EMDR for Complex Posttraumatic Stress Disorder

By Jeff Dwarshuis LMSW ACSW

When Eye Movement Desensitization and Reprocessing (EMDR) was developed by Francine Shapiro in 1989 it was used as a method of treatment for Posttraumatic Stress Disorder (PTSD). EMDR dramatically reduced or eliminated the negative impacts of traumatic memory leading to PTDS. Today it is recognized as the treatment of choice for PTSD and thousands of people have benefited from its use.

Since that time, researchers and therapists have expanded the use of EMDR to include several other mental health diagnoses besides PTSD. It was discovered that not only did EMDR eliminate the impacts of acute memories leading to PTDS, but it also eliminated the negative impacts and irrational self perceptions caused by bad memories and bad experiences in general.

This is particularity true with individuals who have a history of repeated abuse or repeated traumatic incidences causing Complex Posttraumatic Disorder.

With this discovery, EMDR treatment could be applied to depression, anxiety, relational problems, performance problems or any problem or mental health diagnosis that was caused by negative life experiences. Due to the complexities of many of these problems, treatment needed to include other suggestions besides EMDR Therapy such as cognitive therapy, psychoeducational reading or communication exercises.

The Two Primary Responses

When using EMDR it is important that the therapist be able to predict how EMDR will impact a client. Having this understanding, the therapist can determine if other treatment suggestions are necessary.

With each EMDR session there are two primary responses by the client. First, the client experiences a distancing from the negative memory and a decrease in related negative emotions, body reactions and negative cognitions that accompany the memory.  These changes are permanent, and the therapist can expect the client be able to discuss, investigate, and revisit any part of the negative experience with an objective view.  Also, the decrease in negative reaction quickly eliminates PTSD symptoms as well as related symptoms of depression and anxiety.

The second distinct response to EMDR is Accelerated Information Processing (AIP). AIP is best described as a fast cognitive restructuring of the irrational thoughts that occur with the recall of negative memory. During EMDR the client has an acceleration of reasonable thoughts, perceptions and considerations related to the event and sees the memory (and sometimes related memories) in a reasonable, rational manner.

AIP is what allows the traumatized war veteran, who once felt helpless during memory recall, to say “I did the best I could and I am a good soldier” and the sexual assault victim who experiences intrusive flashbacks to say “It is over and I am OK”.

AIP is found to work also on future pictures that cause negative reactions such as performance topics, workplace assignments, athletic competitions or personal assertions. AIP, in these cases, allows the client to look ahead to the future performance picture with a rational and reasonable perspective on their ability to successfully complete the task.

The distancing from traumatic memory and AIP are both an expected result of each successful EMDR session. Knowing that these responses occur allows the therapist to predict how a client will think, feel and act after EMDR is completed and this can aid the therapist in considering other client needs.

The Best Expected Level

In addition to knowing the responses to EMDR, it is also helpful to know that EMDR will bring a client to what is known as their “best expected level”. For example, a client who was abused at a young age may have carried negative memories and related complications for a lifetime. EMDR will bring this person to their “best expected level” which means all symptoms and negative physical, emotional and cognitive reactions should be reduced or eliminated. The client is likely to feel better than they ever have felt before. However, if that person was raised in an environment of conflict, they may not have the skills to communicate their needs or their progress. For this client the treatment plan would require added suggestions for communication skills. A similar client may experience all the benefits listed above. However, if that client has a history of neglect, the client may not be able to explain their internal changes. This client would benefit from cognitive therapy exercises designed to help one pay attention to specific changes in thoughts and feelings. In general, EMDR will bring someone to their “best expected level” but will not teach things that have not been learned. Recognizing this specific quality of EMDR, the therapist and client can address additional needs and the treatment objectives can be suggested as necessary.

Therapeutic Considerations

EMDR is a highly effective method of treatment for most all mental health diagnoses and can be used often. Clients who use EMDR complete treatment more quickly than traditional therapy (3-4 times more quickly) and are in a better position to not have to return to therapy.

Many therapists will find that Integrated EMDR is different from traditional therapy. With EMDR, the therapist acts as a “technical manager” over a treatment process and offers little feedback or interpretation. In this way, the therapist’s role is diminished and there is more reliance on a treatment method and client participation. Also, therapists traditionally make suggestions and interpretations to clients. However, with EMDR and the impact of AIP, the best interpretations are done by the client. Therapeutic interpretations are best done during times of review.

Also, the process of evaluation for positive change in Integrated EMDR can be difficult. Often the client experiences a dramatic shift in their life. However, since EMDR will bring someone to their “best expected level” the client experiences life as they should and at times will not recognize the differences. Successful EMDR is comparable to the person who has felt the pain of a sore foot for weeks and wakes one morning with no pain and not recognizing that anything is different. EMDR is the same. Often the client is unaware of changes until the therapist reviews symptoms and cognitive self-beliefs.


Cognitive Therapy – Basic and Beyond by Judith Beck (1995)

Cognitive Therapy for Challenging Problems by Judith Beck (2005)

The Trauma Model – A Solution to the Problem of Comorbidity in by Colin Ross MD (2000)

Traumatic Stress: The Effects of Overwhelming Experience on The Mind, Body and Society by Bessel Vander Klok, Alexander Mc Farlane, and Lars Weisaeth (2007)

Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures by Francine Shapiro PhD (2001)

EMDR as an Integrative Psychotherapy Approach: Experts from Diverse Orientations Explore the Paradigm Prism Edited by Francine Shapiro PhD (2002)

Getting Past Your Past: Take Control of Your Life with Self Help Techniques from EMDR Therapy by Francine Shapiro PhD (2012)  

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