In 1992, a colleague had an informal meeting introducing EMDR. I later took the training that year on my birthday. EMDR therapy has continued to be one of the best birthday gifts I have ever received. EMDR allowed me to work through clients’ early adverse experiences and identify their trauma-based issues in ways I had not had access to prior to learning this way of doing psychotherapy.

Over the many years of involvement with the EMDR community and colleagues, we have seen and are seeing meaningful changes in our clients’ lives. The research that is coming in from clinicians and scholars all over the world is documenting that these consequential changes are occurring.

This is a published definition of EMDR therapy that I worked on with colleagues who have been experienced EMDR practitioners for many years:

Eye Movement Desensitization and Reprocessing (EMDR) therapy is an integrative, client-centered approach that treats problems of daily living based on disturbing life experiences that continue to have a negative impact on a person throughout the lifespan. Its Adaptive Information Processing theory hypothesizes that current difficulties are caused by difficult memories that are inadequately processed, and that symptoms are reduced or eliminated altogether when these memories are processed to resolution using dual attention bilateral stimulation. These targeted memories, once resolved, are hypothesized to result in memory consolidation.

The standard application of EMDR therapy is comprised of eight phases and a three-pronged approach to identify and process:

1. Memories of past adverse life experiences that underlie present problems; 

2. Present-day situations that elicit disturbance and maladaptive responses;  

3. Anticipatory future scenarios that require adaptive responses. 

There is strong empirical evidence for its use in the treatment of PTSD, and it has also been found to be an effective, transdiagnostic treatment approach for a wide range of diagnoses in a variety of contexts and treatment settings with diverse populations.

More information is available at the following link:

https://doi.org/10.1891/EMDR-D-21-00029

Our approach conceptualizes depression as a stress- and trauma-based disorder, especially for those depressed patients who do not respond well to current guideline approaches.

Through observation, we have seen that most depressive episodes are related to stressful life experiences; when this happens, memory changes occur that are closely linked to depressive symptomatology. These are called pathogenic memories and are important for treatment. Unlike in PTSD, these memories are not linked to life-threatening situations that would fulfill the criteria for PTSD. Although there may be life-threatening events that are part of the patient’s symptom picture, our experience shows that, for the most part, they do not have to be the triggering event that precipitates depression. However, processing the pathogenic memories related to adverse life events results in a decrease in depression symptoms.

It is also important to address negative self-beliefs through their “proof memories,” which are recollections that “prove” to the patient that their belief is true. Another group of states that are important to check on are depressive and/or suicidal states; these are the memories of the sensory data attached to an older depressive/suicidal episode that is not occurring in the present time. Also, an essential part of this protocol is to work to prevent relapses (see question nine).

According to our observations, a large number of our patients lose their depressive symptoms at the end of treatment. The aim of the EMDR Protocol for the Treatment of Depression (DeprEnd©) is to do all that is needed to make sure that patients are in complete remission. When this occurs, relapses are noticeably reduced.

Even if the number of controlled studies is still low, there are already some consistent findings in the studies that have been done so far. A meta-analysis of eight EMDR RCT studies on treating depression concluded that EMDR seemed to have a significantly higher number of full remissions than other interventions (like CBT). Another meta-analysis of nine RCT studies with depressive patients concluded that EMDR may be considered an effective treatment for improving symptoms of depression, with effects comparable to other active treatments.

As the rate of full remissions is closely linked with relapses, it is likely that EMDR also reduces the number of relapses.

In a follow-up naturalistic study of an inpatient EMDR treatment center with patients who were diagnosed with severe depression, 55 percent of them with recurrent depression and significant comorbidity reached full remission. Twelve months after the end of treatment, 74 percent were still relapse-free.

With all this in mind, it seems that EMDR therapy could contribute to a significant improvement in the treatment of chronic and recurrent depression (the forms of depression where the usual treatments often fail).

More information is available at the following links:

https://doi.org/10.3389/fpsyt.2021.700458 
https://doi.org/10.1080/20008198.2021.1894736 
https://doi.org/10.3389/fpsyg.2022.937204 

Neurobiological models have shown structural and functional changes in the brain that are associated with EMDR therapy. Pagani and his team showed that limbic structures as well as tertiary visual cortex structures were active in PTSD patients prior to EMDR reprocessing. During EMDR, structures in the orbito-frontal cortex were activated and interacted with the limbic structures. They interpreted this as reprocessing occurring. An hour later, after EMDR reprocessing, the active brain structures were in the left temporo-occipital region; they concluded that the emotional memory was reprocessed and patients then could access their executive functioning in the prefrontal cortex.

EMDR therapy is based on a completely different neurobiological mechanism than talk therapy. In 2019, Baek and his Korean group published research that used an animal model to show how EMDR worked on a cellular level. They described a neuronal pathway that was supported by the superior colliculus (SC) – a structure that mediates the persistent lessening of fear. They were successful in causing a lasting reduction in fear in mice by pairing visual alternating bilateral stimulation (ABS) during fear extinction. ABS provided the strongest fear-reducing effect and yielded increases that continued in the activities of the SC and mediodorsal thalamus (MD). The optogenetic manipulation showed that the SC-MD circuitry was necessary and sufficient to prevent the return of the fear. ABS suppressed the fear-encoding cells from being activated and stabilized the inhibitory neurotransmission in the basolateral amygdala via a feedforward inhibitory circuit from the MD. Together, these results reveal the neural circuit that underlies an effective strategy for sustainably attenuating traumatic memories.

More information is available at the following links:

https://doi.org/10.3389/fpsyg.2018.00475
https://doi.org/10.1038/s41586-019-0931-y 

Yes. In cases of severe depression, most patients have been treated with medication. These medications can continue to be used during EMDR therapy treatment if they do not sedate the patient or blunt their access to their affective responses too much. If that happens, it could then reduce the possibility of activating their affect while engaging in EMDR therapy; this would lessen the efficacy of the EMDR work. However, note that the medication can probably be reduced as treatment progresses; this happens usually after the targeting and reprocessing of the depression-activating events transpire and changes in vegetative symptoms occur.

Also, there are successful experiences for patients when using other psychiatric interventions like transcranial magnetic stimulation; this can assist patients by readying them to be more responsive to psychotherapeutic treatment, such as EMDR therapy.

The power of EMDR therapy is not with single-episode depression, but with more complicated cases that turn into chronic illness. In these cases, classic treatment often fails, and clients stay ill or continue to relapse. However, it is important to note that each patient’s treatment is formulated based on that individual’s life history. There are a series of individual patients who had a higher number of relapses who, after working within the DeprEnd© framework, have lost their recurrent depression diagnoses completely.

Also, EMDR therapy has an excellent record of addressing memories that are stress- and/or trauma-related. Targeting these types of memories with the Standard EMDR Protocol and three-pronged approach has resulted in reconsolidation of the memories without the distressing affect and beliefs that had been connected with them in the past.

Negative self-belief systems and self-perceptions are an integral part of working with patients suffering from depression. This is done by asking clients “to prove” their negative belief by asking them how they know this belief is true and/or what experiences this belief is based upon. Clients float back to earlier adverse experiences that support their conclusion that their belief is true, and these memories are reprocessed to relieve them of their distressing emotions and somatic tension. This is done within the framework of EMDR therapy’s eight phases and three-pronged protocol that addresses memories concerning the “proof,” incidents, present triggers, and future concerns and anxieties of what is to come to make sure all aspects of the belief are reprocessed.

The potential challenge when treating depression is the enormous problem of patient relapse. This occurs when the episode triggers depression incidents, negative self-beliefs, and depressive and suicidal states that are not fully reprocessed and reconsolidated into memories that are no longer activated and can be viewed calmly.

The EMDR Protocol for the Treatment of Depression addresses this through a four-step process that includes the following:

1. Working with triggers to focus on the worst part of the current situation and reprocessing the triggers with the EMDR Standard Protocol.

2. Working with projections into the future: It is helpful to work with the patient’s negative projections or anticipatory anxiety, especially fear of a new depressive episode. This is done by identifying a challenging situation in the future, a positive cognition, and emotion/s and then using bilateral stimulation to reprocess any activated emotions and sensations.

3. Building up specific resources for challenging situations is an important part of this protocol. Resources such as Arne Hofmann’s Absorption Technique, Korn and Leeds EMDR Resource and Development Technique, or other resources that therapists have in their repertoire of positive resources are useful in this process.

4. Working with the memory of a depressive state/s. Processing the depressive state that contains body states and the memories of body states is essential. This is done with the EMDR Standard Protocol.