17 `Eye Movement Desensitisation & Reprocessing (EMDR)`

Eye Movement Desensitisation &
David Blore PhD
Consultant Psychotherapist
Specialist lecturer, Teesside University
3rd year DClin Psych
Teesside University 16.11.12
Introductory discussion
• Who has heard of EMDR?
• What have you heard?
• NICE recommendations for PTSD
• March 2005
• Reviewed December 2011
• PTSD, ASD, Adjustment Disorder (DSM IV TR)
• Volunteers needed after the break!
Objectives and Agenda
What is, and isn’t, EMDR
The eight phase model
Reconsolidation of Memory; Adaptive Information Processing
Video parts 1 & 2
Video part 3
Potential of EMDR
Further reading/ resources
What EMDR isn’t
Exposure therapy
A commercial gimmick
What EMDR isn’t
The eye movements are irrelevant
Dismantling studies originally focussed on the role of eye movements
(e.g. Tallis & Smith 1994). The conclusions were that the eye
movements were redundant and thus EMDR amounted to a form
of imaginal exposure.
However, Propper & Christman (2008) and Gunter & Bodnar (2009)
have shown EMs have a direct effect on memory retrieval,
attention flexibility, quality and vividness of the memory itself.
Jeffries & Davis (2012) have argued that eye movements are an
essential component of EMDR
What is EMDR?
• It is an eight phase treatment:
Commencing with history taking, preparation and specific target
assessment and then moving to desensitisation, installation and
body scan, finishing with closure and starting the following session
with a re-evaluation
It follows that EMDR is not just “finger wagging”…
What is EMDR?
• It is an information processing based therapy:
EMDR did not grow out of a theory prediction but from an accidental
and replicable observation:
“…disturbing thoughts lost much of their power when I engaged
in a particular kind of repeated saccadic (i.e. rapid and
rhythmic) eye movements. Indeed, these thoughts disappeared
altogether and if deliberately retrieved, no longer seemed
valid.” (Shapiro 1991 p.133, contents of brackets added; see also Shapiro 1989b)
General agreement that EMDR functions according to the Adaptive
Information Processing (AIP) theory*, which was devised specifically
to account for the changes observed in EMDR
(Shapiro 2001; Dworkin 2005, pp223-4)
What is EMDR?
Although AIP is the acknowledged theoretical framework to explain how
EMDR works, it is by no means the only theory to account for
observed changes.
Nine other theoretical mechanisms have been identified (Shapiro 2001, pp. 324-38)
of which Reconsolidation of Memory Theory (Cahill & McGaugh 1998) is the
arguably the best neurophysiological theory of psychological change
What is EMDR?
Open access searchable database of everything EMDR:
Nearly 7000 references
Excellent efficacy summary:
Includes all current RCTs and meta analyses plus commentary
Demonstration of EMDR
Volunteers needed!
Check on safety
Old anxiety
Phobia – to include float back
Demonstration of EMDR
What is the potential of EMDR?
• PTSD and similarly obviously traumatic
• Relapse prevention in OCD
• Ultra low BMI eating disorders
• Etc.
Requires a modified definition and conceptualisation of “trauma”:
Unresolved distressing life events on a ‘distress continuum’ give rise to
mental health dis-ease
What is the potential of EMDR?
Phobias and the 70-30 ‘rule’
MUPS and pain generally particularly phantom limb
Clients with ‘locked-in syndrome’
But this only addresses negative mental health…
Maslow’s criticism
of the ‘negative only’ view of mental health:
• “The science of psychology has been far more successful on
the negative than on the positive side. It has revealed to us
much about man’s shortcomings, his illness, his sins, but little
about his potentialities, his virtues, his achievable aspirations,
or his full psychological height. It is as if psychology has
voluntarily restricted itself to only half its rightful jurisdiction,
and that, the darker, meaner half.” (Maslow 1954)
What is the potential of EMDR?
• Performance enhancement – the British Olympic team
has an EMDR Consultant
• Personal Development – business coaching
• EMDR and mindfulness go well together
• Positive Psychology & EMDR – www.linkedin.com group
• Etc.