September 2011 Issue

Eye Movement Desensitization And Reprocessing — History and Clinical Applications in Helping Patients With Lifestyle Change
By Rita Carey Rubin, MS, RD, CDE, and Bill Rubin, MS
Today’s Dietitian
Vol. 13 No. 9 P. 10

It was a sunny day in 1987 when Francine Shapiro, then a graduate student in psychology, accidentally discovered a connection between spontaneous lateral eye movements and the psychological processing of negative thoughts and emotions.

Shapiro had been diagnosed with cancer several years earlier and had researched various mind-body therapies during her treatment and recovery. Consequently, she may have had a heightened awareness of the connections between her thoughts and her body and as she walked around a small lake on that day in 1987, she noticed how her eyes spontaneously moved in a rapid, lateral fashion when she focused on an anxiety-provoking thought.

She later made two observations: After experiencing a succession of eye movements, she seemed to effortlessly stop focusing on the disruptive thought and when she intentionally brought the thought back to mind, it had lost some of its negative emotional charge. Intrigued, she began to experiment with herself and others, discovering more about this peculiar mind-body connection and its potential to ameliorate anxiety.

EMDR Development and Historical Application
Shapiro’s experience that day eventually inspired her to develop a therapy called Eye Movement Desensitization and Reprocessing (EMDR). In later experiments with herself, she intentionally prompted left-to-right lateral eye movements similar to those we experience during rapid eye movement sleep. Subsequent to these eye movements, again she noticed how negative thoughts would shift away from her awareness and when she intentionally brought them back into focus, they were consistently less disturbing.

She asked colleagues and acquaintances to try this process, and they reported similar results. When she discovered that most people needed help maintaining the eye movements as they focused on negative thoughts, Shapiro began to use the lateral motion of her hand as a visual guide. This simple procedure—connecting eye movements with disturbing mental images—seemed to rapidly reduce the emotional impact and urgency of negative thoughts and eventually became the foundation of EMDR therapy.

Shapiro designed a randomized controlled study later that year, investigating the impact of EMDR on people suffering from posttraumatic stress disorder (PTSD). In this study, published in 1989 in the Journal of Traumatic Stress and the Journal of Behavior Therapy and Experimental Psychiatry, she discovered that “almost without exception, those treated with EMDR successfully resolved their traumatic memory … In addition, they made huge leaps in the way they felt about themselves. Subjects shed their deep-rooted denial, fear, guilt, shame, and anger and replaced these with improved self-esteem, confidence, forgiveness, and acceptance.”1

Ever since, EMDR has been employed as a rapid, effective way to help people deal with traumatic events in their lives. It’s been used with survivors of catastrophic events, such as the Oklahoma City bombing and the destruction of the World Trade Center buildings in New York City. Numerous testimonials exist from those who lived through these horrific experiences as to how EMDR helped them ameliorate or eliminate flashbacks, nightmares, anxiety, depression, and negative beliefs about themselves related to these events.

Recently, therapists have expanded the application of EMDR beyond the treatment of PTSD to numerous diverse issues, ranging from chronic depression and anxiety to lifestyle behavior change.

EMDR and Lifestyle Behavior Change
People typically face a variety of challenges as they attempt to shift habits and live in a healthier fashion. Some obstacles are environmental (eg, long workdays, easy access to junk food), while others are emotional and often more intractable. For example, individuals may harbor long-held negative beliefs about their ability to make and sustain lasting lifestyle change, or they may experience strong negative emotions concerning specific health-promoting foods or activities. Psychological counseling often is recommended to help individuals resolve emotional barriers to change, and EMDR can be an effective and expeditious approach.

Bill Rubin, MS, a psychotherapist and coauthor of this article, has practiced EMDR therapy for 17 years. During this time, he has used EMDR to help numerous clients overcome emotional obstacles to lifestyle change. A recent and pertinent case involved a middle-aged man who presented with lifelong obesity and a distinct inability to relax. (All information shared here regarding this client’s case is used with his written consent.)

Patrick (not his real name) was raised in the restaurant business. As a young boy, he acquired two habits: a taste preference for calorie-dense foods and a strong desire to work and be productive. Nearing retirement age, he wanted to improve his health, lose weight, and learn how to relax. Unfortunately, past failures gave him little confidence in his ability to achieve these goals.

His first EMDR session addressed the negative feelings he experienced concerning dietary change. Previously, when Patrick had avoided his favorite high-calorie foods, feelings of deprivation eventually overcame his desire to lose weight. He’d consume his favorite foods with abandon, go off his diet, and feel like a failure.

A few weeks after his initial EMDR session, Patrick realized that his core belief about making dietary changes had shifted from one of deprivation to “a commitment to wellness.” He regularly avoided sweets and high-fat foods and lost 14 pounds.

Subsequent sessions focused on his belief that he was inadequate if he wasn’t working or engaged in some productive activity. After the first month of weekly therapy, Patrick experienced the following changes: He continued to lose weight and limit his intake of unhealthful foods. His ability to relax improved, and he noted his increased ability to laugh, sit still long enough to watch a movie with his wife, and relate better with family and friends.

In a conversation one year later, Patrick shared that he’s maintaining a healthy weight, is physically active, more relaxed, and has adapted to retirement.

Evidence and Controversy
Controversy exists regarding the effectiveness of EMDR compared with traditional cognitive behavioral therapy.2,3 Consequently, the American Psychiatric Association lists EMDR in its most recent practice guidelines as a therapy “under investigation.” However, positive studies and reviews abound, and many researchers consider EMDR an effective and rapid treatment for individuals suffering from PTSD or depression.3,4 When considering psychological intervention studies, it’s important to note that results are profoundly influenced by the skills of the practitioners involved. Many therapists worldwide use EMDR and obtain good results.

The underlying mechanisms connecting eye movements to the mental processing and eventual release of traumatic memories and negative convictions are unknown. It’s hypothesized that left-to-right eye movements, which bilaterally stimulate the hemispheres of the brain, expedite the release and resolution of deep-seated negative beliefs. This neurological process facilitates emotional healing. Thus, when applied to individuals struggling with behavioral changes, EMDR represents a rapid and effective way to move through the emotional and cognitive resistance obstructing attempts to create a healthier life.

— Rita Carey Rubin, MS, RD, CDE, is a dietitian practicing in northern Arizona.

— Bill Rubin, MS, has been a psychotherapist for 30 years and has trained in EMDR with Francine Shapiro, PhD.


1. Shapiro F, Forrest MS. EMDR: The Breakthrough “Eye Movement” Therapy for Overcoming Anxiety, Stress, and Trauma. New York: Basic Books;1997:18.

2. Devilly GJ, Spence SH. The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of post-traumatic stress disorder. J Anxiety Disord. 1999;13(1-2):131-157.

3. Bisson JI, Ehlers A, Matthews R, Pilling S, Richards D, Turner S. Psychological treatments for chronic post-traumatic stress disorder. Br J Psychiatry. 2007;190:97-104.

4. Bae H, Kim D, Park YC. Eye movement desensitization and reprocessing for adolescent depression. Psychiatry Investig. 2008;5(1):60-65.