Journal of Psychotherapy Integration

© 2019 American Psychological Association 2019, Vol. 29, No. 1, 23–31

1053-0479/19/$12.00 http://dx.doi.org/10.1037/int0000136

Integrating EMDR in Psychotherapy

Marina Balbo Francesca Cavallo

EMDR Italy Association, Bovisio Masciago, Italy Centro Terapia Metacognitiva Interpersonale,
Rome, Italy, and Institute San Raffaele Sulmona,
Spinal Cord Unit, Italy
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Isabel Fernandez
This document is copyrighted by the American Psychological Association or one of its allied publishers.

EMDR Italy Association, Bovisio Masciago, Italy

Eye movement desensitization and reprocessing (EMDR) has significantly contributed

to psychotherapy in the last 30 years. Studies support EMDR as effective for posttrau-
matic stress disorder symptoms. It was also applied to other disorders because it can
help resolve and reprocess memories of traumatic experiences that can contribute, as
risk, precipitating and predisposing factors to the development of mental disorders.
What these disorders have in common is the maladaptive processing of information
associated with stressful and pathogenic events. EMDR therapy has given a contribu-
tion to psychotherapy as an effective method that can help the innate processing system
process all aspects of a traumatic experience. After working with traumatic memories
that may be part of the patient’s life story, EMDR therapy focuses on current triggers
and symptoms and then provides the patient with instruments to deal with future
situations that may cause anxiety. While working with this method, it is possible to
enhance metacognitive skills and promote a change in dysfunctional emotions, beliefs,
and behaviors. These are some common objectives that EMDR therapy shares with
most psychotherapy approaches.

Keywords: posttraumatic stress disorder, eye movement desensitization and

reprocessing, psychotherapy, mental disorder

Eye movement desensitization and reprocess- formation processing (AIP), which states that
ing (EMDR) is a therapeutic approach developed pathological phenomena can be associated with
by Francine Shapiro (1989), which became a fun- some past disturbing experiences, dysfunction-
damental tool for many psychotherapists, sup- ally stored in memory, that can trigger a perma-
ported by a large number of publications prov- nent dysfunctional pattern of emotions, behav-
ing its empirical validity in treating, in iors, and cognitions (Shapiro, 2001). Such a
particular, posttraumatic stress disorder model explains the experiential factors that can
(PTSD). The theoretical model is adaptive in- contribute to the development of several mental
disorders. This can be used to create a struc-
tured therapeutic plan to work on the memories
of key experiences in the patient’s life story,
Marina Balbo, EMDR Italy Association, Bovisio Mas- which may be connected to the patient’s current
ciago, Italy; Francesca Cavallo, Centro Terapia Metacogni- difficulties and symptoms. According to AIP,
tiva Interpersonale, Rome, Italy, and Institute San Raffaele
Sulmona, Spinal Cord Unit, Italy; Isabel Fernandez, EMDR
the memories of the patient’s traumatic and
Italy Association, Bovisio Masciago, Italy. stressing events are stored in a static form
This research was supported by the TMI Center, Pescara. within the neural networks, and this leads to the
Correspondence concerning this article should be ad- development of cognitive, emotional, and be-
dressed to Francesca Cavallo, Department CTMI Rome,
Institute San Raffaele Sulmona, Spinal Cord Unit, Italy,
havioral patterns that characterize a number of
Corso Umberto 25, Pescara, Italy 65126. E-mail: dysfunctions. Traumatic experiences can be as-
[email protected] sociated with complex, painful, and extremely
23
 24 BALBO, CAVALLO, AND FERNANDEZ

stressful experiences and with early relation- such experiences to attain full integration in the
ships or attachment. It is important to consider neural networks that are naturally driven toward
that, regardless of the selected therapeutic ap- mental health (Shapiro, 2001). Traumatic and
proach, clinicians use narrative to understand highly stressful emotional experiences may
how patients interpret these events because, for block the information-processing mechanism.
instance, it is not always possible to identify the EMDR acts on these blocks and activates the
complex dysfunctional adaptations originating innate self-healing mechanism (Balbo, 2016) by
from chronic abuse and neglect (Balbo, 2016). bilateral stimulation. Recent research has aimed
Many supportive RCTs confirm the therapeu- to confirm the effectiveness of eye movements
tic efficacy of EMDR therapy for processing by investigating what happens in the human
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

traumatic memories. The effectiveness of brain during an EMDR process. At the end of a
This document is copyrighted by the American Psychological Association or one of its allied publishers.

EMDR therapy in treating PTSD has undergone therapeutic trial involving 20 patients with a
the scrutiny of several meta-analyses (Benish, diagnosis of PTSD, researchers observed that
Imel, & Wampold, 2008; Bradley, Greene, eye movements were correlated with changes in
Russ, Dutra, & Westen, 2005; Chen, Zhang, Hu, the brain blood dynamics at the prefrontal cor-
& Liang, 2015; Davidson & Parker, 2001; Jonas tex level. As such, EMDR is associated with
et al., 2013; Seidler & Wagner, 2006; Van Etten lower oxyhemoglobin concentration, which
& Taylor, 1998), and the World Health Orga- could be linked to a reduced prefrontal cortex
nization considers EMDR the treatment of activity and to reduced stress as well (Balbo,
choice for PTSD in children, teenagers, and 2016).
adults. This is in contrast with guidelines from The AIP paradigm (the model at the basis of
the American Psychological Association EMDR therapy), then, offers a unified theory
(2017), which suggests that there is strong evi- that can be considered as a common substrate
dence for cognitive-behavioral therapy, cogni- for all therapeutic approaches because it con-
tive-processing therapy, and cognitive therapy ceptualizes disorders associated with informa-
but only weak evidence for EMDR. Clearly, tion stored in a dysfunctional way (Solomon &
future studies are needed to better understand Shapiro, 2008). This aspect provides a valuable
whether one treatment works better than an- contribution to several approaches in psycho-
other. Psychotherapy can use different ap- therapy because EMDR works on memories of
proaches, but working on memories of the most meaningful traumatic experiences in the pa-
important experiences with EMDR is some- tient’s life story, which is a common point of
thing very useful to facilitate integration. many therapies. In EMDR therapy, memories
EMDR can foster psychotherapy effectiveness are actually processed therapeutically to desen-
if integrated with other methods. Such an inte- sitize emotional and dysfunctional feelings, al-
gration would offer more possibilities to suc- lowing to change the cognitive perspective and
cessfully process the traumatic memories. body sensations. Memory-targeted work makes
EMDR a method that can be easily integrated
Case Context and Method into other approaches. Memory and its sponta-
neous processing, thanks to the reactivation of
A principle explaining EMDR contribution the innate processing system, allowed EMDR to
consists of considering the existence of an in- become a common language in psychotherapy.
nate system, which is physiologically oriented Adverse childhood, teenage, and adult experi-
to process information to promote mental ences, including dysfunctional attachment rela-
health. Such an adaptive mechanism allows to tionships, can be considered as traumatic and
resolve any negative emotions and beliefs, highly stressful experiences, which can be pro-
which could otherwise lead to anxiety and other cessed and resolved through EMDR therapy
symptoms (Shapiro, 1989). Memory and its along with contributions from all major psycho-
spontaneous processing, thanks to the reactiva- therapy approaches (Burke Harris, 2018). In this
tion of the innate processing system, allowed regard, we can talk about an integrated ap-
EMDR to become a common language in psy- proach (Goldfried & Newrnan, 1992) and a
chotherapy. Alternating bilateral stimulation common language (Balbo, 2016). The integra-
(eye movements, tapping, etc.) during EMDR tion of EMDR therapy into clinical practice is a
processes allows the adaptive processing of process that can allow clinicians to develop
 INTEGRATING EMDR IN PSYCHOTHERAPY 25

further competences and effectiveness also us- and neglect by significant persons (Siegel,
ing this therapeutic tool. The characteristics of 2003). Minor traumas may also be associated
EMDR processes make it specifically suitable with experiences in which caregivers failed to
to be integrated into other theoretical-method- provide physical and psychological support or
ological perspectives. The common need to un- were emotionally violent. If the memories of
derstand the multiple dimensions of personality these experiences are not processed, they can
has revolutionized the boundaries of psycho- continue to affect the patient’s life. EMDR ther-
therapy (Rimini et al., 2016). Any psycho- apy can be an important tool to approach these
therapy aims at changing the meaning people memories and turn them into adaptive resolu-
ascribe to interpersonal relationships. Psycho- tion. Furthermore, if abreactions occur, they
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

therapy is a cooperative and experiential pro- enable the patient to express anger, pain, cry, or
This document is copyrighted by the American Psychological Association or one of its allied publishers.

cess, and it aims at improving patients’ aware- desperation in a context in which he or she feels
ness of the way they process information to accepted and protected (Alexander & French,
decrease suffering and let them live a more 1946). The processing of traumatic memory and
fulfilling life. Three main classes of factors are the recognition of the suffering it has generated
to be considered along this path. The first con- promotes patient improvement. The change oc-
sists of cognitive factors, including the normal- curs when the client experiences new behaviors
ization mechanism by which patients under- during the therapy session, with the support and
stand that they are not alone, that other people feedback of the therapist. The need to overcome
have similar problems, and that human suffer- our own theoretical boundaries arises from a
ing is universal. The patient’s insight is impor- number of reasons, which may be summarized
tant because growth takes place when patients as follows. On the one hand, scientific and cul-
understand themselves and others by acquiring tural changes create a stimulating ground for a
a different perspective of their motivations and complex and multidisciplinary understanding of
behaviors. Finally, a paramount aspect is related human beings and psychological and natural
to behavioral modeling through which people phenomena. On the other, the need for a stron-
observe other people who are not suffering as ger awareness of the limits and constraints of
they are, and this can have beneficial effects. each theoretical orientation fosters more open-
With regard to emotional factors, the accep- mindedness. These are some of the aspects that
tance mechanism is fundamental to learn how to EMDR shares with other approaches.
recognize and earn the others’ full respect, par-
ticularly the therapist’s respect. Change, in ther- Resources
apy, means being in a healthy relationship based
on altruism and on taking care of the other EMDR therapy includes some techniques to
person. In addition, transference is a kind of enhance the patient’s ego through the installa-
emotional connection between the therapist and tion of positive memories of a safe place or
the patient, which can be referred to earlier memories of achievements or protective figures.
memories (Safran & Muran, 2000). Psycho- Clinicians can use these resources to prepare
pathological disorders often develop when one patients to better deal with everyday life and
is unable to create, maintain, or end significant also to enhance their strength. The positive
relationships. Processing of current negative ex- memory, skill, and ability installation protocol
periences, which is the main concern for people can be used also to prepare patients for trauma
turning to therapy, requires their connection processing.
with previous experiences. EMDR is basically
focused on the identification of relational and Identifying and Processing Appropriate
interpersonal traumas that may have contributed Targets
to such discomfort, disturbance, and difficulties
causing the patient to seek professional help and The first stage of EMDR is focused on case
start therapy. It is possible, therefore, to detect conceptualization to identify key traumatic or
some relational traumatic events (minor trau- highly stressful situations in the patient’s life
mas) in the patient’s life history, which are story that have contributed to the difficulties or
apparently less meaningful and represent unre- disorders for which the patient decided to seek
solved issues arising from abandonment, abuse, professional help and engage in therapy. This is
 26 BALBO, CAVALLO, AND FERNANDEZ

a common factor of all psychotherapeutic inter- Systemic Aspects

ventions. When EMDR is applied, several strat-
egies and techniques can be used to identify key Chronic dysfunctional family dynamics hav-
memories (targets), which are still disturbing ing an impact on the family members are at the
and which will be later processed through the core of family therapy. Their understanding was
protocol. During this phase, the clinician and crucial and showed therapists new scenarios. In
the patient agree on the therapeutic plan, which, EMDR therapy, the identification of memories
after addressing past memories, will focus on representing these dynamics is fundamental be-
current triggers and then prepare the patient for cause they will become part of a work plan so
the future. that they can be processed and a change will be
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

brought about not only for the single individual

This document is copyrighted by the American Psychological Association or one of its allied publishers.

Cognitive Aspects but also for the whole family system.

Let us now go through some of the main-
These are characterized by dysfunctional stream approaches currently existing in the
scheme concepts (empirical inference rules) world of psychotherapy, whose theoretical
connected to the self, linked to both negative cores are in line with EMDR and may be inte-
and positive cognitions. The dysfunctional cog- grated into it. The processing process promoted
nitive scheme is one of the references to identify by EMDR processes activates the patient’s abil-
the experiences that contributed to shape these ity to make free associations. Freud (1901)
negative beliefs, and later the memories of these identified a primary and a secondary process to
experiences shall be processed through EMDR lay the foundations for a treatment strategy sim-
processes. The goal is to remove the associa- ilar to that of EMDR, focused on the need to
tions and information stored in a dysfunctional consider the primary process, fostering a better
way in the memory, which maintain the dys- integration between the primary and the second-
functional cognitive scheme. At the end of each ary process. There is a similarity between
EMDR session, a positive belief will be in- Freud’s theory and that of the EMDR. Often
stalled, connected with the traumatic memory, processing takes place during EMDR through a
to help strengthening the patient’s self-image. free association process that leads to an adaptive
resolution of all parts of traumatic memory. The
Elements Originating From the Cognitive-
processing of traumatic memories can therefore
Evolutionist Perspective take place through the associative channels (as
The attachment theory represents the most Freud claimed) of the different phases of the
effective reference for the identification of therapeutic process (Shapiro, 2001). Recalling
childhood traumatic experiences, particularly the past to understand the present through the
when such experiences have contributed to a patient’s past experiences is common to both
disorganized attachment (Bowlby, 1973). approaches. EMDR fosters the recovery of past
EMDR therapy fosters the resolution of attach- material and its treatment through an adaptive
ment traumas by reprocessing the most signifi- resolution, in which the memory spontaneously
cant episodic memories that represent relation- loses its negative emotional charge at the end of
ships with early caregivers and/or parents. the session, and it is associated with a positive
self-belief. The psychodynamic approach and
Somatic Aspects EMDR share the idea that the therapeutic pro-
cess must free the person from any psychoevo-
Body aspects are of paramount importance in lutionary fixations and from relived experiences
EMDR therapy because special attention is paid or intruding memories. To this purpose, Shapiro
to body sensations and to the localization of (2001) stated that the model can be applied to
emotions during several phases of the EMDR diseases caused by earlier experiences that trig-
process while the patient is processing traumatic ger a continuous pattern of emotions, behaviors,
memories. In one of the last protocol phases, the and cognitions and create identity structures.
absence of body tension will support that the Through alternated bilateral stimulation,
memory has really been processed. The body EMDR leads the patient out of the dimension of
has the last word when checking whether the conversation and narrative memories and in-
memory has been completely reprocessed. vites him/her to focus on the details of the
 INTEGRATING EMDR IN PSYCHOTHERAPY 27

situation, like the experiential fragments at a cessing in an EMDR process, patients usually
sensory, cognitive, somatic, and emotional level have new insights and become aware of their
while doing sets of eye movements. Such stim- abilities, and at the same time, some of their
ulation and the therapeutic presence of the cli- positive beliefs are enhanced. At the end of a
nician activate reexperiencing, free association, session, patients reconsider the event in a more
and processing possibilities under safety condi- adult and functional way, feel more empower-
tions. This condition is essential in treating a ment, and integrate more appropriate emotions
posttraumatic disorder; it fosters the possibility regarding the memory, without any disturbing
to tackle the traumatized patient’s fears working body sensations.
only through memory. Patients can relive a It should be pointed out that a strong point of
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

trauma with a supportive continuum. This con- EMDR therapy is the use of eye movements to
This document is copyrighted by the American Psychological Association or one of its allied publishers.

dition also fosters the patient’s trust in his abil- weaken the connections between subcortical
ities and resources, thus helping him/her feel emotional variables and the cortical cognitive
safe and able to handle emotions. There are also ones, and the fact that it allows the innate in-
points in common with the Gestalt. EMDR has formation processing system to complete what
in common, with Gestalt, the importance of it had not been able to do by itself (van der Kolk
contact with the emotional and body experi- et al., 2007). For this reason, therapists accom-
ences, encouraging the integration of these as- panies the patient’s processing and follow the
pects on a cognitive level, through the use of the different stages in the protocol only during the
individual’s own resources. Furthermore, both sets of bilateral stimulation (lasting about 25 s
approaches underscore the importance of a good each). After each set, patients give feedback of
therapeutic alliance (Balbo, 2016). what they noticed; the clinician is not directive
As in cognitive formulations, EMDR therapy and usually does not intervene to avoid inter-
is based both on the formulation and conceptu- fering and disrupting the patient’s natural pro-
alization of the individual patient’s understand- cessing.
ing and specific disorder (Balbo, 2016). Thera- The attachment theory underlines that the
pists try to help patients changing the cognitions attachment safety experienced in the therapeutic
with which they gave meanings to event to relationship allows the exploration of painful
change affect responses and behavior strategies feelings and promotes introspection (Holmes,
(van der Kolk, 1994). In EMDR therapists as- 1993). So therapists, according to the attach-
sess negative beliefs about the self that the ment theory, try to increase the patient’s sense
patients have in that moment (negative cogni- of safety and empowerment because this will
tion) when they think about a traumatic mem- increase his or her introspective and exploration
ory. Exploration is focused on beliefs about abilities (Balbo, 2016). To this purpose, the
responsibility, safety, self-defectiveness (self- EMDR approach seems particularly useful:
value), and control. In EMDR, negative think- Therapists accompany and support processing
ing and beliefs will be changed after processing without judging, respecting the patient’s timing
memories of those experiences that had contrib- and trusting his or her innate ability to process
uted to its development. Once these memories memories, reactivated by alternated bilateral
are processed, a positive belief is installed, and stimulation. Therapists therefore trust the pro-
after working with some of these memories, the cess and show this with their therapeutic pres-
dysfunctional negative cognitive schema will ence, focused on the patient and on the different
lose its foundation so that it will no longer stages of reprocessing. Feeling safe in therapy
generate discomfort. From a cognitive-behav- temporarily deactivates the attachment system
ioral perspective, the patient can return to the and activates an explorative and collaborative
present without their load of negative emotions attitude to be shared with the clinician. The
and memories, which used to limit their ability above considerations show how the integration
to function in everyday life and which had con- between psychotherapies starts only when dog-
tributed to developing symptoms, discomforts, matism preventing the enrichment of theoretical
and difficulties. After reprocessing a traumatic aspects with new and scientific perspectives is
memory, patients are more capable of exposing abandoned.
themselves to those situations causing anxiety The contribution of EMDR (van der Hart,
they used to avoid. During spontaneous pro- Nijenhuis, & Solomon, 2010) to such a process
 28 BALBO, CAVALLO, AND FERNANDEZ

promotes research and focus on how disorders able to handle this by herself,” without asking
develop by assuming a common origin for the for anyone’s help. The reason she changed her
disease in the maladaptive processing of infor- mind is because she has become too irritable
mation concerning stressing and pathogenic and feels a growing discomfort caused by
events. In the holistic EMDR idea of biological, emerging intrusive thoughts and memories con-
psychological, and social dimensions, each psy- nected to the robbery. The latter—so vivid and
chotherapist can access different patients’ aspects. recurrent—prevent her from sleeping and pro-
Furthermore, aspects concerning all psychothera- voke night anxiety and insomnia. For instance,
pies, such as the therapeutic alliance, the rela- she suddenly remembers the robber’s tone of
tionship, and the therapeutic contract, are con- voice or the frightened face of her colleague
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

sidered as extremely important through who was sitting at the desk near her at the time.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

assessment phases and the therapy protocol. In She also reports serious, recurrent impaired
the last decades, EMDR has become a tool for a concentration and moments of blank mind,
constructive, stimulating, and creative dialogue, which hinder her search for a new job. Her
always aimed at investigating the most effective irritability and prostration trigger social discom-
method to provide the help that patients need to fort too.
adaptively resolve the experiences underneath Antonella understands that she often answers
psychological disorders from a self-healing per- to small criticisms in a way that is not adequate,
spective (Balbo, 2016). A further element of even though she cannot identify a specific cause
interest is the increasing support for EMDR as a for such behaviors. In addition, she often reports
concrete and accessible tool for working with feeling unsafe and prone to self-blaming. Be-
patients. EMDR helps patients to recognize that fore the event, Antonella says that she has al-
the dysfunctional material associated with cur- ways been a lively, patient, happy, and extro-
rent symptoms and distress is linked to their verted woman. Such characteristics are opposite
trauma history, and, by working on those trau- to those she uses to define herself upon consul-
matic memories, patients can change their emo- tation, when she describes herself as constantly
tions, beliefs, and behaviors (van der Hart, Ni- being on alert and with hyperarousal, prone to
jenhuis, & Steele, 2006). isolation, and she reports avoiding crowded
places. Her speech is well articulated and con-
Case Study: PTSD After a Stressful sistent; however, it rapidly accelerates when she
Experience talks about the robbery. Her history showed no
former psychological problems before the trau-
Antonella (not the patient’s real name; in- matic robbery. No clinical or dysfunctional in-
formed consent of the patient was obtained to formation is reported regarding her family en-
guarantee the confidentiality of the information vironment. In addition, Antonella will soon get
provided) is 35 years old. Her complaint in the married. From the clinical interview (Phase 1 of
first clinical interview is that “she has been EMDR) and Impact Event Scale (Weiss & Mar-
dragging on for about 4 months, when a trau- mar, 1997), she meets the criteria for PTSD. In
matic situation occurred at work.” During a Phase 2, we proceed with psychoeducation, and
bank robbery, a thief approached her desk, Antonella is informed about PTSD symptoms
pointed a gun at her head, and ordered her to and reactions to stressful situations. At this
deliver the money in the safe. She does not feel stage, the clinician provides information to un-
like talking about the event because it triggers a derstand the patient’s symptoms through psy-
lot of anxiety. Since then, she has always tried choeducation and normalization. The clinician,
to avoid people, objects, and situations associ- together with the patient, identifies needs and
ated with that condition. During the days imme- the therapeutic goals and after that explains the
diately after the robbery, the client chose to take method (EMDR) that will be used and its dura-
a sick leave because it was extremely difficult tion. So the psychological contract is based on
for her to restart her daily routine at the bank. cooperation and shared objectives. This is im-
She spent entire days without leaving her home portant to build a therapeutic alliance to be able
to avoid friends and relatives’ questions about to proceed with the other stages of EMDR ther-
what had happened. Until consultation, Anto- apy. To help the patient familiarize with EMDR
nella says she has always been convinced “to be and eye movements, we start with a positive
 INTEGRATING EMDR IN PSYCHOTHERAPY 29

memory. We install a positive and pleasant body. Any possible residues of trauma, in the
memory with the safe place exercise. After in- body memories, were processed. After 1 week,
stalling this resource, Antonella uses it to relax SUD is still zero in Phase 8 (reevaluation), so
and manage anxiety. After this preparation the results were maintained. She reported she
phase (Phase 2), we can start working with the was able to sleep better and was considering
memory of the robbery. going back to work at the bank because it is the
During the assessment, Phase 3, we ask the job she likes the most. The following sessions
patient to think about the most disturbing frag- were addressed to resolve the triggers related to
ments of the memory through structured ques- her being stuck at home and to her fear of
tions. Regarding her experience, Antonella meeting thieves in the street. Also, watching
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

identified the worst image (the moment in robbery scenes on TV and hearing the police
This document is copyrighted by the American Psychological Association or one of its allied publishers.

which she feels the gun in touch with her skin), sirens were not provoking anxiety as they used
the self-referred negative belief, the negative to. Standard EMDR therapy was used to process
cognition (I am going to die), the disturbing current triggers.
emotion she feels now when thinking about the The future template included one session
image, and the negative cognition (fear and
only, related to her return to work. In this ses-
helplessness), the level of disturbance (subjec-
sion, Antonella was asked to imagine going
tive units of disturbance [SUD] from zero to
back to work, entering the bank, going to her
10 ⫽ 9) during which she feels the disturbance
in the body when thinking about the image and desk, staying with her colleagues with a positive
the negative cognition (stomach and head). In cognition, “I am safe,” and while doing this,
Phase 4, desensitization, Antonella is asked to bilateral stimulation was done until she could
focus on the worst image, the negative belief, think about this future situation without anxiety
and the body sensation and to follow the fingers and with a positive feeling. Treatment of this
of the clinician, which makes sets of brief eye PTSD case took five sessions. Follow-ups after
movements. After each set, Antonella is able to 3, 6, and 12 months were still showing stable
give a feedback and talk about the whole expe- results. After this traumatic experience, Anto-
rience. While processing, she feels the weapon nella went back to her everyday life and was not
coldness, the robber’s cigarette smell, and his constrained to find a new job and her lifestyle.
words in her ears . . .; everything is as it was in
that moment. She was reliving it. She remem-
Conclusion
bers her colleague’s frightened face confirming
her same feeling of fear linked to the possibility EMDR is an effective treatment to reduce
of dying. During the processing stage (making
symptoms of PTSD, although there is debate
associations, seeing the image less vivid, etc.),
about what are the actual neural mechanisms
she has a positive insight; the patient refers that
that contribute to its effect (Calancie, Khalid-
she could hear that the police was arriving,
and she remembered when the thief escaped Khan, Booij, & Munoz, 2018). The integrative
without hurting anyone. She also refers that therapist can take advantage by using EMDR
after trying to calm down her colleagues and techniques when working on traumatic memo-
realizing it was over, she was very active. The ries, and this has significant changes of achiev-
SUD level drops to zero, the memory lost the ing therapeutic gains faster. Future studies are
negative feelings, and she could think about it needed to understand which patients benefit
as a bad experience, but it was not triggering from EMDR work and which may refuse it or
any anxiety or discomfort at the end of the fail to respond completely. This would open the
session. The positive cognition “I am safe” was way for both motivating therapies from differ-
installed (Phase 5: installation of the positive ent orientations to adopt memory desensitiza-
cognition) and she could think about the mem- tion and reprocessing strategies and EMDR
ory of feeling safe and feeling that everything therapists to continue adopting other tech-
was finally over. In Phase 6, body sensations are niques. EMDR therapy, as most therapies, is
checked, and she reports no body disturbance or focused on the therapeutic relationship and con-
tension when the memory of the experienced tributes to the need of having a tailored therapy
danger is recalled. There was no tension in her to suit best the needs of every single client.
 30 BALBO, CAVALLO, AND FERNANDEZ

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Integración de EMDR en psicoterapia

La desensibilización y el reprocesamiento del movimiento ocular (EMDR por sus siglas en inglés) han contribuido
significativamente a la psicoterapia en los últimos 30 años. Los estudios apoyan EMDR como eficaz para los síntomas del
trastorno de estrés postraumático. También se ah aplicado a otros trastornos porque puede ayudar a resolver y reprocesar
recuerdos de experiencias traumáticas que pueden contribuir, como factores de riesgo, precipitantes y predisponentes al
desarrollo de trastornos mentales. Lo que estos trastornos tienen en común es el procesamiento inadaptado de la información
asociada con eventos estresantes y patógenos. La terapia EMDR ha contribuido a la psicoterapia como un método eficaz
que puede ayudar al sistema de procesamiento innato a procesar todos los aspectos de una experiencia traumática. Después
de trabajar con recuerdos traumáticos que pueden formar parte de la historia de la vida del paciente, la terapia EMDR se
centra en los desencadenantes y síntomas actuales y luego le proporciona al paciente instrumentos para enfrentar situaciones
futuras que pueden causar ansiedad. Mientras se trabaja con este método, es posible mejorar las habilidades metacognitivas
y promover un cambio en las emociones, creencias y comportamientos disfuncionales. Estos son algunos de los objetivos
comunes que la terapia EMDR comparte con la mayoría de los enfoques de psicoterapia.

Trastorno por estrés postraumático, desensibilización y reprocesamiento por movimientos oculares, psicoterapia, trastorno
mental

在心理治疗中整合快速眼动法（EMDR)
眼动脱敏重建（EMDR，又称“快速眼动法”）在过去的30年里对心理治疗发挥了重大的贡献。研究证明快速眼动法
（EMDR）对于治疗创伤性应激障碍的症状很有效。它也被应用于其他病症因为它能够帮助解决和重建创伤相关
经历的记忆，这些经历作为潜在风险，可以导致促成和诱发心理疾病发展的因素。这些疾病的共同之处在于它们
对于压力相关及病理性事件信息的非适应性地处理。快速眼动（EMDR）疗法作为一种有效的方式对心理治疗很
有贡献，它能够帮助内在的处理系统处理创伤经历的各个方面。在同那些或许是患者部分人生故事的创伤记忆工
作后，快速眼动（EMDR）疗法专注于现阶段的触发因子以及症状，并且接下来为患者提供方式去处理未来可能
造成焦虑的情况。在使用这一方法的时候，很可能能够提升元认知技能，并且促进失衡情绪、信念和行为的改变。
快速眼动（EMDR）疗法的这些普遍目的同其他心理治疗方式都是相通的。

创伤性应激障碍, 眼动脱敏及重建, 心理治疗, 心理疾病

Received March 1, 2018

Revision received July 12, 2018
Accepted July 17, 2018 䡲