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various evidence-based treatments is limited, even when their efficacy had been demon-
strated in a controlled trial. The results further suggest that patients recover from a short
course of treatment but that the vast majority of patients need prolonged additional treat-
ment. As noted by Ost, Thulin, and Ramnerö (2004), “there is still much room for further
development of CBT methods for PDA [panic disorder with agoraphobia] because only
60% of the patients treated in RCTs [randomized controlled trials] published since 1990
have achieved a clinically significant improvement” (p. 1106).
Given these findings and the difficulty that many clients experience in undergoing direct
therapeutic exposure to their fear and body sensations, EMDR is emerging as a viable treat-
ment alternative. However, to understand how EMDR may be beneficial in the treatment of
panic disorders, with or without agoraphobia, an explanation of the theoretical framework
for EMDR, the adaptive information processing (AIP; Shapiro, 1995, 2001, 2002) model,
is necessary. In brief, the AIP model is based on the idea that the neurobiological system
naturally attempts to process current perceptions in a manner that promotes associations to
relevant stored information, to facilitate learning, and to relieve emotional distress. The
resulting transfer of information from implicit to explicit memory systems (Shapiro, 2001;
Stickgold, 2002) allows disturbing thoughts, emotions, and bodily sensations to be resolved
by facilitating access to the stored material and linking it with more adaptive information.
However, the intense affect and subsequent dissociation that accompany trauma may inter-
fere with this process, causing the information (e.g., images, thoughts, emotions, and sen-
sations) to be dysfunctionally stored within the memory network. Because the event is
isolated within the network, preventing associations with adaptive information, the unre-
solved material is easily triggered during similar encounters, often leading to intrusive
thoughts, emotions, and somatic responses. The consequent habitual response patterns can
manifest in characterological difficulties, psychopathology, and the avoidance behaviors
associated with phobias and panic disorders.
Does the AIP model have a place among the models of fear acquisition? There is much
debate in the literature about whether fear is acquired through associative conditioning or
whether it is nonassociative (innate) by nature (Davey, 2002; Kleinknecht, 2002; Marks,
2002; McNally, 2002; Mineka & Ohman, 2002; Poulton & Menzies, 2002a, 2002b). Some
theorists believe that fear acquisition requires an aversive event that serves as an associa-
tive learning experience, although memory of the event may not be accessible within the
memory network (Kleinknecht, 2002; Mineka & Ohman, 2002). Other theorists support the
nonassociative model, which proposes that certain fears have been naturally selected
because of their ability to provide safety (e.g., fear of heights, water, strangers, etc.), and
are therefore innate in all humans (Poulton & Menzies, 2002a, 2002b). Because exposure
to the fear-provoking stimuli over time facilitates habituation, those with limited opportu-
nities of exposure are at risk of phobias (Poulton & Menzies, 2002a, 2002b). The AIP
model would emphasize that regardless of origin, the problem is essentially formed and
sustained by the inability of adaptive information to link with the network containing infor-
mation regarding the feared event.
Although proponents of the conditioning model might appreciate EMDR ability to
access and target an etiological conditioning event, it is also possible to address past, present,
and future symptoms in the absence of a known etiological event. Thus, EMDR has the
ability to address panic and phobia regardless of the method by which the symptoms, or
46 Clinical Case Studies