An essential part of recovering from the experience of traums is believed to be the treatment of fear-related responses, particularly the overcoming of dysfunctional avoidance of stimuli related to the trauma. Actual "period" (or duration) of exposure is less important than the actual exposure itself -- aim for "quality", or "richness" of experience if you can (if it's imaginal exposure -- using your imagination, try to incorporate as many of the stimuli associated with the feared situation as you can -- hence, carrying out the exposure in a situation where you can fully concentrate is an advantage, but, if this is too much for you, a variety of ways can be found around it -- again, aim for rich, though brief exposure as the "necessary minimum"). EMDR can in some ways be considered one approach to these difficulties of exposure versus tolerability of exposure.
A variety of therapeutic techniques have been used to bring about this exposure, the point of the exposure being to not only overcome dysfunctional or problematic attempts at coping with those stimuli, through avoidance, but a way of bringing new meaning to those experiences. For example, someone hurt by those close to one, as a result of sexual abuse by a caregiver, say, may later try to avoid all close relationships, or experience great reluctance to engage in physical intimacy, which could be a major stumbling block to enjoying happy, successful, and longlasting marital relations. Bringing "new meaning" to previous experiences of abuse might involve showing how the person emotionally "shut down" during the abuse, and thus did not enjoy the experience -- the abuser might have warned the victim that they would be blamed for the abuse because they "enjoyed" and "took part" in the abuse -- and thus exercised what power and control they had during the experience -- something that could be helpful in dealing with feelings of guilt and shame. One of the therapeutic techniques that has been used to facilitate this comgination of exposure and reprocessing is "Eye Movement Desensitisation and Reprocessing" -- more commonly known as EMDR.
Eye Movement Desensitization and Reprocessing (EMDR) appears as simple as a therapist waving a hand in front of a patient's face while the patient recounts details of the trauma, but it is what happens at the psychological level that is much more complicated and controversial. EMDR is currently endorsed both under the VA/DoD Clinical Practice, and the Substance Abuse and Mental Health Services Administration Guidelines (SAMHSA) for the Management of Post-Traumatic Stress Disorder as a treatment of "significant benefit."
Eye Movement Desensitization and Reprocessing (EMDR) is a relatively new clinical treatment that has been scientifically evaluated primarily with combaat trauma survivors. EMDR's originator was Dr. Francine Shapiro, and complicating its evaluation has been a proprietary training program restricting its investigation to only those who have gone through the training. When considering the possibility that EMDR may be helpful for you or someone you know, an important first step is to speak with therapist(s) who have had advanced EMDR training and are experienced in selecting clients and successfully conducting EMDR. Whether or not EMDR achieves results beyond that of exposure alone remains controversial.
Briefly, in EMDR a qualified therapist guides the client in vividly but safely recalling distressing past experiences ("desensitization") and gaining new understanding "reprocessing") of the events, the bodily and emotional feelings, and the thoughts and self-images associated with them. The "eye movement" aspect of EMDR involves the client moving his/her eyes in a back-and-forth ("saccadic") manner while recalling the event(s).
EMDR has shown evidence of therapeutic effectiveness in several scientific studies. After receiving between one and twelve sessions of EMDR, many (but not all) adolescents and adult clients have reported a variety of benefits. EMDR recipients in these studies have included adult and adolescent child and domestic abuse survivors, combat veterans, rape and violent assault survivors, victims of life-threatening accidents and disasters, and individuals with severe panic attacks or depression. Some of these individuals were seeking help from the VA, from their HMO medical plan, or from mental health specialists at clinics or counseling centers, while others were not actively seeking health care or mental health treatment, but agreed to participate in a research study in order to receive treatment.
EMDR is not a certain cure, nor always effective. In even the most successful studies approximately 25-33% of participants report no clear benefit. EMDR's most consistent benefit is helping clients to feel better about themselves because they feel less troubled by and more able to cope with trauma memories. EMDR is less likely to actually change how much bodily arousal and mental hypervigilance trauma survivors experience -- although such changes do occur at times.
EMDR also is not always the best treatment to deal with PTSD or related psychological problems. One study with Vietnam military veterans diagnosed with PTSD showed EMDR to be no better than other widely used forms of counseling. Another study with spider phobic children showed EMDR to be less helpful than an "in vivo exposure" treatment in which the children gradually and safely saw and touched a variety of real or artificial spiders.
EMDR involves carefully but intensively confronting very frightening or disturbing memories. Some clients report that the eye movement feature of EMDR helped them to rapidly feel less terrified, intimidated, or hopeless while undergoing this therapeutic "exposure" to sources of fear, anxiety, or depression. However, several studies suggest that "direct therapeutic exposure" by vividly and safely confronting stressors without eye movements is equally as effective as EMDR. These studies, with combat veterans or civilian trauma survivors diagnosed with PTSD, and with adults with phobias or panic disorder, raise the question of whether eye movements are essential to the positive results that can occur following EMDR.That question remains unanswered.
There is a shortage of longterm follow up studies, with that of Macklin et al (2000)showing that, five years after treatment, not only were gains in therapy not maintained, but some patients even got worse.
Further information on EMDR, from EMDR practitioners, can be found >here -- [LINK].
Personal stories can be found via this link -- [LINK]
If you or someone you know are considering undergoing EMDR, you should be aware, however, that PTSD is a complex and devastating disorder. No single procedure can "cure" PTSD. The best treatment plan is based upon a thorough professional assessment, and may include individual therapies such as EMDR or therapeutic exposure, but also a range of other appropriate services such as group and family therapy, addiction care, medication, stress and anger management, vocational therapy, and health care. EMDR, like any other therapy, should be done with these basic guidelines:
- with a goal of helping the survivor make sense of confusing disturbing experiences
- with an emphasis on gaining self-esteem and personal empowerment
- vividly and without avoiding any aspect of the experience, however stressful
- guided by the survivor's desire for healing, not as a test of strength or stamina
- with an emphasis upon helping the survivor find realistic new hope and optimism
- free from pressure, demands, manipulation, or criticism from the therapist
- with a goal of helping the survivor develop accurate and realistic self-understanding
- guided by the survivor's bodily and emotional feelings and awareness
- at an intensity and pace that the survivor feels is helpful, not overwhelming
- guided by an active and involved therapist