What is EMDR Therapy?

Mary-Lauren O’Crowley, NCC, LPC

Eye Movement Desensitization Reprocessing (EMDR) is an interactive therapy founded by Francine Shapiro back in 1987. Unlike traditional psychotherapy models, EMDR is nontraditional psychotherapy rooted in mindfulness and non-judgmental awareness, resulting in transformative healing. EMDR is one of the treatment modalities that follows the adaptive information processing (AIP) model. According to AIP, people with PTSD have disturbing thoughts that remain unprocessed over time. As per the World Health Organization (WHO), trauma, negative thoughts, and maladaptive behaviors result from unprocessed memories. In most cases, people fear processing such thoughts because of the high level of disturbance that comes with it.  For example, when working with a traumatized individual, the EMDR restores the brain’s normal way of dealing with problems, including informational processing. 

EMDR is usually an individual therapy conducted 1-2 times a week for approximately 8-12 sessions. The number of sessions that clients take depends on the trauma type and severity. However, the National Institute for Health and Care Excellence (NICE) recommends clients be taken through 8-12 sessions to treat simple traumas and more sessions when dealing with multiple or severe traumas. As a structured approach, EMDR helps address the client’s past, present, and future aspects of a disturbing memory. From past experiences, EMDR sessions tend to take a longer time than other typical therapy sessions. According to Shapiro (2014), this type of therapy takes 90 minutes. 

During EMDR sessions, the therapist asks the client to pay attention from one side to the other while thinking about the disturbing memory. To ensure that clients successfully do so, the therapist moves their finger side to side in the client’s line of vision.  In some cases, EMDR therapists ask clients to pay attention to tapping and other sounds that occur sequentially from left to right. The side-to-side motion is known as bilateral stimulation, which is known to enhance memory processing. When conducting the bilateral stimulation, therapists ask clients to recall their most disturbing events simultaneously. Progressively, therapists tell clients to change their thoughts and focus on their life’s pleasant moments. 

EMDR Phases 

EMDR is an 8-phase therapy that includes history taking where the therapist gains the client’s adequate information on past experiences. The second phase is preparation, where clients are requested to choose a self-image that can offer stabilization. The subsequent stages are assessment and desensitization. During the assessment, the client’s disturbing memories and thoughts are recorded, evaluated, and measured. In the fourth phase, known as desensitization, the therapist employs bilateral stimulation. The therapist may choose to use eye movements, taps, or tones to help clients reprocess distressing events. During the desensitization phase, the therapist stops periodically to examine the client’s disturbance level. The exercise allows therapists to note the client’s positive cognition (positive self-statements preferable to negative cognition) and negative cognition (negative self-statements that seem true). 

The sixth EMDR phase is known as an installation where the earlier selected positive cognition or affirmation is used. The subsequent phases include body scan, closure, and reevaluation. The EMDR therapist examines the client’s body for pain, stress, and discomfort during the body scan phase. The issue is not fully processed if the client shows physical tension or distress even after the bilateral stimulation. In such cases, the bilateral stimulation continues. In the final phases, also known as closure and reevaluation, the therapist conducts a debriefing and shares crucial information with the client.  During reevaluation, the client discusses their week with the therapist and shares any new sensations and experiences. In addition, the client’s level of disturbance is assessed. The main objective of the reevaluation phase is to ensure that the client is processing all the relevant historical events. Such information helps towards treatment and the client’s recovery. 

What does EMDR treat?

When individuals experience a traumatic event such as the sudden loss of a family member, sexual assault, or a natural disaster, they may subsequently experience disturbing and strong emotions and physiological responses that overwhelm the brain and nervous systems’ ability to cope, leading to prolonged states of fight or flight. This may look like anger outbursts, irritability, crying spells, or feelings of panic or dread. With inadequate processing of an event, the dysfunctional memory is stored in an isolated memory network. Triggers, or activating events, can then lead individuals to re-experience aspects of the actual traumatic event in the present, resulting in inappropriate or uncontrollable overreactions. 

EMDR is an innately natural therapy that primarily supports the brain and nervous system in addressing and processing distressing material, engaging a natural process known as Adaptive Information Processing. As mentioned earlier, EMDR is mainly known to treat PTSD as recommended by NICE; However, EMDR is also said to effectively treat other issues, including chronic pain, loss and grief, smoking cessation, and disturbing or distressing memories related to car accidents, childhood abuse, neglect, and addictions. Evidence on the success of EMDR when treating other disorders is less clear, and hence more research is required. 

EMDR has proven efficacy as a therapeutic technique when it comes to PTSD. After a series of EMDR treatments, patients can often recall painful events without experiencing a severe emotional or physiological reaction. Further research on EMDR success in treating other issues, including chronic pain, depression, anxiety, among others, is required.

 Reference

Brown, S., Stowasser, J and Shapiro, F. (2016). EMDR Therapy and the Treatment of Substance Abuse and Addiction. Retrieved from https://www.researchgate.net/publication/308925851_EMDR_Therapy_and_the_Treatment_of_Substance_Abuse_and_Addiction

Huso, D. (2010). Treating Child Abuse Trauma with EMDR. Social Work Today, 10(2), 20. Retrieved from https://www.socialworktoday.com/archive/032210p20.shtml

Shapiro, F. (2014). The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experience. The Permanente Journal, 18(1). https://doi.org/10.7812/tpp/13-098