The Brain and Regulation of Eye Movement

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EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma.

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When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Using the detailed protocols and procedures learned in EMDR training sessions, clinicians help clients activate their natural healing processes.

More than thirty positive controlled outcome studies have been conducted on EMDR therapy. There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense.

Over , clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 25 years. EMDR therapy is an eight-phase treatment. Eye movements or other bilateral stimulation are used during one part of the session. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement REM sleep, internal associations arise and the clients begin to process the memory and disturbing feelings.

In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. EMDR therapy combines different elements to maximize treatment effects. A full description of the theory, sequence of treatment, and research on protocols and active mechanisms can be found in F.

Focus is given to past disturbing memories and related events. Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions. With EMDR therapy, these items are addressed using an eight-phase treatment approach. Client and therapist identify possible targets for EMDR processing. These include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.

Initial EMDR processing may be directed to childhood events rather than to adult onset stressors or the identified critical incident if the client had a problematic childhood. Clients generally gain insight on their situations, the emotional distress resolves and they start to change their behaviors. The length of treatment depends upon the number of traumas and the age of PTSD onset. Generally, those with single event adult onset trauma can be successfully treated in under 5 hours.

Multiple trauma victims may require a longer treatment time. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions.

A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions. These involve the client identifying three things: 1. The vivid visual image related to the memory 2. A negative belief about self 3. Related emotions and body sensations. In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation.

These sets may include eye movements, taps, or tones. The type and length of these sets is different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneouly happens. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track. When the client reports no distress related to the targeted memory, s he is asked to think of the preferred positive belief that was identified at the beginning of the session.

At this time, the client may adjust the positive belief if necessary, and then focus on it during the next set of distressing events. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses. She hypothesizes that humans have an inherent information processing system that generally processes the multiple elements of experiences to an adaptive state where learning takes place.

She conceptualizes memory as being stored in linked networks that are organized around the earliest related event and its associated affect. Memory networks are understood to contain related thoughts, images, emotions, and sensations. The AIP model hypothesizes that if the information related to a distressing or traumatic experience is not fully processed, the initial perceptions, emotions, and distorted thoughts will be stored as they were experienced at the time of the event.

Shapiro argues that such unprocessed experiences become the basis of current dysfunctional reactions and are the cause of many mental disorders.

She proposes that EMDR therapy successfully alleviates mental disorders by processing the components of the distressing memory. These effects are thought to occur when the targeted memory is linked with other more adaptive information. When this occurs, learning takes place, and the experience is stored with appropriate emotions able to guide the person in the future.

In this first study, the focus was on one memory, with effects measured by changes in the Subjective Units of Disturbance SUD scale.

What is the central nervous system (CNS)?

Since that time, EMDR therapy has evolved into an integrative approach that addresses the full clinical picture. Other studies using participants with PTSD e. EMDR therapy is recognized as an effective trauma treatment and recommended worldwide in the practice guidelines of both domestic and international organizations:. American Psychiatric Association EMDR is recommended as an effective treatment for trauma. Bleich, A.

A position paper of the Israeli National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community. Jerusalem, Israel. EMDR is one of three methods recommended for treatment of terror victims. Chambless, D. Update of empirically validated therapies, II.

The Clinical Psychologist, 51, Note that this evaluation does not cover the last decade of research. CREST The management of post traumatic stress disorder in adults. Good evidence was found that the intervention improves important health outcomes and concludes that benefits substantially outweigh harm. Multidisciplinary Guideline Anxiety Disorders. Utrecht, Netherlands. Foa, E.

Background

Since the time of this publication, three additional randomized studies on EMDR have been completed see below. Psychotherapy: An evaluation of three approaches. National Collaborating Centre for Mental Health Post traumatic stress disorder PTSD : The management of adults and children in primary and secondary care. London: National Institute for Clinical Excellence.

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Their review of the evidence also indicated that EMDR leads to an improvement in mental health functioning. United Kingdom Department of Health Treatment choice in psychological therapies and counselling evidence based clinical practice guideline. London, England. Best evidence of efficacy was reported for EMDR, exposure, and stress inoculation. World Health Organization Guidelines for the management of conditions that are specifically related to stress.

Geneva, WHO. Unlike CBT with a trauma focus, EMDR does not involve a detailed descriptions of the event, b direct challenging of beliefs, c extended exposure, or d homework. Twelve studies with PTSD populations assessed treatment maintenance by analyzing differences in outcome between post-treatment and follow-up. Follow-up times have varied and include periods of 3, 4, 9, 15 months, and 5 years after treatment. Of the three studies with combat veteran participants only one Carlson et al. This study found that treatment effects were maintained at 9 months.

The Brain and Regulation of Eye Movement | A. Shakhnovich | Springer

The other two studies provided limited treatment: Devilly, Spence and Rapee provided two sessions and moderate effects at post-test were not maintained at follow-up. Pitman et al. It appears that the provision of limited treatment may be inadequate to fully treat the disorder, resulting in remission of the partial effects originally achieved. There is much anecdotal information that EMDR therapy is effective in the treatment of specific phobias.

Unfortunately, the research that has investigated EMDR treatment of phobias, panic disorder, and agoraphobia has failed to find strong empirical support for such applications. Although these results are due in part to methodological limitations in the various studies, it is also possible that EMDR therapy may not be consistently effective with these disorders.

De Jongh, Ten Broeke, and Renssen suggest that since EMDR therapy is a treatment for distressing memories and related pathologies, it may be most effective in treating anxiety disorders which follow a traumatic experience e.

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