Eye Movement Desensitization and Reprocessing (EMDR) Therapy
EMDR Therapy is a clearly researched psychotherapy method for effectiveness with posttraumatic stress disorder and other disorders. It has been endorsed by many organizations in including: World Health Organization (2013), SAMHSA’s National Registry of Evidence-based Programs and Practices (2011), Department of Veterans Affairs & Department of Defense (2010), American Psychiatric Association (2004), and International Society for Traumatic Stress Studies (2009)
How does EMDR work?
The underlying premise of EMDR is that panic and anxiety experiences are processed differently by the brain than are usual experiences. One theory of memory is that during severe stress a part of the brain responsible for modulating emotions (the amygdala) temporarily shuts down another part of the brain (the hippocampus) responsible for usual memory processing. The traumatic experience is trapped outside of the usual brain processing power, and EMDR allows the client to access the experience and transform it to declarative memory using the hippocampus. With EMDR the hippocampus may not be so shut down by the emotions evoked by the experience so that that the client can withstand while doing the processing. Distraction by and attention to the bilateral stimulation may play a part in helping the client experience the emotions as tolerable. How bilateral distraction to each side specifically facilitates processing of distressing experiences is not yet understood.
Description of the EMDR process:
A comprehensive description of EMDR can be found in Eye Movement Desensitization and Reprocessing, 2nd Edition (Shapiro, 2001). The basic EMDR protocol involves an eight-phase process that usually occurs over several sessions. A short explanation of the process is described below:
Phase 1: Client history and treatment planning:
This phase usually occurs over the first few sessions. Often the person being evaluated is asked to complete an information form that includes questions about current and past medical status, family and childhood history, and current symptoms. During the interview, the clinician asks supplementary questions. These questions include facts about the person’s past as well as current and past symptoms. Thew3 clinician might contact other/previous healthcare providers.
Detailed information is necessary in order to arrive at an independent assessment of the client’s condition. In complicated situations, contact with the person’s family may be requested. For children, parents are involved in the consultation. The clinician generally shares his/her impressions with the client and a decision about how to go about treatment is agreed upon.
Phase 2: Preparation phase
If it agreed that that EMDR is to be used in therapy, there are several steps in preparation for the actual processing of the material. A degree of trust must exist between the client and clinician. The clinician explains the theoretical background for EMDR and describes the actual steps in the process. The clinician learns about the client’s self-soothing skills and teaches the client new skills to increase the ability of the client to tolerate the processing of traumatic material. One of the commonly used techniques is to establish a “safe/calm/comforting place” in the client’s imagination to which the client can return during times of emotional disturbance.
The clinician informs the client about the various forms of bilateral attention stimulation (eye movements, tapping, auditory) that could be applied. Safety procedures are discussed and set in place. The client’s concerns and fears are addressed.
Phase 3: Assessment phase
The assessment phase begins the unique core of the EMDR process. The client is asked what the target incident will be. He/she is asked what picture represents the worst part of the experience. The client associates words best go with the picture (or experience) that express a negative belief (called a negative cognition) about him/herself in the present time. Next, the client decides what he/she would like to believe about self in place of the negative thought. The client assesses the validity of the positive thought (called a positive cognition) relative to the target experience, on a seven-point scale.
The client describes the emotions associated with the target event and scales the disturbance on an eleven-point scale. The client notes the related body feeling.
Phase 4: Desensitization phase
The desensitization process begins with the client to holding in focus a picture, a negative self-belief and a body sensation associated with a disturbing event. The therapist then helps the client focus on a bilateral stimulus while holding the target event in mind. The stimulus may consist of rapid hand movements or moving lights in the client’s field of vision; alternating tones to the ears; or alternating taps on the hands or knees.
These sets of bilateral attention may last from less than a half minute to several minutes, depending on the client’s response. For the bilateral stimulation, the client is asked to clear his/her mind and to allow whatever comes into awareness. After giving a short description of what thought or feeling that comes up in the client’s mind, the clinician leads another set of eye movements (or other method of bilateral stimulation). Over many sets of bilateral stimulation, the therapist guides the client thorough the processing of whatever comes to mind.
Phase 5: Installation of Positive Cognition
When the processing of the disturbing memory is complete, as measured by the amount of residual disturbance of the memory, the positive thought (positive cognition) is revisited and scaled as to validity in the presence of the original experience. Sets of bilateral attention are applied until the positive thought is experienced as being totally valid.
Phase 6: Body scan
The client is asked to clue his/her eyes, concentrate on the target experience and mentally scan the entire body. If sensations or lack of sensations are reported, short sets of bilateral stimulation are applied until negative sensations subside or a positive feeling is experienced.
Phase 7: Closure
The client is guided to a neutral or positive emotional state prior to leaving the session.
The client may continue to process the material for days after a session, perhaps having new insights, vivid dreams, strong feelings, intrusive thoughts, or renewed recall of past experiences. These experiences may feel confusing to the client, but they are considered to be a continuation of the healing process.
The client is asked to keep a record of new sensations and experiences and report them to the clinician at the next session. If the client becomes concerned or surprisingly disturbed, he/she should let the clinician know right away.
Phase 8: Re-evaluation
At the beginning of the next session, the client reviews the week, discussing any new sensations or experiences and reviewing his/her log. The disturbance of the previous session’s target experience is assessed to help decide on the course of action.
Generally, the reprocessing is applied to past events, current triggers and anticipated future events related to the target event.
Within EMDR, there are specific protocols for a variety of situations including single traumatic events, recent traumatic events, phobias, excessive grief, illness and somatic disorders and well as procedures to enhance emotional resources such as confidence and self-esteem.
Precautions in EDMR therapy:
There are specific procedures to be followed depending on the client’s presenting problem, emotional stability, medical condition, and other factors. Specifically, the following may occur:
Distressing, unresolved memories might surface through the use of the EMDR procedure.
Some clients have experienced reactions during the treatment sessions that neither they nor the administering clinician may have anticipated, including a high level of emotion or physical sensations.
Subsequent to the treatment session, the processing of incidents or material may continue, and other dreams, memories, flashbacks, feelings, etc., may surface.
Memories of past events targeted for EMDR treatment may be altered (clarity of memory may either be experienced as decreased or enhanced, while associated disturbing emotion may be fully resolved).
It is very important that the therapist be fully and formally trained in EMDR. Otherwise, there is a risk that EMDR could be incomplete, ineffective, or even harmful. EMDR training programs will send a list of local clinicians they have trained. You can see the list of EMDR International Association approved training events at the EMDRIA website. EMDRIA also maintains a list of members, Certified Therapists and Approved Consultants. EMDRIA staff may be contacted by telephone (512-451-5200) or email firstname.lastname@example.org.