While initially named and best known for the eye movements that form part of this treatment method, eye movements are only one of various components in EMDR therapy.
Since its initial conceptualization in 1987 by Dr. Francine Shapiro, who during a walk in the woods noticed how her spontaneous eye movements were affecting her thoughts and feelings, EMDR was developed, tested and and subsequently refined, before being applied to the treatment of Vietnam veterans, who by 1975 had returned home, plagued by their harrowing war experiences. Since then, EMDR therapy has become one of the primary treatment methods of PTSD by the World Health Organization (WHO), having been researched and used worldwide to treat people diagnosed with various conditions. Among others, these include traumatic experiences of various kinds (e.g., following a car accident or fall), PTSD (post traumatic stress disorder), anxiety in its various shapes and forms, and depression.
EMDR therapy focuses on present, past and future experiences.
During the therapy, the patient maintains a dual awareness to both past and present events. In other words, he or she maintains a foothold in the present, while processing past experiences.
Its aim is to help liberate the patient from the past, so he or she can live a healthy and productive present with an increase in sense self-esteem and efficacy. Moreover, it becomes increasingly possible to imagine a future free from the limiting shackles of the past.
The Adaptive Information Processing (AIP) model associated with EMDR informs clinical practice. Similarities with the so-called REM (rapid eye movement) stage of sleep which is associated with dreaming, have also been noted. In both, the brain is busy processing residual experiences and updating them.
Today it is widely believed that we have an innate neurophysiological system geared to process information in such a way that learning will occur. This is where all change occurs, regardless of the therapeutic approach used. When properly integrated within active, dynamic memory networks, this learning becomes available for future use. It thus serves an invaluable adaptive function.
When the system is functioning well, there is an adaptive resolution of the disturbing memories, which become less vivid and less impactful. In EMDR, the targeted memory becomes linked (and in a sense, updated) with additional information. Although it continues to exist (i.e., it cannot be erased or deleted), it changes in the process, leading to insights, conclusions and action plans derived from these past experiences. The patient learns what he can from the disturbing past experience, storing the event in memory anew, in a more adaptive, healthier and more empowering form (e.g., "I survived.") Present triggers, which were disproportionately distressing, no longer function as such. They are desensitized, evoking less anxiety and/or intensity of feeling. The new learning may be applied to future events.
Another form of therapy which I practice, SE (somatic experiencing), also relies on dual awareness, yet stresses the necessary conditions for the optimal discharge of excess energy hitherto stored in the body in the form of symptoms (see relevant description/articles for more information).
The innate neurophysiological system may become unbalanced, whether during the stresses of early development and cumulative trauma; single event “shock trauma”; or complex trauma—all of which which tax the ability of the nervous system to contain this stressful activation and settle down.
Similar to other psychotherapies, such as dynamic psychotherapy, the AIP model associated with EMDR assumes that most clinical presentations and psycho-pathologies are derived from or influenced by earlier life experiences, experiences that set in motion a continued pattern of coping, one involving affect (feelings and emotions), behavior, cognition and internal identity structures. It is assumed that at the time of the disturbing event, insufficiently processed information was stored in memory in an encapsulated, and thus isolated, static form. This prevented it from communicating with and being updated by other experiences, stored in separate neural memory networks.
In sum, during EMDR therapy, key memories are identified, targeted and reprocessed. They can then be stored in a more benign fashion, in the service of adaptation.
Desensitization refers to a process of becoming less sensitive, and thus less reactive to something that hitherto triggered or activated you. The negative charge or intensity of feeling associated with the activating stimulus (e.g., your stepmother, a boss, your neighbor’s dog) is lessened and no longer destabilizes you in some way e.g., by making you anxious. As relevant associations emerge and communicate, certain insights may be gained along the way.
Reprocessing means allowing the brain and autonomous nervous system to process anew, digesting an experience and allowing its meaningful and more adaptive aspects to inform your future behavior, now they are in communication with active memory networks. Aspects of the experience which do not have an adaptive value tend to be spontaneously discarded.
Reprocessing is needed when raw experiences, often of a traumatic nature, are not integrated in real time with existing memory networks, remaining encapsulated in their initial form, that is, with the sights, smells, thoughts and feelings experienced at the time. The reprocessing allows their transformation into something with adaptational value (from an evolutionary/survival point of view).
This reprocessing is initiated via bilateral stimulation (BLS) of both right and left hemispheres of the brain, most often visually. The patient is asked to follow the therapist’s hand movements with his eyes, during short “sets” of varying duration, and reports what comes up for him. Other forms of BLS may be used, such as auditory BLS (sounds presented to the ears) or tactile (e.g., a gentle tapping on one’s knees).
During the work of EMDR, the therapist acts as a facilitator of the patient’s spontaneous self-healing process. Baseline measures of the patient’s current state are taken, and are typically used to gauge the patient’s progress during the session. Based on varying patient needs and time constraints, the therapist will select specific protocols to guide the work. From time to time, the therapist intervenes verbally, in order to help the patient link together various experiences and reach certain adaptive insights on his or her own. In large measure, the patient remains in control of the session. For example, he may indicate he no longer wishes to continue processing the issue he was working on, and halt the bilateral stimulation.
Please read this in conjunction with other materials provided in this section. Just so you know, the Articles section is updated from time to time.
An integrative psychotherapy approach, Eye Movement Desensitization and Reprocessing (EMDR) is well researched and has been found effective for the treatment of trauma, helping millions of people of various ages relieve psychological stress.
Its practice involves the use of standardized protocols that incorporate elements from various treatment modalities. Despite its structured approach, the EMDR therapist may exercise a great deal of flexibility when following the patient’s flow.
Treatment of the selected targets (e.g., memories, patterns) chosen for EMDR therapy typically involves a three-pronged protocol that includes:
* focusing on the present disturbance/s that led to the decision to seek therapy;
* identifying past memories relevant to the matter at hand, and
* developing future action plans, i.e., having the patient envision how s/he would like to deal with similar situations in the future.
This approach can help alleviate presenting symptoms, meanwhile focusing on the root causes of the disturbance or difficulty. Thus, the goal of EMDR therapy is to process completely the experiences that are causing problems, and to help access or develop new ones needed for wellness and health. Inherent in the model behind this approach is the concept of self-healing.
It is important to realize that processing does not mean talking about certain experiences but rather, setting up a learning state that allows experiences that have been causing problems to be "digested" and stored appropriately in one’s brain.
It is assumed that so-called “negative” emotions, feelings and behaviors are generally caused by unresolved earlier experiences which may end up pushing one in the wrong direction. During EMDR reprocessing, you will be able to let go of inappropriate emotions (such as excessive guilt or anger), often accompanied by unpleasant body sensations and negative beliefs about yourself.
The goal of EMDR therapy is thus to leave you with the emotions, understanding, and perspectives that may lead to healthy and adaptive behaviors and interactions. This means that parallel to the process of letting go of what can be discarded, that which is useful to you from a past experience, such as an insight, will be learned and stored with appropriate emotions in your brain, and this may guide you in positive ways in the future.
For example, abuse victims begin EMDR therapy with a negative view of themselves in regard to the event/s in question; thanks to the activation of the adaptive information system, which allows old and maladaptive information to be updated, they reach a positive sense of self-worth.
At least one or two meetings are necessary for the therapist to begin to get to know you and understand the nature of your difficulties, as well as to assess whether EMDR is indicated.
Before you begin treatment, the therapist will take the time to explain what EMDR is and answer any questions you may have.
A therapeutic agreement is made, delineating your aims and goals.
Typically, an EMDR session lasts 45 to 90 minutes. It is difficult to know in advance how many sessions are necessary, and will depend on the nature of your difficulties, your treatment goals, your history of trauma, and your life circumstances.
Much research has focused on the treatment of Post Traumatic Stress Disorder (PTSD) and there over twenty controlled EMDR studies. Clinically, success has been seen with many other conditions, some of which have been specifically researched.
EMDR can be helpful with stress reduction, performance anxiety, panic attacks, phobias, complicated grief, chronic pain, sexual/physical/emotional abuse, and various other disorders. With certain modifications, dissociative disorders and addictions have also been successfully treated.
If you are able to maintain dual awareness and maintain one foot in the present during the reprocessing of past events, realizing that what you are currently experiencing is basically over and done with, and that once reprocessed, certain aspects are best left behind as you make new connections and reach helpful insights, then chances are this is for you.
Yes. While EMDR is considered to be a psychotherapy in its own right, it can definitely be used as an adjunct in other modalities.
Psychotherapists who underwent special training (Levels I and II) provided by a recognized EMDR Institute that forms part of the international community, such as EMDR Europe or EMDRIA.
EMDR therapists may be in the process of accreditation or already accredited as EMDR practitioners.