Eye Movement Desensitization and Reprocessing (EMDR) - Detailed Report

Phases of Treatment

• The first phase is a history-taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan.
• During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these.
• In phase three through six, a target memory (or image) is identified and processed using the following EMDR procedures:
• The client identifies four things: 1) the most vivid visual image related to the memory (if available), 2) a negative belief about self, 3) related emotions and body sensations, 4) preferred positive belief.
• The client is instructed to focus on the image related to the memory, the negative thought, and the body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Although eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The client is instructed to just notice whatever happens.
• The clinician then instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report, the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. Client-directed association refers to following what the client responds to after doing the eye movements. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing.
• When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements.
• In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.
• In phase eight, re-evaluation of the previous work, and of progress since the previous session, takes place. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. (Excerpt obtained from EMDR website.)

Aberghaderi, N., Greenwald, R., Rubin, A., Dolatabadim S., & Zand, S.O. (In press). A comparison of CBT and EMDR for sexually abused Iranian girls. Clinical Psychology and Psychotherapy.

Fourteen Iranian girls ages 12-13 who had been sexually abused were randomly assigned (with some adjustments to promote equivalence between groups) to receive up to 12 sessions of Cognitive Behavioral therapy (CBT) or EMDR treatment. Assessment of post-traumatic stress symptoms and problem behaviors was completed at pre-treatment and 2 weeks post-treatment. Both treatments showed large effect sizes on the post-traumatic symptom outcomes, and a medium effect size on the behavior outcome, all statistically significant. A non-significant trend on self-reported post-traumatic stress symptoms favored EMDR over CBT. Treatment efficiency was calculated by dividing change scores by number of sessions; EMDR was significantly more efficient, with large effect sizes on each outcome. Limitations include a small sample, single therapist for each treatment condition, no independent verification of treatment fidelity, and no long-term follow-up.

Chemtob, C.M., Nakashima, J., & Carlson, J.G. (2002). Brief-treatment for elementary school children with disaster-related PTSD: A field study. Journal of Clinical Psychology, 58, 99-112.

This study was conducted using two groups in an ABA design plus a 6 month follow-up. EMDR was found to be an effective treatment for children with disaster-related PTSD who had not responded to another intervention. Measures included the Revised Children's Manifest Anxiety Scale and the Children's Depression Inventory. This is the first controlled study for disaster-related PTSD, and the first controlled study examining the treatment of children with PTSD.

Fernandez, I., Gallinari, E., & Lorenzetti, A. (2004). A school- based EMDR intervention for children who witnessed the Pirelli building airplane crash in Milan, Italy. Journal of Brief Therapy, 2, 129-136.

A non-randomized trial of a group intervention of EMDR was provided to 236 schoolchildren exhibiting PTSD symptoms 30 days post-incident (witnessing Pirelli building airplane crach in Milan Italy). At four-month follow up, teachers reported that all but two children showed a return to normal functioning after treatment.

Greenwald R. (1998). Eye movement desensitization and reprocessing (EMDR): New hope for children suffering from trauma and loss. Clinical Child Psychology and Psychiatry, 3(2), 279-287.

Case study involving a 10-year-old girl who was diagnosed with posttraumatic stress disorder. She had one introductory and five treatment sessions over a 2 month-period, and was reassessed at 2 months after the end of treatment and was assessed with the Parent Report of Post-traumatic Symptoms (PROPS), the Child Report of Post-traumatic Symptoms (CROPS), the Subjective Units of Distress Scale (SUDS), and the Problem Rating Scale (PRS).

Scheck, M., Schaeffer, J.A., & Gillette, C. (1998). Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11, 25-44.

To study the efficacy, of Eye Movement Desensitization and Reprocessing (EMDR) with traumatized young women, 60 women between the ages of 16 and 25 were randomly assigned to two sessions of either EMDR or an active listening (AL) control. Factorial ANOVA (analysis of variance) interaction effects and simple main effects for outcome measures (Beck Depression Inventory, State-Trait Anxiety Inventory, Penn Inventory for Posttraumatic Stress Disorder, Impact of Event Scale, Tennessee Self-Concept Scale) indicated significant improvement for both groups and significantly greater pre-post change for EMDR-treated participants. Pre-post effect sizes for the EMDR group averaged 1.56 compared to 0.65 for the AL group. Despite treatment brevity, the post treatment outcome variable means of EMDR-treated participants compared favorably with non-patient or successfully treated norm groups on all measures.

Shapiro, F. (2002). EMDR twelve years after its introduction: A review of past, present, and future directions. Journal of Clinical Psychology, 58, 1-22.

Shapiro, F. (2002) In the blink of an eye. The Psychologist, 15(3), 120-125.

Chemtob, C.M., Nakashima, J., Hamada, R.S., & Carlson, J.G. (2002). Brief-treatment for elementary school children with disaster-related posttraumatic stress disorder: A field study. Journal of Clinical Psychology, 58, 99-112.