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EMDR

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Eye movement desensitisation and reprocessing

EMDR ( eye movement desensitisation and reprocessing) is an effective therapy for relieving the symptoms of trauma (especially post-traumatic stress disorder), whose positive effects have been scientifically validated in a number of well-controlled studies. EMDR therapy was founded in 1987 by Francis Shapiro. During the therapy, bilateral stimulation is used, which means that the patient has to make horizontal eye movements during the therapy while recalling traumatic memories. Tactile or auditory stimulation are also used as types of bilateral stimulation.

Standard EMDR protocol

    • Reviewing the patient's history

    • Assessing suitability for EMDR therapy

    • Preparing for therapy

    • Asking the patient to recall a negative memory

    • Identify the most difficult and painful moment and the negative cognitions attached to it and belonging to that moment.

    • Also identify positive cognition and rate how much they believe in it on a scale.

    • Assess the subjective distress, the associated memories and try to identify where the distress is located in his/her body.

  • Followed by a desensitisation phase

    • The patient is asked to recall the negative memory along with the negative cognition and the location of the distress in the body, while following the therapist's fingers with the eyes (an alternative is to perform a task that puts a strain on working memory)

    • After each set of eye movements, the patient tells his observations

    • Once the distress has been sufficiently reduced, the therapist can proceed to the next phase (this may take several sessions)

  • Installation phase

    • By supporting eye movements (or an alternative task that puts a strain on working memory), positive cognition is installed

  • Addressing distress that remains in the body.

  • End of therapy.

  • Assessing the success of recovery of a previous memory and the need for re-therapy.

How does EMDR work?

EMDR is based on the Adaptive Information Processing Model( AIP)

The basic premise of the AIP model is that there is an information processing system in the brain that assimilates new experiences into an existing memory network. When the system is working properly, current sensory perceptions are successfully integrated and linked to pre-existing knowledge, allowing us to make sense of our experience. The problem arises when painful experiences are not processed in the right way and become frozen in their own neural network, unable to connect to the rest of the memory networks that store adaptive information. Shapiro (2001) suggests that in such a case, a number of internal and external factors may trigger the original perception, leading to maladaptive emotional and cognitive states, with associated symptoms such as intrusive thoughts, nightmares, anxiety, etc. Non-functional stored memories are thus thought to underlie maladaptive responses, as the perception of the current situation is automatically linked to associative memory networks. 

The negative belief (e.g. "I am not worthy of love") is thus not the cause of the current dysfunction, but a symptom resulting from unprocessed life events that contain this affect and perspective. Emotions, attitudes and beliefs are thus understood as manifestations of physiologically stored perceptions and reactions to them, in memory networks (Solomon and Shapiro, 2008). 

Using EMDR

EMDR therapy can only be used by suitably qualified (clinical) psychologists or psychotherapists who have completed a 7-day EMDR training course and have also received appropriate supervision. 

EMDR AND FND

Given the clinically proven efficacy of EMDR treatment for PTSD (Korn, 2009; Seidler and Vagner, 2006; Valiente-Gómez et al., 2017), it is assumed that the therapy would also be effective for FND patients who have associated PTSD and for FND patients who have associated dissociative symptoms. However, there are a small number of studies that have examined the efficacy of EMDR for the treatment of functional neurological disorders.

    • Cope, S. R. (2020). EMDR as an adjunctive psychological therapy for patients with functional neurological disorder: illustrative case examples. Journal of EMDR Practice and Research.

    • Korn, D. L. (2009). EMDR and the treatment of complex PTSD: A review. Journal of EMDR Practice and Research, 3(4), 264-278.

    • Myers, L., Sarudiansky, M., Korman, G., and Baslet, G. (2021). Using evidence-based psychotherapy to tailor treatment for patients with functional neurological disorders. Epilepsy & Behavior Reports, 16, 100478.

    • Seidler, G. H., and Wagner, F. E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioural therapy in the treatment of PTSD: a meta-analytic study. Psychological medicine, 36(11), 1515-1522.

    • Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd ed.). New York: Guilford

    • Solomon, R. M., and Shapiro, F. (2008). EMDR and the adaptive information processing modelpotential mechanisms of change. Journal of EMDR practice and Research, 2(4), 315-325.

    • Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Perez, V., and Amann, B. L. (2017). emdr beyond PTSD: A systematic literature review. frontiers in psychology, 8, 1668.