Eye Movement Desensitization And Reprocessing

Eye movement desensitization and reprocessing (EMDR) is a technique developed by Shapiro [50] on the basis of the observation that lateral eye movements facilitate cognitive processing of traumatic material. It is a form of exposure (desensitization) with evident cognitive components accompanied by rhythmic eye movements. Designed originally as a treatment for traumatic memories, it was called eye movement desensitization (EMD). Its essence was as follows. After identifying a traumatic target memory, the therapist asked the patient to articulate a self-referent negative cognition associated with the memory and a positive cognition to replace the negative one. The therapist then moved his/her fingers back and forth in front of the patient's eyes, instructing the patient to track his/her fingers visually while concentrating on the distressing memory. After each set of 10-12 eye movements, the therapist asked the client to provide ratings of distress and strength of belief in the positive cognition. The therapist repeated this procedure until distress subsided and belief in the positive cognition increased.

According to Shapiro [50], a single 50-minute session of EMD was 100% successful in abolishing distress associated with a traumatic memory in survivors of combat, rape, and childhood sexual or emotional abuse. To explain these impressive results, she hypothesized that the crucial component of the EMD procedure is the repeated eye-movements while the memory is maintained in awareness. Shortly thereafter, Shapiro reconceptualized EMD in terms of accelerated information processing and renamed it eye movement desensitization and reprocessing (EMDR). The shift from EMD to EMDR appears, however, more conceptual than procedural.

Vaughan et al. [51] found no difference among the effects of EMDR, applied relaxation, and ''image habituation training'' in cases of civilian PTSD, although all treatments were better than a wait-list.

EMDR has been controversial for a number of reasons, especially the lack of theoretical foundation for the therapeutic impact of eye movements and the lack of empirical data obtained with reliable methodology. Researchers have compared EMDR to the relationship between therapist and patient used in EMDR technique without eye movements and in most of the studies they did not find differences in the effects [52]. Therefore any efficacy demonstrated by EMDR may be more attributable to the facilitation of information processing than to eye movements. According to one view, what is effective in EMDR (imaginal exposure) is not new, and what is new (eye movements) is not effective [53]. Consistent with this interpretation, a meta-analysis revealed that EMDR produced effects similar to those produced by conventional behavioral and cognitive-behavior therapy treatments for PTSD [54].

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