What is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) Therapy is a therapeutic modality that aims to help individuals reduce the distress stemming from traumatic memories. EMDR is thought to be a shorter-term trauma treatment modality and can be very effective. EMDR operates under the assumption that the natural pathways in the brain work towards healing; however, trauma can create blocks in this process, preventing healing and creating worsening emotional distress. If these blockages can be removed, people can then go on to heal and move forward in healthy ways following trauma, and EMDR therapy aims to help people to do just that.
How did EMDR originate?
Psychologist Dr. Francine Shapiro founded EMDR therapy in 1987. The idea for EMDR came to Dr. Shapiro while she was walking in the park, and she realized that eye movements seemed to reduce the negative emotional reactions to her distressing memories. She began researching and conducting experiments, recognized that others responded positively to the effects of eye movements, and then started adding other therapeutic and cognitive treatment aspects to create what she called Eye Movement Desensitization (EMD). In 1991, after a few years of research into the evidence for EMD’s effectiveness, Shapiro changed the approach’s name to EMDR to fully encompass the treatment’s effects on information processing in the brain, in addition to its desensitization effects. She referred to this process as Accelerated Information Processing. After years of research, EMDR is widely accepted and recommended as an effective treatment modality.
How does EMDR work?
The theory behind EMDR involves the information processing system that all humans have. This system takes information from our experiences and environment and stores it as accessible memories. Our memories are stored as networks that include all associated sensory information, emotions, thoughts, etc. In everyday learning, new information combines with already stored material in memory. It becomes linked to our beliefs, emotions, thoughts, and bodily sensations in a way that makes sense in relation to past information. However, under traumatic or emotionally distressing circumstances, information processing is often interfered with and incomplete. It then blocks the new information from being connected with information that is held in previously stored memory networks, which can result in difficulty or inability to make sense of or fully process what the individual has gone through, because the memory is stored in a dysfunctional way and lacks the necessary associative connections from past memories. It can result in overwhelming, distressing emotional reactions, symptoms, thoughts, and feelings when these types of memories are triggered or recalled. It is when symptoms of PTSD, anxiety, depression, and other mental health diagnoses may be seen. EMDR aims to help individuals fully reprocess and integrate distressing memories so they can be linked to adaptive memory information and healthily stored in the brain, enabling the individual to heal and move forward.
What are the 8 phases of EMDR?
Phase 1: History Taking and Treatment Planning: In this phase, the client and therapist develop a shared understanding of the client’s treatment goals and how EMDR can best support them. The client’s history is explored, and a treatment plan is developed, including the selection of the traumatic events to be processed. Client resources and strengths are also explored during this time.
Phase 2: Preparation: During this phase, client-therapist rapport is established, the therapist explains the process of EMDR and sets expectations for the treatment, all client questions and concerns are addressed, and the client and therapist work on coping techniques to apply when the client feels overwhelmed or distressed by the content of the sessions.
Phase 3: Assessment: The target event to be reprocessed and the images, sensations, beliefs, and feelings the client has associated with it are identified. During this phase, the client will choose specific images or moments of the target event that best represent the memory, identify the emotions and physical sensations associated, and then choose a negative core belief related to the event (i.e., “I am unlovable”) and choose a replacement positive statement that they would rather believe. During this phase, the Subjective Units of Distress Scale is used to assess the emotional distress associated with the traumatic memory, rated from 1 (no distress) to 10 (maximum distress). The Validity of Cognition Scale is used to rate, on a scale from 1 (completely false) to 7 (entirely true), how much you believe in a positive self-cognition. An example of a positive cognition this scale might be measuring is how much you believe the statement “I am safe now.” These scales help to measure progress over time.
*Phases 4, 5, and 6 are the Reprocessing Phases and all utilize dual attention bilateral stimulation. In this process, the client is focusing on both the present moment and the distressing memory while engaging in eye movements, tapping, or sounds. This process helps the brain reprocess and reintegrate the memory.
Phase 4: Desensitization: The client will think about the traumatic event while engaging in eye movements or tapping until their Subjective Units of Distress Level reaches 0 or 1. The goal is to lower the distress and emotional reactivity associated with the event.
Phase 5: Installation: A new positive belief that contradicts previously held negative beliefs about the event is strengthened and repeated during bilateral stimulation. It is reinforced until it feels entirely true using the Validity of Cognition Scale.
Phase 6: Body Scan: The client scans their entire body, looking for continued negative sensations or distress while thinking about the painful event. If there is continued distress, bilateral stimulation is continued until all disturbance has left the body.
Phase 7: Closure: Any reprocessing session ends with closure. During this phase, the goal is to help the client restore a sense of safety and calmness before leaving the therapy session and returning to their day-to-day routine.
Phase 8: Reevaluation: Each session during reprocessing begins with a reevaluation or check-in on the client’s level of distress and how their symptoms have changed. Depending on their distress level and their level of cognition regarding more positive beliefs, this will determine where the treatment is headed and the starting point for the new session.
*An event is fully reprocessed when the client’s Subjective Units of Distress gets to 0, Validity of Cognition gets to 7, and there is no bodily disturbance associated.*
How does Bilateral Stimulation Work?
Bilateral stimulation works by engaging both hemispheres of the brain through repetitive sensory stimulation, thereby improving communication between the two sides. The main ways of doing this are eye movements, tapping, and/ or auditory tones. For many, the idea that eye movements or simple tapping can help process traumatic memories seems hard to believe. The reason this works is not entirely proven; however, eye movements are thought to reduce the emotional response to the memory and help reintegrate it into the brain more safely.
Who can EMDR help?
EMDR is most utilized to treat trauma and Post Traumatic Stress Disorder (PTSD), and most research into EMDR studies its efficacy for the treatment of trauma-related symptoms. It can include both big “T” and little “t” traumas. And although EMDR is mainly utilized to treat trauma, EMDR could be applicable for anyone who has specific memories or events linked to negative emotions, beliefs, or symptomology. Scelles and Bulnes (2021) found that EMDR can show success in treating disorders aside from PTSD in their systematic review.
Other diagnoses EMDR could be applied to include:
- Anxiety Disorders
- Depression
- Dissociative Disorders
- Stress-Related Disorders
- Chronic Pain
- Addiction
- OCD
Length of Treatment
The length of EMDR treatment really depends on the client and the number of memories to be processed. Phase one (History and Treatment Planning) often takes 1-2 sessions; Phase two (Preparation) can take 1-4 sessions; and, on average, it takes about three sessions for reprocessing of each memory to occur (phases four, five, and six). EMDR is often a preferred treatment modality because it is a shorter-term treatment, and clients usually see improvements in symptoms sooner than with other modalities.
