Eye Movement Desensitization and Reprocessing

What is EMDR Therapy?

Eye Movement Desensitization and Reprocessing (EMDR) therapy is an extensively researched, effective psychotherapy method proven to help people recover from trauma and other distressing life experiences, including PTSD, anxiety, depression, and panic disorders.

The core of EMDR treatment involves activating components of the traumatic memory or disturbing life event and pairing those components with alternating bilateral or dual attention stimulation. This process appears to facilitate the resumption of normal information processing and integration. This treatment approach can result in the alleviation of presenting symptoms, diminution of distress from the memory, improved view of the self, relief from bodily disturbance, and resolution of present and future anticipated triggers.

How is EMDR therapy different from other therapies?

EMDR therapy does not require talking in detail about the distressing issue or
completing homework between sessions. EMDR therapy, rather than focusing on changing the emotions, thoughts, or behaviors resulting from the distressing issue, allows the brain to
resume its natural healing process.

EMDR therapy is designed to resolve unprocessed traumatic memories in the brain. For many clients, EMDR therapy can be completed in fewer sessions than other psychotherapies. A wide variety of research studies have been implemented using various treatment aspects and protocols as their focus since EMDR Therapy's initial development. Many of these studies support EMDR Therapy as an empirically validated treatment of trauma. 

How does EMDR therapy affect the brain?

Our brains have a natural way to recover from traumatic memories and events. This process involves communication between the amygdala (the alarm signal for stressful events), the hippocampus (which assists with learning, including memories about safety and danger), and the prefrontal cortex (which analyzes and controls behavior and emotion). While many times traumatic experiences can be managed and resolved spontaneously, they may not be processed without help.

Stress responses are part of our natural fight, flight, or freeze instincts. When distress from a disturbing event remains, the upsetting images, thoughts, and emotions may create feelings of overwhelm, of being back in that moment, or of being “frozen in time.” EMDR therapy helps the brain process these memories, and allows normal healing to resume. The experience is still remembered, but the fight, flight, or freeze response from the original event is resolved.”

Who can benefit from EMDR therapy?

EMDR therapy helps children and adults of all ages. Therapists use EMDR therapy to address a wide range of challenges:

• Anxiety, panic attacks, and phobias

• Chronic Illness and medical issues

• Depression and bipolar disorders

• Dissociative disorders

• Eating disorders

• Grief and loss

• Pain

• Performance anxiety

• Personality disorders

• PTSD and other trauma and stress-related issues

• Sexual assault

• Sleep disturbance

• Substance abuse and addiction

• Violence and abuse

Experiencing EMDR Therapy

After the therapist and client agree that EMDR therapy is a good fit, the client will work through the eight phases of EMDR therapy with their therapist.

Attention will be given to a negative image, belief, and body feeling related to this event, and then to a positive belief that would indicate the issue was resolved.

A typical EMDR therapy session lasts from 60-90 minutes. EMDR therapy may be used within a standard talking therapy, as an adjunctive therapy with a separate therapist, or as a treatment all by itself.

EMDR PROTOCOL

EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences.  Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal.  EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma.  When you cut your hand, your body works to close the wound.  If a foreign object or repeated injury irritates the wound, it festers and causes pain.  Once the block is removed, healing resumes.  EMDR therapy demonstrates that a similar sequence of events occurs with mental processes.  The brain’s information processing system naturally moves toward mental health.  If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering.  Once the block is removed, healing resumes.  Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.

More than 30 positive controlled outcome studies have been done on EMDR therapy. 

Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions.  Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy.  Millions of people have been treated successfully over the past 25 years.

EMDR therapy is an eight-phase treatment. 

Eye movements (or other bilateral stimulation) are used during one part of the session.  After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision.  As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.  For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.”  Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes.  The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them.  Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.

Treatment Description:

EMDR therapy combines different elements to maximize treatment effects.  A full description of the theory, sequence of treatment, and research on protocols and active mechanisms can be found in F. Shapiro (2001) Eye movement desensitization and reprocessing:  Basic principles, protocols and procedures (2nd edition) New York: Guilford Press.

EMDR therapy involves attention to three time periods:  the past, present, and future.  Focus is given to past disturbing memories and related events.  Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions.  With EMDR therapy, these items are addressed using an eight-phase treatment approach.

Phase 1:  The first phase is a history-taking session(s).  The therapist assesses the client’s readiness and develops a treatment plan.  Client and therapist identify possible targets for EMDR processing.  These include distressing memories and current situations that cause emotional distress.  Other targets may include related incidents in the past.  Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.

Initial EMDR processing may be directed to childhood events rather than to adult onset stressors or the identified critical incident if the client had a problematic childhood.  Clients generally gain insight on their situations, the emotional distress resolves and they start to change their behaviors.  The length of treatment depends upon the number of traumas and the age of PTSD onset.  Generally, those with single event adult onset trauma can be successfully treated in under 5 hours.  Multiple trauma victims may require a longer treatment time.

Phase 2:  During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress.  The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.

Phases 3-6:  In phases three to six, a target is identified and processed using EMDR therapy procedures.  These involve the client identifying three things:
1.  The vivid visual image related to the memory
2.  A negative belief about self
3.  Related emotions and body sensations.

In addition, the client identifies a positive belief.  The therapist helps the client rate the positive belief as well as the intensity of the negative emotions.  After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation.  These sets may include eye movements, taps, or tones.  The type and length of these sets is different for each client.  At this point, the EMDR client is instructed to just notice whatever spontaneously happens.

After each set of stimulation, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind.  Depending upon the client’s report, the clinician will choose the next focus of attention.  These repeated sets with directed focused attention occur numerous times throughout the session.  If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.

When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session.  At this time, the client may adjust the positive belief if necessary, and then focus on it during the next set of distressing events.

Phase 7:  In phase seven, closure, the therapist asks the client to keep a log during the week.  The log should document any related material that may arise.  It serves to remind the client of the self-calming activities that were mastered in phase two.

Phase 8:  The next session begins with phase eight.  Phase eight consists of examining the progress made thus far.  The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses