Eye Movement Desensitisation and Reprocessing
Traumatic memories are held in an unprocessed, state-specific form, and an eight-phase protocol pairing brief attention to the memory with bilateral stimulation is proposed to enable the brain’s natural information-processing system to integrate them.
It works. The argument is entirely about why — and the eye movements may not be the reason.
Who built it
Francine Shapiro
1948–2019Psychologist
Noticed in 1987 that spontaneous eye movements during a walk seemed to reduce the intensity of her own distressing thoughts, developed a protocol around the observation, and built it into one of the most widely disseminated trauma treatments in the world.
EMDR
Theory of personality
The Adaptive Information Processing model proposes an innate system that metabolises experience into adaptive memory networks. Under high arousal the system is overwhelmed, and the memory is stored unprocessed — with its original images, affect, sensations and beliefs intact and unlinked to adaptive information. Current triggers activate the unprocessed network directly, which is why a trauma memory feels present rather than past.
Theory of psychopathology
Pathology consists of unprocessed memory networks. Once processed, the memory remains but loses its charge and its present-tense quality, and the associated negative belief — "I am powerless", "it was my fault" — is replaced by an adaptive one that the person can actually feel rather than merely assert.
Theory of change
The eight phases
- 1History taking and treatment planning — identifying targets, past, present and future.
- 2Preparation — stabilisation, resourcing, the safe/calm place, and explaining the method.
- 3Assessment — for the chosen target: the image, the negative cognition, the desired positive cognition, the validity of that cognition (VoC 1–7), the emotion, the subjective distress (SUD 0–10), and the body location.
- 4Desensitisation — sets of bilateral stimulation with brief attention to the memory, following wherever association leads, until SUD reaches 0.
- 5Installation — strengthening the positive cognition until VoC reaches 7.
- 6Body scan — processing any remaining physical residue.
- 7Closure — returning to stability at the end of every session, whether or not processing is complete.
- 8Re-evaluation — checking the target at the start of the next session.
The mechanism debate
Working memory taxation
- The best-supported account
- Dual attention loads working memory, degrading the vividness and emotionality of the recalled image
- Predicts that any sufficiently taxing dual task works — and studies find that it does
- Supported by laboratory analogue work
Other proposals
- Orienting response and REM-like processing — theoretically attractive, weakly supported
- Interhemispheric communication — largely discredited
- Simply an efficient form of exposure with cognitive restructuring
- Memory reconsolidation — plausible and hard to test in humans
Key concepts
The vocabulary you need to read the literature and to be understood in supervision.
Where it sits in the transtheoretical grid
Which change processes the system leans on, and at what level of content it aims.
- Counterconditioning
Substituting an incompatible response for the problem response - relaxation, assertion, exposure, defusion, opposite action.
- Catharsis / dramatic relief
Experiencing and expressing affect about the problem, whether by corrective emotional experience or by evoking what has been avoided.
- Consciousness raising
Increasing information about oneself and the problem - feedback, interpretation, education, observation.
- Helping relationship
Being open and trusting about problems with someone who cares; the relationship as vehicle, and as medicine in its own right.
- Symptom & situational problems
- Maladaptive cognitions
- Intrapersonal conflicts