Eye Movement Desensitization and Reprocessing (EMDR)

What is it?

EMDR (Eye Movement Desensitization and Reprocessing) therapy is a type of therapy that uses bilateral stimulation to assist people in the recovery process from traumas or distressing experiences. Initially used for PTSD, this practice has expanded to help in other less traumatic, yet limiting, areas.

In simple terms helps patients rewire the reactions and mental associations with an unpleasant event. Over a few sessions, the old links associated with these memories are replaced with new ones, creating new, healthier behaviors. Unlike other treatments that focus on directly altering the emotions, thoughts, and responses, EMDR therapy focuses directly on the memory. It intends to change the way the memory lives in the brain, thus reducing or eliminating problematic symptoms.

Core philosophy

The basics

For many people, EMDR is a  new concept. It is oftentimes a complement to psychotherapy sessions and it is based on the premise that traumas are memories that could not be properly processed. Instead, negative emotions and associations crystallized and became “stuck” in the psyche of the individual. When trigger events occur, these emotions come to the surface, creating undesired behaviors.

There are eight phases of treatment and the initial one focuses on taking a thorough client history followed by a preparation stage. In the Rapid Eye Movement portion, the client focuses on a troubling memory and identifies the belief they have about themselves connected to this negative memory. For example, in dealing with rape, the person may believe “I am dirty”. The individual then formulates a positive belief that they would like to have about themselves (“I am worthwhile and a good person in control of my life”).

The therapist takes notes of all the physical sensations and emotions that accompany the memory. The individual then goes over the memory while focusing on an external stimulus that creates bilateral (side to side) eye movement (Dual Attention Stimulation (DAS)). Therapists often achieve this by moving a finger. After each set of bilateral movements, the therapist assesses how the individual feels. This process continues until the memory is no longer disturbing. The individual is processing the trauma with both hemispheres of the brain stimulated. At this point, the therapist installs the positive belief, via bilateral movement, to replace the negative one. Each session normally lasts for about one hour.

Interactions with our brain

When we learn a new behavior we create a new neural network. Frequent repetitions of the behavior strengthen that neural network through myelination of the nerve pathways which allow the signals to move quickly. Traumatic memories can be thought of as impaired encoding of neural networks. These memories are not integrated with other positive experiences and are limited in their ability to accommodate new information.

Traumatic memories live in the right hemisphere of the brain. EMDR Therapy helps you build bridges and access your resources. This occurs by reactivating the neural networks associated with a traumatic event and facilitating integration throughout the brain. EMDR works because the “bilateral” stimulation bypasses the area of the brain that has become stuck due to the trauma and is preventing the left side of the brain from self-soothing the right side of the brain.

There have been several hypothesized reasons for the effectiveness of EMDR Therapy. Dr. Arielle Schwartz summarizes them as:

  • DAS taxes working memory: this interrupts your ability to focus on the disturbances associated with the traumatic event.
  • DAS rhythms stimulate the cerebellum and thalamus: stimulation of the thalamocortical connections appears to enhance information processing throughout the brain.
  • Bilateral eye movements mimic REM sleep: this facilitates communication across left and right hemispheres.
  • DAS stimulates the anterior cingulate cortex (ACC): The ACC connects upper brain centers to lower brain centers, associated with relief from flooding and re-experiencing symptoms of PTSD.
  • DAS stimulates the orienting response: The orienting response is a reflex that draws your attention to new stimuli. It allows you to observe your current environment and to assess threat. It helps you integrate new information which can change emotionally loaded memories.

These various hypothesized mechanisms of EMDR Therapy are not mutually exclusive. The actual underlying mechanisms are still a subject of research.

History

Walking in the park

In 1987, Francine Shapiro was strolling in the park when she noticed that eye movements alleviated the negative emotions associated with her own distressing memories. She made a conclusion that the eye movement had a desensitization effect and tried that with other people, getting the same results. She also concluded that the eye movement by itself did not have a therapeutic effect, so she decided to add other treatment elements, including a cognitive component, and developed a standard procedure that she called Eye Movement Desensitization (EMD).

Shapiro designed a randomized controlled study later that year, investigating the impact of EMDR on people suffering from posttraumatic stress disorder (PTSD). In this study, published in 1989 in the Journal of Traumatic Stress and the Journal of Behavior Therapy and Experimental Psychiatry, she discovered that “almost without exception, those treated with EMDR successfully resolved their traumatic memory”.

Shapiro continued to develop this treatment approach, incorporating feedback from clients and other clinicians who were using EMD. In 1991 she changed the name to Eye Movement Desensitization and Reprocessing (EMDR) to reflect the insights and cognitive changes that occurred during treatment, and to identify the information processing theory that she developed to explain the treatment effects.

Expanding the field

Shapiro felt compelled to train other individuals in this technique in order to help people. However, since EMDR was still experimental, she decided to only teach it to licensed clinicians, trained only by the EMDR Institute in the same model. In 1995, the label experimental was removed and a textbook of procedures was published. Since the initial studies were published in 1989, hundreds of case studies have been published and there have been numerous controlled outcome studies. These studies have demonstrated EMDR’s effectiveness in PTSD treatment and EMDR is now recognized as efficacious in the treatment of PTSD.

A professional association, independent from Shapiro and the EMDR Institute was founded in 1995 to establish standards for training and practice. The EMDR International Association (EMDRIA) states its primary goal is to “establish, maintain, and promote the highest standards of excellence and integrity in Eye Movement Desensitization and Reprocessing (EMDR) practice, research and education.”

As with other alternative practices, some people consider EMDR a pseudoscience despite its effectiveness. However, this method is very popular nowadays as an effective technique to speed up emotional and mental healing.

Benefits and uses

EMDR has long been used to treat people with PTSD, anxiety, and depression. It has shown, however, to have benefits for all people. Here are a few ways that EMDR treatment can help you.

Change your beliefs

Many of us subconsciously hold self-limiting beliefs based on unhappy experiences in our past. Perhaps a childhood rejection has led you to feel as if your presence is an imposition to those around you. EMDR treatment helps to take the power away from these negative beliefs, showing you that they are merely an interpretation of an event and that other, more valid, and positive interpretations are available.

Recover from trauma

Psychologists recommend EMDR for PTSD sufferers, as it has proven extremely effective at processing all kinds of trauma. Through bilateral stimulation, both sides of the brain engage to reprocess distressing memories.

Speed up results

EMDR therapy takes a different approach from that of talk therapy, and issues that patients have tried to talk through for years can resolve in a handful of sessions. You also don’t have to divulge every detail of your memories in EMDR, which is helpful if you have trouble vocalizing.

Manage stress in the initial phases

Everyday stresses take a toll over time if not dealt with, and can lead to complete burnout. There’s no need to wait until you feel completely overwhelmed to do something about it, however. Having the occasional EMDR therapy session can help you unburden yourself from all the stresses on your shoulders.

Enhance yourself

EMDR treatment is valuable for everybody, not just people who are consciously suffering. Transforming negative beliefs can improve your relationships, work performance, creativity, health, and more. By quieting the voice that says “I can’t” or “why bother”, you unlock your true potential.

Who practices it

Since its creation back in 1989 by the psychologist Francine Shapiro, over 20,000 mental health professionals have become certified in this practice. In order to become certified in EMDR, you must have a degree. This can be a social work degree, a degree in psychiatry, a degree in psychology, etc. Your average person cannot enroll in an EMDR certification class and expect to treat patients using this technique.

The EMDR International Association (EMDRIA) is a nonprofit public benefit corporation, which is a professional association for EMDR practitioners. EMDRIA offers high principles of quality and reliability in EMDR therapy certification.

EMDR therapy trained clinicians are initially considered “EMDR Therapy Trained” upon completion of their training. Becoming an EMDR Certified Therapist involves ongoing EMDR Consultation with an EMDRIA Approved Consultant. This process can take anywhere from approximately one year to several years beyond completion of the training.

Looking at the EMDRIA directory is a great place to find qualified practitioners in your area. When looking for EMDR therapists, never hesitate to ask questions, including their credentials, where they trained, and if they are working towards certification. Ask them about their own description of EMDR and how and when they use it with patients. Much like psychotherapy, finding a good EMDR therapist is much about fit.

What to expect

Initial phase

Your EMDR therapy session could take anywhere from three sessions to several months of sessions. It consists of eight distinct phases, which span across this time period. The process is complete when you feel empowered to take back your life from the trauma that has been controlling it.

Keeping in mind that each EMDR session is approximately 60 minutes, you probably won’t get too far into the process during your first session, but you will start laying the ground for Phase 1, also known as History-Taking. In this phase, you will be:

  • Getting to know your therapist: with the goal of feeling comfortable in the treatment environment.
  • Talking about your childhood: this will help expose many traumatic events (since usually they happen during childhood).
  • Discussion of mental predispositions: where you will discuss your belief systems. This is the time where you need to be open and honest.
  • Digging at core issues: at this point, you should be discussing the sources of your distress. This might include sharing negative feelings or talking about bad memories.

Subsequent phases

Subsequent phases are:

  • Phase 2 – Preparation: During this phase, your therapist will help you learn ways to deal with stress and anxiety.
  • Phase 3 – Assessment: The therapist will have you select one of the targeted memories you selected in phase one. You’ll identify a vivid mental image related to the memory as well as a negative belief about yourself and related emotions and body sensations. The therapist will also ask you to identify a positive belief related to the mental picture of the memory.
  • Phase 4 – Desensitization: While you focus on the targeted memory, your therapist will lead you through stimulation sets. These sets may include eye movements, tactile taps, or auditory tones. After each stimulation set, your therapist will instruct you to discuss any insights that came to mind. This process continues until the target memory no longer distresses you.
  • Phase 5 – Installation: When you are no longer experiencing distress, your therapist will ask you to focus on your positive belief. While doing this, your therapist will take you through more stimulation sets.
  • Phase 6 – Body Scan: After you strengthened your positive belief, your therapist will ask you to note if you have any sort of physical response while thinking of the target memory and the positive belief. The purpose of this is to identify any residual distress.
  • Phase 7 – Closure: During this phase, you and your therapist will discuss the positive steps you’ve made. Your therapist may assign homework to help maintain progress between sessions.
  • Phase 8 – Reevaluation: Every new session begins with reevaluation. You and your therapist will discuss your current psychological state and whether the treatment is working.

While the sequence of these phases is linear, one phase can span multiple sessions. Also, these phases can be repeated depending on the patient’s progress.

Interesting facts

EMDR is a specific and very effective treatment that can help you in your wellness journey. Here are some interesting facts about EMDR:

  • EMDR is the most extensively researched method of treatment for PTSD. In fact, a 2007 study found that EMDR was more effective for PTSD patients than Prozac, an antidepressant medication.
  • Studies show that PTSD symptoms from a single traumatic event can often be resolved in three to six sessions of EMDR.
  • Many PTSD patients find it easier to gain benefit from EMDR than traditional psychotherapy and counseling. Perhaps because it targets the traumatic experience.
  • EMDR makes use of the brain’s neuroplasticity. When a memory is activated, the chemistry of that neuronal circuit enters a malleable state. This presents an opportunity to decouple the patient’s feeling of threat from the traumatic memory.

Closing statement

EMDR Therapy can be an effective treatment for patients experiencing a mental health crisis who have a trauma picture, resulting in significant improvements in their mental well-being. The underlying principles of EMDR apply, however, to more subtle, less traumatic aspects of the psyche, driving positive behavior.

EMDR can be either a very specific way of addressing particular unresolved points or it can be a complement to your psychotherapy sessions. By creating room in your brain to reframe and make sense of poor experiences in a positive way, EMDR can have a meaningful impact on your everyday life.