Eye Movement Desensitization and Reprocessing (EMDR)

EMDR
EMDR

An information processing therapy that uses bi-lateral stimulation of the brain to process traumatic reactions and that has proven effective in treating trauma-based conditions. Eye movement desensitization and reprocessing (EMDR) was developed in 1987 by Francine Shapiro and it has been refined over the years into a comprehensive therapy for trauma (although the procedures can also be used to treat clients with other problems and disorders. Since its inception, hundreds of case studies and controlled empirical studies have validated the effectiveness of EMDR for clients with trauma and other clients.

            EMDR therapy assumes that trauma causes an overload of an information processing system that exists in all people.  This processing system takes perceptions of the present and links them into already existing networks of memories in order to make sense of them.  An event may be initially disturbing, but if the processing system is functioning well, the person learns from the experience, and it is then stored in memory with the appropriate feelings, thoughts, and sensations.  However, if a trauma disrupts the system, then the event is stored in the brain in the form that it was experienced.

Memories of an event contain the image, thoughts, physical sensations, and emotions that occurred at the time. Each of these elements comes from a different area of the brain and is combined into what we call a “memory.”  External or internal reminders can trigger that memory, and these images, thoughts, sounds, emotions, and sensations arise and can cause the symptoms of POSTTRAUMATIC STRESS DISORDER (PTSD). Even if all the symptoms of PTSD do not exist, recent research has indicated that general life events, even those which are not officially designated as “trauma,” can cause many of these symptoms and debilitate the person. The symptoms can stem from one event or a series of events that are stored in the memory networks.

EMDR is a form of therapy that integrates aspects of other orientations, such as psychodynamic, cognitive-behavioral, and experiential. It differs from the other therapies in that it focuses on the physically stored memories in the brain, with specific procedures and protocols to process the memories to an adaptive resolution. What is useful is learned and stored with useful associations in the brain, and the negative aspects are discarded. Unlike with hypnosis, the client is always aware of what is occurring and does not take the suggestions of the therapists.  Rather, the client’s own processing mechanism activates the insights and associations that arise.

EMDR is an 8-phase treatment approach, The first phase is a history taking session during which the therapist assesses the client’s readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.

During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress- reducing techniques whenever necessary, during or between sessions. However, one of the goals is not to need these techniques once therapy is complete.

In phases three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, and related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.

After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his or her eyes back and forth following the therapist’s fingers as they move across his or her field of vision for 20 to 30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his or 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 facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. Occasionally processing will become blocked and the client “loops” around that same material and cannot move on.  When looping occurs, the therapist will first change the direction or speed of bilateral stimulation.  If looping persists, the therapist might offer an “interweaver” or rational statement to move the process along.  For example, a client might be stuck on being beaten in the home and feel they should have defended themselves.  The therapist might say “You were only a child and your parents were much bigger than you” as a way to move out of the loop.  ,When the client reports no distress related to the targeted memory, the clinician asks him or her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.

In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.

The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.

After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures.

These phases also include a form of bilateral stimulation (eye movements, taps, or tones) that many researchers believes stimulate an “orienting response” causing new positive associations to arise, as the negative ones are discarded. Some researchers have compared the progressions to those that occur in Rapid Eye Movement (REM) sleep, which is believed to be the body’s own mechanism for processing survival information.

During the reprocessing phases, the trauma memory is transformed with new insights, emotions, sensations, and beliefs that automatically arise. The rape victim can move from a sense of shame and guilt to the feeling of being a strong and resilient woman. Research has indicated that these changes can occur very rapidly, often within three sessions.

EMDR sessions end with a closure phase that resolves any distress from incomplete treatment and prepares the client for any continued processing between sessions. As homework, the client keeps a log of any new thoughts, feelings, or images that may arise. The next sessions begins with a Reevaluation to check on the previous work and guide the clinician to choosing the next target.

In addition to treating PTSD, EMDR can also address any clinical complaint that is based upon, or made worse by, disturbing life experiences. These more general disturbances are called small “t” trauma. That is, while humiliations in grade school may be commonplace, they can also have long-lasting negative effects (small “t” trauma) and they felt “traumatic” when they occurred. They also appear to be stored in the BRAIN in a way that holds the original negative emotions, thoughts, and body sensations. Processing these types of memories can help resolve a wide range of pathologies.

Empirical support has been established for the efficiency and effectiveness of EMDR.  Furthermore, physiological studies find positive structural changes occur in the brain following successful EMDR therapy. In 1995 a professional organization was independently formed to establish ethical and training standard for therapists practicing EMDR. This organization is called the Eye Movement Desensitization and Reprocessing International Association or EMDRIA. Both the EMDR Institute and EMDRIA have websites available for more information and help finding a trained therapist.

Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. Guilford Press, 472 pages.

 

This section is a reprint from the book titles “The A to Z of Trauma: A Concise Guide to the Causes, Symptoms, and Treatment of Traumatic Stress Disorders” (2009)  by Ronald M. Doctor, Ph.D. and Frank  N. Shiromoto, Ph.D. published by Checkmark Books, New York.  This entry was written by Ron Doctor and Francine Shapiro for this book.