Eye Movement Desensitization and Reprocessing - EMDR

Eye Movement Desensitization and Reprocessing (EMDR) has been around since the early 1980’s. Francine Shapiro noticed that while walking in the park, thinking of her stresses, her eyes were moving back and forth. She recognized that she felt better afterwards. She tried it again on herself and then her friends and colleagues, they experienced the same results. Over the next few years, she fine tuned the protocol and completed the first randomized control study. Her protocol was further flushed out and the protocol was published in her first book.  You can access her articles here.

The fact of the matter is that we’re not quite sure!  Someday we’ll have technology to evaluate that!  There are a few theories:

· The eye movement component stimulates the brain in a way that’s similar to REM sleep phase, we are activating a dream state while you are conscious and allowing the brain to process naturally.

· The combination of bi-lateral stimulation (eye movements, audio sounds, tapping, buzzers) and recalling a painful memory doesn’t allow the brain to attend to both at the same time. Our body learns to habituate once it recognizes that there is not current danger.

· Working memory is necessary to both notice the memory and the BLS, it is not capable of holding both simultaneously. The BLS disrupts working memory as well as the vividness and emotionality of the memory being addressed.

EMDR processing can be very fast, at times it can take multiple sessions.  Because everyone’s situation is a little different, in terms of extent of/type of trauma, availability of coping skills, and current life situation, there is no magic number of sessions.  It is the therapist’s responsibility to make sure you are emotionally ready to address difficult, emotional experiences of your past, which also varies from person to person.  There is also no way to predict how long it will take to process a memory.  Sometimes seemingly benign memories take several sessions to work through, whereas troublesome memories may process in one session. 

EMDR is an effective therapy for many, many diagnoses.  It is often only considered as a treatment of trauma; however, this is not true. EMDR is appropriate with:

· Anxiety

· Depression

· Trauma

· Obsessive – Compulsive Disorder

· Phobias

· Chronic Pain

· Addictions (drug, alcohol, gambling, pornography, sex, technology)

· Eating disorders

EMDR is not appropriate for psychosis (such as schizophrenia), Traumatic Brain Injury (will not assist in recovering lost cognitive functioning but can assist by processing the trauma that caused the injury) and physiological disorders such as bipolar (will not regulate moods, but can be used to process experiences/behavior that are disturbing due to past manic episodes).

An EMDR processing session starts with the therapist reviewing the intended memory to be worked on, this is often decided on beforehand. Your therapist will ask you specific questions about that memory, this helps active your brain and laser focus it on the problem areas. The Bilateral Stimulation (BLS) will then start, either with eye movements, audio tones, tapping, or using buzzers. How your body responds varies person to person and session to session. Often, you will experience an increase in intensity in your emotional and physiological response to the memory. This is because your brain is looking at it in a different way. It’s not just seeing a visual representation of it, it now includes the emotions, somatic sensations and what you believe about yourself. Often this increase is uncomfortable and manageable. Sometimes you may need to pause and work with your therapist on self-regulation skills. Other times, your body may protect you by shutting your emotions down, necessitating calming interventions with your therapist. Before EMDR processing, your therapist should evaluate your emotion tolerance and provide you with tools and exercises to make sure you are equipped.

For a phase-by-phase description of the protocol, please click here. 

EMDR stimulates your brain in a unique way. This stimulation doesn’t stop when you leave your therapist’s office. It continues to work for another 48-72 hours. For many people they don’t experience the aftereffects in any significant or disruptive way. Other people will notice feeling fatigued, irritable, having strange dreams, or other memories coming up to the surface in the day or so following the processing session. If you find it difficult to return to your life after an EMDR session, please alert your therapist so they can take more steps to contain the side effects.

Although EMDR is considered a new approach, it has been around and studied since the early 1990’s. Research findings are so overwhelming that many national and international organizations recognized EMDR as an approved and effective treatment.  You can find these treatment guidelines here and copies of research material here.

Your memories will not be erased. You will still have your memories. EMDR changes how the memory is stored. What was once a painful and emotional memory can be processed into something that happened, that no longer activates an uncomfortable response. 

At times, forgotten memories or pieces of memory may come up. It is a normal part of processing if this happens. The goal is not to find any repressed memories, rather to work through what is there.

Your therapist will complete a thorough intake assessment with you. This allows them to get a sense of what prior experiences are contributing to your symptoms today. EMDR is often worked backwards, starting with your presenting problems and looking to your past to identify where they started. There are specific techniques that will be used to identify which memories are most important to address and in what order. 

There are a number of benefits to using to EMDR. The first one being that it is not used in a vacuum. Your therapist will pull from a number of different modalities, as needed, to work on your therapeutic goals. EMDR itself is a culmination of a number of approaches, CBT is used to identify negative self-beliefs, somatic processing is used to address physiological responses to the memory, and free association is pulled from the psychoanalytic approach. Drawing from so many disciplines allows for full processing of the whole memory, often much faster than traditional talk therapy. 

All processing with EMDR is done internally. Your brain does the work while noticing the Bilateral Stimulation. There is no need to retell/relive the experience over and over. In fact, your therapist may never know all the details of what happened. You also will not have to do any homework, except noticing any changes you may be experiencing. All work is done in session. 

Studies show long term treatment effectiveness, if treatment is completed. Often clients leave therapy once they start to feel better, or don’t process through everything. In these cases, treatment effects tend to be short-lived. Think of it as an infection, like strep throat. If you stop taking antibiotics when you start feeling better it is likely to return; if you complete the treatment it is unlikely to resurface.

It’s important to work with a therapist that is qualified. There are multiple levels of EMDR practitioners, all approved through the EMDR International Association (EMDRIA).

EMDR trained – completed the 6 days of training, 10 hours of group consultation and passes a post-test. Unfortunately, at this level there isn’t a way to verify what they understand of EMDR or that they are implementing it correctly.

EMDR Certified – certified EMDR therapists completed the training and participated in additional training. They attended at least an additional 13 hours of training, another 20 hours of consultation on their use of EMDR, have practice using EMDR and have recommendation letters from approved EMDR therapists. At this level, the therapist must demonstrate knowledge and understanding to be approved.

EMDR Approved Consultant – EMDR certified therapist completes additional training, an additional 20 hours of consultation on their ability to advise EMDR trained and EMDR certified therapists, and additional recommendation letters. Therapists that have been certified and are working towards being an Approved Consultant are called Consultants in Training. 

EMDR trainer – have been evaluated and approved to train basic EMDR and/or advanced topics in EMDR. Training content as well as training abilities are assessed.