Basic and Clinical

February 2013, Volume 4, Number 1

Methodological Aspects of Cognitive Rehabilitation with Eye

Movement Desensitization and Reprocessing (EMDR)
Afsaneh Zarghi*1, Alireza Zali1, Mehdi Tehranidost2

1. Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2. Psychiatry Department, Rouzbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Article info: A B S T RAC T

Received: 15 May 2012
First Revision: 10 June 2012 A variety of nervous system components such as medulla, pons, midbrain, cerebellum, basal
Accepted: 1 August 2012 ganglia, parietal, frontal and occipital lobes have role in Eye Movement Desensitization and
Reprocessing (EMDR) processes. The eye movement is done simultaneously for attracting
client's attention to an external stimulus while concentrating on a certain internal subject. Eye
movement guided by therapist is the most common attention stimulus. The role of eye movement
has been documented previously in relation with cognitive processing mechanisms. A series
of systemic experiments have shown that the eyes’ spontaneous movement is associated with
emotional and cognitive changes and results in decreased excitement, flexibility in attention,
memory processing, and enhanced semantic recalling. Eye movement also decreases the
memory's image clarity and the accompanying excitement. By using EMDR, we can reach
Key Words: some parts of memory which were inaccessible before and also emotionally intolerable.
Rehabilitation, Various researches emphasize on the effectiveness of EMDR in treating and curing phobias,
Eye Movement, pains, and dependent personality disorders. Consequently, due to the involvement of multiple
Desensitization, neural system components, this palliative method of treatment can also help to rehabilitate the
Reprocessing. neuro-cognitive system.

1. Introduction The adaptive information processing model is an infor-

I
mation processing theory for defining and anticipating
In 1989, a hypothesis was suggested that eye the therapeutic effects of EMDR (Brom, 1989; Brown,
movement has desensitization effects (Shap- & Shapiro, 2006). All human beings have an informa-
iro, 1989). This was also tested on different tion processing system which is comparable with other
persons and similar results were found. Later systems of the body. The information processing sys-
on, some other elements were added to this in- tem processes the multiple elements of our experiences
tervention which involved cognitive components and a and stores the memories in an accessible and useful way
method of treatment so called Eye Movement Desensi- (Bower, 1981; Davidson et al., 2001). The memories
tization (EMD) (Shapiro, 1998). The development and are stored in networks which consist of thoughts, im-
accomplishment of this treatment method continued; ages, emotions, and related sensations; these networks
its name changed into "Eye Movement Desensitiza- are adaptively connected with each other. The learn-
tion and Reprocessing" (EMDR) in order to reflect the ing occurs when the new associations parallel with the
cognitive and attitudinal changes associated with illness previously stored materials (Stickgold, 2002). When a
which occurs during the treatment (Shapiro, 2001; Bar- negative or traumatic event takes place, the information
rowcliff, 2001). processing maybe done imperfectly due to the negative

* Corresponding Author:
Afsaneh Zarghi, MD. MPH. PhD
Department of Neuroscience, Functional Neurosurgery Research Center, Shohada hospital, Tajrish Avenue, Tehran, Iran
Tel/fax: 00982188518463
E-mail: [email protected]

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emotions or the interference of emotional dissociation unpleasant emotions (Williams et al., 1997; Spector, &
with those processing. As a result, new information Read, 1999; Gunter, & Bonder, 2008). The question at
does not make an appropriate connection with the more hand is that how the eye movement along with other
adaptive information which is stored in memory net- stimuli has an effect in the treatment's outcome. Stud-
works (De Jongh et al., & Foa et al., 1998). EMDR can ies designed with the purpose of comparing EMDR
be helpful for clinical relief from agonizing memories (with eye movement) and EMDR without eye move-
by reprocessing the components. This could involve ment indicate that the eye movement causes a decrease
major or minor traumatic memories. The information in arousal, flexibility in attention and memory process-
processing is done through making adaptive connection ing, and improvement of semantic recalling (Foa et al.,
between previous memories and traumatic ones (An- 1989; Engelhard et al., 2010).
drade et al., 1997). During this treatment, learning oc-
curs and new experience with the associated emotion is In some studies, it has been noticed that the eye move-
stored in the individual's memory and prepare him/her ment decreases the vividness of the memory images
for the proper reaction in the future situation (Chemtob and also the companying arousal. The eye, in order to
et al., 2000). The EMDR and behavior therapy methods focus voluntarily and fixate the object, stores vivid im-
along with pharmacologic interventions are considered ages from moving object, focuses on near or far objects,
a palliative treatment. The EMDR is more effective than and needs complete coordination of muscles and also
behavior therapy and its effects are obtained in a shorter three sets of intraocular muscles (ciliary muscles, dila-
time (Keane et al., 1989; Van Etten et al., 1998; Foa, tors, and iris sphincters) (Barrowcliff et al., 2004). The
& Rothbaum, 1998). Various studies show the stability neural mechanisms which direct these functions are in
of the EMDR effects during the time. In a study, the medulla, pons, mid brain, cerebellum, basal ganglia,
war survivors who participated in a course of treatment parietal, frontal, and occipital lobes. The precise binu-
(12 sessions) showed therapeutic effects after 9 months clear vision is reached by coordinated function of ocu-
(Carlson et al., 1998). An investigation on gradual stud- lar muscles which allow a visual stimulus that is on the
ies of therapeutic effects of EMDR shows that just one similar parts of the two retinas. The simultaneous and
course of treatment (in comparison with limited treat- symmetrical movements of the eyes are called conju-
ments) could be insufficient for the complete improve- gate movement or gaze (Barrowcliff et al., 2004; Brown
ment of the disorder. et al., 1997). The simultaneous movement of the eyes
in opposite directions to each other which happens in
2. Mechanism of Action convergence with the eyes is called disconjugate. These
two natural types of eye movement are called version
Although the eye movement is the most distinct char- and vergence, respectively. The movement of the eyes
acteristic of the treatment, the EMDR is not a simple in horizontal axis could be saccadic or in form of slow
process and eye movement is not its only main com- pursuing movements. The purpose of saccadic move-
ponent. There are rather various components associated ments is rapid changing of visual fixation in order to
with its therapeutic effect. The eye movement is used bring new images of objects on the fovea. The sacca-
to draw the client's attention to an external stimulus dic movement can be made by asking the client dur-
while the client is simultaneously concentrating on the ing the examination (Kuicken et al., 2001-2002; Parker
internal agonizing subject (Andrade et al., 1997; Bae et al., 2009). Command saccades are slower pursuing
et al., 2008; Kuicken et al., 2001). The eye movements eye movements and its purpose is to store a clear and
(EMs) are defined as dual attention stimuli which con- stable image from a moving object. The brain circuits
vey a trend during which the client concentrates on both for soft/slow pursuit movement are less known. One of
internal and external stimuli. The eye movement with the routes is probably rooted from the posterior parietal
the therapist's guide is the most common dual attention cortex, adjacent temporal and anterior occipital cortex
stimulus used, but there are many other forms of stimuli and descents into dorsolateral pons core on the other
like hand-tapping and auditory stimulation that can be side. Also, some papillae from frontal eye field and dor-
used in this treatment method (Shapiro, 1995; Lee et al., solateral pons core on the other side and papillae from
2006; Kavanagh et al., 2001). The role of eye move- flocus and cerebellum dorsal vermis are involved in it
ment has been already documented in relation to cog- (Kuicken et al., 2001-2002; Lee et al., 2006; Parker et
nitive process mechanisms. A collection of systematic al., 2009). In addition to the routes mentioned above,
experiments have revealed that the eye's spontaneous during the EMDR, the sensory circuits are involved in
movement is associated with cognitional changes and the optical nerve to optic chiasm after formation of opti-
cal tract through optic radiation which moves towards

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the occipital cortex. In order to preserve the proper tone & Bodner, 2008). The client does identify a positive
of pupil and adjusting the entering light, the afferent vi- opinion against the negative opinion s/he has, and deter-
sional routes from retina toward pretectal cores of mid mines the amount of credibility that s/he holds for these
brain and constricting routes of pupil from mid brain opinions. For instance, the traumatic memory of a car
towards the retina are involved. accident can be accompanied by the negative opinion
of "It was my fault" and the opposite positive opinion
3. Technical Considerations could be "I have done what I could" and "It was not my
fault".
The EMDR, by combining the effective psycho-
therapy elements in treatment, presents the maximum In the desensitization phase, the fourth phase; the ther-
therapeutic effects. These psychotherapies consist of apist asks the client to hold the target image, negative
psychodynamic, cognitional-behavioral, interpersonal, thought, and the unpleasant physical emotions while
empirical, and body-centered approaches. EMDR is simultaneously following the therapist's hand move-
a treatment method for processing of information and ment direction (bilateral stimulation) with his/her eyes
uses an 8 phase approach for treatment (Shapiro, 2002a) and following it for 20 to 30 seconds. Depending on the
(Figure 1). During this method, the client accompanies need a longer duration may be required (Ironson et al.
his/her present and previous experiences in different 2002; van den Hout et al. 2001).
doses consecutively, while simultaneously concentrat-
ing on an external stimulus. Then the client is ordered 3.3. Treatment (5th to 7th phase)
to consider new elements for the next series of dual at-
tention. This succession of dual attention and personal In the fifth and sixth phases, installation and body
association is repeated through the treatment session in scan are performed and worked on by using the EMDR
attention and memory problems (Shapiro, 2002b; Lee method. Although the eye movement is the most com-
et al., 2006). mon used external stimulus, the therapist also uses other
stimuli like auditory sense, tapping, and various forms
3.1. Diagnosis (1st phase) of tactile stimulation. The type of dual attention and the
required time for each subsequent set is determined on
The first phase in EDMR treatment is taking an initial the basis of the therapist's needs (Lee et al., 2006). The
history during which the therapist evaluates the client client is asked to think only on what is happening. Af-
and designs a treatment plan (Verder, 2002). The thera- ter that the therapist demands the client to empty his/
pist and client both consider the probable aims of treat- her mind and pay attention to any thoughts, emotions,
ment which consists of agonizing events and the present images, memories, or physical emotions which s/he
situation that causes emotional distress. The related his- percepts. Based on the information presented by the cli-
torical events and development of the skills in specific ent, the therapist determines the subject that should be
behaviors will be needed in future situations. worked on for the next step of treatment. In most cases,
a client-centered association process is persuaded and
3.2. Assessment (2nd to 4th phase) it is repeated during the treatment session. If the client
feels discomfort, the therapist uses some methods to
In the second phase, the therapist assesses the cli- help the client to continue the information processing.
ent's skills and preparation for confrontation with stress When the therapist is unable to reach the target memory,
and emotional distress (Horowitz et al., 1979; Brown, s/he would ask the client to pay attention to a positive
& Shapiro, 2006). In this phase, the well-formed cop- thought identified by the client or a better thought exist-
ing skills and stabilized condition of client should be ing in mind. Concentrating on the incident while simul-
assured of. If necessary, at first, it must concentrate on taneously making eye movements should be done after
learning the new skills. These skills include relaxation that. (Przybyslawski et al., 1999; Suzuki et al., 2004).
and coping skills. Following several sets, the client reports an increased
confidence on the positive thought. The client will be
The third phase, assessment; consists of the assess- asked about the existence of physical emotions and if
ment of target memory in which the client is asked to any negative emotions exist, that would be processed
focus on the most vivid image or thought related to the just like above. If positive emotions exist they would
memory (if available), a negative opinion towards him/ be amplified.
herself, and emotional and physical sensation with con-
comitant measurements (Kavanagh et al. 2001; Gunter,

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In the seventh phase, the therapist asks the client to response. The orienting response is a natural response
make a list from any events that aroused the client and consisting of attention and interest which is activated
made him/her to use self-calming techniques (which is when the attention is given to the new stimulus. There
taught in the second phase). are 3 different models for conceptualization of orienting
response in EMDR: cognitive information processing,
3.4. Re-evaluation (8th phase) neurobiological model and behavioral model. These
models are not specified and observe a single phenome-
The next session is started with the eighth phase which non from different points of view (Maxfield et al., 2002;
consists of re-evaluation of previous works and the Parker et al., 2009). Barrow Cliff and colleagues be-
progress rate in comparison with the previous session. lieved that orienting in EMDR is an investigatory reflex
The EMDR can be used in processing of all related past which leads into a relaxing response (basic relaxation).
events, the present distressing events, and future scenar- By the time it is determined that no threats exist, this
ios which need different answers. The main objective relaxation through reciprocal inhibition leads into thera-
is to make the most profound and most comprehensive peutic result (Barrowcliff et al., 2001). Some believe
treatment in the least time possible. After the EMDR that orienting response can disassemble the traumatic
process, clients mostly report that the related emotional segment of the memory network and cut the previous
distress with the memory is reduced to a large extent and concepts and in return allows the new information to
they have received an important cognitive insight on be organized and formed in a new compatible shape
this context (Spector, & Read, 1999; Mol et al., 2005). (Feske, 1998; Ironson et al., 2002). In a study (Kuicken
These cognitive and emotional changes mostly lead into et al., 2001) which the orienting response was evalu-
simultaneous personal and behavioral changes which ated, they showed that the orienting response increases
will become better with EMDR standard methods. attentional flexibility. In addition, it is plausible that the
orienting response induce neurobiological mechanisms
which simplify the activation of episodic memories and
mixing them in cortical semantic memory (Stickgold,
2002). There are various studies showing that the eye
movement and other stimuli are effective on perception
of the subject memory, and decreasing vividness of the
image and its accompanying emotion. Two probable
mechanisms are suggested for explanation of this effect
of EMDR in treatment (Kvanagh et al., 2001; van den
Hout et al., 2001). Some has posed a hypothesis that
the effect of eye movement ruins the working memory
and by a decrease in vividness, the volume of the ac-
companying emotion becomes lower. This group also
suggests that this effect can take part in treatment like
a "supplementary response for imaginary exposure"
(Marks et al., 1998). Some others have proposed the hy-
pothesis that Eye Movements (EMs) decreases the so-
matic perception along the recalling and this leads into
Figure 1. Different phases of EMDR decrease of excitation and vividness (Barrowcliff et al.,
2001; Van Etten et al., 1998). They have proposed the
theory that this effect allows the client to access some
parts of his/her memory which was inaccessible before
4. Discussion and the client could not bear its excitation. This expla-
nation has found similarities between EMDR and recip-
The therapeutic effect of EMDR on treatment of dis-
rocal inhibition. The physiological basis of EMDR like
eases has been noted in many studies (Van Etten et al.,
other psychotherapies is unknown. Thus, all presented
1998; Davidson et al., 2001). Still no clear relationship
neurobiological models have theoretical aspects. The
has been found between the complex sensory and emo-
testing of the hypotheses of neurological mechanisms
tional routes during the EMDR and therapeutic effects.
of EMDR needs development of advanced brain imag-
One hypothesis could be (Lee et al., 2006) that dual at-
ery techniques (Vander, 2001). Rauch and colleagues
tention stimulation can cause the provoking of orienting

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(Rauch et al., 1996) performed PET studies on PTSD recalling memory; they had not found such effect on se-
clients while they were encountered with precise and mantic memory (Gunter, & Bodner, 2008). Some stud-
clear narrations of their traumatic memories. The clients ies have revealed the efficacy of EMDR on treatment
had only shown increased activity in right hemisphere of many diseases (Cooper et al., 1989; Chambless et
of the brain, in regions which had the most shares of al., 1998; Chemtob et al., 2000). Although these results
emotional arousal, and the increase in the right visual could be due to methodological limitations in various
cortex activity which reflected the reported flashbacks studies, EMDR could be a treatment for these disorders.
in clients. The Broca's area, a part of left hemisphere Since the EMDR is a treatment for agonizing memories,
of the brain having the responsibility of interpreting the probably it is effective in treatment of anxiety disorders
personal experience into communicable language, had secondary to a traumatic experience and it is less effec-
shown the least activity (Rauch et al., 1996; Stickgold, tive in treating phobic disorders with unknown onset
2002). The SPECT prior and after the EMDR showed (for instance ophidiophobia) (Devilly, & Spence, 1999;
an increase in activity of bilateral anterior cingulate. De Jongh et al., 2002). The methodological limitations
This region brings closer the experience of real threat to consist of failure in application of EMDR protocol and
the perceived threat. Another important finding of this also cofounding effects after attempting to do EMDR
study was that the metabolism in pre-frontal lobe will (Maxfield et al., 2002). Some of the publishers have
be increased after the treatment (Vander, 2001; Stick- shown that if the EMDR protocol is done completely
gold, 2002). A theory had been presented to describe for phobia, it will have therapeutic effects on medical
the effects of EMDR. During the EMDR the bilateral and dentistry phobias (De Jongh et al., 1998). There are
migratory stimulation makes the client continually case reports and case series of supplementary and pal-
take his/her attention from the middle line (Parker et liative treatment of other medical disorders by EMDR;
al., 2009). Stickgold proposed the hypothesis that the cases like dissociative disorders, body deformity dis-
neurobiological mechanisms similar to REM, with the orders, pain disorders, personality disorders, phantom
change in attention, results into activation of episodic limb pain, and drug dependency disorders. Application
memories and combining them into cortical semantic of EMDR has been described in disorders like attach-
memory (Stickgold, 2002). Some of the independent ment disorder, depression, social anxiety, memory and
researchers have provided evidence in support of this emotional disorders, distress associated with infertility,
theory. They have shown that sporadic left and right body image disorders, and marital discord (Goodman et
eye movements facilitate the performance of episodic al., 1998; Foa et al., 2000; Shapiro, 2002b) (Figure 2).

Figure 2. Diseases treated by EMDR

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Selective attention and its alterability into sustained at- Carlson, J.G., Chemtob, C.M., Rusnak, K., Hedlund, N.L., &
Muraoka, M.Y. (1998). EMDR for Combat-related PTSD. J.of
tention in memory, which results in memory coding and
traumatic, stress, 11, 324.
memory storage changes, have influence on information
processing and learning of new events. Hence, EMDR Chambless, D.L., Baker, M.s., Baucom, D.H., Beutter, L.E.
(1998). Update on empirically validated therapies. The clini-
method can be accounted as a palliative treatment along cal psychologist, 51, 3-16.
with types of treatment and using this method due to
involvement of multiple components of neural system Chemtob, C.M., Tolin, D.F., van der Kolk, B.A., & Pitman, R.K.
(2000). Guidelines for treatment of PTSD: Eye movement de-
can comprise neuro-cognitive system rehabilitation. It is sensitization and reprocessing. Journal of Traumatic Stress,
recommended that further investigations follow up this 13, 569–570.
path and determine the EMDR roles on attention and
Cooper, N.A., Clum, C.A. (1989). Imaginal flooding as a sup-
memory changes more than before. plementary treatment for PTSD in Combat veterans: A con-
trolled study. Behavior therapy, 28, 381-391.
Acknowledgment Davidson, P.R., parker, K.ch. (2001). Eye movement desensiti-
zation and processing: A meta-analysis. J of consulting and
By this mean we give our gratitude to Dr. Rahmati, clin psychology, 69, 305-316.
Research Vice-Chancellor of Shahid Beheshti Univer-
De Jongh, A., ten Broeke, E., Reussen, M.R. (1998). Treatment of
sity of Medical Sciences and Dr. Raadpey, the respected specific phobias, with eye movement desensitization and re-
authority of Shohada Hospital. processing: protocol, empirical status and conceptual issues.
J of Anxiety Dis, 13, 69-85.

De Jongh, A., van der Ord, H.S.,Ten broeke, E. (2002). Efficacy

of EMDR in the treatment of specific phobia: 4 single-case
studies on dental phobia. J, of clin psychology, 58, 1489-1503.

Devilly, G.J., & Spence, S.H. (1999). The relative efficacy and
treatment distress of EMDR and a cognitive behavioral treat-
ment protocol in the amelioration of post traumatic stress
disorder. Journal of Anxiety Disorders, 13, 131–157.
References
Engelhard, I.M., van den Hout, M.A., Janssen, W.C., van der
Andrade, J., Kavanagh, D., & Baddeley, A. (1997). Eye-move- Beek, J. (2010). Eye movements reduce vividness and emo-
ments and visual imagery: A working memory approach to tionality of ‘‘flashforwards.’’ Behavior Research and Thera-
the treatment of post-traumatic stress disorder. British Jour- py, 48(5), 442-7.
nal of Clinical Psychology, 36, 209–223.
Feske, U. (1998). Eye movement desensitization and reprocess-
Bae, H., Kim, D., & Park, Y.C. (2008). Eye movement desensiti- ing treatment for posttraumatic stress disorder. Clinical Psy-
zation and reprocessing for adolescent depression. Psychia- chology: Science and Practice, 5, 171-181.
try Investigation, 5, 60–65.
Foa, E.B., Steketee, G., & Rothbaum, B. (1989). Behavioral/cog-
Brom, D., Kleber, R., Defares, P.B. (1989). Brief psychotherapy nitive conceptualizations of post-traumatic stress disorder.
for posttraumatic stress disorders. Journal of consulting and Behavior Therapy, 20, 155–176.
clinical psychology, 57, 607-612.
Foa, E.B., & Rothbaum, B.O. (1998). Treating the trauma of
Brown, S., & Shapiro, F. (2006). EMDR in the treatment of rape: A cognitive-behavioral therapy for PTSD. New York:
borderline personality disorder. Clinical Case Studies, 5, Guilford Press.
403–420.
Foa, E.B., Friedman, M., & Keane, T. (2000). Effective treat-
Brown, K.W., McGoldrick, T., & Buchanan, R. (1997). Body ments for posttraumatic stress disorder: Practice guidelines
dysmorphic disorder: Seven cases treated with eye move- from the International Society for Traumatic Stress Studies.
ment desensitization and reprocessing. Behavioural & Cog- New York: Guilford Press.
nitive Psychotherapy, 25, 203–207.
Goodman, L.A., Corcoran, C., Turner, K., Yuan, N., & Green,
Barrowcliff, A.L., Gray, N.S., MacCulloch, S., Freeman, T.C., B.L. (1998). Assessing traumatic event exposure: General is-
MacCulloch, M.J. (2001). Horizental rhythmical eye move- sues and preliminary findings for The Stressful Life Events
ments consistently diminish the arousal provoked by audio- Screening Questionnaire. Journal of Traumatic Stress, 11,
tory stimuli, Br, S clin psychol, 42, 289-302. 521–542.

Barrowcliff, A.L., Gray, N.S., Freeman, T.C.A., & MacCulloch, Gunter, R.W., & Bodner, G.E. (2008). How eye movements af-
M.J. (2004). Eye-movements reduce the vividness, emotional fect unpleasant memories: Support for a working-memory
valence and electrodermal arousal associated with negative account. Behaviour Research and Therapy, 46, 913–931.
autobiographical memories. Journal of Forensic Psychiatry
and Psychology, 15, 325–345. Horowitz, M.J., Wilner, N., & Alvarez, W. (1979). Impact of
event scale: A measure of subjective distress. Psychosomatic
Bower, G. (1981). Mood and memory. American psychologist, Medicine, 41, 207–218.
36, 129 -148.

102
Basic and Clinical
February 2013, Volume 4, Number 1

Ironson, G.I., Freund, B., Strauss, J.L., & Williams, J. (2002). A Shapiro, F. (2002b). EMDR as an integrative psychotherapy ap-
comparison of two treatments for traumatic stress: A com- proach: experts of diverse orientation explore the paradigm
munity based study of EMDR and prolonged exposure. Jour- prism. Washington DC. APA press.
nal of Clinical Psychology, 58, 113-128.
Spector, J., & Read, J. (1999). The current status of eye move-
Kavanagh, D.J., Freese, S., Andrade, J., & May, J. (2001). Effects ment desensitization and reprocessing (EMDR). Clinical Psy-
of visuospatial tasks of desensitization to emotion memories. chology and Psychotherapy, 6, 165-174.
British Journal of Clinical Psychology, 40, 267–280.
Stickgold, R. (2002). EMDR: a putative neurobiological mecha-
Keane, T.M., Fairbank, S.A., Caddail, J.M., Zimmening, R.T. nism of action. clin psycho, 58 (1), 61-75.
(1989). Implosive (Flooding) therapy reduces symptoms of
PTSD in Vietnam Combat veterans Behavior therapy, 20, Suzuki, A., Josselyn, S.A., Frankland, P.W., Masushige, S.,
245-260. Silva, A.J., & Kida, S. (2004). Memory reconsolidation and ex-
tinction have distinct temporal and biochemical signatures.
Kuiken, D., Bears, M., Miall, D., & Smith, L. (2001). EMDR Fa- Journal of Neuroscience, 24, 4787– 4795.
cilitates attentional orienting imagination, cognition and per-
sonality, 1; 3-30. Vander Kolk, B.A. (2001). The psychobiology and psychophar-
macology of PTSD. Hum psychopharmacol, 16 (51), 49-64.
Kuiken, D., Bears, M., Miall, D., & Smith, L. (2001–2002). Eye
movement desensitization reprocessing facilitates attention- Van den Hout, M., Muris, P., Salemink, E., & Kindt, M. (2001).
al orienting. Imagination, Cognition and Personality, 21 (1), Autobiographical memories become less vivid and emotion-
3–20. al after eye movements. British Journal of Clinical Psychol-
ogy, 40, 121–130.
Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active
ingredient in EMDR: Is it traditional exposure or dual focus Van Etten, M., Tayler, S. (1998). Comparative efficacy of treat-
of attention? Clinical Psychology and Psychotherapy, 13, ments for PTSD: A meta-analysis. Clinical psychology and
97–107. psychotherapy, s, 126-144.

Maxfield, L., Heyer, L.A. (2002). The relashionship between ef- Verder folk, B.A. (2002). Beyen the talking cure: somatic experi-
ficacy and methodolgy in studies investigating EMDR treat- ence and subcortical imprints in the treatment, of truma, in:
mant of PTSD. J.of clin psychology, 58, 23-41. Shapiro f(Ed), EMDR as an integrative treatment approach:
experts of diverse orientation explore the paradigm prism.
Mol, S.S.L., Arntz, A., Metsemakers, J.F.M., Dinant, G., Vilters- Washington DC: American psychological association books.
Van Montfort, P.A.P., & Knottnerus, A. (2005). Symptoms of
post-traumatic stress disorder after non-traumatic events: Williams, J.M.G., Watts, F.N., MacLeod, C., & Mathews, A.
Evidence from an open population study. British Journal of (1997). Cognitive psychology and emotional disorders, 2nd
Psychiatry, 186, 494–499. ed. Chichester: Willey.

Parker, A., Buckley, S., & Dagnall, N. (2009). Reduced misinfor-

mation effects following saccadic bilateral eye movements.
Brain and Cognition, 69, 89–97.

Przybyslawski, J., Roullet, P., & Sara, S.J. (1999). Attenuation of

emotional and nonemotional memories after their reactiva-
tion: Role of β adrenergic receptors. Journal of Neuroscience,
19, 6623–6628.

Rauch, S.L., van der Kolk, B.A., Fisler, R.E., Alpert, N.M., Orr,
S.P., Savage, C.R., Fischman, A.J., Jenike, M.A., Pitman, R.K.
(1996). A symptom provocation study of PTSD using PET
and script-driven imaging. Arch Gen psychiatry, 53, (5) 3807.

Shapiro, F. (1989). Eye movement desensitization: A new treat-

ment for post-traumatic stress disorder. Journal of Behavio-
ral therapy and experimental psychiatry, 20, 211-217.

Shapiro, F. (1995). Eye movement desensitization and reproc-

essing: Basic principles, protocols and procedures (1st Edi-
tion). New York: Guilferd press.

38. Shapiro, F. (1998). Efficacy of eye movement, desensitiza-

tion procedure in the treatmant of traumatic memories. J of
thraumatic stress, 2, 199-223.

Shapiro, F. (2001). Eye movement desensitization and reproc-

essing: Basic principles, protocols, and procedures (2nd ed.).

Shapiro, F. (2002a). EMDR: Basic Principles, protocols and pro-

cedures (2 nd Ed). New York: Guilford press.

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