**5. Eye Movement Desensitisation and Reprocessing**

EMDR has evolved from a simple technique into an integrative psychotherapy that addresses both the cognitive perception of trauma and the resultant physiological condition, an interaction of mind and body. Psychological problems are addressed and successful treatment outcome is achieved in a short space of time, as negative cognitions and emotions are replaced with positive thoughts and memories, body sensations are changed, and new behaviours emerge [53]. Changes in anxiety and fear are only by-products of a comprehensive reprocessing of the whole experience. The conceptualisation of the transformation of stored disparate experiences and the accompanying memories through a rapid learning process is the key to understanding the basis and application of EMDR [53].

## **5.1 Background**

Initially EMDR was called Eye Movement Desensitisation, beginning with a behavioural orientation similar to the roots of CBT [54, 55], as it was thought that eye movements were unique in causing an effective desensitisation. Subsequently it was discovered that other forms of bilateral stimulation (tactile and auditory) also resulted in positive effects [56]. The word 'reprocessing' was added when it was realised that through a process of desensitisation the treatment achieved positive changes in traumatic memories, as well as a reduction in anxiety. EMDR is a relatively new psychotherapy first used in the treatment of post-traumatic stress disorder (PTSD) [57]. However since its inception it has expanded widely now treating a wide range of pathologies including treatment of trauma, anxiety disorders and associative conditions as well as phobias. The treatment protocols have evolved enabling treatment of diverse forms of trauma responsible for psychological and physiological disorders, particularly those that are anxiety-based. The philosophy underlying this hypnotically-based approach to treatment is that individual conditions that are emotionally-based can be healed quickly, effectively and profoundly; dissociative disorders and phobias, and the consequences of these and other past negative-rooted traumas can be changed using EMDR [58]. In 2004 it was placed in the "A" category as strongly recommended for the treatment of trauma and anxiety-related conditions in both the American Psychiatric Association and the American Department of Defence. Through a process of desensitisation it was found that dissociative disorders and past negative-rooted experiences can be changed effectively and quickly, allowing for the emergence of new positive behaviours [58].

#### **5.2 Theory**

EMDR is based on the premise that earlier life experiences can elicit a continued pattern of similar affect, behaviour and cognition (the three main constituents of anxiety [59], and that present-day stimuli can elicit similar affective behavioural memories of earlier experiences. The theory of EMDR adopts a model that emphasises cognitive information processing of past negative experiences and memories, the bilateral movements adopted inducing a light hypnotic trance. Both physical and emotional memories of subjective trauma can be reprocessed resulting in a state of positive mental and emotional wellbeing [56]. A putative neurobiological mechanism for the efficacy of EMDR has been offered [60], which presents a complete model of how EMDR could lead to specific improvements in PTSD and related conditions. It suggests that during EMDR the flow of information from the

*Cognitive Hypnotherapy and EMDR: Two Effective Psychodynamic Therapies for the Rapid… DOI: http://dx.doi.org/10.5772/intechopen.101770*

hippocampus (which stores information) to the neo-cortex (which analyses information) is directionally reversed in EMDR similar to REM sleep cycles. This allows for cognitive re-evaluation of previously maladjusted/negative encoded information. The theory is that, through guided eye movements or other sources of bilateral brain stimulation such as hand taps or alternating sounds, traumatic information held in neurological networks is changed and connected to more positive cognitions stored in subjective memory [56, 61].

#### **5.3 Disparate memories and EMDR practice**

EMDR targets memories directed at the negative/traumatic experience and deals specifically with reprocessing these memories as quickly as possible. It is aimed at the pivotal event that caused the initial fear/reaction and addresses all the contemporary stimuli that might independently trigger the subjective fear [62]. It is believed that traumatic information of disparate memories cause dysfunctional cognitive and emotional behaviour [63], and that this information, held in neurological networks in the brain, is changed during the process of EMDR [61].

It is argued that through assimilation negative memory adds to subjective knowledge regarding expectations and potential warning signs and suggests that when a distressing experience results in persistent anxiety the information processing system has stored the experience without adequately processing it to an adaptive resolution. The event is 'frozen in time' in the moment of fear and pain and this lays the foundation for future inappropriate dysfunctional responses to similar events [62].

When subjective implicit memories have not been processed this may be at the root of a variety of psychological issues in the present [20, 64]. Emotions, sensations and perspectives of earlier events colour the perceived view of similar present-day events; a current situation similar to an earlier event will automatically link into the memory network in which the earlier event is stored [53].

The procedures have been developed to identify, access and target dysfunctionally stored experiences and to stimulate the innate processing system. This allows adaptive resolution of the information and shifts the information to the appropriate memory systems [60, 63]; pinpointing the target (the traumatic experience) and reprocessing the disparate memory is crucial in the initial stages of treatment.

#### **5.4 Protocols and procedure in therapy**

During therapy a dual-attention approach is used to facilitate the processing of the cognitive, affective and sensory elements of a recalled disturbing event [64]. An eight-phase psychotherapeutic treatment approach has been adopted with standardised procedures and protocols to address the full range of clinical conditions caused or exacerbated by previous negative experiences [64]. Subsequently this developed into an adaptive information process (AIP) model, the premise of which is that every person has both an innate tendency to move towards health and wholeness and the inner capacity to achieve it [64].

The AIP model has been adopted for experiences for the highest level of trauma, 'A' category, as well as for small trauma designated as 't' trauma. Small trauma is described as experience not rising to the highest level of trauma, but nonetheless causing significant psychological damage to require treatment. The treatment of both 'A' and 't' trauma guides the procedures and protocols of the clinical practice of EMDR [53].
