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Dr Shapiro_ 2012_ New York Times


									                                Dr Francine Shapiro ( - New York Times 2012

Ask an Expert About E.M.D.R.

        The psychological therapy known as eye movement desensitization and reprocessing,
or E.M.D.R., has gained increasing attention in recent years as a treatment for post-traumatic
stress disorder among returning war veterans and others suffering from the results of serious
trauma. The integrative approach uses rapid eye movements and other procedures to access
and process disturbing memories.

       “Recent research has demonstrated that certain kinds of everyday life experiences can
cause symptoms of P.T.S.D. as well,” says Francine Shapiro, the originator of E.M.D.R.
“Many people feel that something is holding them back in life, causing them to think, feel
and behave in ways that don’t serve them. E.M.D.R. therapy is used to identify and process
the encoded memories of life experiences that underlie people’s clinical complaints.”

        The therapy has been recognized as effective by numerous organizations, including
the American Psychiatric Association and the Department of Defense, but controversy exists
as to how it works.

Francine Shapiro, Ph.D., is a senior research fellow at the Mental Research Institute in Palo
Alto, Calif., director of the EMDR Institute, and founder of the nonprofit EMDR
Humanitarian Assistance Programs, which provides pro bono training and treatment to
underserved populations worldwide. Her latest book is “Getting Past Your Past: Take
Control of Your Life with Self-Help Techniques from EMDR Therapy” (Rodale, 2012).

The Evidence on E.M.D.R.
THE NEW YORK TIMES March 2, 2012

        This week, readers of the Consults blog posed questions about eye movement
desensitization and reprocessing, or E.M.D.R., a psychological therapy pioneered by
Francine Shapiro that uses eye movements and other procedures to process traumatic
memories. The therapy has been used increasingly to treat post-traumatic stress disorder and
other traumas. You can learn more about how E.M.D.R. therapy is done here. Below, Dr.
Shapiro addresses reader questions about the current state of research on E.M.D.R. therapy.

       Question: Much of the research in support of E.M.D.R. has been published by
       Francine Shapiro. Please comment on the results of empirical studies conducted by
       researchers who are not E.M.D.R. practitioners, both pro and con. J. Tyson Merrill,
       Ithaca, N.Y.

       Question: As a clinical psychologist and scientist-practitioner trained in evidence-
       based methods of treatment, I strongly urge The Times to offer a more balanced
       presentation of the evidence when presenting an “expert” opinion. Individuals’

                                 Dr Francine Shapiro ( - New York Times 2012

       psychological well-being (and their treatment costs) are at stake when we talk about
       what “works.” Susan, Hawaii

Dr. Shapiro responds:

        A number of readers have asked about research on E.M.D.R. I invite any dialogue on
the findings or on my interpretation of the studies; I’ve included a comprehensive reference
section of published studies on E.M.D.R. to enable interested readers to access them on their
own (click here to see the list).

       E.M.D.R. therapy is recommended as an effective treatment for post-traumatic stress
disorder in the practice guidelines of a wide range of organizations, like the American
Psychiatric Association (in 2004), the Department of Veterans Affairs and Department of
Defense (in 2010), the International Society of Traumatic Stress Studies (in 2009), and other
organizations worldwide, including in Britain, France, the Netherlands and Israel. The one
exception is a report published in 2007 by the Institute of Medicine that stated that more
research was needed to establish efficacy. Since that time, six more randomized E.M.D.R.
therapy studies have been conducted.

Randomized Trials on E.M.D.R.

        The effectiveness of E.M.D.R. therapy has been well established as the result of about
20 randomized controlled studies. Only one of the randomized trials was conducted by me; it
was published in The Journal of Traumatic Stress in 1989. At that point, I believed that since
I’d originated the therapeutic approach, it was important the data be independently tested.

        Some of the initial studies looked at multiply traumatized combat veterans, but they
used only two treatment sessions and reported mixed or negligible results (for example, see
Boudewyns et al, 1993; Jensen, 1994). These studies were later criticized in both the
Department of Veterans Affairs/Department of Defense and International Society of
Traumatic Stress Studies practice guidelines for using an inadequate dose of treatment for
this population (see DVA/DoD 2004, 2010 and Chemtob et al, 2000). A subsequent study
(Carlson et al., 1998) conducted at a Veterans Affairs facility used 12 treatment sessions and
reported a 78 percent remission in P.T.S.D.

        Regarding the issue of research by nonpractitioners of E.M.D.R., all good studies
should include fidelity checks to ensure that the treatments are being done appropriately. All
of the 20 randomized studies have involved people who were originally trained in other
approaches before evaluating E.M.D.R. therapy.

        For instance, the first civilian clinical outcome research on E.M.D.R. in the United
States was published in The Journal of Consulting and Clinical Psychology in 1995, with a
15-month follow-up published in 1997 (Wilson, Becker and Tinker, 1995, 1997). The
principal investigator was a dissertation student and the second author was her faculty
adviser; both had been trained in a variety of approaches. The research reported a remission
of 84 percent of those initially found to have P.T.S.D. resulting from a single trauma after
three 90-minute sessions.

                                 Dr Francine Shapiro ( - New York Times 2012

       The second randomized E.M.D.R. study of civilians (Rothbaum, 1997) was conducted
by an established cognitive behavioral therapy researcher. It reported a 90 percent P.T.S.D.
remission in sexual assault victims after three 90-minute sessions. The third civilian study
was financed by Kaiser Permanente (Marcus et al., 1997, 2004) and reported that after an
average of six 50-minute sessions, 100 percent of the single-trauma victims and 77 percent of
the multiple-trauma victims no longer had P.T.S.D.

       The rest of the randomized studies to date have generally continued to show
substantial success rates (termed “effective” by the researcher) with mixed trauma groups.

Placebo, Therapist and Expectation Effects

       Question: Can you comment on the perception that the alleged efficacy of E.M.D.R.
       is due to placebo or patient expectancy effects? eln, Vermont

       Question: How have studies controlled for the effect of the caring and supportive
       environment that a therapist provides? PinkFreud, California

Dr. Shapiro responds:

        Several readers asked whether E.M.D.R.’s effects can be attributed to the effects of
placebo, or client expectations, or perhaps to the powerful effects of the therapeutic alliance.
Research studies are designed to control for and rule out these potential confounding factors
by having the therapists provide two different treatments. There are currently 16 clinical trials
in which E.M.D.R. was compared with other therapies. The effects of E.M.D.R. research
indicate the outcome can be directly attributed to the provision of the treatment.

        Some studies that examined whether patient expectations were related to outcomes
did not find that expectations played any role in E.M.D.R. treatment (for example, see
Gosselin and Matthews, 1995). Other clinical trials have examined the placebo effect
directly; for example, one study compared E.M.D.R. with a pill placebo and found E.M.D.R.
superior for those participants who completed therapy (van der Kolk et al., 2007).

        Another randomized study found E.M.D.R. superior to eclectic therapy, which uses a
variety of psychological approaches (Edmonds, Rubin and Wambach, 1999). An additional
study that evaluated the participant’s perceptions of E.M.D.R. compared with other therapies
(Edmonds, Sloan and McCarty, 2004) concluded that “survivors’ narratives indicate that
E.M.D.R. produces greater trauma resolution, while within eclectic therapy, survivors more
highly value their relationship with their therapist, through whom they learn effective coping
strategies.” These findings are not meant to imply that the therapeutic relationship is
unimportant in E.M.D.R., but rather that E.M.D.R. emphasizes innate healing capacities that
require a minimum of clinical “intrusion.”

                                 Dr Francine Shapiro ( - New York Times 2012

Comparing E.M.D.R. With Exposure Therapy

       Question: How do you respond to the numerous studies that have shown that the
       results from E.M.D.R. have nothing to do with the actual “eye movements” and
       appear to be explained by the “exposure” piece of treatment in E.M.D.R. (e.g. the
       story retelling)? Is E.M.D.R. (as I have always suspected) just another version of
       prolonged exposure using snapping, waving of hands or light bars to induce eye
       movements that have no clinical relevance? Levin, San Diego

       Question: I am a psychologist and have undergone E.M.D.R. My sense of it, along
       with a number of researchers, is that the healing component is the use of imagination
       (for exposure and desensitization), as a client feels their way through their fears, and
       that there is a lack of strong evidence that the bilateral reprocessing is necessary.
       PinkFreud, California

Dr. Shapiro responds:

       First, it would be useful to describe briefly how E.M.D.R. and prolonged exposure
therapy differ, for those who are unfamiliar with the therapies.

        E.M.D.R. therapy is an eight-phase treatment approach. During memory reprocessing,
the client recalls a disturbing event for a short period (for example, 30 seconds) while
simultaneously undergoing bilateral stimulation that can consist of moving the eyes from side
to side, vibrations or tapping movements on different sides of the body, or tones delivered
through one ear, then the other, via headphones. New associations emerge and often become
the new focus of attention. No homework is required, and the client is not asked to describe
the memory in detail. The goal is to let the brain’s information processing system make new
internal connections as the client focuses on the thoughts, emotions, memories and other
associations that are freely made during the sets of bilateral stimulation.

         Some exposure researchers (Marks et al., 1998) have proposed that these types of
brief exposures should actually make people worse. In contrast, in prolonged exposure
therapy, the client intensely focuses on describing the traumatic memory in detail, as if
reliving it. The narrative is usually repeated two to three times within the therapy session, and
it is recorded. The client is then assigned the homework of listening to the recording as well
as engaging in in vivo exposure, which involves going to a previously avoided anxiety-
provoking environment, to allow habituation to occur.

       Nine randomized studies have compared E.M.D.R. therapy with various forms
of cognitive behavioral therapy containing exposure therapy, with or without the
addition of cognitive therapy. Meta-analyses, which pooled data from all the studies,
have reported comparable effects. In all but one of the individual studies, E.M.D.R. was
equal or superior (on some measures) to cognitive behavioral therapy.

        The exception (Taylor et al., 2003) compared eight sessions of E.M.D.R. therapy with
eight sessions of cognitive behavioral therapy. The cognitive behavioral therapy component
consisted of four sessions of imaginal exposure, in which the client holds the traumatic event
in mind while describing it in detail, plus four sessions of therapist-assisted in vivo exposure,
in which the therapist accompanies the client to an anxiety-provoking environment, plus one
                                 Dr Francine Shapiro ( - New York Times 2012

hour of daily homework, totaling about 50 hours over the course of the treatment. The
E.M.D.R. component used only standard therapy sessions and no homework. Cognitive
behavioral therapy was superior on some measures.

        Another study (Ironson et al., 2002) compared E.M.D.R. and prolonged exposure, and
used in vivo homework in both groups. It found that while both approaches resulted in
substantial improvement, 70 percent of E.M.D.R. participants achieved a good outcome in
three active treatment sessions, compared with 17 percent of those in the prolonged exposure
group. E.M.D.R. also had fewer dropouts (none, versus 30 percent of the prolonged exposure
group). Another study funded by the National Institute of Mental Health that was conducted
by a well-known exposure therapy researcher (Rothbaum et al., 2005) found that both
E.M.D.R. and prolonged exposure were effective, and stated: “An interesting potential
clinical implication is that E.M.D.R. seemed to do equally well in the main despite less
exposure and no homework. It will be important for future research to explore these issues.”

How Important Are Eye Movements in E.M.D.R.?

       Question: Have you been able to decisively prove that the eye movements
       themselves serve a true clinical role, and if so what evidence have you garnered to
       show this is the case? Levin, San Diego

Dr. Shapiro responds:

        A number of component analysis studies were conducted in the 1990s that attempted
to compare E.M.D.R. with eye movements and E.M.D.R. without eye movements. A meta-
analysis of these studies found no effects for the eye movements (Davidson and Parker,
2001). The International Society of Traumatic Stress Studies task force (Chemtob et al.,
2000) evaluating the research included in the meta-analysis stated: “Overall, the studies
reviewed here provide little support for the hypothesis that eye movements are critical to the
effects of E.M.D.R. However, a final conclusion regarding this issue is precluded by
methodological limitations of the various studies . . . including treatment refractory subjects,
questionable adequate treatment dosage and fidelity, and limited power due to small

        This area still remains the subject of controversy and has drawn the attention of
numerous memory researchers. In the past decade, about 20 randomized trials have evaluated
the eye movements in isolation. They compared the eye movements with exposure-only
conditions and consistently reported significantly superior effects for the eye movements
compared to the no-eye-movement groups.

        These studies explored various theories about the effects of eye movements, and two
dominant theories have emerged: that eye movements (1) interfere with working memory
processes (van den Hout et al, 2011) and (2) link into the same processes that occur during
R.E.M. sleep (Stickgold, 2002). In support of these theories, eye movements have been
shown to decrease the emotionality and vividness of memories, create physiological
relaxation responses, facilitate access to associative memories and lead to an increase in
recognition of information that is true.
                                 Dr Francine Shapiro ( - New York Times 2012

       According to the working memory theory, benefits occur when the limited capacity of
the working memory is taxed by the simultaneous focus on the dual attention task (eye
movements) and the negative memory. Because of the limited resources, the memory
becomes less vivid, less complete and less emotional. This theory is supported by numerous
randomized studies that have all shown that lateral eye movements reduce the self-rated
vividness or emotional effect of unpleasant autobiographical memories (for example,
Barrowcliff et al., 2003, 2004; Engelhard et al., 2010. 2011; Kavanagh, Freese, Andrade and
May, 2001; Maxfield, Melnyk and Hayman, 2008; Schubert et al., 2010; Van den Hout et al.,
2001, 2011).

        The theory that eye movements link into the same processes that occur during R.E.M.
sleep is supported by research demonstrating the effects of eye movements on physiological
states and memory retrieval. Eye movements have been demonstrated to induce a state of
relaxation, or decreased psychophysiological arousal, in nonrandomized (Elofsson et al.,
2008; Sack et al., 2008) and randomized (Barrowcliff et al., 2004; Schubert et al., 2011)
studies using physiological measures. One hypothesis is that this relaxation response is a
reaction to changes in the environment, part of an orienting response that is elicited by the
shifts of attention caused by the repeated bilateral stimulation, which links into processes
similar to what occurs during R.E.M. sleep (Stickgold 2002, 2008). Further support for the
R.E.M. theory is found in numerous randomized trials that indicate that bilateral saccadic eye
movement enhances retrieval of episodic memory, increases recognition of true information
and improves certain measures of attention (for example, Christman et al., 2003, 2006;
Kuiken et al., 2002; 2010; Parker, Relph and Dagnall, 2008; Parker, Buckley and Dagnall,
2009; Parker and Dagnall, 2010)

        Still, controversy remains regarding why E.M.D.R. works. It’s possible that both the
working memory and R.E.M. theories are correct and that the mechanisms interact
synergistically. We await the results of randomized controlled trials to further determine what
role eye movements and other bilateral stimulation make to treatment outcome independent
of the rest of E.M.D.R. procedures.

Ask an Expert About E.M.D.R.
THE NEW YORK TIMES March 16, 2012

E.M.D.R. and Post-Traumatic Stress Disorder

       Question: Please explain the mechanics of how P.T.S.D. occurs and why. Why is it
       some soldiers end up with P.T.S.D.? Why is it that not everyone raped gets P.T.S.D.?
       NANA, Dania Beach, FL

Dr. Shapiro responds:

         Post-traumatic stress disorder, or P.T.S.D., occurs when an experience is so disturbing
that it disrupts the information processing system of the brain. This system has as one of its
main functions the transformation of disturbing experiences into mental adaptation. That is, it

                                 Dr Francine Shapiro ( - New York Times 2012

takes a disturbing event and processes it in such a way that appropriate neural connections are
made within the memory networks, which eliminate those aspects of the event (for example,
negative thoughts, unpleasant emotions and physical sensations) that are no longer useful.

        Sometimes, however, the event is so disturbing that the system is unable to perform
these natural functions. The result is that the memory of the incident is stored along with the
psychological and physical aspects of the event, including the negative beliefs that it
engendered. Such an unprocessed traumatic memory may be stimulated by a current
experience, and the encoded negative emotions, thoughts and sensations can emerge and
color the perception of the present.

        The reason that some people are affected more than others depends on genetics, the
intensity of the experience, length of exposure and earlier life experiences. Some people have
had positive experiences that contribute to greater resilience. Others have had negative
experiences that can make them susceptible to later problems. For instance, an official
diagnosis of P.T.S.D. requires that the individual experience a major trauma, like a rape,
accident or battlefield experience. However, recent research indicates that in many cases,
P.T.S.D. symptoms can occur as the result of less dramatic events. Some examples are hurtful
childhood experiences with parents and peers, which can have a very negative effect on a
person’s sense of self-worth. These events can set the groundwork for a wide range of
symptoms, including a vulnerability to P.T.S.D.

E.M.D.R. and REM Sleep

       Question: Please explain the process of R.E.M. and E.M.D.R.
       NANA, Dania Beach, FL

Dr. Shapiro responds:

        A Harvard researcher has suggested that the eye movements used in E.M.D.R. seem
to stimulate the same processes that exist in rapid eye movement, or R.E.M., sleep. R.E.M.
occurs in the same stage of sleep as dreaming, and during this time, scientists believe, the
brain processes survival information. The implication is that, like R.E.M. sleep, the eye
movements of E.M.D.R. facilitate the transfer of episodic memory, which includes emotions,
physical sensations and beliefs associated with the original event, into semantic memory
networks, in which the meaning of the event has been extracted and negative associations are
no longer present.

        The proposed link between E.M.D.R. eye movements and R.E.M. sleep has now been
the subject of about a dozen randomized studies. Supporting the hypothesis were findings that
E.M.D.R. eye movements decrease physiological arousal, increase episodic associations and
increase the recognition of true information. Despite these results, many questions remain
about the underlying mechanism for the effects of E.M.D.R. This is not a unique situation,
however, since the neurobiological explanation for any form of therapy, and even many
pharmaceuticals, remains obscure.

                                  Dr Francine Shapiro ( - New York Times 2012

        In addition, see my earlier post, “The Evidence on E.M.D.R.,” for information about
studies on E.M.D.R. and R.E.M.

How E.M.D.R. is Done

       Question: Will you articulate to me and to the people here how you describe the
       E.M.D.R. process and protocol? NANA, Dania Beach, FL

Dr. Shapiro responds:

        The eight phases of E.M.D.R. therapy begin with history taking, in which the
presenting problems and early clinically significant life events are identified, and goals for
the client’s fulfilling future set. The next phase involves preparing the client for memory
processing. During processing, the client is directed to attend briefly to certain aspects of the
memory while the information processing system is simultaneously stimulated. During this
phase, the client engages in periodic sets of eye movements (sometimes taps or tones) for
approximately 30 seconds each. It is during this time that the process of transforming the
“stuck memory” into a learning experience and an adaptive resolution is observed. New and
useful emotions, thoughts and memories emerge, and old and counterproductive ones are
resolved. For example, the feelings of shame and fear voiced by a rape victim at the
beginning of an E.M.D.R. session may be replaced by the feeling that she is a strong and
resilient woman. E.M.D.R. therapy specifically addresses issues involving the past, present
and future.

E.M.D.R. vs. Other Therapies for Trauma

       Question: How is E.M.D.R. different from other kinds of therapies for trauma
       victims? BizB, Rockville, MD

Dr. Shapiro responds:

        Besides E.M.D.R. therapy, very few trauma treatments have a strong empirical basis.
Two others that are well known are prolonged exposure therapy and cognitive processing
therapy. Both are forms of trauma-focused cognitive behavior therapy, which require clients
to describe in great detail their traumatic memory.

        In prolonged exposure therapy, clients must describe the memory as if it were
happening to them in the present. They repeat this two to three times during the session while
an audio recording is made. The rationale for this form of treatment is that the reason clients’
problems persist is that they are avoiding reminders of the instigating events. Therefore, it is
considered important for them to learn firsthand that they can experience the distress without
being overwhelmed. Likewise, they are required to do daily homework between sessions that
consists of listening to the recordings of their description of the event and visiting locations
associated with it, to cause the disturbance to dissipate.

                                 Dr Francine Shapiro ( - New York Times 2012

       In cognitive processing therapy, clients are asked to provide details about the
traumatic event so that their negative beliefs can be identified and then challenged and
changed. This occurs during sessions and by doing daily homework assignments.

        In contrast to the preceding treatments, the emphasis in E.M.D.R. is to help the
information processing system make the automatic connections required to resolve the
disturbance. Specific procedures are used to help clients maintain a sense of control during
memory work as the therapist guides their focus of attention. They need only focus briefly on
the disturbing memory during the processing while engaged in the bilateral stimulation (eye
movements, taps or tones) as the internal associations are made. The client’s brain makes the
needed links as new emotions, sensations, beliefs and memories emerge. All the work is done
during the therapy sessions. It is not necessary for the client to describe the memory in detail,
and no homework is used.

E.M.D.R. and Childhood Trauma

       Question: I sought out an E.M.D.R. practitioner for the lifelong problems I’ve had
       from having rejecting, abusive parents. Do you agree that E.M.D.R. isn’t a good
       choice for someone like me? What do you suggest for someone with a difficult history
       like mine, who has been chronically anxious since very early childhood?
       Shaun, Grand Rapids

       Question: Why do some think E.M.D.R. isn’t helpful with childhood trauma? From
       what my therapist told me, it sounds like it is often used with individuals with issues
       stemming from childhood. Isn’t that the point? But in the past I’ve heard that it may
       not be indicated for P.T.S.D. related to chronic trauma over a period of years,
       particularly when the trauma was sustained in childhood. Is that true? If so, why or
       why not? Ernest K, Denver

       Question: Have there been changes in your E.M.D.R. methods over the years to
       address some of the questions being raised in this forum — specifically for treatment
       of people with complex trauma (multiple traumas) and childhood traumas like sexual
       abuse or neglect? benslow, USA

Dr. Shapiro responds:

         E.M.D.R. therapy is widely used to treat chronic childhood trauma survivors.
However, with this presenting problem, it often takes longer than with adult trauma victims
for the client to feel secure and safe enough to do memory processing. Further, because of the
larger number of events and earlier onset for childhood trauma victims, the processing work
itself generally takes longer.

       As I noted above, E.M.D.R. therapy is an eight-phase approach. The first two of these
phases — history-taking and preparation — need to be more extensive with multiply
traumatized survivors of childhood abuse than with adult trauma survivors. Stabilization and
the development of skills and self-capacities, like the ability to self-soothe and tolerate
emotions, are the primary focus in the preparation phase of E.M.D.R. treatment. There are
                                  Dr Francine Shapiro ( - New York Times 2012

often fears related to emotion and connections with others that must be addressed during the
early phase of treatment before a survivor is able to move into work that focuses on the past.

        E.M.D.R. therapy targets the way in which memories are stored in the brain. These
include “takeaway” messages, like “I’m not good enough,” “It’s not O.K. to ask for what I
want” and “I’m powerless to protect myself.” These feelings and beliefs are based on the
child’s perceptions at the time of the experiences, whether they involved a major traumatic
event like the loss of a parent to death or divorce, or something less dramatic but more
insidious, like a daily diet of criticism or fear that something bad is going to happen.

        The amount of exposure to bad experiences affects the development of symptoms. In
general, the more severe and longer the exposure and the younger the age at exposure, the
greater the impact will be in the form of pervasive and debilitating symptoms. Not always,
but often, the amount of time needed for therapy also depends on whether the person has had
any positive role models and significant figures who were supportive and nurturing. When
these have been lacking, more time will generally be needed for preparation and
comprehensive treatment. For some clients, this process will take longer because they have
more negative experiences to process. For others, more stand-alone experiences occurred that
changed the course of their lives. And, of course, there’s everyone in between.

        These childhood traumatic memories and the pain and symptoms associated with
them can be systematically reprocessed over time with E.M.D.R. The bottom line is that
given an opportunity, the information processing system of the brain will move toward

        E.M.D.R. therapy is used extensively in the treatment of chronic victimization and
childhood traumatization. In fact, a study conducted by a large H.M.O. reported that within
12 sessions, 77 percent of multiple trauma victims treated with E.M.D.R. lost the diagnosis of
post-traumatic stress disorder (Marcus et al., 1997, 2004). Another study with adult survivors
of childhood sexual abuse also found it to be effective (Edmond et al., 1999, 2004). Both
adult and childhood abuse survivors are represented in most studies that involve participants
with mixed forms of trauma, and 20 randomized studies have found E.M.D.R. therapy to be
effective in the treatment of P.T.S.D.

        However, as mentioned above, the amount of treatment needed will vary depending
on the type of trauma and how pervasive it was during childhood. For instance, one study
compared eight sessions of E.M.D.R. therapy with eight weeks of Prozac with multiply
traumatized adults. It reported that after treatment, 100 percent of adult-onset participants
treated with E.M.D.R. no longer received a P.T.S.D. diagnosis, and 75 percent of the
childhood-onset E.M.D.R. participants no longer had that diagnosis. But losing a P.T.S.D.
diagnosis is only part of the story; at the six-month follow-up, the E.M.D.R. group continued
to improve, while the Prozac group became more symptomatic. At that point, 75 percent of
the participants treated with E.M.D.R. who were traumatized as adults were symptom-free,
compared with 33.3 percent of the E.M.D.R.-treated group traumatized in childhood;
everyone in the Prozac group continued to be symptomatic.

        In clinical practice it is to be expected that more than eight sessions will be needed for
successful treatment of childhood abuse, as comprehensive E.M.D.R. therapy addresses the
entire clinical picture. The goal is not only to remove symptoms, but also to bring clients to
                                Dr Francine Shapiro ( - New York Times 2012

full emotional health and fulfillment, both individually and in their personal relationships.
Initial results from research under way reveal positive effects after approximately 24 sessions
for those suffering from severe childhood abuse. These results support clinical observations
that although many victims of childhood trauma will need comprehensive E.M.D.R. therapy,
significant benefit can be observed within a few months after starting memory processing.
It’s also worth noting that once processing begins, it is unnecessary to address each and every
memory; treatment effects will generalize from a given memory to other similar events.

        In all cases, a three-pronged approach should be used that addresses earlier
experiences of abuse, current situations that trigger disturbance, and the skills and education
necessary to ensure that the person is not only symptom-free, but able to flourish and thrive
in the world. When someone has had an extremely difficult childhood that includes neglect or
abuse, it is important to interview prospective clinicians to find someone who is experienced
and well trained in phase-oriented trauma treatment for chronic childhood abuse and the use
of E.M.D.R. therapy. Ideally, the clinician chosen will also be someone who stays informed
with regard to the newest developments in treatment.

Who Does E.M.D.R.?

       Question: Is it possible to do E.M.D.R. treatment to friends or relatives if one
       identifies that the person needs E.M.D.R. treatment? Mekdes, Ethiopia

       Question: Even though I am a certified hypnotherapist and possess a master’s in
       health administration, I am not allowed to become an E.M.D.R. practitioner myself.
       Why not? Julietta, NY

Dr. Shapiro responds:

         E.M.D.R. therapy is taught only to people who are licensed to provide mental health
services in their state. There are a wide variety of techniques from E.M.D.R. therapy that I
have included in my new self-help book, “Getting Past Your Past” (Rodale, 2012). However,
in this country, major memory processing with E.M.D.R. therapy should be conducted only
by a licensed therapist who has had training approved by the E.M.D.R. International
Association (, an independent professional association that sets the
standards for all E.M.D.R. therapy training conducted in the United States.

        Comparable organizations exist in most countries worldwide, as well as regional
organizations like E.M.D.R. Europe (, E.M.D.R. Asia (www.emdr- and E.M.D.R. Iberoamerica (

        It is widely accepted in the field of psychology that training in any therapy being
performed is ethically mandatory. However, clinicians may have been misled in their choices.
Unfortunately, there are a number of substandard trainings being conducted in the United
States that don’t meet the international associations’ criteria. Therefore, potential clients
should interview clinicians to ensure they received the correct training and have experience
with their problem, and inquire about their success rate.

                                 Dr Francine Shapiro ( - New York Times 2012

E.M.D.R. and Epilepsy

       Question: Can E.M.D.R. be safely used in patients with well-controlled epilepsy, and
       can it be successful in increasing seizure thresholds and/or eliminating the cause of
       the seizures (assuming no cerebral lesions cause the seizures)?
       KFJ, NYC

Dr. Shapiro responds:

       To my knowledge, there have been no negative reports using E.M.D.R. therapy with
epilepsy patients. However, I suggest that the person work with an experienced clinician who
can be sensitive to any potential negative reactions. The therapist should also carefully review
with the client the cautions described in my text, “Eye Movement Desensitization and
Reprocessing: Basic Principles, Protocols and Procedures,” so the person can make an
informed choice.Two articles have been published that have reported successful results in the
E.M.D.R. treatment of psychogenic seizures.

E.M.D.R. and Anxiety

       Question: My teenage son has had E.M.D.R. therapy for anxiety attacks that were
       very limiting in his ability to progress (go for job interviews, attend college classes
       that were intimidating to him). After a period of time here he seemed to improve, he
       stopped going to therapy and said he felt only life experiences would help him
       overcome some of his anxieties. After not seeing a therapist for a year, he told me
       today that he thought he needed to return. Is this a common result? Are patients ever
       “cured” through E.M.D.R. therapy, or will some patients need recurrent therapy
       throughout their lives? monkeyboy, Kansas

Dr. Shapiro responds:

         I believe the problem here is that your son terminated therapy prematurely. Some
clients stop because they feel better and then want to do the rest on their own. However, the
full protocol for E.M.D.R. treatment involves (1) processing the memories that set the
foundation for the problem, (2) processing the current situations that trigger disturbance and
(3) incorporating the experiences into the memory networks that are necessary to overcome
skill or developmental deficits.

        With longstanding anxieties, this would involve venturing out and noticing any new
anxieties that arise. These would be addressed with further processing, since some anxiety
responses are not revealed within the confines of the therapy session alone. For stable
treatment effects, your son should address his various anxiety issues using this full
application of E.M.D.R. therapy.

                                Dr Francine Shapiro ( - New York Times 2012

E.M.D.R. and Pain

       Question: I am a physical therapist specializing in the treatment of complex and
       chronic pain. Modern pain science views pain as an output of the brain, and there are
       novel therapies developed within my field to retrain the brain. Many (though certainly
       not all) of my patients also have a history of trauma. Is there any research (including
       functional M.R.I.) showing the effects of E.M.D.R. on chronic pain or on centers in
       the brain particularly associated with pain processing? Helen Gattling-Austin,
       Charlottesville, VA

       Question: I’ve read about and experienced the resolution of some traumas using
       E.M.D.R., but can E.M.D.R. resolve chronic pain that resulted from a physical injury?
       Sally Stone, Northbrook, IL

Dr. Shapiro responds:

       In the book “Practical Pain Management” (2001), A. L. Ray and A. Zbik have a
chapter that describes their use of E.M.D.R. therapy for chronic pain. The authors note that
the application of E.M.D.R. that is guided by a theoretical formulation known as the adaptive
information processing model appears to provide benefits to chronic pain patients not found
with other treatments. Specifically, rather than merely managing pain, the treatment often
substantially reduces or eliminates it. This occurs because applications of E.M.D.R. therapy
have revealed that the pain is frequently caused by the memory of the experience during
which the injury took place.

        E.M.D.R. therapy cannot remove pain caused by nerve damage. However, many types
of pain that seem to have an organic cause are actually the result of “pain memory.” For
instance, four researchers have independently published articles detailing the successful
treatment of “phantom limb” pain. The aggregate of these, as well as anecdotal reports,
indicates an 80 percent success rate involving the substantial reduction or elimination of the
phantom pain once the trauma memory has been processed. Follow-up assessments reported
as long as two years later have revealed stable results. Unfortunately, no brain scans were
performed, and no randomized trials have yet been conducted on this topic.

Long-Ago Trauma?

       Question: Is E.M.D.R. effective even if the event took place 15 years ago?
       Kelly, Atlanta

Dr. Shapiro responds:

     Yes, E.M.D.R. is effective regardless of the time since the event. The unprocessed
memory remains stored in the brain. However, it can be accessed and successfully processed.

                                 Dr Francine Shapiro ( - New York Times 2012

         A year ago, an 80-year-old survivor of World War II asked her clinician to contact
me. She had lived through numerous traumas during the war in Japan (bombing, rape, losing
her mother and father) and had lived a life of “quiet desperation.” However, recently she had
become severely dysfunctional because her husband had developed a hearing problem, and
his shouting and playing the TV at a loud volume were bringing back reactions that emerged
out of the chaos of the war years. This inability to cope any longer is often what brings
people into therapy. After the traumas were processed, she told her clinician, “I feel free for
the first time in my life.” Even at 80, her brain was able to “digest” and store appropriately
the unprocessed information that had been embedded for the past seven decades. It’s never
too late.

March 26, 2012: Dr. Shapiro responds to additional reader questions about E.M.D.R.

Stored Memories and E.M.D.R.

       Question: You write: “Many people feel that something is holding them back in life,
       causing them to think, feel and behave in ways that don’t serve them. E.M.D.R.
       therapy is used to identify and process the encoded memories of life experiences that
       underlie people’s clinical complaints.” 
In my experience this feeling of being held
       back is common to people in general, not just those who have experienced a traumatic
       Can E.M.D.R. be helpful even if people don’t remember specifically the traumatic
       event (example: abuse as an infant)? Or helpful to people who have had a traumatic
       event and remember it but do not necessarily associate it as being traumatic?
       c.r., Brooklyn

Dr. Shapiro responds:

        Recent research indicates that general life experiences can actually cause even more
post-traumatic stress disorder symptoms than major trauma. In fact, our memory networks are
the foundation of most clinical complaints.

        While genetic defects or organic insults, like those caused by injuries or toxins, can
certainly contribute to dysfunction, research indicates that life experiences are also generally
involved. Childhood humiliations, rejections, disappointment, bullying by peers, insensitive
actions by authority figures and parental fights can be so disturbing that they disrupt the
brain’s information processing system. The experiences then become stored as unprocessed
memories and set the groundwork for later dysfunction. These stored memories include the
emotions, physical sensations and beliefs that were experienced at the time of the original
event. When something happens in the present, it can trigger this memory and shape our
current perceptions and actions.

        In E.M.D.R. therapy, we use specific techniques to help identify the memories that
underlie the problems so they can be processed. At other times, by focusing on the present
disturbance during processing, the earlier event will automatically emerge because of the
associations in the memory networks. If the event took place too early in life for it to be

                                Dr Francine Shapiro ( - New York Times 2012

encoded with a visual image, implicit memory processing still occurs, as evidenced by the
elimination of the symptoms. So, regardless of the events in the person’s history or how he or
she currently views them, E.M.D.R. therapy can be useful as the appropriate connections are
made during the information processing sessions.

False Memories and E.M.D.R.

       Question: As a therapist, I work with a number of patients who were abused as
       children. As such they may have also created false memories in this process. How
       useful would E.M.D.R. be as treatment for them? Ibialik1b, laguna hills, ca

       Question: Can E.M.D.R. prompt memories of past trauma to emerge? Can E.M.D.R.
       cause the creation of false memories? KJ, Seattle

Dr. Shapiro responds:

        All memory is fallible. During E.M.D.R. memory processing, associated memories
may arise, but as with any form of therapy, there is no assumption without corroboration that
they are true.

       For instance, one of my clients came to me claiming that she had been raped by the
devil when she was a child. During processing, she recognized that it was someone in a
Halloween costume. However, if the memory had emerged on its own during processing,
there would have been no assumption that it had actually been the devil.

       Likewise, another client entered therapy concerned that perhaps her father had
molested her, because she felt herself being held down and saw his face. During memory
processing she remembered being attacked in a barn by some adolescents, and her father had
come in to rescue her. She realized that this was the image of her father that she had been
remembering. She was able to corroborate that this event had actually happened by asking
her mother about it.

        Many “false memories” can be created throughout childhood by a variety of causes.
In addition to abuse, children may hear a story or see something on TV and come to believe it
happened to them. These vicarious experiences may then be stored accordingly.

       Processing during E.M.D.R. therapy can allow these images to dissolve as the brain
makes the appropriate connections. In talk therapy, false memories can sometimes be created
through the inadvertent suggestions of the therapist, but this is unlikely in E.M.D.R. therapy
because the clinical input is minimal while the client’s brain makes the appropriate internal

       Some of the randomized controlled research conducted on the eye movement
component of E.M.D.R. has also indicated that it causes an increased recognition of positive
information, and an increased accurate assessment of false information. Further research will
determine to what degree these findings also enter into the memory processing outcomes.

                                Dr Francine Shapiro ( - New York Times 2012

Addictions and E.M.D.R.

       Question: You mentioned that this can help people who “behave in ways that don’t
       serve them.” Could this help someone who is trying to quit drinking, or with other
       types of addictions? Mamie Hetherington, Ontario

Dr. Shapiro responds:

        It is now widely recognized that there is a relationship between addictions and trauma.
There is also recent research indicating that general life events can cause even more P.T.S.D.
symptoms than major trauma. So whenever we observe addiction in a client, the next step is
to determine the earlier life experiences that might be causing the person to “self-medicate.”

        There can be a wide range of such experiences, from a very disturbing one-time event
during adulthood or childhood to pervasive abuse or neglect, especially from an addicted
parent who raised the child and modeled that behavior. Life can also be problematic for those
whose parents modeled the substance-abuse behavior and simultaneously failed to teach them
how to deal with their own negative emotions. E.M.D.R. therapy processes the past
experiences that are causing the emotional pain and the current situations that trigger the
desire to use, while incorporating what is needed by the client to make healthier choices in
the future.

        The Thurston County Drug Court Program in Washington State initiated a
randomized study to evaluate a combination of Seeking Safety, a “present-focused” cognitive
behavior therapy treatment designed to help people struggling with both P.T.S.D. and
substance abuse, and E.M.D.R. therapy. In this particular program design, Seeking Safety
was used to establish safety and stabilization before moving on to individual trauma
treatment with E.M.D.R. The combination of Seeking Safety and E.M.D.R. was intended to
be compared against Seeking Safety without E.M.D.R. plus the drug court “program as
usual” treatment services, which consisted of other types of weekly cognitive behavior
therapy groups, individual counseling and substance abuse education.

        The study was originally designed to randomly place participants reporting a trauma
history into groups that provided Seeking Safety with either E.M.D.R. or the “program as
usual.” However, after two months, the drug court administrator and the researchers decided
to end the randomization part of the study because of ethical concerns. The participants who
received E.M.D.R. spoke so highly of it and reported feeling so much better that those in the
standard care group were upset that they weren’t going to have a chance to receive E.M.D.R.
Since no other specific trauma treatment was being offered in the “program as usual,” this
posed an ethical concern for the drug court program administrator and investigators.

       As a result, the study was converted into an open pilot program in which all those
who had experienced a major trauma would be offered E.M.D.R. on a voluntary basis. An
evaluation of the program revealed that 91 percent of those who ultimately received
E.M.D.R. therapy graduated from the program, compared with only 62 percent who did not
receive it.

                                 Dr Francine Shapiro ( - New York Times 2012

       Graduation from such a program is considered to be the best predictor of whether
people will relapse into criminal behavior. E.M.D.R. therapy is now strongly recommended
for anyone in this Washington State drug court program who has a history of trauma.

A Cancer Diagnosis and E.M.D.R.

       Question: I am 50 years old and was diagnosed with an aggressive form of breast
       cancer five years ago. My doctor has given me a clean bill of health, but I can’t shake
       my fear that it will return. I thought that with time I’d feel better, but I don’t.
       Everyone tells me it is important to “be positive.” Could E.M.D.R. help me to get on
       with my life? ML Williams, North Dakota

Dr. Shapiro responds:

         You are not alone in experiencing fear. In a study of 244 breast cancer survivors five
to nine years post-diagnosis, published in the journal Oncology Nursing Forum, researchers
found that fears of recurrence were frequent. The most commonly reported experiences that
triggered fear included yearly follow-up appointments, doctors’ appointments, hearing of
another’s cancer, physical symptoms or pain, news reports about breast cancer, and the
anniversary of the diagnosis. The time that had elapsed since diagnosis was unrelated to the
frequency of such triggers. Sadly, some people mistakenly believe that this overwhelming
fear is the inevitable and “natural” outcome of cancer.

        Receiving a life-threatening diagnosis can be classified as a trauma. Many people
with a cancer diagnosis have entered E.M.D.R. therapy because of anxiety and fear that
persists even after the medical treatment has been successfully completed. These long-lasting
negative reactions can often be tracked back to the moment of diagnosis or something that
happened during treatment that was particularly distressing.

        The information processing system of the brain has stored the experience — with the
emotions, physical sensations and beliefs that occurred at the time of the event. So, even
though medical tests may now show no sign of the disease, the fear and anxiety encoded in
that unprocessed memory remains. These feelings can increase dramatically around the time
of yearly testing or by any event that reminds the person of the cancer experience. E.M.D.R.
therapy is successfully used to process and alleviate these disturbing responses. The therapy
allows people to get on with their lives without being haunted by fear.

        Also relevant to many breast cancer survivors are unpleasant or painful physical
sensations at the site of the surgery. Many times, these sensations can be caused by
unprocessed memories. As I noted previously in “E.M.D.R. and Pain,” above, research has
been published on the successful E.M.D.R. treatment of phantom limb pain, and the
principles guiding the therapy applications are the same in the cases of “phantom breast
sensations” which persist after a mastectomy in up to 55 percent of cases (Dworkin, 2006).
Although E.M.D.R. therapy cannot eliminate pain caused by actual nerve damage, it is
successful in treating the uncomfortable sensations and chronic pain caused by stored
unprocessed memories.

                                 Dr Francine Shapiro ( - New York Times 2012

The important thing to remember is that no matter how long it has been since diagnosis and
treatment, fears of recurrence need not be a permanent psychological scar of breast cancer.

E.M.D.R. in Children

       Question: What kind of results have been found using E.M.D.R. in children? Is it as
       effective/can it be tolerated? Emily, CT

Dr. Shapiro responds:

       E.M.D.R. therapy is widely used with children. It is designated as an effective
treatment for trauma and considered “Well-Supported by Research Evidence” by the
California Evidence-Based Clearinghouse for Child Welfare. Numerous studies with children
have demonstrated that E.M.D.R. therapy is effective in reducing P.T.S.D. symptoms, as well
as behavioral and self-esteem problems.

       E.M.D.R. therapy is tolerated well by children, and positive results are often more
quickly obtained than with adults because there are fewer memories to deal with. Although
E.M.D.R. therapy entails specific, well-delineated procedures and steps, they are tailored to
the needs of each individual. Therefore, playful and child-friendly strategies are used to make
E.M.D.R. therapy developmentally appropriate and appealing for children.

        Each child in E.M.D.R. therapy is seen as an individual with distinctive needs and
assets. Each will need different levels of preparation before the traumatic memories that lie at
the core of their suffering can be processed. The amount of time needed will vary depending
on the level of traumatization, internal resources and external support available. The well-
trained E.M.D.R. clinician will be able to assess how extensive the preparation should be for
each child. As a result, when E.M.D.R. therapy is done appropriately, children will arrive at
the moment of accessing and processing trauma memories with the proper psychological
resources and abilities.

        When possible, it is best to process disturbing experiences in childhood to prevent
years of unnecessary suffering. These early traumatic and adverse experiences can have a
profound and toxic affect on the child’s learning capacity, self-esteem and ability to form
healthy and fulfilling relationships in the future. Aggressiveness, oppositional behaviors,
school failure, anger outbursts, social isolation and the like may be some of the
manifestations of past experiences that remain unprocessed in the child’s brain and continue
to be activated by daily life triggers.

        The ultimate goal of E.M.D.R. therapy is to tap into the child’s own information
processing system so these memories of trauma and adversity can be processed and
integrated. As a result, children can be free to respond to life’s demands with a healthy and
age-appropriate sense of self, power and responsibility so they can follow a path to successful
and rewarding lives.

                                  Dr Francine Shapiro ( - New York Times 2012

E.M.D.R. and Failure to Thrive

       Question: Is there any evidence that E.M.D.R. is successful with adopted children
       who, when adopted, were diagnosed with failure to thrive?
       Martha Stern, San Marino, CA

Dr. Shapiro responds:

        There are multiple possible medical causes for failure to thrive, but high on the list is
likely to be parental rejection or withdrawal. One can only assume that the loss of the parent
can also be an early trigger for the problem. When the child’s needs are not met, multiple
systems shut down and the child becomes unresponsive.

         Among the population of neglected or abused adopted children treated through The
Attachment and Trauma Center of Nebraska, for example, it is not uncommon to find a
failure to thrive diagnosis early in life that is related to pre-adoption conditions. A majority of
the adopted children presenting for treatment also have some type of food-related problem,
like poor appetite, hoarding or gorging, in addition to other behavioral issues. Research in
which E.M.D.R. and family therapy are being used to treat these issues is under way, and the
preliminary findings suggest that the food issues improve along with the other behavioral
issues as the children begin to trust their adoptive parents to care for them.

        Children learn to more closely attend to their emotions and the body’s signals for
hunger, satiation, sleep and elimination when they have a secure attachment with a parent
who is sensitive and responsive to their needs. Attuned parents help their children develop
regular eating, elimination and sleep habits. Their children learn to trust adults to care for
them and to seek comfort from them when they are stressed.

        When children experience traumatic loss, neglect or abuse prior to adoption, they
learn that they cannot trust or rely on their caregivers. Their inability to trust may leave them
unable to seek or accept comfort or even simple nourishment from their caregivers. As they
get older, they may sneak food, hide food or gorge on food as a survival mechanism. They
may exhibit very challenging behaviors related to extreme underlying anxiety.

        The E.M.D.R. therapy with these children focuses first on reinforcing positive
experiences of closeness with their adoptive parents. It then targets and reprocesses past
experiences in which the children learned not to trust. Current triggers to problematic
behaviors are reprocessed, and finally, E.M.D.R. is used to develop future templates for
positive behaviors.

        Children who learn to turn to their adoptive parents for comfort and security can more
readily allow them to help regulate their emotions, food, sleep cycles and behaviors. They are
moved on to a positive course in life as the memory processing and new experiences allow
them to develop a healthy attachment. This is the foundation for the development of a
positive sense of self and safety in the world. It also sets the foundation for positive future

                                Dr Francine Shapiro ( - New York Times 2012

       These are among the outcomes currently being documented with research in The
Attachment and Trauma Center of Nebraska with severely disturbed children, many of whom
previously experienced multiple failed adoption attempts.

Grief and E.M.D.R.

       Question: Has E.M.D.R. been successful in treating P.T.S.D. or complicated grief
       from loss of a child from suicide?
       Karen Schreiber, Palo Alto

Dr. Shapiro responds:

        With the sudden loss of a child from any cause, a parent can be troubled by intrusive
thoughts and images. Many times these include images of the deceased in pain, or the scene
of death — real or imagined. The negative emotions can often involve feelings of sorrow
about things the grieving person now wishes he or she could have done, or guilt about
mistakes or things not done. These feelings can be overwhelming. In addition, people are
often unable to remember the person at all without the intrusion of such thoughts and

        E.M.D.R. therapy has been very successful in addressing these grief-related issues. In
a multi-site study published in the journal Research on Social Work Practice, E.M.D.R.
significantly reduced symptoms more often than cognitive behavior therapy on behavioral
measures, and on four of five psychosocial measures. E.M.D.R. was more efficient, inducing
change at an earlier stage and requiring fewer sessions. After treatment, those who had
received E.M.D.R. could remember the deceased in a positive way, without the negative
emotions. The heartfelt connection was still there, but without the pain.

Self-Help Using E.M.D.R.

       Question: Is the self-help book effective with people who have already had extensive
       therapy that was found to be very effective but with time, the effects faded, i.e., the
       anxiety, negative self-talk and critical nature returned? I am very interested in finding
       methods, strategies, etc. for people who haven’t the means or wherewithal to get
       therapy. LindaMC, Arlington, MA

       Question: Dr. Shapiro, does any source for laypeople, including your upcoming
       book, provide effective instruction on self-administration of E.M.D.R.? Is there a way
       for a motivated, suffering person who either can’t afford– or otherwise won’t see– a
       therapist to help heal themselves? Thank you. Shaun, Grand Rapids

Dr. Shapiro responds:

        Yes, my self-help book “Getting Past Your Past” contains a wide range of techniques
used in E.M.D.R. therapy that readers can employ to deal with disturbing emotions, physical
                                 Dr Francine Shapiro ( - New York Times 2012

sensations and beliefs. The reason for writing the book was to provide people with the ability
to take both personal exploration and empowerment into their own hands. For that reason,
I’ve also included chapters to explain how different problems develop, as well as clinical
cases that will illustrate the interconnectedness of memory networks and our automatic
responses. They can help readers to better understand themselves, family members and others
in their lives.

        In the book, I’ve included a wide range of self-help techniques that will allow people
to (a) manage stress, (b) change their emotions, physical sensations and negative thoughts in
the present, (c) help get rid of negative intrusive images, (d) identify situations that trigger
negative reactions and help prepare for them in advance, and (e) identify the unprocessed
memories that are causing the negative reactions. People will be able to understand the causes
of problems, including areas where they feel stuck, or pushed into unhealthy behaviors.

        Additional techniques include ones taught to Olympic athletes to achieve peak
performance. These can also help people prepare for challenges like presentations, job
interviews and social situations. These techniques can benefit any reader.

        However, if they are not sufficient to resolve any particular problem, there are
guidelines to help determine if more comprehensive memory processing would be beneficial,
and suggestions about how to find a fully trained E.M.D.R. therapist who would be most
suited to address the issue. In those cases, having completed the exercises suggested in the
book, readers will already have finished most of the E.M.D.R. history-taking and preparation
phases, which should accelerate the therapy process.

April 10, 2012: Dr. Shapiro responds to additional reader questions about E.M.D.R.

Overcoming the Trauma of Medical School

       Question: I have a 60-year-old physician patient who has ongoing anxiety, now with
       associated depression of many years. Her anxiety began with the trauma of medical
       school, which she experienced much as a “hazing,” demeaning experience along with
       the usual stress of learning the expected amount of information in a limited amount of
       time. She experienced three years of almost debilitating anxiety, then became
       Psychodynamic “talk therapy” and medication have helped some, but she has never
       been able to resolve the anxiety issues from this period. She feels she has never been
       able to return to her previously relaxed self. She is an excellent clinician,
       conscientious, happy and successful in her practice. Could she be a candidate for
       E.M.D.R. ? William Goodin, M.D., Batesville, Ark.

Dr. Shapiro responds:

        Your client would be an excellent candidate for E.M.D.R. therapy. The bottom line is
that disturbing experiences like those you describe can overwhelm the information processing
system and be stored in the brain with the emotions, physical sensations and beliefs that were

                                 Dr Francine Shapiro ( - New York Times 2012

experienced at the time of the event. The negative reactions continue to be triggered because
the stored memories remain unchanged and are unable to link up with anything more
adaptive. This means that regardless of the number of positive experiences your client may
have had as a physician, the feelings of anxiety and insecurity that were encoded in medical
school remain. Processing those earlier experiences can allow these negative feelings to

        Even though the experiences have been debilitating her for the past 30 to 40 years,
they can be accessed and processed. For instance, a French-Egyptian woman in her 70s had
experienced similar feelings stemming from a childhood experience in which she had felt
demeaned by her mother. Her mother placed her brother in front of her and went behind him
like a coach, urging him on by saying: “She’s a girl, go on, beat her.” As she described it,
“When I heard that, my whole world tumbled down, the stars and moon fell down.” She
realized during the E.M.D.R. memory reprocessing session that because of the event she had
“always been subservient.” After processing her grief and anger, she declared: “I’ve never
wanted to be a boy. I’m proud of being a woman.”

       These encoded experiences, whether 1, 10 or 60 years ago, can continue to distort a
person’s sense of self and place in the world. But they can be fully processed. As the woman
described above put it: “When I started I was down on the ocean floor; now I’ve surfaced.”

Conversion Disorder and E.M.D.R.

       Question: Are there studies that show the effectiveness of E.M.D.R. in treating
       conversion disorder? My understanding is that “conversion,” or the manifestation of
       physical symptoms that result from a psychological disturbance (as opposed to having
       a physiological cause), is closely related to — or a form of — P.T.S.D.?
       Two years ago, I was diagnosed with conversion disorder that, at its worst, caused
       violent seizurelike symptoms and temporarily paralyzed me from the neck down. I
       have been doing E.M.D.R. on a regular basis with a licensed therapist trained in the
       method (in addition to traditional talk therapy), and the physical symptoms have
       steadily improved.
       It’s been difficult finding info on E.M.D.R. as it relates to conversion disorder.
       MB, Baldwin, N.Y.

Dr. Shapiro responds:

       Conversion disorder is a subcategory of somatoform disorder and involves medically
unexplained symptoms that give the appearance of being neurological in nature. These would
include psychogenic nonepileptic seizures, myoclonic (jerking) movements and paralysis.
Research has indicated that more than 50 percent of those with medically unexplained
symptoms like these have P.T.S.D. However, other research has indicated that “adverse life
experiences” that do not rise to the level of major trauma can also be associated with the

                                 Dr Francine Shapiro ( - New York Times 2012

        As I’ve described previously, research has also indicated that a wide range of life
experiences can cause more symptoms of P.T.S.D. than result from major trauma. In short,
there is ample evidence that psychological factors are implicated, and from an E.M.D.R.
therapy perspective, the primary contributors to these are unprocessed memories of the events
that preceded the physical symptoms.

        There are no randomized controlled studies of E.M.D.R. treatment with those
suffering from conversion disorder, but clinicians and researchers have reported success with
this population. For instance, in their article “Eye Movement Desensitization and
Reprocessing in the Psychological Treatment of Trauma-Based Psychogenic Non-Epileptic
Seizures” (2007), Susan Kelly and Selim Benbadis reported that “at the outset, it was
predicted that PNES with a trauma base could be eliminated or substantially improved by
treating the trauma with E.M.D.R. This proved to be true for two of three patients.” They
conjectured that the third patient might have been hampered by fear of giving up disability

       Another case report, from The Journal of Clinical Psychology, describes the treatment
of a combat veteran, “Bob,” who suffered from “frequent myoclonic movements that began
in 1968.” The report continues:

         He described an upper-body “shaking” occurring at least 20 times a day and “over
50–60 times a day” when in social situations. Processing the first experience, being left alone
and unarmed in the field at night, linked to several other experiences, including being asked
to escort the remains of his younger cousin home after Bob’s return from Vietnam. He
experienced an abreaction that faded with two sets of eye movements and, by the end of the
first session, he reported “feeling joy at being alive.” Before the next session his daughter
reported his jerking motions were down to no more than three a day.

       After completing E.M.D.R. treatment, the report said, “at one-month and 6-month
follow-ups Bob reported no incidents of shaking and all other symptoms were in remission.”

        Approximately 20 published articles have reported success in treating a variety of
somatic problems and somatoform disorders. Over all, these indicate that the processing of
earlier memories related to the physical symptoms appears to alleviate many medically
unexplained symptoms. These include the treatment of phantom limb pain that I’ve
previously described.

Hyperactivity and E.M.D.R.

       Question: What is the effectiveness of E.M.D.R. with hyperactive individuals, like
       those with diagnosed A.D.H.D.? Shaleela L, Brooklyn

Dr. Shapiro responds:

       E.M.D.R. therapy will not cure organically based A.D.H.D. However, sometimes
people are misdiagnosed with A.D.H.D., but it turns out that the problem is really caused by
unprocessed memories that produce symptoms that mimic those of A.D.H.D. For instance,
                                  Dr Francine Shapiro ( - New York Times 2012

inability to concentrate, anxiety, inattention, hyperarousal, jumpiness, impulsivity and acting
out can also be symptoms of a traumatic event or other “adverse life experiences.” A well-
trained clinician using E.M.D.R. therapy should be able to help determine if these kinds of
unprocessed disturbing experiences are involved. They can be either causal or contributing

        In addition, those in whom A.D.H.D. has been accurately diagnosed are often exposed
to a wide variety of experiences that can exacerbate the problem. These include failure
experiences at school, rejections, humiliations and other kinds of interactions caused and/or
contributed to by the inattentiveness, overactivity and impulse-control deficits that
characterize this behavioral disorder. These unprocessed memory systems also become the
foundation for how individuals with A.D.H.D. form and shape their sense of self.

        They may perceive themselves as not being good enough — or competent enough or
adequate enough — and experience accompanying feelings of shame, anxiety or depression.
The memory networks that contain such information become the basis for how they perceive
and respond to present experiences and challenges. As they continue to be debilitated by the
negative feelings, new failure experiences pile up and continue to make matters worse.
E.M.D.R. therapy can be used to process the memories of the negative experiences, which
can help reduce the symptoms being caused by anxiety and promote the development of a
healthier sense of self and competence.

         In sum, E.M.D.R. therapy can assist individuals with misdiagnosed A.D.H.D. by
directly addressing causal factors, and processing the memories of trauma and adversity that
are at the core of the A.D.H.D.-like symptoms. Further, in the case of organically based
A.D.H.D., E.M.D.R. therapy can be used in conjunction with well-accepted A.D.H.D.
treatments to address contributing psychological factors that exacerbate present symptoms.

Primal Therapy and E.M.D.R.

       Question: How can E.M.D.R. heal trauma without requiring a person to relive and
       integrate it, as in primal therapy? Where do all those powerful feelings go?
       brucethewriter, Ste-Adèle, Quebec

Dr. Shapiro responds:

        There are many different forms of therapy, and each is guided by a different
underlying theory. Primal therapy involves the belief that a “forceful upheaval” is necessary
to eliminate neurosis. However, the theoretical stance that it is necessary to relive your past is
not supported by research. There are now more than 20 randomized studies documenting the
positive effects of E.M.D.R. therapy with trauma victims, with follow-up evaluations as long
as three years out. The elimination of post-traumatic stress symptoms with E.M.D.R. is
achieved without reliving the trauma because a different understanding of how the brain
works and the mechanisms of healing guide this form of therapy.

        Clinical experience and research over the past 25 years indicate that the intense
feelings that disrupt the lives of trauma victims exist because of the way the memory of the
                                  Dr Francine Shapiro ( - New York Times 2012

trauma was stored. The event was so disturbing that it disrupted the information processing
system of the brain, and the memory therefore became encoded with the emotions, physical
sensations and beliefs experienced at that time.

        However, in E.M.D.R. therapy, the client is prepared in a certain way, and once the
memory is accessed, the information processing system of the brain is stimulated and the
appropriate connections are made. During that time, the experience of processing is unique to
the individual client as the brain digests the information.

     Some can feel disturbance as a shadow of the original experience. Others can feel a
momentarily high arousal. And still others can feel any gradation in between.

        We prepare E.M.D.R. clients with self-control techniques so they feel free to “let
whatever happens, happen” without forcing the experience into any particular mold – like an
emotional upheaval. When the information is allowed to process spontaneously, the negative
emotions are replaced with more positive ones as the memory takes its proper place in the
past. These psychological events mirror the experience of uninterrupted information
processing that occurs in everyday life. The shifts in powerful feelings occur automatically,
just as any disturbance you might have in the present is naturally replaced by different
emotions once you have come to terms with it.

        In E.M.D.R. therapy, it is unnecessary for the client to relive the disturbing event for
his or her reactions to change. In fact, numerous studies of the eye movement component of
E.M.D.R. have shown that it causes an immediate decrease in negative emotion and imagery
vividness. Once it is processed, the memory is transformed into a learning experience that is
appropriately stored in the brain.

        According to the Harvard researcher Robert Stickgold, the memory is transferred
from episodic to semantic memory, where the meaning of the event is extracted and no longer
contains the emotions associated with it at the time of the event. In short, it is not necessary to
relive the trauma for the memory to become integrated within the semantic memory network.

E.M.D.R. and a Broken Friendship

       Question: Is E.M.D.R. effective on past trauma that was created by the individual?
       For example, if an individual sabotaged a relationship by saying mean and hurtful
       things and as a result relives the events and what she said on a daily basis, would
       E.M.D.R. help her move on from this past mistake? (The friend hasn’t talked to her
       since and the relationship cannot be repaired.) O Sullivan, Wilmington, Del.

Dr. Shapiro responds:

        The research now indicates that many kinds of life experiences can cause more post-
traumatic stress disorder symptoms than major trauma does. Having intrusive thoughts of an
event are one of the symptoms of P.T.S.D. Regardless of the cause of the disturbing
experience, E.M.D.R. therapy can help process the memory of the event so that the person is
able to learn from it and get on with life.
                                 Dr Francine Shapiro ( - New York Times 2012

The protocols used in E.M.D.R. involve processing the past events that set the groundwork
for the disturbance, processing the current situations that trigger distress, and processing what
is needed for the future. This three-pronged approach can help to expand the person’s
awareness and incorporate the skills necessary to guide him or her to more life-enhancing
responses in the future. For instance, there may have been a variety of unprocessed memories
that pushed the person into behaviors that sabotaged the relationship, and in comprehensive
E.M.D.R. therapy this issue would be addressed as well.

Treating War Trauma with E.M.D.R

       Question: When I was an internist at the most highly academically affiliated Veterans
       Affairs hospital in the country, I asked a clinical psychologist with whom I worked
       whether E.M.D.R. would be applicable to some of my patients, and I was told that
       there was reluctance to use it because it had been tried in some Vietnam veterans and
       had elicited emotions that neither the patient or the therapist could control without
       untoward outcomes. What are your ways of getting around this experience, and why
       does it happen? cbchill, Chapel Hill

       Question: Could you talk about E.M.D.R. as a way to treat combat and war trauma?
       Elaine, Minneapolis

Dr. Shapiro responds:

        E.M.D.R. is an eight-phase therapy approach. The second phase is preparation, which
includes teaching clients a range of emotional state change techniques so that when memory
processing begins they can control the feelings that may emerge during sessions, and allow
them to return to “neutral” if they desire. The preparation is also important so that the
techniques can be used to deal with any negative emotional responses that arise between
sessions. For a detailed description see my recently published book “Getting Past Your Past.”
The self-control techniques provide clients with a sense of self-mastery. Without the ability to
feel and be in control of the therapy process, “untoward outcomes” can occur with any form
of trauma treatment.

        When E.M.D.R. therapy is performed appropriately, it is well tolerated by combat
veterans. For instance, a randomized study of Vietnam veterans conducted at a V.A. medical
center reported that after 12 sessions, 77 percent of them no longer had post-traumatic stress
disorder. Importantly, none of the veterans dropped out of the study, which means that the
therapy was well tolerated by all those who participated.

       As mentioned in my post “The Evidence on E.M.D.R.,” other research with combat
veterans has been faulted for insufficient treatment doses and/or faulty application. For
instance, in some research, only one memory was treated with the multiply traumatized
combat veterans and/or only two sessions were administered. Clearly, this is an insufficient
time for both preparation and adequate processing for this population.

                                 Dr Francine Shapiro ( - New York Times 2012

       The most recent recommendation for the E.M.D.R. treatment of combat veterans is to
use approximately 12 sessions, including at least one session of preparation. When the
veteran has mastered the self-control techniques, it is appropriate to proceed with processing.

        E.M.D.R. therapy has been used extensively with combat veterans and, as described
in an article by the Department of Veterans Affairs and Department of Defense clinicians in
The Journal of Clinical Psychology, it has a variety of advantages for veterans. While other
forms of trauma treatments need detailed descriptions of the event by the client, this is
unnecessary in E.M.D.R. Therefore, the veteran can be effectively treated even if he or she
chooses not to discuss the event for any reason, including that it is classified information.

       Not needing to speak in detail has also been reported to make the therapy easier for
those with traumatic brain injury. In addition, unlike other trauma treatments, there is no
homework, which is why it is being employed in combat situations. Further, physical
symptoms such as pain and unexplained medical symptoms remit along with the trauma
symptoms and emotions that are often most troubling to veterans.

As reported in the article:

         Combat veterans with P.T.S.D. may report large amounts of survivor guilt, perpetrator
guilt, grief and anger. [E.M.D.R.] generally has no more difficulty with these emotions than
any other emotion, or cognitions, or physical sensations. Indeed, E.M.D.R. has been found to
reduce symptoms of mourning on behavioral and psychosocial measures in a multisite
study…. For veterans, this translates into the ability to access positive memories of the dead
where once they may have feared that reduction of their grief might equate to a loss of the
memories of the dead….

        E.M.D.R. provides rapid encouragement to remain in treatment by often providing
symptom relief in the first or second session of desensitization. The client-centered nature of
E.M.D.R. is empowering while not requiring details of the event, sustained disturbance or
focus on the event, homework, or other tasks. This is particularly salient, as veterans in crisis
may not be able to complete in vivo exposure or homework. Finally, E.M.D.R. encourages
the resolution of disturbances manifested physically, emotionally, and cognitively, and does
so even when the disturbance is generated from several different experiences. For war
veterans whose traumatic events are usually multiple, this is an effective tool.

        Since E.M.D.R. therapy is not available in all V.A. facilities, the E.M.D.R.
Humanitarian Assistance Programs, our nonprofit group, has made arrangements for free
treatment for combat veterans in certain locations. Because E.M.D.R. therapy does not
require homework to be effective, it can be provided on consecutive days. In fact, some
programs now provide morning and afternoon sessions, which can allow treatment to be
completed within a week.

      You can find locations for free treatment at the EMDR Humanitarian Assistance
Programs Web site.

The E.M.D.R. Humanitarian Assistance Programs
                                 Dr Francine Shapiro ( - New York Times 2012

       Question: Dr. Shapiro,
       How can I, can we, begin to form an outreach somehow to support those who need us
       the most — P.T.S.D., trauma, emotional people with such painful memories, those on
       the brink of suicide — with empathy and compassion? Give me options to consider.
       Thank you. NANA, Dania Beach, Fla.

Dr. Shapiro responds:

        Thank you for your interest. Our nonprofit organization, the E.M.D.R. Humanitarian
Assistance Programs (HAP), provides support for underserved populations throughout the
United States and worldwide. It began when an F.B.I. agent called and requested help after
the Oklahoma City bombing in 1995, because the local clinicians were traumatized. We sent
volunteers to help conduct treatment and provided pro bono clinical trainings. Since then, we
have provided similar services after every natural and manmade disaster, including the 9/11
attacks, Hurricane Katrina and the Columbine shootings. The organization has also arranged
to provide free E.M.D.R. therapy for combat veterans at various locations.

        HAP also provides free training for underserved populations worldwide. These
include working with local clinicians after the earthquake in Haiti and other natural disasters
throughout Latin America and in the aftermath of the tsunamis in Asia. We also work with
clinicians to provide trauma treatment in areas of ethnopolitical and religious violence. It is
clear that ongoing unhealed trauma begets more violence.

        The after-effects of trauma can be transmitted across generations, resulting in ongoing
cycles of violence and pain that affect individuals, families and societies. For those people
and organizations working in countries in need of significant conflict prevention, mediation,
reconstruction and reconciliation, these unhealed memories can present a grave challenge.

        The evidence is clear that even with the best of intentions, those attempting to reach
across the table are hampered by the negative reactions that automatically arise because of
earlier experiences of violence, pain and humiliation. The very sight of those on the other
side of the divide and/or the mere mention of the conflict by those attempting to mediate
disputes can trigger these unhealed memories that are stored in the brain and contain the
negative emotions, thoughts and physical sensations encoded at the time of the event. These
involuntary reactions hamper the ability to be rational, pragmatic and open to new ways of

        Because the “past is present,” these unprocessed memories of traumas have resulted
in generations of ongoing hostility. The stories of violence, oppression and human rights
abuses told to children often result in vicarious traumatization, in which children feel as
though the experience is happening to them. Those who have been traumatized carry internal
wounds that can result in flashes of anger and pain that can prevent reconciliation and cause a
variety of other societal problems, like addictions and domestic violence. These effects are
also seen in victims of natural disasters and domestic abuse. All of these disturbing events
can affect productivity and the ability to learn and participate in reconstruction programs and
development opportunities.

       Two important goals for HAP are to educate the public about the effects of trauma
and help those in need of treatment. All of the clinicians and educators participating in HAP
                                 Dr Francine Shapiro ( - New York Times 2012

projects volunteer their time. You can help support the humanitarian efforts for these global
efforts through donations and outreach assistance.

May 10, 2012: Dr. Shapiro responds to additional reader questions about E.M.D.R.

Relationships and E.M.D.R.

       Question: Can E.M.D.R. help with relationship problems or other interpersonal
       issues? Liz, Boston

Dr. Shapiro responds:

        E.M.D.R. therapy is widely used to address relationship problems. Interpersonal
issues generally stem from childhood experiences that forged the person’s self-perception and
view of the world. These include a sense of how relationships should be and what to expect
from others.

        In many instances, people duplicate problems they have witnessed in their families of
origin. Parental discord, for example, can set the groundwork for future relationship
problems. In addition, there is a large body of literature that demonstrates how relationship
problems between parents and children can create insecure attachment styles that are
duplicated in adult relationships. A child who has not been listened to or who is dismissed or
not shown love, for instance, will come to expect these responses as an adult. In extreme
cases, this can result in someone remaining in an abusive relationship. When children have
not been taught appropriate ways to communicate their needs, their adult relationships are
likely to suffer.

        Relationship issues are dealt with in E.M.D.R. therapy by using a multipronged
approach. The first step is to process the earlier memories that have set the groundwork for
the interpersonal difficulties. Then the current situations that trigger the negative responses
are processed, and finally the appropriate communication skills are taught.

        Many family therapists incorporate E.M.D.R. therapy into their clinical practices in
order to overcome “therapeutic impasses.” These occur when, despite instruction on “how” to
act with partners or children, the old, dysfunctional patterns of behavior continue to emerge.
From an E.M.D.R. perspective, this is because the unprocessed memories are being triggered,
causing the negative emotions and perspectives to arise and inappropriately shape the client’s
reactions in the present.

        Processing the persons’ earlier memories can liberate them to make the adaptive
responses needed for healthy interpersonal relationships. Examples of how E.M.D.R. therapy
is used for these purposes are described in the Handbook of E.M.D.R. and Family Therapy

                                 Dr Francine Shapiro ( - New York Times 2012

Autism and E.M.D.R.

       Question: Can E.M.D.R. work for someone with Asperger’s?
       Lawrence W. James, Colorado

       Question: Can E.M.D.R. help treat people who are intellectually disabled?
       Mamie Hetherington

Dr. Shapiro responds:

        E.M.D.R. therapy has been shown to be highly successful with those suffering from
autism spectrum disorder as well as intellectual disabilities, as reported in both published
articles and conference presentations. Since E.M.D.R. therapy does not require that the client
provide coherent descriptions of the traumatic event, it is highly amenable for those with
Asperger’s syndrome and other forms of autism spectrum disorder, as well as those with
intellectual disabilities.

        In people with intellectual disabilities only, E.M.D.R. therapy doesn’t differ
significantly from the way it is generally applied with children. The procedure has to be
adapted to the client’s developmental level of functioning. However, intellectual disabilities
often accompany other disorders, including autism spectrum disorder, and additional
adjustments would need to be made.

        Since the autism spectrum disorder population is acutely sensitive to environmental
disruption, many everyday experiences can cause emotional disturbance, including trauma
symptoms. For instance, one child displayed a high level of post-traumatic stress symptoms
after going through a car wash. While recent research has shown that general life experiences
can cause even more symptoms of post-traumatic stress disorder than major trauma in the
general population, the susceptibility is even more problematic for those with autism.

        Reports of positive treatment effects with autism spectrum disorder include a loss of
trauma symptoms, increased stability of mood, greater communication and an increase in
socialization. For instance, a boy with autism spectrum disorder was found to have developed
P.T.S.D. symptoms after watching the movie “E.T.,” with symptoms that persisted for several
years. As part of his treatment, he was asked to draw the most disturbing picture that came to
mind when he thought of the movie. This image was targeted and processed in one E.M.D.R.
session. It soon became clear that the fear caused by the movie had blocked his personal
growth. After processing, major changes took place. He no longer clung to his parents, took
up a variety of activities and was very proud of his new-found strength. It turned out that a
large part of his over-dependency on his parents had been due to his P.T.S.D.

        Another boy with autism spectrum disorder was beaten up by children while playing
outside. According to his mother, most non-autistic children would have been able to handle
what happened. However, her son stayed inside the house for about a year and a half. He only
went out to go to school by bus, and he became very aggressive toward his brother. After one
E.M.D.R. session his pattern of fear was eliminated, and within two sessions the disturbing
memory was completely processed. Subsequently, his behavior returned to what it had been
before the event.

                                  Dr Francine Shapiro ( - New York Times 2012

         On the other hand, two other autism spectrum disorder clients had experienced
various events that the clinician assumed would be traumatic (that is, a mother’s serious
illness, and forced separation from a parent for several years), but produced no disturbance at
all. Nevertheless, both suffered from their own outbursts of anger, which was posited to be
because they knew that their behavior was “breaking the rules.” As the clinician verbalized it,
”Working with people with autism spectrum disorder often is like solving a puzzle.”

         For clients with autism spectrum disorder, the way E.M.D.R. treatment proceeds can
vary greatly depending on the person. Some clients are totally nonverbal, some are over-
precise with regard to linguistic usage, some show little emotion, some overreact and show
fierce abreactions, sometimes the process goes incredibly fast, while in other cases it takes a
lot of time.

        Potential problems the clinician has to be able to deal with include social and
communicative deficits, lack of imaginative power, difficulty with change, limited interest,
lack of initiative, and sensory under- and over-sensitivity. Consequently, it is critical that any
E.M.D.R. therapist selected be familiar with the population being treated.

Peak Performance and E.M.D.R.

       Question: Dr. Shapiro, you wrote that your book “Getting Past Your Past” includes
       techniques “taught to Olympic athletes to achieve peak performance. These can also
       help people prepare for challenges like presentations, job interviews and social
       situations.” What’s the relationship between sports performance and job interviews or
       social situations, and what does it have to do with E.M.D.R. therapy?
       Ernest K, Denver

Dr. Shapiro responds:

        People seek therapy for a variety of reasons, but in general the reasons can be
summarized as being “stuck” and prevented from acting in ways that are healthy and
adaptive. E.M.D.R. therapy is used to process the memories of experiences that set the
foundation for the problems, process the current situations that cause disturbance and trigger
negative behaviors, and incorporate the skills needed to achieve positive outcomes in the

        For those interested in achieving “peak performance” in sports, the person’s history is
examined to identify what memories may be blocking them from achieving their goals. Often
this turns out to be previous failures, injuries and negative comments by coaches or peers.
These memories remained stored in the brain with the negative emotions, beliefs and body
reactions that occurred at the time of the event. For instance, as I describe in “Getting Past
Your Past”:

        Kyle was a top state-ranked high school athlete who came to therapy to work on his
lack of confidence and motivation. He processed memories of injuries and distractions such
as imposing opponents, parental comments and disappointing looks on his coach’s face. A
number of techniques [in the book] were used to help him stay focused on the game. Upon
                                 Dr Francine Shapiro ( - New York Times 2012

graduation, Kyle received a scholarship to attend a prominent university as part of their
NCAA Division I highly ranked team. As he said, “This doesn’t just help with my sport, does
it? I’m getting straight A ’s for the first time!” He’d attended an academically challenging
parochial school and had been struggling with learning disabilities.

         Some of the techniques taught in the book involve ways to achieve a state of calm and
confidence. Many people mistakenly believe that it is important to feel anxious in order to
perform well. However, performance research demonstrates that while “arousal” is involved,
the way we deal with the arousal makes the difference between success and failure.
Therefore, performers, executives and athletes are taught ways to achieve optimal emotional
and physical states. In addition, E.M.D.R. therapy incorporates “positive memory templates”
that set the stage for positive performance in the future. A survey of Olympic athletes and
coaches reported that 90 percent of the athletes and 94 percent of the coaches incorporated
these kinds of imagery techniques into their training programs.

         So whether your desired “peak performance” involves athletics, executive
functioning, social interactions or optimizing a job interview and social interactions, you can
utilize these techniques to prepare yourself to do your best.

E.M.D.R. and the Harried Mother

       Question: I recently went to six E.M.D.R. sessions to treat chronic anxiety and have
       experienced about 60 percent relief. I realize that I should now try to stop the anxiety
       from building up again, but the reality is I’m a working mom of a toddler, so I
       generally come last, meaning I can’t just devote myself to this work fully. Have you
       seen E.M.D.R. help people going forward even if they don’t have the time to always
       focus on relaxation techniques? Also — thank you — it really helped!
       Kim Z., Pa.

Dr. Shapiro responds:

        I can sympathize with the time constraints you have. However, there are two good
analogies from other fields that might help put things into perspective: (1) finish the bottle of
antibiotics, and (2) put on your own oxygen mask first.

        There is a three-pronged approach to E.M.D.R. therapy: Processing the past
experiences that set the groundwork for the problem, processing the current situations that
trigger the disturbance, and addressing needs for the future. The last of these also includes
putting yourself on the priority list.

         Once the processing is complete, there will be a better foundation for emotional
stability, which means less susceptibility to stress and anxiety. The self-help techniques you
learn in E.M.D.R. therapy are there to help you to quickly shift from anxiety to calm when
needed. They are procedures that everyone can benefit from. Once you learn the techniques,
they take only a moment to employ. And, if you complete the therapy there will be much less
need for them.

                                 Dr Francine Shapiro ( - New York Times 2012

       So, if you achieved 60 percent relief in six sessions, can you permit yourself six more
to process the memories that are pushing the remaining anxiety?

Can E.M.D.R. Be Done in Groups?

       Question: Does E.M.D.R. have to be done one-on-one? Or is it possible to do in
       Brave Heart, Chicago

Dr. Shapiro responds:

       E.M.D.R. is generally used one-on-one for comprehensive therapy. However, a group
protocol has also been developed and has been used extensively in the aftermath of natural
and man-made disasters.

        A number of articles have been published reporting the positive effects with groups of
children and adults. For instance, a group intervention with E.M.D.R. [Fernandez, I.,
Gallinari, E., & Lorenzetti, A. (2004). A school- based E.M.D.R. intervention for children
who witnessed the Pirelli building airplane crash in Milan, Italy. Journal of Brief Therapy, 2,
129-136.] was provided to 236 schoolchildren exhibiting P.T.S.D. symptoms in Italy 30 days
after they witnessed an airplane crash into a skyscraper adjacent to the school. In addition to
the usual symptoms of P.T.S.D., the children refused to play in the courtyard and would only
eat lunch in the school corridors. The majority also declared they would never fly, and
refused to go on travel planned by their parents. The children were treated in groups of 19 by
two therapists who administered one 90-minute session. The entire school was treated in
three days. At four-month follow up, teachers stated that after the one treatment session all
but two children returned to normal functioning. The parents also reported that they were
finally able to confirm vacation plans since their children were no longer afraid to fly.

        The same group protocol has been used after natural disasters for both children and
adults throughout Latin America [Jarero, I., Artigas, L., & Hartung, J. (2006). E.M.D.R.
integrative group treatment protocol: A post-disaster trauma intervention for children and
adults. Traumatology, 12, 121-129]. In these cases, one session has been sufficient to reduce
trauma symptoms from the severe range to low (subclinical) levels of distress. In addition, the
group E.M.D.R. therapy [Zaghrout-Hodali, M., Alissa, F. & Dodgson, P.W. (2008). Building
resilience and dismantling fear: E.M.D.R. group protocol with children in an area of ongoing
trauma. Journal of E.M.D.R. Practice and Research, 2, 106-113.] was provided to children
experiencing trauma reactions due to violent conflict. Four sessions were sufficient to
eliminate their symptoms and also provided “inoculation” against further traumatization:

        A follow-up consultation (session 5) four to five months after closure confirmed that
the children continued to live normal lives in spite of ongoing traumatic incidents. The
children did not show symptoms of posttraumatic stress that they had prior to E.M.D.R., even
though, for example, a new guard tower had been built, giving the military full control of the
area with the ability to shoot directly into the residences of the refugee camp and the
children’s home. At follow-up, the therapists noted that none of the symptoms of

                                 Dr Francine Shapiro ( - New York Times 2012

posttraumatic stress had returned and none of the children had developed posttraumatic stress

        Unlike other empirically supported forms of trauma treatment, E.M.D.R. therapy does
not require homework to be successful. Therefore, the individual and group E.M.D.R. therapy
protocols can be used on successive days. This makes it highly useful for field teams
interested in treating those suffering from natural and manmade disasters worldwide. More
information about the use of E.M.D.R. in these instances is available through the nonprofit
E.M.D.R. Humanitarian Assistance Programs (

July 30, 2012: Dr. Shapiro responds to additional reader questions about E.M.D.R.

Memories of Childhood Abuse

       Question: Is E.M.D.R. effective for repression of childhood abuse memories? I have
       no memories of abuse, but circumstantial evidence is strong.
       Aaron Euler, Missoula, Montana

Dr. Francine Shapiro responds:

        We don’t use the word “repression” in E.M.D.R. therapy. That is a term generally
used in psychodynamic therapy and involves a specific theory of causation.

With E.M.D.R. therapy, the premise is that an experience is incompletely processed and
dysfunctionally stored in the brain. For instance, some experiences can be so disturbing that
the memories are stored in isolation, or without a clear image. However, whether or not the
event is remembered, there are ways to process and relieve the current disturbance.

        Most people do not seek therapy to retrieve memories. Rather, most generally seek
therapy because they feel stuck in some way, or have symptoms such as negative thoughts,
emotions or behaviors. If you have symptoms often associated with childhood abuse, they are
interfering with optimal functioning in the present. Since memories are stored in associative
networks, with E.M.D.R. therapy it is possible to target a recent or particularly disturbing
example of a time when you experienced these negative reactions.

        During processing of that event with E.M.D.R., earlier memories may arise. However,
it is important to keep in mind that all memory is fallible. Just because an image emerges
does not make it true. For instance, children can be tricked or traumatized by a movie, TV
program or story. Many children hear a story that feels so real they can later believe it
happened to them.

        Also, memory can come up in fragments and be misleading. For instance, one client
believed that her father might have molested her because she felt herself being held down and
saw her father’s face. During E.M.D.R. processing, she remembered being attacked by some
boys and that her father had come to her rescue. She was later able to verify this fact. In other
words, some corroboration is needed to make sure that any emerging imagery is actually true.
This is the case with any form of therapy.
                                 Dr Francine Shapiro ( - New York Times 2012

         It’s important that you make sure to go to a well-trained clinician who does not
pressure you in any way. In my book “Getting Past Your Past,” one of the first stories I relate
is of a client who spent years going from one therapist to another. At one point, at her
therapist’s suggestion, they spent two years trolling for memories of satanic abuse because
she had abandonment issues, anxiety and an eating problem, as well as recurrent images of
the color red and a candle.

       Since she continued to suffer, she tried another therapist who told her about E.M.D.R.
therapy. Using the E.M.D.R. procedures, they targeted the images, and processing brought up
the memory of a car accident that appeared to be the actual cause of all her problems. But the
only way she could be sure was by specifically asking her mother about it. The irony was that
her mother had tried to protect her when she was a child by not talking to her about the
accident. This attempt to shield her had inadvertently resulted in years of suffering and
confusion. Processing eliminated all of the symptoms.

       The bottom line is that a true memory may emerge or it may not. But it is not
necessary to regain an image for successful processing to take place. So, consider going for
E.M.D.R. therapy to eliminate your symptoms, regardless of whether you retrieve an image.

Fibromyalgia and E.M.D.R.

       Question: My daughter has been diagnosed with fibromyalgia. A typical 18 year old
       with life-after-school-related stress but with this added factor working against her
       health. She doesn’t sleep well or eat well and has anxiety, usually escalating at night
       and first thing in the a.m. A friend psychologist suggested we look into E.M.D.R. I
       read your article yesterday and wondered what you might offer.
       L. Narducci Ask, Brooklyn, N.Y.

Dr. Francine Shapiro responds:

        At present, fibromyalgia falls into the category known as medically unexplained
symptoms, or MUS. However, trauma has been identified as one of the possible causes or
contributors. Although many people discount that possibility because they have not
experienced a major upheaval such as rape or combat, psychological research has indicated
that general life experiences can cause even more post-traumatic stress disorder symptoms
than major trauma. Many different types of life experiences may be negatively affecting your
daughter. In addition, the field of psychoneuroimmunology has clearly revealed the negative
impact of stress on the immune system.

        Positive results with E.M.D.R. therapy have been reported with medically
unexplained symptoms and with a variety of pain conditions. Further, your daughter’s
inability to sleep, in addition to the anxiety, indicates to me that E.M.D.R. therapy may be a
useful addition to her treatment. An E.M.D.R. therapist can help identify and process the
events that may be negatively impacting her. In addition to the 20 randomized trials
supporting E.M.D.R. therapy in the treatment of trauma, one study specifically evaluated
symptoms “such as sleep, depression, anxiety and poor quality of life” and found E.M.D.R. to
be highly effective.
                                 Dr Francine Shapiro ( - New York Times 2012

       Please make sure to chose a clinician trained in a course that has been approved by the
E.M.D.R. International Association (, and who has had experience with
your daughter’s symptoms.

Bipolar Disorder and E.M.D.R.

       Question: I have bipolar I disorder. I had been having a mild depression with
       generalized anxiety. Do you think E.M.D.R. helps with depression and generalized
       anxiety and will it stick? In other words will I have to do E.M.D.R. again?
       Edith Willimas, Pottersville, N.J.

Dr. Francine Shapiro responds:

        Many clinicians have reported positive results subsequent to E.M.D.R. therapy with
those suffering from bipolar disorder. Research is currently under way in Spain, and
preliminary reports indicate positive effects with this population. Preliminary research has
also shown positive E.M.D.R. treatment outcomes with generalized anxiety disorder, with
effects maintained at follow-up. Positive effects have also been reported in numerous
E.M.D.R. studies for those suffering from depression related to trauma and other life
experiences. In one of these studies, E.M.D.R. therapy outperformed Prozac.

        It should be noted that psychological research has indicated that there is often a
relationship between bipolar disorder and trauma. In that regard, more than 20 randomized
controlled trials have indicated that comprehensive E.M.D.R. therapy results in the
remediation of symptoms related to trauma and other disturbing life experiences. The effects
are maintained at follow-up.

       E.M.D.R. therapy can help address the disturbing life experiences that may be
contributing to your symptoms. Please be sure to chose a clinician trained in a course
approved by the E.M.D.R. International Association (, and who has had
experience with your symptoms.

The Cost of E.M.D.R.

       Question: EMDR is an eight-step process. How much would that cost?
       Jeff Eastman, Saint Louis

Dr. Francine Shapiro responds:

        E.M.D.R. therapy is an eight phase approach that includes: history taking,
preparation, and the steps needed to complete processing targets that involve (a) the
memories that set the groundwork for the problems, (b) the current situations that trigger
disturbance, and (c) needed skills and education for the future.

                                  Dr Francine Shapiro ( - New York Times 2012

       The cost for any form of therapy varies from one region to another throughout the
United States, as well as the degree/license of the clinician. The other factor is the length of
time needed to complete the therapy.

       If a person is suffering from a single trauma, research indicates that E.M.D.R. therapy
can be completed in as little as three sessions. If there are more issues involved, the length of
treatment, and cost, increases.

        The E.M.D.R. Humanitarian Assistance Programs has conducted low-cost trainings
for many non-profit organizations throughout the United States. These organizations offer a
sliding scale and, at times, free treatment for underserved populations and for combat
veterans. You can access a list of those organizations on the HAP Website or by e-mail at:

How Long do People Need E.M.D.R.?

       Question: I received E.M.D.R. for longstanding issues from childhood after so many
       other types of therapies had been unsuccessful. While previous (non-E.M.D.R.)
       counselors taught me how to counteract negative thoughts and gave me tools to use
       when things upset me, following E.M.D.R. therapy I simply don’t slide into those
       negative thoughts and feelings in the first place. I find it easy now to care for myself
       in more healthy ways, and I don’t get blown out of the water by daily challenges as I
       used to.
 The results of E.M.D.R. have been really dramatic; and did not require the
       amount of time that other types of therapy were requiring. I guess I just wonder if my
       experience was typical. Is there actually any research on how long people need
       E.M.D.R. therapy compared to other types of therapy? Ernest K, Denver

Dr. Francine Shapiro responds:

        There is research supporting your experience that E.M.D.R. therapy can be completed
rapidly. There are two randomized studies reporting 84 percent to 100 percent of single-
trauma victims no longer had P.T.S.D. after three 90-minute treatment sessions. In addition, a
study funded by Kaiser Permanente indicated that within an average of six 50-minute
sessions, 100 percent of the single-trauma victims and 77 percent of the multiple-trauma
victims no longer had P.T.S.D.

       Each form of therapy is guided by a different theory of practice and contains different
procedures. E.M.D.R. therapy and two forms of trauma focused-cognitive behavioral therapy
(C.B.T.) have the most research support and are considered “A” level treatments by
organizations such as the Department of Defense. There are many differences between the
treatments, including the procedures considered necessary to achieve positive effects. The
C.B.T. treatments focus on challenging negative beliefs and behaviors, both during sessions
and with daily homework. E.M.D.R. therapy, on the other hand, focuses on processing the
memories so that associations spontaneously arise as learning takes place. No treatment
homework is assigned.

                                 Dr Francine Shapiro ( - New York Times 2012

       There are now 10 randomized studies comparing C.B.T. and E.M.D.R. therapy. In
seven of the 10 studies, E.M.D.R. therapy had superior outcomes on at least some measures
and/or was more efficient, using fewer sessions in five of the seven studies (Arabia et al.,
2011; de Roos et al., 2011; Ironson et al., 2002; Jaberghaderi et al., 2004; Lee et al., 2002;
Nijdam et al., 2012; Power et al., 2002). The other three studies (and four of the ones just
mentioned) all used daily homework in the C.B.T. condition compared to none in the
E.M.D.R. condition (Rothbaum et al., 2005; Taylor et al., 2003; Vaughan et al., 1994). The
Taylor study is the only one that found C.B.T. superior on some measures, and it used both
imaginal and therapist-assisted in vivo exposure (where the client goes to a feared location)
during half the sessions, plus an additional 50 hours of homework.

        The bottom line is that E.M.D.R. therapy generally appears to be more rapid and does
not use homework to achieve positive effects. As you discovered, the negative thoughts and
feelings disappear once the memories are processed. In addition, your quality of life improves
as you view yourself and life’s challenges in a different way.

E.M.D.R. and the Brain

       Question: I have little knowledge of the controversies behind it; is it because it is still
       relatively new? What parts of the brain are highlighted during this therapy? My
       observation is this: to lay people, connecting eye movement to trauma and treatment
       sounds wacky, almost a hoax. I suspect that this may be, in part, why E.M.D.R. is not
       better known — it sounds too unbelievable. Are there any plans for a public
       information campaign by credible sources so that more people can be helped? What
       are the roadblocks to this? Joshua, San Francisco

Dr. Francine Shapiro responds:

         The controversy regarding E.M.D.R. therapy stems from misinformation. When it
was first introduced in 1989, the use of eye movements did seem strange to many people, and
unfortunately the early research examining that component did not show positive effects. In
2000, a committee of the International Society for Traumatic Stress Studies (ISTSS)
criticized all the previous research on the eye movement component as being poorly done.
However, many people remain influenced by those discredited initial research reports.

      Critics are also generally unaware that in the past 10 years more than 20 new
randomized studies have demonstrated positive effects for the eye movement, including
immediate declines in negative emotions.

        At this point, most major organizations, such as the American Psychiatric
Association, ISTSS and the DVA/DoD, recommend E.M.D.R. as a treatment for trauma.
Consequently, few people argue that E.M.D.R. therapy is not effective, but others say it is
controversial because “no one knows for sure why it works.” However, that is true of all
forms of psychotherapy and most pharmaceuticals. Others claim E.M.D.R. therapy is no
different than traditional C.B.T. However, as I described above, there are indeed major
differences between the treatments, including the fact that E.M.D.R. therapy does not need

                                 Dr Francine Shapiro ( - New York Times 2012

the one to two hours of daily homework used in C.B.T. trauma treatments to achieve positive

         Unfortunately, articles on the Internet continue to fan controversy by circulating
outdated criticism and other misinformation. Therefore, the best public information campaign
is for those people who have had positive experiences, and know the actual facts, to let others
know about it.

        As for your question regarding the brain, there are about a dozen neuroimaging
studies with a range of findings summarized in an article by Bergmann.

         Pre/Post evaluations of E.M.D.R. therapy have reported left frontal lobe activation,
decreased occipital activation and decreased temporal lobe activation. These findings are
indicative of (a) emotional regulation due to increased activity of the prefrontal lobe, (b)
inhibition of limbic over-stimulation by increased regulation of the association cortex, (c)
reduction in the intrusion and over-consolidation of traumatic episodic memory due to the
reduction of temporal lobe activity, (d) the reduction of occipitally mediated flashbacks, and
(e) the induction of a functional balance between the limbic and prefrontal areas.

        Recent modifications in neuroimaging paradigms have illustrated findings of bilateral
dorsolateral prefrontal activation, as well as left orbitofrontal and right ventromedial
prefrontal activation. The implications of these findings have yet to be fully understood, but
suggest repair in memory function, working memory/concentration, and affect regulation,
respectively. In addition, the finding of increased thalamic activation following successful
E.M.D.R. treatment was noted for the first time. The consequence of such a change suggests
the repair of failures in cognitive, memorial, affective, somatosensory, and interhemispheric
integration, which are disrupted in P.T.S.D.

         Similarly, consistencies have been seen in psychophysiological studies, manifested by
findings of parasympathetic relaxation responses, increased heart rate variability
parasympathetic tone, reduced electrodermal function, reduced EEG P3a function, and
increased vagal parasympathetic function. These findings suggest that E.M.D.R. affects the
affect regulatory systems, inducing an initial “compelling” parasympathetic state change that
facilitates information processing and neural linkage repair and the eventual stable trait
change that is seen as a result of successful E.M.D.R. treatment.

Breathing and E.M.D.R.

       Question: I’m curious about the relationship of intentional, lateral eye movements
       and changes both in the psoas and diaphragm. Obviously both of these soft tissue
       structures are involved in traumatic responses. But why is it that, when I intentionally
       shift my eyes laterally, my breathing softens & deepens rather than being triggered
       into a panic response? Lynn, Santa Fe

                                 Dr Francine Shapiro ( - New York Times 2012

Dr. Francine Shapiro responds:

        There are approximately 10 randomized studies that have investigated the hypothesis
that the lateral eye movements cause relaxation because of a so-called orienting response, or
O.R. All the studies have documented a decrease in negative emotion and arousal.

         When an animal in the wild is startled because of sudden movement it reflexively
shifts its eyes to investigate. When safety is noted, the animal relaxes. This compelled O.R.
response is parasympathetic, habituating and geared toward information processing. The O.R.
is differentiated from the startle response (S.R.) and defensive response (D.R.), both of which
are sympathetic, sensitizing and geared toward action, rather than information processing.

        Research has identified both the relaxation response and the retrieval of information
during the sets of eye movements used in E.M.D.R. therapy. In clinical practice, clients report
that new associations are made, indicating that learning is taking place.

Sexual Perpetrators and E.M.D.R.

       Question: Has E.M.D.R. been successful with sexual perpetrators?
       Liz, Boston

Dr. Francine Shapiro responds:

        While research indicates that traditional programs for sex offenders are not successful,
the reason may be that these programs have not changed much in the past 20 years. They
primarily involve group therapy that focuses on clarifying motives, learning skills to help
avoid situations where deviant feelings might be triggered, and ways to try to deal with the

        In comparison, a small study reporting the successful E.M.D.R. treatment of sexual
perpetrators was published in the Journal of Forensic Psychiatry and Psychology. Ten
perpetrators who had themselves been molested as children were evaluated after receiving
E.M.D.R. treatment. An average of six sessions of E.M.D.R. therapy were added to a
traditional cognitive-behavioral therapy (C.B.T.) program, and the results were compared to
C.B.T. alone.

        In addition to the Sexual Offender Treatment Rating Scale (SOTRS), the researchers
used the penile plethysmograph to evaluate levels of deviant arousal pre/post and at a one-
year follow-up. The results indicated that all but one of those receiving E.M.D.R. therapy
experienced a decrease in deviant arousal that was also correlated with a “decrease in sexual
thoughts, increased motivation for treatment, and increased victim empathy.” The effects
were maintained at follow-up. This change was not demonstrated in the C.B.T.-only

        Transcripts of interviews with the molesters indicated that important alterations took
place in both self-awareness and the way they viewed their victims after E.M.D.R. treatment.
While molesters often exhibit profound denial that they had done anything wrong and a lack
                                 Dr Francine Shapiro ( - New York Times 2012

of empathy for their victims, after treatment these perpetrators took responsibility for their
actions and no longer viewed children as sexual objects. The following is an excerpt from one
of the transcripts published in “Getting Past Your Past,” in which the perpetrator explains
what changed because of the E.M.D.R. processing of his own molestation:

         I was still blaming myself for what happened, as well as putting blame on my victim
like she was the one who caused this now. Up until this, thinking of what happened to me, I
thought, “You’re not a victim, because you brought this on to yourself. You was asking for
it.” But I didn’t do jack squat. I didn’t do nothing. I didn’t cause it. And it helped me to have
insight into my own abuse and see that it wasn’t my fault. No more than it was my victim’s
fault. It’s hard. It’s hard to look at. But, the more you do, the more clear you become on what
you did, as well as reality. Once you do see it clear, you can go back and say, “Oh, why in
the world did I do this?” Or “How in the world could they do this to me?” and “How could I
do this to them?” And that hurts. It’s a big reality check. I had no understanding of feelings,
of my own feelings. To be able to understand theirs, I had to really be able to understand
mine. And once I could understand mine, I could understand theirs.

        The processing of the perpetrators’ own memories of their abuse changed their views
and physiological reactions. Given their new perspectives and sense of self, they no longer
needed to fight deviant arousal. Reports of E.M.D.R. therapy with other sexual perpetrators
(child molesters and rapists) continue to indicate positive effects, and additional research is

        Targeting memories of sexual abuse with E.M.D.R. therapy results in learning taking
place. What is useful is incorporated and what is useless is discarded. That includes the
transformation of negative emotions, thoughts and body reactions.

        In the case of these sexual perpetrators who had themselves been molested as
children, after E.M.D.R. treatment, the men placed responsibility for their own childhood
experiences on their abusers, where it belonged. Simultaneously, they took on the appropriate
level of responsibility for their own actions. The remorse they felt regarding their own
deviant actions is consistent with a new sense of awareness and the long-lasting physiological
changes in sexual response demonstrated by the penile plethysmograph. It indicates that, with
the proper treatment, offenders can be reclaimed into society. It further indicates that
generations of victimization can be halted if sufficient resources are directed towards
perpetrator treatment.

       We look forward to the outcomes of more extensive research in this area.

Francine Shapiro, Ph.D., is a senior research fellow at the Mental Research Institute
in Palo Alto, Calif., director of the EMDR Institute, and founder of the nonprofit
EMDR Humanitarian Assistance Programs, which provides pro bono training and
treatment to underserved populations worldwide. Her latest book is “Getting Past
Your Past: Take Control of Your Life with Self-Help Techniques from EMDR
Therapy” (Rodale, 2012).

Dr Francine Shapiro ( - New York Times 2012


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