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EMDR and the Neurobiology and Treatment of Trauma

By Dr. Don Dorsey

The Treatment (tx) of Psychological Trauma (PTSD). Recent metaanalyses of research studies and professional research panels have consistently supported the efficacy of both Cognitive-Behavior Therapy (CBT) and EMDR in the tx of psychological trauma. Ordinary talking psychotherapies, on the other hand, are viewed as being ineffective or inefficient (Van Etten & Taylor, 1998, ISTSS/Foa 2000, Chambless, et al, 1998, Van der Kolk, et al, 1996). Paraphrasing van der Kolk (1997), the most we can expect from ordinary talking psychotherapies is to train the left frontal cortex ("conscious brain") to attempt to slowly learn how to over-ride an already aroused right limbic system ("emotional/survival brain"). While both CBT and EMDR appear to be quite effective in the tx of simple PTSD (e.g. rape, accidents, earthquakes, etc.), EMDR appears to offer several additional advantages. First, EMDR appears to be more efficient (Van Etten & Taylor, 1998). Second, while CBT (e.g. exposure therapy) is potentially problematic in the tx of complex PTSD,(e.g. adults traumatized as children) (van der Kolk, 2000; Ford, 1998; Foa, 1999), clinical evidence suggests that EMDR may be quite suited (Shapiro, 2001). Third, to date EMDR is the only modality that has demonstrated robust differences between pre-tx and post-tx measurements of brain physiology (SPECT Scan, QEEG, etc.) (Lansing, et al, 1999). In very recent research, EMDR demonstrated more rapid treatment effects than prolonged exposure therapy and better toleration (0 dropout rate for EMDR, 30% dropout rate for P.E.) (Ironson, et. al, 2002.

EMDR. Because it is highly experiential and quite complex, EMDR is very difficult to describe in words. In simplistic terms, it appears to involve two critical elements: 1.) dual focus or dual attention, and 2.) bi-lateral stimulation. Typically, the client is asked to focus on several aspects of a distressing experience. At the same time, the client's attention is grounded (orienting response) on some form of bilateral stimulation such as eye movements, tapping, or sound. This combination of dual focus and bilateral stimulation tends to generate a reduction in the emotional charge associated with the distressing experience (desensitization). As this desensitization occurs the client is guided through a process of cognitive re-structuring in which the personal meanings associated with the disturbing experience are transformed (e.g. "I'm in danger" becomes "I'm safe now").

EMDR was created by Dr. Francine Shapiro, a senior research fellow at The Mental Research Institute. Because of her empirical orientation, from the beginning (1989), she conducted and strongly encouraged others to conduct research investigations. These research findings have not only supported the efficacy of EMDR, but have guided its evolution from a simple to a complex therapeutic process. EMDR now appears to be effective not only in the tx of severe trauma, but clinical evidence suggests it is also effective in the tx of a diverse range of other human problems - e.g. addictive behaviors, chronic pain, dissociation disorders, etc. Updated reviews of research on EMDR are available at www.EMDR.com.

My Personal Experience. I was first trained in EMDR in 1991 and have been training other professional clinicians in its use since 1992 (EMDR Institute, TTSN, EMDR-HAP). I believe that my exposure to EMDR is the most significant professional learning experience I have encountered in my 35+ years as a psychologist and as a university professor/ clinical trainer. In my clinical practice I work with adults who have been mistreated, abused or neglected as children (complex PTSD). I use EMDR as a primary tx strategy with about 80% of my clients. EMDR has dramatically impacted my effectiveness with this population. Our work together is significantly deeper, more comprehensive and much briefer (reducing tx time by more than 50%). Even with those clients with whom I do not use EMDR my effectiveness has increased, due, I believe, to a deeper understanding of just what needs to occur developmentally for real change to occur. The majority of clinicians I have trained or supervised in the use of EMDR report a similar impact on their own practices. I strongly recommend EMDR for both clinicians untrained in its use and for individuals seeking help for unresolved issues.

Don Dorsey
Professor, California State University, Northridge
Licensed Psychologist, Woodland Hills, California
Founding Partner, The Traumatic Stress Network (TTSN)
EMDRIA Approved Consultant and Instructor in EMDR

 

 

   
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