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Eye movement desensitization and reprocessing Basic principles protocols and procedures. Francine Shapiro. Guilford Press New York 1995 398 pp $40

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2:153-155 (1996)
Shapiro. Guilford Press, New York, 1995. 398 pp,
While walking outdoors one day, Francine Shapiro
noticed that certain of her disturbing thoughts had
suddenly disappeared. When she regenerated these
images, they had lost their negative emotional valence.
Curious why her distress had diminished so quickly,
Shapiro attended closely to her behavior while accessing additional disturbing memories. Realizing that she
had been shifting her eyes back and forth, Shapiro
concluded that rapid eye movements possess hitherto
untapped therapeutic powers. These serendipitous observations motivated Shapiro to develop Eye Movement Desensitization and Reprocessing (EMDR), a
new treatment for posttraumatic stress disorder.
Shapiro’s interest in traumatic stress emerged after
she had overcome a serious illness. She had been
working on her doctorate in English literature at New
York University when she was diagnosed with cancer.
After her recovery, she abandoned literature, moved to
California, and enrolled in the doctoral program in
clinical psychology at the Professional School for Psychological Studies. She is now licensed to practice
clinical psychology in the State of California where
she is a Senior Research Fellow at the Mental Research Institute and Executive Director of the EMDR
Institute. In 1994 the California Psychological Association honored her with its Distinguished Scientific
Achievement in Psychology Award.
Shapiro’s EMDR Institute has been a spectacular financial success. She and her associates have taught
EMDR to more than 14,000 mental health professionals in training workshops throughout the world.
Moreover, until the publication of her book, Shapiro
demanded that all workshop trainees sign a document
stating that they would not teach EMDR to other
therapists. Because they were debarred from learning
the technique from other trained professionals, therapists have had to pay $ 3 5 5 to learn it in a Shapiro
Reminiscent of Wolpe’s (1958) systematic desensitization, EMDR is a relatively straightforward procedure for reducing distress associated with traumatic
memories. After identifying a target memory, the
therapist has the patient articulate a self-referrent
“negative cognition” related to the memory (e.g., “I
am shameful”) and a “positive cognition” to replace
the negative one (e.g., “I am honorable”). The therapist rapidly moves her finger back and forth in front of
the patient’s eyes, and instructs the patient to track her
finger while simultaneously concentating on the disturbing memory. After each set of 10-20 eye movements, the therapist has the patient provide ratings of
distress and strength of belief in the positive cognition. The therapist repeats this procedure until distress associated with the memory subsides and belief
in the positive cognition increases.
Although first described in a brief case report
(Shapiro, 1989), EiMDR is now the subject of an entire book. Shapiro’s monograph contains 12 chapters
and three appendices. Opening chapters compare and
contrast EMDR to other treatments (e.g., imaginal
exposure) and sketch the information processing/
neural network theory that Shapiro believes underlies EMDR’s effectiveness. Succeeding chapters address assessment, procedural variants, coping with
obstacles in therapy, and dealing with difficult cases.
The closing chapter revisits theoretical issues, and
summarizes the growing body of outcome research on
EMDR. Among the appendices are data from a survey
of EMDR therapists that confirm the procedure’s
safety and lack of negative side effects.
Few recent therapeutic techniques have received as
much acclaim or as much criticism as EMDR. It has
been controversial. On the one hand, many therapists
praise it as a powerful procedure for helping traumatized people overcome horrific memories. On the
other hand, some critics consider it merely another
version of exposure therapy. Indeed, Shapiro now acknowledges that eye movements are not an essential
component of Eye Movement Desensitization and Reprocessing, as several studies have shown. She hastens
to add, however, that some form of rhythmic movement is necessary (e.g., tapping on the patient’s
forearm). Other critics view EMDR as an elaborate
psychosocial placebo that works through the power of
suggestion rather than through eye movement-induced reconfiguration of neural networks, as hypothesized by Shapiro.
The story of EMDR is remarkably similar to that of
Mesmerism, another psychological treatment developed outside mainstream medicine (Darnton, 1968).
Like Shapiro, Mesmer discovered his method while
walking outdoors. He too developed an elaborate biological theory for his treatment’s effectiveness, and he
too established a lucrative institute, held training
workshops, and insisted that workshop trainees refrain
from teaching his technique to others. Like Shapiro,
Mesmer was attacked by critics in the medical establishment who argued that his treatment worked only
through the power of suggestion, not through a specific biological mechanism (i.e., animal magnetism).
Book Reviews
Finally, Darnton’s (1968, p. 53) book on Mesmerism
contains an eerily contemporary illustration of a patient tracking a Mesmerizer’s finger as he moves it
back and forth in front of the patient’s eyes.
Shapiro’s book makes for dull reading. It is riddled
with speculative jargon about information processing
and neural networks that merely provides a transparent veneer of cognitive neuroscience. It is needlessly
long. Much of it contains clinical common sense (e.g.,
taking a patient’s history), and the rest concerns a
technique whose original description appeared in a
brief report, but whose description now apparently
warrants a full-length monograph of nearly 400 pages.
On the positive side, Shapiro writes clearly and explicitly about her methods. Any mental health professional who wants to learn about EMDR can do so by
reading this authoritative text.
Darnton R (1968) Mesmerism and the End of the Enlightenment
in France. Cambridge, MA: Harvard University Press.
Shapiro F (1989) Eye Movement Desensitization: A new treatment
for post-traumatic stress disorder. J Behav Ther Exp Psychiat
20:211-2 17.
Wolpe J (1958) Psychotherapy By Reciprocal Inhibition. Stanford,
CA: Stanford University Press.
RichardJ. McNally
Department of Psychology
Harvard University
Cambridge, Massachusetts
ADOLESCENTS. Edited by John S. March.
Guilford Press, New York, 1995.448 pp, $40.00.
In Anxiety Disorders in Children and Adolescents, Dr.
John March has assembled an impressive group of
contributors who are among the foremost experts in
childhood anxiety disorders. The result is a comprehensive, scholarly review of research and clinical practice in this rapidly advancing field.
The book is organized into three major sections: I.
Foundations, which focuses on theoretical models,
epidemiology, and assessment; 11. Disorders, which
devotes a chapter to each of the childhood-onset anxiety disorders defined in DSM-IV; and 111. Treatment,
which addresses the major treatment approaches applied to anxiety disorders in children and adolescents.
Section One opens with a chapter that describes
neurobiologic conceptual models, and reviews recent
findings regarding neurotransmitter systems, animal
models of anxiety, and brain imaging studies. The next
chapter provides an overview of neuropsychological
models of anxiety. The authors examine the extant evidence for the relationship between neuropsychological
deficits and internalizing conditions, with a focus on
findings pertaining specifically to anxiety disorders.
Research investigating the impact of anxiety on
neurocognitive performance is also reviewed. Although much of the focus in the first two chapters is
on adult studies, findings from child research are reviewed when available.
Following the chapters on neurobiology and neuropsychology is an interesting chapter by Biederman
and colleagues which reviews a growing body of literature on the association between behavioral inhibition
and anxiety disorders in children. The chapter ends
with a thought-provoking discussion of the potential
applications of these research findings for improving
our efforts at early identification and intervention with
at risk children.
A highlight of the first section is a chapter that addresses social developmental theory and research as it
relates to anxiety disorders in children. Although this
literature is likely unfamiliar to many clinical psychologists and psychiatrists, it becomes apparent after
reading this chapter that greater collaboration between developmental, social cognition, and clinical researchers will lead to more effective interventions and
more fruitful research into the mechanisms underlymg
anxiety in children.
The remaining chapters in the first section of the
book cover epidemiology and assessment. Costello
and Angold’s chapter on epidemiology provides a
thorough review of recent findings on the prevalence
of anxiety disorders in youth and on potential risk factors for these disorders. This chapter contains several
useful tables that summarize the results of recent epidemiologic studies. The chapter on assessment provides
a general overview of semisu-uctured and structured diagnostic interviews, parent- and teacher-report instruments, and child self-report measures for assessing
anxiety. Discussion of assessment issues related to specific disorders is provided in the following section of
the book.
Section Two contains chapters covering each of the
anxiety disorder diagnoses included in DSM-TV. Each
of these chapters addresses diagnosis, phenomenology,
differential diagnosis, epidemiology, assessment, and
treatment. The sections on diagnosis review the revisions to the classification of childhood anxiety disorders introduced in DSM-TV. Case studies at the end of
the chapters illustrate the features of the disorders and
highlight the complexities of differential diagnosis.
This section of the book also includes chapters on selective mutism and on comorbidity of disorders. Although selective mutism has not traditionally been
considered an anxiety disorder, several lines of evidence are reviewed which suggest that this disorder
may be a manifestation of social phobia.
T h e third section of the book covers the major
treatment modalities used to treat anxiety disorders in
children and adolescents. It includes chapters on cognitive behavior therapy, pharmacological treatment,
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