Eye movement desensitization and reprocessing, more commonly referred to as EMDR, is an emerging field in psychotherapy. In particular, it has become a popular choice for clinicians who have been working with individuals who suffer from post-traumatic stress disorder, a condition that’s known to occur in the survivors of:
- Vehicle accidents
- Abusive parenting
- Extremely stressful childhood environments
- Sexual assaults and rapes
- Catastrophic natural disasters
While most modern types of therapy are focused on talk sessions with counselors and/or the administration of drugs, eye movement desensitization and reprocessing can go a very different direction. The idea here is to utilize rapid eye movements to tamp down powerful emotions that arise from remembering events that seared traumas into a person’s mind. These eye movements are intended to be rapid and rhythmic.
Basic Concerns Being Addressed
At the core of EMDR is the theory that the brain has a natural resilience to handling difficult and even dangerous experiences. Extremely painful events, especially ones that occur repeatedly or that have a high probability of happening again, can overwhelm the ability of the brain to hold off memories that trigger the fight-or-flight instinct. These experiences are about more than just emotions. Patients can develop beliefs, attitudes, habits and even physical sensations that simply no longer serve them in a positive way. The hope is that by teaching the client to actively process traumas, they will begin to take control of their well-being and replace negative feelings with positive ones.
Effectiveness and Controversy
Not surprisingly, some elements of this method are similar to traditional talk therapy solutions. The notion that eye movement can have a large impact on mental and emotional well-being is not without controversy. It has, however, been approved by the:
- American Psychiatric Association
- U.S. Department of Veterans Affairs
- U.S. Department of Defense
- International Society of Traumatic Stress Studies
- World Health Organization
A number of randomized tests have been conducted to determine the potential efficacy of the treatment. Evaluations of its efficacy in treating PTSD in both adults and children indicate that the treatment is comparable to other respected methods, such as cognitive behavioral therapy, in treating PTSD. Intriguing but less statistically compelling results also indicate that EMDR may improve symptoms of anxiety and depression.
According to a study published by the APA, EMDR was effective in treating:
- 100 percent of individuals who had experienced a single trauma
- 77 percent of those who had been through multiple traumas
There is still ongoing testing of how effective EMDR may be in treating depression and anxiety. Some clinicians are also interested in whether the technique might be used to treat panic attacks, addictions and substance use disorders, medical anxieties, social phobias, sexual dysfunctions and panic attacks.
Getting Ready for EMDR Therapy
Eye movement desensitization and reprocessing is designed to follow eight distinct steps. These are:
- Studying patient history and planning therapy
- Outlining the treatment plan, establishing trust and explaining the goals
- Assessing negative feelings and potential positive replacements
- Desensitizing the patient, the part that includes the eye movements
- Installing and strengthening positive replacement feelings
- Conducting a body scan to assess whether negative reactions are still present
- Closure at the end of each session
- Re-evaluation at the beginning of any new sessions if necessary
Phase 1: Patient History
The first concern is always to evaluate whether the patient is ready for therapy. A practitioner will work up a detailed history of the client to identify what issues are present and whether there might be secondary problems. Dysfunctions, symptoms and personal characteristics are broken down into a distinct list of things that might be targeted as either negatives that need to be replaced or positives that can be installed. Eventually, a decision has to be made about whether a patient is prepared to go through the following seven steps, potentially repeatedly.
Phase 2: The Treatment Plan
With a treatment plan in mind, the clinician will begin to establish a therapeutic relationship with the client. An emphasis at this stage is placed on ensuring that clients have set sensible expectations rather than unrealistically hoping for a quick cure. Another major goal of the second phase is ensuring that the patient learns self-control techniques that allow them to:
- Cope with incomplete or failed sessions
- Maintain emotional stability between sessions
These techniques may include the use of metaphors and stop signals that allow the patient to take control of situations when they feel unstable. Finally, the therapist will explain what they believe to be the client’s symptom pattern and how they can go about actively processing trauma.
Phase 3: Assessment
Target memories have been fully assessed by this phase, and the therapist will ask the client to bring up the most directly stressful version of a specific memory. The hope is that the negative beliefs and feelings that accompany it will supply the therapist with an idea of the irrationality of the event that caused the trauma.
Two measurements are utilized in this stage. First is Validity of Cognition, a tool that’s employed to assess positive change between sessions. Second is the Subjective Unit of Distress, a measure of the severity of the traumatic memory in question. The goal is to ensure that the therapist will have an objective standard for determining what is or is not working as the patient progresses through later phases and repeated sessions.
Phase 4: Desensitization
Client eye movement is encouraged by the therapist, who moves their finger around close to the client’s face and asks the client to track the movement. While these finger and eye movements are occurring, the patient is also encouraged to focus on the mental image of the target memory. They are encouraged to maintain a mental and an emotional openness to however certain feelings might surface during the process.
With the conclusion of each round of finger and eye moments, the therapist will then tell the patient to blank out the image that they were previously asked to focus on. The client should take a deep breath and block the image out completely.
Phase 5: Installation
Positive cognition is encouraged during this phase. That likely has you wondering, “What is a positive cognition?”
Our memories lead us to certain conclusions about ourselves and our lives. These are cognitions that can be either negative or positive, and they have the tendency to become self-fulfilling prophecies. Negative cognitions can resonate with how we react to situations, ultimately triggering responses that are hard to control.
During the earlier assessment phase, a list of both negative and positive cognitions was made. In treating a combat veteran, for example, the focus of Phase 4 might have been on the idea that “I am not safe,” a common feeling for people who’ve repeatedly gone into battle or been near firefights. In phase 5, the therapist will work on installing a positive cognition that the patient has consciously expressed a desire to attain. This might be something like:
- “I am safe.”
- “My choices are now mine to make.”
- “I am strong.”
The logic is fairly easy to follow: Identify a negative cognition and then install a positive cognition.
Phase 6: Body Scanning
You may recall that physical sensations were noted as one of the problems that can follow from negative cognitions. The point of body scans in Phase 6 is to determine whether physical sensations, such as tension arising from the memory of a targeted image or event, are still present. A therapist may then decide to include these sensations as targets for future sessions of reprocessing.
Phase 7: Closure
There’s a good chance that a single session is not going to lead to the full reprocessing of negative memories of traumas. For that reason, the patient will be reminded of previously taught self-control methods to ensure they can maintain stability. They will also be encouraged to document any disturbances that might occur between sessions.
Phase 8: Re-evaluation
Working from a comparison of the original VOC score and the current one, the therapist will decide whether further sessions of eye movement desensitization and reprocessing are necessary. If that is not the case, then sessions are terminated with the end of Phase 7. If there appear to still be disturbances that need to be treated, a new session will be arranged, and a re-evaluation will occur before proceeding from Phase 4 again during the next session.
The History of EMDR
In 1987, a psychologist in California, Francine Shapiro, discovered that her sense of anxiety about disturbing thoughts she was having was reduced when she moved her eyes around to take in her surroundings. She decided to follow up on this idea by conducting sessions with her patients. In the process, she established the earliest underpinnings of EMDR. She would go on to publish her first study of the process in 1989, triggering a number of investigations. The focus of these studies has been on:
There has, however, been further research into the potential efficacy of EMDR in treating depression, eating disorders and even schizophrenia.
EMDR has received a lot of attention. A lot has focused on the idea of it being a “miracle cure” while others have stereotyped the process as a movie-style form of hypnotism. Neither of those assessments is close to true. What has been seen, however, is a level of effectiveness that has allowed EMDR to be embraced by many major health organizations, particularly the APA.
EMDR developed a professional following over the course of the 1990s. A major moment in the acceptance of EMDR was when the U.S. Department of Defense took an interest in it as a possible way to treat soldiers who had developed PTSD during operations during the wars in Iraq, Afghanistan and other regions in the 2000s. In 2010, following a study of its efficacy in treating a group of veterans who had mostly served during the Vietnam War, the Department of Defense and the Department of Veterans Affairs both recommended EMDR as a treatment for individuals who had experienced combat-related stresses.
As the acceptance of EMDR has progressed, therapists began to test its efficacy in cases involving people who had not been through combat and who had not experienced anxiety or PTSD. This has led to EMDR’s use in treating daily life stressors, attachment disorders and family dysfunctions. Treatment of problems in children has also become more common. The prevailing view, however, continues to be that EMDR is most effective when helping patients who are coping with major traumas or highly disturbing thoughts.
The most widely recognized accrediting organization is the EMDR International Association, frequently referred to as the EMDRIA. Techniques of eye movement desensitization and reprocessing are often taught to therapists, social workers and counselors, but you should also make sure you’re working with a professional who has been properly licensed and who has also received appropriate training in the method.