Review: Eye Movement Desensitization and Reprocessing (EMDR) in the Treatment of War Veterans

Silver, Rogers and Russell (2008) outline EMDR as an “eight-phase therapeutic approach” based on the Adaptive Information-Processing (AIP) model to treat combat veterans. The foundation of EMDR resides in the clients “neurologically based information processing” (Silver, et al., 2008, p. 948) center and employs an “adaptive resolution” mechanism from the neuroprocessor to resolve traumatic memories by utilizing the two underlying cognitions of adaptation; accommodation and assimilation. Accommodation involves the modification of our internal representations to adapt our normal operating schema. Assimilation involves utilizing an old schemata in a novel way.

When the individual traumatic experience such as combat, the mind begins to lose concordance with the internal operating system and equilibrium begins to unravel into trauma induced sequelae. EMDR seeks to reconcile the traumatic memories into a more collective consciousness within the individual by unblocking the portion of memory that has become entrenched. The combination of EMDR coupled with the AIP model corrects maladaptive behavior and cognitions through an adaptive resolution of the triggering stressor and the unprocessed memory that cause abreactions within everyday living.

The authors provide a brief overview of each phase in relation to the clinician’s main goals and expectations of the combat veteran. The treatment begins with a client history centering on the presenting problem(s), expressively the history of stressors and triggers. During the second phase the clinician prepares the client by educating her in what to expect, the clients role in treatment, information of EMDR and stress reduction techniques. An assessment follows in the third phase, concentrating on a goal-directed triggering of the patient’s affect through the client talking about the major stressors. The client has been given directions to deliberate on imagery, negative emotions and thoughts, and corporal sensations thus leading to the desensitization process.

During this step the practitioners expound on a key tenet of the procedure; the patient controls the therapy sessions and can at anytime halt the treatment. The fourth phase represents a fluid exchange between the client and the clinician where initially the patient is directed to speak of experiences shared in the history and assessment phases. The client has been informed that they do not need to disclose detailed dissections of the memories; a superficial discussion of the memories holds enough salience to stimulate eye movement. The practitioner employs a technique known as bilateral stimulation; a combination of eye movements, sounds and physical tapping to induce information processing to combine associated memories. This process proceeds until a complete resolution has been achieved. In phase five the helper helps the consumer to consolidate a new self affirmation in relation to the original stressors and formulate a novel experiential connexion to replace the trauma driven script.

The next step seeks to check bodily sensations to explore the need to reverse direction in phases or to go forward. Phase six involves a “body scan” whereby the client is directed to concentrate on the presenting problems and the newly associated positive perceptions. Bilateral stimulation can be implemented during this phase when bodily sensations do not match congruently with the recently identified cognitions. As with all therapies a closure needs to be ensured. The seventh phase addresses unfinished processing, covers the use of stress reduction and the probability of possible processing between sessions. The eighth phase includes a reevaluation and assessment to see if additional sessions would be needed to continue unprocessed memories, sensations, emotions and imagery.

In the article the authors chose to leave out two of the techniques in bilateral stimulation, the use of sounds and physical taps. I found this to be concerning, but not surprising as to the historical handling of the bastard child of psychological etiology of somatic disorders and related sequelae. Other considerations I encountered were their conclusions that EMDR therapy was “especially useful during combat situations” (Silver, et al., 2008). The article spent much of its time explaining the therapy and only one paragraph to state the argument in one of the main points in the abstract; that homework would not be necessary for using EMDR and would prove useful in a combat zone.

Considered an evidence-based practice, EMDR has weathered the storm of critics and naysayers and has attained the approval and endorsement of governmental and private entities including but not limited to the Veterans Administration, the Department of Defense and the American Psychological Association. Since the treatments inception in 1989, the efficacy has been proven to a high standard. Silver et al. (2008), reports of research on combat veterans has resulted in remission rates as high as 77% of PTSD patients. After 3-month and 9-months follow-up testing were reported to maintain the positive effects of the treatments.

One of the most interesting aspects of EMDR was the capacity to treat concurrent diagnosis such as depression and anxiety disorders in the same sessions with no distinctions made. Another feature I found that entice my interest to learn and master this therapy was empowering the client to control the procedure, mirroring a fundamental principle in social work, the strengths perspective. The final characteristic that has attracted me was the ability to maintain a safe distance from vicarious traumatization and avoid compassion fatigue that permeates the treatment of trauma based disorders.

Silver, S. M., Rogers, S., and Russell, M. (2008). Eye Movement Desensitization and Reprocessing (EMDR) in the Treatment of War Veterans. Journal of Clinical Psychology: In Session, 64(8), 947-957.