What is EMDR Therapy?

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a psychotherapy treatment initially designed to alleviate the distress associated with traumatic memories.  The adaptive Information Processing model posits that EMDR therapy facilitates the accessing and processing of traumatic memories and other adverse life experiences to bring these to an adaptive resolution.  It’s growing in popularity, particularly for treating post-traumatic stress disorder (PTSD).  PTSD often occurs after experiences such as military combat, physical assault, rape, or car accidents.

After successful treatment with EMDR therapy, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced. In addition, during EMDR therapy, the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus.  These new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.

EMDR Therapy
EMDR Therapy combats PTSD among other disorders.
EMDR therapy uses a three-pronged protocol: 
  • The past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information
  • The current circumstances that elicit distress are targeted, and internal and external triggers are desensitized
  • Imaginal templates of future events are incorporated to assist the client in acquiring the skills needed for adaptive functioning

What are the benefits?

People dealing with traumatic memories and those who have PTSD are thought to benefit the most from therapy. It’s thought to be particularly effective for those who struggle to talk about their past experiences. Although there is not sufficient research to prove its effectiveness in these areas, EMDR therapy is also being used to treat:

Recommended Guidelines

Guidelines issued by more than one professional organization have recently boosted the credibility of this therapy.  These guidelines define who may benefit from the treatment.  For example:

  • The American Psychiatric Association (APA) [1] has noted that Eye Movement Desensitization & Reprocessing effectively treats symptoms of acute and chronic PTSD.  According to the APA, EMDR may be particularly useful for people who have trouble talking about the traumatic events they’ve experienced.  The APA guidelines note that other research is needed to tell about improvements from EMDR over time.
  • The Department of Veterans Affairs and the Department of Defense have jointly issued clinical practice guidelines.  These guidelines “strongly recommended” Eye Movement Desensitization & Reprocessing for the treatment of PTSD in both military and non-military populations.  They also note that this approach has been as effective as other psychological treatments in some studies and less effective in others.

How This Therapy Works

Even the most enthusiastic Eye Movement Desensitization and Reprocessing supporters have not agreed on how the therapy works.  At this point, only theories exist. By inducing the recall of distressing events and diverting attention from their emotional consequences, EMDR therapy in some respects borrows basic principles used in prolonged exposure therapy, the gold standard behavioral psychotherapeutic treatment of PTSD.  In addition, some therapists believe that EMDR reduces anxiety.  This allows patients to take control of their upsetting thoughts better.  Others say that we don’t yet understand how EMDR works.  According to the APA guidelines, EMDR needs further study to more fully understand.

Treatment Description

Eye Movement Desensitization & Reprocessing 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).
    • Your therapist will first review your history and decide where you are in the treatment process.  This evaluation phase also includes talking about your trauma and identifying potential traumatic memories to treat specifically.
  • Phase 2:  Preparation
    • 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 various 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.
  • Phase 3:  Assessment
    • During the third phase of treatment, your therapist will identify the specific memories that your therapist will target and all the associated components (such as the physical sensations stimulated when you concentrate on an event) for each target memory.
  • Phases 4-7:  Treatment
    • Your therapist will then begin using EMDR therapy techniques to treat your targeted memories.  During these sessions, you will be asked to focus on a negative thought, memory, or image.
    • Your therapist will simultaneously have you do specific eye movements.  The bilateral stimulation may also include taps or other activities mixed in, depending on your case.
  • Phase 8:  Evaluation
    • The next session begins with phase eight.  Phase eight consists of examining the progress made thus far.  The treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.

What to Know Before You Try it

EMDR therapy is considered to be safe, with many fewer side effects than those of prescription medications.  That said, there are some side effects that you may experience.

EMDR therapy causes a heightened awareness of thinking which does not end immediately when a session does.  This can cause light-headedness. It can also cause vivid, realistic dreams.  It often takes several sessions to treat PTSD with EMDR therapy.  This means that it doesn’t work overnight.  The beginning of treatment may be exceptionally triggering to people starting to deal with traumatic events, precisely because of the heightened focus.  While the therapy will likely be effective in the long run, it may be emotionally stressful to move through the course of treatment.

Talk to your therapist about this when you start treatment so you’ll know how to cope if you experience these symptoms.

What Can You Expect From EMDR?

An EMDR treatment session can last up to 90 minutes.  First, your therapist will move their fingers back and forth in front of your face and ask you to follow these hand motions with your eyes.  At the same time, the EMDR therapist will have you recall a disturbing event.  This will include the emotions and body sensations that go along with it.

Gradually, the therapist will guide you to shift your thoughts to more pleasant ones. Some therapists use alternatives to finger movements, such as hand or toe-tapping or musical tones. People who use the technique argue that EMDR can weaken the effect of negative emotions.  Before and after each EMDR treatment, your therapist will ask you to rate your level of distress.  The hope is that your disturbing memories will become less disabling.

Although most research into EMDR has examined its use in people with PTSD, EMDR is sometimes used experimentally to treat many other psychological problems.  They include:

  • Panic attacks
  • Eating disorders
  • Addictions
  • Anxiety, such as discomfort with public speaking or dental procedures

How Effective Is EMDR?

According to psychologist Francine Shapiro, almost 20,000 practitioners have been trained to use EMDR since the developed technique in 1989.  While walking through the woods one day, Shapiro happened to notice that her own negative emotions lessened as her eyes darted from side to side. Then, she found the same positive effect in patients.

EMDR appears to be a safe therapy with no adverse side effects.  Still, despite its increasing use, mental health practitioners debate EMDR’s effectiveness.  Critics note that most EMDR studies have involved only small numbers of participants.  However, other researchers have shown the treatment’s effectiveness in published reports that consolidated data from several studies.

Therefore, EMDR therapy has proven to be effective in treating trauma and PTSD.  It may also help treat other mental conditions like anxiety, depression, and panic disorders. Some people may prefer this treatment to prescription medications, which can have unexpected side effects.  Others may find that EMDR therapy strengthens the effectiveness of their drugs. If you think EMDR therapy is right for you, make an appointment with a licensed therapist.

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Sources

[1] American Psychiatric Association (APA) – https://www.apa.org/search?query=EMDR