What elements of EMDR contribute to its effectiveness?
EMDR is a complex therapeutic approach that integrates elements of many traditional psychological orientations and combines these in structured protocols. These include psychodynamic (Fensterheim, 1996; Solomon & Neborsky, 2001; Wachtel, 2002), cognitive behavioural (Smyth & Poole, 2002; Wolpe, 1990; Young, Zangwill, & Behary, 2002), experiential (e.g., Bohart & Greenberg, 2002), physiological (Siegel, 2002; van der Kolk, 2002), and interactional therapies (Kaslow, Nurse, &Thompson, 2002). Consequently EMDR contains many effective components, all of which are thought to contribute to treatment outcome.
Marks, Lovell, Noshirvani, Livanou, & Thrasher (1998) propose that emotion can be conceptualised as a “skein of responses,” viewed as “loosely linked reactions of many physiological, behavioural, and cognitive kinds” (p. 324). They suggest that different types of treatment will weaken different strands within the skein of responses and that “some treatments may act on several strands simultaneously” (p. 324). EMDR is a multi-component approach that works with strands of imagery, cognition, affect, somatic sensation, and related memories. This complexity makes it difficult to isolate and measure the contribution of any single component, especially as different clients with the same diagnosis may respond differently to different elements.
Shapiro’s (2001) AIP model conceptualizes EMDR as working directly with cognitive, affective, and somatic components of memory to forge new associative links with more adaptive material. A number of treatment elements are formulated to enhance the processing and assimilation needed for adaptive resolution. These include: (1) Linking of memory components The client’s simultaneous focus on the image of the event, the associated negative belief, and the attendant physical sensations, may serve to forge initial connections among various elements of the traumatic memory, thus initiating information processing. (2) Mindfulness. Mindfulness is encouraged by instructing clients to “just notice” and to “let whatever happens, happen.” This cultivation of a stabilized observer stance in EMDR appears similar to processes advocated by Teasdale (1999) as facilitating emotional processing. (3) Free association. During processing, clients are asked to report on any new insights, associations, emotions, sensations, images, that emerge into consciousness. This non-directive free association method may create associative links between the original targeted trauma and other related experiences and information, thus contributing to processing of the traumatic material (see Rogers & Silver, 2002). (4) Repeated access and dismissal of traumatic imagery. The brief exposures of EMDR provide clients with repeated practice in controlling and dismissing disturbing internal stimuli. This may provide clients with a sense of mastery, contributing to treatment effects by increasing their ability to reduce or manage negative interpretations and ruminations. (5) Eye movements and other dual attention stimuli. There are many theories about how and why eye movements may contribute to information processing, and these are discussed in detail below.