusive PTSD symptoms and reduced anxiety (Navarro, 2018).

Is one of only two therapeutic models that have evidence-based research to support positive outcomes for the treatment of PTSD (Navarro, 2018). EMDR is found to be faster than trauma centred CBT or exposure therapy with lower drop-out rates amongst participants in trials (Navarro, 2018).

The protocol for EMDR is highly prescriptive, involves specialised training, and is a “parsimonious and painstakingly detailed procedure” (Navarro, 2018, p. 111).

EMDR “is a complex approach, with a variety of procedures and protocols that are deemed necessary for full effectiveness” (Shapiro, 2018, p. 24).

Hase, M., & Brisch, K. H. (2022). The therapeutic relationship in EMDR therapy. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.835470

Hill, M. (2020). Adaptive Information Processing theory: Origins, principles, applications, and evidence. Journal of Evidence-based Social Work, 17(3), 317–331. https://doi.org/10.1080/26408066.2020.1748155

Navarro, P., Landin-Romero, R., Guardiola-Wanden-Berghe, R., Moreno-Alcázar, A., Valiente-Gómez, A., Lupo, W., García, F., Fernández, I., Pérez, V., & Amann, B. (2018). 25 years of Eye Movement Desensitization and Reprocessing (EMDR): The EMDR therapy protocol, hypotheses of its mechanism of action and a systematic review of its efficacy in the treatment of post-traumatic stress disorder. Revista de Psiquiatría y Salud Mental, 11(2), 101-114. https://doi.org/10.1016/j.rpsm.2015.12.002

Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) therapy (3^rd ed.). Guilford Publications.