Dr. Ian McCabe

Eye Movement Desensitization and Reprocessing (EMDR) is a new and controversial psychological technique that claims to alleviate a range of emotional problems, including anxiety, depression, panic attacks, phobias and, in particular, post traumatic stress. Proponents claim that EMDR is the most revolutionary and successful technique to enter psychological treatment in the last 20 years.

EMDR was developed by American psychologist Francine Shapiro, who noted that moving her eyes rapidly seemed to decrease her anxiety about her own disturbing memories. She tested her theory on friends and students, who also found it helpful. Today, approximately 50,000 therapists have been trained in the method and over a million people have been treated effectively with EMDR.

Normally, minor disturbances, upsets or shocks are processed during Rapid Eye Movement sleep. However, overwhelming events may not be processed and instead be stored as painful memories in the unconscious. This happens because during a traumatic event, a part of the right hemisphere of the brain (the amygdala) produces such a high level of fear that it may close down the part of the left hemisphere (the hippocampus) that normally processes information into memory. Because the trauma is not effectively processed, it can return to haunt the sufferer.

EMDR combines eye movement with elements of other therapeutic approaches, such as cognitive-behavioural therapy. During an EMDR session, the client's eyes follow the left-to-right movement of the therapist's finger. The eye movement apparently has the effect of connecting and stimulating the right and left hemispheres of the brain thereby giving the brain a second chance to process a traumatic memory. This allows the client to effectively reprocess the trauma. While the memory itself is not erased, the emotions associated with it are lessened or are replaced by positive feelings. Reported results are primarily relief from anxious feelings associated with past traumas and an increase in self-esteem. Hormones released by the brain during the EMDR process serve to make the changes permanent.

I was initially very skeptical of this quick-fix approach, believing that brief therapies such as this were band-aids that hid symptoms for only a short while. However, after hearing success stories from several colleagues, I trained in the EMDR technique.

While working at a New York clinic, I counselled several clients* who suffered from childhood traumas. A woman, now aged 64, could eat only food that was cut into small pieces or liquefied. This was related to her choking on a sliver of orange as a child. We used EMDR while discussing the likelihood that a similar incident would happen to her again. After four sessions she reported that she was eating food normally.

A 27-year-old man had, ten years earlier, taken Ecstasy at a party that was raided by the police. That night he suffered from heart palpitations, was ditched by his girlfriend and learned that a school friend had reputedly died of a heart attack. He began to believe that he would die of a sudden heart attack and was constantly worried that any pain meant that death was imminent. After our eighth session of EMDR, his fear left him and he began jogging.

A woman of 29 had been sexually abused by her tennis coach in her early teens and was told it was her fault. She was left with a sense of worthlessness, began abusing drugs and did not play tennis again for 16 years. As the sessions progressed, she felt less disturbed by the abuse, was able to cognitively and emotionally process the trauma and state that her sense of worthlessness was no longer valid. Once this negative concept was eradicated I asked her "on a scale of 0-7 how true is it that you are worthwhile?" This was intended to install and reinforce a positive belief that she was a worthwhile person who was not to blame for the sexual abuse. After several sessions she reported that her level of emotional disturbance about the abuse was significantly reduced. She had resumed playing tennis and now had a sense of personal worth and was prepared to tackle her drug dependence.

EMDR appears to be particularly effective for people in addiction, many of whom have suffered physical and sexual trauma that may resurface if the alcohol or other drug is removed. By alleviating the emotional effect of the original trauma, EMDR can help the person face reality without the support of drugs.

There are lingering questions regarding the scientific validity and reliability of the method. Its runaway success has been compared to Mesmerism. This was enormously popular in the late 18th century and it claimed to heal people by using magnetic forces to rearrange the chemical imbalances in their bodies. Critics say that EMDR's apparent success may be due to a hypnotic effect, whereby the client is repeatedly encouraged to see the trauma as less frightening and may simply be trying to please the therapist. However, even if these criticisms are true, it would appear that the technique does work! It is more likely that the reason that it works is because the therapist is more actively involved with the client than in other methods. The therapist's attentive participation may well be that indefinable ingredient that inspires confidence in the client and acts as additional support to the healing process.

EMDR is one of the most thoroughly researched techniques for treating trauma available today. Both the clinical division of the American Psychological Association and the American Psychiatric Association have endorsed it. The Northern Ireland Department of Health, Social Services and Public Safety has called EMDR and cognitive-behavioural therapy the "treatments of choice" for post traumatic stress disorder.

*Clients granted permission and their identities have been disguised.

( Ian Mc Cabe, Ph.D, PsyD, Reg. Psychol. Ps.S.I., is a director of Alcohol Consultancy Services, Dublin. ianmccabe@eircom.net).