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woman with anxietyOver the last few decades, the concept of psychological trauma has been receiving considerable attention from both the media and the scientific community [1].

A survey carried out in 2017 by the WHO World Mental Health on nearly 70,000 adults from 24 countries including both low and high economic status [2] has shown that, at some stage in their life, over 70% of the participants had experienced trauma, which makes clear that exposure to a very upsetting event in one’s lifetime is quite common.

Exposure to events such as violence, disasters, acts of terrorism, accidents, sexual abuse, and war can induce in a person an extreme sense of powerlessness and even a disruption of beliefs and expectations in life [1].

Victims of traumatic experiences often lose their sense of invulnerability, their trust in a benevolent world, and their idea that other people can be trusted [3]. Moreover, these psychological symptoms are most often accompanied by a significant increase in anxiety and can lead to long-term disability [4].

Origins of EMDR and Clinical Research Supporting Its Use

It was in 1989, when Francine Shapiro, a psychologist from California, was taking a stroll in the woods. She had been occupied with several disturbing thoughts and feelings and all of a sudden she started noticing that, as she shifted her eyes from one scene to another, from one focus point to another focus point, she could feel that her anxiety levels drifted [5].

Intrigued by this discovery, she started experimenting with her clients, gradually developing a technique that was eventually introduced as a therapeutic intervention for trauma with the publication of the first randomized controlled trial [6].

Further clinical research has demonstrated the usefulness EMDR in a wide variety of psychological conditions and stress-induced physical disorders with medically unexplained symptoms, for example in patients with a history of harsh physical punishment (i.e., pushing, grabbing, shoving, slapping, hitting) in the absence of more severe child maltreatment, which is most often associated with emotional and personality disorders as well as substance abuse/dependence [7].

EMDR is today recommended as an effective treatment of trauma by numerous organizations, including the American Psychiatric Association[8], the Department of Defense [9] and the World Health Organization [10].

How does EMDR Work?

EMDR Therapy consists of eight treatment phases, each of which can be further subdivided as per the client’s needs [11].

  • Phase 1: History and planning

In this phase, the therapist takes a detailed history of the client, in the attempt to establish the focus points for EMDR processing, that is, to make the client recall the cause of distress or trauma. This offers the therapist the opportunity to identify the core therapy targets and also gather enough information to decide how long the treatment will take.

  • Phase 2: Counseling

Throughout this phase, the therapist will assure the client that there are several ways to take care of his/her stressful experiences and of the distressing memories attached.

The therapist will also paint different scenarios and backgrounds which the client could use during the treatment. Sometimes, deep breathing and mindful relaxation are also suggested.

  • Phases 3-6: Treatment

At this stage, the client is ready to undergo treatment with three main aspects of the traumatic experience in his mind:

  1. A faint, vivid picture related to the traumatic memory
  2. The negative thoughts associated with the experience
  3. All the emotions and sensations attached to the negative thoughts

The therapist then asks the client to divert all his/her energy and emotions into thinking about these three aspects of the trauma, while engaging in specific eye movements.

Once the eye movement task has been completed, the therapist will ask the client to focus on what is left behind in his/her mind. Whatever the client reports will automatically become the next focus for the treatment. If the client reports no particularly distressing thought or memory, he/she is made to hold tightly to a positive affirmation about herself/himself.

  • Phase 7: Closure

With the treatment session approaching its end, the client is told to keep a log and to regularly practice the techniques learned during phase 2.

  • Phase 8: Evaluation/Next Session

This takes place a week or so after phase 7. Progress made so far is noted and then the session starts again.

Conclusions

EMDR is a psychotherapeutic approach that qualified therapists can employ to treat the disruptive effects of psychological trauma and other stressful life experiences. Well-conducted clinical research indicates that EMDR can significantly contribute to alleviate psychological suffering and improve wellbeing in relatively short periods of time.

 

References

  1. Kleber, R.J., Trauma and Public Mental Health: A Focused Review. Front Psychiatry, 2019. 10: p. 451.
  2. Kessler, R.C., et al., Trauma and PTSD in the WHO World Mental Health Surveys. Eur J Psychotraumatol, 2017. 8(sup5): p. 1353383.
  3. Janoff-Bulman, R., Shattered assumptions. 1992: Free Press.
  4. Vitriol, V., et al., Depression and psychological trauma: an overview integrating current research and specific evidence of studies in the treatment of depression in public mental health services in chile. Depress Res Treat, 2014. 2014: p. 608671.
  5. Shapiro, F., The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. Perm J, 2014. 18(1): p. 71-7.
  6. Shapiro, F., Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Trauma Stress. , 1989. 2(2): p. 199–223.
  7. Afifi, T.O., et al., Physical punishment and mental disorders: results from a nationally representative US sample. Pediatrics, 2012. 130(2): p. 184-92.
  8. Ursano, R.J., et al., Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Am J Psychiatry, 2004. 161(11 Suppl): p. 3-31.
  9. Department of Veterans Affairs, D.o.D., A/DoD clinical practice guideline for management of post-traumatic stress. 2010, Veterans Health Administration: Washington, DC.
  10. WHO, Guidelines for the management of conditions specifically related to stress. 2013: Geneva, Switzerland.
  11. Valiente-Gomez, A., et al., EMDR beyond PTSD: A Systematic Literature Review. Front Psychol, 2017. 8: p. 1668.