What is Eye Movement Desensitization and Reprocessing (EMDR) therapy?
Eye Movement Desensitisation and Reprocessing (EMDR) therapy was originally developed in 1987, by Francine Shapiro, for the treatment of post-traumatic stress disorder (PTSD). It is now a very well-established therapeutic option, still mainly used as a treatment for PTSD, but also used to treat a variety of other mental health disorders associated with emotional dysregulation.
There are many effective therapy methods that can be used to treat trauma, including behavioural and medical approaches, but mounting evidence suggests that EMDR therapy frequently outperforms them all.
EMDR therapy is based on the idea that our minds have a natural capacity to process what happens to us, in a healthy and adaptive way. However, this natural processing and healing capacity can be overwhelmed by significantly stressful/traumatic experiences, preventing the mind from effectively processing the information at the time.
These unprocessed memories are believed to contain the distorted emotions, thoughts, images and physical sensations that occurred at the time of the traumatic event. When these memories are triggered, the stored, unprocessed elements are re-experienced – causing the distressing symptoms of PTSD (or other trauma-related disorders) to be relived over and over again.
During EMDR therapy, under guidance from a trained therapist, the patient relives the traumatic or triggering experiences in brief doses, while performing rapid eye movements (and other forms of rhythmic left-right (bilateral) stimulation, e.g. tones or taps). These are directed by the therapist, and help the brain to process the old memories correctly. Over time, as the memories are properly integrated, problematic symptoms are reduced and eventually eliminated.
It is thought to be a particularly effective treatment option for those unable to talk about their past experiences, for whatever reason. It can also be a quicker approach than many other trauma-based treatments, as it does not involve extended exposure to the distressing memory, detailed description of the trauma, or homework assignments.
The type of problem, its severity and an individual’s life circumstances are all factors that may affect how many EMDR treatment sessions are required to achieve maximum results.
How does EMDR therapy work?
EMDR therapy is used to treat unprocessed memories by addressing the past, present and future aspects of a targeted memory and combining them with guided eye movements.
The way visual processing works in the brain is extremely complex. Each eye has a left and right visual hemisphere, which are processed independently by the opposite hemispheres of the brain. Once the images are processed in each hemisphere, the hemispheres then work together to form a coherent picture that represents what we are seeing.
This inter-hemispheric communication is known to activate working memory and visual exploration. EMDR therapy takes advantage of these activated brain states to directly access and update stored memories.
Research indicates that EMDR has similar effects to rapid eye movement (REM) sleep, in which the body and mind integrate information during sleep. Much like REM, EMDR helps to direct the brain wherever it needs to go in order to heal.
The eight phases of EMDR therapy
EMDR therapy uses a structured eight-phase approach that includes:
- Phase 1: Client history and treatment planning
- Phase 2: Preparation
- Phase 3: Assessment
- Phase 4: Desensitisation
- Phase 5: Installation
- Phase 6: Body scan
- Phase 7: Closure
- Phase 8: Re-evaluation
During this phase, the client’s full history is evaluated and assessed, and a treatment plan is formulated. The therapist and client work together to identify targets for treatment that can include past memories, current triggers and future goals.
The therapist explains the treatment and introduces the procedures that will be used. They also teach the client several techniques to cope with emotional and psychological stress, such as deep breathing and mindfulness. These are valuable and essential skills needed for the treatment phases ahead.
The third phase focuses on exploring and assessing specific memories that will be targeted during treatment. As these target memories are activated, the memory components that come up are identified and explored, such as images, emotions, physical sensations and beliefs. Positive thoughts and images are then identified, which can be used during treatment to replace the negatives.
EMDR therapy techniques are used to process the targeted memories to adaptive resolution. During this phase, the client focuses on the target memory while simultaneously carrying out specific eye movements guided by the therapist. This is called bilateral stimulation (BLS) and can include taps or other movements, as appropriate. It is during this phase that desensitisation occurs, reducing the client’s distressing reactions to the memory, to the point that the memory is no longer disturbing.
After bilateral stimulation, the therapist focuses on installing the positive thoughts and images (as identified in Phase 3), to replace the negative associations with the target memory.
During this phase, the client uses a body scan to observe their physical responses when thinking of the target memory. The body scan is a meditative technique, where the body is scanned from head to toe, to notice any physical sensations that are occurring – where any residual stress may be ‘stuck’. EMDR procedures can then be repeated to target these physical sensations for further processing and release.
Phases 4–6 are brought to an end with ‘closure’. The therapist stabilises the client (using the techniques taught during Phase 2) and explains what they can expect to feel between sessions. If the targeted memory was not fully processed, specific instructions and techniques are provided to ensure client safety until the following session.
This final phase involves a review of the effectiveness of the treatment so far. This phase is often used at the start of the following session, during which the therapist evaluates the client’s current mental state and whether treatment effects have been sustained. They also address any new memories may have come up since the last session. The therapist and client then work together to identify any additional trauma targets for the current session.
A typical EMDR therapy session lasts from 60–90 minutes. Processing a specific memory generally takes one to three sessions.
The protocol is very specific and requires a therapist with a high level of training and expertise.
What is EMDR used to treat?
EMDR therapy was initially developed for the treatment of post-traumatic stress disorder (PTSD) but is now a well-researched and effective treatment approach used to treat a variety of other conditions, including:
- bipolar disorders
- chronic illness and pain
- complicated grief and loss
- dissociative disorders
- eating disorders
- panic attacks
- personality disorders
- post-traumatic stress disorder (PTSD)
- self-esteem issues
- sexual assault
- sleep disturbances.
EMDR therapy has been shown to be effective in treating people of all ages. It is thought to be particularly effective for those who struggle to talk about their past experiences or current issues in more ‘traditional’ talking therapy sessions. However, it is often used alongside other treatment options for maximum results.
Is EMDR safe?
EMDR is typically a safe and effective treatment option to relieve psychological stress and can be used with all ages, including children, adolescents and adults. However, it is a technique that requires the therapist to have an advanced level of skill and training, along with an extensive understanding of the dynamics of the brain’s ability to process.
The risks of EMDR therapy are primarily limited to emotional distress during or shortly after a treatment session. As with many psychotherapies, EMDR requires the client to recall traumatic events, and treatment may therefore cause:
- an increase in emotional distress
- heightened physical sensations during sessions?
- vivid dreams and / or nightmares
- short-term depression
- the surfacing of new traumatic memories.
However, these risk factors are minimal when therapy is carried out under the guidance of a trained therapist, as part of a multidisciplinary team.
Any side effects that do occur, typically subside as the therapy progresses.
How effective is EMDR?
Whether EMDR is used as a primary source of treatment, or as a complementary treatment alongside talk therapy sessions, studies have shown strong evidence that it is a quick and effective treatment for a variety of mental health conditions. It provides long-term solutions to recovery and well-being in a relatively short period of time.
Using EMDR to treat PTSD, and other mental health disorders has had overwhelmingly positive results, leading those involved with addiction treatment to evaluate whether EMDR therapy could benefit their clients. Recent data indicates that EMDR therapy can be a highly effective treatment for substance use disorders, particularly when the substance use disorder co-occurs with other mental health disorders (dual diagnosis).
Several studies have found that the benefits of EMDR persist over time, with patients less likely to experience relapse or problems relating to depression in the years following treatment.
EMDR has been extensively researched and is recognised by many national and international organisations as an effective treatment for many mental health conditions, including The American Psychiatric Association (APA), Substance Abuse and Mental Health Services Administration (SAMHSA) and the World Health Organization (WHO).
If you think EMDR may be of benefit to you or a loved one, please contact us for further support and guidance.