Introduction

Eye movement desensitisation and reprocessing (EMDR) was originated and developed by Dr Francine Shapiro and introduced into the professional and clinical world with her seminal randomised control study in 1989 (Shapiro, 1989). At that time it was introduced as 'eye movement desensitisation'. Shapiro (1991) added the word 'reprocessing' to the title to emphasise the cognitive and information processing elements central to the procedure. Shapiro has been well aware of the problems generated by naming the procedure after eye movements (Shapiro, 2002). Eye movements have been only one form of bilateral stimulation used and bilateral stimulation is itself only one component of a number of components making up the procedure. Whilst a few components are unusual, most components are recognisable from other well known therapies but all are arranged in a unique order. Although EMDR procedures have been standardised since 1991, there has been some evolution in ideas about the theoretical underpinnings of EMDR since 1989, in the light of clinical and research findings. Such evolution is a hallmark of evidence-based practice, which should adapt and evolve in response to new findings.

Eye movement desensitisation and reprocessing was originally designed to treat traumatic or 'dysfunctional' memories and experiences and their psychological consequences, and the procedure has mainly been used in the treatment of post traumatic stress disorder (PTSD). However, there have been increasing reports over the years in the scientific literature on the use of EMDR to treat, for example, test anxiety (Maxfield & Melnyk, 2000), personality disorders (Fensterheim, 1996), gambling (Henry, 1996), work performance (Foster & Lendl, 1996), dysmorphophobia (Brown, McGoldrick & Buchanan, 1997), panic disorder (Goldstein &Feske, 1994), pain (Hekmat, Groth & Rogers, 1994), grief (Sprang, 2001) and

Handbook of Evidence-based Psychotherapies: A Guide for research and practice. Edited by C. Freeman & M. Power. Copyright © 2007 John Wiley & Sons, Ltd.

a wide range of experientially based disorders (Manfield, 1998; Zabukovec et al., 2000). Shapiro (2001, 2002) describes EMDR as an integrative approach, which

• facilitates resolution of memories

• desensitises stimuli that trigger present distress as a result of second-order conditioning

• incorporates adaptive attitudes skills and behaviours for enhanced functioning.

There were only six randomised controlled studies across all psychological treatments for PTSD from 1980 when the diagnosis of PTSD entered DSM-III up until 1992 (Solomon, Gerrity & Muff, 1992). Although the publication of Shapiro's seminal 1989 study initially attracted little attention, this changed after the publication by Joseph Wolpe of a successful case using EMD procedures (Wolpe & Abrams, 1991). These events precipitated the publication of over 100 case studies and, at the time of writing, 20 randomised controlled studies, on EMDR and PTSD alone. This amounts to significantly more research into EMDR than for any other single psychological or psycho-pharmacological approach to PTSD and provides a strong basis on which evidence can be adjudged.

Eye movement desensitisation and reprocessing has been controversial, particularly in its early years, although much of the controversy may be based on misreading or misunderstanding (Perkins & Rouanzoin, 2002). For example (Rosen et al., 1999; Herbert et al., 2000) have attacked EMDR as being promoted as a 'one-session cure'. Shapiro (2002) has pointed out that even in her 1989 seminal paper she stated that 'it must be emphasised that the EMD procedure as presented here serves to desensitise the anxiety related to traumatic memories, not to eliminate all PTSD related symptomatology and complications, nor to provide coping strategies to victims.' In fact some 13 years after the introduction of EMDR there seems to be a growing consensus that, for 'simple'(one-off) trauma, EMDR, although a highly efficient procedure, averages out at around three to five longish treatment sessions (Shapiro, 2001; Van Etten & Taylor, 1998). There has also been much debate about the utility of the eye movement component of EMDR, and about the theoretical basis of EMDR, both of which will be addressed in separate sections in this chapter. Suffice it to say that whatever the merits of the criticisms of EMDR, it has been an astoundingly successful therapeutic procedure in terms of the research interest and publications generated in a relatively short period of time and in terms of the tens of thousands of clinicians across the world who have trained in the procedure. As adherence amongst clinicians has grown, and as the evidence base has grown, this has been reflected in wide acceptance in evidence-based guidelines. It has been acknowledged as effective in the treatment of PTSD by independent reviewers for the American Psychological Association (APA) (Chambless et al., 1998) and by the American Department of Veteran Affairs and Department of Defense (2004). It has been designated an effective psychotherapy for PTSD in the practice guidelines of the International Society for Traumatic Stress Studies (Chemtob, Tolin & Van der Kolk, 2000; Shalev et al., 2000) and it is recommended UK by the National Institute for Clinical Excellence (NICE, 2005), as one of only two empirically supported treatments of choice for adult PTSD, as well as in a number of other international guidelines on the management of PTSD.

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