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adapt [2026/09/28 10:36] – Link governing principles; clarify residual and prospective stimuli, coping hypotheses and outcome dependencies. andrewtaustinadapt [2026/09/28 14:52] (current) – Improve narrow-screen chronicity layout, callout spacing and reference-link formatting andrewtaustin
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 The practical purpose of this framework is to guide decisions before, during and after an IEMT intervention. A proposed governing aim is to help the person develop responses that support their chosen life, health and relationships under actual conditions. This means considering environmental changes and other sources of help, agreeing outcomes beyond immediate relief, and revising the formulation in response to what happens. See [[governing_principles|Roy’s Adaptation Model as Governing Principles for IEMT Practice]] for the proposed principles and a formulation record. The practical purpose of this framework is to guide decisions before, during and after an IEMT intervention. A proposed governing aim is to help the person develop responses that support their chosen life, health and relationships under actual conditions. This means considering environmental changes and other sources of help, agreeing outcomes beyond immediate relief, and revising the formulation in response to what happens. See [[governing_principles|Roy’s Adaptation Model as Governing Principles for IEMT Practice]] for the proposed principles and a formulation record.
  
-<WRAP center round important 90%>+<WRAP round important>
 **Evidence and scope** **Evidence and scope**
  
-IEMT is a developing approach. A 2026 peer-reviewed exploratory study involving 33 adults from the general population found lower self-reported distress after both IEMT-directed and EMDR-directed eye movements than after a control condition, immediately and at one-week follow-up. IEMT and EMDR did not differ significantly. The study was small, used a non-clinical sample and a single negative memory, and does not establish IEMT as a treatment for PTSD or any other diagnosis.[(iemtstudy>van Heugten-van der Kloet D, Boonstra A, Trouk N and ten Brinke A (2026), “An Exploratory Comparison of IEMT- Versus EMDR-Directed Eye Movements on Changes in Emotionality and Distress During Recall of Negative Memories”, //Journal of Evidence-Based Psychotherapies// 26(1), 1–18.[[https://doi.org/10.24193/jebp.2026.1.1|DOI]])]+IEMT is a developing approach. A 2026 peer-reviewed exploratory study involving 33 adults from the general population found lower self-reported distress after both IEMT-directed and EMDR-directed eye movements than after a control condition, immediately and at one-week follow-up. IEMT and EMDR did not differ significantly. The study was small, used a non-clinical sample and a single negative memory, and does not establish IEMT as a treatment for PTSD or any other diagnosis.[(iemtstudy>van Heugten-van der Kloet D, Boonstra A, Trouk N and ten Brinke A (2026), “An Exploratory Comparison of IEMT- Versus EMDR-Directed Eye Movements on Changes in Emotionality and Distress During Recall of Negative Memories”, //Journal of Evidence-Based Psychotherapies// 26(1), 1–18. [[https://doi.org/10.24193/jebp.2026.1.1|DOI]])]
  
 This framework should therefore be read as a way of organising assessment, reflection and outcome monitoring. It is not a diagnosis, a medical explanation or a substitute for evidence-based mental-health or medical care. This framework should therefore be read as a way of organising assessment, reflection and outcome monitoring. It is not a diagnosis, a medical explanation or a substitute for evidence-based mental-health or medical care.
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 ==== Sister Callista Roy and the development of RAM ==== ==== Sister Callista Roy and the development of RAM ====
  
-Sister Callista Roy began developing her adaptation model while studying nursing in the 1960s and published its conceptual framework in 1970. The model became internationally influential in nursing education, research and practice. Boston College describes its central proposition as the promotion of patient adaptation through attention to the whole person—biological, psychological, social and spiritual—in interaction with a changing environment.[(roybc>Boston College (2016), “50th Anniversary of the Roy Adaptation Model”.[[https://www.bc.edu/bc-web/bcnews/science-tech-and-health/nursing/roy-adaptation-model.html|Boston College]])]+Sister Callista Roy began developing her adaptation model while studying nursing in the 1960s and published its conceptual framework in 1970. The model became internationally influential in nursing education, research and practice. Boston College describes its central proposition as the promotion of patient adaptation through attention to the whole person—biological, psychological, social and spiritual—in interaction with a changing environment.[(roybc>Boston College (2016), “50th Anniversary of the Roy Adaptation Model”. [[https://www.bc.edu/bc-web/bcnews/science-tech-and-health/nursing/roy-adaptation-model.html|Boston College]])]
  
-Roy and colleagues continued to refine the model across several decades.[(royresearch>Roy C, Whetsell MV and Frederickson K (2009), “The Roy Adaptation Model and Research”, //Nursing Science Quarterly// 22(3), 209–211.[[https://pubmed.ncbi.nlm.nih.gov/19694080/|PubMed]])] The model is best understood as a nursing conceptual system: it provides a disciplined way to assess the person and environment, identify effective and ineffective responses, select interventions and review outcomes.+Roy and colleagues continued to refine the model across several decades.[(royresearch>Roy C, Whetsell MV and Frederickson K (2009), “The Roy Adaptation Model and Research”, //Nursing Science Quarterly// 22(3), 209–211. [[https://pubmed.ncbi.nlm.nih.gov/19694080/|PubMed]])] The model is best understood as a nursing conceptual system: it provides a disciplined way to assess the person and environment, identify effective and ineffective responses, select interventions and review outcomes.
  
 ==== IEMT and the adaptation lens ==== ==== IEMT and the adaptation lens ====
  
-IEMT was developed by Andrew T. Austin from 2006, drawing on earlier eye-movement approaches and later incorporating work on language, identity and interactional patterns. A concise account appears in the //SAGE Encyclopedia of Theory in Counseling and Psychotherapy//.[(austin2015>Austin AT (2015), “Integral Eye Movement Therapy”, in //The SAGE Encyclopedia of Theory in Counseling and Psychotherapy//, pp. 540–541.[[https://doi.org/10.4135/9781483346502.n187|DOI]])]+IEMT was developed by Andrew T. Austin from 2006, drawing on earlier eye-movement approaches and later incorporating work on language, identity and interactional patterns. A concise account appears in the //SAGE Encyclopedia of Theory in Counseling and Psychotherapy//.[(austin2015>Austin AT (2015), “Integral Eye Movement Therapy”, in //The SAGE Encyclopedia of Theory in Counseling and Psychotherapy//, pp. 540–541. [[https://doi.org/10.4135/9781483346502.n187|DOI]])]
  
 IEMT asks how a person learned a particular feeling or way of being, how that pattern is reproduced in the present, and what happens when the associated representation is updated. The Adaptive IEMT Model adds a wider systems question: IEMT asks how a person learned a particular feeling or way of being, how that pattern is reproduced in the present, and what happens when the associated representation is updated. The Adaptive IEMT Model adds a wider systems question:
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 The person is an **open system**. Inputs from the environment are processed through coping mechanisms; responses become visible in behaviour and functioning; consequences then feed back into the person–environment relationship. The person is an **open system**. Inputs from the environment are processed through coping mechanisms; responses become visible in behaviour and functioning; consequences then feed back into the person–environment relationship.
  
-<WRAP center round box 90%>+<WRAP round box>
 **A simplified adaptive loop** **A simplified adaptive loop**
  
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 The [[iemt#patterns_of_chronicity|Patterns of Chronicity]] are practitioner labels for recurring interactional patterns. They are **not diagnoses, personality types or evidence that the client is deliberately resisting change**. In this proposed application, a recurring pattern may be explored as an attempt to manage a particular demand. Its function and consequences remain questions for assessment. An IEMT pattern label does not by itself establish compensatory adaptation in Roy’s model, deliberate resistance or a cause of the client’s difficulty. The [[iemt#patterns_of_chronicity|Patterns of Chronicity]] are practitioner labels for recurring interactional patterns. They are **not diagnoses, personality types or evidence that the client is deliberately resisting change**. In this proposed application, a recurring pattern may be explored as an attempt to manage a particular demand. Its function and consequences remain questions for assessment. An IEMT pattern label does not by itself establish compensatory adaptation in Roy’s model, deliberate resistance or a cause of the client’s difficulty.
  
-^ Pattern ^ Observable form ^ Possible adaptive function ^ Possible cost ^ Practitioner focus ^ +**The Three-Stage Over-Reaction** 
-| **The Three-Stage Over-Reaction** | Escalating emotion, pressure or intensity in response to another person. | Attempts to secure recognition, protection or change in the environment. | Regulation becomes dependent on the other person’s reaction; conflict may escalate. | Slow the sequence, identify the trigger and consequence, and restore internal choice without dismissing legitimate needs. | + 
-| **The Maybe Man** | Repeated uncertainty or qualification when identifying experience: “maybe”, “perhaps”, “I don’t know”. | Avoids premature commitment, error, conflict or an unwanted identity implication. | The target remains too diffuse to evaluate or update. | Respect genuine uncertainty while distinguishing missing information from habitual non-commitment. | +  * **Observable form:** Escalating emotion, pressure or intensity in response to another person. 
-| **The Great Big What-If** | Repeated hypothetical exceptions are used to dismiss a proposition without examining the person’s relevant experience. | May postpone commitment or seek certainty; this remains a hypothesis. | Can prevent a useful proposition from being considered or tested. | Address legitimate concerns, clarify the specific exception, and distinguish this sequence from ordinary anticipation or reasonable doubt. | +  * **Possible adaptive function:** Attempts to secure recognition, protection or change in the environment. 
-| **Testing for the Existence of the Problem** | Repeated checking to see whether the old feeling, symptom or identity remains. | Seeks certainty and protects continuity with a familiar self-state. | Checking may recreate attention, arousal or doubt and obscure functional change. | Agree in advance how change will be measured and shift testing towards real-world behaviour over time. | +  * **Possible cost:** Regulation becomes dependent on the other person’s reaction; conflict may escalate. 
-| **Being at Effect** | Experience is described as entirely caused and controlled by another person or event. | Communicates impact, locates responsibility or protects against self-blame. | If applied globally, it may conceal areas of influence and choice. | Validate actual impact and power differences while identifying the smallest safe domain of agency. |+  * **Practitioner focus:** Slow the sequence, identify the trigger and consequence, and restore internal choice without dismissing legitimate needs. 
 + 
 +**The Maybe Man** 
 + 
 +  * **Observable form:** Repeated uncertainty or qualification when identifying experience: “maybe”, “perhaps”, “I don’t know”. 
 +  * **Possible adaptive function:** Avoids premature commitment, error, conflict or an unwanted identity implication. 
 +  * **Possible cost:** The target remains too diffuse to evaluate or update. 
 +  * **Practitioner focus:** Respect genuine uncertainty while distinguishing missing information from habitual non-commitment. 
 + 
 +**The Great Big What-If** 
 + 
 +  * **Observable form:** Repeated hypothetical exceptions are used to dismiss a proposition without examining the person’s relevant experience. 
 +  * **Possible adaptive function:** May postpone commitment or seek certainty; this remains a hypothesis. 
 +  * **Possible cost:** Can prevent a useful proposition from being considered or tested. 
 +  * **Practitioner focus:** Address legitimate concerns, clarify the specific exception, and distinguish this sequence from ordinary anticipation or reasonable doubt. 
 + 
 +**Testing for the Existence of the Problem** 
 + 
 +  * **Observable form:** Repeated checking to see whether the old feeling, symptom or identity remains. 
 +  * **Possible adaptive function:** Seeks certainty and protects continuity with a familiar self-state. 
 +  * **Possible cost:** Checking may recreate attention, arousal or doubt and obscure functional change. 
 +  * **Practitioner focus:** Agree in advance how change will be measured and shift testing towards real-world behaviour over time. 
 + 
 +**Being at Effect** 
 + 
 +  * **Observable form:** Experience is described as entirely caused and controlled by another person or event. 
 +  * **Possible adaptive function:** Communicates impact, locates responsibility or protects against self-blame. 
 +  * **Possible cost:** If applied globally, it may conceal areas of influence and choice. 
 +  * **Practitioner focus:** Validate actual impact and power differences while identifying the smallest safe domain of agency.
  
 A pattern should only be named when doing so is useful, respectful and grounded in observable interaction. The label must never be used to override the client’s account, minimise abuse or relocate responsibility from a harmful environment to the person experiencing it. A pattern should only be named when doing so is useful, respectful and grounded in observable interaction. The label must never be used to override the client’s account, minimise abuse or relocate responsibility from a harmful environment to the person experiencing it.
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 ===== Worked formulation example ===== ===== Worked formulation example =====
  
-<WRAP center round box 95%>+<WRAP round box>
 **Illustrative example only — not a treatment prescription** **Illustrative example only — not a treatment prescription**
  
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 ===== Physiological adaptation and Selye’s General Adaptation Syndrome ===== ===== Physiological adaptation and Selye’s General Adaptation Syndrome =====
  
-Hans Selye’s General Adaptation Syndrome (GAS) is a historically important model of the non-specific biological stress response. It describes **alarm**, **resistance** and **exhaustion**.[(selye1950>Selye H (1950), “Stress and the General Adaptation Syndrome”, //British Medical Journal// 1(4667), 1383–1392.[[https://pubmed.ncbi.nlm.nih.gov/15426759/|PubMed]])]+Hans Selye’s General Adaptation Syndrome (GAS) is a historically important model of the non-specific biological stress response. It describes **alarm**, **resistance** and **exhaustion**.[(selye1950>Selye H (1950), “Stress and the General Adaptation Syndrome”, //British Medical Journal// 1(4667), 1383–1392. [[https://pubmed.ncbi.nlm.nih.gov/15426759/|PubMed]])]
  
   * **Alarm** describes initial mobilisation in response to a challenge.   * **Alarm** describes initial mobilisation in response to a challenge.
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   * **Exhaustion** describes breakdown when demands exceed the organism’s capacity over time.   * **Exhaustion** describes breakdown when demands exceed the organism’s capacity over time.
  
-GAS can offer a memorable analogy for acute mobilisation, sustained coping and overload. It should not be used as a literal account of every psychological problem. Selye’s model was developed largely from physiological research and has recognised imprecisions; contemporary stress science is more differentiated.[(gashistory>Jackson M (2014), “Evaluating the Role of Hans Selye in the Modern History of Stress”, in //Stress, Shock, and Adaptation in the Twentieth Century//.[[https://www.ncbi.nlm.nih.gov/books/NBK349158/|NCBI Bookshelf]])]+GAS can offer a memorable analogy for acute mobilisation, sustained coping and overload. It should not be used as a literal account of every psychological problem. Selye’s model was developed largely from physiological research and has recognised imprecisions; contemporary stress science is more differentiated.[(gashistory>Jackson M (2014), “Evaluating the Role of Hans Selye in the Modern History of Stress”, in //Stress, Shock, and Adaptation in the Twentieth Century//. [[https://www.ncbi.nlm.nih.gov/books/NBK349158/|NCBI Bookshelf]])]
  
 In particular: In particular:
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 ==== Direct IEMT research ==== ==== Direct IEMT research ====
  
-The 2026 study by van Heugten-van der Kloet and colleagues is the most directly relevant controlled research currently cited on this page. All 33 participants received IEMT, EMDR and control conditions in randomised order while recalling a pre-selected negative memory. Both active conditions produced lower Subjective Units of Distress scores than control immediately after the intervention and at one-week follow-up; IEMT and EMDR did not significantly differ. While blinded to the condition labels, 60.6% of participants preferred IEMT.[(iemtstudy2>Maastricht University research record for van Heugten-van der Kloet et al. (2026).[[https://cris.maastrichtuniversity.nl/en/publications/an-exploratory-comparison-of-iemt-versus-emdr-directed-eye-moveme/|Maastricht University]])]+The 2026 study by van Heugten-van der Kloet and colleagues is the most directly relevant controlled research currently cited on this page. All 33 participants received IEMT, EMDR and control conditions in randomised order while recalling a pre-selected negative memory. Both active conditions produced lower Subjective Units of Distress scores than control immediately after the intervention and at one-week follow-up; IEMT and EMDR did not significantly differ. While blinded to the condition labels, 60.6% of participants preferred IEMT.[(iemtstudy2>Maastricht University research record for van Heugten-van der Kloet et al. (2026). [[https://cris.maastrichtuniversity.nl/en/publications/an-exploratory-comparison-of-iemt-versus-emdr-directed-eye-moveme/|Maastricht University]])]
  
 **What this supports:** IEMT-directed eye movements merit further investigation for short-term modulation of distress linked to a negative autobiographical memory. **What this supports:** IEMT-directed eye movements merit further investigation for short-term modulation of distress linked to a negative autobiographical memory.
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 ==== Broader eye-movement research ==== ==== Broader eye-movement research ====
  
-Laboratory and clinical-component studies of eye movements during memory recall have often examined a **working-memory account**: recalling an image and performing a concurrent task compete for limited working-memory resources, which may reduce subsequent vividness or emotionality.[(gunterbodner>Gunter RW and Bodner GE (2008), “How eye movements affect unpleasant memories: support for a working-memory account”, //Behaviour Research and Therapy// 46(8), 913–931.[[https://doi.org/10.1016/j.brat.2008.04.006|DOI]])]+Laboratory and clinical-component studies of eye movements during memory recall have often examined a **working-memory account**: recalling an image and performing a concurrent task compete for limited working-memory resources, which may reduce subsequent vividness or emotionality.[(gunterbodner>Gunter RW and Bodner GE (2008), “How eye movements affect unpleasant memories: support for a working-memory account”, //Behaviour Research and Therapy// 46(8), 913–931. [[https://doi.org/10.1016/j.brat.2008.04.006|DOI]])]
  
-A 2021 meta-analysis of laboratory dual-task studies found support for modulation of emotional memories, including through tasks other than eye movements.[(mertens2021>Mertens G, Lund M and Engelhard IM (2021), “The effectiveness of dual-task interventions for modulating emotional memories in the laboratory: a meta-analysis”, //Acta Psychologica// 220, 103424.[[https://doi.org/10.1016/j.actpsy.2021.103424|DOI]])] However, laboratory changes in ratings are not the same as durable clinical recovery.+A 2021 meta-analysis of laboratory dual-task studies found support for modulation of emotional memories, including through tasks other than eye movements.[(mertens2021>Mertens G, Lund M and Engelhard IM (2021), “The effectiveness of dual-task interventions for modulating emotional memories in the laboratory: a meta-analysis”, //Acta Psychologica// 220, 103424. [[https://doi.org/10.1016/j.actpsy.2021.103424|DOI]])] However, laboratory changes in ratings are not the same as durable clinical recovery.
  
-Mechanism findings are mixed. For example, a 2024 randomised trial of eye-movement desensitisation versus retrieval-only in 91 people with PTSD did not find added neurocognitive benefits from eye movements; both conditions improved over time.[(susanty2024>Susanty D et al. (2024), “The effect of eye movement desensitization on neurocognitive functioning compared to retrieval-only in PTSD patients: a randomized controlled trial”, //BMC Psychiatry//.[[https://pmc.ncbi.nlm.nih.gov/articles/PMC11673372/|Full text]])] This does not test IEMT, but it cautions against presenting any single eye-movement mechanism as settled.+Mechanism findings are mixed. For example, a 2024 randomised trial of eye-movement desensitisation versus retrieval-only in 91 people with PTSD did not find added neurocognitive benefits from eye movements; both conditions improved over time.[(susanty2024>Susanty D et al. (2024), “The effect of eye movement desensitization on neurocognitive functioning compared to retrieval-only in PTSD patients: a randomized controlled trial”, //BMC Psychiatry//. [[https://pmc.ncbi.nlm.nih.gov/articles/PMC11673372/|Full text]])] This does not test IEMT, but it cautions against presenting any single eye-movement mechanism as settled.
  
 ==== Clinical-guideline context ==== ==== Clinical-guideline context ====
  
-Major clinical guidelines cited here recommend trauma-focused CBT and/or EMDR for PTSD. NICE specifies that EMDR should use a validated manual, be delivered by trained practitioners with ongoing supervision, and include preparation and methods for managing distress.[(niceptsd>National Institute for Health and Care Excellence, PTSD guideline NG116, recommendations 1.6.18–1.6.20; last reviewed 2025.[[https://www.nice.org.uk/guidance/ng116/chapter/recommendations|NICE]])] The World Health Organization’s 2023 guidance likewise includes trauma-focused CBT and EMDR among interventions that should be considered for adults with PTSD.[(whoptsd>World Health Organization (2023), “Posttraumatic stress disorder: psychological interventions – adults”.[[https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/conditions-related-to-stress/posttraumatic-stress-disorder-%28ptsd%29--psychological-interventions---adults|WHO]])]+Major clinical guidelines cited here recommend trauma-focused CBT and/or EMDR for PTSD. NICE specifies that EMDR should use a validated manual, be delivered by trained practitioners with ongoing supervision, and include preparation and methods for managing distress.[(niceptsd>National Institute for Health and Care Excellence, PTSD guideline NG116, recommendations 1.6.18–1.6.20; last reviewed 2025. [[https://www.nice.org.uk/guidance/ng116/chapter/recommendations|NICE]])] The World Health Organization’s 2023 guidance likewise includes trauma-focused CBT and EMDR among interventions that should be considered for adults with PTSD.[(whoptsd>World Health Organization (2023), “Posttraumatic stress disorder: psychological interventions – adults”. [[https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/conditions-related-to-stress/posttraumatic-stress-disorder-%28ptsd%29--psychological-interventions---adults|WHO]])]
  
 These sources do not establish IEMT as equivalent to EMDR. Practitioners and clients should not infer that similarity in one component, or one exploratory comparison, confers the evidence status of a complete guideline-recommended treatment. These sources do not establish IEMT as equivalent to EMDR. Practitioners and clients should not infer that similarity in one component, or one exploratory comparison, confers the evidence status of a complete guideline-recommended treatment.
  • Last modified: 2026/09/28 10:36
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