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.