# Bolstering the adaptive information processing model: a narrative review - Bolstering the adaptive information processing model: a narrative review

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# Bolstering the adaptive information processing model: a narrative review - Bolstering the adaptive information processing model: a narrative review

October 25, 2024Recent Articles

**Uyarlanabilir bilgi işleme modelinin güçlendirilmesi: Bir anlatı incelemesi - *Bolstering the adaptive information processing model: a narrative review***

Authors: Jenny Ann Rydberg*, Lisa Virgitti and Cyril Tarquinio

University of Lorraine, Inserm, INSPIIRE, Nancy, France

Translated by: Specialist Psychologist Gizem Pozam

In recent years, various theoretical models have been proposed to complement the adaptive information processing model of eye movement desensitization and reprocessing therapy. A narrative review of these models was conducted to assess their individual contributions, as well as their convergences, contradictions, and potential complementarities. Seven theoretical models were identified. All focus on the effects of EMDR therapy as a comprehensive psychotherapeutic approach, with its principles, procedures, and protocols. Some refer to concepts related to propositional or predictive processing theories. Overall, the contribution of these proposals appears to bolster Shapiro's original AIP model, potentially offering additional depth and breadth to case conceptualization and treatment planning in clinical practice, as well as a more precise theoretical understanding. The present exploratory comparative analysis may serve as a preliminary foundation to guide research into the relative value of the theoretical proposals put forward to improve current standards for the clinical practice and teaching of EMDR therapy.

KEYWORDS

EMDR, adaptive information processing, theory, psychotherapy, psychopathology, integration

1 Introduction

Over the past thirty years, considerable efforts have been made to explain how the following occur

How EMDR therapy works, that is, how treatment effects are achieved at the neurological or cerebral level, has been explained through various proposed mechanisms of action (1, 2). Most focus on the bilateral or dual-attention stimulation (BL/DAS) component of EMDR, typically eye movements. However, the treatment outcomes of EMDR as a comprehensive psychotherapeutic approach cannot be explained by BL/DAS alone; other mediators are believed to exist among the “core elements that, in their total form rather than as independent elements, we believe are essential and unique to EMDR therapy” (3, p. 192).

Theoretical models, on the other hand, primarily address the more abstract or higher-level question of why a treatment method works. Although they may address how specific mediators activate particular neurophysiological mechanisms, they are situated within a broader framework that can also encompass mental, cognitive, emotional, behavioral, somatic, and social levels. The purpose of such theoretical models of psychotherapy is to describe and explain the origins of psychopathology, the methods, techniques, and principles used in implementing a particular approach, and how these bring about therapeutic change.

The adaptive information processing (AIP) model is regarded by the vast majority of EMDR clinicians worldwide as unique, inherent, and essential to the practice of EMDR therapy (4, 5). Understandably, given this consensus, no alternative theories have been presented, although a small number of complementary theoretical models have proposed additional dimensions or constructs to extend Shapiro's original model. To our knowledge, no review has yet been conducted to describe, compare, or summarize these proposals, and they are very rarely cited in other EMDR literature. In other words, the potential value of their contributions has remained largely untapped. This article represents a step toward filling that gap.

2 Method

A narrative review methodology (6) was followed to identify articles presenting complementary, alternative, or contradictory theoretical models of EMDR therapy. To be included, articles had to address Shapiro's AIP model (4, 7, 8) while also proposing new theoretical hypotheses about the origins of psychopathology or the effects of EMDR treatment.

A comparative analysis was then conducted to explore how Shapiro's AIP model could be compared with and distinguished from the other theoretical proposals.

The source of the original AIP model is the three editions of Francine Shapiro's (4, 7, 8) seminal book Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme: Temel protokoller, ilkeler ve prosedürler. To identify articles addressing proposed additions or modifications to the AIP model, two searches were conducted for articles published up to July 1, 2023: (1) a comprehensive review of all articles in EMDR Uygulama ve Araştırma Dergisi and (2) a search of PsycInfo, Web of Science, and Google Scholar using keywords related to “EMDR,” “model,” “theory,” and “adaptive information processing.” Of approximately 100 articles initially identified, eighteen were retained based on their titles and abstracts, and only nine remained after an in-depth examination of their content. These nine articles propose seven theoretical models (two of which consist of two parts and therefore two articles).

The AIP model and each of the seven other theoretical models are summarized below. Due to space constraints and to enable comparison, the descriptions are abbreviated and therefore necessarily incomplete. The authors' recommendations for EMDR practice and their discussions of neurological evidence have been substantially condensed. These descriptions are then supplemented by a comparative analysis.

3 Description of the theoretical models

3.1 The original model: adaptive information processing

The AIP model constitutes the “general model that provides the theoretical framework and principles” guiding EMDR treatment, as well as “an explanation of the basis of pathology and personality development” (8, p. 30).

The AIP model is presented as a working hypothesis and proposes that the brain contains an intrinsic, adaptive, physiological information processing system “configured to process information and restore mental health ... just as the rest of the body is physiologically configured to heal when injured” (7, p. 15). This system “allows information to be processed to an ‘adaptive resolution’ ... connections are made with appropriate associations and ... the experience ... is integrated into a positive emotional and cognitive schema ... that can be used in the future” (7, p. 29). This hypothesis draws on the concept of memory networks, understood as associated systems or patterns of information such as memories, thoughts, images, emotions, and sensations (8, p. 33; 4, p. 26). Shapiro used the term neural network to refer to “the neurobiological configuration of an individual memory” (4, p. 26). EMDR therapy is conceptualized as progressing through memory networks associated with the initial treatment target—“a specific memory or dream image; a person; an actual, imagined, or projected event; or some aspect of experience such as a bodily sensation or thought” (8, p. 34).

The information processing paradigm “provides a way to explain the treatment effects and guide the appropriate application of the method to various presenting problems” in EMDR therapy (8, p. 16). When this information processing system is blocked, dysfunction and pathology arise: most psychopathology is “derived from earlier life experiences that activate a continuing pattern of affect, behavior, cognitions, and consequent identity structures ... (the pathological structure) is inherent in the static, insufficiently processed information stored at the time of the disturbing event” (7, p. 14). “Pathology is viewed as configured by the impact of earlier experiences held in the brain in a state-specific form” (4, p. 15).

Shapiro's initial discovery during a walk in the park in 1987 led to the realization that rapid eye movements promote accelerated information processing of past experiences underlying current dysfunction and pathology. Other forms of BL/DAS (auditory or tactile) were subsequently shown to have similar effects. Clinical experience and feedback led to the development and refinement of principles, protocols, and procedures consistent with the AIP model, implemented as a comprehensive treatment approach and resulting in greater treatment effects than those produced by “EMD as originally described” (4, p. 15). These effects involve not only desensitization (e.g., “the reduction of emotional or physical reactivity to stimuli achieved through means such as deconditioning techniques”; 9), but also cognitive restructuring of memories, the emergence of spontaneous insights, and increased self-efficacy, referred to as reprocessing (8, p. 13).

Shapiro proposed the AIP model as a unifying theory underlying all psychological methods (7, p. 52), since all can “ultimately be described as working with information physiologically stored in the brain” (p. 17). Thus, EMDR therapy may be considered one method among “a range of Accelerated Information Processing treatments” (p. 29).

3.2 Complementary models

3.2.1 A dialectical perspective

Dialectical structures are structures of polarity that result in a dynamic unity of opposites. The dialectical perspective of Laub and colleagues (10–12) is presented as applicable to various psychotherapeutic approaches, with the potential to enrich understanding of how the adaptive information processing system operates and how it can be facilitated.

This view builds on the dialectical premise that change arises from the internal movement of a developmental process toward optimal integration—more specifically, two information processing movements: the horizontal dialectical movement between opposites and the vertical dialectical movement of whole/part shifts.

The horizontal dialectical movement can be compared to Shapiro's (8) proposal that dysfunctionally stored and adaptive information are linked through their respective memory networks in EMDR therapy. Laub and colleagues (10) also describe this as the movement of an emerging sequence of thesis, antithesis, and synthesis, with the final step representing a higher level of integration with a new balance.

The vertical dialectical movement rests on the observation that the universe operates as a highly differentiated collection of interacting systems, hierarchically organized within larger systems: a whole thus becomes part of a higher-order whole. This hierarchical organization expands toward greater integration or wholeness through whole/part shifts. Such a sequence may progress from a fragment to an event, then to an episode, a theme, and finally an identity.

With its two movements, this dialectical perspective illustrates how differentiation and linking constitute complementary aspects of the AIP system. Psychopathology such as PTSD arises when there is excessive differentiation (avoidance, hypoactivation) or excessive linking (intrusions, hyperactivation). EMDR therapy facilitates the restoration of balance between these two dialectical movements, the integration of experience, and the formation of new adaptive memory networks.

In clinical practice, this perspective calls for a focus on facilitating the horizontal dialectical movement between opposites (e.g., between a traumatic memory and a resourced experience, or between past dysfunctional relationships and the current therapeutic alliance) and the vertical movement of whole/part shifts to integrate the many aspects of experience.

3.2.2 Neural cognition theory

Neural cognition theory (or Theorie neuronale de la ́ Cognition: TnC) is a general framework intended to elucidate cognitive processes at the neural network level (13, 14). Khalfa and Touzet (15) argue that the treatment effects of EMDR therapy can be explained simply by the properties of normally functioning neurons and neural networks.

In TnC, “the cortical column is the information processing unit for continuous values, whereas the neuron only handles transient binary values” (13, p. 2). A cortical column is a functional cluster of 110,000 neurons. Since a single neuron will become exhausted after a few dozen repeated depolarizations (spikes), such cortical columns of neurons are necessary to ensure sustained neural activity.

“The total number of neurons in the brain is estimated at 82 billion, but the cortex accounts for only 20% of the total number of neurons in the brain. This means that the number of cortical columns is close to 160,000. Recent careful analyses of cortical architecture have shown that the cortex [consists of] 360 areas (or cortical maps), with an average of 450 columns per map” (13, p. 2). “Each map is [dedicated] to a particular dimension of the event. Cortical maps receive sensory inputs from the visual, auditory, olfactory, and proprioceptive cortices (or primary cortex). The secondary cortex [consists of] maps that receive inputs from the maps of the primary cortex and represent relationships such as those between shape and color.”

Research has identified the functional role of eighty of the 360 cortical maps mentioned above; this role consists of encoding a particular dimension of reality (i.e., a high-level representation such as machines, faces, body parts, or animals). The cortex can therefore be understood as “a hierarchy of maps, each encoding a specific dimension of a situation or event and each organized according to the person's unique experiences” (13, p. 2). “Within a particular map, at any given time, there is competition between columns due to local inhibition between them: each inhibits the others but is also inhibited by them. . All neural activities of a GSA are coherent, meaning that they are part of an attractor that bends the dynamics of the activities toward the memorized GSA” (13, p. 3).

3.2.2.1 Neural cognition theory, stress, and traumatic memory

The physiological changes associated with potentially dangerous situations are known as stress. These changes are adaptive solutions involving enhanced strength and accelerated processing. A potentially dangerous situation must be recognized and identified as quickly as possible to achieve the shortest possible response latency. This latency increases by 10 ms with each cortical step. The need for speed therefore overrides the need for precision: recognition takes place in a single cortical step, even if it is less refined. This is the role of the amygdala, which acts as an early warning system that initiates fight-or-flight behaviors. In parallel, the cortex analyzes the situation in detail and can interrupt the defensive behavior initiated (in the event of a false alarm) or supplement the ongoing action (in the event of a confirmed threat).

The amygdala “is known to be fundamental to the acquisition and expression of fear conditioning, as well as its extinction. It has strong connections with the medial prefrontal cortex (mPFC)” (13, p. 4).

Stress-induced accelerated processing requires enhanced neural memorization, so that a single event permits learning and automatically strengthens the GSA associated with the stressful situation. This GSA will be easily recalled, and each recall will produce the same physiological stress response, causing this GSA to prevail over others. This corresponds to acute stress disorder or PTSD.

The stressful situation experienced by the person leads to the formation of a traumatic memory, which is part of episodic memory. Compared with controls, patients with PTSD appear to show abnormal activation in the amygdala and prefrontal cortex in response to such situations. The amygdala recognizes the traumatic event, which is then processed by the cortex. “Synaptic LTP guarantees that memorization of the traumatic event involves neural connections between the amygdalae and the cortex ... In addition to its cortical representation, the GSA of the traumatic event includes activation of the amygdalae. Whenever the event is recalled ... part of the amygdala is also activated ... with the automatic stress response ... causing a negative emotion. Each recall strengthens the association between the cortex and the amygdalae” (13, p. 4).

Flashbacks in PTSD can be understood as repeated recall of traumatic events that maintains and even reinforces the stress response. However, a potentially traumatizing event does not invariably lead to PTSD. “According to TnC, ... the impact of the event will depend on pre-existing cortical and amygdala connections for similar GSAs. The more a set of GSAs has been strengthened by several traumatic or harmful events, the greater the person's risk of developing PTSD may be” (13, p. 4).

3.2.2.2 Bilateral or dual-attention stimulation and new global states of activation

Within TnC, Khalfa and Touzet (13) relate BL/DAS to GSAs as follows: sensory neurons detect BL/DAS and transmit the information to their target neurons, which in turn propagate the information, and so on. When the therapist elicits the client's traumatic memory, the current GSA is the one representing that traumatic memory (GSA0). Further information is progressively elaborated, leading to the addition of new column activations to GSA0. The new GSA—GSA1—is a stable GSA, meaning one in which the added columns are relevant, and this added information can be verbalized by the client.

GSA1 is larger than GSA0, and Khalfa and Touzet (13) note that it does not involve any new connections with the amygdala. Amygdala activation decreases in relative weight compared with cortical activation. During each iteration of trauma recall and BL/DAS, new column activities are added to the current GSA. After N sets of BL/DAS, the initial GSA0 has been replaced by a new, larger GSA—GSAn—which no longer elicits amygdala activation because the additional columns have no connections to it. In addition, the prefrontal cortex is more involved in the new GSAn. The stress response no longer occurs, and the client no longer experiences intense negative emotions related to the traumatic memory. The additional columns correspond to aspects that are new in the context of GSA0, and this can be described as memory reconsolidation or the learning of new associations.

Finally, Khalfa and Touzet (13, p. 5) argue that TnC can also explain “why it is more effective than non-alternating bilateral stimulation or unilateral stimulation. Bilateral stimuli have a broader recruitment area than unilateral stimuli. The ability of stimulation to recruit a broad area depends on map-level predictions that elicit inhibitory processes. Alternation and intermittency are discontinuities that do not support predictions. Since predictions permit inhibition, less predictable stimuli are more effective than non-alternating bilateral or non-intermittent bilateral stimuli.”

With regard to the AIP model, TnC accepts that traumatic events are stored in the brain with their original emotions, sensations, and beliefs and are subsequently reconsolidated. TnC's explanations address the neural mechanisms underlying reconsolidation and argue that this memory reconsolidation involves “both learning new associations and forgetting old ones” (13, p. 6). However, no specific recommendations for clinical practice are offered.

3.2.3 The three-dimensional model of the experiential self

Fingelkurts and Fingelkurts (16) suggest that their previously published, neurophysiologically grounded, three-dimensional model of the complex experiential self (17, 18) could serve as a more comprehensive theoretical model of EMDR therapy, since other proposed mechanisms of action, which they group into three broad categories (working memory, psychophysiological, and sleep-related), fail to account for the full range of EMDR therapy's effects in treating post-traumatic stress disorder (PTSD).

The three-dimensional model of the experiential self (3DMES) is based on the neurophysiology of the default mode network, identified as the self-referential brain network, and the functional-topographic specialization of three subnetworks or operational modules within this network, as studied both under normal, healthy conditions and under pathological conditions in which self-consciousness is diminished or lost.

The three brain operational modules (OMs; the anterior OM, right posterior OM, and left posterior OM) can be estimated easily and reliably by applying operational analysis to the EEG signal. They represent three distinct types of self-referential processing that together create a unified sense of self.

The anterior module mediates the first-person perspective and sense of agency. It can be likened to the sense of a ‘witnessing observer’ or ‘Self.’ The right posterior module supports (a) the experience of the self as a localized, embodied entity through interoceptive and exteroceptive processing, (b) thoughts about emotions, and (c) autobiographical memories; together, these form the basis of representational-emotional agency or the sense of ‘Me.’ The left posterior module accompanies the experience of thinking about and reflecting on oneself, including moment-to-moment narrative thoughts and inner speech. This corresponds to reflective agency or the sense of ‘I.’

Each module is irreducible to the others and can become stronger or weaker depending on the individual's physiological and mental state, training (e.g., meditation), or pathology (e.g., PTSD).

The Fingelkurts brothers report that their research examining functional integrity (through EEG operational synchrony) shows that individuals with PTSD symptoms exhibit a pattern of reduced integrity of the left posterior OM (the ‘I’ component), alongside increased integrity of the anterior OM (the ‘Self’ component) and right posterior OM (the ‘Me’ component). These findings help explain the experiences of individuals with PTSD: hyperactivity and heightened vigilance toward oneself and one's surroundings = increased ‘Self’; heightened emotional, sensory, and somatic states that tend to re-emerge as persistent intrusions = increased ‘Me’; and greater avoidance/reduced narration, a lack of verbal representation and linguistic/contextual information, often leading to detachment and depersonalization/derealization = decreased ‘I’ (16).

These findings lead to recommendations that PTSD therapy should aim to increase functional synchrony in the left posterior OM and decrease functional synchrony in the anterior and right posterior OMs. Such changes correspond to the effects of EMDR therapy. Although such effects may also be observed in other psychotherapeutic approaches, Fingelkurts and Fingelkurts argue that EMDR therapy is uniquely suited to achieving these goals because of the neurophysiology of eye movements (EM). Their detailed explanation refers to saccadic eye movements, together with the finding that EM-related changes in neural activity occur predominantly in the alpha frequency range, corresponding to 7–13 Hz oscillations in the EEG signal. The authors offer no recommendations or implications for clinical practice.

3.2.4 The network balance model of trauma and resolution

Chamberlin's (19, 20) network balance model of trauma and resolution (NBMTR) aims to clarify the biological basis of how the dysfunctionally stored memories postulated by the AIP model are formed and subsequently resolved into a state of mental health, using EMDR therapy as an example.

3.2.4.1 Level I

The first level of the NBMTR (19) is based on the triple network model of psychopathology, which proposes that major clinical syndromes may arise from dysfunction in the brain's large-scale neural networks (21): the default mode network (DMN; responsible for internal reflection), the central executive network (CEN; active when a person is engaged in a task related to the external world), and the salience network (SN; the “network switch” involved in emotional processing, homeostatic regulation, and reward). Although optimal processing of experience requires coordination among these networks, this balance can be compromised or lost under conditions of severe stress, disrupting coordination among critical structures embedded within these networks (e.g., the hippocampus, amygdala, and prefrontal cortex).

Whereas the triple network model and its applications to PTSD emphasize dysfunction within individual networks, the NBMTR proposes that dysfunction arises from disrupted patterns of interaction among large-scale networks as a complex adaptive system. PTSD results from insufficiently processed and dysfunctionally stored memories and the accompanying failure to restore network balance. The critical factor in treating PTSD is therefore the restoration of network balance and adaptive information processing, combining emotional processing (SN) and the elaboration of associated cognitions (CEN), while maintaining awareness of internal experience (DMN) as well as the external environment (CEN).

The NBMTR explains that in PTSD, the DMN is hypoactive (as it corresponds to prefrontal cortex and hippocampal areas), as is the CEN (also associated with the prefrontal cortex), whereas the SN is hyperactive (associated with the amygdala). Furthermore, stress-induced disruptions in network balance do not resolve in PTSD, leading to a vicious cycle: prefrontal cortex functioning decreases, the amygdala produces even more norepinephrine and dopamine, and this further reduces prefrontal cortex activity. Over time, this can result in a persistent state of dysregulation, blocked information processing, and the formation of memories characterized by vivid ‘flashbulb’ recollections alongside fragmentation and loss of memory for contextual details—the ‘dysfunctionally stored memories’ of the AIP model. It is precisely this vicious cycle that maintains network imbalance and blocks the AIP system, causing specific memories to be processed dysfunctionally.

From the NBMTR perspective, the protocols and procedures of EMDR therapy are particularly well suited to eliciting and promoting balance among large-scale neural networks. Chamberlin argues that the standard protocol is highly consistent with what she calls ‘contemporary network science,’ with each phase activating particular neural networks in a specific sequence. No new changes to current protocols and procedures are therefore proposed. The EMDR therapist facilitates a state of network balance, which is necessary for adaptive information processing of memories. Interventions for blocked processing include changing the direction or speed of eye movements (activating the CEN), attending to sensations (activating the SN), or returning to the target (activating the DMN) to restore network balance. From the NBMTR perspective, if the networks are balanced, the memory will process.

3.2.4.2 Level II

The second level of the NBMTR (20) focuses on the role of memory as the fundamental substrate for predictions that guide behavior. It can be described as a goal-directed processing perspective, proposing that if networks are balanced, poor predictions based on dysfunctionally stored memories will be mismatched and the memories will be updated.

Predictive processing theory provides a way to understand many cognitive activities, such as perception, attention, and learning, from the perspective that the brain's main function is to predict its own immediate experience through probabilistic inference, use sensations as feedback to verify the accuracy of its predictions, and minimize prediction errors.

The predictive processing model of EMDR focuses on memory as the fundamental substrate for predictions that guide behavior through cycles of perceptual inference. Incoming sensory information cues the retrieval of specific memories. The brain alternates between sampling the external world and searching memory in a continuous stream of processing. The cycle of selecting incoming information, matching it from memory, predicting, and further sampling continues throughout life as the brain attempts to minimize errors in its predictions. When the brain registers a prediction error, it can update memory through a process of memory reconsolidation, thereby reducing uncertainty and enabling more successful behavior in the future.

The predictive processing perspective is highly consistent with the AIP model's description of dysfunctionally stored memories as the basis of post-traumatic psychopathology. If memory is the substrate of predictive processing, then such state-specific memories, frozen in time, will lead to prediction errors and suboptimal behavior. The NBMTR postulates that imbalance in the SN, DMN, and CEN compromises the coordinated interaction of brain regions required to carry out this processing, obstructing the brain's usual efforts to minimize prediction errors and improve future predictions and behavior. Once network balance is restored, the memory will be processed and reconsolidated. No recommendations for clinical practice have been formulated at this level.

Chamberlin extensively reviews research on eye movements to explain various clinical phenomena observed in EMDR therapy, such as the restoration of attention, facilitation of memory search, and amplification of prediction errors to enhance memory reconsolidation. Reviewing neurobiological research in detail, the author cites findings suggesting that “the hippocampal theta rhythm is crucial in regulating information flow through the neural circuits responsible for encoding and retrieving episodic memory ... saccadic eye movements play a critical role in this by resetting the theta rhythm and thus synchronizing incoming information flow through different regions, including the hippocampus and prefrontal cortex, in the processing of experience and memory” (20, p. 5).

3.2.5 The Zeigarnik effect

The Zeigarnik effect (ZE) is a property of memory discovered in 1927 by psychologist Bluma Zeigarnik, who observed that individuals remember interrupted tasks better than completed tasks. Fox (22) shows that some components of EMDR treatment involve mechanisms related to the ZE that may contribute to the effectiveness and efficiency of EMDR therapy.

The ZE directs attention toward an unfinished goal, particularly through intrusive memories and the engagement of cognitive resources. Failure to complete personally meaningful tasks activates the motivational component of rumination, creating a memory bias toward completing the interrupted behavior.

This lack of completion is characteristic of traumatizing events—the ZE therefore plays a role in the development and maintenance of PTSD. From the AIP perspective, the ZE is related to the intrusions, ruminations, and re-experiencing characteristic of PTSD, which can be understood as attempts to integrate maladaptive memory networks of unprocessed traumatic experiences into adaptive memory networks. While rumination may facilitate integration, it may also increase subjective distress and result in overwhelm or subsequent avoidance. The dual demands to both assimilate and avoid traumatic material account for the hyperarousal/re-experiencing and avoidance observed in PTSD.

Fox argues that activation of the targeted memory network in EMDR therapy is maintained by the ZE's drive toward completion, which elicits impulses toward resolving unfinished actions and thereby strengthens motivation in subsequent stages of the treatment process.

Prospective memory, which enables a person to remember to perform intended actions at a particular future time, includes both a prospective dimension (recalling the memory at the appropriate time) and a retrospective dimension (remembering the task itself). Individuals often recognize that a traumatic event is unfinished but fail to act on the prospective intention. EMDR may alleviate both the retrospective and prospective aspects of prospective memory through the different phases and prongs of the standard protocol.

During EMDR processing, the client's focus on the memory is repeatedly interrupted by the question, “What do you notice now?” These interruptions are likely to heighten the ZE by adding salience to the memory of the unfinished task (the traumatic event), thereby sustaining attention and motivation toward completing the action. In terms of clinical implications, Fox suggests that therapists identify events experienced as unfinished for targeting and encourage clients to imagine how they would like such situations to end, in order to increase their motivation toward completion.

3.2.6 The biopsychosocial adaptive information processing model

Cotraccia's biopsychosocial AIP (BPS-AIP) model (23) expands the psychological and social dimensions in addition to Shapiro's description of neural networks inherent in the information processing system. The effects of adverse life experiences on the AIP system are seen not only as disruptions of neurophysiological structures, but also as imbalances in personal and interpersonal processes of communication and representation.

In this view, attachment relationships can either provide the context for trauma or facilitate access to adaptive information (past instances of adaptive actions) and appropriate updating of models of the self and the world (the source of adaptive resolution or healing). The pathogenic nature of traumatic experiences lies in their capacity to disrupt communication and representation at subpersonal (brain), personal (self), and interpersonal (others, relationships) levels.

According to Cotraccia, the biopsychosocial availability of adaptive information is essential to the effectiveness of EMDR therapy. Early relationships establish context-sensitive constraints that structure experiences into healthy/integrated or dissociated/unintegrated internal working models (IWMs), through instances of communicating with caregivers and developing adaptive ways to cope with stressful situations. Each IWM can be viewed as an attractor, that is, a state space to which a system returns after a temporary disturbance.

From an information processing theory perspective, BPS-AIP conceptualizes trauma as disruptive noise, defined by a lack of resources for attunement and communication rather than by the nature of the stimuli present in the experience. Conversely, the capacity for internal and interpersonal attunement serves as an indicator of the robustness of the BPS-AIP system. In EMDR therapy, the psychosocial components of the therapeutic relationship are viewed as causally related to positive outcomes through the provision of a context that enables the consolidation of autobiographical memory.

A decade after the initial publication, Cotraccia (24) expanded the model to incorporate Graziano's (25, 26) work on attention schemas and social cognition, defining an attention schema as content integrated with implicit self-models that sustain subjective mental states of BPS connectedness or disconnectedness. According to this theory, the brain contains a model or schema that predicts what it and others will attend to and to which it itself attends.

In a connected BPS-AIP system, there is a degree of integration among subpersonal, personal, and interpersonal levels that allows the individual to maintain autonoetic consciousness (the experience of self) under stress and over time. In a disconnected BPS-AIP system, however, the person may lose the experience of autonoetic consciousness under stress.

Stressful life experiences become traumatizing when there is a failure of global BPS-AIP connectedness. The BPS-AIP system then reorganizes around the lack (absence) of attentional resources: there is an intolerance of sustaining attention to one's own process, and the scarcity of information gathered from subjective experience impairs self-regulatory and homeostatic functioning. A BPS-AIP system organized around disconnection continually searches for something that is absent but should be present. The person's behavior and attention focus on others' experiences, leaving the trauma unattended.

The therapeutic relationship in EMDR therapy offers something that should be present but is missing: a self-modeling system that enables adjustable monitoring of attention between therapist and client within an interpersonal interaction, thereby supporting the client's engagement with their own self-process.

In terms of clinical applications, Cotraccia recommends identifying maladaptive attractors or IWMs to target these relational experiences and representations of the self and the world. Cotraccia also highlights the value of the therapeutic relationship and reparative attachment experiences, as well as the importance of developing autonoetic consciousness in producing treatment effects.

3.2.7 The goal-directed predictive processing perspective

Vanderschoot and Van Dessel (27) discuss recent evidence that contradicts dominant theories of fear-, anxiety-, and stress-related disorders in general and PTSD in particular, as well as theories of trauma-focused therapy, including the AIP model, which have traditionally relied on conditioning effects and associative mental processes. Propositional theories, on the other hand, argue that the generation and activation of propositional information (inference-making) promote and sustain maladaptive behavior.

As these authors note, recent neuroscientific insights have contributed to the growing popularity of predictive processing (PP) theories, which propose that belief-based processes involving causal inferences (i.e., predictions) form the basis of cognition.

Propositional information differs from associative information in that it has a truth value and can encode variations in the type of relationship between two events or representations (e.g., “speaking loudly can protect against rejection” or “speaking loudly can cause rejection”). Thus, unlike associations, which cannot capture beliefs, propositions support inferential reasoning. These differences have important implications that support the idea that propositional theories of PTSD may offer added value over associative theories.

Vanderschoot and Van Dessel illustrate how the AIP model can be adapted to integrate lessons from propositional theories. Although some authors, such as Chamberlin (20), have attempted to explain PTSD and the effects of EMDR treatment within a PP framework, they argue that “these theories focus on explanation at the neural rather than the behavioral level and therefore do not provide guidance for predicting and influencing behavior that can readily be integrated into clear recommendations for clinical practice. PP theories [comprise many different implementations] and often involve reference to various complex constructs and processes that may be difficult to translate into and integrate with EMDR theory and practice” (27, p. 112). The goal-directed predictive processing (GDPP) perspective therefore identifies the core premises of leading propositional theories at the level of cognitive and mental processes.

3.2.7.1 Core premises

The mental system as a network of beliefs about the world. Inferences are drawn from these beliefs and form the basis of thoughts, feelings, and behavior. While causal inferences or predictions influence perceptions, behavior corresponds to ‘active inference,’ which involves predicting one's own behavior.

Highly automatic inferences that follow general principles of biological systems, such as entropy reduction. An individual's belief network comprises different belief modules activated by particular contextual stimuli that evoke predictions. “These modules have a hierarchical structure, such that higher hierarchical levels contain more generative beliefs (i.e., beliefs that generate more predictions and are more generally applicable), whereas lower hierarchical levels contain beliefs that apply only to specific situations or aspects of the world” (27, p. 112). Beliefs from higher hierarchical levels carry more weight and can therefore override beliefs from lower levels. The goal of minimizing disorder arising from prediction errors underlies the process of updating beliefs and assigning them greater or lesser generative power.

Context-dependent inferences about desired outcomes (i.e., goals). Beliefs about desired outcomes lead to inferences about actions and behaviors likely to achieve those outcomes. In this view, goals determine all behavior. Activation of beliefs about a specific, contextually activated desired outcome may generate inferences that lead to maladaptive behavior, potentially conflicting with other personally relevant goals.

In summary, GDPP “explains behavior (and thoughts and feelings) as the outcome of three inferential steps. First, internal or external cues lead to the registration of (homeostatic) desired states (i.e., goals) ... Second, to reduce the prediction error between desired and actual states, inferences are made about the consequences of contextually relevant actions ... Finally, when a sufficient match is achieved between predicted action outcomes and current goals, action execution is predicted and the action is elicited” (27, p. 113).

3.2.7.2 The goal-directed predictive processing perspective on PTSD

The AIP model considers traumatic memories to be stored in distinct memory networks (belief modules in PP), disconnected from adaptive information in other networks. From the GDPP perspective, a traumatic event can lead to a substantial prediction error because of the large, unanticipated discrepancy between the actual (unsafe) state and the expected (safe) state. This prediction error is assigned high value because it conflicts with the goal of being safe and surviving (a fundamental homeostatic goal represented at a very high level). The belief network is updated immediately to minimize prediction error if this unexpected situation occurs again. However, the event may not be integrated into other existing belief modules because of inconsistencies with highly generative beliefs. Instead, a new module may be created that integrates as much sensory information as possible to provide sufficient opportunities to update the belief module in the future.

Contrary to the claim that memories and beliefs related to a traumatic event are frozen in time or stored in a state-specific form, the GDPP perspective considers prolonged suspension of processing unlikely (since there would be high entropy in the overall belief network). Instead, repeated attempts will be made to integrate memories of the traumatic event into existing belief networks. When trauma-related stimuli facilitate the prediction of similar events, prediction error will arise because the event is not encountered again, and the relevant beliefs and predictions will lose influence. In other words, these beliefs and predictions are represented at a lower level, meaning they are activated in fewer contexts and have a weaker influence on behavioral prediction.

In individuals at risk of PTSD, however, predictions may not be updated in this way. Instead, they may maladaptively believe that unpleasant events are likely to occur and that only avoidance behaviors prevent those events from recurring. As a result, they may continue to avoid the feared situation, thereby preventing adaptive updating of their predictions. From this perspective, the generative beliefs present in a person's belief network determine why some individuals develop PTSD while others do not.

3.2.7.3 The goal-directed predictive processing perspective on EMDR therapy

The GDPP perspective is highly compatible with the AIP model in understanding EMDR therapy as promoting the integration of information stored in trauma-related memory networks with information from more adaptive networks. An important difference, which could be considered a valuable update to the AIP model, is that relevant beliefs and predictions (rather than associations) should be regarded as the main target of therapy (focusing on updating beliefs rather than developing associations). More specifically, changes occur because of prediction errors that facilitate the integration of traumatic and adaptive information.

For optimal effectiveness, therapy should focus on supporting clients in learning to predict a reduction in their symptoms and representing these predictions at higher hierarchical levels to promote behavioral changes outside the therapeutic context. Clients should also be encouraged to confront avoided situations to elicit prediction errors and supported in generating new inferences based on past experiences of success and adaptive behavior. From the GDPP perspective, the main determinant of treatment success is the extent to which a client learns to predict the effectiveness of EMDR treatment based on their initial sessions in which they reprocess a previously avoided target, experience a reduction in associated distress, and observe changes in the relevant beliefs/predictions (e.g., from “I am in danger” to “I am safe”). These initial successes (the experience of processing a disturbing memory to an adaptive resolution) lead the client to predict the success and effectiveness of EMDR therapy in treating other (past, present, future) targets.

4 Comparison of the theoretical models

The comparative analysis of the original and complementary theoretical models included in this review focuses on the following questions:

- At which level(s) are the explanations or hypotheses focused (neural/neurophysiological, mental/cognitive, behavioral, etc.)?

- If included, what types of neurological evidence are described?

- Is an explanation of psychopathology provided, and does it relate specifically to PTSD, trauma-related pathology or dysfunction, or psychopathology and personality development in general?

- Are the effects of EMDR treatment attributed to or explained by BL/DAS?

- Are other potential mediators, or simply general EMDR principles and procedures, also identified as responsible for treatment effects?

- Is the AIP system mentioned as an innate system of the brain?

- Is the AIP model addressed?

- For the complementary models, what are the new aspects or constructs? In particular, is the model based on associative or predictive processing?

4.1 The adaptive information processing model

Shapiro's original AIP model (7) addresses mental and behavioral levels while stipulating their translation to the neural or neurophysiological level. It was developed on the basis of evidence from clinical practice before sufficient neurobiological data were available. Subsequent editions of Shapiro's seminal book (4, 8) incorporated the latest available research into the original model without introducing any fundamental changes. The AIP model aims to explain the origins of all psychopathology (not biologically based or chemically induced) and personality development, understood to arise from insufficiently processed, maladaptive traumatic memories held in a state-specific form. Treatment effects are attributed not only to BL/DAS but to the entire comprehensive psychotherapeutic approach, with its principles, procedures, and protocols. The central premise of the AIP model is the existence of an intrinsic information processing system in which associative processing plays an important role, while EMDR therapy is considered a particularly effective and efficient way to restore and enhance the functioning of this innate system—an effect described as accelerated information processing.

4.2 The dialectical perspective

The dialectical perspective (10) operates at mental and philosophical levels. It is not based on neurological evidence. Its explanation of psychopathology rests on the obstruction of the two dialectical movements, illustrated through the example of PTSD, without elaborating on how this process might contribute to other forms of psychopathology or dysfunction. The model does not focus on the specific effects of BL/DAS, instead considering the principles and procedural steps of EMDR therapy. It refers to associative processing and neither contradicts nor addresses potential limitations of the AIP model, merely proposing an explanation of how the innate AIP system functions, what obstructs it, and how EMDR therapy restores its functioning in a manner consistent with general principles of therapeutic change.

4.3 Neural cognition theory

TnC (13) addresses the neural level and how it translates to the cognitive level to provide an original description of the innate AIP system. It provides extensive detail about the organization of neurons into cortical columns and maps, their functioning, and the formation of GSAs across all brain structures. Its explanation of psychopathology is limited to PTSD. The effects of EMDR treatment are related both to BL/DAS and to EMDR procedural steps in general. The model refers equally to associations and predictions without identifying any potential conflict between the two types of processes. Regarding the AIP model, TnC agrees that traumatic events are stored with their original emotions, physical sensations, and beliefs and are reconsolidated through EMDR therapy. In this view, memory reconsolidation involves both learning new associations and forgetting old ones, and this learning relates to the predictive role of neuronal GSAs in cortical columns and other brain structures. In summary, this theory extends Shapiro's AIP model without arguing for any correction or modification and does not address the effectiveness of EMDR therapy beyond the treatment of PTSD.

4.4 The three-dimensional model of the experiential self

The 3DMES (16) operates at the neural level and focuses specifically on the DMN. It does not attempt to explain psychopathology or personality development in general, focusing solely on PTSD. Based on this disorder, it explains both the origins of pathology and how psychotherapeutic change is achieved. Some concepts, such as the distinctions between what the authors call Me/I, would have benefited from further clarification. While the Fingelkurts brothers claim to offer a more comprehensive theoretical model explaining the full range of EMDR treatment effects and psychotherapeutic change in general, they elaborate on why they believe the saccadic eye movements of EMDR therapy may be particularly effective in producing such therapeutic change. AIP as an innate system is not addressed, and the AIP model is mentioned only briefly to note that it does not provide a satisfactory explanation at the neurobiological or neurophysiological level. Finally, this model reasons in terms of neither associations nor predictions and does not advocate any changes to Shapiro's AIP model.

4.5 The network balance model of trauma and resolution

The NBMTR (19, 20) primarily considers the neural level and its implications for cognitive and behavioral levels. Its neural starting point is the notion that balance among three major large-scale neural networks is necessary for mental health and optimal functioning. It also explores the cognitive dimension through a predictive processing perspective. While the hypotheses at the first level of the model concern psychopathology in general, its second level places particular emphasis on PTSD in relation to the maladaptive, frozen-in-time memories described by Shapiro. The effects are not limited to BL/DAS. The NBMTR predictive processing model of EMDR focuses on memory as the fundamental substrate for predictions that guide behavior through cycles of perceptual inference. However, the NBMTR also mentions associative processing (for example, referring to “associations linking different networks”) without addressing potential inconsistencies between associative and predictive processes. It is presented as consistent and compatible with the AIP model and therefore proposes no changes to Shapiro's model.

4.6 The Zeigarnik effect

The ZE (22) operates at the mental and cognitive level. Although not based on neurological evidence, it attempts to provide neural and psychophysiological data consistent with its hypotheses. Psychopathology is conceptualized through the lens of trauma; personality development is not addressed. BL/DAS is viewed as only one of many mediators associated with the procedural steps of EMDR therapy. It treats the innate AIP system as a memory reconsolidation system and refers to the AIP model. It does not seek to criticize or contradict Shapiro's model, but merely offers an additional explanatory cognitive mechanism. While referring to both associations and predictive processing, it does not address potential contradictions between them.

4.7 The biopsychosocial adaptive information processing model

The BPS-AIP model (23, 24) focuses on cognitive and social/interpersonal levels to explain the development of personality and psychopathology through the lenses of trauma as noise and trauma as absence (without explicitly using these terms). Although eye movements are mentioned, they are presented as only one of many mediators explaining the treatment effects of EMDR therapy. The BPS-AIP model proposes that the innate AIP system is inherently biopsychosocial. It draws on attention schema and predictive processing theories to bridge the gap between neurophysiological hypotheses about mechanisms of action and the impact of interpersonal experiences involving attachment and attunement, or their inadequacy. Both associations and predictions are mentioned without comparing the two types of processes. BPS-AIP is presented as a proposal to complement rather than modify Shapiro's AIP model.

4.8 The goal-directed predictive processing perspective

The GDPP perspective (27) focuses on the mental and cognitive level. It provides an explanation for the development of PTSD and the treatment effects of EMDR therapy for PTSD without considering other forms of psychopathology or personality development. Eye movements or other forms of BL/DAS are understood to play an important role, but not to be solely responsible for outcomes. Indeed, the extent to which a client learns to predict the effectiveness of EMDR treatment is regarded as decisive. Shapiro's hypothesized AIP system is not addressed as such, but the GDPP perspective considers the mental system to constitute a network of beliefs about the world. While Vanderschoot and Van Dessel agree with the AIP model that EMDR therapy enables the integration of trauma-related information with more adaptive information, they advocate a significant modification of the AIP model: the main targets of therapy would be the relevant beliefs and predictions rather than associations, and the focus would be on updating beliefs rather than promoting associations. In this view, prediction errors promote change by facilitating the integration of traumatic information with adaptive information sufficiently consistent with the client's belief network.

5 Discussion

Seven theoretical models were identified and described in this narrative review. Although their levels of explanation differ, all address the AIP model to some degree and share the view that BL/DAS alone does not account for the full range of EMDR treatment effects. In other words, they share the aim of elaborating the theoretical foundations of the AIP model and EMDR as a comprehensive psychotherapeutic approach.

Four of the seven models focus primarily on psychological processes, two exclusively (the dialectical and GDPP perspectives), and two with reference to speculatively corroborating neural evidence to support the proposed psychological mechanisms (Zeigarnik and BPS-AIP). Unsurprisingly, the two predominantly neural models, TnC and 3DMES, were proposed by neuroscience researchers. The NBMTR adopts an intermediate position, addressing both neural aspects (based on large-scale neural networks) and the psychological dimension (through predictive processing theory).

According to Shapiro's AIP model, psychopathology and personality development can be explained as consequences of adverse or disturbing life experiences (sometimes termed big-T and small-t traumas). Although initial research focused on PTSD, subsequent studies have provided promising support for positive outcomes in other types of mental disorders (28). Shapiro consistently defined trauma in its broadest sense, in relation to blocked processing of memories associated with these experiences, thereby creating dysfunction. Among the complementary models, the Zeignarik and BPS-AIP proposals agree with Shapiro's understanding of trauma (traumatic experiences or traumatic memories) as the common origin of all psychopathology; the dialectical and NBMTR hypotheses also draw more narrowly on the example of PTSD. TnC, 3DMES, and the GDPP perspective address only the development of PTSD.

Regarding the popular view that traumatic memories are static and frozen in time, remaining in their original state-specific forms, most theoretical models either agree (TnC, NBMTR) or do not address the issue. The GDPP perspective disagrees, considering that the mental system will inevitably attempt to update memories and integrate them into existing belief networks. Instead, the GDPP model explores why some individuals are predisposed to avoid situations that would lead to prediction errors and the updating of trauma-related beliefs.

With the exception of the dialectical perspective and 3DMES, all complementary theoretical models refer to predictions or predictive processing. While most present these as compatible with the notion of associating maladaptively stored memories with adaptive memory networks, the GDPP perspective once again takes a different stance, going so far as to advocate a significant modification of the AIP model by replacing the concept of associative processing with predictive processing: in this view, merely facilitating associations would not suffice for therapeutic change. What is required, rather, is the updating of beliefs produced by prediction errors that promote the integration of traumatic information with adaptive information sufficiently consistent with the individual's belief network. Overall, however, there appears to be a majority view in favor of propositional and predictive processing theories, whether explicitly stated or not (e.g., in relation to GSAs, IWMs, belief modules, attention schemas, etc.). Another recurring concept among the complementary proposals is the balance necessary for health (e.g., within or between neural networks, between dialectical movements, or between attention to internal experience and awareness of the external world), paired with the idea that pathology arises when this balance is disrupted. This dynamic view contrasts with the immobility depicted in the AIP model's blocked processing and static memories.

Beyond the new insights, agreements, and areas of disagreement introduced by these complementary theoretical models, some questions appear to remain unanswered. If all psychopathology is trauma-based (arising from disturbing or adverse life experiences), why is there such a wide range of mental disorders and dysfunction in addition to PTSD, and what are the specific determinants of each? A theoretical model of EMDR therapy has yet to be presented that explains why, following similar experiences and comparable histories, one person develops PTSD, another develops a different mental disorder, and a third remains healthy or subclinical.

Furthermore, even if all non-organically based psychopathology is accepted as arising from trauma (which itself still awaits a precise definition), this does not mean that treatment strategies or effects applied to PTSD also apply to other diagnoses with different symptomatology. Why should the mechanisms of EMDR therapy used in treating PTSD be relevant to other disorders or forms of dysfunction? Conversely, if the same mechanisms apply to all disorders in all contexts, is there really a need for the many specialized EMDR protocols that have continued to be developed since Shapiro's (7) initial protocols and procedures for specific situations?

Indeed, if the AIP system is innate and universal, if all psychotherapeutic change involves accelerated information processing, and if all psychopathology involves pathogenic memories (29), then this effectively validates Shapiro's position that the AIP model could serve as a unifying theory for all psychological modalities. In this sense, the AIP model becomes a meta-model identifying common factors in all psychotherapeutic change and all psychopathology (not organically or chemically induced).

Furthermore, EMDR therapy is regarded as an integrative, comprehensive psychotherapeutic approach that cannot be reduced to the effects of its best-known component, eye movements (or other BL/DAS), as its name might suggest. Recently, the Council of Scholars' What Is EMDR? working group stated that what makes EMDR therapy unique is the way its procedural elements are combined (3). But in what way is this combination of integrative elements specific to EMDR therapy and potentially superior to other methods? None of the current theoretical models offers any guidance on this beyond the specific effects of BL/DAS, primarily eye movements—leaving open the question of whether hypotheses based on saccades have any relevance to the practice of EMDR therapy in clinical settings.

In summary, most complementary theoretical models are exclusively or largely psychological, while others introduce new ideas at the neural level. All focus on the effects of EMDR therapy as a comprehensive psychotherapeutic approach, with its principles, procedures, and protocols, sometimes also emphasizing the specific role of BL/DAS. Many refer to the concept of balance, and most incorporate concepts related to propositional theories or predictive processing.

It should be noted that the theoretical models reviewed do not propose any changes to existing treatment protocols beyond those already accepted within recognized specialized protocols, incompatible with standard protocols and procedures, or not already documented (in comparable language).

Overall, the cumulative contribution of these proposals appears to bolster Shapiro's original AIP model, potentially offering additional depth and breadth to case conceptualization and treatment planning in clinical practice, as well as a more precise theoretical understanding, but without involving significant changes to current standard clinical practice.

The present review shares the limitations of all narrative reviews, as it cannot claim the methodology associated with scoping or systematic reviews. Although some theoretical proposals complementary to the AIP model may have been overlooked, the present work should be considered a preliminary exploration of the potential value and relevance of the topic. Furthermore, a detailed review of the empirical literature on the hypotheses of each theoretical model could have enabled a more in-depth critical analysis of each model, but such an undertaking is beyond the scope of the present article and the space constraints of a single paper.

Future studies should assess the role of associative and predictive processing in EMDR therapy, verify the compatibility of the neurological and psychological processes described in the various models, and determine whether explanatory hypotheses based on saccadic eye movements are relevant to theoretical models or models of mechanisms of action, given the observation that “the smooth eye pursuit that occurs during EMDR therapy is in fact ... very different from saccadic movements” (2, p. 15). A larger, more comprehensive and systematic review could address both hypotheses about mechanisms of action related to the different mediators of EMDR therapy, including but not limited to BL/DAS, and broader theoretical proposals concerning EMDR therapy as a comprehensive psychotherapeutic approach. Future theoretical papers, on the other hand, could compare the theoretical proposals currently described for EMDR therapy and the AIP model with the models underlying other psychotherapeutic approaches and models of trauma-related and general psychopathology. Finally, future efforts could aim to assess how the AIP model might incorporate the unique determinants and trajectories that lead to the development of different forms of trauma-related psychopathology beyond PTSD.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material. Further inquiries may be directed to the corresponding author.

Author contributions

JR: Writing – review and editing, Writing – original draft, Methodology, Conceptualization. LV: Writing – review and editing, Investigation. CT: Writing – review and editing, Supervision.

Funding

The author(s) declare that they received no financial support for the research, authorship, and/or publication of this article.

Conflict of interest

JR serves as an editor for the Journal of EMDR Practice and Research, provides consultation on EMDR therapy, and has published books, book chapters, and articles on EMDR therapy. CT provides workshops and university courses in EMDR therapy and has published books, book chapters, and articles on EMDR therapy.

The other author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

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