EMDR - Eye Movement Desensitization and Reprocessing

Information About EMDR

Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.

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The Definition of EMDR

Eye movement desensitization and reprocessing (EMDR): This therapy is based on the idea that negative thoughts, feelings and behaviors are the results of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions, and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements.

Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.

The World Health Organization's (WHO) new practice guidelines have indicated that trauma-focused cognitive behavioral therapy (CBT) and EMDR therapy are the only psychotherapies recommended for children, adolescents, and adults with PTSD.

What Is EMDR?

EMDR 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, 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 training sessions, clinicians help clients activate their natural healing processes.

What Does EMDR Treat?

• • Abuse - Physical / Sexual
• • Addictions Combined with PTSD
• • Anger Dyscontrol
• • Anxiety Disorders
• • Attachment Disorder
• • Body Dysmorphic Disorder
• • Body Image Disturbance
• • Depression
• • Dissociative Disorders
• • Distress Related to Infertility
• • Eating Disorders
• • Existential Angst
• • Generalized Anxiety Disorder
• • nsomnia
• • Marital Discord
• • Pain Disorder
• • Panic Disorders
• • Performance Anxiety
• • Personality Disorders
• • Phobias
• • Pornography
• • PTSD
• • Social Phobia
• • Trauma – Neglect / Violence

How Many Sessions Will It Take?

Usually, processing begins by the third session. The number of sessions depends upon the specific problem and client's history. However, repeated controlled studies by EMDR therapists have shown that a single trauma can be processed within three sessions in 80-90% of the participants. While every disturbing event does not need to be processed, the amount of therapy will depend upon the complexity of the history.

How Does EMDR Work?

When a traumatic or very negative event occurs, information processing in the brain tends to be incomplete – due in part to strong negative feelings or dissociation that interferes with the brain’s ability to attend, process, and store the sensory input of the event. This leaves the brain unable to establish normal neural connections with sensory and emotional information stored in other memory networks. For example, a woman who has been raped may “know” that rapists are responsible for their crimes, but this information does not properly connect with her (incorrect) feeling that she was to blame for the attack.

These memories are dysfunctionally stored without appropriate associative connections and with many elements still unprocessed. When the individual thinks about the trauma, or when the memory is triggered by similar situations, the person may feel like she is reliving it or may experience strong emotions and physical sensations. Such memories have a lasting negative effect that interferes with the way a person sees the world and the way they relate to other people.

EMDR has a direct effect on the way that the brain processes information. The EMDR protocol causes normal information processing to be resumed, so a person no longer relives the images, sounds, and feelings when the event is brought to mind. The traumatic memory still remains, but it is less upsetting.

During REM (rapid eye movement) sleep, the eyes rapidly move back and forth as the brain processes and organizes sensory information. The eye movement protocol of EMDR uses this same course of action to re-process and re-organize dysfunctional or disorganized information caused by a traumatic event.

What Is An EMDR Session Like?

by Francine Shapiro and Margot Silk Forrest

Eye Movement Desensitization and Reprocessing (EMDR) is an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches. To date, EMDR has helped an estimated two million people of all ages relieve many types of psychological stress. Below is a Brief Description of EMDR Therapy.

8 Phases of Treatment

The Eight Phases of EMDR - Juniper Campbell, LPC: mental health and counseling services.

The amount of time the complete treatment will take depends upon the history of the client. Complete treatment of the targets involves a three-pronged protocol (1-past memories, 2-present disturbance, 3-future actions), and are needed to alleviate the symptoms and address the complete clinical picture. The goal of EMDR therapy is to completely process the experiences that are causing problems, and to include new ones that are needed for full health.

"Processing" does not mean talking about it. "Processing" means setting up a learning state that will allow experiences that are causing problems to be "digested" and stored appropriately in your brain. That means that what is useful to you from an experience will be learned and stored with appropriate emotions in your brain - and then be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded. Negative emotions, feelings and behaviors are generally caused by unresolved earlier experiences that are pushing you in the wrong direction.

The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.

Phase 1: History and Treatment Planning

Generally takes 1-2 sessions at the beginning of therapy and can continue throughout the therapy, especially if new problems are revealed. In the first phase of EMDR treatment, the therapist takes a thorough history of the client and develops a treatment plan. This phase will include a discussion of the specific problem that has brought him into therapy, his behaviors stemming from that problem, and his symptoms. With this information, the therapist will develop a treatment plan that defines the specific targets on which to use EMDR.

These targets include the event(s) from the past that created the problem, the present situations that cause distress, and the key skills or behaviors the client needs to learn for his future well-being. One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of his disturbing memories in detail.

So while some individuals are comfortable, and even prefer, giving specifics, other people may present more of a general picture or outline. For example, when the therapist asks, "What event do you remember that made you feel worthless and useless?" the person may say, "It was something my brother did to me." That is all the information the therapist needs to identify and target the event with EMDR.

Phase 2: Preparation

For most clients, this will take only 1-4 sessions. For others with a very traumatized background, or with certain diagnoses, a longer time may be necessary. Basically, your clinician will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you are generally able to proceed to the next phase. One of the primary goals of the preparation phase is to establish a relationship of trust between the client and the therapist.

If the EMDR client does not trust his therapist, he may not accurately report what he feels and what changes he is (or isn't) experiencing during the eye movements. It’s important to note that the person does not have to go into great detail about his disturbing memories. If he just wants to please the clinician and says he feels better when he doesn't, no therapy in the world will resolve his trauma. In any form of therapy, it is best to look at the clinician as a facilitator or guide who needs to hear of any hurt, need, or disappointments in order to help achieve the common goal. EMDR is a great deal more than just eye movements, and the clinician needs to know when to employ any of the needed procedures to keep the processing going.

During the Preparation Phase, the clinician will explain the theory of EMDR, how it is done, and what the person can expect during and after treatment. Finally, the clinician will teach the client a variety of relaxation techniques for calming himself in the face of any emotional disturbance that may arise during or after a session. Learning these tools is an important aid for anyone. The happiest people on the planet have ways of relaxing and decompressing from life's inevitable and often unsuspected stress. One goal of EMDR therapy is to make sure that the client can take care of himself.

Phase 3: Assessment

Used to access each target in a controlled and standardized way so it can be effectively processed. Processing does not mean talking about it. See the Reprocessing sections below. The clinician identifies the aspects of the target to be processed. The first step is for the person to select a specific picture or scene from the target event (which was identified during Phase One) that best represents the memory. Then, he chooses a statement that expresses a negative self-belief associated with the event. Even if he intellectually knows that the statement is false, it is important that he focus on it. These negative beliefs are actually verbalizations of the disturbing emotions that still exist.

Common negative cognitions include statements such as:

• "I am helpless."
• "I am worthless."
• "I am unlovable."
• "I am dirty."
• "I am bad."

The client then picks a positive self-statement that he would rather believe. This statement should incorporate an internal sense of control, such as:

• "I am worthwhile."
• "I am lovable."
• "I am a good person."
• "I am in control."
• "I can succeed."

Sometimes, when the primary emotion is fear, such as in the aftermath of a natural disaster, the negative cognition can be: "I am in danger," and the positive cognition can be "I am safe now."

"I am in danger" can be considered a negative cognition because the fear is inappropriate - it is locked in the nervous system, but the danger is actually past.

The positive cognition should reflect what is actually appropriate in the present. At this point, the therapist will ask the person to estimate how true he feels his positive belief is using the 1-to-7 Validity of Cognition (VOC) scale. "1" equals completely false," and 7" equals "completely true." It is important to give a score that reflects how the person "feels," not "thinks." We may logically "know" that something is wrong, but we are most driven by how it "feels."

Also, during the Assessment Phase, the person identifies the negative emotions (fear, anger) and physical sensations (tightness in the stomach, cold hands) he associates with the target.

The client also rates the disturbance using the 0to10 Subjective Units of Disturbance (SUD) scale with (0=no disturbance) and (10=the worst feeling you've ever had).

For a single trauma, reprocessing is generally accomplished within three sessions. If it takes longer, you should still see some improvement within that amount of time. Phases One through Three lay the groundwork for the comprehensive treatment and reprocessing of the specific targeted events. Although the eye movements (or taps, or tones) are used during the following three phases, they are only one component of a complex therapy.

The use of the step-by-step eight-phase approach allows the experienced, trained EMDR clinician to maximize the treatment effects for the client in a logical and standardized fashion. It also allows both the client and the clinician to monitor the progress during every treatment session.

Phase 4: Desensitization

This phase focuses on the client's disturbing emotions and sensations as they are measured by the SUDs rating. This phase deals with all of the person's responses (including other memories, insights, and associations that may arise) as the targeted event changes and its disturbing elements are resolved. This phase gives the opportunity to identify and resolve similar events that may have occurred and are associated with the target. That way, a client can actually surpass her initial goals and heal beyond her expectations.

During desensitization, the therapist leads the person in sets of eye movements (or other forms of stimulation) with appropriate shifts and changes of focus until his SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). Desensitization starts with the main target, followed by the associated memories. For instance, a person may start with a horrific event and soon have other associations with it. The clinician will guide the client to a complete resolution of the target.

Phase 5: Installation

The goal is to concentrate on and increase the strength of the positive belief that the person has identified to replace his original negative belief. For example, the client might begin with a mental image of being beaten up by his father and a negative belief of "I am powerless." During the Desensitization Phase, he will have reprocessed the terror of that childhood event and fully realized that as an adult, he now has the strength and choices he didn't have when he was young.

During this fifth phase of treatment, his positive cognition, "I am now in control," will be strengthened and installed. How deeply the person believes his positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal is for the person to accept the full truth of his positive self-statement at a level of 7 (completely true). Fortunately, just as EMDR cannot make anyone shed appropriate negative feelings, it cannot make the person believe anything positive that is not appropriate either.

So if the person is aware that he actually needs to learn some new skill, such as self-defense training, in order to be truly in control of the situation, the validity of his positive belief will rise only to the corresponding level, such as a 5 or 6 on the VOC scale.

Phase 6: Body Scan

After the positive cognition has been strengthened and installed, the therapist will ask the person to bring the original target event to mind and see if he notices any residual tension in his body. If so, these physical sensations are then targeted for reprocessing. Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts.

This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in motoric or (body systems memory) rather than (narrative memory) and retains the negative emotions and physical sensations of the original event. When that information is processed, however, it can then move to narrative (or verbalizable) memory, and the body sensations and negative feelings associated with it disappear.

Therefore, an EMDR session is not considered successful until the client can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.

Phase 7: Closure

Ends every treatment session The Closure ensures that the person leaves at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the person in using a variety of self-calming techniques in order to regain a sense of equilibrium.

Throughout the EMDR session, the client has been in control (for instance, he is instructed that it is okay to raise his hand in the "stop" gesture at any time) - and it is important that the client continue to feel in control outside the therapist's office. He is also briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and which techniques he might use on his own to help him feel calmer.

Phase 8: Reevaluation

At the beginning of subsequent sessions, the therapist checks to make sure that the positive results (low SUDs, high VOC, no body tension) have been maintained, identifies any new areas that need treatment, and continues reprocessing the additional targets. The Reevaluation Phase guides the clinician through the treatment plans that are needed in order to deal with the client's problems.

As with any form of good therapy, the Reevaluation Phase is vital in order to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment - as it is to complete an entire course of treatment with antibiotics.

Past, Present and Future

Although EMDR may produce results more rapidly than previous forms of therapy, speed is not the issue, and it is important to remember that every client has different needs. For instance, one client may take weeks to establish sufficient feelings of trust (Phase Two), while another may proceed quickly through the first six phases of treatment only to next reveal something even more important that needs treatment.

EMDR Is Not Hypnotherapy

There are three distinctive differences between hypnosis and EMDR.

• First, one of the major uses of hypnosis among clinical practitioners is to deliberately begin by inducing in the patient an altered state of mental relaxation. In contrast, when beginning EMDR, mental relaxation is not typically attempted. In fact, deliberate attempts are often actually made to connect with an anxious (emotionally disturbing as opposed to relaxed) mental state.
• Second, therapists often use hypnosis to help a patient develop a single, highly focused state of aroused receptivity (Spiegel, 1978). In contrast, with EMDR attempts are made to maintain a duality of focus on both positive and negative currently held self-referencing beliefs, as well as the emotional arousal brought about by imaging the worst part of a disturbing memory.
• Third, one of the proposed effects of hypnotizing a person is that they will have a decrease in their generalized reality orientation (GRO: Shor, 1979). In contrast, in EMDR, attempts are made to repeatedly ground the patient by referencing current feelings and body sensations to prevent the patient from drifting away from reality. Specific encouragement/inducement is made towards rejecting previously irrational/self-blaming beliefs in favor of a newly reframed positive belief with an increase in subjective conviction about that belief.

EMDR Is Not Exposure Therapy

During exposure therapy, clients generally experience long periods of high anxiety (Foa McNally, 1996), while EMDR clients generally experience rapid reductions in SUD levels early in the session (Rogers et al., 1999). This difference suggests the possibility that EMDR’s use of repeated short focused attention may invoke a different mechanism of action than that of exposure therapy with its continual long exposure.

EMDR Is Not A Placebo Treatment

A number of studies have found EMDR superior in outcome to placebo treatments and to treatments not specifically validated for PTSD. EMDR has outperformed active listening (Scheck et al., 1998), standard outpatient care consisting of individual cognitive, psychodynamic, or behavioral therapy in a Kaiser Permanente Hospital (Marcus et al., 1997), relaxation training with biofeedback (Carlson et al., 1998). EMDR has been found to be relatively equivalent to CBT therapies in seven randomized clinical trials that compared the two approaches. Because the treatment effects are large and clinically meaningful, it can be concluded that EMDR is not a placebo treatment.

Will I Relive My Trauma In Therapy?

Many people are conscious of only a shadow of the experience, while others feel it to a greater degree. Unlike some other therapies, EMDR clients are not asked to relive the trauma intensely and for prolonged periods of time. In EMDR, when there is a high level of intensity, it only lasts for a few moments and then decreases rapidly. If it does not decrease rapidly on its own, the clinician has been trained in techniques to assist it in dissipating. The client has also been trained in techniques to immediately relieve the distress.