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Adaptive Information Processing and EMDR

The Adaptive Information Processing model (Shapiro, 2001, 2002, 2007) is used to explain EMDR's clinical effects and guide clinical practice. This model is not linked to any specific neurobiological mechanism since the field of neurobiology is as yet unable to determine this in any form of psychotherapy (nor of most medications).  This section includes literature to provide an overview of the model and procedures, as well as selected research and case reports that demonstrate the predictive value of the model in the treatment of life experiences that appear to underlie a variety of clinical complaints.

Afifi, T.O., Mota, N.P., Dasiewicz, P.,   MacMillan, H.L.  & Sareen, J. (2012). Physical punishment and mental disorders: Results from a nationally representative US sample. Pediatrics, 130 DOI:10.1542/peds.2011-2947
- Harsh physical punishment [
i.e., pushing, grabbing, shoving, slapping, hitting] in the absence of [more severe] child maltreatment is associated with mood disorders, anxiety disorders, substance abuse/dependence, and personality disorders in a general population sample.

Arseneault, L., Cannon, M, Fisher, H.L. Polanczyk, G. Moffitt, T.E. & Caspi, A. (2011).
Childhood trauma and children’s emerging psychotic symptoms: A genetically sensitive longitudinal cohort study. American Journal of Psychiatry, 168, 65–72.
- Trauma characterized by intention to harm is associated with children’s reports of psychotic symptoms. Clinicians working with children who report early symptoms of psychosis should nquire about traumatic events such as maltreatment and bullying.

Bae, H., Kim, D. & Park, Y.C. (2008).
Eye movement desensitization and reprocessing for adolescent depression. Psychiatry Investigation, 5, 60-65.
- Processing of etiological disturbing memories, triggers and templates resulted in complete remission of Major Depressive Disorder in two teenagers. Treatment duration was 3-7 sessions and effects were maintained at follow-up.

Brown, S. & Shapiro, F. (2006).
EMDR in the treatment of borderline personality disorder. Clinical Case Studies, 5, 403-420.
- 20 EMDR sessions that focused on reprocessing the memories seemingly at the foundation of the pathology, along with triggers and future templates resulted in a complete remission of BPD, including symptoms of affect dysregulation, as measured on the Inventory of Altered Self Capacities.

Brown, K. W., McGoldrick, T., & Buchanan, R. (1997).
Body dysmorphic disorder: Seven cases treated with eye movement desensitization and reprocessing. Behavioural and Cognitive Psychotherapy, 25, 203–207.
- Seven consecutive cases were treated with up to three sessions of EMDR.  Complete remission of BDD symptoms were reported in five cases with effects maintained at one- year follow-up.

Doering, S., Ohlmeier, M. C., Jongh, A., Hofmann, A., & Bisping, V. (2013).
Efficacy of a trauma?focused treatment approach for dental phobia: a randomized clinical trial. European Journal of Oral Sciences, 121, 584-593.
- Three sessions of EMDR therapy memory processing resulted in remission of dental phobia. After 1 yr, 83.3% of the patients were in regular dental treatment (d = 3.20). The findings suggest that therapy aimed at processing memories of past dental events can be helpful for patients with dental phobia.

de Roos, C.,
Veenstra, A.C, et al. (2010). Treatment of chronic phantom limb pain (PLP) using a trauma-focused psychological approach. Pain Research and Management, 15, 65-71.
- 10 consecutive cases of phantom limb pain were treated with EMDR resulting in the reduction or elimination of pain in all but two cases.  Results were maintained at 2.8-year follow-up.

Felitti, V. J., et al. (1998).
Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258.
- We found a strong dose response relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.

Fernandez, I., & Faretta, E. (2007).
EMDR in the treatment of panic disorder with agoraphobia. Clinical Case Studies, 6, 44-63.
- As predicted by AIP, the processing of etiological events, triggers and memory templates was sufficient to alleviate the diagnosis without the use of therapist-assisted in vivo exposure.

, P. & Bouchard, S. (2008). Preliminary evidence for the efficacy of EMDR in treating generalized anxiety disorder. Journal of EMDR Practice and Research, 2. 26- 40.
- Four subjects were evaluated using a single case design with multiple baselines Results indicate that subsequent to targeting the experiential contributors, at posttreatment and at 2 months follow-up, all four participants no longer presented with GAD diagnosis.

Heins et al. (2011).
Childhood trauma and psychosis: a case-control and case-sibling comparison across different levels of genetic liability, psychopathology, and type of trauma. American Journal of Psychiatry, 168, 1286-1294.
- Discordance in psychotic illness across related individuals can be traced to differential exposure to trauma. The association between trauma and psychosis is apparent across different levels of illness and vulnerability to psychotic disorder, suggesting true association rather than reporting bias, reverse causality, or passive gene-environment correlation.

Madrid, A., Skolek, S., & Shapiro, F. (2006).
Repairing failures in bonding through EMDR. Clinical Case Studies. 5, 271-286.
- EMDR processing of experiential contributors to bonding disruption, in addition to current triggers, and a memory template of an alternative/problem free pregnancy and birth resulted in the repair of maternal bonding, analogous to the positive findings with the repair of disrupted attachment.

McGoldrick, T., Begum, M. & Brown, K.W. (2008).
EMDR and olfactory reference syndrome: A case series. Journal of EMDR Practice and Research 2, 63-68.
- EMDR treatment of four consecutive cases of ORS whose pathological symptoms had endured for 8–48 years resulted in a complete resolution of symptoms in all four cases, which was maintained at follow-up.

Mol, S. S. L., Arntz, A., Metsemakers, J. F. M., Dinant, G., Vilters-Van Montfort, P. A. P., & Knottnerus, A. (2005).
Symptoms of post-traumatic stress disorder after non-traumatic events: Evidence from an open population study. British Journal of Psychiatry, 186, 494–499.

- Supports a basic tenet of the Adaptive Information Processing model that “Life events can generate at least as many PTSD symptoms as traumatic events.”  In a survey of 832 people, for events from the past 30 years the PTSD scores were higher after life events than after traumatic events.

Nazari, H., Momeni, N., Jariani, M., & Tarrahi, M. J. (2011).
Comparison of eye movement desensitization and reprocessing with citalopram in treatment of obsessive-compulsive disorder. International Journal of Psychiatry in Clinical Practice, 15, 270-274.
- There was significant difference between the mean Yale–Brown scores of the two groups after treatment and EMDR was more effective than citalopram in improvement of OCD signs.

Obradovic, J., Bush, N.R.,
Stamperdahl, J., Adler, N.E. & Boyce, W.T. (2010). Biological sensitivity to context: The interactive effects of stress reactivity and family adversity on socioemotional behavior and school readiness. Child Development, 1, 270–289.
- A substantive body of work has established that environmental adversity can have a deleterious effect on children’s functioning” “Exposure to adverse, stressful events . . .has been linked to socioemotional behavior problems and cognitive deficits.

Perkins, B.R. & Rouanzoin, C.C. (2002).
A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points of confusion. Journal of Clinical Psychology, 58, 77-97.
- Reviews common errors and misperceptions of the procedures, research, and theory.

Raboni, M.R., Tufik, S., & Suchecki, D. (2006).
Treatment of PTSD by eye movement desensitization and reprocessing improves sleep quality, quality of life and perception of stress. Annals of the New York Academy of Science, 1071, 508-513.
- Specifically citing the hypothesis that EMDR induces processing effects similar to REM sleep (see also Stickgold, 2002, 2008), polysomnograms indicated a change in sleep patterns post treatment, and improvement on all measures including anxiety, depression, and quality of life after a mean of five sessions.

Ray, A. L. & Zbik, A. (2001).
Cognitive behavioral therapies and beyond. In C. D. Tollison, J. R. Satterhwaite, & J. W. Tollison (Eds.) Practical Pain Management (3rd ed.; pp. 189-208). Philadelphia: Lippincott.
- The authors note that the application of EMDR guided by the Adaptive Information Processing model appears to afford benefits to chronic pain patients not found in other treatments.

Ricci, R. J., Clayton, C. A., & Shapiro, F. (2006).
Some effects of EMDR treatment with previously abused child molesters: Theoretical reviews and preliminary findings. Journal of Forensic Psychiatry and Psychology, 17, 538-562.
- As predicted by the Adaptive Information Processing model the EMDR treatment of the molesters’ own childhood victimization resulted in a decrease in deviant arousal as measured by the plethysmograph, a decrease in sexual thoughts, and increased victim empathy.  Effects maintained at one year follow up.

Russell, M. (2008).
Treating traumatic amputation-related phantom limb pain:  a case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services. Clinical Case Studies, 7, 136-153.
- Since September 2006, over 725 service-members from the global war on terrorism have survived combat-related traumatic amputations that often result in phantom limb pain (PLP) syndrome. . . . Four sessions of Eye Movement Desensitization and Reprocessing (EMDR) led to elimination of PLP, and a significant reduction in PTSD, depression, and phantom limb tingling sensations.

Schneider, J., Hofmann, A., Rost, C.,  & Shapiro, F. (2008).
EMDR in the treatment of chronic phantom limb pain. Pain Medicine, 9, 76-82.
- As predicted by the Adaptive Information Processing model the EMDR treatment of the event involving the limb loss, and the stored memories of the pain sensations, resulted a decrease or elimination of the phantom limb pain which maintained at 1-year follow-up.

Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2007).
EMDR and phantom limb pain: Case study, theoretical implications, and treatment guidelines. Journal of EMDR Practice and Research, 1, 31-45.
- Detailed presentation of case treated by EMDR that resulted in complete elimination of PTSD, depression and phantom limb pain with effects maintained at 18-month follow-up.

Shapiro, F. (2001).
Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (Second Edition).  New York: Guilford Press.
- EMDR is an eight-phase psychotherapy with standardized procedures and protocols that are all believed to contribute to therapeutic effect.  This text provides description and clinical transcripts and an elucidation of the guiding Adaptive Information Processing model.

Shapiro, F. (2002).
(Ed.) EMDR as an integrative psychotherapy approach: Experts of diverse orientations explore the paradigm prism. Washington, DC: American Psychological Association Books.
- EMDR is an integrative approach distinct from other forms of psychotherapy. Experts of the major psychotherapy orientations identify and highlight various procedural elements.

Shapiro, F. (2006).
EMDR and new notes on adaptive information processing: Case formulation principles, scripts and worksheets. Hamden, CT: EMDR Humanitarian Assistance Programs (
- Overview of Adaptive Information Processing model, including how the principles are reflected in the procedures, phases and clinical applications of EMDR.  Comprehensive worksheets for client assessment, case formulation, and treatment as well as scripts for various procedures.

Shapiro, F. (2007).
EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice and Research, 1, 68-87.
- Overview of EMDR treatment based upon an Adaptive Information Processing case conceptualization.  Early life experiences are viewed as the basis of pathology and used as targets for processing.  The three-pronged protocol includes processing of the past events that have set the foundation for the pathology, the current triggers, and templates for appropriate future functioning to address skill and developmental deficits.

Shapiro, F. (2012).
EMDR therapy: An overview of current and future research. European Review of Applied Psychology, 62, 193-195.
- Research findings indicate that EMDR therapy and TF-CBT are based on different mechanisms of action in that EMDR therapy does not necessitate daily homework, sustained arousal or detailed descriptions of the event, and appears to take fewer sessions. EMDR is guided by the adaptive information processing model, which posits a wide range of adverse life experiences as the basis of pathology.

Shapiro, F., Kaslow, F., & Maxfield, L. (Eds.) (2007).
Handbook of EMDR and Family Therapy Processes. Hoboken, NJ: Wiley.
- Using an Adaptive Information Processing conceptualization a wide range of family problems and impasses can be addressed through the integration of EMDR and family therapy techniques.  Family therapy models are also useful for identifying the targets in need of processing for those engaged in individual therapy.

Solomon, R. M. & Shapiro, F, (2008).
EMDR and the adaptive information processing model: Potential mechanisms of change. Journal of EMDR Practice and Research, 2, 315-325.
- This article provides a brief overview of some of the major precepts of the Adaptive Information Processing model, a comparison and contrast to extinction-based information processing models and treatment and a discussion of a variety of mechanisms of action.

Teicher, M.H. . Samson, J.A., Sheu, Y-S, Polcari, A. & McGreenery, C.E. (2010).
Hurtful words: Association of exposure to peer verbal abuse with elevated psychiatric symptom scores and corpus callosum abnormalities. American Journal of Psychiatry, 167, 1464 - 1471.
- These findings parallel re­sults of previous reports of psychopathol­ogy associated with childhood exposure to parental verbal abuse and support the hypothesis that exposure to peer verbal abuse is an aversive stimulus associated with greater symptom ratings and mean­ingful alterations in brain structure.

Uribe, M. E. R., & Ramirez, E. O. L. (2006).
The effect of EMDR therapy on the negative information processing on patients who suffer depression. Revista Electrónica de Motivación y Emoción (REME), 9, 23-24.
- The study evaluated the impact of EMDR treatment on bias mechanisms in depressed subjects in regard to negative emotional valence evaluation. “The results indicated that it generated important cognitive emotional changes in such mechanisms.”  Priming tests indicated changes in the negative valence evaluation of emotional information indicative of recovery with decreased reaction times in the neutral and positive stimuli processing.

van den Berg, D.P.G. & van den Gaag, M. (2012).
Treating trauma in psychosis with EMDR: A pilot study. Journal of Behavior Therapy & Experimental Psychiatry, 43, 664-671.
- This pilot study shows that a short EMDR therapy is effective and safe in the treatment of PTSD in subjects with a psychotic disorder. Treatment of PTSD has a positive effect on auditory verbal hallucinations, delusions, anxiety symptoms, depression symptoms, and self-esteem.

Varese et al. (2012).
Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin, doi:10.1093/schbul/sbs050.
- These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.

Wesselmann, D. & Potter, A. E. (2009).
Change in adult attachment status following treatment with EMDR: Three case studies. Journal of EMDR Practice and Research, 3, 178-191.
- Subsequent to EMDR treatment “all three patients made positive changes in attachment status as measured by the [Adult Attachment Inventory], and all three reported positive changes in emotions and relationships.”

Wilensky, M. (2006).
Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain. Journal of Brief Therapy, 5, 31-44.
- Five consecutive cases of phantom limb pain were treated with EMDR. Four of the five clients completed the prescribed treatment and reported that pain was completely eliminated, or reduced to a negligible level. . . The standard EMDR treatment protocol was used to target the accident that caused the amputation, and other related events.

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