Adaptive Information Processing Models

The Adaptive Information Processing model (Shapiro, 2001, 2002, 2007) is used to explain EMDR’s clinical effects and guide clinical practice. This model is not linked to any specific neurobiological mechanism since the field of neurobiology is as yet unable to determine this in any form of psychotherapy (nor of most medications). 

 

This section includes literature to provide an overview of the model and procedures, as well as selected research and case reports that demonstrate the predictive value of the model in the treatment of life experiences that appear to underlie a variety of clinical complaints.

 

Afifi, T.O., Mota, N.P., Dasiewicz, P.,   MacMillan, H.L.  & Sareen, J. (2012). Physical punishment and mental disorders: Results from a nationally representative US sample. Pediatrics, 130, 184-192.
Harsh physical punishment [i.e., pushing, grabbing, shoving, slapping, hitting] in the absence of [more severe] child maltreatment is associated with mood disorders, anxiety disorders, substance abuse/dependence, and personality disorders in a general population sample.

 

Allon, M. (2015). EMDR group therapy with women who were sexually assaulted in the Congo. Journal of EMDR Practice and Research, 9, 28-34.
Rape victims were successfully treated within three sessions using both individual and group protocols. They reported the simultaneous remission of back and abdominal pain. These processing results are consistent with the reported remission of PLP with EMDR therapy.

 

Arseneault, L., Cannon, M, Fisher, H.L. Polanczyk, G. Moffitt, T.E. & Caspi, A. (2011). Childhood trauma and children’s emerging psychotic symptoms: A genetically sensitive longitudinal cohort study. Am J Psychiatry, 168, 65–72.
Trauma characterized by intention to harm is associated with children’s reports of psychotic symptoms. Clinicians working with children who report early symptoms of psychosis should nquire about traumatic events such as maltreatment and bullying.

 

Bae, H., Kim, D. & Park, Y.C. (2008). Eye movement desensitization and reprocessing for adolescent depression. Psychiatry Investigation, 5, 60-65.
Processing of etiological disturbing memories, triggers and templates resulted in complete remission of Major Depressive Disorder in two teenagers. Treatment duration was 3-7 sessions and effects were maintained at follow-up.

 

Behnam Moghadam, M., Alamdari, A.K., Behnam Moghadam, A. & Darban, F. (2015). Effect of EMDR on depression in patients with myocardial infarction Global Journal of Health Science, 7, 258-262.
In this randomized study, the mean depression level in experimental group significantly decreased following the intervention. These changes were significantly greater compared to the control group. Conclusion: “EMDR is an effective, useful, efficient, and non-invasive method for treatment and reducing depression in patients with MI.”

 

A 12-month follow-up reported maintenance of treatment effects: Behnam, M. M., Behnam, M. A., & Salehian, T. (2015). Efficacy of eye movement desensitization and reprocessing (EMDR) on depression in patients with myocardial infarction (MI) in a 12-month follow up. Iranian Journal of Critical Care Nursing, 7, 221-226.

 

Brown, S. & Shapiro, F. (2006). EMDR in the treatment of borderline personality disorder. Clinical Case Studies, 5, 403-420.

20 EMDR sessions that focused on reprocessing the memories seemingly at the foundation of the pathology, along with triggers and future templates resulted in a complete remission of BPD, including symptoms of affect dysregulation, as measured on the Inventory of Altered Self Capacities.

 

Brown, K. W., McGoldrick, T., & Buchanan, R. (1997). Body dysmorphic disorder: Seven cases treated with eye movement desensitization and reprocessing. Behavioural and Cognitive Psychotherapy, 25, 203–207.
Seven consecutive cases were treated with up to three sessions of EMDR.  Complete remission of BDD symptoms were reported in five cases with effects maintained at one- year follow-up.

 

Doering, S., Ohlmeier, M. C., Jongh, A., Hofmann, A., & Bisping, V. (2013). Efficacy of a trauma‐focused treatment approach for dental phobia: a randomized clinical trial. European Journal of Oral Sciences, 121, 584-593.
Three sessions of EMDR therapy memory processing resulted in remission of dental phobia. After 1 yr, 83.3% of the patients were in regular dental treatment (d = 3.20). The findings suggest that therapy aimed at processing memories of past dental events can be helpful for patients with dental phobia.

 

de Roos, C., Veenstra, A.C, et al. (2010). Treatment of chronic phantom limb pain (PLP) using a trauma-focused psychological approach. Pain Research and Management, 15, 65-71.
10 consecutive cases of phantom limb pain were treated with EMDR resulting in the reduction or elimination of pain in all but two cases.  Results were maintained at 2.8-year follow-up.

 

Faretta, E. (2013). EMDR and cognitive behavioral therapy in the treatment of panic disorder: A comparison. Journal of EMDR Practice and Research, 7, 121-133.
As predicted by AIP, the processing of etiological events, triggers and memory templates was sufficient to alleviate the diagnosis without the use of treatment specific homework in contrast to the CBT group. In this study, there was “a continuing decrease in frequency of panic attacks for participants with PD or PDA in the EMDR condition at follow-up that was significantly greater than that found in the CBT treatment group.”

 

Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258.
We found a strong dose response relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.

 

Fernandez, I., & Faretta, E. (2007). EMDR in the treatment of panic disorder with agoraphobia. Clinical Case Studies, 6, 44-63.
As predicted by AIP, the processing of etiological events, triggers and memory templates was sufficient to alleviate the diagnosis without the use of therapist-assisted in vivo exposure.

 

Gauhar, M., & Wajid, Y. (2016). The efficacy of EMDR in the treatment of depression. Journal of EMDR Practice and Research, 10(2), 59-69.
This [RCT] investigated the efficacy of eye movement desensitization and reprocessing (EMDR) psychotherapy in treating the primary diagnosis of major depressive disorder by processing past or present trauma that was affecting the quality of life. . . . Results showed significant improvements on all measures with large effect sizes.

 

Gauvreau, P. & Bouchard, S. (2008). Preliminary evidence for the efficacy of EMDR in treating generalized anxiety disorder. Journal of EMDR Practice and Research, 2. 26- 40.
Four subjects were evaluated using a single case design with multiple baselines Results indicate that subsequent to targeting the experiential contributors, at post-treatment and at 2 months follow-up, all four participants no longer presented with GAD diagnosis.

 

Gold, S. D., Marx, B. P., Soler-Baillo, J. M., & Sloan, D. M. (2005). Is life stress more traumatic than traumatic stress?. Journal of Anxiety Disorders, 19, 687-698.
[The non-Criterion A] group reported significantly greater severity of PTSD symptomatology than those who reported a Criterion A1 PTSD event. In addition, significantly more people in the DSM trauma-incongruent group met criteria for PTSD than those in the DSM trauma-congruent group.

 

Heim, Plotsky & Nemeroff (2004). Importance of studying the contributions of early adverse experience to neurobiological findings in depression. Neuropsychopharmacology, 29, 641–648.
The available data suggest that (1) early adverse experience contributes to the pathophysiology of depression, (2) there are neurobiologically different subtypes of depression depending on the presence or absence of early adverse experience, likely having confounded previous research on the neurobiology of depression, and (3) early adverse experience likely influences treatment response in depression.

 

Heins et al. (2011). Childhood trauma and psychosis: a case-control and case-sibling comparison across different levels of genetic liability, psychopathology, and type of trauma. Am J Psychiatry, 168, 1286-1294.
Discordance in psychotic illness across related individuals can be traced to differential exposure to trauma. The association between trauma and psychosis is apparent across different levels of illness and vulnerability to psychotic disorder, suggesting true association rather than reporting bias, reverse causality, or passive gene-environment correlation.

 

Madrid, A., Skolek, S., & Shapiro, F. (2006). Repairing failures in bonding through EMDR. Clinical Case Studies. 5, 271-286.
EMDR processing of experiential contributors to bonding disruption, in addition to current triggers, and a memory template of an alternative/problem free pregnancy and birth resulted in the repair of maternal bonding, analogous to the positive findings with the repair of disrupted attachment.

 

McGoldrick, T., Begum, M. & Brown, K.W. (2008). EMDR and olfactory reference syndrome: A case series. Journal of EMDR Practice and Research 2, 63-68.
EMDR treatment of four consecutive cases of ORS whose pathological symptoms had endured for 8–48 years resulted in a complete resolution of symptoms in all four cases, which was maintained at follow-up.

Mol, S. S. L., Arntz, A., Metsemakers, J. F. M., Dinant, G., Vilters-Van Montfort, P. A. P., & Knottnerus, A. (2005). Symptoms of post-traumatic stress disorder after non-traumatic events: Evidence from an open population study. British Journal of Psychiatry, 186, 494–499.
Supports a basic tenet of the Adaptive Information Processing model that “Life events can generate at least as many PTSD symptoms as traumatic events.”  In a survey of 832 people, for events from the past 30 years the PTSD scores were higher after life events than after traumatic events.

 

Nazari, H., Momeni, N., Jariani, M., & Tarrahi, M. J. (2011). Comparison of eye movement desensitization and reprocessing with citalopram in treatment of obsessive-compulsive disorder. International Journal of Psychiatry in Clinical Practice, 15, 270-274.
There was significant difference between the mean Yale–Brown scores of the two groups after treatment and EMDR was more effective than citalopram in improvement of OCD signs.

 

Obradovic, J., Bush, N.R., Stamperdahl, J., Adler, N.E. & Boyce, W.T. (2010). Biological sensitivity to context: The interactive effects of stress reactivity and family adversity on socioemotional behavior and school readiness. Child Development, 1, 270–289.
A substantive body of work has established that environmental adversity can have a deleterious effect on children’s functioning” “Exposure to adverse, stressful events . . .has been linked to socioemotional behavior problems and cognitive deficits.

 

Perkins, B.R. & Rouanzoin, C.C. (2002). A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points of confusion. Journal of Clinical Psychology, 58, 77-97.
Reviews common errors and misperceptions of the procedures, research, and theory.

 

Raboni, M.R., Tufik, S., & Suchecki, D. (2006). Treatment of PTSD by eye movement desensitization and reprocessing improves sleep quality, quality of life and perception of stress. Annals of the New York Academy of Science, 1071, 508-513.
Specifically citing the hypothesis that EMDR induces processing effects similar to REM sleep (see also Stickgold, 2002, 2008), polysomnograms indicated a change in sleep patterns post treatment, and improvement on all measures including anxiety, depression, and quality of life after a mean of five sessions.

 

Ray, A. L. & Zbik, A. (2001). Cognitive behavioral therapies and beyond. In C. D. Tollison, J. R. Satterhwaite, & J. W. Tollison (Eds.) Practical Pain Management (3rd ed.; pp. 189-208). Philadelphia: Lippincott.
The authors note that the application of EMDR guided by the Adaptive Information Processing model appears to afford benefits to chronic pain patients not found in other treatments.

 

Read, J., Fosse, R., Moskowitz, A., & Perry, B. (2014). The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry, 4(1), 65-79.
[C]ontrary to long-held beliefs among biolog­ically oriented researchers and clinicians, the eti­ology of psychosis and schizophrenia are just as socially based [e.g., early-life adversity] as are nonpsychotic mental health problems, such as anxiety and depression.

 

Ricci, R. J., Clayton, C. A., & Shapiro, F. (2006). Some effects of EMDR treatment with previously abused child molesters: Theoretical reviews and preliminary findings. Journal of Forensic Psychiatry and Psychology, 17, 538-562.
As predicted by the Adaptive Information Processing model the EMDR treatment of the molesters’ own childhood victimization resulted in a decrease in deviant arousal as measured by theplethysmograph, a decrease in sexual thoughts, and increased victim empathy.  Effects maintained at one year follow up.

 

Robinson, J. S. & Larson, C. 2010. Are traumatic events necessary to elicit symptoms of posttraumatic stress? Psychological Trauma: Theory, Research, Practice, and Policy, 2, 71-76.
Research data indicated similar levels of posttrauma symptom severity for all three symptom clusters among people who had endorsed the experience of only a traumatic type event and people who had reported the experience of only stressful negative life events [e.g., loss of job, problems with school or work, or change in financial status].

 

Russell, M. (2008). Treating traumatic amputation-related phantom limb pain:  a case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services. Clinical Case Studies, 7, 136-153.
Since September 2006, over 725 service-members from the global war on terrorism have survived combat-related traumatic amputations that often result in phantom limb pain (PLP) syndrome. . . . Four sessions of Eye Movement Desensitization and Reprocessing (EMDR) led to elimination of PLP, and a significant reduction in PTSD, depression, and phantom limb tingling sensations.

 

Schneider, J., Hofmann, A., Rost, C.,  & Shapiro, F. (2008). EMDR in the treatment of chronic phantom limb pain. Pain Medicine, 9, 76-82.
As predicted by the Adaptive Information Processing model the EMDR treatment of the event involving the limb loss, and the stored memories of the pain sensations, resulted a decrease or elimination of the phantom limb pain which was maintained at 1-year follow-up.

 

Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2007). EMDR and phantom limb pain: Case study, theoretical implications, and treatment guidelines. Journal of EMDR Science and Practice, 1,31-45.
Detailed presentation of case treated by EMDR that resulted in complete elimination of PTSD, depression and phantom limb pain with effects maintained at 18-month follow-up.

 

Shapiro, F. (2018). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (3rd).  New York: Guilford Press.
EMDR is an eight-phase psychotherapy with standardized procedures and protocols that are all believed to contribute to therapeutic effect.  This text provides description and clinical transcripts and an elucidation of the guiding Adaptive Information Processing model.

 

Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd ed.).  New York: Guilford Press.
EMDR is an eight-phase psychotherapy with standardized procedures and protocols that are all believed to contribute to therapeutic effect.  This text provides description and clinical transcripts and an elucidation of the guiding Adaptive Information Processing model.

 

Shapiro, F. (2002). (Ed.). EMDR as an integrative psychotherapy approach: Experts of diverse orientations explore the paradigm prism. Washington, DC: American Psychological Association Books.
EMDR is an integrative approach distinct from other forms of psychotherapy. Experts of the major psychotherapy orientations identify and highlight various procedural elements.

 

Shapiro, F. (2006). EMDR and new notes on adaptive information processing: Case formulation principles, scripts and worksheets. Camden, CT: EMDR Humanitarian Assistance Programs (http://www.emdrhap.org)
Overview of Adaptive Information Processing model, including how the principles are reflected in the procedures, phases and clinical applications of EMDR.  Comprehensive worksheets for client assessment, case formulation, and treatment as well as scripts for various procedures.

 

Shapiro, F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice and Research, 1, 68-87.
Overview of EMDR treatment based upon an Adaptive Information Processing case conceptualization.  Early life experiences are viewed as the basis of pathology and used as targets for processing.  The three-pronged protocol includes processing of the past events that have set the foundation for the pathology, the current triggers, and templates for appropriate future functioning to address skill and developmental deficits.

 

Shapiro, F. (2012). EMDR therapy: An overview of current and future research. European Review of Applied Psychology, 62, 193-195.
Research findings indicate that EMDR therapy and TF-CBT are based on different mechanisms of action in that EMDR therapy does not necessitate daily homework, sustained arousal or detailed descriptions of the event, and appears to take fewer sessions. EMDR is guided by the adaptive information processing model, which posits a wide range of adverse life experiences as the basis of pathology.

 

Shapiro, F. (2014). The role of eye movement desensitization & reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18, 71-77.
An overview of the substantial body of research demonstrating that adverse life experiences contribute to both psychological and biomedical pathology, as well as the research demonstrating the clinical effects of EMDR therapy as guided by the Adaptive Information Processing model.

 

Shapiro, F., Kaslow, F., & Maxfield, L. (Eds.) (2007). Handbook of EMDR and Family Therapy Processes. Hoboken, NJ: Wiley.
Using an Adaptive Information Processing conceptualization a wide range of family problems and impasses can be addressed through the integration of EMDR and family therapy techniques.  Family therapy models are also useful for identifying the targets in need of processing for those engaged in individual therapy.

 

Simhandl, C., Radua, J., König, B., & Amann, B. L. (2014). The prevalence and effect of life Events in 222 bipolar I and II patients: A prospective, naturalistic 4 year follow-up study. Journal of Affective Disorders.
Our data suggest a high and continuous number of life events prior to affective episodes. Life events after the index episode worsened the course of bipolar I patients with more depressive episodes. This underlines the importance of detection and treatment of emerging life events.

 

Solomon, R. M. & Shapiro, F, (2008). EMDR and the adaptive information processing model: Potential mechanisms of change. Journal of EMDR Practice and Research, 2, 315-325.
This article provides a brief overview of some of the major precepts of the Adaptive Information Processing model, a comparison and contrast to extinction-based information processing models and treatment and a discussion of a variety of mechanisms of action.

 

Teicher, M.H. . Samson, J.A., Sheu, Y-S, Polcari, A. & McGreenery, C.E. (2010). Hurtful words: Association of exposure to peer verbal abuse with elevated psychiatric symptom scores and corpus callosum abnormalities. Am J Psychiatry, 167, 1464 – 1471.
These findings parallel re­sults of previous reports of psychopathol­ogy associated with childhood exposure to parental verbal abuse and support the hypothesis that exposure to peer verbal abuse is an aversive stimulus associated with greater symptom ratings and mean­ingful alterations in brain structure.

 

Uribe, M. E. R., & Ramirez, E. O. L. (2006). The effect of EMDR therapy on the negative information processing on patients who suffer depression. Revista Electrónica de Motivación y Emoción (REME), 9, 23-24.
The study evaluated the impact of EMDR treatment on bias mechanisms in depressed subjects in regard to negative emotional valence evaluation. “The results indicated that it generated important cognitive emotional changes in such mechanisms.”  Priming tests indicated changes in the negative valence evaluation of emotional information indicative of recovery with decreased reaction times in the neutral and positive stimuli processing.

 

van den Berg, D.P.G. & van den Gaag, M. (2012). Treating trauma in psychosis with EMDR: A pilot study. Journal of Behavior Therapy & Experimental Psychiatry, 43, 664-671.
This pilot study shows that a short EMDR therapy is effective and safe in the treatment of PTSD in subjects with a psychotic disorder. Treatment of PTSD has a positive effect on auditory verbal hallucinations, delusions, anxiety symptoms, depression symptoms, and self-esteem.

 

Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., et al. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin, 38 (4), 661-671.
These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.

 

Wesselmann, D. & Potter, A. E. (2009). Change in adult attachment status following treatment with EMDR: Three case studies.  Journal of EMDR Practice and Research, 3, 178-191.
Subsequent to EMDR treatment “all three patients made positive changes in attachment status as measured by the [Adult Attachment Inventory], and all three reported positive changes in emotions and relationships.

 

Wilensky, M. (2006). Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain. Journal of Brief Therapy, 5, 31-44.
Five consecutive cases of phantom limb pain were treated with EMDR. Four of the five clients completed the prescribed treatment and reported that pain was completely eliminated, or reduced to a negligible level. . . The standard EMDR treatment protocol was used to target the accident that caused the amputation, and other related events.

Mechanism of Action

 

EMDR contains many procedures and elements that contribute to treatment effects.  While the methodology used in EMDR has been extensively validated (see above), questions still remain regarding mechanism of action. However, since EMDR achieves clinical effects without the need for homework, or the prolonged focus used in exposure therapies, attention has been paid to the possible neurobiological processes that might be evoked. Although the eye movements (and other dual attention stimulation) comprise only one procedural element, this element has come under greatest scrutiny. Randomized controlled studies evaluating mechanism of action of the eye movement component follow this section.

 

de Jongh, A., Ernst, R., Marques, L., & Hornsveld, H. (2013). The impact of eye movements and tones on disturbing memories of patients with PTSD and other mental disorders. Journal of Behavior Therapy and Experimental Psychiatry, 44, 447–483.
The findings provide further evidence for the value of employing eye movements in EMDR treatments. The results also support the notion that EMDR is a suitable option for resolving disturbing memories underlying a broader range of mental health problems than PTSD alone.

 

El Khoury-Malhame, M. et al. (2011). Attentional bias in post-traumatic stress disorder diminishes after symptom amelioration. Behaviour Research and Therapy 49, 796-801.
Attentional bias toward aversive cues in PTSD has been hypothesized as being part of the dysfunction causing etiology and maintenance of PTSD. The aim of the present study was to investigate the cognitive strategy underlying attentional bias in PTSD and whether normal cognitive processing is restored after a treatment suppressing core PTSD symptoms.” An average of 4.1 EMDR sessions resulted in remission of PTSD. Post treatment “similarly to controls, EMDR treated patients who were symptom free had null e-Stroop and disengagement indices.

 

Elofsson, U.O.E., von Scheele, B., Theorell, T., & Sondergaard, H.P. (2008). Physiological correlates of eye movement desensitization and reprocessing. Journal of Anxiety Disorders, 22, 622-634.
Changes in heart rate, skin conductance and LF/HF-ratio, finger temperature, breathing frequency, carbon dioxide and oxygen levels were documented during the eye movement condition.  It was concluded the “eye movements during EMDR activate cholinergic and inhibit sympathetic systems. The reactivity has similarities with the pattern during REM sleep.

 

Hornsveld, H. K., Landwehr, F., Stein, W., Stomp, M., Smeets, S., & van den Hout, M. A. (2010). Emotionality of loss-related memories is reduced after recall plus eye movements but not after recall plus music or recall only. Journal of EMDR Practice and Research, 4, 106-112.
Recall-plus-music was added to investigate whether reductions in emotionality are associated with relaxation. . . Participants reported a greater decline in emotionality and concentration after eye movements in comparison to recall-only and recall-with-music. It is concluded that eye movements are effective when negative memories pertain to loss and grief.

 

Kapoula Z, Yang Q, Bonnet A, Bourtoire P, & Sandretto J (2010). EMDR Effects on Pursuit Eye Movements. PLoS ONE 5(5): e10762. doi:10.1371/journal.pone.0010762
EMDR treatment of autobiographic worries causing moderate distress resulted in an “increase in the smoothness of pursuit [which] presumably reflects an improvement in the use of visual attention needed to follow the target accurately. Perhaps EMDR reduces distress thereby activating a cholinergic effect known to improve ocular pursuit.

 

Kristjánsdóttir, K. & Lee, C. M. (2011).  A comparison of visual versus auditory concurrent tasks on reducing the distress and vividness of aversive autobiographical memories. Journal of EMDR Practice and Research, 5, 34-41.
Results showed that vividness and emotionality ratings of the memory decreased significantly after eye movement and counting, and that eye movement produced the greatest benefit. Furthermore, eye movement facilitated greater decrease in vividness irrespective of the modality of the memory. Although this is not consistent with the hypothesis from a working memory model of mode-specific effects, it is consistent with a central executive explanation.

 

Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, 13, 97-107.
This study tested whether the content of participants’ responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing which would be expected given Shapiro’s proposal of dual focus of attention. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner, which indicates the underlying mechanisms of EMDR and exposure therapy are different.

 

Leer, A., Engelhard, I. M., & van den Hout, M. A. (2014). How eye movements in EMDR work: changes in memory vividness and emotionality.
Journal of behavior therapy and experimental psychiatry, 45 (3), 396-401.
This study provides corroborating evidence that EM during recall causes reductions in memory vividness and emotionality at a delayed post-test and that the magnitude of these effects is related to intervention duration.

 

Lilley, S.A., Andrade, J., Graham Turpin, G.,Sabin-Farrell, R., & Holmes, E.A. (2009). Visuospatial working memory interference with recollections of trauma. British Journal of Clinical Psychology, 48, 309–321.
Tested patients awaiting PTSD treatment and demonstrated that the eye movement condition had a significant effect on vividness of trauma memory and emotionality compared to counting and exposure only.  In addition, “the counting task had no effect on vividness compared to exposure only, suggesting that the eye-movement task had a specific effect rather than serving as a general distractor” (p. 317).

 

MacCulloch, M. J., & Feldman, P. (1996). Eye movement desensitization treatment utilizes the positive visceral element of the investigatory reflex to inhibit the memories of post-traumatic stress disorder: A theoretical analysis. British Journal of Psychiatry, 169, 571–579.
One of a variety of articles positing an orienting response as a contributing element (see Shapiro, 2001 for comprehensive examination of theories and suggested research parameters).  This theory has received controlled research support (Barrowcliff et al., 2003, 2004).

 

Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D., & Bellorado, N. (2007). Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: Implications for EMDR therapy. Journal of Nervous and Mental Disease, 195, 785-788.
Specifically, the EM manipulation used in the present study, reported previously to facilitate episodic memory, resulted in decreased interhemispheric EEG coherence in anterior prefrontal cortex. Because the gamma band includes the 40 Hz wave that may indicate the active binding of information during the consolidation of long-term memory storage (e.g., Cahn and Polich, 2006), it is particularly notable that the changes in coherence we found are in this band.

 

With regard to PTSD symptoms, it may be that by changing interhemispheric coherence in frontal areas, the EMs used in EMDR foster consolidation of traumatic memories, thereby decreasing the memory intrusions found in this disorder.

 

Rogers, S., & Silver, S. M. (2002). Is EMDR an exposure therapy? A review of trauma protocols. Journal of Clinical Psychology, 58, 43-59.
Theoretical, clinical, and procedural differences referencing two decades of CBT and EMDR research.

 

Rogers, S., Silver, S., Goss, J., Obenchain, J., Willis, A., & Whitney, R. (1999). A single session, controlled group study of flooding and eye movement desensitization and reprocessing in treating posttraumatic stress disorder among Vietnam war veterans: Preliminary data. Journal of Anxiety Disorders, 13, 119–130.
This study was designed as primarily a process report to compare EMDR and exposure therapy.  A different recovery pattern was observed with the EMDR group demonstrating a more rapid decline in self-reported distress.

 

Sack, M., Hofmann, A., Wizelman, L., & Lempa, W. (2008). Psychophysiological changes during EMDR and treatment outcome. Journal of EMDR Practice and Research, 2, 239-246
During-session changes in autonomic tone were investigated in 10 patients suffering from single-trauma PTSD.  Results indicate that information processing during EMDR is followed by during-session decrease in psychophysiological activity, reduced subjective disturbance and reduced stress reactivity to traumatic memory.

 

Sack, M., Lempa, W. Steinmetz, A., Lamprecht, F. & Hofmann, A. (2008). Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR) – results of a preliminary investigation. Journal of Anxiety Disorders, 22, 1264-1271.
The psycho-physiological correlates of EMDR were investigated during treatment sessions of trauma patients.  The initiation of the eye movements sets resulted in immediate changes that indicated a pronounced de-arousal.

 

Servan-Schreiber, D., Schooler, J., Dew, M.A., Carter, C., & Bartone, P. (2006). EMDR for PTSD: A pilot blinded, randomized study of stimulation type. Psychotherapy and Psychosomatics. 75, 290-297.
Twenty-one patients with single-event PTSD (average IES: 49.5) received three consecutive sessions of EMDR with three different types of auditory and kinesthetic stimulation.  All were clinically useful.  However, alternating stimulation appeared to confer an additional benefit to the EMDR procedure.

 

Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology, 58, 61-75.

 

Stickgold, R. (2008). Sleep-dependent memory processing and EMDR action. Journal of EMDR Practice and Research, 2, 289-299.
Comprehensive explanations of mechanisms and the potential links to the processes that occur in REM sleep.  Controlled studies have evaluated these theories (see next section; Christman et al., 2003; Kuiken et al. 2001-2002).

 

Suzuki, A., et al. (2004). Memory reconsolidation and extinction have distinct temporal and biochemical signatures. Journal of Neuroscience, 24, 4787– 4795.
The article explores the differences between memory reconsolidation and extinction. This new area of investigation is worthy of additional attention.  Reconsolidation may prove to be the underlying mechanism of EMDR, as opposed to extinction caused by prolonged exposure therapies.  Memory reconsolidation after retrieval may be used to update or integrate new information into long-term memories . . . Brief exposure … seems to trigger a second wave of memory consolidation (reconsolidation), whereas prolonged exposure . . leads to the formation of a new memory that competes with the original memory (extinction).

 

van den Hout, M., et al. (2011). EMDR: Tones inferior to eye movements in the EMDR treatment of PTSD. Behaviour Research and Therapy, 50, 275-79.
EMs outperformed tones while it remained unclear if tones add to recall only. . . EMs were superior to tones in reducing the emotionality and vividness of trauma memories. [I]n contrast to EMs, tones hardly tax working memory and induce a smaller reduction in emotionality and vividness of aversive memories. Interestingly, patients’ preferences did not follow this pattern: the perceived effectiveness was higher for tones than for EMs. . . . Clearly, the superior effects of EMs on emotionality and vividness of trauma memories were not due to demand characteristics.

 

van Schie, K., van Veen, S. C., Engelhard, I. M., Klugkist, I., & van den Hout, M. A. (2016). Blurring emotional memories using eye movements: Individual differences and speed of eye movements. European Journal of Psychotraumatology, 7.
Contrary to the theory, the data do not support the hypothesis that EM speed should be adjusted to [working memory capacity] (hypothesis 4). However, the data show that a dual task in general is more effective in reducing memory ratings than no dual task (hypothesis 1), and that a more cognitively demanding dual task increases the intervention’s effectiveness (hypothesis 2).

 

Wilson, D., Silver, S. M., Covi, W., & Foster, S. (1996). Eye movement desensitization and reprocessing: Effectiveness and autonomic correlates. Journal of Behaviour Therapy and Experimental Psychiatry, 27, 219–229.
Study involving biofeedback equipment has supported the hypothesis that the parasympathetic system is activated by finding that eye movements appeared to cause a compelled relaxation response. More rigorous research with trauma populations is needed.

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