EMDR Therapy

Overview

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a modern approach in mental health treatment. EMDR aims to help individuals recover from trauma and distressing life experiences. It involves specific eye movements while processing these memories.

Compared to traditional therapies, EMDR is relatively new, with its first clinical trial conducted in 1989. Subsequent trials have consistently shown its effectiveness, often leading to faster results compared to other therapeutic methods.

Reasons for undergoing the procedure

EMDR therapy benefits individuals of all ages and can effectively treat a wide range of mental health disorders. It is applicable to adolescents, teenagers, and adults, with some specialists also offering EMDR for children.

Diverging from traditional talk therapy, EMDR focuses on altering emotions, thoughts, or behaviors related to traumatic experiences rather than extensively discussing distressing issues. This approach supports the brain’s natural healing process.

While often used interchangeably, “mind” and “brain” denote distinct concepts. The brain functions as a bodily organ, whereas the mind encompasses an individual’s thoughts, memories, beliefs, and life experiences, shaping their identity.

The mind’s functionality depends on the brain’s structural organization, which includes networks of interconnected brain cells across various regions, particularly those involved in memory and sensory processing. These networks facilitate efficient collaboration among these areas, explaining how sensory stimuli such as sights, sounds, smells, tastes, and touch can evoke vivid memories.

Adaptive information processing

EMDR is grounded in the Adaptive Information Processing (AIP) model, a framework proposed by Francine Shapiro, PhD, who also developed EMDR therapy. This model posits that the brain stores normal and traumatic memories differently.

During ordinary experiences, memories are typically stored and integrated smoothly into existing networks of related memories. However, during distressing events, this integration may not occur effectively. The brain can enter a state where there is a disconnection between sensory experiences (what you feel, hear, see) and how these experiences are processed and stored as memories.

Traumatic memories often remain isolated and fragmented, hindering the brain’s natural healing process. Trauma is likened to an unhealed wound in the brain, where the perception that danger persists prevents the brain from receiving signals that the threat has passed.

Moreover, subsequent experiences may become linked to earlier trauma memories, reinforcing negative associations repeatedly. This disrupts the connections between sensory input and memory, causing psychological distress akin to an injury to the mind. Just as the body reacts sensitively to pain from a physical injury, the mind can become hypersensitive to stimuli associated with traumatic events—things seen, heard, smelled, or felt.

These effects can occur not only with consciously recalled events but also with memories that have been suppressed. Similar to learning to avoid touching a hot stove due to the pain it causes, the mind may attempt to suppress traumatic memories to avoid the associated distress. However, this suppression is not always effective, resulting in persistent negative symptoms, emotions, and behaviors stemming from the unresolved trauma.

Triggers

Visual, auditory, and olfactory stimuli that bear a connection to a traumatic event can trigger memories that were inadequately stored. Unlike other memories, these can evoke intense feelings of fear, anxiety, anger, or panic.

In conditions like Post-Traumatic Stress Disorder (PTSD), flashbacks arise from the incomplete storage and integration of traumatic memories. This leads the mind to access these memories uncontrollably, in a distorted and overwhelming manner. Individuals experiencing flashbacks often describe feeling as though they are reliving the disturbing event, blurring the boundaries between past and present experiences.

Reprocessing and repair

During EMDR therapy, you engage with memories of a traumatic event through specific methods. By incorporating eye movements and guided instructions, accessing these memories facilitates the reprocessing of your recollections of the negative event.

This reprocessing aids in healing the psychological impact of that memory. Recalling the event will no longer evoke the sensation of reliving it, and the associated emotions will become significantly more manageable.

Reasons for undergoing the procedure

EMDR is most commonly used to treat PTSD. It is also used by mental health professionals to treat the following conditions:

• Anxiety disorders include panic disorder, generalized anxiety disorder, social anxiety/phobia, and phobias.
• Depression disorders include major depressive disorder, persistent depressive disorder, and depression associated with illness.
• Dissociative disorders include depersonalization or derealization disorder and dissociative identity disorder or amnesia.
• Anorexia nervosa, bulimia nervosa, and binge-eating disorder.
• Gender dysphoria is the belief that the gender you were assigned at birth is not the same as your actual gender.
• Obsessive-compulsive disorders(OCD), hoarding disorder, and body dysmorphic disorder.
• Antisocial, avoidant, and borderline personality disorders.
• Acute stress disorder, PTSD, and adjustment disorder are examples of trauma disorders.

Risks

EMDR therapy is generally low-risk, with the most common adverse effects being occasional negative thoughts or feelings that may emerge between sessions. Your doctor can provide guidance on what to expect and offer strategies to effectively manage and address these experiences.

During the procedure

EMDR therapy unfolds across eight distinct phases, spanning multiple sessions where parts of different phases may intertwine. Initially, phases 1 and 2 are typically addressed in early sessions, while phases 3 through 8 extend over subsequent sessions.

Treatment for a single distressing event or memory typically requires three to six sessions. More intricate or longstanding traumas may necessitate eight to 12 sessions, occasionally more. Each session typically lasts between one hour and 90 minutes. The eight phases include:

1. Patient history and information gathering: In this initial phase, your doctor collects comprehensive information about your personal history. This helps assess whether EMDR therapy is suitable for you. It involves discussing distressing events and memories you wish to address, as well as outlining your therapeutic goals.
2. Preparation and education: During this phase, your doctor explains what to expect during EMDR sessions. They also provide guidance on how to enhance your stability and sense of safety during the therapy. Tools and techniques are offered to help you manage emotions effectively.
3. Assessment: In this stage, your doctor assists you in identifying specific memories and themes that will be the focus of reprocessing. Negative beliefs stemming from the trauma are pinpointed, alongside positive beliefs you aim to cultivate for personal growth.
4. Desensitization and reprocessing: Here, your doctor guides you through activating the targeted memory. This involves exploring specific negative images, thoughts, feelings, and physical sensations. Throughout this process, you observe your emotional responses and gain new insights into your experience.
5. Installation: During this phase, your doctor will guide you to concentrate on cultivating the positive belief as you process a memory. This positive belief can be either what you identified in phase 3 or something new that emerges during phase 4.
6. Body scan: Your doctor guides you in focusing on bodily sensations associated with the targeted memory. This phase tracks your progress throughout EMDR therapy, aiming for symptom reduction until they are minimal or absent, signifying completion of reprocessing.
7. Closure and stabilization: Acting as a transitional phase between sessions, this phase involves discussions on managing expectations and stabilizing emotions. Your doctor ensures you feel calm and secure before concluding the session, and may encourage journaling of new insights for future sessions.
8. Reevaluation and continuing care: The final phase involves reviewing your progress and current well-being. This helps determine if additional sessions are needed or if adjustments to therapy goals are necessary. Planning for future challenges and identifying coping strategies based on your newfound understanding of yourself and past traumas are also addressed.

Sense activation during phase 4

In the early days of EMDR, bilateral stimulation typically involved using vision. Practitioners would hold up a hand with two fingers extended and instruct you to track the movement of their finger from side to side using only your eyes.

Modern approaches to EMDR now integrate a variety of sensory modalities. For example, specialized light devices with moving lights can replace hand movements, engaging your vision similarly. Alternatively, sound-based methods use speakers emitting tones from each side of your body. Some therapies incorporate tactile stimulation, such as gentle tapping on hands, arms, or thighs to activate bilateral touch sensations. Additionally, handheld devices that pulse can provide another tactile option if preferred.

Outcome

Most patients undergo EMDR therapy for several weeks to several months, with minimal recovery time between sessions. Your doctor can provide guidance on self-care during these intervals.