EMDR – Eye Movement Desensitization and Reprocessing
Francine Shapiro, PhD, an American psychologist, developed Eye Movement Desensitization and Reprocessing (EMDR) Therapy as a breakthrough therapy with special capacity to overcome the often devastating effects of psychological trauma in the late 1980s. An ever-growing community of therapists soon saw directly its power to transform lives. At the same time, controlled research studies consistently demonstrated its efficacy and effectiveness. For many therapists who took up this therapy, EMDR felt like a “gift” to themselves and their clients, and they were eager to “pay it forward” by spreading the word to colleagues.
Description of an EMDR Therapy Session
Eye Movement Desensitization and Reprocessing (EMDR) is an approach to psychotherapy that has been practiced in the U.S. and around the world for the past 25 years. It integrates many of the successful elements of a range of therapeutic approaches, yet there are aspects of EMDR that are unique. In particular, the therapist leads a patient in a series of lateral eye movements while the patient simultaneously focuses on various aspects of a disturbing memory. The left – right eye movements in EMDR therapy are a form of “bilateral stimulation”. Other forms of bilateral stimulation used by EMDR therapists include alternating bilateral sound using headphones and alternating tactile simulation using a handheld device that vibrates or taps to the back of the patient’s hands.
EMDR therapy is applicable for a wide range of psychological problems that result from overwhelming life experiences. During the processing of difficult memories, a person who has been abandoned by a spouse may come to realize that she is loveable and is no longer overwhelmed by negative feelings about herself or participate in unproductive behaviors stemming from those feelings. A person fearful of driving due to a terrible car accident in the past may end the session feeling safe to drive again.
The therapeutic effects of bilateral stimulation were discovered by Francine Shapiro, Ph.D., who grasped their power in psychotherapy. Dr. Shapiro found—quite by accident—that emotional and behavioral symptoms resulting from disturbing experiences tend to resolve naturally when a person allows him/herself to recall various elements of a memory while engaging in bilateral stimulation such as lateral eye movements. Dr. Shapiro and her associates developed a number of procedures for coordinating this “dual awareness”. The procedures have been refined and validated through controlled research at several centers around the world. Precise and careful use of these procedures can lead to a safe processing of memories, such that the negative thoughts and emotions disappear.
More than a set of “techniques”, the EMDR approach provides a model for understanding human potential, including how positive experiences support adaptive living, or psychological health, and how upsetting experiences can sometimes lead to psychological problems that interfere with a person’s ability to meet life challenges. The EMDR protocol guides clinicians in careful assessment and preparation work, particularly for persons with histories of multiple traumas. EMDR procedures should only be used by a fully trained EMDR clinician, who holds licensure in the mental health field.
“EMDR is one of the most powerful tools I’ve encountered for treating posttraumatic stress. In the hands of a competent and compassionate therapist, it gives people the means to heal themselves.”
EMDR 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). The therapist assesses the client’s readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.
Initial EMDR processing may be directed to childhood events rather than to adult onset stressors or the identified critical incident if the client had a problematic childhood. Clients generally gain insight on their situations, the emotional distress resolves and they start to change their behaviors. The length of treatment depends upon the number of traumas and the age of PTSD onset. Generally, those with single event adult onset trauma can be successfully treated in under 5 hours. Multiple trauma victims may require a longer treatment time.
Phase 2: 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 a variety of 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.
Phases 3-6: In phases three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying three things:
1. The vivid visual image related to the memory
2. A negative belief about self
3. Related emotions and body sensations.
In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones. The type and length of these sets is different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneously happens.
After each set of stimulation, the clinician instructs the client to let his/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 choose the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.
When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session. At this time, the client may adjust the positive belief if necessary, and then focus on it during the next set of distressing events.
Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.
Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was originally designed by Francine Shapiro to alleviate the distress associated with traumatic memories.
EMDR therapy facilitates the accessing and processing of traumatic memories and other adverse life experience to bring these to an adaptive resolution.
Treatment with EMDR therapy relieves emotional (affective) distress, reformulates negative beliefs, and physiological arousal is reduced.
During EMDR therapy the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Therapist directed lateral eye movements are the most commonly used external stimulus but a variety of other stimuli including hand-tapping and audio stimulation are often used (Shapiro, 1991).
EMDR is incredibly effective as a treatment for Trauma and PTSD – controlled tests have seen over 80-90% success rate in clients with severe symptoms. It’s still not certain exactly why it is so effective – Shapiro (1995, 2001) hypothesizes that EMDR therapy facilitates the accessing of the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.
EMDR therapy uses a three pronged protocol:
(1) the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information;
(2) the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized;
(3) imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning.
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 therapy 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 therapy training sessions, clinicians help clients activate their natural healing processes.
More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 25 years.
EMDR therapy is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.” Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes. The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.