EMDR Therapy

Moving beyond things that have happened in the past can be challenging for many people, especially when the memories attached to those events have been stored in the mind under disturbing and traumatic circumstances.

The desire to leave upsetting memories behind prompts some people to try Eye Movement Desensitization and Reprocessing (EMDR), a form of psychotherapy that was initially developed to treat clients with post-traumatic stress disorder (PTSD).

PTSD is an anxiety disorder that is characterized by memories, flashback, or stimuli that can set off a fight-or-flight response in the individuals who relive the trauma.

What Is EMDR Therapy?

Eye Movement Desensitization and Reprocessing therapy can help people process unresolved, traumatic experiences in new and different ways that benefit them in the present and beyond.

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How Is EMDR Therapy Different from Other Therapies?

The American Psychological Association (APA) writes that EMDR differs from other psychological treatments because:

  • It focuses on changing how the brain stores a particular memory. Other treatments focus on changing the emotions, thoughts, and responses resulting from traumatic experiences.
  • It does not include extended exposure to the upsetting memory or detailed descriptions of the trauma experienced.

Clients are not required to complete homework assignments or challenged on dysfunctional beliefs, APA writes.

People across age groups, including children and teenagers, have found EMDR beneficial. The approach helps clients:

  • Boost their health and well-being
  • Reduce stress and anxiety
  • Unblock negative and distorted thinking that affects how they see the past, present, and future
  • Neutralize negative thought patterns and feelings and build ones that are supportive and positive
  • Improve personal and professional performance, which can help improve life areas
  • Learn how to bounce back and recover from unpleasant experiences

EMDR Therapy: The Basics

The EMDR International Association defines Eye Movement Desensitization and Reprocessing therapy as “an evidence-based psychotherapy for post-traumatic stress disorder.” In addition to PTSD, clients who have other anxiety disorders, depression, sexual dysfunction, schizophrenia, among other disorders, may also benefit from EMDR sessions.

The APA informs that the Adaptive Information Processing model guides EMDR therapy, which focuses on three time periods: the past, present, and future. In this model, “symptoms of PTSD and other disorders (unless physically or chemically based) result from past disturbing experiences that continue to cause distress because the memory was not adequately processed,” APA writes.

“These unprocessed memories are understood to contain the emotions, thoughts, beliefs and physical sensations that occurred at the time of the event. When the memories are triggered, these stored disturbing elements are experienced and cause the symptoms of PTSD and/or other disorders.”

A client and therapist usually work together to determine the nature of a specific problem to be resolved and if EMDR is the proper therapy needed. Once it has been agreed upon that EMDR is what’s needed, then sessions can be scheduled. These sessions can last anywhere from 60-90 minutes, depending on how everything goes.

The EMDR International Association noted that the nature of the problem, life circumstances, and the amount of trauma that occurred will determine how many treatment sessions are needed.

The American Psychological Association Therapy can run six to 12 sessions and occur once or twice a week. Clients can schedule sessions on consecutive days.

The benefits of EMDR have been widely reported since American psychologist Francine Shapiro, Ph.D., first developed it in 1989, when it was originally called Eye Movement Desensitization. By 1991, the therapy was called Eye Movement Desensitization Reprocessing to reflect the changes that take place in the brain during treatment and to identify the information process theory.

Personal experience led Shapiro to create EMDR. In 1987, during an outdoor stroll, she had troubling thoughts come to mind but noticed the negative feelings attached to these thoughts stopped when she moved her eyes from side to side. She assumed that her eye movements had desensitizing effects.

How Does EMDR Work?

In eye movement desensitization reprocessing therapy, a therapist will work with a client as the person talks through traumatic experiences or negative emotions as they revisit them. The therapist will guide them through this process, which can get emotionally heavy.

As EMDR clients go through the steps of reprocessing a memory for a short period, which can last 30 seconds, for example, they will concentrate their focus on bilateral stimulation, or an unrelated physical or auditory stimulus. Traditionally, this is when the therapist will move their finger back and forth while the patient follows with their eyes. Vibrations, tones delivered in one ear, and tapping movements on different sides of the body, are all forms of bilateral stimulation.

EMDR therapy’s goal is to help desensitize a person to memories and triggers that cause anxiety, panic, or stress. Focusing on another task simultaneously while discussing negative feelings helps clients reprocess their memories and emotions.

As a New York Timesblog on EMDR describes it, “The goal is to let the brain’s information processing system make new internal connections as the client focuses on the thoughts, emotions, memories, and other associations that are freely made during the sets of bilateral stimulation.”

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In an October 2017 article Shapiro wrote for Brain World Magazine, she shares some insight into the eye movements, saying they “have been found to cause an immediate decline in negative emotions and imagery vividness, as well as increased memory accuracy and episodic retrieval. These observations support two theories: that the eye movements disrupt working memory and that they link into the same processes that occur in REM sleep.”

She continues, “In EMDR therapy, it is during the sets of eye movements—each of which lasts approximately 30 seconds—that the brain makes the associations and neural connections needed to integrate, or digest, the disturbing memory. What is useful is incorporated and what is useless is discarded.”

The Eight Phases of EMDR

Eye Movement Desensitization and Reprocessing therapy consists of eight phases. Below is a general overview of how each phase works. According to the EMDR International Association, the procedures may be implemented in more than one way as long as the goals of each phase are achieved.

Before EMDR therapy begins, the therapist completes a client assessment before developing a treatment plan for the client. Both the client and therapist work together to identify possible targets that will be focused on during EMDR therapy. These may include upsetting memories, current challenges or situations that cause emotional distress, as well as past events. Phase 1 may take one or two sessions to complete, according to the EMDR International Association. However, adjustments can be made throughout therapy, especially if new problems arise.

The therapist explains procedures to the client and practices eye movements and other bilateral stimulation movements. The therapist also makes sure the client can handle emotional distress in several different ways. During this stage, clients may use imagery and stress reduction techniques during and between sessions. The EMDR International Association says this phase can take one to four sessions.

The third phase of assessment activates the memory that is the focus of the session. Each part of the memory is identified and reviewed. Those parts are a) image, b) cognition, and c) affect and body sensation. The Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale are both used during the sessions to evaluate the client’s changes in emotion and cognition.

An example of an SUD question the therapist might ask is, “On a scale of 0 – 10, where 0 is no disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does it feel to you now?”

For VOC, a therapist might ask the client, “When you think of that picture, how true do those words (“those words” being the client’s positive cognition) feel to you now on a scale of 1 – 7, where 1 is completely false and 7 feels completely true?”

According to APA guidance, it can take one to three sessions to process one specific memory.

In this phase, the client focuses on the negative memory while engaged in eye movements or other bilateral stimulation movements. The client is also asked to notice any new thoughts that have emerged as they focus on this memory and share them if they are present. According to the EMDR International Association, these observations may include new insights, associations, information, and emotional, sensory, somatic, or behavioral shifts.

In this phase, the therapist asks the client to check for a potential new belief that is related to the target memory that’s positive. The client then chooses a new belief or a positive cognition that was established earlier. The person is asked to hold the new belief in mind, along with the target memory, and to rate the new positive belief on the Validity of Cognition (VOC) scale of one to seven. Bilateral stimulation continues until the positive belief reaches Level 7

The client is asked to observe their body’s response as they think about the incident and the earlier positive cognition. They are also asked to identify any positive or negative physical sensations. Bilateral stimulation continues on the areas of the body where the sensations are present until the client reports that the sensations are either neutral or positive.

The phase known as closure happens at the end of the session. If the target memory was not fully processed in the active session, then the client is given instructions and techniques that can help provide stability when the session ends and between subsequent sessions. The client may also be asked to observe and record any meaningful observations or new symptoms experienced.

Reevaluation of the client’s treatment happens at the start of the next session. The therapist evaluates the client’s present psychological state and checks to see if the effects of treatment have been maintained. The therapist also checks to see whether any memories have been discovered since the previous session and if there are current triggers or anticipated challenges.  If any new identity targets that emerge, phases 3-8 are repeated.

How Can EMDR Help Addiction Recovery?

Taking time to reflect honestly on the beginnings of one’s addiction, as well as why it happened, is a part of recovery. Clients can use eye movement desensitization and reprocessing therapy during their sessions with a counselor as they process their reasons for using drugs and alcohol. EMDR therapy can be incorporated into the addiction treatment plan.

Once EMDR therapy starts, the recovering user can be guided in a different direction as they recall unpleasant memories and learn how to create a healthy response to replace the negative ones that live inside of their memories. EMDR therapy also teaches clients how to relax as they find ways to deal with stress, anger, fear, and other possibly debilitating emotions. Addressing these emotions can help clients in recovery who could benefit from relapse prevention techniques.

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EMDR therapy can help people who are simultaneously managing a substance use disorder and a mental health disorder, a condition known as dual diagnosis. When both conditions are present, substance treatment that addresses both concurrently is often found to be effective.

An addiction health care professional will have to access an individual’s needs before determining whether EMDR therapy is appropriate. 

This therapy can also be combined along with others, such as art therapy, faith-based therapy, and art therapy, among so many others, that can help people find the sobriety and peace of mind they have been seeking.

Does EMDR Really Help Recovery From Traumatic Experiences?

Shapiro notes that studies have shown that EMDR therapy has demonstrated favorable outcomes and that the approach has been deemed an effective treatment for trauma by different groups, including the American Psychiatric Association and the Department of Defense.

As with many things, different therapies work for different people. Some people have been found to respond to EMDR treatment well and have been able to heal from their trauma.

EMDR has not been met without its share of critics or controversy since it came on the scene nearly 30 years ago. There are also other perspectives out there about EDMR’s effectiveness and if the therapy treatment works.

In its article “Does EMDR Really Work?”, the Cognitive Behavioral Therapy Los Angeles highlights past research that compared the effects of standard EMDR with EMDR therapy without the eye movement component.

According to the site, “What these studies found was that there was no difference whatsoever between the two treatments, suggesting there is no benefit to moving one’s eyes back and forth.

Eliminating the eye movement component, you are left with a therapy in which the patient recounts their trauma narrative repeatedly during the session, a treatment identical to prolonged exposure.”

The article also notes that numerous studies that compared EMDR to another PTSD treatment, called Prolonged Exposure, “showed virtually no difference in effectiveness.”

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The article did say; however, noted research that found EMDR to be effective in significantly reducing symptoms of post-traumatic stress disorder.

Critics have also noted what they say are similarities between EMDR therapy and cognitive behavioral therapy (CBT). In both therapies, the goal is to get clients to reprocess their thought patterns, and both involve having a therapist guide the client through their memories and emotions via talking. Unlike CBT, however, EMDR does not require clients to remember every detail of event to process it.

It helps to remember the EMDR International Association’s definition of the integrative psychotherapy, which says, “In the broadest sense, EMDR is “an integrative psychotherapy approach intended to alleviate human suffering and to assist individuals to fulfill their potential for development, while minimizing risks of harm in its application.”

“For the client, EMDR treatment aims to achieve comprehensive treatment safely, effectively and efficiently, while maintaining client stability.”

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