Eye Movement Desensitization and Reprocessing

Eye Movement Desensitization and Reprocessing (EMDR) is a one-on-one form of psychotherapy that is designed to reduce trauma-related stress, anxiety, and depression symptoms associated with posttraumatic stress disorder (PTSD) and to improve overall mental health functioning. Treatment is provided by an EMDR therapist, who first reviews the client's history and assesses the client's readiness for EMDR. During the preparation phase, the therapist works with the client to identify a positive memory associated with feelings of safety or calm that can be used if psychological distress associated with the traumatic memory is triggered. The target traumatic memory for the treatment session is accessed with attention to image, negative belief, and body sensations. Repetitive 30-second dual-attention exercises are conducted in which the client attends to a motor task while focusing on the target traumatic memory and then on any related negative thoughts, associations, and body sensations. The most common motor task used in EMDR is side-to-side eye movements that follow the therapist's finger; however, alternating hand tapping or auditory tones delivered through headphones can be used. The exercises are repeated until the client reports no emotional distress. The EMDR therapist then asks the client to think of a preferred positive belief regarding the incident and to focus on this positive belief while continuing with the exercises. The exercises end when the client reports with confidence comfortable feelings and a positive sense of self when recalling the target trauma. The therapist and client review the client's progress and discuss scenarios or contexts that might trigger psychological distress. These triggers and positive images for appropriate future action are also targeted and processed. In addition, the therapist asks the client to keep a journal, noting any material related to the traumatic memory, and to focus on the previously identified positive safe or calm memory whenever psychological distress associated with the traumatic memory is triggered.

The underlying mechanism for how this process works to reduce trauma-related stress, anxiety, and depression is unknown. Researchers have theorized that the positive effect is due to adaptive information processing, the theoretical model behind EMDR. Through adaptive information processing, the dual-attention exercises disrupt the client's stored memory of the trauma to allow for an elimination of negative beliefs, emotions, and somatic symptoms associated with the memory as it connects with more adaptive information stored in the memory networks. Once recall of the trauma no longer elicits negative beliefs, emotions, or somatic symptoms and the memory simultaneously shifts to a more adaptive set of beliefs, emotions, and somatic responses, it is stored again, overwriting the original memory of the trauma.

EMDR is typically delivered in 60- to 90-minute sessions, although shorter sessions have been used successfully. The number of sessions varies with the complexity of the trauma being treated. For an isolated, single traumatic event, one to three sessions may be sufficient for treatment. However, when the trauma involves repeated traumatic events, such as combat trauma and physical, sexual, or emotional abuse, many more sessions may be needed for comprehensive treatment. Although all the studies reviewed for this summary involved adults, the intervention was also developed for use with children and adolescents.