Physiological studies have found that the EMs are associated with a de-arousal response driven by increased parasympathetic relative to sympathetic changes. Stationary eyes Between/within-groups experimental design. Importantly, approximately half of the studies (42/87) included in this systematic review have investigated the mechanisms underlying BLS, and more specifically the EMs, compared to different control conditions. EM effects of taxing WM on disturbing memories do no differ between PTSD and other metal disorders. Received 2017 Jun 29; Accepted 2018 Jul 18. Recall with EM decrease vividness vs. recall only. Some trauma has so many branches you have to go down before you find the root issue. The most widespread use of EMDR is for treating post-traumatic stress disorder (PTSD). 4. Who is EMDR best suited for? He argued that re-experiencing the trauma in the context of the desensitization session would operate as an extinction trial of the traumatic experience. (1997). The effect of EMs is mediated by VSSP taxation. Exp 1:HC = 46 Exp 2: HC = 18 Exp 3: HC = 30 Exp 4: HC = 24. Compared to recall only, EM and Tetris both decreased emotionality. Engelhard I. M., van Uijen S. L., van den Hout M. A. This OR pairs an adaptive explorative response with clinically induced unpleasant memories to remove their negative effect. Wilson et al. No differences in vividness and emotional valence between all conditions. GUID:C49DD41D-C2BE-42D3-8D49-529E23A1A09C, GUID:A3416C49-E8B4-45AC-9F09-7559A819BFA0, eye movement desensitization and reprocessing, mechanism of action, eye movements, bilateral stimulation, systematic review. Potential EMDR side effects include: Tiredness following therapy: One of the physical side effects that people often report is feeling tired . sharing sensitive information, make sure youre on a federal Elofsson et al. Orbitofrontal activity shifted to posterior associative regions post-treatment. (2013). Proponents of EMDR maintain that the treatment more effectively reprocesses trauma than exposure therapy, and does so at a faster rate. Exp 1: HC = 36 Exp 2: HC = 36 Exp 3: HC = 72, Stationary eyes Horizontal EMs Auditory shadowing Drawing. In support of taxing working memory resources, analog research proved that implementing other demanding tasks during recall also reduced vividness and emotionality of negative memories (Engelhard et al., 2010b; de Jongh et al., 2013). The studies were classified into broad categories according to three overarching models/hypothesis for the mechanism of action underlying EMDR: (i) psychological models (ii) psychophysiological models and (iii) neurobiological models. The efficacy of EMDR for PTSD is an extremely controversial subject among researchers, as the available evidence can be interpreted in several ways. Brain functional changes concurrent to EMDR therapy have also been examined with other neuroimaging techniques different to SPECT. Research on the working memory account has demonstrated reductions in vividness of disturbing memories in healthy subjects (van den Hout et al., 2011b, 2012, 2014; van Veen et al., 2015, 2016; Onderdonk and van den Hout, 2016; van Schie et al., 2016; Leer et al., 2017). These findings have provided a solid foundation to direct research efforts, in order to unravel the brain correlates underlying the efficacy of EMDR. Fears or anxiety triggered by related people, places, things or situations. While it has gained in popularity over the years, it has also been mired in controversy. EM enhance interhemispheric interaction facilitating retrieval of episodic memories. These effects are consistent with the theoretical framework of EMDRthe AIP model- and with patient reports of increased autobiographical memory retrieval during therapy. Results support the WM theory: the more taxing a dual-task is, the more a memory image degrades. EM led to decreased interhemispheric coherence. Years later, researchers would demonstrate that this effect is mediated by the EMs disrupting working memory resources, thereby reducing vividness and decreasing the emotionality of traumatic imagery (Andrade et al., 1997; Kavanagh et al., 2001). EM may increase interhemispheric interaction leading to increased contextual information associated with previously learnt items. On one hand, studies have shown that EMDR produces greater reduction in PTSD symptoms compared to control groups receiving no treatment. Bilateral eye movements enhance the retrieval of episodic memories. (2015). This hypothesis has received some indirect support from psychophysiological research. As with other psychotherapies, the effectiveness of EMDR contrasts with a limited knowledge of its underlying mechanism of action. Accessibility Pre-post treatment Within group Between group. Cognitively demanding dual task increases the intervention's effectiveness. Discrepancies were resolved by MP and BLA (Supplementary Table 1). it triggered months, almost a year, worth of devastating trauma memory recovery and flashbacks. Psychotherapy may induce alterations in gene expression and structural changes in the brain. A., Nowoweiski S. J., Bernier D., Tarzwell R., Beutel M. E. (2014). A small set of brain imaging studies has investigated the structural brain correlates of EMDR therapy, with a focus on memory (e.g., Letizia et al., 2007) and emotion processing structures. The results showed increased activity post-EMDR treatment in the anterior cingulate gyrus and the left frontal lobe. Title says it all. Shapiro proposed that EMDR can assist in processing the traumatic memories, and that different forms of bilateral stimulation such as the EMs, would facilitate this processing (Shapiro, 2001; Shapiro and Maxfield, 2002). Results suggest that EMDR leads to an integration of dissociated aspects of traumatic memories and, consequently, a decrease of hyperarousal symptoms. 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). 2. Decrease perfusion in the left and right occipital, left parietal, and right precentral lobes Increased perfusion in the left inferior frontal gyrus. Some theories suggest it's because it mimics REM sleep, allowing memory consolidation to occur. A working memory explanation for the effects of eye movements in EMDR. (1996) proposed a combination of Pavlovian and Darwinian theories whereby the dual attention task provoked by the EMs serves to trigger an OR. The few studies presenting with low risk of bias found no difference between EMDR and other therapeutic interventions. Short for Eye Movement Desensitization and Reprocessing, it involves recalling a specific . Effects of psychotherapy on hippocampal volume in out-patients with post-traumatic stress disorder: a MRI investigation, How psychotherapy changes the brainthe contribution of functional neuroimaging. Bilateral saccadic eye movements and tactile stimulation, but not auditory stimulation, enhance memory retrieval. Nazari H., Momeni N., Jariani M., Tarrahi M. J. Eye Movement Desensitization and Reprocessing (EMDR) therapy is a new psychotherapy method used to treat people's past trauma or the painful symptoms caused by distressing experiences. Eye-movement Desensitization and Reprocessing (EMDR) has been widely supported in the literature for its effectiveness in treating Post-traumatic Stress Disorder (PTSD) and a variety of other diagnoses and symptoms. Why is EMDR so controversial? Physiological correlates of eye movement desensitization and reprocessing. EMDR was associated with increased grey matter volume in thalamus and parahippocampal regions. A second contentious issue in EMDR revolved around the potential overlap with other psychotherapies, in particular with tfCBT. were the first to introduce the idea that the effect of EMDR is mediated by the distancing from the traumatic memory and the reduction of imagery vividness (Sharpley et al., 1996b). Unfortunately, Dyck did not back up this hypothesis with empirical data. Novo P., Landin-Romero R., Radua J., Vicens V., Fernandez I., Garcia F., et al.. (2014). Leer A., Engelhard I. M., van den Hout M. A. Lower levels of electrodermal arousal were identified in EM compared to noEM. Dyck was the first author to provide an account of the underlying mechanism of EMDR, largely in terms of classic conditioning theory (Dyck, 1993). 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. Maxfield L., Melnyk W. T., Gordon Hayman C. A. The automatic search was later completed with a manual search using reference lists of included papers and web-based searches in an EMDR-centered library (https://emdria.omeka.net/). These include the state of relaxation most patients experience after a few sets of bilateral stimulation (Wilson et al., 1996; Schubert et al., 2008), the spontaneous generation of positive insight, the reports of increased recognition of accurate information, attentional flexibility (El Khoury-Malhame et al., 2011) and improved retrieval of episodic memory (Shapiro and Laliotis, 2015). Why EMDR is so effective is still unclear. FOIA Lohr J. M., DeMaio C., McGlynn F. D. (2003). The reasons someone might think it is a controversial therapy option are the potential adverse side effects and the lack of long-term research. I'm still early in the process. EMDR therapy is a trauma therapy that is sometimes considered controversial. The EMDR therapy protocol for bipolar disorder, Eye Movement Desensitization and Reprocessing (Emdr) Therapy Scripted Protocols and Summary Sheets: Treating Anxiety, Obsessive-Compulsive, and Mood-Related Conditions. Selected theoretical, speculative papers were also included if they were first to provide an mechanistic hypothesis for EMDR to guide future empirical research. The OR toward any stimulus that constitute a potential threat manifests itself as an initial freeze response accompanied by changes in autonomic responses that include increased blood flow, heart rate, and skin conductance. de Jongh A., Ernst R., Marques L., Hornsveld H. (2013). EMs slow down reaction times to auditive cues. Years of sleep research that has demonstrated that REM sleep serves a number of adaptive functions, including memory consolidation via the integration of emotionally charged autobiographical memories into general semantic networks (Born et al., 2006; Stickgold and Wehrwein, 2009). 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). The BLS effect during fear extinction may rely on taxation of working memory, reducing vividness and emotionality, or may provoke memory reconsolidation. EMDR has been proclaimed by its advocates as an extremely effective and efficient treatment for Post-Traumatic Stress Disorder (PTSD) and related anxiety disorders. Conversely, when symptoms disappeared, upon bilateral stimulation, and trauma recall, patients showed a shift in cortical activity toward associative left temporo-occipital regions. van den Hout M., Muris P., Salemink. The psychologist Francine Shapiro developed E.M.D.R. and how these mechanisms can be measured or demonstrated. EMDR is safe and effective, but there are some risks associated with the therapy. There were no associations between changes in EM-related interhemispheric connectivity and memory performance. recent progress in the search for treatment mechanisms, How eye movements affect unpleasant memories: support for a working-memory account. Results: Eighty-seven studies were selected for review and classified into three overarching models; (i) psychological models (ii) psychophysiological models and (iii) neurobiological models. EMDR treatment reverse the functional imbalance between the limbic area and the prefrontal cortex. Horizontal EM and tactile stimulation enhance memory retrieval. In its relatively short life as a therapeutic option, EMDR has not been without controversy, in . A number of recent functional neuroimaging studies have reported activity changes in these neuronal networks after EMDR treatment, providing further support for this hypothesis (Levin et al., 1999; Lansing et al., 2005; Landin-Romero et al., 2013) [for more details on these studies see section below]. Although it focuses on reporting reviews of randomized controlled trials, it can also be used as a basis for reporting systematic reviews of other types of research (Moher et al., 2009). where improved sleep and partial recovery of depressive and anxiety symptoms was observed in 13 PTSD patients after successive treatment with EMDR (Raboni et al., 2014). Another EEG study did not find EEG changes following EMs and improved memory retrieval, undermining any effects of increased interhemispheric communication in treatment response (Samara et al., 2011). EEG activity was compatible to de-potentiation memory synapses. Autonomic changes during EMDR compatible with a relaxation response. EM may induce changes but not necessarily decreases in interhemispheric interaction. 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). Sharpley C. F., Montgomery I. M., Scalzo L. A. EMDR decreased symptoms and increased parasympathetic tone. Front. a review. The use of a dual attention tasks is perhaps one of the most distinctive elements of EMDR. EM, eye movements; EMDR, eye movement desensitization and reprocessing; HC, healthy controls; NA, not applicable; OR, orienting response; PTSD, posttraumatic stress disorder; VSSP, visuospatial sketchpad WM, working memory; BLS, bilateral stimulation. Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: a matched pairs study in an inpatient setting. Instead, a systematic review was conducted, using the PRISMA guidelines as referenced above. AM-A has also received a grant by EMDR Europe (201803). van Schie K., van Veen S. C., Engelhard I. M., Klugkist I., van den Hout M. A. EMDR group showed desensitization. Bossini L., Santarnecchi E., Casolaro I., Koukouna D., Caterini C., Cecchini F., et al.. (2017). Saccadic EM led to recall of earlier childhood events. Recently, more sophisticated structural and functional neuroimaging studies using high resolution structural and temporal techniques are starting to provide preliminary evidence into the neuronal correlates before, during and after EMDR therapy. APA Concerns APA Division 12 states: "The efficacy of EMDR for PTSD is an extremely controversial subject among researchers, as the available evidence can be interpreted in several ways. ago. In her revision of the EMDR principles and procedures, Shapiro suggested that the EMs and the dual attentional task led to specific psychophysiological changes that may underlie treatment efficacy. How do you stop CBT overeating? First, most studies are performed in non-clinical populations and therefore cannot address which additional mechanisms contribute to treatment effects in PTSD. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). 1062 E. Lancaster Ave. 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. Eye Movement Desensitization and Reprocessing, or EMDR, is a popular PTSD treatment for patients and clinicians alike. Evaluating the effect of eye movements on positive memories such as those used in resource development and installation. In particular, studies examining neuroimaging and behavioral changes on-line, before, during and after therapy, hold promise to unravel the neurobiological signatures of EMDR. EMDR decrease symptoms of depression and anxiety in PTSD. Increased perfusion in PFC and decreased perfusion in temporal association cortex. Reduction of memory vividness due to recall+EM is also evident from non-self-report data. Sack et al. (2016). Engelhard I. M., van den Hout M. A., Dek E. C., Giele C. L., van der Wielen J. W., Reijnen M. J. 5. Thirty-two papers were classified as psychological models. This mechanisms may be explained by increased interhemispheric interaction. The EMs were originally described as the crucial component of EMDR (Shapiro, 1989a,b). EMs) offer a temporary response aid for imaginal exposure without affecting desensitization. Low level electrocortical amplitude was observed during EMDR. (2003). In addition to these effects, the EMs were accompanied by changes in respiratory patterns, consistent with a relaxation response. Harper M. L., Rasolkhani-Kalhorn T., Drozd J. F. (2009). Doering S., Ohlmeier M. C., de Jongh A., Hofmann A., Bisping V. (2013). In the current work, we have conducted a comprehensive review of the literature that examined different hypothesis for the mechanism of action of EMDR using the PRISMA guidelines for transparent reporting of reviews and meta-analyses. Yaggie M., Larry S., Seth M., Angela A., Chad W., Mike G., et al. EM slow down reaction time in a stimulus discrimination task. Phases of EMDR . What are the 8 stages of EMDR? Eye movement desensitization and reprocessing (EMDR) is a fairly new, nontraditional type of psychotherapy. Sometimes it is so hard. Efficacy of a trauma-focused treatment approach for dental phobia: a randomized clinical trial, A proposal for a conditioning model of eye movement desensitization treatment for posttraumatic stress disorder, Unlocking the Emotional Brain Eliminating Symptoms at Their Roots Using Memory Reconsolidation. This stimulation would lead to the deactivation of the ventralaffectiveanterior cingulate gyrus, which in turn would enable the reciprocal inhibition of the dorsal (cognitive) anterior cingulate gyrus. The following . 4. 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. Facilitating access to emotions: neural signature of EMDR stimulation. A total of 87 studies written in English met the inclusion criteria and were selected for review. EM may help the recall of pleasant memories. October 27, 2022 EMDR therapy is a trauma therapy that is sometimes considered controversial. and if so, why? Treatment gains in EMDR may result from de-potentiation of fear in memory synapses. Thus, external stimulation similar to the adverse experience can trigger sensations and images from the traumatic event so that the person re-experiences feelings or bodily sensations. EM showed a larger decrease in self-reported vividness and emotionality than control conditions. Tones inferior to eye movements in the EMDR treatment of PTSD, Psychopathology and psychological problems in patients with burn scars: epidemiology and management. Differential activation between smooth pursuit and saccadic eye movements. (2014). The reasons someone might think it is a controversial therapy option are the potential adverse side effects and the lack of long-term research. 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. EMDR is an evidence-based therapy primarily used to treat posttraumatic stress (PTSD), but as it gains momentum in mental health circles, indications for its use are ever-expanding.The question . Furthermore, BLA received a grant by EMDR Europe (201805). This explanation has many similarities to the reciprocal inhibition techniques (i.e., systematic desensitization) first described by Wolpe. Adjusting EM speed is not helpful to reduce emotionality of aversive memories. Bruny T. T., Mahoney C. R., Augustyn J. S., Taylor H. A. The reasons someone might think it is a controversial therapy option are the potential adverse side effects and the lack of long-term research. Aubert-Khalfa S., Roques J., Blin O. Novo Navarro P., Marini A. M., Scott J., Landin-Romero R., Amann B. L. (2013). Boukezzi S., El Khoury-Malhame M., Auzias G., Reynaud E., Rousseau P. F., Richard E., et al.. (2017a). The controversy continues. The competition in resources will impair imagery, and as such, the disturbing images would become less emotional and vivid. Negative memories are rated as less vivid after recall + EM but not after recall only. Similarly, EMDR would promote the reorganization of the traumatic memories, reducing the strength of the traumatic episodic memories that are mediated by the hippocampus and the associated negative emotion processed by the amygdala (Stickgold, 2002, 2008). Study 1 found that RT was slowest in the EM condition. Consequently, neuroimaging research findings should be considered promising but preliminary and conclusions concerning the EMDR neurobiological correlates speculative. An investigation of some hypothetical mechanisms underlying EMDR. (1999). eye movements) is a superfluous addition. The studies were selected by RL-R and AM-A. They found significant metabolic decreases in occipital, left parietal and posterior frontal lobes and metabolic increases in the left inferior frontal gyrus after successful removal of the PTSD symptoms. The advent of non-invasive neuroimaging techniques such as the electroencephalogram (EEG), single-positron emission computed tomography (SPECT), near-infrared spectroscopy (NIRS) and structural and functional magnetic resonance imaging (sMRI, fMRI) have enabled the in-vivo examination of structural and functional brain changes. Eye-movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder, An orienting response model of eye movement desensitization. Support for increase in limbic processing along with decreased frontal activation as the neurobiological correlate of the therapeutic reintegration of information. This demonstrates that the effects observed in EMDR treatment are the result of more than occupying WM systems with visual stimuli alone. Symptoms of PTSD were reduced after EMDR. No effects of EM on memory emotionality when associated with blockage of noradrenaline. On a similar scope, Corrigan has proposed that auditory, visual, and tactile BLS would facilitate the simulation of thalamo-cingulate tracts (Corrigan, 2002). Littel M., Kenemans J. L., Baas J. M. P., Logemann H. N. A., Rijken N., Remijn M., et al.. (2017a). EMDR contributes to removal of PTSD symptoms vs. control conditions. Following standardized procedures, this new material usually becomes the focus of the next set. Psycho-physiological changes compatible with de-arousal during EMDR. Pre-, during and post- treatment Within subject. Can EMDR make did worse? McGuire T. M., Lee C. W., Drummond P. D. (2014). 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). EMDR was associated with grey matter increases in the prefrontal cortex. Interhemispheric phase and amplitude coherence in EEG were not affected by EM. Accordingly, the activation of this circuitry is hypothesized to facilitate the integration of somatosensory, memory, cognitive, emotional, and synchronized hemispheric functions that are disrupted in PTSD. 10. In recent years, a new wave of increasingly sophisticated neuroimaging studies has been carried out to uncover the neurobiological underpinnings of EMDR. EMs reduce vividness of past and future feared events.