Article

EMDR Works . . . But How? Recent Progress in the Search for Treatment Mechanisms

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Abstract

Eye movement desensitization and reprocessing (EMDR) is a highly scrutinized but efficacious psychotherapy commonly used in the treatment of posttraumatic stress disorder. Despite much theorizing and speculation, EMDR's mechanism of action remains unspecified. This article reviews several accounts of how EMDR works to reduce symptoms and/or aid memory reprocessing, including disruption of a traumatic recollection in working memory, increased psychological distance from the trauma, enhanced communication between brain hemispheres, and psychophysiological changes associated with relaxation or evocation of a rapid-eye-movement-like brain state. Several gaps in knowledge are also identified: The working memory account has received considerable support but has yet to be evaluated using clinical samples. How psychological distancing translates into symptomatic improvement is unclear. Psychophysiological effects of EMDR are well demonstrated but leave open the question of whether they constitute a treatment mechanism or an outcome of memory processing. Multiple mechanisms may work to produce treatment gains in EMDR; hence, an integrative model may be necessary to capture its myriad effects.

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... It does not address other proposed mechanisms such as psychological distancing, working memory, and inter-hemispheric communication. For a review of these and other nonbiological theories, see Gunter and Bodner (2009). Dyck (1993) examined the underlying mechanisms of eye movement desensitization (EMD), the original prototype of EMDR, suggesting that PTSD and EMD be viewed from the perspective of a conditioning model. ...
... The working memory account and IHC account are not neurobiological theories and thus are beyond the purview of this article. See Gunter and Bodner (2009) for a summary of this research. This article reviews only Gunter and Bodner's (2008) fi ndings regarding the investigatory/orienting refl ex. ...
... Gunter and Bodner interpret their fi nding of increased arousal as an indicative inconsistency with the OR. They note in this and another publication (Gunter & Bodner, 2009) that the bulk of the evidence to date suggests that eye movements are associated with a de-arousal/parasympathetic response during EMDR sessions and question whether the discrepancy in their fi nding may be due to the populations of study or the procedural or methodological differences between studies (i.e., the timing of arousal measurements). With respect to procedural diff erences, it should be noted that arousal measurements patterns of REM sleep. ...
Article
Historically, mechanisms of action have often been difficult to ascertain. Thus far, the definitive discovery of eye movement desensitization and reprocessing (EMDR)'s underlying mechanisms has been equally elusive. We review the neurobiological studies of EMDR, as well as the theoretically driven speculative models that have been posited to date. The speculative theoretically driven models are reviewed historically to illustrate their growth in neurobiological complexity and specificity. Alternatively, the neurobiological studies of EMDR are reviewed with regard to their object of investigation and categorized as follows: findings before and after EMDR therapy (neuroimaging and psychophysiological studies) and findings during the EMDR set (psychophysiological, neuroimaging, and qEEG studies).
... Indeed, not only horizontal eye-movements, but any dual-task that induces sufficient WM load can reduce the negative experience elicited by the memory [7,8]. However, how immediate effects of eye movements cascade into long-term effects and eventually into symptom reduction is still an empirical question [9,10]. It is possible that, due to the eye-movements, the memory is reappraised [4] or that the memory is reconsolidated in a degraded fashion into long-term memory [5]. ...
... How these immediate effects become long-term effects is still a question that needs to be answered [9,10]. A possibility that we considered in the current study is that a degraded memory needs to be reconsolidated into long-term memory [5] and that experiencing acute stress would improve reconsolidation of that particular memory [24,25]. ...
Article
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Combining recall of an emotional memory with simultaneous horizontal eye movements (i.e., Recall + EM) reduces memory aversiveness. However, the long-term persistence of this effect is inconsistent across studies. Given that stress may aid in the consolidation of memories, we examined whether acute stress can boost the long-term effects of degraded memories. To test this, participants recalled two negative memories, which were assigned to a Recall + EM or Recall Only condition. Before and after each intervention they rated memory aversiveness (i.e., immediate effects) followed by a stress-induction or control procedure. After a 24h-period, participants rated each memory again (i.e., long-term effects). We found that Recall + EM produces immediate effects but that these effects dissolve over time. Moreover, acute stress did not boost potential long-term effects of Recall + EM. Degraded memories were not retained better by applying stress. We discuss these results and how long-term effectiveness may still be achieved.
... Rather notably, the scientific community has been divided as to the absence of an empirically validated model explaining the effectiveness of EMDR (Coubard, 2016;Gunter & Bodner, 2009;Perkins & Rouanzoin, 2002;Rodenburg, Benjamin, de Roos, Meijer, & Stams, 2009). Several hypotheses have been proposed to explain the treatment mechanism underlying EMDR (see Coubard, 2016). ...
... Stickgold (2007), for example, has suggested that EMDR may activate a neurobiological state similar to REM sleep. Others have suggested a working-memory account of EMDR that posits that unpleasant memories become less vivid and less emotional when eye movements use up the brain's resources for processing visuospatial information (Gunter & Bodner, 2009;Kavanagh, Freese, Andrade, & May, 2001). Because an understanding of EMDR's treatment mechanism is lacking, additional research is needed. ...
... Rather notably, the scientific community has been divided as to the absence of an empirically validated model explaining the effectiveness of EMDR (Coubard, 2016;Gunter & Bodner, 2009;Perkins & Rouanzoin, 2002;Rodenburg, Benjamin, de Roos, Meijer, & Stams, 2009). Several hypotheses have been proposed to explain the treatment mechanism underlying EMDR (see Coubard, 2016). ...
... Stickgold (2007), for example, has suggested that EMDR may activate a neurobiological state similar to REM sleep. Others have suggested a working-memory account of EMDR that posits that unpleasant memories become less vivid and less emotional when eye movements use up the brain's resources for processing visuospatial information (Gunter & Bodner, 2009;Kavanagh, Freese, Andrade, & May, 2001). Because an understanding of EMDR's treatment mechanism is lacking, additional research is needed. ...
Chapter
The chapter discusses the application of various treatment models under the cognitive-behavioral therapy umbrella to treat trauma. The chapter presents an overview of the key theoretical assumptions, treatment process, practice strategies, and a review of the research behind each of the models addressed.
... This has been predominantly research with non-clinical populations, justified in that normal processes are being investigated with the intention of then extrapolating this to how these memory processes might explain therapeutic changes in clinical PTSD. There are a number of accounts of how EMs may ameliorate negative reactions to memories using healthy volunteers (see Gunter, 2009 for a review). This present review will discuss three accounts that currently seem to have the most research to support them: the orienting response hypothesis, the increased interhemispheric interaction account, and the working memory account. ...
... As clinicians we should be able to justify the techniques we use, and although we have begun to develop an understanding as to why EMs may be an important component of EMDR, further research is needed. It should be noted that it is not unusual to be uncertain about how any psychotherapy works, not just EMDR (Gunter, 2009). Whilst it may feel uncomfortable to some clinicians to practise EMDR without knowing exactly how it works, the growing research base will aid us in our search for answers. ...
Article
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Background: Controversy continues to exist regarding how EMDR works and whether its mechanisms differ from those at work in standard exposure techniques. Aims: To investigate first whether eye movement bilateral stimulation is an essential component of EMDR and, second, the current status of its theoretical basis. Method: A systematic search for relevant articles was conducted in databases using standard methodology. Results: Clinical research evidence is contradictory as to how essential EMs are in PTSD treatment. More positive support is provided by analogue studies. With regards to potential theoretical support, some evidence was found suggesting bilateral stimulation first increases access to episodic memories; and second that it could act on components of working memory which makes focusing on the traumatic memories less unpleasant and thereby improves access to these memories. Conclusions: The results suggest support for the contention that EMs are essential to this therapy and that a theoretical rationale exists for their use. Choice of EMDR over trauma-focused CBT should therefore remain a matter of patient choice and clinician expertise; it is suggested, however, that EMs may be more effective at reducing distress, and thereby allow other components of treatment to take place.
... How WM taxation and changes in vividness and/or unpleasantness cascade into changes in PTSD symptoms is still a matter of debate (e.g., Gunter & Bodner, 2009). Theoretically, dual-tasks have the potential to affect the core symptom of intrusive memories. ...
... To conclude, because the path to changes in (analogue) PTSD symptoms has been relatively unexplored in EMDR research (e.g., Gunter & Bodner, 2009;Maxfield, 2008), we examined in a series of experiments whether dual-task interventions would reduce involuntary intrusive memories. The results are inconclusive: Prolonged dual-task interventions strongly affected intrusive memories in experiment 2, but there was only substantial evidence for no effect in experiment 3. We made a first step in relating changes in voluntary hotspot vividness/ unpleasantness and involuntary intrusive memories, which were consistently not related. ...
Article
Patients with post-traumatic stress disorder frequently and involuntarily experience intrusions, which are strongly linked to the trauma hotspot. Voluntary memory characteristics (i.e., vividness and unpleasantness) of this hotspot can be reduced by performing a dual-task, such as making horizontal eye movements, which is frequently used in Eye Movement Desensitization and Reprocessing. We tested whether such dual-task interventions would also reduce involuntary memory (i.e., intrusions). Moreover, we examined if changes in hotspot vividness and unpleasantness predicted intrusion frequency. Additionally, we examined whether the effects were dependent on dual-task modality. We tested this in three experiments. Participants watched a trauma film and performed one of the interventions 10-min post-film (1) Recall + Eye movements, (2) Recall + Counting, or (3) No-Task Control. Before and after the intervention, participants rated the hotspot vividness and unpleasantness. They recorded intrusive memories about the film in a diary for a week. Unexpectedly, we found that hotspot vividness and unpleasantness ratings were not affected by the intervention. However, the prolonged (experiment 2), but not standard (experiment 1), dual-task interventions resulted in a lower number of intrusions, regardless of modality. However, this effect was not replicated in experiment 3. We discuss potential explanations and present suggestions for future research.
... The simultaneous execution of these dual attention tasks is thought to impede recall of the emotional memory and result in lowered vividness and emotionality of the memory after the intervention (van den Hout . These changes are hypothesized to set off a cascade of events that eventually result in PTSD symptom reduction (Gunter & Bodner, 2009). Experimental evidence supports this dual attention explanation for changes in memory vividness and emotionality and shows that larger effects are related to tasks that load more on WM compared low loading tasks (Maxfield, Melnyk, & Hayman, 2008;van Schie, van Veen, Klugkist, Engelhard, & van den Hout, 2016;van den Hout et al., 2011). ...
... Lab analogue studies frequently employ variables that are a reflection of the process of change (e.g., vividness and emotionality), while clinical studies use measures that reflect clinically relevant outcomes (e.g., PTSD diagnosis, symptom reduction; seeLee & Cuijpers, 2013; Cuijpers, van Veen, Sijbrandij, Yoder, & Cristea, submitted). It is possible that changes in process variables are not directly or causally linked to changes in clinical outcome measures or clinical analogue measures (e.g., van Schie, Kessler, van den Hout,& Engelhard, under review), or that there are multiple mechanisms of action in EMDR (e.g.,Gunter & Bodner, 2009;Maxfield, 2008). Thus, higher WM taxation and linked changes in vividness and/or emotionality may not result in symptom change per se. ...
Article
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Background and objective: A recent, large randomized controlled trial employing different forms of eye (non-)movements in eye movement desensitization and reprocessing (EMDR) showed that fixating the eyes either on a therapist's moving or non-moving hand led to equal reductions in symptoms of post-traumatic stress disorder (PTSD). However, numerous EMDR lab analogue studies found that eye movements produce larger memory effects than eyes stationary. These beneficial effects are typically explained by differences in working memory (WM) taxation. We tested the degree of WM taxation of several eye (non-)movement conditions used in the clinical trial. Methods: All participants (N = 40) performed: (1) eyes moving by following the experimenter's moving finger, (2) eyes fixed on the experimenter's stationary finger, (3) eyes closed, or (4) looking unfocused into the room. Simultaneously they performed a simple reaction time task. Reaction times are an objective index of the extent to which different dual attention tasks tax WM. Results: Eyes moving is more taxing than eyes fixed, while eyes fixed did not differ from eyes unfocused. All conditions were more taxing than eyes closed. Limitations: We studied WM taxation in a laboratory setting; no clinical interventions were applied. Conclusions: In line with previous lab studies, making eye movements was more taxing than eyes fixed. We discuss why this effect was not observed for reductions in PTSD symptoms in the clinical trial (e.g., differences in dependent variables, sample population, and intervention duration). For more comprehensive future insights, we recommend integration of mechanistically focused lab analogue studies and patient-oriented clinical studies.
... 11 Under this hypothesis, it is not important which sensory channels incentivize communication between the left and right hemispheres but that there is an alternating and rhythmic left-right stimulus. 12 Left-right beeping, tactile simulation, or visual stimuli can potentially create interhemispheric communication. 9 The second hypothesis is that EMDR places a stress on working memory during recall experiences. ...
... While the capacity of long-term memory is extensive, that of working memory is limited. 12 By taxing working memory, EMDR inhibits the negative effects of unpleasant memories on individuals with PTSD. 14 ...
Article
DEPARTMENT EDITORS Julie P. Gentile, MD Professor and Chair, Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton, Ohio Allison E. Cowan, MD Associate Professor, Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton, Ohio EDITORS' NOTE The patient cases presented in Psychotherapy Rounds are composite cases written to illustrate certain diagnostic characteristics and to instruct on treatment techniques. The composite cases are not real patients in treatment. Any resemblance to a real patient is purely coincidental. ABSTRACT Eye movement desensitization and reprocessing (EMDR) is a specific treatment modality that utilizes bilateral stimulation to help individuals who have experienced trauma. This stimulation can occur in a variety of forms, including left-right eye movements, tapping on the knees, headphones, or handheld buzzers, known as tappers. This type of psychotherapy allows the individuals to redefine their self-assessment and responses to a given traumatic event in eight defined steps. While EMDR is relatively new type of psychotherapy, existing literature has demonstrated positive results using this form of therapy when treating patients with post-traumatic stress disorder (PTSD) by utilizing eye movements to detract from negative conceptualizations as a response to a specific trigger, while reaffirming positive self-assessments. Research indicates that EMDR could be a promising treatment for mental health issues other than PTSD, including bipolar disorder, substance use disorders, and depressive disorders. In this article, the eight fundamental processes of EMDR are illustrated through a composite case vignette and examined alongside relevant research regarding its efficacy in treating PTSD.
... In the meta-analysis of Bisson, Ehlers, Matthews, Pilling, Richards, and Turner (2007), several studies showed the effectiveness of EMDR in reducing the symptoms of PTSD. EMDR turns out to be as effective as cognitive behavioral therapy (CBT) for patients with a diagnosis of PTSD (Bradley, Greene, Russ, Dutra & Westen, 2005;Gunter & Bodner, 2009;van den Hout et al. 2010b). In a review of meta-analytic findings, Olatunji, Cisler and Deacon (2010) report that rates of change in diagnostic status (i.e., no longer meeting criteria for PTSD) across treatment conditions were better for EMDR (60%), exposure therapy (53%) and CBT (46%) than for wait-list control (14%) and supportive control (36%).The multidisciplinary guideline for anxiety disorders of the Dutch Mental Health Care organization (GGZ, 2003) describes both EMDR and CBT as 'treatments of choice for PTSD.' ...
... Subsequently, a reconsolidation process takes place that involves once more storing the memory that is reduced in vividness and emotionality in long-term memory. When someone recalls this reconsolidated memory at a later time, this memory will be less aversive and vivid than before (Suzuki et al., 2004;Gunter & Bodner, 2009;van den Hout et al., 2010b). The current study is theoretically based on the working memory hypothesis. ...
... Rather notably, the scientific community has been divided as to the absence of an empirically validated model explaining the effectiveness of EMDR (Coubard, 2016;Gunter & Bodner, 2009;Perkins & Rouanzoin, 2002;Rodenburg, Benjamin, de Roos, Meijer, & Stams, 2009). Several hypotheses have been proposed to explain the treatment mechanism underlying EMDR (see Coubard, 2016). ...
... Stickgold (2007), for example, has suggested that EMDR may activate a neurobiological state similar to REM sleep. Others have suggested a working-memory account of EMDR that posits that unpleasant memories become less vivid and less emotional when eye movements use up the brain's resources for processing visuospatial information (Gunter & Bodner, 2009;Kavanagh, Freese, Andrade, & May, 2001). Because an understanding of EMDR's treatment mechanism is lacking, additional research is needed. ...
Chapter
Cognitive-behavioral therapy (CBT) encompasses various psychotherapeutic approaches that are rooted in the fundamental principle that a person’s thinking is the prime determinant of emotional and behavioral responses to life situations. The historical influences of CBT can be found in behavioral approaches such as John Watson’s classical conditioning and B. F. Skinner’s operant conditioning, with their focus on antecedents and reinforcers of behavior and an empirical approach to evaluating behavior, and Albert Bandura’s social learning theory and social cognitive theory, with a focus on observational or vicarious learning. Other influences that shaped the philosophical foundations of CBT include Greek and Roman Stoicism and the Eastern philosophies of Buddhism and Taoism, with their emphasis on reason, logic, and acceptance. Nonetheless, CBT as an organized system of psychotherapy, which originated during the 1950s and 1960s with the works of Albert Ellis’s rational-emotive behavior therapy (REBT) and Aaron Beck’s cognitive therapy (CT). Both of these models stress that cognitions, in the form of judgments, meanings, attributions, and assumptions tied to life events, are the primary factors that influence how individuals respond to environmental cues. The CBT emphasis on internal, private, conscious thought represents a departure from psychoanalytic theory, which emphasizes unconscious motivation of behavior, as well as from behaviorism, with its focus on external observable and measurable behaviors. Although there are differences among the various cognitive-behavioral approaches, there are fundamental similarities that include a focus on conscious thinking; the importance laid on information processing and the role that cognitions play in how we process information from our environment and respond to situations; and the assumption that, by changing irrational or maladaptive thoughts in a more rational, logical, realistic, and balanced perspective, people are capable of increasing healthy functioning. CBT is a present-oriented, relatively brief, structured, problem-focused, empirically driven form of psychotherapy. In CBT both the clinician and the client take an active approach in addressing the client’s problem. In a nutshell, the therapeutic work revolves around identifying maladaptive thinking; assessing the validity and functionality of such thoughts by evaluating available evidence for or against the thoughts; and formulating a more rational, logical, realistic, and balanced approach to interpreting one’s reality. In the late 20th and early 21st centuries various models of CBT have been applied to a wide range of mental health problems, substance abuse issues, and other disorders. More importantly, CBT has generated voluminous research studies, making it one of the most empirically based systems of psychotherapy.
... Après être intervenu comme facilitateur lors de nombreuses formations EMDR au cours des dernières 15 années, j'ai développé une manière plus conviviale de présenter les MO qui augmente la probabilité que les stagiaires continueront à les utiliser dans leur pratique.@BULLET Cela permet d'établir la distance psychologique thérapeutique par rapport au souvenir (Schubert,Lee & Drummond, 2011) @BULLET Cela maximise les effets sur la mémoire de travail (Maxfield, Melnyk & Hayman, 2008 ; van den) @BULLET Cela active la réponse d'orientation (MacCulloch & Feldman, 1996) @BULLET Cela augmente la flexibilité cognitive et attentionnelle (Kuiken, Bears,Miall & Smith, 2002) @BULLET Les MO sont associés à la diminution de l'intensité de l'imagerie et des affects (Gunter & Bodner, 2009 ;Maxfield, et al., 2008) @BULLET Cela favorise une communication hémisphérique accrue (Propper & Christman, 2008) @BULLET Cela améliore le rappel de la mémoire épisodique (Christman, Garvey,Propper & Phaneuf, 2003) @BULLET En raison de la connexion étroite avec les mécanismes attentionnels (Corbetta et al., 2008 ;Moore & Armstrong, 2003; Pierrot-Deseilligny,client, car ce n'est qu'à des vitesses plus rapides que les MO de poursuite ressemblent à des MO saccadiques, ce qui correspond à la découverte première – pendant cette balade dans le parc – des MO saccadiques lors desquels les yeux font des bonds d'un côté à l'autre. De plus, il existe certaines preuves selon lesquelles le rappel amélioré des souvenirs épisodiques se produit davantage avec les saccades qu'avec les MO lents (Christman et al., 2003).et ...
Article
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Les Questions & réponses cliniques sont une rubrique régulière du Journal of EMDR Practice and Research dans laquelle des cliniciens chevronnés répondent à la question posée par un lecteur face à une difficulté clinique. Dans ce numéro, la réponse provient d'Elan Shapiro, un psychologue près de Haïfa en Israël, facilitateur de l'EMDR Institute et superviseur EMDR Europe accrédité. Les lecteurs peuvent adresser leurs questions à journal@emdria.org.
... The positive results are encouraging and are consistent with what I have observed in the use of EMDR with my clients. While the authors explored the relevance of their findings to the working memory account of how EMDR works (Andrade, Kavanagh, & Baddeley, 1997;Gunter & Bodner, 2009), my interest lies solely in the clinical relevance of reprocessing flash-forwards within the three-pronged standard protocol of EMDR. ...
Article
“Translating Research Into Practice” is a new regular journal feature in which clinicians share clinical case examples that support, elaborate, or illustrate the results of a specific research study. Each column begins with the abstract of the study, followed by the clinician's description of their own application of standard eye movement desensitization and reprocessing (EMDR) procedures with the population or problem treated in the study. The column is edited by the EMDR Research Foundation with the goal of providing a link between research and practice and making research findings relevant in therapists' day-to-day practices. In this issue's column, Lisa Bellecci-St. Romain references Engelhard et al.'s (2011) study examining the impact of eye movements on recurrent, intrusive visual images about potential future catastrophes—“flash-forwards.” Illustrating the findings by Engelhard et al., Bellecci-St. Romain describes the successful use of the EMDR standard protocol in two cases—a woman fearful of returning to work even after past memories are cleared and a young man in early sobriety whose reprocessing of the past is interrupted by concerns of an imminent court appearance. The case examples are followed with a discussion of the importance of recognizing and targeting flash-forwards as present triggers in the three-pronged EMDR standard protocol.
... Processes identified in EMDR include mindfulness, somatic awareness, free association, cognitive restructuring, and conditioning. These processes may interact to create the positive effects achieved with EMDR (Gunter & Bodner, 2009;Solomon & Shapiro, 2008). However, the mechanism of change in EMDR that has received the most attention in the scientific literature is eye movements and other bilateral stimulation (i.e., tones and tapping) that are used as a dual-attention task within the procedure. ...
Article
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The purpose of this study was to determine the effectiveness of EMDR in reducing PTSD symptoms, anxiety and depression.Method Thirty-six women participated in this study; 12 were treated with EMDR, 12 received eclectic psychotherapy, and 12 were assigned to the control group.ResultWomen in the EMDR condition showed significantly reduced PTSD and anxiety compared with those in the eclectic psychotherapy condition. The two psychotherapy approaches led to significantly reduced scores (PTSD, depression, anxiety) after treatment compared to the control group. These effects were maintained at the 6-month follow-up. Finally, effect sizes for the IES and STAI scores were greater for the subjects in the EMDR condition.Conclusion This study met our expectations in the sense that our findings confirm the advantages and the potential of EMDR.
... An a priori decision was made to search only published work and to control for publication bias by a posteriori analysis. Additional studies were identified by manual searches of past meta-analyses (Davidson & Parker, 2001;Rodenburg, Benjamin, de Roos, Meijer, & Stams, 2009) and recent reviews of the role of eye movements in EMDR (Gunter & Bodner, 2009;Smeets, Dijs, Pervan, Engelhard, & van den Hout, 2012). ...
Article
Background and objectives: Eye Movement Desensitisation and Reprocessing (EMDR) is now considered evidence based practice in the treatment of trauma symptoms. Yet in a previous meta-analysis, no significant effect was found for the eye movement component. However methodological issues with this study may have resulted in a type II error. The aim of this meta-analysis was to examine current published studies to test whether eye movements significantly affect the processing of distressing memories. Method: A systematic review of the literature revealed two groups of studies. The first group comprised 15 clinical trials and compared the effects of EMDR therapy with eye movements to those of EMDR without the eye movements. The second group comprised 11 laboratory trials that investigated the effects of eye movements while thinking of a distressing memory versus the same procedure without the eye movements in a non-therapy context. The total number of participants was 849. Results: The effect size for the additive effect of eye movements in EMDR treatment studies was moderate and significant (Cohen's d = 0.41). For the second group of laboratory studies the effect size was large and significant (d = 0.74). The strongest effect size difference was for vividness measures in the non-therapy studies (d = 0.91). The data indicated that treatment fidelity acted as a moderator variable on the effect of eye movements in the therapy studies. Conclusions: Results were discussed in terms of current theories that suggest the processes involved in EMDR are different from other exposure based therapies.
... problem-solving strategies of childhood used in adulthood) to interfere with learning and adaptation. (d) the mechanism of action was not known prior to its clinical use (Lilienfeld, Lynn, & Lohr, 2003 Detailed investigation of these criticisms is beyond the scope of this paper; however, the interested reader is encouraged to review the following articles for more information addressing criticism related to neural mechanism of action: Gunter and Bodner (2009); Maxfield and Hyer (2002); Perkins and Rouanzoin (2002); Schubert and Lee (2009); and Söndergaard and Elofson (2008). In regards to criticism that EMDR is simply a repackaged exposure therapy (Lilienfeld et al., 2003;McNally, 1999), Shapiro (2007) ...
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Fibromyalgia is a syndrome characterized by chronic pain and fatigue. It notably impacts individuals and their families, creates notable opportunity costs for society, and places heavy demands on the medical system. Fibromyalgia has no cure. Its etiology is uncertain but likely biopsychosocial. In a subset of individuals experiencing Fibromyalgia, the experience of one or more traumatic experiences precipitates the onset of symptoms. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for traumatic stress injuries. None of the handful of published accounts of EMDR treatment of Fibromyalgia have utilized the standard evidenced-based, trauma-focused EMDR (TF-EMDR) protocol, opting instead for untested modifications of EMDR related protocols rendering generalization of effects across studies difficult at best. The current study explored whether the use of the TF-EMDR protocol was sufficient to reduce chronic physical and psychological symptoms of Fibromyalgia in three female participants. Standardized symptom measures of post-traumatic stress, depression, pain, and Fibromyalgia-specific symptoms were administered at pre, post, and 3-month follow-up. Results indicated a decrease in symptoms across all standardized symptom measures. Participants’ pain and symptoms of Fibromyalgia decreased, as did depression and trauma symptoms. Other results of treatment included: improved sleep, improved communication with loved ones, and improved sexual functioning. Treatment observations suggest TF-EMDR may help facilitate participants’ ability to: identify their emotions, observe the relationship between emotions and physical sensation, and observe (without trying to change) emotions and physical sensation. Results are promising and support the use of TF-EMDR in the treatment of Fibromyalgia patients with a history of trauma. Keywords: EMDR, Fibromyalgia, chronic pain, trauma, multiple case study
... Along with this, the heart rate and breathing also decreased with the dual attention (Sack et al., 2008, p. 1268). It was also argued that dual tasks of other sorts might be beneficial when dividing attention with distractors requiring sufficient memory to interfere with holding that memory in the mind likening this to resemble other counseling techniques like " detached mindfulness " or " detached processing " (Gunter & Bodner, 2009, p. 164). The concept of eye movements enhancing the retrieval of information from long-term memory followed the hypothesis laid out by Shapiro in the " adaptive information-processing model " (Leeds, A., 2009, p.19). ...
... Après être intervenu comme facilitateur lors de nombreuses formations EMDR au cours des dernières 15 années, j'ai développé une manière plus conviviale de présenter les MO qui augmente la probabilité que les stagiaires continueront à les utiliser dans leur pratique.@BULLET Cela permet d'établir la distance psychologique thérapeutique par rapport au souvenir (Schubert,Lee & Drummond, 2011) @BULLET Cela maximise les effets sur la mémoire de travail (Maxfield, Melnyk & Hayman, 2008 ; van den) @BULLET Cela active la réponse d'orientation (MacCulloch & Feldman, 1996) @BULLET Cela augmente la flexibilité cognitive et attentionnelle (Kuiken, Bears,Miall & Smith, 2002) @BULLET Les MO sont associés à la diminution de l'intensité de l'imagerie et des affects (Gunter & Bodner, 2009 ;Maxfield, et al., 2008) @BULLET Cela favorise une communication hémisphérique accrue (Propper & Christman, 2008) @BULLET Cela améliore le rappel de la mémoire épisodique (Christman, Garvey,Propper & Phaneuf, 2003) @BULLET En raison de la connexion étroite avec les mécanismes attentionnels (Corbetta et al., 2008 ;Moore & Armstrong, 2003; Pierrot-Deseilligny,client, car ce n'est qu'à des vitesses plus rapides que les MO de poursuite ressemblent à des MO saccadiques, ce qui correspond à la découverte première – pendant cette balade dans le parc – des MO saccadiques lors desquels les yeux font des bonds d'un côté à l'autre. De plus, il existe certaines preuves selon lesquelles le rappel amélioré des souvenirs épisodiques se produit davantage avec les saccades qu'avec les MO lents (Christman et al., 2003).et ...
Article
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Note de l'Editeur: les Questions & Réponses cliniques sont une rubrique régulière de la revue. Des cliniciens chevronnés y répondent à la question posée par un lecteur face à une difficulté clinique. Dans ce numéro, les réponses viennent de deux cliniciens qui sont superviseurs EMDR certifiés: Farnsworth Lobenstine, travailleur social clinicien qui exerce en libéral à Amherst, Massachusetts, et Elan Shapiro, psychologue libéral de la région de Haïfa, en Israël. Les lecteurs peuvent adresser leurs questions à journal@emdria.org.
... Propper and Christman (2008) suggest that an increased interaction between brain hemispheres is the underlying mechanism for the benefits of eye movements in EMDR. According to this account, the increased interaction between the hemispheres enhances retrieval of (trauma) memories and associated content from long-term memory, which facilitates reprocessing (see also Gunter and Bodner, 2009). This type of processing is referred to by Korn and Leeds (2002) in their description of RDI as " new functional associations [that] bring additional ego-strengthening material into consciousness " (p. ...
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Resource development and installation (RDI) is an eye movement desensitization and reprocessing (EMDR)-related procedure developed to strengthen positive associations in positive and resourceful memories (Korn & Leeds, 2002). This study tested the assumption that bilateral stimulation (horizontal eye movements [EM]) in RDI “appears to lead to spontaneous, rapid increases in affective intensity . . . and to rich, emotionally vivid associations“ (Korn & Leeds, p. 1469). This study also tested whether eye movement effects could be better accounted for by working memory or by interhemispheric interaction theory. Fifty-three undergraduate students each recalled three memories of pride, perseverance, and self-confidence. They provided pretest and posttest ratings of each memory for vividness, pleasantness, and experienced strength of the positive quality, before and after performing three simultaneous tasks during recall: horizontal EM, vertical EM, and recall only. Results were fully in line with working memory predictions, with significant decreases for all variables following both eye movement tasks. There was no support for the interhemispheric hypothesis. It is concluded that the effectiveness of bilateral stimulation in RDI is questionable. Clinical implications are discussed.
... • Because most of EMDR research is based on the use of EMs (Shapiro, 2001) • For the possible links with REM (Stickgold, 2002 (Kuiken, Bears, Miall, & Smith, 2002) • For the diminished imagery and affect vividness associated with EMs (Gunter & Bodner, 2009;Maxfield, et al., 2008) • For increased hemispheric communication (Propper & Christman, 2008) ...
Article
The Clinical column is a regular Journal of EMDR Practice and Research feature in which master clinicians answer a question posed by a reader who is requesting assistance with clinical challenges. In this issue's column, the response is written by Elan Shapiro, who is a psychologist near Haifa, Israel; an EMDR institute facilitator; and an approved EMDR Europe consultant. Readers can send questions for future issues to journal@emdria.org.
... An a priori decision was made to search only published work and to control for publication bias by a posteriori analysis. Additional studies were identified by manual searches of past meta-analyses (Davidson & Parker, 2001;Rodenburg, Benjamin, de Roos, Meijer, & Stams, 2009) and recent reviews of the role of eye movements in EMDR (Gunter & Bodner, 2009;Smeets, Dijs, Pervan, Engelhard, & van den Hout, 2012). ...
Article
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The processes that underlie the effectiveness of eye movement desensitization and reprocessing (EMDR) are examined by evaluating the procedural differences between it and exposure therapy. Major factors include the degree of emphasis placed on reliving versus distancing in the therapies and the degree to which clients are encouraged to focus on direct trauma experiences versus experiences associated with the trauma. Research results indicate that, unlike traditional imaginal exposure, reliving responses in EMDR did not correlate with symptom improvement. Instead, consistent with an information processing model, the degree of distancing in EMDR was significantly associated with improvement. A case study is described to highlight these methodological divergences in the respective therapies relating to reliving. Finally, the research regarding the possible sources of the distancing response within EMDR was examined. The results indicate that the distancing process was more likely to be an effect produced by eye movements than by any therapist instructions. Theoretical and research evaluations indicate that the mechanisms underlying EMDR and traditional exposure therapy are different.
... In the first case, the patient may have habituated to the intrusive images of her first birth experience, possibly serving a similar function to that postulated for prolonged exposure in CBT or to 'detached processing' in EMDR -enabling traumatic images to be observed from a detached perspective. 19 However, it remains unclear as to the other post-traumatic symptomatology; she is described as remaining anxious and the other symptom clusters are not mentioned. In the second case, delivery was successful and the woman was clearly able to manage her anxiety; however, the techniques described seem to be more straightforward anxiety management strategies rather than addressing the wide-ranging post-traumatic symptoms. ...
... Processes identified in EMDR include mindfulness, somatic awareness, free association, cognitive restructuring, and conditioning. These processes may interact to create the positive effects achieved through EMDR (Gunter & Bodner, 2009;Solomon & Shapiro, 2008). However, the mechanism of change in EMDR that has received most attention in the scientific literature is the eye movements (EMs) and other bilateral stimulation (i.e., tones and tapping) that are used as a dual-attention task within the procedure. ...
Article
This study aimed to investigate the psychophysiological correlates and the effectiveness of different dual-attention tasks used during eye movement desensitization and reprocessing (EMDR). Sixty-two non-clinical participants with negative autobiographical memories received a single session of EMDR without eye movements, or EMDR that included eye movements of either varied or fixed rate of speed. Subjective units of distress and vividness of the memory were recorded at pre-treatment, post-treatment, and 1 week follow-up. EMDR-with eye movements led to greater reduction in distress than EMDR-without eye movements. Heart rate decreased significantly when eye movements began; skin conductance decreased during eye movement sets; heart rate variability and respiration rate increased significantly as eye movements continued; and orienting responses were more frequent in the eye movement than no-eye movement condition at the start of exposure. Findings indicate that the eye movement component in EMDR is beneficial, and is coupled with distinct psychophysiological changes that may aid in processing negative memories.
... It has been suggested that it is the exposure portion of the treatment that works to improve children's symptoms rather than the rapid eye movements themselves. 73 ...
Article
Millions of children and adolescents each year are exposed to potentially traumatic events (PTEs), placing them at risk for posttraumatic stress (PTS) disorder symptoms. Medical providers play an important role in the identification and treatment of PTS, as they are typically the initial point of contact for families in the wake of a PTE or during a PTE if it is medically related (eg, injury/illness). This paper offers a review of the literature focused on clinical characteristics of PTS, the assessment and diagnosis of PTS, and current effective treatments for PTS in school-age children and adolescents. The clinical presentation of PTS is often complex as symptoms may closely resemble other internalizing and externalizing disorders. A number of screening and evaluation tools are available for medical providers to assist them in the accurate diagnosis of PTS. Treatment options are available for youth at minimal risk of PTS as well as for those with more intensive needs. Additional training regarding trauma-informed medical care may benefit medical providers. By taking a trauma-informed approach, rooted in a solid understanding of the clinical presentation of PTS in children and adolescents, medical providers can ensure PTS does not go undetected, minimize the traumatic aspects of medical care, and better promote health and well-being.
... The dual attention task is not used in any other treatment for any other disorder and it first emerged from anecdotal experience of its original developer, not basic research. Several hypotheses for the mechanism underlying dual attention tasks have been explored including respondent conditioning (i.e., memory paired with lower arousal resulting from eye movements), mindfulness-like distancing and free association, orientating to trauma content without avoidance, enhancing retrieval of episodic memory by increasing interhemispheric interaction, and reducing vividness of trauma content due to taxing working memory (Gunter & Bodner, 2009;Jeffries & Davis, 2013). Dismantling studies demonstrate that neither the dual attention tasks (e.g., eye movements) nor cognitive elements contribute to outcome (Cahill, Carrigan, & Frueh, 1999;Cusack & Spates, 1999). ...
Chapter
While effective treatments for PTSD exist, many people suffering with the disorder do not access them. In an effort to provide direction for the field, the current chapter surveys the landscape of treatment options, highlights the empirical support of these treatments, and then moves on to discuss issues in implementation of evidence-based PTSD treatment. Attention is focused on the interventions with the most evidence of efficacy, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). The Consolidated Framework for Implementation Research (CFIR) is presented as a context to understand the current state of PE and CPT implementation. In particular, findings from the PE and CPT roll-outs within the U.S. Veterans Health Administration are reviewed from the perspective of CFIR. Additionally, current research directions are reviewed that may improve implementation such as treatment innovations (e.g., massing exposure sessions and using virtual reality) and the emerging emphasis on multidisciplinary psychopathology research (e.g., Research Domain Criteria). Overall, this chapter is optimistic on the expanded utilization of evidence-based PTSD treatment; however, the field must embrace a nuanced view of implementation to bridge the science-practice gap.
... Over the past years, several hypotheses have been proposed (Stickgold, 2002;Gunter and Bodner, 2009;Bergmann, 2010) although only few studies have directly explored the neuronal mechanisms associated with the EMDR treatment. From a functional perspective, EEG and fMRI studies performed during EMDR treatment indicated higher activity in prefrontal structures including the vmPFC (Richardson et al., 2009;Pagani et al., 2012), which is in line with the previously described prefrontal abnormalities in PTSD patients (Hughes and Shin, 2011). ...
Article
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Posttraumatic stress disorder (PTSD) is a highly debilitating and prevalent psychological disorder. It is characterized by highly distressing intrusive trauma memories that are partly explained by fear conditioning. Despite efficient therapeutic approaches, a subset of PTSD patients displays spontaneous recurrence of traumatic memories after successful treatment. The development of animal behavioral models mimicking the individual variability in treatment outcome for PTSD patients represent therefore an important challenge as it allows for the identification of predicting factors of resilience or susceptibility to relapse. However, to date, only few animal behavioral models of long-lasting fear recovery have been developed and their predictive validity has not been tested directly. The objectives of this study were twofold. First we aimed to develop a simple animal behavioral model of long-lasting fear recovery based on auditory cued fear conditioning and extinction learning, which recapitulates the heterogeneity of fear responses observed in PTSD patients after successful treatment. Second we aimed at testing the predictive validity of our behavioral model and used to this purpose a translational approach based (i) on the demonstration of the efficiency of Eye Movement Desensitization and Reprocessing (EMDR) therapy to reduce conditioned fear responses in PTSD patients and (ii) on the implementation in our behavioral model of an electrical bilateral alternating stimulation of the eyelid which mimics the core feature of EMDR. Our data indicate that electrical bilateral alternating stimulation of the eyelid during extinction learning alleviates long-lasting fear recovery of conditioned fear responses and dramatically reduces inter-individual variability. These results demonstrate the face and predictive validity of our animal behavioral model and provide an interesting tool to understand the neurobiological underpinnings of long-lasting fear recovery.
... When a patient retrieves the mental image of the trauma and performs the dual task such as eye movements, the mental image of the trauma is rendered less vivid and emotional since the two tasks (retrieving the memory and performing eye movements) compete for limited working memory capacity (Van den Hout & Engelhard, 2012). This effect is retained upon retrieval (Gunter & Bodner, 2009;Ho & Lee, 2012;Leer et al. 2014). Other explanations that have been put forward to explain how EMDR works include that eye movements induce an orienting response, similar to rapid eye movements (REM) during sleep, which facilitates cortical integration of traumatic memories (e.g. ...
Article
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Background: Previous research indicates a high prevalence of post-traumatic stress disorder (PTSD) and depression among refugees. Eye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD for victims of natural disasters, car accidents or other traumatic events. The current study examined the effect of EMDR on symptoms of PTSD and depression by comparing the treatment with a wait-list control condition in Syrian refugees. Method: Adult refugees located in Kilis Refugee Camp at the Turkish-Syrian border with a PTSD diagnosis were randomly allocated to either EMDR (n = 37) or wait-list control (n = 33) conditions. All participants were assessed with the Mini-International Neuropsychiatric Interview Plus at pre-intervention, at 1 week after finishing the intervention and at 5 weeks after finishing the intervention. The main outcome measures were the Harvard Trauma Questionnaire (HTQ) and the Impact of Event Scale-Revised. The Beck Depression Inventory and the Hopkins Symptoms Checklist-25 were included as secondary outcome measures. The Trial Registration no. is NCT01847742. Results: Mixed-model analyses adjusted for the baseline scores indicated a significant effect of group at post-treatment indicating that the EMDR therapy group showed a significantly larger reduction of PTSD symptoms as assessed with the HTQ. Similar findings were found on the other outcome measures. There was no effect of time or group × time interaction on any measure, showing that the difference between the groups at the post-treatment was maintained to the 5-week follow-up. Conclusions: EMDR may be effective in reducing PTSD and depression symptoms among Syrian refugees with PTSD located in a refugee camp.
... Egy friss áttekintő tanulmány szerint az eljárás biológiai alapjairól szóló hipotézisek bizonyos fokig még mindig spekulatívak, ám ez elmondható általában a pszichoterápiáról (Navarro és mtsai, 2018). Az eljárásban minden bizonynyal több aktív komponens van jelen (Gunter & Bodner, 2009). ...
Article
Theoretical background: Eye Movement Desensitization and Reprocessing (EMDR) has been used as a psychotherapeutic method for 30 years. The procedure developed by Francine Shapiro in the late 1980's in the United States was first widely disputed, but is now an evidence-based method in the treatment of posttraumatic stress disorder (PTSD). Its use is increasing in several other mental disorders as well, such as panic disorder, depression and obsessive-compulsive disorder. In Hungary, the method is not widely used yet. Aim: A presentation of the history, theoretical background, hypotheses referring to the mechanisms of action, structure and effects of EMDR therapy. Method: Systematic review of the literature through keyword search using the name of the method in English-language databases (ISI Web of Science, PubMed, Scopus, PsycINFO). The overview focuses mainly on review articles or on studies of high-quality evidence (e.g. randomized controlled trials). Results: Desensitization, a better access to trauma memories and deeper information-processing take place during EMDR, resulting not only in stress reduction, but also in a more adaptive, higher-level functioning. Neuroimaging reveals that bilateral stimulation, EMDR's specific factor, brings about parasympathetic activation, and induces favorable changes in the functioning of the brain structures affected by PTSD. Several hypotheses (e.g. deconditioning, working memory, REM-hypothesis) have been suggested for EMDR's mechanisms of action. Most probably, the procedure involves several active components. After successful EMDR-therapy, individuals come to terms with the events disrupting their life course, and include them into a unified narrative, which may contribute to the integration of the personality. Conclusions: EMDR is not just a novel combination of well-known and original therapeutic elements, nor a technical adjunct to existing schools of trauma therapy, but an evidence-based, full-fledged, integrative yet independent psychotherapeutic method, with a theoretical model, mechanisms of action and assets of its own.
... Since LF may be linked to variability in sympathetic nervous system, eye movements effect in reducing its activity. These outcomes are consistent with those obtained by previous studies, where a reduction in sympathetic activity [31] and mostly an increase in parasympathetic [32] during pre-RECALL were reported, reinforcing the hypothesis that eye movements are dearousing. Eventually, by adopting NIRS imaging technique to assess modification in PFC oxygenation during submission of EMDR, brain activity was non-invasively examined. ...
Article
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Introduction: Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic treatment resolving emotional distress caused by traumatic events. With EMDR, information processing is facilitated by eye movements (EM) during the recall of a traumatic memory (RECALL). The aim of this study is to investigate the effects of ocular movements of EMDR on the hemodynamics of the prefrontal cortex (PFC). Material and methods: Two groups were recruited: a trial group (wEM) received a complete EMDR treatment, whereas a control group (woEM) received a therapy without EM. PFC hemodynamics was monitored by near-infrared spectroscopy during RECALL and during focusing on the worst image of the trauma (pre-RECALL). The parameters of oxy- (oxy-Hb), and deoxy-hemoglobin (deoxy-Hb) were acquired and analyzed in time domain, by calculating the slope within pre-RECALL and RECALL periods, and in the frequency domain, by calculating the mean power of oxy-Hb and deoxy-Hb in the very-low frequency (VLF, 20-40 mHz) and low frequency (LF, 40-140 mHz) bandwidths. We compared pre-RECALL with RECALL periods within subjects, and pre-RECALL and RECALL parameters of wEM with the corresponding of woEM. Results: An effect of group on mean slope of oxy-Hb and deoxy-Hb in pre-RECALL and oxy-Hb in RECALL periods was observed. wEM showed a lower percentage of positive angular coefficients during pre-RECALL with respect to RECALL, on the opposite of woEM. In the frequency domain, wEM had significant difference in oxy-Hb and deoxy-Hb LF of left hemisphere, whereas woEM showed no difference. Discussion and conclusion: We observed the effect of EM on PFC oxygenation during EMDR, since wEM subjects showed a mean increase of oxy-Hb during RECALL and a decrease during pre-RECALL, as opposed to woEM. Frequency analysis evidenced a reduction of activity of sympathetic nervous system in wEM group during pre-RECALL. Our outcomes revealed a different hemodynamics induced by eye movements in wEM with respect to woEM group.
... Previous systematic reviews and meta-analyses of EMDR have been limited to specific elements and hypotheses or were nonsystematic in nature (Gunter and Bodner, 2009;McGuire et al., 2014). Some examples of this are reviews focusing on the effect of the EMs on the therapy (Jeffries and Davis, 2013;Lee and Cuijpers, 2013), and on the physiological and the neurobiological correlate of EMDR (Bergmann, 2008;Pagani et al., 2013). ...
Article
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Background: Eye movement desensitization and reprocessing [EMDR] is an innovative, evidence-based and effective psychotherapy for post-traumatic stress disorder [PTSD]. As with other psychotherapies, the effectiveness of EMDR contrasts with a limited knowledge of its underlying mechanism of action. In its relatively short life as a therapeutic option, EMDR has not been without controversy, in particular regarding the role of the bilateral stimulation as an active component of the therapy. The high prevalence of EMDR in clinical practice and the dramatic increase in EMDR research in recent years, with more than 26 randomized controlled trials published to date, highlight the need for a better understanding of its mechanism of action. Methods: We conducted a thorough systematic search of studies published until January 2018, using PubMed, ScienceDirect, Web of Knowledge and Scopus databases that examined the mechanism of action of EMDR or provided conclusions within the framework of current theoretical models of EMDR functioning. Results: Eighty-seven studies were selected for review and classified into three overarching models; (i) psychological models (ii) psychophysiological models and (iii) neurobiological models. The evidence available from each study was analyzed and discussed. Results demonstrated a reasonable empirical support for the working memory hypothesis and for the physiological changes associated with successful EMDR therapy. Recently, more sophisticated structural and functional neuroimaging studies using high resolution structural and temporal techniques are starting to provide preliminary evidence into the neuronal correlates before, during and after EMDR therapy. Discussion: Despite the increasing number of studies that published in recent years, the research into the mechanisms underlying EMDR therapy is still in its infancy. Studies in well-defined clinical and non-clinical populations, larger sample sizes and tighter methodological control are further needed in order to establish firm conclusions.
... Ainsi, la reprogrammation de la mémoire de travail couplée aux modifications psychophysiologiques permettrait une amélioration des symptômes liés à l'ESPT (Gunter & Bodner, 2009 (Haour & Servan-Schreiber, 2009). ...
Thesis
Un vécu traumatique de l’accouchement et ses conséquences représentent un problème majeur souvent sous-estimé pour la santé de la femme (Ayers, 2004). Certaines femmes peuvent développer après leur accouchement un état de stress post-traumatique (ESPT). Une prévalence moyenne de 2% de femmes qui manifestent un ESPT postpartum est reconnu et un tiers des femmes présentent des symptômes cliniquement significatifs d’un ESPT (revue de la littérature Olde et al., 2006 ; Denis & Callahan, 2009). Partie 1 : une étude longitudinale quantitative avec quatre temps d’évaluation (fin de grossesse et 2, 6, 12 mois postpartum) a été menée auprès de 400 femmes. A deux mois postpartum 163 femmes ont répondu aux questionnaires, 32 femmes (19,6%) présentent des symptômes d’un ESPT suite à l’accouchement. A six mois postpartum, 97 femmes ont poursuivi l’étude et 11 présentent des symptômes d’ESPT (11,5%). L’analyse longitudinale et multifactorielle a montré des différences significatives entre le groupe des femmes « ESPT postpartum » et le groupe témoin concernant le sentiment d’auto-efficacité, les stratégies de coping et la qualité de vie. A douze mois postpartum, 80 femmes ont répondu aux questionnaires, 13 d’entre elles (16,5%) présentent des symptômes d’un ESPT postpartum. Une analyse de régression linéaire indique que les antécédents obstétricaux-gynécologiques, la présence d’affects dépressifs en prépartum et l’utilisation de la stratégie de coping d’auto-blâme ainsi que la difficulté à réinterpréter les situations de manière positive en postpartum (T2) prédisent l’apparition de symptômes d’ESPT postpartum à un an. Les résultats de l’analyse de médiation montrent un effet de la stratégie de coping auto-blâme (T2) sur la relation entre la perception du soutien à l’autonomie par l’équipe soignante à T2 et le score d’ESPT à un an postpartum (T4). Partie 2 : une étude qualitative a été menée afin de connaître les représentations des soignants sur le développement d’un état de stress post-traumatique suite à l’accouchement à l’aide une étude par entretiens. Indépendamment, un protocole de prise en charge des femmes présentant un ESPT consécutif à l’accouchement a été élaboré afin d’évaluer l’effet d’une prise en charge psychothérapeutique (thérapie EMDR) chez ces femmes en souffrance. Conclusion : les résultats de cette étude confirment la présence d’un ESPT postpartum chez un certain nombre de femmes. A partir de ces résultats, une réflexion clinique est proposée sur les améliorations possibles de la prise en charge des femmes souffrant d’un ESPT suite à l’accouchement
... Studies on several hypothetical psychological and neurological mechanisms are suggestive but still inconclusive (Gunter & Bodner, 2009). To complement that work, we speculate about how BLS operates across the analogy with Buddhist practice, particularly the Vajrayana, the esoteric component of the Mahayana. ...
... It has been suggested that it is the exposure portion of the treatment that works to improve children's symptoms rather than the rapid eye movements themselves. 73 ...
Article
Full-text available
Millions of children and adolescents each year are exposed to potentially traumatic events (PTEs), placing them at risk for posttraumatic stress (PTS) disorder symptoms. Medical providers play an important role in the identification and treatment of PTS, as they are typically the initial point of contact for families in the wake of a PTE or during a PTE if it is medically related (eg, injury/illness). This paper offers a review of the literature focused on clinical characteristics of PTS, the assessment and diagnosis of PTS, and current effective treatments for PTS in school-age children and adolescents. The clinical presentation of PTS is often complex as symptoms may closely resemble other internalizing and externalizing disorders. A number of screening and evaluation tools are available for medical providers to assist them in the accurate diagnosis of PTS. Treatment options are available for youth at minimal risk of PTS as well as for those with more intensive needs. Additional training regarding trauma-informed medical care may benefit medical providers. By taking a trauma-informed approach, rooted in a solid understanding of the clinical presentation of PTS in children and adolescents, medical providers can ensure PTS does not go undetected, minimize the traumatic aspects of medical care, and better promote health and well-being.
... Associative linking is an essential element of the AIP model, whereas differentiation is less emphasized. It is implied in the concept of psychological distancing where it is referred to as the capacity to view traumatic experiences from a detached perspective (Gunter & Bodner, 2009;Lee, Taylor, & Drummond, 2006;Maxfield, Melnyk, & Hayman, 2008). This is similar to what has been suggested in this article in relation to MDA. ...
Article
This article proposes a dialectical perspective on the adaptive information processing (AIP) model (F. Shapiro, 1995, 2001) with application to eye movement desensitization and reprocessing (EMDR) therapy. Dialectical principles may contribute to a more detailed understanding of the way the AIP system works as well as adding new therapeutic guidelines. Our dialectical perspective is based on 2 propositions. The first is that the movement of the AIP system toward integration consists of 2 dialectical movements: horizontal and vertical. The horizontal movement is between various opposites of the individual such as danger versus safety, dependence versus independence, worthlessness versus self-worth. The vertical movement relates to whole/part shifts in which a whole becomes a part of the next higher whole. The synergetic flow of both dialectical movements is depicted as a spiral of the AIP system. The second proposition suggests that the AIP system operates through cycles of differentiation and linking. These cycles separate the condensed and fragmented memory network into parts, enabling new links to occur. Differentiation and linking are also discussed in relation to dialectical attunement and mindful dual awareness. Using clinical vignettes, we illustrate how this perspective can supply the EMDR therapist a map of the client's associative processing, enhance attuned therapeutic presence, and promote effective dialectical interweaves when processing is stuck.
Article
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This article summarizes current concepts of the working memory with regard to its role within emotional coping strategies. In particular, it focuses on the fact that the limited capacity of the working memory to process now-relevant information can be turned into an advantage, when the individual is occupied by dealing with unpleasant emotion. Based on a phenomenon known as dual-task interference (DTI), this emotion can be chased by intense arousal due to clearly identifiable external stressors. Thus, risk perception might be used as a 'DTI inductor' that allows avoidance of unpleasant emotion. Successful mastery of risk adds a highly relevant dopaminergic component to the overall experience. The resulting mechanism of implicit learning may contribute to the development of a behavioural addiction. Besides its putative effects in the development of a behavioural addiction, the use of DTI might be of a more general interest for the clinical practice, especially in the field of psychotherapy. © 2013 S. Karger AG, Basel.
Article
EMDR is een geprotocolleerde, evidence-based behandelprocedure gericht op het ‘desensitiseren’ – verzwakken – van herinneringen aan beschadigende gebeurtenissen. Volgens de Multidisciplinaire richtlijn Angststoornissen uit 2003 is EMDR één van de twee meest in aanmerking komende psychologische interventies bij de posttraumatische stressstoornis (PTSS). Een belangrijk voordeel ten opzichte van andere behandelmethoden is de snelheid waarmee resultaten worden bereikt. Daarnaast ervaren veel patiënten en therapeuten EMDR als relatief weinig emotioneel belastend. Wij zullen de behandelaanpak illustreren aan de hand van twee casussen en informatie verschaffen over verwijzing, opleiding, beroepsvereniging en kwaliteitsbeleid.
Research
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Rewind Technique as a potential treatment for PTSD in Emergency Services Workers. This research looks at the need for a short, non invasive intervention to suit the logistics & culture of our emergency services personnel, for whom the incidence of PTSD is higher than average due to the nature of their jobs.
Thesis
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L’EMDR est une thérapie intégrative créée en 1987 par Shapiro évaluée comme efficace et rapide sur les états de stress post traumatiques. En 1995, elle améliore pour arriver à ce qu’elle appelle le Traitement Adaptatif de l’Information – TAI - (« Adaptative Informational Process : AIP »), révisé en 2001 et 2006. Cette théorie postule qu’il existe au plan cérébral un système de traitement des informations capable d’intégrer les nouvelles expériences à des réseaux de mémoire existants. Depuis d’autres pathologies ont été traitées avec l’EMDR. D’autre part, en 1998, Seligman donne naissance à la psychologie positive. Au lieu de considérer la «santé mentale » comme la « réduction des troubles neuropsychiatriques », il propose non plus d’aider les gens à passer de - 5 à 0 sur l’échelle de bonheur, mais de permettre à chacun de passer de 0 à + 5 sur un continuum de bonheur. Allier ces deux perspectives pose un certain nombre d’interrogations mais ouvre également des perspectives enthousiasmantes. Trois études ont porté sur les forces de caractères avec un échantillon de 60 sujets, pour la première, 100 sujets pour la seconde et une étude de cas avec pour objectif d’évaluer l’optimisation de l’intégration des forces avec des éléments provenant de l’EMDR. Les deux études suivantes ont porté sur la création d’un protocole EMDR d’optimisme et l’étude de ses possibilités. Nos conclusions sont que, plus que jamais, une théorisation rigoureuse est nécessaire (et elle est déjà à l’œuvre dans le cadre de la psychologie positive) et la validation scientifique des assertions est déterminante pour l’efficacité des interventions alliant psychologie positive et EMD
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El presente estudio de campo fue realizado tras el descubrimiento de 218 cuerpos en fosas clandestinas, en el estado mexicano de Durango en abril de 2011. Se llevó a cabo una evaluación psicométrica preliminar, con los 60 empleados de la Procuraduría General del Estado que se encontraban trabajando con los cuerpos. Esto para establecer los criterios de selección y medidas de base. Se administraron la Escala de Impacto del Evento (IES) y la escala Short PTSD Rating Interview (SPRINT). Los 32 individuos que arrojaron puntajes de estrés postraumático y de Trastorno por Estrés Postraumático (TEPT) de moderados a severos, fueron tratados con el Protocolo de EMDR para Incidentes Críticos Recientes (EMDR-PRECI). Los participantes se asignaron a dos grupos: Grupo de Atención Inmediata (GAI, síntomas severos) y Grupo de Atención Demorada (GAD, síntomas moderados). Cada sesión individual con los clientes tuvo una duración entre 90 y 120 minutos. Los resultados demostraron que una sesión de terapia EMDR empleando el Protocolo para Incidentes Críticos Recientes (PRECI), produjo una mejoría significativa en la sintomatología de TEPT y estrés postraumático. Esto tanto para el grupo de atención inmediata como para el grupo de atención demorada. Este estudio provee evidencia preliminar, que sustenta la eficacia del protocolo en un escenario natural de situación de masacre humana, con un grupo de adultos traumatizados trabajando bajo estrés extremo. Se recomienda más investigación para evaluar la eficacia del protocolo.
Article
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Introduction. - This article evaluates developments in the field of early psychological intervention (EPI) after trauma in general and the place of early eye movement desensitization and reprocessing (EMDR) intervention (EEI) in particular. The issues and dilemmas involved with EPI and EEI will be outlined; related research presented and the current status evaluated. Literature and clinical findings. - Reviewing the literature and drawing on findings from initial research and case studies, the rationale and contribution that EMDR therapy has to offer is discussed relative to current evidence and theory regarding post-traumatic stress syndromes and trauma memories. The relative advantages of EEI will be elaborated. Discussion and conclusion. - It is proposed that EEL, while trauma memories have not yet been integrated, may be used not only to treat acute distress but may also provide a window of opportunity in which a brief intervention, possibly on successive days, could prevent complications and strengthen resilience. Through the rapid reduction of intrusive symptoms and de-arousal response as well as by identifying potential obstructions to adaptive information processing (AIP), EMDR therapy may reduce the sensitisation and accumulation of trauma memories. (C) 2012 Published by Elsevier Masson SAS.
Article
EMDR is een geprotocolleerde, evidence-based behandelprocedure gericht op het ‘desensitiseren’ – verzwakken – van herinneringen aan beschadigende gebeurtenissen. Volgens de Multidisciplinaire richtlijn Angststoornissen uit 2003 is EMDR één van de twee meest in aanmerking komende psychologische interventies bij de posttraumatische stressstoornis (PTSS). Een belangrijk voordeel ten opzichte van andere behandelmethoden is de snelheid waarmee resultaten worden bereikt. Daarnaast ervaren veel patiënten en therapeuten EMDR als relatief weinig emotioneel belastend. Wij zullen de behandelaanpak illustreren aan de hand van twee casussen en informatie verschaffen over verwijzing, opleiding, beroepsvereniging en kwaliteitsbeleid.
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This article presents an overview of the eye movement desensitization and reprocessing (EMDR) Humanitarian Trauma Recovery Interventions in Latin America and the Caribbean and provides the reader with clinical stories from the front lines. During our many years working in the field, we have observed that psychological trauma is a challenging consequence of the multifaceted situations confronting individuals and communities after disasters. In this article, we describe the EMDR humanitarian interventions provided since 1998 in Latin America and the Caribbean to address survivors' psychological distress after natural disasters (e.g., flooding, landslides, earthquakes), man-made disasters, human massacre, and severe interpersonal violence. Treatment has been provided to child, adolescent, and adult survivors, often in community settings, and to first responders and cancer patients. The EMDR early intervention protocols are brief effective interventions that can be used in the field or emergency situations; there is a body of research supporting the use of modified EMDR therapy protocols to treat acute trauma in both group and individual formats (Jarero, Artigas, & Luber, 2011).
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This study was conducted in the United Kingdom at two major conferences to examine how therapists (N = 83) integrated eye movement desensitization reprocessing (EMDR) into their clinical practice. Data from a mixed methodology suggests that up to 40% of the sample experienced difficulties post-EMDR training. Results indicated that analytically trained and humanistic therapists experienced significantly more difficulties in integrating EMDR into the current clinical practice than integrative or cognitive behavioral clinicians. This study also ascertained that EMDR clinicians experienced workplace difficulties and challenges. Consideration is given to how the study findings may have implications for both the teaching and learning of EMDR and workplace issues.
Chapter
Eye movement desensitization and reprocessing (EMDR) was developed in the late 1980s as a treatment for posttraumatic stress disorder. Since then the therapy has been shown to be efficacious for this and other disorders. It is broadly disseminated and widely practiced. There are several controversies surrounding this therapy. Though eye movements were originally proposed to be an important active component of the intervention, several studies have called that claim into question. Questions remain, including what the mechanisms of action are for EMDR, how distinctive this therapy is from other interventions that include exposure and information-processing components, and what training is needed to be technically proficient? Moreover, use of EMDR for memory recovery poses significant risk, as it incorporates many features that memory researchers have shown to promote development of false memories. Keywords: EMDR; information processing and cognitions; psychotherapies; eye movement; post-traumatic stress disorder (PTSD)
Article
Dit artikel beschrijft het belang van het inzetten van eye movement desensitization and reprocessing (EMDR) om traumatisering te voorkomen of te behandelen bij kinderen en adolescenten. Paediatric medical traumatic stress en posttraumatische stressstoornis worden besproken om de relevantie van EMDR voor de kindergeneeskunde toe te lichten. Er volgt een korte beschrijving van het behandelprotocol en twee verklaringsmodellen voor het effect van EMDR. Ter illustratie worden er in het artikel twee casussen beschreven. Er wordt gepleit voor vroege risicosignalering en tijdige doorverwijzing door kinderartsen en medische teams. Geconcludeerd wordt dat EMDR een kindvriendelijke en breed toepasbare methode is om de negatieve gevolgen van traumatische ervaringen die kinderen in een medische setting opdoen te behandelen of te voorkomen. Summary This article describes the importance of using eye movement desensitization and reprocessing (EMDR) to prevent or treat trauma in children and adolescents. Paediatric medical traumatic stress (PMTS) and post traumatic stress disorder (PTSD) are discussed to clarify the relevance of EMDR for pediatrics. A brief description of the treatment protocol and two explanatory models for the effect of EMDR are given. To illustrate, two cases from the hospital practice are described. Early risk detection and timely referral by pediatricians and medical teams is being advocated. It is concluded EMDR is a child-friendly and widely applicable method to treat or prevent the negative impact of traumatic experiences which children acquire in a medical setting.
Article
Le Développement et installation de ressources (DIR) est une procédure EMDR (désensibilisation et retraitement par les mouvements oculaires) développée afin de renforcer les associations positives dans les souvenirs positifs qui sont pleins de ressources (Korn & Leeds, 2002). Cette étude a testé la supposition selon laquelle les stimulations bilatérales (mouvements oculaires [MO] horizontaux) dans le DIR paraissent “conduire à des augmentations spontanées et rapides de l'intensité affective... et à des associations riches et émotionnellement vives” (Korn & Leeds, p. 1469). Cette étude a également testé si les effets des mouvements oculaires pouvaient être mieux expliqués par la théorie de la mémoire du travail ou par celle de l'interaction hémisphérique. Cinquante-trois étudiants du premier cycle se sont chacun rappelé trois souvenirs de fierté, de persévérance et de confiance en soi. Ils ont apporté des évaluations prétest et post-test de chaque souvenir en termes de clarté, d'agrément et de la force éprouvée de la qualité positive, avant et après avoir réalisé trois tâches simultanées au cours du rappel : des MO horizontaux, des MO verticaux et le rappel seul. Les résultats étaient pleinement concordants avec les prédictions de la mémoire de travail, avec des diminutions significatives pour toutes les variables après les deux tâches de mouvements oculaires. Il n'y avait pas de soutien en faveur de l'hypothèse interhémisphérique. Il est conclu que l'efficacité des stimulations bilatérales dans le DIR est discutable. Les implications cliniques sont envisagées.
Article
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Le protocole EMDR (désensibilisation et retraitement par les mouvements oculaires) individuel pour une utilisation paraprofessionnelle dans les situations de traumatisme aigu (EMDR-PROPARA) fait partie d'un projet développé à l'initiative du Dr Francine Shapiro. Cet essai clinique randomisé a examiné l'efficacité de ce protocole, administré par des thérapeutes EMDR expérimentés. Trente-neuf premiers intervenants en service actif ayant subi des traumatismes ont été répartis de manière aléatoire en deux groupes et ont reçu des séances de quatre-vingt-dix minutes, soit d'EMDR-PROPARA, soit de thérapie de soutien. Les participants du groupe EMDR-PROPARA ont montré une amélioration immédiatement après le traitement, et leurs scores au Short PTSD Rating Interview (SPRINT), lors d'un suivi à trois mois, avaient encore baissé. Comparativement, les participants du groupe ayant bénéficié de la thérapie de soutien présentaient une amélioration non significative après le traitement et une augmentation des scores au SPRINT lors du second suivi. La différence significative entre les deux traitements donne un support préliminaire à l'hypothèse de l'efficacité de l'EMDR-PROPARA pour réduire la gravité des symptômes post-traumatiques et favoriser une amélioration subjective globale. Les auteurs recommandent que des études mieux contrôlées soient menées afin d'évaluer plus précisément l'efficacité de cette intervention.
Article
Le but de cette étude était d'investiguer l'efficacité de l'intervention EMDR (désensibilisation et retraitement par les mouvements oculaires) rapide à l'aide du protocole EMDR de l'épisode traumatique récent (EMDR recent traumatic episode protocol [R-TEP]) après un événement traumatique dans une collectivité, lors duquel un missile a frappé un bâtiment dans un quartier très fréquenté de la ville. Dans un essai contrôlé randomisé de groupes parallèles avec liste d'attente/traitement reporté, 17 rescapés manifestant une détresse post-traumatique ont été traités avec la psychothérapie EMDR en utilisant le protocole R-TEP. Des praticiens EMDR bénévoles ont effectué le traitement lors de deux journées consécutives. Les participants étaient assignés de manière aléatoire à la condition du traitement immédiat ou à celle de la liste d'attente/traitement reporté. Les évaluations à l'aide de l'échelle Impact of Event Scale-Revised (Échelle révisée d'impact de l'événement [IES-R]) et de l'inventaire bref de la dépression du Patient Health Questionnaire (PHQ-9) ont été réalisées lors du pré- et du post-traitement ainsi qu'au suivi après trois mois. Une semaine post-traitement, les scores du groupe de traitement immédiat s'étaient significativement améliorés sur l'IES-R en comparaison du groupe liste d'attente/traitement reporté qui n'a montré aucune amélioration avant le traitement. Lors du suivi après trois mois, les résultats de l'IESR étaient maintenus et les scores PHQ-9 montraient une amélioration significative. Cette étude pilote apporte des preuves préliminaires qui soutiennent l'efficacité de l'EMDR R-TEP dans la réduction du stress post-traumatique chez les victimes civiles d'hostilités et qui montrent que ce modèle d'intervention, brièvement ajouté aux services locaux à la suite d'incidents traumatiques à grande échelle, fondé sur une intervention EMDR sur deux jours consécutifs, peut être efficace.
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Eye movement desensitization and reprocessing (EMDR) has been established as an efficacious therapy for posttraumatic stress disorder (PTSD). The working mechanism of the procedure is, however, still partly unknown. It is therefore important to explore the physiological effects of eye movements and alternative bilateral stimulation. This article describes our research on the effects of eye movements during authentic EMDR sessions of chronic PTSD in refugees with war and torture experiences and places this research in the context of other findings. The findings point to defi nite physiological effects of eye movements; namely a dearousal with increased fi nger temperature and changes in the balance between the parasympathetic and sympathetic autonomous nervous systems.
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Research has consistently demonstrated that performance is degraded when participants engage in two simultaneous tasks that require the same working memory resources. This study tested predictions from working memory theory to investigate the effects of eye movement (EM) on the components of autobiographical memory. In two experiments, 24 and 36 participants, respectively, focused on negative memories while engaging in three dual-attention EM tasks of increasing complexity. Compared to No-EM, Slow-EM and Fast-EM produced significantly decreased ratings of image vividness, thought clarity, and emotional intensity, and the more difficult Fast-EM resulted in larger decreases than did Slow-EM. The effects on emotional intensity were not consistent, with some preliminary evidence that a focus on memory-related thought might maintain emotional intensity during simple dual-attention tasks (Slow-EM, No-EM). The findings of our experiments support a working memory explanation for the effects of EM dual-attention tasks on autobiographical memory. Implications for understanding the mechanisms of action in EMDR are discussed.
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This study was designed to investigate the question of whether psychophysiological changes during EMDR sessions are related to subjective and objective reduction of PTSD symptoms. During-session changes in autonomic tone in relation to session-to-session changes of subjective stress, trauma-related symptoms, and psychophysiological reactions during a traumatic reminder were investigated in 10 patients suffering from single-trauma PTSD. Treatment duration followed each patient's individual needs and ranged between 1 and 4 sessions, resulting in a total of 24 EMDR treatment sessions from which psychophysiological data were completely recorded. Treatment with EMDR was followed by a significant reduction of trauma-related symptoms, elimination of the PTSD diagnosis in 8 of the 10 participants, as well as by significantly reduced psychophysiological reactivity to an individualized trauma script. Psychophysiological dearousal in sessions correlated significantly with decrease in script-related reactions in heart rate and parasympathetic tone, and with changes in subjective disturbance. Our results indicate that information processing during EMDR is followed by during-session decrease in psychophysiological activity, reduced subjective disturbance and reduced stress reactivity to traumatic memory.
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The growing body of literature on the effects of bilateral saccadic eye movements, patterned after those employed in eye movement desensitization and reprocessing (EMDR), on memory is reviewed. Research indicates that engaging in bilateral saccadic eye movements prior to lab-based memory testing results in significant improvement in episodic memory across a wide range of memory tests. Other effects of these types of eye movements on hemispheric activation and emotional state are also discussed. The findings are interpreted within a framework suggesting that bilateral saccadic eye movements, such as those employed in EMDR, increase interaction between the left and right cerebral hemispheres. This framework is also used to explain the effects of such eye movements on memory during EMDR treatment of posttraumatic stress disorder.
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Eye movement desensitization and reprocessing (EMDR) is a therapeutic approach guided by the adaptive information processing (AIP) model. This article provides a brief overview of some of the major precepts of AIP. The basis of clinical pathology is hypothesized to be dysfunctionally stored memories, with therapeutic change resulting from the processing of these memories within larger adaptive networks. Unlike extinction-based exposure therapies, memories targeted in EMDR are posited to transmute during processing and are then again stored by a process of reconsolidation. Therefore, a comparison and contrast to extinction-based information processing models and treatment is provided, including implications for clinical practice. Throughout the article a variety of mechanisms of action are discussed, including those inferred by tenets of the AIP model, and the EMDR procedures themselves, including the bilateral stimulation. Research suggestions are offered in order to investigate various hypotheses.
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The processes that underlie the effectiveness of eye movement desensitization and reprocessing (EMDR) are examined by evaluating the procedural differences between it and exposure therapy. Major factors include the degree of emphasis placed on reliving versus distancing in the therapies and the degree to which clients are encouraged to focus on direct trauma experiences versus experiences associated with the trauma. Research results indicate that, unlike traditional imaginal exposure, reliving responses in EMDR did not correlate with symptom improvement. Instead, consistent with an information processing model, the degree of distancing in EMDR was significantly associated with improvement. A case study is described to highlight these methodological divergences in the respective therapies relating to reliving. Finally, the research regarding the possible sources of the distancing response within EMDR was examined. The results indicate that the distancing process was more likely to be an effect produced by eye movements than by any therapist instructions. Theoretical and research evaluations indicate that the mechanisms underlying EMDR and traditional exposure therapy are different.
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We provide an "executive-attention" framework for organizing the cognitive neuroscience research on the constructs of working-memory capacity (WMC), general fluid intelligence, and prefrontal cortex (PFC) function. Rather than provide a novel theory of PFC function, we synthesize a wealth of single-cell, brain-imaging, and neuropsychological research through the lens of our theory of normal individual differences in WMC and attention control (Engle, Kane, & Tuholski, 1999; Engle, Tuholski, Laughlin, & Conway, 1999). Our critical review confirms the prevalent view that dorsolateral PFC circuitry is critical to executive-attention functions. Moreover, although the dorsolateral PFC is but one critical structure in a network of anterior and posterior "attention control" areas, it does have a unique executive-attention role in actively maintaining access to stimulus representations and goals in interference-rich contexts. Our review suggests the utility of an executive-attention framework for guiding future research on both PFC function and cognitive control.
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College students generated autobiographical memories from distinct emotional categories that varied in valence (positive vs. negative) and intensity (high vs. low). They then rated various perceptual, cognitive, and emotional properties for each memory. The distribution of these emotional memories favored a vector model over a circumplex model. For memories of all specific emotions, intensity accounted for significantly more variance in autobiographical memory characteristics than did valence or age of the memory. In two additional experiments, we examined multiple memories of emotions of high intensity and positive or negative valence and of positive valence and high or low intensity. Intensity was a more consistent predictor of autobiographical memory properties than was valence or the age of the memory in these experiments as well. The general effects of emotion on autobiographical memory properties are due primarily to intensity differences in emotional experience, not to benefits or detriments associated with a specific valence.
Article
Eye movement desensitization and reprocessing (EMDR), a controversial treatment suggested for posttraumatic stress disorder (PTSD) and other conditions, was evaluated in a meta-analysis of 34 studies that examined EMDR with a variety of populations and measures. Process and outcome measures were examined separately, and EMDR showed an effect on both when compared with no treatment and with therapies not using exposure to anxiety-provoking stimuli and in pre-post EMDR comparisons. However, no significant effect was found when EMDR was compared with other exposure techniques. No incremental effect of eye movements was noted when EMDR was compared with the same procedure without them. R. J. DeRubeis and P. Crits-Christoph (1998) noted that EMDR is a potentially effective treatment for noncombat PTSD, but studies that examined such patient groups did not give clear support to this. In sum, EMDR appears to be no more effective than other exposure techniques, and evidence suggests that the eye movements integral to the treatment, and to its name, are unnecessary.
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Article
Eye Movement Desensitization Reprocessing (EMDR) is a controversial treatment for Posttraumatic Stress Disorder that requires clients to make rapid eye movements while revisualizing a traumatic event. Although seemingly effective, the process by which EMDR exerts its effects is poorly understood. We propose that EMDR's eye movements facilitate the orienting response, i.e., the attentional adjustment to unexpected stimuli. Since the orienting response has been implicated in spontaneous transformations of dream content during REM sleep, we reasoned that, similarly, activation of the orienting response during EMDR may facilitate content transformations in traumatic memories. To examine this hypothesis, 25 undergraduates completed 20 seconds of eye movements or 20 seconds of visual fixation before each of two tasks: 1) a covert visual attention task, in which a cue indicated the likely position of a subsequent target, and 2) a sentence rating task, in which sentences with either metaphoric or non-metaphoric endings were rated for strikingness. Repeated measures ANOVAs indicated that the eye movement manipulation facilitated attentional adjustments to targets presented in invalidly cued locations and increased the extent to which metaphoric sentence endings were found striking. Together these results suggest that the eye movements in EMDR induce attentional and semantic flexibility, thereby facilitating transformations in the client's narrative representation of the traumatic event. The implications of these findings for theories of dream formation and metaphor comprehension are also considered.
Article
To test the psychometric properties of the Subjective Units of Disturbance Scale (SUDS), this study analyzed the data from 61 patients treated with EMDR. The pretreatment self-reported questionnaires, the in-session records of EMDR, and the Clinical Global Impression–Change (CGI-C) scale at the termination of EMDR were reviewed. The initial score of the SUDS at the first session was significantly correlated with the patient's level of depression, the state anxiety, and distress from the impact of events. The final score of the SUDS at the first session was significantly correlated with the CGI-C score at termination. Consequently, this study confirmed that the SUDS in EMDR sessions has good psychometric properties.
Article
Patients with posttraumatic stress disorder (PTSD) demonstrate abnormal psychophysiological responses to stressful events. Given that eye movement desensitization and reprocessing (EMDR) therapy appears to be a treatment of choice for trauma victims, the aim of the present study was to determine if psychophysiological responses to stress decreased after a single EMDR session. Six PTSD patients were treated by an EMDR therapist. Their psychophysiological responses (heart rate and skin conductance) were recorded before and after the EMDR session under two conditions: (a) in a relaxed state and (b) while visualizing their own traumatic event. At the end of the session, all patients had a significant reduction in their PTSD symptoms, which confirms previous results demonstrating the efficacy of the EMDR approach. Second, after only one EMDR session, heart rate and skin conductance during the trauma recall decreased significantly as compared to a relaxing state.
Article
The unique efficacy of eye movement desensitization and reprocessing (EMDR) in the treatment of posttraumatic stress disorder is thought to result from changes in the brain/mind state induced by bilateral sensory stimulation, but the nature and specific consequences of these changes remain unknown. The possibility that bilateral stimulation induces a brain/mind state similar to that of rapid eye movement sleep is supported by studies showing that sleep facilitates forms of memory processing arguably necessary for the resolution of trauma. Such studies, along with direct studies of the impact of bilateral stimulation on memory and emotional processing, and dismantling studies identifying the requisite features of such bilateral stimulation for effective trauma processing, will eventually lead to an understanding of the neurobiological basis of EMDR.
Article
In eye movement desensitization and reprocessing (EMDR), one might argue, "Change occurs when distressing memories are processed." But the question is—how does the information get processed? How can one isolate and measure the mechanism that makes this happen? Others will respond, "EMDR works because the eye movements have a certain effect." However, there is a lot of confusion about the role of eye movements and tactile and auditory stimulation. When people talk about EMDR's mechanism of action, they generally are referring to the mechanism of eye movements (EM). They tend to overlook the fact that there is a lot more to EMDR than EM. This special issue of the Journal of EMDR Practice and Research contains a number of articles that address preliminary issues related to the complex questions. There are two research studies: a study investigating the physiological effects of EM and a study evaluating the effect of EM on the components of autobiographical memory. There are several articles by researchers who have summarized their findings and provided a theoretical perspective on related issues. Two theoretical articles propose neurobiological and other mechanisms of action. All these articles make a real contribution to our conceptualizations of EMDR mechanisms. It is our hope and intention that this issue will stimulate thinking, and provide ideas and models for future research, with the expectation that findings will help to guide and direct clinical practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Very little is known about the mechanisms that underlie the therapeutic effectiveness of eye movement desensitization and reprocessing (EMDR). This study tested whether the content of participants' responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing, which would be expected given Shapiro's proposal of dual process of attention. The responses made by 44 participants with post-traumatic stress disorder (PTSD) were examined during their first EMDR treatment session. An independent rater coded these responses according to whether they were consistent with reliving, distancing or focusing on material other than the primary trauma. The coding system was found to have satisfactory inter-rater reliability. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner. Cross-lagged panel correlations suggest that processing in a more detached manner was a consequence of the EMDR procedure rather than a measure that covaried with improvement. Copyright © 2006 John Wiley & Sons, Ltd.
Article
The enormous popularity recently achieved by Eye Movement Desensitization and Reprocessing (EMDR) as a treatment for anxiety disorders appears to have greatly outstripped the evidence for its efficacy from controlled research studies. The disparity raises disturbing questions concerning EMDR's aggressive commercial promotion and its rapid acceptance among practitioners. In this article, we: (1) summarize the evidence concerning EMDR's efficacy; (2) describe the dissemination and promotion of EMDR; (3) delineate the features of pseudoscience and explicate their relevance to EMDR; (4) describe the pseudoscientific marketing practices used to promote EMDR; (5) analyze factors contributing to the acceptance of EMDR by professional psychologists; and (6) discuss practical considerations for professional psychologists regarding the adoption of EMDR into professional practice. We argue that EMDR provides an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapeutic techniques. Such distinctions are of critical importance for clinical psychologists who intend to base their practice on the best available research.
Article
Dyck's (Journal of Behavior Therapy and Experimental Psychiatry, 1993) conditioning model of EMD provides a useful description of failure of habituation in post-traumatic stress disorder, but may not account for some common EMD phenomena. An alternative model proposes that the therapist's waving hand--in the presence of a trauma-related cortical set--triggers an intense orienting response (OR). Intrinsic effects of the OR facilitate continuing attention to the memory without avoidance, and provide for effective input of new trauma-related information. The person's neuronal model of the trauma alters to reflect his survival and current safety--as true outcome of the trauma--and associated conditioned responses extinguish. Proposals for experimental evaluation of the model are described.
Article
Eye movement desensitisation and reprocessing (EMDR) has attracted controversy and has led to publications covering a wide range of psychological problems treated by EMDR, in particular, post-traumatic stress disorder (PTSD). There is growing clinical evidence of the effectiveness of EMDR, but a lack of a convincing theoretical basis to explain its rapid effect. This paper argues that a combination of Pavlovian and Darwinian theory provide a theoretical explanation for the therapeutic effectiveness of EMDR. We suggest that the investigatory component of the orienting reflex is an evolutionary development enabling organisms to assess their environment for both opportunities and threats. We propose that EMDR is rapidly effective because it is a clinical method of Pavlovian conditioning by which the positive visceral element of the investigatory reflex can be paired with clinically-induced noxious memories to remove their negative affect. Compared with established forms of treatment for PTSD, EMDR is rapid, with resulting clinical and economic benefits. Our suggested theoretical basis for EMDR has implications for further explanatory research and for developments in EMDR treatment.
Article
It has been claimed that the symptoms of post-traumatic stress disorder (PTSD) can be ameliorated by eye-movement desensitization-reprocessing therapy (EMD-R), a procedure that involves the individual making saccadic eye-movements while imagining the traumatic event. We hypothesized that these eye-movements reduce the vividness of distressing images by disrupting the function of the visuospatial sketchpad (VSSP) of working memory, and that by doing so they reduce the intensity of the emotion associated with the image. This hypothesis was tested by asking non-PTSD participants to form images of neutral and negative pictures under dual task conditions. Their images were less vivid with concurrent eye-movements and with a concurrent spatial tapping task that did not involve eye-movements. In the first three experiments, these secondary tasks did not consistently affect participants' emotional responses to the images. However, Expt 4 used personal recollections as stimuli for the imagery task, and demonstrated a significant reduction in emotional response under the same dual task conditions. These results suggest that, if EMD-R works, it does so by reducing the vividness and emotiveness of traumatic images via the VSSP of working memory. Other visuospatial tasks may also be of therapeutic value.
Article
In 1974, Baddeley and Hitch proposed a three-component model of working memory. Over the years, this has been successful in giving an integrated account not only of data from normal adults, but also neuropsychological, developmental and neuroimaging data. There are, however, a number of phenomena that are not readily captured by the original model. These are outlined here and a fourth component to the model, the episodic buffer, is proposed. It comprises a limited capacity system that provides temporary storage of information held in a multimodal code, which is capable of binding information from the subsidiary systems, and from long-term memory, into a unitary episodic representation. Conscious awareness is assumed to be the principal mode of retrieval from the buffer. The revised model differs from the old principally in focussing attention on the processes of integrating information, rather than on the isolation of the subsystems. In doing so, it provides a better basis for tackling the more complex aspects of executive control in working memory.
Article
Eye movement desensitization and reprocessing (EMDR), a controversial treatment suggested for posttraumatic stress disorder (PTSD) and other conditions, was evaluated in a meta-analysis of 34 studies that examined EMDR with a variety of populations and measures. Process and outcome measures were examined separately. and EMDR showed an effect on both when compared with no treatment and with therapies not using exposure to anxiety-provoking stimuli and in pre post EMDR comparisons. However, no significant effect was found when EMDR was compared with other exposure techniques. No incremental effect of eye movements was noted when EMDR was compared with the same procedure without them. R. J. DeRubeis and P. Crits-Christoph (1998) noted that EMDR is a potentially effective treatment for noncombat PTSD. but studies that examined such patient groups did not give clear support to this. In sum, EMDR appears to be no more effective than other exposure techniques, and evidence suggests that the eye movements integral to the treatment, and to its name, are unnecessary.
Article
Numerous studies have provided evidence for the efficacy of eye movement desensitization and reprocessing therapy (EMDR) in the treatment of posttraumatic stress disorder (PTSD), including recent studies showing it to be more efficient than therapist-directed flooding. But few theoretical explanations of how EMDR might work have been offered. Shapiro, in her original description of EMDR, proposed that its directed eye movements mimic the saccades of rapid eye movement sleep (REM), but provided no clear explanation of how such mimicry might lead to clinical improvement. We now revisit her original proposal and present a complete model for how EMDR could lead to specific improvement in PTSD and related conditions. We propose that the repetitive redirecting of attention in EMDR induces a neurobiological state, similar to that of REM sleep, which is optimally configured to support the cortical integration of traumatic memories into general semantic networks. We suggest that this integration can then lead to a reduction in the strength of hippocampally mediated episodic memories of the traumatic event as well as the memories' associated, amygdala-dependent, negative affect. Experimental data in support of this model are reviewed and possible tests of the model are suggested.
Article
Theories of cognitive functioning in anxiety propose decreased processing efficiency associated with worry but have paid scant attention to possible neural mechanisms. This study examined interhemispheric processing in individuals differing in self-reported worry under high- and low-evaluative conditions. Measures of interhemispheric processing were letter-matching tasks, with matches occurring either within or across hemispheres and requiring either a physical identity (A-A) or a name identity match (A-a). Results indicated that the across-hemisphere advantage (AHA) for the more difficult name identity task was exaggerated under high-evaluative conditions, indicating that interhemispheric processing was especially beneficial under the processing load of evaluation stress. Regardless of task condition, high worriers displayed a reduced AHA compared with low worriers, reflecting ineffective coordination of interhemispheric resources in worriers.
Article
Eye movement desensitization and reprocessing (EMDR) is a psychological treatment method used primarily for people who have experienced trauma. This article provides a systematic research synthesis of EMDR studies targeting trauma symptomatology published between 1997 and 2003. This synthesis builds on the Revised Gold Standard (RGS) as a guide to evaluate empirical EMDR studies. Modifications and additions to the RGS criteria are proposed. The resulting standard is referred to as the Platinum Standard (PS). Sixteen EMDR studies are reviewed and critiqued using the PS criteria. None of the studies reviewed met full PS criteria. The mean score for the studies on the PS was 8.28, with 9 of the studies exceeding the mean. The review calls for researchers to employ more rigorous research designs for EMDR effectiveness using PS criteria. Implications for practice, policy, and research are discussed.
Article
The authors present a multidimensional meta-analysis of studies published between 1980 and 2003 on psychotherapy for PTSD. Data on variables not previously meta-analyzed such as inclusion and exclusion criteria and rates, recovery and improvement rates, and follow-up data were examined. Results suggest that psychotherapy for PTSD leads to a large initial improvement from baseline. More than half of patients who complete treatment with various forms of cognitive behavior therapy or eye movement desensitization and reprocessing improve. Reporting of metrics other than effect size provides a somewhat more nuanced account of outcome and generalizability. The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.
Article
Experimental analogues of post-traumatic stress disorder suggest that loading the visuospatial sketchpad of working memory with a concurrent task reduces the vividness and associated distress of predominantly visual images. The present experiments explicitly tested the hypothesis that interfering with the phonological loop could analogously reduce the vividness and emotional impact of auditory images. In Experiment 1, 30 undergraduates formed non-specific images of emotive autobiographical memories while performing a concurrent task designed to load either the visuospatial sketchpad (eye movements) or phonological loop (articulatory suppression). Participants reported their images to be primarily visual, corresponding to the greater dual-task disruption observed for eye movements. Experiment 2 instructed participants to form specifically visual or auditory images. As predicted, concurrent articulation reduced vividness and emotional intensity ratings of auditory images to a greater extent than did eye movements, whereas concurrent eye movements reduced ratings of visual images much more than did articulatory suppression. Such modality-specific dual-task interference could usefully contribute to the treatment and management of intrusive distressing images in both clinical and non-clinical settings.
Article
Eye movement desensitization and reprocessing (EMDR) is an established treatment for post-traumatic stress disorder (PTSD). However, its working mechanism remains unclear. This study explored physiological correlates of eye movements during EMDR in relation to current hypotheses; distraction, conditioning, orienting response activation, and REM-like mechanisms. During EMDR therapy, fingertip temperature, heart rate, skin conductance, expiratory carbon dioxide level, and blood pulse oximeter oxygen saturation, were measured in male subjects with PTSD. The ratio between the low and high frequency components of the heart rate power spectrum (LF/HF) were computed as measures of autonomic balance. Respiratory rate was calculated from the carbon dioxide trace. Stimulation shifted the autonomic balance as indicated by decreases in heart rate, skin conductance and LF/HF-ratio, and an increased finger temperature. The breathing frequency and end-tidal carbon dioxide increased; oxygen saturation decreased during eye movements. In conclusion, eye movements during EMDR activate cholinergic and inhibit sympathetic systems. The reactivity has similarities with the pattern during REM-sleep.
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Eye movement desensitization and reprocessing can reduce ratings of the vividness and emotionality of unpleasant memories-hence it is commonly used to treat posttraumatic stress disorder. The present experiments compared three accounts of how eye movements produce these benefits. Participants rated unpleasant autobiographical memories before and after eye movements or an eyes stationary control condition. In Experiment 1, eye movements produced benefits only when memories were held in mind during the movements, and eye movements increased arousal, contrary to an investigatory-reflex account. In Experiment 2, horizontal and vertical eye movements produced equivalent benefits, contrary to an interhemispheric-communication account. In Experiment 3, two other distractor tasks (auditory shadowing, drawing) produced benefits that were negatively correlated with working-memory capacity. These findings support a working-memory account of the eye movement benefits in which the central executive is taxed when a person performs a distractor task while attempting to hold a memory in mind.