Eye Movement integration Ttierapy

An Introduction to Eye Movement IntegrationTherapy

Danie Beaulieu, PhDAcademie Impact, Lac-Beauport, Quebec

Abstract:Eye Movement Integration Therapy (EMI) is an innovative treatment for the psychological conse-quences of distressing memories. It promotes healthful integration of the traumatic memory withcounterbalancing, ameliorative information by using guided eye movements to facilitate accessto the recorded multisensory and affective dimensions of the client's experience. It is a powerfulmethod that appears to tap into the mind's natural ability to heal itself. This article presents thebackground, development and application of EMI, as well as the neurological aspects of traumaticmemories. Consideration is also given to possible mechanisms that may contribute to the observedefficacy of this therapeutic approach.

Keywords:Eye Movement Integration Therapy (EMI), Post Traumatic Stress Disorder (PTSD), Phobia, Panic Dis-order, Anxiety, Bereavement, Psychosomatic Pain, Stress

European Journal of Clinical Hypnosis; 2005 volume 6 - issue 3

Oanie Be^uheu

In the history of psychotherapy, tew problemshave remained as great a challenge as the treal-menl of clients whose problems arc rooted inmemories of distressing experience. Allhoughmany people are able to recover from traumaticexperiences without intervention and withoutlong-term consequences, in some, trauma cancreate memories that are highly emotionallycharged and fragmented and whose resolutionrequires treatment. Created in 1989 and con-tinuously refined since then. Eye MovementIntegration Therapy (EMI) offers one of Ihcmost effective and innovative therapeutic ap-proaches for these clients. EMI taps into thenatural healing processes of the mind that, forwhatever reason,, did not occur spontaneouslyin the client. It promotes rapid resolution ofdistressing experiences and their problematicpsychological consequences by integrating thetraumatic imprints with counterbalancing andameliorating information from the client's ownresources. Metaphorically, traumatic memoriesare like chlorine: they are caustic and damagingin concentrated form. EMI allows ihat chlorineto be diluted with clear, healthful water in theform of healing information, rendering thetraumatic memories harmless and even purify-ing, in the same way that chlorine added to adrinking water supply or a swimming pool ispurifying.

As the name implies. EMI uses guided eyemovements to facilitate this integration proc-ess. In simple terms, problematic traumaticmemories have been isolated and sealed offfrom the sort of normal access we have to otherforms of memory. They may intrude at unex-pected moments as flashbacks or nightmaresand induce behaviors such as avoidance ofcertain situations which may stimulate unde-sired recollection and induce other deleteriouseffects in the person's daily life. People whohave lived through trauma without developingthis kind of difficulty have evidently resolvedtheir memories in a more healthful way, EMIappears to tap into the natural mechanisms ofthe mind to integrate the trauma that is etchedin memory with the healthful, beneficialmemories of the client, placing the trauma ina different, more healthy perspective. The eyemovements allow the client brief, deep contactwith the multisensory content of both the trau-matic memory and positive memory traces.The traumatic memory does not disappear, but

its power to disrupt the client's life and causelimitations in their functioning is abolished.Thus. EMl's impressive efficacy derives fromits ability to help the mind do precisely whatit was designed to do: heal itself using its owninner resources.

This article will present a brief introductionto EMI, its origins and development, how anEMI therapy session is conducted, as well aspossible mechanisms for its effects. The vari-ous types of problems that can be addressedwith EMI will also be discussed, and a caseillustrating its application will be presented.A single article cannot supply enough infor-mation to assure the correct application of anew therapy: tny intention is [o introduce thisextremely efficacious method to a wider audi-ence, in hopes that more therapists will beginto explore its potential. Additional training ishighly recommended before attempting to usethese methods with clients.

Origins and development

As stated above. EMI uses eye movements toallow the client to access memory traces andto integrate traumatic memories with amelio-rating information. Eye movements and theircorrelation to thought processes have longbeen the subject of intense interest among NLPresearchers. Robert Diltz and others showedthat, in the absence of visual distractors. thedirection of our eye movements is related tothe sensory content of the thoughts or memo-ries we are focusing on (Dilts. 1990). Classi-cally, for example, gazing upward and to theleft tends to be associated with rememberedvisual images, while gazing downward andto the right is related with kinesthetic feelingssuch as emotions, touch, visceral sensations,and muscle movement. These tendencies holdstatistically for large populations, but each in-dividual will have their own particular patternof eye movements that are associated with dif-ferent thought processes,

In the late 1980s. Steve and Connirae Andreasbegan to examine this relationship with an eyeon its therapeutic potential (Andreas & An-dreas. 1989). They supposed that if thoughtscould influence the direction of eye movements,perhaps deliberate eye movements could influ-ence the content of thoughts. After testing the

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hypothesis with a few volunteers, they realizedthat the technique had the potential to help peo-ple change the way they perceived problematicsituations in their lives. Eventually, they beganapplying the technique as a treatment for trau-matic memories and fears about future situa-tions. I learned the EMI method in 1993. in aworkshop conducted by Steve Andreas, whichincluded a demonstration with a volunteerwho had suffered symptoms of PTSD sincehis service in Vietnam (Andreas, 19931. Theeffects were dramatic and convincing: after a45-minute treatment the volunteer had radi-cally and positively changed his perception ofan especially disturbing memory of an attackin which a friend had died.

Since that time, I have worked, with encour-agement from the Andreases, to develop EMIinto a comprehensive therapeutic approach. 1have added to my understanding of EMI and itsunderlying principles by extensive reading andpractice. I studied NLP and another eye-move-ment-based therapy. Eye Movement Desensiti-zation and Reprocessing (EMDR), developedby Francine Shapiro (Shapiro. 1995)

I studied the scientific literature on tlie neuro-bioiogy of eye movements, thought paltcrns.memory.and trauma, seeking to understand thebiological and psychological mechanisms thatmight lie behind EMI's astonishing efficacy.[ added a much tnore in-depth pretreatmentwork-up, and a more analytical understandingof how memories function. I blended in moreNEP anchoring techniques to help clients dealwith emotional distress during and betweensessions. And I made sure to follow up aftertreatment with every client, to ensure that reso-lution had been truly complete and enduring.

The treatment, in brief

After extensive experience with my clients,and years of teaching the now substantiallymodified EMI to my colleagues in Quebec. Iunderstood enough about how EMI worked towrite a book about it, with the kind permissionof the Andreases (Beaulieu, 2003). .Althoughthis article can only scratch the surface of whatis presented in detail in the book, awareness ofits existence will, I hope, help other therapistshelp their clients overcome the effects of trau-matic and distressing experiences. Even the

book is insufficient to really master EMI: it issuch an experiential therapy that it is essentialto paiiicipate in workshops or supervised prac-tice that provides the opportunity to experiencethe effects of guided eye movements. Briefly,however. T would like to sketch out how thetreatment is conducted, with the caveat thatthis information is wholly inadequate to sub-stitute for training.

Before beginning treatment with EMI. I rec-ommend that the therapist conduct a full clientwork-up. Devote a session to exploring thereasons the client has sought help, his familyand soeial environment, and his physical andpsychological condition. Explore the copingstrategies that the client has been relying on todeal with his current problems, as well as thosehe has used routinely in the past. All of thisinformation will help the therapist recognizepotential problems before they arise, and avertdifficulties during the future sessions.

During the work-up, begin to develop anunderstanding of the structure of the client'stroubling memories. Was there a single,overwhelming event or a series of repetitivetraumas? Arc the memories clear, sequential,eidetic recollections, or vague, hazy, disjointedfragments? What emotions are associated withthe memories? What are the associated cogni-tions? What consequences do these distressingmemories have in the clietit's current life? Itis not necessary to delve into the details of allthe client's memories —the EMI treatment willallow them to be revealed when and if theybecome relevant —but it is very useful to havea good grasp of the scope and architecture ofthe problem.

Once the nature of the distressing memory isidentified, the therapist can map the clientsvisual range by moving his hand, with the firsttwo fi ngers extended. to the lim its that the cl ientcan comfortably follow with his eyes, withoutmoving his head. At the same time, the thera-pist can explore the areas or "quadrants" of thevisual range that are more and less emotionallycomfortable for the client. Very often, a cer-tain quadrant will be associated more stronglywith negative emotions related to the trauma.Likewise, it is a good idea to determine whichquadrant allows the client to contact positivefeelings, so that the therapist can always relyon this location to modulate the intensity of the

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Danie Beaulieu

treatment.

The treatment is begun with the client concen-trating on a particular memory that appears tobe central to his experience: a highly emotion-ally-charged episode, or the earliest memory ofa repeated trauma, or the first scene in a se-quence of recollections of a single distressingevent. The guided eye movements are begun bymoving the hand, with two lingers extended, orholding a bright marker, smoothly and ratherslowly, at a distance and rhythm that the cli-ent is comfortable following. The client shouldalways feel that he is in complete control ofhow the movements arc dono. We may want tostart the treatment using an eye movement thatconnects quadrants previously identified as rel-atively untroubled for the client, so that painfulmaterial is not contacted [no abruptly and theclient has time to adjust to the procedure. Theeye movements that are normally used in anEMI session are illustrated in Figure I.

After three or four back-and-foilh movements,the hand is softly pulled back toward the thera-pist's body, and the client is asked an ojien-ended question, such as. "What's there now?"or "What are you experiencing now.'".allowingthe client to describe what is happening duringthe eye movements in her own fashion. Theclient is encouraged tti describe her experiencein at least three sensory or affective modalities(visual, auditory, kinesthetic. gustatory or ol-factory and emotions) or sub-modalities (color,intensity, loudncss. hot/cold, rough/smooth,etc.). We avoid distracting the client from herown description, but when she has hnished weinquire further, "Are there images? Physicalsensations? Emotions?" in order to fully ex-plore the dimensions of the experience.

These three dimensions —visual, kinesthetic.and affective —are often the principal modesin which the rc-cxperience of traumatic mem-ory occurs. However, we could also ask aboutsounds, smells, tastes, thoughts, following theclient's lead, but consistently trying to elicitinformation in at least three dimensions.

Each therapeutic session should conclude onlyafter completing all of the eye-movement pat-tenis at least once and assuring that the clienthas reached a tolerable emotional plateau. Be-cause it is not always possible to accomplishthis within the sixty minutes of a typical thera-py session, we try to schedule 75- to 90-minute

sessions for EMI. Often, complete resolutionof problems related to a single tratuiiatic eventcan be achieved in one session, and the mostcomplex cases I have seen were successfullytreated with a total of only five or six sessions.When planning U'eatment. then, it is best to at-tempt to estimate how complex the problem is,and perhaps to break it down into elements thatcan be treatetl in a single 9(l-minute perittd.

hdtlow-up is always required, even for clientswho seem to have resolved their difliculties in asingle treatment session. The enhanced accessto (.listressing memories that is catalyzed bythe eye movements and the linkages that beginto form between newly contacted informationcontinue for several days following EMI treat-ment. Many clients will report increased dreamactivity, or surprising, illuminating insights, ordramatically altered behavior in the days andweeks that follow an EMI ircatment. A tollow-up session permits the therapist to assure thatno problcTiiatic mcnu)ry circuits remain to betreated, and that the ciieiil lias ihc proper toolbox to deal with the outcomes and repercus-sions of the treatment.

Applications

In the years since the development of EMI, ithas been applied to a wide variety of clientsand problems. In fact, the limits of its usesare still not known. Traumatic and disturbingmemories can clearly be effectively treated byintegration with counterbalancing information;however, any problem that involves a negativeperception of a situation may similarly be sus-ceptible to treatment with EMI.

EMI has successfully been used to treat clientsstruggling with phobias, panic disorder, anxie-ty, bereavement and even psychosomatic pain.We can view each of these problems as being aquestion of perspective. Phobias, for example.involve perceiving unthreatening situations asthreatening, whereas extended or unhealthygrieving may involve perceiving the loss asinsurmountable and life as no longer worthliving. In these situations, HMI can as.sist theclient to regain access lo memories, emotions,physical states, and sensory and cognitiveinformation that have remained isolated fromtheir habitual, adapted thought patterns.

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Eve Movement

1 2 3 4

G H

Figure 1. Guided eye movements for EMI.

Pattern A: Sciimcnls Al . A2, and A3 are alllniri/()iilal. with AI at the tipper edge of the visualrange, A2 at the level <^ii the client's eyes, and A3 atthe lower edge of the visual range.

Pattern B: Segments BLB2.and B3 are all verti-cal, with B1 at the left edge of the visual range. B2oriented at the center of the client's body and faee.and B3 at the right edge of the visunl range.

Pattern C: Segments CI and C'2 Jestribe :in"X" from the extreme eorners of the visuul range.Each diagonal line is used as a separate segment.However, if one of the diagonal segments is used,the next segment performed should be the alternatediagonal.

Pattern D: Segments I) 1, D2.03. and D4 describetwo ""X""s,side by side, one in eaeh half of the visualfieitl. moving between Ihe extreme borders. Again,tlie paired diagitnals should be performeil consecu-tively. Once an "X" is started, the next segmentshould complete it before moving on to anothersegrnent, |-Io\\e\er. the D3/D4 pair \\K:<::<\ not be per-formed immediately after the DI/D2 pair.

Pattern E: Segmenis HI. F.2. E3. and E4 Je.scribe

two "X^'s. one above the other. El and H2 are donein the upper half of the visual held, moving to eachextreme of the visual range. E3 and E4 are done inthe lower half of the visual range. They should beperformed as described for pattern D.

Pattern F: Segments El . E2. E3. and E4 form atarge diamond shape, moving between the lop. side,bottom and other side of the visual range. Eachsegtnent may be performed separately, or. \\ theelient desires, the four segments can be performedtogether as a single, diamorid pattern. This pattern isreservetl for u^e lowaid the end viS integration.

Pattern G: This single-segment pattern toltows acounterclockwise spiral from the outer edges of thevisual range to theeenter. in steadily smaller cireles.then spirals outward again, then inward, repeatingas needed. This segment should always end wilh aninward spiral, linishing at the eenter of the visualfield. This pattern is reserved for use toward the endof integration.

Pattern H: This single-segment pattern i.s per-fortned as in Pattern G. but forms a clockwise spiralpattern. This pattern is reserved for use toward theend ol'intetiraiion.

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Represetitative Session

One of my clients was troubled by nightmaresand ititrusive, fragmentary metiiories fromhis childhood with a violent father. AlthoughBrian was functional, the irrepressible stressreactions induced by those memories drainedhis energy and left him in a state of near-coti-stant anxiety. We began treatment with Brianfocusing on the emotionally charged earlymemory of his father beating the family dog. Iled Brian through a series of guided eye move-ments, beginning with calm, steady horizontaltTiovements from one extreme to another of hisvisual range. Each set of eye movements wasfollowed by a pause to let Brian reveal the newmaterial that he had contacted in different mo-dalities. Gradually, 1 worked through the entireseries of segtiients and patterns, choosing thesequence according to the intensity of Brian'sreactions.

As we proceeded. Brian vividly recalled a se-ries of details from the incident, some of whichhe had never consciously recalled before: thecries of the dog in pain, and the blood on thedog's skin and on the walking stick. In addi-tional segments he relived begging his fathernot to hit the dog. not to kill the dog; he sawagain the hatred in his father's face; and feltagain the child's sadness, rage and helpless-ness, the pain in his chest and the weaknessin his legs. Using the eye movements and thebrief pauses, we eventually explored not onlyBrian's memory of his father beating the dog.but also associated memories of the father'sabuse of his wife, and eventually, in a subse-quent session, of Brian himself.

As the treatment advanced, it became clearthat Brian was contacting not only painfullydetailed recollections, but also experiences,insights and perspectives from other aspects ofhis life, gradually integrating his fragmentedchildhood tiiemories with a wider, healthiercontext. When we eventually reached the pointwhen no new information was being revealedwith additional eye movemetits. Brian realizedthat the systematic violence meted out by hisfather was neither judgment nor punishment,but rather a symptom of his father's problemswith alcohol and anger control. He felt relievedof the physical and emotional sensations ofshame and fear that he had carried for years.Rather than feeling terrorized that his father

might still have power over him. he now re-gretted that he had never experienced having agood father, while also recognizing that he hadnonetheless become a mature, understandingatid competent adult.

This case illustrates the interconnectedness oftraumatic tiiemories. Although the beating ofthe dog and the violence toward Brian's moth-er and Brian himself all occurred on separateoccasions, they were connected by the natureof the experience. Working on a single prob-lem may lead to others that are related by thecomplex architecture of the memory networks.Reaching a completely ecological integrationcannot be achieved without addressing all ofthe related material.

EMI and EMDR

ln addition to having substantially contrib-uted to the development of EMI over the lasttwelve years. I am trained in EMDR. Thesetwo therapies use eye movements, but thereare a number of critical differences. EMI canoffer added flexibility for therapists who useEMDR. due to its adaptability to the needs ofthe client and its emphasis on multisensory ex-perience. In EMDR, one basic eye movementis used —a quite rapid, saccadic movementfrom side to side. It was only later in the de-velopment of EMDR that the option of usingalternative directions of eye movement {onlyif the client is not progressing) or other typesof stimuli (flashing lights, knee taps, etc.) wasintroduced. However. In practice, most EMDRclinicians tend to use the side-to-side eyemovement.

EM! has a dramatically different emphasis, de-rived from its origins in NEP and its develop-ment as a multisensory intervention.

The premise of EMI, derived from observationsof natural eye movements and their associatedthoughts, is that all of the different quadrantsof the visual lield should be explored in orderto facilitate contact with the entirety of the cli-ent's relevant multisensory experience. Thus,we use a well-defined series of eye movements(horizontal, vertical, diagonal, circular) thatconnect each of the visual quadrants with allof the others in a systematic manner. Each ofthese eye movements facilitates contact withdifferent aspects of the client's recorded expe-

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riencc. Very often, the most profound eontaetwith ihc client's disliirbiiii: memories will bemade when his gaze is directed in a particulardirection, whereas positive material emergesfrom u completely different, but equally dis-tinct quadrant. Similarly, visual informationmay emerge when we guide his eye move-ments in a particular way. and kinestheticinformation will emerge with a differenl eyemovement. Years of clinical experience, byhundreds of practitioners, has shov '̂n that con-tact with, and integration of all of this informa-tion—the negative and the positive, in all oftheir multisensory aspects—is the basis for theremarkable efficacy of EMI,

Another important facet of the EMI approachis the emphasis given to respecting the client'sneeds and preferences. We posit that EM! actsby facilitating an essentially natural process ofhealthful integration of experience that has. forwhatever reason, not occurred spontaneouslyfor our clients. To be maximally effective.therefore, the process must be as "organic" aspossible. The therapist adjusts the position ofher hand so that the distance from the client'seyes is completely comfortable —both physi-cally and psychologically. Similarly, the speed,length and direction of the guided movementsare adjusted at the client's request. One cli-ent may be comfortable with a fairly rapidmovement, while another prefers a very slow,smooth rhythm. All of these parameters can bechanged at any point in the therapy, to assurethat there is nothing that causes an irritation.distraction or interruption of the client's con-tact with his experience, in fact, throughout thetreatment, EMI therapists will periodically askthe client if the way in which the movementsare done is to his liking, and make any neededadjustments.

All of these variables —the direction, distance,speed and length of the eye movements —givethe therapist and the clietit enormous flexibilityto line tune the process lo the needs of a partic-ular case. Every client is unique, as new EMItherapists rapidly diseover. it is astonishinghow a seemingly minor adjustment can resultin a dramatic change in the client's ability tomake conlact with his memories. The therapistcan also modify any of these variables whenshe Judges that a change will favour contactwith or integration of certain elements, Eorexample, moving her hand closer to the client

can have the effect of "pushing" gently to helpdeepen contact, whereas moving slightly awaymay diminish the intensity of a particularlyoverwhelming emotional recollection.

This flexibility favours the development of aclose therapeutic relationship, another key ele-ment in the eflicacy of EMI. The therapist andclient thus become a therapeutic team, workingtogether to suss out the most pertinent informa-tion to bring resolution in each case. The clientfeels actively involved in his own healing andhis sense of control over the process minimizesany resistance.

EMDR trainers warn new therapists about thepossibility of "abreactions"— adverse, highlyemotional reactions that can be frightening forbolh the client and the therapist. Therapistsrequire great skill and training in psychologyto handle these powerful reaetions. EMI, incontrast, equips the therapist —and the client —with built-in "safe harbours" or anchorages:eye movements or specific visual quadrants towhich they can have recourse when powerfulemotional material threatens to overwhelm theprocess. The same intense experiences may becontacted, but the therapeutic team remainsmuch more in control in HMI. Abreactionsmay still occur, but they normally do not in-terrupt the process or damage the therapeuticrelatit)nship,

The neurobiology of distressingexperience

In order to understand how HMl works, wehave to understand how memories are formed.In ordinary circumstances, sensory informa-tion is funneled from the sense organs to thethalamus, and from there the information isshunted to the various specialist parts of thebrain: the occipital lobe for visual informa-tion, the temporal lobe for auditory and verbalinformation, and the frontal lobe, where theinformation is processed and integrated withstored knowledge to form a perception. Sig-nals from the frontal lobe are sent back downto the limbic region, and the amygdala, whereemotional associations are attached to the per-ception: pleasure, distaste, fear. etc. Short-termrecall and long-term consolidation of memo-ries depend on the hippoeampus. which hasconnections with all these parts of the brain

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and orchestrates the activation of all the bitsof sensory, cognitive and affective informationthat compose a given integrated memory.

Distressing experience affects the mind differ-ently than ordinary experience does. Work byJoseph Ledoux and others has demonstratedthat survival reactions in thefaceof thteateningor intense situations use an alternative "emer-gency" pathway (LeDoux, 1992). Informationfrom the thalamus can be sent directly —via asingle synapse —to the amygdala, part of theprimitive reptilian part of the human brain,which initiates survival behaviors and emo-tional responses a split second before the in-formation can reach the more distant frontallobe and form a elear perception. Essentially,nature has designed a shortcut to permit quickreactions in the lace of a sudden threat, basedon a "quick and dirty" reading of the sensoryinformation by the amygdala.

If the amygdala pereeives a threat message inthe unprocessed sensory information, it sendsout signals to the brain and endocrine organs toinitiate the "fight or flight" response. It shutsdown non-essential functions and triggers ajoit of adrenaline that tenses the museles. setsthe heart racing, quickens respiration and ingeneral readies the body to deal with whateverterrible thing is about to happen. If it later turnsout that the sinuous object on the forest pathwas not a snake but just a curved stick, thefrontal lobe will send out signals that permitthe body to relax, etimb down out of the treeit had jumped into, and eventually let the heartbeat and breathing return to a normal rhythm.

The central roles of the hippocampus and theamygdala usually work hand in hand. Moder-ately elevated activity in the amygdala causesimproved connectivity of the hippocampus,andheightened potential for learning. Exeessivestimulation of the amygdala by overwhelm-ing experience, however, causes impairedhippocampal functioning due to the intensityof the neuroendocrine stress responses. Thismeans that the hippocampus may not be ableto coordinate the sensory and emotional infor-mation received during a crisis into integratedmemories. The end result is that traumatiememories are often recorded as fragmentary,nonintegrated bits and pieces. The conver-sion of these nonintegrated memories intointegrated form is thought by trauma experts

such as Bessel van der Kolk to be essential forrecovery from the psychological impact of thetraumatic event (Van der Kolk. McEarlane, andWeisaeth. 1996),

Many clients have had key experiences in theirlives that have left enduring imprints in theirmultisensory memory networks. Not all survi-vors of abuse, ttauma or other distressing epi-sodes will have trouble integrating the memory,but for many the traces remain paradoxicallystrong and fragmentary simultaneously. In themost severe eases, traumatic memories cancontribute to severe mental disturbances suchas dissociative disorder or post traumatic stressdisorder. In milder cases, anxiety or depressionmay be the only sign. The spectrum of symp-toms that may stem from unresolved memoriesof distressing events also includes nightmares,flashbacks, emotional numbing, avoidancebehaviors and panic attacks (Van der Kolk.McFarlane, and Weisaeth, 19%). EMI is use-ful for treating any constellation of symptomsor difficulties that can be rea.sonably traced toa traumatizing incident or period of the client'slife,

EMI appears to be able to facilitate access tothese troubling, nonintegrated memories, bycircumventing the routine patterns of thoughtand avoidance that the client has habitu-ally followed. Eigurativeiy speaking, the eyemovements appear to redirect the client's mindinto dusty corners that have been neglected,releasing information —whether painful orhealing —that can then be naturally incorpo-rated into a new. healthful perspective on theircurrent life and their past experience. It is al-most as if EMI activates an inner homeostatieguide that leads the client out of the maze oftheir troubling memories. The varying patternsof eye movements, the reassuring environ-ment of the therapist's office, the focus on thesensory, cognitive and affective aspects of thememory —all of these ingredients eombine toproduce an astonishingly effective interven-tion.

Eye movements and the mind

Although the treatment of many clients bymany EMi therapists has convincingly demon-strated the excellent efficacy of this approach,the precise mechanisms underlying this effi-

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eaey remain to be elucidated. The foundationsof EMI in the NLP theories of associations be-tween eye movements and thought processesare reasonable, but does not adequately explainwhat is happening at the neuronal level. How-ever, several other lines of evidence point tothe intricate interplay between eye movementsand thoughts.

It has long been known that the hemispheres ofthe brain have tieveloped laterali/ed specializa-tions that permit a complementary division oflabor (Springer and Deutseh. 1993). For exam-ple, the left hemisphere in humans is far moreinvolved in language processing than the right;both Broca's area and Wernicke's area, the ver-bal centers of the brain, are located in the lefttemporal area. In contrast, the right hemisphereexcels at spatial perception. In addition, the lefthemisphere is thought to dominate in analyti-cal thinking and the development of coherencefrom multiple sensory inputs, whereas the righthemisphere appears more linked to emotionalresponses and detection of exceptions friimmultiple inputs (Ramachandran, 1995). Coor-dination of the activity of the two hemispheresappears to be controlled in part by an automatic"switching" meehanism. whose function canbe measured in the laboratory by the alternat-ing perception of conflicting visual inputs tothe right and left eyes (Miller ct al.. 2000). Ex-ogenous activation of one hemisphere, usingcaloric vestibular stimulation or single-pulsetranscranial magnetic stimulation, can increasethe time that the input to the contralateral eyeis perceived. The same researeh grtmp demon-stratcd that the "switching" mechanism func-tiiMis on a distinctly different rhythm in peoplewith bipolar disorder. They hypothesize thatthis delayed switching may be related to theprofound mood swings that characterize thisdisorder (Pettigrew and Miller, 1998). Thisresearch suggests the possibility that guidedeye movements, such as those used in EMI.may be able to stimulate the hemispheres ofthe brain, similar to the action of exogenousactivators, and affect the attentional signalsused in processing and thus the pereeption ofmemories and other information. Similarly, itis possible that, in the face of overwhelmingexperience, the "switching" mechanism is dis-turbed and permits the development ol the .sortof disequilibrium of perception that character-izes many post trautnatic stress disorders,

Another area in which eye movements havebeen extensively studied is sleep. Althoughrapid eye movements (REM) that resemblesaccades are well known to occur in sleep,they are not the only type of eye movementthat can occur. Slow rolling eye movements.with some similarity to those used in EMI, arecharacteristic of Stage 1 sleep, which also in-volves production of theta waves arising fromthe hippocampus. It is also known that peoplerecall dreaming (if the definition of dreamingincludes any mental content, whether narrativeor non-narrative in structure) when awokenfrom REM or non-REM sleep {reviewed inNielsen, 2000). In addition to the restorativerole of sleep, many researchers now believethat sleep plays a critieal role in memory eon-solidation and learning. Sinee the process ofintegration facilitated by EMI involves access-ing and transducing memories, and since theeye movements of sleep and EMI share certainsimilarities.an exploration of the mental activi-ties during sleep may shed light on conceivablemechanisms of EMI. In particular, it is possiblethat highly distressing memories that routinelydisrupt sleep when activated-either in theform of nightmares (in REM sleep) or nightterrors (during slow wave sleep)-remainfragmentary and isolated from integration withless distressing content because they do not un-dergo the normal consolidation processes dur-ing sleep that are essential to learning (Gais,Plihal, Wagner, and Born, 2000). The use of awide variety of eye movements in EMI may beproviding a "second chance" for this requiredconsolidation to occur.

A hnai area of research involves the obser-vation of disturbances of eye movements inpeople with schizophrenia. Disorders of eyemovements have been used as a biologicalmarker to assist in the diagnosis of schizophre-nia. Dubbed eye-tracking dysfunction (ETD),the observed abnormalities constitute disrup-tions in normal smooth pursuit eye movements(Holzman. 1985, 1992). Up to 85% of peoplewith schizophrenia often show slowed velocityin eye-traeking tests, as well as saccades awayfrom the target and velocity arrests. Schizo-phrenia is characterized by incoherence of per-eeption and thought, hallucinations, and poorintegration of sensory inputs. This associationof disordered thought and sensory perceptionswith ETD raises interesting questions for peo-

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pie with psychological trauma. Could patients with traumatic memories present similar difticultiesin integration of sensory information and manifest disordered thought patterns as a result of theirstressful experience',' It is very tempting to speculate that there is an underlying connection be-tween these processes and that the eye movements in EMI impose an external source to overcomethe processing deficits temporarily induced by trauma.

These various lines of evidence, as well as the existence of other eye-movement-based psycho-therapies, begin to provide hints at the underlying neurobiological basis for the eflicacy EMIdemonstrates in clinical settings. Clearly, further research will be needed to clarify which of thesemechanisms is at work and which other elements of EMI contribute to its effects.

My enthusiasm for EMI is based not only on my own experience, but also on that of the manyclinicians, psychologists and social workers whom I have trained in the last ten years. Many havetold me amazing anecdotes of the transformative effects EMI has had for their clients. Together,we eonducted a small pilot study and ft)und that, on average, a single treatment with EMI couldreduce post-traumatic stress symptoms by 48%, while a full course of treatment reduced symp-toms by H3%. These results are conlirmed every time a client troubled by unresolved distressingmemories seeks help from a skilled EMI practitioner. Releasing them from the burden of thetraumatie baggage they have earried for years never ceases to be one of my iireatest professionalrewards.

In addition to its ability to help people in distress, EMI offers a new way of examining the natureof memory, consciousness and multisensory experience. It is my hope that research on the applica-tion of EMI will also lead to new insights into the functioning; ol the human mind.

About the Author:

Danie Beaulieu, PhD, is a psychologist, trainer and international speaker based in Quebec City.Canada. She is the author of Eye Movement Integration Therapy: the comprehensive clinicalguide (Crown House), as well as twelve other books.

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