Motivation and emotion/Book/2015/Eye Movement Desensitisation and Reprocessing Therapy and emotion

Overview
"'EMDR is the most revolutionary important method to emerge in psychotherapy in decades' - Herbert Fensterheim Ph.D, Cornell University"

This book chapter describes the theory and processes of Eye Movement Desensitisation and Reprocessing Therapy, and its influence on emotion. The theory of EMDR involves previous theoretical underpinnings and involvement with the treatment of anxiety related disorders, most prominently, Post-traumatic Stress Disorder. The theory of cognitive and emotional neuroentrainment are described with reference to the eight-phase model that makes up the theory of EMDR. There is a brief description of how each phase works and can be applied when undertaking training. EMDR theory has had a long struggle with controversy based on whether the theory is valid; these aspects are considered in the final part of the chapter.

What is EMDR?
Eye Movement Desensitisation and Reprocessing Therapy (EMDR) was developed by psychologist Francine Shapiro in the early 1980s (Shapiro, 1989). The theory involves identifying the unprocessed trauma that are persistent in affecting an individual's psychological health. The client is instructed to think and recall the worst facet of their traumatising memory, whilst doing so, they are simultaneously directed to systematically move their eyes from left to right - this acts as a bilateral stimulation (BLS). The role of the BLS is to desensitise the client to the distressing memory, as well as reprocess the memory.

EMDR has employed an eight-phase or an eight-stage model; which involves comprehensive history exploration and formulation. This is followed by a preparation phase in which the client is instructed on how they can deal with manage the distressing memories. The next phase: involves isolating the distressing memory, the attached negative cognition, the positive cognition desired, and the levels of distress. This is followed by the practicing of the BLS. Finally, after the desired positive cognition is employed, the therapist carefully checks for any sign of bodily sensations before they conclude with a debrief (Shapiro & Solomon, 2010). The eight stage protocol is further explained below.

This theory emphasises the experience of disturbing memories as one of the major causes of psychotherapy (Shapiro & Laliotis, 2010). EMDR has received an alarming amount of support and has developed and grown to include the following disorders:
 * Dissociative Disorders
 * Panic Disorders
 * Eating Disorders
 * Learning Difficulties
 * Depression
 * Drug and Tobacco Abuse
 * Post-Traumatic Stress Disorder

Approach
The practice of EMDR requires the therapist to follow the eight phases proposed in the original model. These phases are as follows:

A Brief History
The theory of EMDR was first introduced in the late 1980s by Francine Shapiro; who noticed that the intensity of an individuals specific eye movements could reduce the intensity of the thought that is causing distress. She began to observe, the cognitive changes, on herself, from systematically making left-right movements of her eyes. She focused on a new perspective and hope, rather than the negative cognition during the desensitization. Her theory was influenced by this discovery, and she went on to study trauma victims, publishing her work in 1989. Shapiro developed her theory to help clients with their Post-Traumatic Stress Disorder (PTSD).

Theoretical Underpinnings
Once the theory of EMDR was discovered, a model insinuating to understand what is occurring when EMDR is in practice was developed: this is known as Adaptive Information Processing (AIP). This model focuses on the idea that present experiences can easily be integrated into existing memories (Shapiro, 2007). When an experience is negative, the processed information stores the traumatic memory in a way that allows it to be 'stuck', therefore not allowing it to process into a solution. In PTSD, traumatic memories are unable to be processed into the self-concept of the individual: therefore not allowing previous experience to play part in dealing with potential, future trauma. By conducting EMDR on PTSD sufferers, individuals are able to re-experience the trauma, as if it is 'currently happening'. The hyper-arousal that this causes leads to avoidance of any object, person or significant detail which may lead the individual to relive the trauma.

Bilateral Stimulation (BLS) is persistent in assisting 'dual attention' - the act of recalling trauma whilst keeping 'one foot in the present', and by doing so, allows the brain to access dysfunctional experiences by stimulating the processing system, and permitting the transformation to evolve into a solution. Once the experiences have reach optimum processing, the necessary information is extracted via the memory, and allowed the brain to accommodate the new information (Logie, 2015).

EMDR and Emotion / Cognition
EMDR theory, focused on neuroentrainment, is derived from the term entrainment, which refers to the spatiotemporal coordination linked between various clients when responding to systematic movements (in this case, left-right eye movement) (Phillips-Silver & Keller, 2012). This tool was developed by these authors to aid in the development of the theoretical and technical aspects to further understand the way in which cognitive neuroentrainment can treat PTSD. EMDR primarily acts as an emotional neuroentrainment, as it's main aim is to treat the anxiety disorder - post traumatic stress disorder (PTSD). While undergoing the desensitisation; it is required to pursue left-right eye movements (Shapiro, 1989), as this has a potential benefit on alleviating and removing negative or unpleasant emotions.

The application of EMDR theory as a cognitive neuroentrainment was first observed when Shapiro first conducted the rhythmic left-right eye movements and observed its effects on cognitive changes. From this discovery, she expanded her protocol and encompassed the theory to use cognitive-behavioural aspects to treat PTSD.

Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD), is a severe anxiety disorder that develops from the exposure to an event or an occasion in which leaves the individual exposed in psychological trauma (American Psychological Association, 2015). The exposure to such events can lead to the distress and threat of harm to either the individual themselves, or someone else.; these can be in the form of physical, mental or sexual integrity. Adults subject to psychological trauma (such as post-war flash-backs) are re-experiences on a conscious level. When compared to childhood trauma, victims of sexual abuse, physical abuse, or neglect are subject to re-experiencing their traumatic events by re-enacting them in later life. Behaviour such as PTSD can at times lead to personality disorders as the child ages later in life.

How does EMDR Affect PTSD?
The study of EMDR on PTSD has shown some significant efficacy in treatment following various studies that have published comparing the effect of EMDR and various forms of antidepressants, cognitive behavioural therapy etc. These meta-analysis have concluded that EMDR is successful in reducing the symptoms of PTSD (Bradley, Greene, Russ, Dutra & Westen, 2005; Van Etten & Taylor, 1998).As PTSD involves unresolved, persistent trauma, it was used to begin the trials for this theory. A meta-analysis conducted on the a series of randomised controlled trails found that when EMDR and trauma focused cognitive behavioural therapy are paired, the results are more effective when used as treatment on adults who suffer from PTSD (Bisson, et al., (2007).

A further study of EMDR for children who suffer from PTSD: whether from physical, or sexual abuse, showed that when using EMDR, treatment outcomes were slightly more effective than when compared to cognitive behavioural therapy (Rodenburg, et al., (2009). The empirical literature of EMDR is more prominent when evaluating PTSD in single-episode trauma occurring in adults (Korn, 2009), however, the individuals assessed based on these findings were found to have a previous experience with abuse related to childhood cruelty or neglect. For example, researchers compared EMDR and stress in comparison to the exposure of treatment of PTSD (Lee, Gavriel, Drummond, Richards, & Greenwald, 2002), they found that at least 58% of their participants recorded traumatic experiences pertaining to sexual or physical abuse as a child. Based on the results from the meta-analysis by Lee et al., (2002) allow the conclusion to be drawn that EMDR therapy can have a significant affect on the emotion of the individual undergoing treatment. This affect reflects a certain aspect of cognitive restructuring. Therefore, the conclusion can be drawn that the emotion connected to EMDR is helpful, as it desensitizes the individuals trauma, and allows the dysfunctional experiences to be used to stimulate the brain's process using BLS.

Controversy
There has been large amounts of controversy in regards to the application of EMDR, dating back to 1989 (Rosen, McNally, Richard & Lilienfeld, 1999). One of the earliest criticisms involved the constant refinement and change in length and requirements of training to be certified as a practitioner of EMDR therapy (Herbert, Lilienfeld, Lohr, Montgomery, O'Donohue, Rosen & Tolin, 2000). However, other EMDR practitioners, while agree that extensive and supervised training is necessary (Lipke, 1992), believe it is quite difficult to grasp a firm understanding than what has already been provided.

Herbert et al., (2000) developed an argument stating that the role of eye movement in EMDR was not the key role: but rather that the theory is false and not necessary to scientific inquiry. A metal-analysis conducted in 2001 found that EMDR with the movement of eyes, was no more effective than without eye movements (Davidson & Parker, 2001). In coherence to this meta-analysis, a further study in 2013 came to the conclusion that the 'eye movements are relevant and provide value in treatment' (Lee & Cuijpers, 2013). Similarly, Salkovskis (2002) reported findings that the use of eye movement is unnecessary and irrelevant, and that the progress made whilst utilising EMDR resulted from its similarities to CBT, and not EMDR as a theory.

Conclusion
The theory of EMDR requires dedication training and expertise in order to be able to treat clients with trauma-related experiences. While the theory involves indentifying the unprocessed trauma, it also aims to desensitise the client to the distressing memory, all while reprocessing it. The eight-stage model outlined above is employed by clinicians to aid in the clients process of relearning and reforming the individuals thought process by encouraging them to write up their own plan.

The previous theories were outlined and discussed with particular attention to Adaptive Information Processing, and its subjectivity to pairing present experiences with existing memories. Similarly, Bilateral Stimulation permits dual attention to be used as an access point to dysfunctional experiences by stimulating the processing system. This allows a solution to be evolved from past and present experiences. The theory of EMDR can act as both an emotional and a cognitive neuroentrainment, this entrainment refers to the spatiotemporal coordination between individuals in response to a rhythmic, or systematic movement. The application of EMDR on entrainment allows discipline to take favour over the development of the mind and the body.

Finally, EMDR has a significant emotional effect on PTSD suffers as it works to ‘rewire’ how the brain deals with the trauma, therefore significantly changing the views of the trauma, and aids the individual in processing the stress in a way that benefits their future encounters with object-related trauma.