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Spotlight on the Treatment of PTSD with Eye Movement

written by: Elise M. • edited by: Paul Arnold • updated: 5/18/2011

What can you expect from PTSD treatment with Eye Movement Desensitization and Reprocessing Therapy? Learn here about the theories that support the efficacy of this treatment, how it works, and why it is helpful to patients with PTSD.

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    What is Eye Movement Therapy?

    Eye Movement Desensitization and Reprocessing (EMDR) Therapy is an integrative psychotherapy that combines aspects of cognitive therapy, psychodynamic therapy, imaginal exposure, and somatic therapies. Other orientations of psychotherapy may also be included depending on the client’s particular needs.

    EMDR is based on the theory that when we are unable to cope with a traumatic event, we may also inadequately process it in our brains. Instead of the memory being processed as a distributed memory network, it is isolated. Because of this isolation the individual is unable to process it fully and continues to re-experience and be disturbed by it.

    EMDR aims to support processing of this isolated memory by integrating the traumatic memory with adaptive information stored in other memory networks or introduced to the client through therapy. When the isolated memory is integrated with new brain memory connections, it changes the memory and decreases its ability to debilitate the patient.

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    What to Expect from EMDR Therapy

    EMDR treatment length depends on the pervasiveness of the trauma. If one traumatic event occurred, it is possible that one month of EMDR sessions may suffice. If multiple or chronic prolonged abuse is present, then weekly sessions over many months may be warranted.

    Treatment is done systematically using multiple treatment components. The first component is taking a full client history and creating a treatment plan. This is done collaboratively between the patient and clinician. The second stage involves the therapist educating the client on what they will expect, as well as teaching them new coping techniques for them to utilize during treatment.

    The third stage involves the client determining a central negative cognition and image closely related to the traumatic event. These will be used to activate the traumatic memory during EMDR. The client then also chooses a positive self-statement that is healthy and empowering. The next phase involves performing the EMDR sessions.

    During EMDR sessions the client focuses on their traumatic memory, often utilizing the negative cognition and image previously discussed. During this period, the therapist has the patient attend to “dual attention stimuli”. These can include having the patient move their eyes from side to side, focus on alternate hand tapping, or listen to bilateral auditory tones. Each session lasts fifteen to thirty seconds.

    Bilateral visual or auditory stimulation is used to evoke neurological and physiological changes in the patient which may aid in the reintegration and processing of the traumatic memory. This reasoning is currently under debate, as some believe that it is just the reexposure to the traumatic memories which help desensitize the patient.

    After each session, the therapist and client discuss the emotions, bodily sensations, thoughts, and images that arose during the session. If a particularly traumatic experience arises, it is used as the focus of the next fifteen to thirty second EMDR session. At the end of each session, the client is also asked to rate their distress level, as well as how much they believe their negative and positive cognitions to be true. The EMDR sessions continue to occur until the client describes either a maximum and almost intolerable level of distress, or no distress at all.

    If the trauma is not fully processed by the end of the session, the therapist helps the patient return to a relaxed state using calming and relaxation coping techniques. At the beginning of each new session the therapist and patient will reevaluate their experiences during the prior week and how much the traumatic memories impacted them that week. New memories or experiences that may have surfaced are also explored and possibly added as targets during the next EMDR sessions.

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    How Does It Help PTSD?

    EMDR was specifically developed to aid individuals to process traumatic events that are debilitating them. PTSD treatment involves re-experiencing the trauma so that the patient will become desensitized to it and eventually have the memory but not relive the traumatic experiences surrounding the memory. EMDR adds to this the introduction of positive cognitions and treating the patient in both the context of the past, present, and future. By this, the EMDR practitioner integrates how the trauma may effect the clients’ future as well as how it is currently effecting them. Numerous studies have been done which show that it is an effective treatment method, although the theory behind why bilateral stimulation works is still under debate.

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    References

    Shapiro, Francine. EMDR: Eye Movement Desensitization of Reprocessing: Basic Principles, Protocols and Procedures. Guilford Press, 2001.

    EMDR Institute, http://www.emdr.com/.