(2015). Wilson et al. In recent years, studies have found accumulating evidence on the contribution of BLS (and in particular the EMs) to treatment gains, including a meta-analysis of 26 randomized controlled trials that found a significant contribution of the EMs in processing emotional memories (Lee and Cuijpers, 2013). Please click on the link below to read the latest EMDR meta-analysis. A recent meta-analysis was conducted by Cuijpers et al. EMDR Treatment: Less Than Meets the Eye? | Quackwatch The imaging findings are consistent with previously described imaging changes of psychotherapy on anxiety disorders. Post-treatment reductions of clinical scores and psychophysiological response. In the absence of arousal, neutral memory vividness did not decrease after recall + EM relative to recall only. EM effects of taxing WM on disturbing memories do no differ between PTSD and other metal disorders. recall + fast EM, recall + slow EM, or recall only. Results have described a restoration of the cortical control over the hyper aroused subcortical limbic structures (Pagani et al., 2015; Amano and Toichi, 2016b; Laugharne et al., 2016; Rimini et al., 2016; Thomaes et al., 2016; Bossini et al., 2017). Results: Eighty-seven studies were selected for review and classified into three overarching models; (i) psychological models (ii) psychophysiological models and (iii) neurobiological models. Littel M., Kenemans J. L., Baas J. M. P., Logemann H. N. A., Rijken N., Remijn M., et al.. (2017a). van den Hout M. A., Engelhard I. M., Rijkeboer M. M., Koekebakker J., Hornsveld H., Leer A., et al.. (2011b). Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder. Some examples of this are reviews focusing on the effect of the EMs on the therapy (Jeffries and Davis, 2013; Lee and Cuijpers, 2013), and on the physiological (Elofsson et al., 2008) and the neurobiological correlate of EMDR (Bergmann, 2008; Pagani et al., 2013). 11. Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. Eye movement during recall reduces objective memory performance: an extended replication. Moher D., Liberati A., Tetzlaff J., Altman D. G., PRISMA Group . EMDR therapy is a trauma therapy that is sometimes considered controversial. Pre-, during and post treatment Within and between group. (2015). Similarly one may ask, why is emdr so controversial? Neurobiological correlates of EMDR monitoring - an EEG study. Horizontal EM enhance the monitoring and dual processing of source memories. The authors suggested that the effectiveness of EMDR might be associated with the reduction of lateral prefrontal cortex over activation during trauma-related recall. The length of an individual treatment session is typically 5090 min, and single memories are typically processed within one-to-three sessions. Treatment with EMDR was followed by a significant reduction of subjective disturbance; trauma related symptoms and reduced psycho-physiological reactivity. EMDR therapy modulates the default mode network in a subsyndromal, traumatized bipolar patient. This theory proposes a central executive system responsible for the integration and coordination of information stored in different slave subsystems. What disorder is EMDR most commonly used to treat? In subsequent years, EMD grew into EMDR in recognition of its hypothesized memory reprocessing effects, and evolved toward a structured eight-phase approach using standardized procedures to address the past, present, and future aspects of a traumatic memory (Shapiro, 2001). Fast EMs produce significant decrease of emotional intensity. EMDR Therapy (Eye Movement Desensitization & Reprocessing) - WebMD In spite of initial controversies, the efficacy of EMDR treatment for PTSD is now well documented (e.g., Shepherd et al., 2000; Davidson and Parker, 2001; Bradley et al., 2005; Novo Navarro et al., 2016). Although the reviewed models, often overlapping with each other, suggest directions for future research, there is a need of advocating for conceptual clarity and consistency. performed the first near-infrared spectroscopy (NIRS) study to monitor brain hemodynamic changes related EMDR treatment during memory recall. These authors have suggested a similar role to other forms of BLS (i.e., tactile or auditory) in eliciting the OR. Herkt D., Tumani V., Grn G., Kammer T., Hofmann A., Abler B. EM did not improve auditory and visual consolidation of memory, undermining this WM taxing as a mechanism of action of EMDR. van Schie K., van Veen S. C., Engelhard I. M., Klugkist I., van den Hout M. A. Is art therapy like EMDR? Low level electrocortical amplitude was observed during EMDR. Effects of eye movement desensitization and reprocessing (EMDR) treatment in chronic pain patients: a systematic review. Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. EMs affect intrusive images about the future. Studes examinig the mechanism of action of EMDR were identified using PubMed, ScienceDirect, Web of Knowledge and Scopus databases. During EMDR memory retention of the traumatic event moves from regions with implicit emotional valence to association areas in which the experience is integrated and consolidated. Nardo et al. The search terms were selected from the thesaurus of the National Library of Medicine (Medical Subject Heading Terms, MeSH) and the American Psychological Association (Psychological Index Terms) and included the terms eye movement desensitization and reprocessing, EMDR, mechanism, action, effects, and correlates. The final search equation was defined using the Boolean conectors AND and OR following the formulation: (eye movement desensitization and reprocessing OR EMDR) AND (mechanism OR action OR effects OR correlates). These networks link the thoughts, images, emotions, and sensations associated with experiences. EM resulted in decreased psychophysiological response and reductions on vividness and emotionality in positive and negative memories. Results showed that EMDR had a large effect size when compared to control conditions in the short-term. The BLS effect during fear extinction may rely on taxation of working memory, reducing vividness and emotionality, or may provoke memory reconsolidation. The funding organizations played no role in the study design, data collection and analysis, or manuscript approval. 6. Elofsson U. O., von Schele B., Theorell T., Sndergaard H. P. (2008). Leer A., Engelhard I. M., Lenaert B., Struyf D., Vervliet B., Hermans D. (2017). EMDR provokes (i) an increase of psychophysiological response at stimulation onsets and (ii) stress related arousal during ongoing stimulation. Event-related potentials and EMDR treatment of post-traumatic stress disorder. Activations shifted from frontal to temporal regions over the course of the treatment. Can EMDR make did worse? The efficacy and psychophysiological correlates of dual-attention tasks in eye movement desensitization and reprocessing (EMDR). On EMDR: eye movements during retrieval reduce subjective vividness and objective memory accessibility during future recall. Reducing vividness and emotional intensity of recurrent flashforwards by taxing working memory: an analogue study. Reduction of memory vividness due to recall+EM is also evident from non-self-report data. Schubert S. J., Lee C. W., Drummond P. D. (2008). O'Driscoll G. A., Strakowski S. M., Alpert N. M., Matthysse S. W., Rauch S. L., Levy D. L., et al.. (1998). This was not found for neutral memories. Similarly, there is ongoing controversy on whether the underlying mechanisms in EMDR differ substantially from those operating in trauma-focused cognitive-behavioral therapy [tfCBT] and standard exposure. Reduced sympathetic activation may explain the improvements observed after EMDR. Differential activation between smooth pursuit and saccadic eye movements. Specific increase in activation of the right amygdala for the bilateral alternating auditory stimulation. The dual-attention tasks in EMDR create orienting responses and short-term dearousal which may aid in the processing and integration of trauma memories. On one hand, studies have shown that EMDR produces greater reduction in PTSD symptoms compared to control groups receiving no treatment. Thirty-two papers were classified as psychological models. What is E.M.D.R.? Understanding the Trauma Therapy Practice - The New Pagani M., Di Lorenzo G., Verardo A. R., Nicolais G., Monaco L., Lauretti G., et al.. (2012). On a similar scope, Corrigan has proposed that auditory, visual, and tactile BLS would facilitate the simulation of thalamo-cingulate tracts (Corrigan, 2002). As the most recent American Psychological Association (APA) recommendations on psychological and pharmacological treatments for PTSD in adults ( 2019) caused controversy due to its "conditional" recommendation of EMDR for the treatment of PTSD, a comment and rectification of available literature was also added to this Research Topic ( Dominguez . The information gap in the EMDR controversy. and how these mechanisms can be measured or demonstrated. Is EMDR therapy actually good for PTSD? : r/TalkTherapy - Reddit Therefore, evidence to date seems to conclude that enhanced interhemispheric communication is not driving the changes to traumatic recollections induced by EMs, which highlights the need for more EEG research and/or other neuroimaging techniques. Psychiatry. In recent years, an extension of the interhemispheric connectivity hypothesis have been suggested, including a two-stage cortical coherence model whereby intra-hemispheric changes in the right hemisphere may occur along with interhemispheric changes (Keller et al., 2016; Yaggie et al., 2016). The authors speculated with large scale network modulation, specifically in the default mode network, as a potential neurobiological correlate of successful EMDR therapy. EMs) offer a temporary response aid for imaginal exposure without affecting desensitization. One of these subsystems is the phonological loop, which stores verbal and auditory information. Figure Figure11 shows a flow-chart for the selection of eligible studies. sharing sensitive information, make sure youre on a federal These changes were correlated to neuropsychological scores, suggesting that traumatic events are processed at the cognitive level following successful EMDR therapy. APA Division 12 does not take issue with EMDRs efficacy as an evidence-based treatment for PTSD, it simply questions whether its mechanisms differ from established CBT and Behavioral interventions. EM, eye movements; EMDR, eye movement desensitization and reprocessing; HC, healthy controls; NA, not applicable; OR, orienting response; PTSD, posttraumatic stress disorder; REM, rapid eye movement. 4. Speed differences of EM do not affect recall. Previous systematic reviews and meta-analyses of EMDR have been limited to specific elements and hypotheses or were non-systematic in nature (Gunter and Bodner, 2009; McGuire et al., 2014). Conversely, AIP theory hypothesizes that when the memories are adequately processed, symptoms can be eliminated and integrated. On the other hand, the existing methodologically sound . Lilley S. A., Andrade J., Turpin G., Sabin-Farrell R., Holmes E. A. It is most often used to alleviate symptoms related to trauma and post-traumatic stress disorder (PTSD). Horizontal EM increase true memories and recollection EM also decreased the magnitude of the misinformation effect. The active ingredient in EMDR: is it traditional exposure or dual focus of attention? A series of early EEG studies found that the EMs led to changes in interhemispheric interaction, facilitating in turn retrieval of episodic memories. (2016). What disorder is EMDR most commonly used to treat? Temporal binding via cortical coincidence detection of specific and nonspecific thalamocortical inputs: a voltage-dependent dye-imaging study in mouse brain slices. 8. The Adaptive Information Processing (AIP) model is the theory that guides the EMDR treatment procedures and offers an explanation for the basis of pathology (Shapiro, 1994, 2001, 2007). (2015). EMDR has been repeatedly shown to reduce mental health side effects, especially with PTSD, but it can also have some uncomfortable side effects. How is EMDR different from ART? Novo Navarro P., Marini A. M., Scott J., Landin-Romero R., Amann B. L. (2013). The BLS and specifically the EMs, seem to be not only the distinctive characteristic of EMDR, but also the factor accounting for the faster response in EMDR therapy compared to other psychotherapies (Nijdam et al., 2012). EMDR, or eye movement desensitization and reprocessing, is a type of trauma-focused psychotherapy invented by Francine Shapiro. Physiological studies have found that the EMs are associated with a de-arousal response driven by increased parasympathetic relative to sympathetic changes. Empirical studies of the past decade have shown the thalamus to be centrally involved in the integration of perceptual, somatosensory, memorial, and cognitive processes; a process alternatively referred to as thalamo-cortical temporal binding or neural global mapping (Llins and Ribary, 2001; Llinas et al., 2002). (2011). This normalization was particularly marked in the default mode network, a subset of brain regions that that activate during self-directed mentation and that de-activates during performance of a wide range of cognitive test. EMDR decreased symptoms and increased parasympathetic tone. Based on their individual experience they suggest that the elephant is like a wall, spear, snake, tree, fan or rope. Studies have found that vertical EMs decrease memory emotionality as effectively as horizontal movements, ruling out the vertical EM as main drivers of interhemispheric changes (Gunter and Bodner, 2008). In this theory the OR resets the thalamus, which in turn enhances cortical temporal binding of consciousness leading to both memory retrieval and integration in semantic networks. Combination of Pavlovian and Darwinian theory to explain the effectiveness of EMDR. EMDR: Empirically Supported Treatment or Pseudoscience? See, for example, this meta-analysis of the . Elofsson et al. Depression or sadness. No differences in vividness and emotional valence between all conditions. Pagani M., Di Lorenzo G., Monaco L., Daverio A., Giannoudas I., La Porta P., et al.. (2015). Barrowcliff A. L., Gray N. S., MacCulloch S., Freeman T. C., MacCulloch M. J. Bethesda, MD 20894, Web Policies (2004). (2009). Wilson D. L., Silver S. M., Covi W. G., Foster S. (1996). EMDR was associated with a significant reduction in the right temporal cortex, and a trend toward a reduction in the left orbitofrontal cortex. The stimulation that you do during EMDR brings working memory into play, which degrades both the intensity of the memory and your reaction to it. Eye movement desensitization and reprocessing ( EMDR) is a form of psychotherapy devised by Francine Shapiro in the 1980s that was originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD). Post EMDR reduced OR to novel stimuli and arousal level. This statement has been revised posteriorly, due to the evidence suggesting a similar role for other forms of BLS. Induction of low frequency stimulation by EM can lead to modification of fear memory traces. High-resolution brain SPECT imaging and eye movement desensitization and reprocessing in police officers with PTSD. The OR is a natural attentional reflex that can occur with any novel environmental stimulus and produces a specific set of changes that increase readiness to respond to danger. As such, evidence for a variety of EMDR therapy applications has recently been reported in randomized controlled trials of bipolar disorder (Novo et al., 2014; Moreno-Alczar et al., 2015), psychosis (van den Berg et al., 2015a,b), unipolar depression (Hase et al., 2015), dental phobia (Doering et al., 2013), obsessive compulsive disorder (Nazari et al., 2011), panic disorder (Faretta, 2012), alcohol dependency (Perez-Dandieu and Tapia, 2014), and pain management (Tesarz et al., 2014). Therefore, some authors argue that the claims of no significant effect of the EMs on treatment outcome are unwarranted (Jeffries and Davis, 2013). Pitman R. K., Rasmusson A. M., Koenen K. C., Shin L. M., Orr S. P., Gilbertson M. W., et al.. (2012). The evidence available from each study was analyzed and discussed. van den Berg D. P., de Bont P. A., van der Vleugel B. M., de Roos C., de Jongh A., van Minnen A., et al.. (2015b). Brain functional changes concurrent to EMDR therapy have also been examined with other neuroimaging techniques different to SPECT. EMDR: eye movements superior to beeps in taxing working memory and reducing vividness of recollections. Horizontal saccadic eye movements enhance the retrieval of landmark shape and location information. This model has been proposed to explain the effects of the EMs on the neural networks. In this study, recall with EMs was associated with significant decreases in blood flow in the lateral prefrontal cortex compared to recall without EMs. In another pioneering fMRI study, Landin-Romero et al. Who is EMDR not appropriate for? (2023) - Seminaristamanuelaranda There were no associations between changes in EM-related interhemispheric connectivity and memory performance. Other psychological models have attempted to explain the treatment gains of EMDR through similar learning and adaptive mechanisms, such as the orienting response (OR). This model postulates that humans have an innate information processing system that assimilates new experiences and stores them into existing memory networks in an adaptive state. Eye Movement Desensitization and Reprocessing, or EMDR, is a popular PTSD treatment for patients and clinicians alike. The following . EMs reduced vividness and emotiveness of trauma vs. control conditions. Rogers and Silvers have described in detail the differences between how exposure (a key component of tfCBT) and EMDR protocols are employed (Rogers and Silver, 2002). Evaluating the effect of eye movements on positive memories such as those used in resource development and installation. The effect of EMs is mediated by VSSP taxation. van Schie K., Engelhard I. M., van den Hout M. A. Unfortunately, Dyck did not back up this hypothesis with empirical data. Discussion: Despite the increasing number of studies that published in recent years, the research into the mechanisms underlying EMDR therapy is still in its infancy. The impact of eye movements and tones on disturbing memories involving PTSD and other mental disorders. Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: a meta-analysis of randomized controlled trials. examined changes in brain activity in a sub-syndromal and traumatized bipolar patient following successful EMDR therapy. EMDR has been growing in popularity in recent years and helps the client reprocess traumatic memories. Evidence of a decrease in heart rate and skin conductance responses in PTSD patients after a single EMDR session, Working memory and the vividness of imagery, Working Memory, in the Psychology of Learning and Motivation: Advances in Research and Theory. The impact of taxing working memory on negative and positive memories, [EMDR and cognitive-behavioural therapy in the treatment of panic disorder: a comparison]. have argued that the physiological profile of EMDR fits well with the REM account (Elofsson et al., 2008; Sondergaard and Elofsson, 2008). Visuospatial working memory interference with recollections of trauma. Bryn Mawr, PA 19010, 1062 E. Lancaster Ave., Suite 13-A, Bryn Mawr, PA 19010, Division 12 of the American Psychological Association (APA). 10. Across the entire EDMR significant decreases of psycho-physiological activity was observed. The effects of beta-adrenergic blockade on the degrading effects of eye movements on negative autobiographical memories. Kapoula Z., Yang Q., Bonnet A., Bourtoire P., Sandretto J. First, most studies used in the meta-analysis did not report follow-up data making long-term interpretation of benefits difficult if not impossible. Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment involving visual stimulation that is designed to reduce distress associated with traumatic events. Finally, the values of lagged coherence were negatively associated with subjective units of disturbance and positively associated with parasympathetic activity. Oh et al. EM induced attentional and semantic flexibility facilitates OR and transformations in the clients traumatic memory. EMDR with EM was associated with greater reduction of distress. Support for a two-stage cortical coherence model, integrating findings from other hypothesis and models. Psychological treatments for chronic post-traumatic stress disorder. Pagani M., Hgberg G., Fernandez I., Siracusano Alberto. Andrade J., Kavanagh D., Baddeley A. After removing duplicates (n = 394), RL-R, and AM-A screened titles and abstracts and excluded studies that were considered non-pertinent (n = 74). Consequently, neuroimaging research findings should be considered promising but preliminary and conclusions concerning the EMDR neurobiological correlates speculative. The effect of different conditions of EMs (i.e., saccadic vs. smooth ocular pursuit; horizontal vs. vertical EMs) on episodic memory and interhemispheric activity has been examined in a set of studies using EEG. Christman S. D., Garvey K. J., Propper R. E., Phaneuf K. A. CBT and behavioral practitioners have questioned whether the mechanisms of action underlying EMDR are simply exposure-based and if bilateral stimulation (i.e. Effects of visuospatial tasks on desensitization to emotive memories. (2009). We acknowledge the generous support by the Centro de Investigacin Biomdica en Red de Salud Mental (CIBERSAM), Madrid, Spain. Successful EMDR treatment reduces psychophysiological arousal associated with trauma. These physiological changes are compatible with a de-arousal response following EMDR treatment. RL-R, AM-A, MP, and BLA have been invited as speakers in national and international EMDR conferences. Autonomic changes during EMDR compatible with a relaxation response. Lansing K., Amen D. G., Hanks C., Rudy L. (2005). 11 Common Questions About EMDR | Alexandria VA Counseling EMDR therapy doesn't require talking in detail about a distressing issue. With few exceptions, the majority of neuroimaging studies reviewed here have significant methodological limitations, including a small sample size, lack of control conditions and inconsistent conceptualization of the parameters measured. He argued that re-experiencing the trauma in the context of the desensitization session would operate as an extinction trial of the traumatic experience. Sack et al. EMs reduced vividness of positive and negative recollections. Electroencephalogram (EEG) studies have also examined brain changes after EMDR therapy in PTSD (Lamprecht et al., 2004; Harper et al., 2009; Grbesa et al., 2010; Pagani et al., 2012). Patients showed greater activity in the orbitofrontal cortex and parahippocampal gyrus while controls showed greater activation in large areas of the frontal, temporal, and parietal lobes, especially in the right hemisphere. Based on feedback from clinicians and patients alike, the completion of the EMDR standardized protocol is a cognitively demanding task and requires attention, self-consciousness, autobiographical semantic memory, and metacognition to successfully identify the potential dysfunctional processes underlying the traumatic memory. EM enhance interhemispheric interaction facilitating retrieval of episodic memories. The efficacy of EMDR for PTSD is an extremely controversial subject among researchers, as the available evidence can be interpreted in several ways. Numerous controlled studies show that EMDR produces more improvement than absence of treatment, at least for alleviating the symptoms of civilian PTSD, such as those triggered by rape. The https:// ensures that you are connecting to the Concurrent tasks matched to the modality of trauma images lessening emotional responses to recollections of trauma. EMDR is a complex therapy with a number of underlying processes simultaneously at play. The EMDR therapy standard protocol includes the following preparation steps: history and treatment plan [Phase I], preparation phase with an introduction to the EMDR protocol and development of coping strategies [Phase II], and an assessment phase with visualization of an image of the traumatic incident, identification of beliefs and emotions associated with the disturbing event, rating of disturbance recalling the traumatic incident, and rating the validity of preferred cognitions of the client (Phase III).