What is EMDR?
EMDR is an empirically validated, integrated approach to psychotherapy developed by Francine Shapiro, PH.D. in 1989. Although it was originally used for the treatment of trauma and PTSD, it has now been shown to be beneficial for an array of mental health concerns. EMDR therapy, for example, can be used to treat substance abuse disorders, anxiety, chronic pain and self-esteem.
EMDR therapy is guided by the Adaptive Information Processing (AIP) model which posits that unprocessed memories, when triggered, result in psychological symptoms. Essentially, trauma is stored and and stuck in the brain’s neural network. The AIP model postulates that symptoms result from past disturbing experiences that continue to cause distress because memories were not adequately processed. These unprocessed memories are believed to contain the emotions, beliefs, thoughts and physical sensations that occurred at the time of the event. Any memory of a traumatic event causes the person to connect to the negative feelings and cognitions associated with it.
More on AIP
Problems ensue when an experience is only partially processed. The AIP model assumes that a particularly distressing event may become stored in state-specific form. This means the event is frozen in time, unable to connect with other memory networks that hold adaptive information. According to Shapiro (1995), when a memory is encoded in a distressing state-specific form, the original perceptions can continue to be triggered by varying stimuli. The result becomes excessive emotional, behavioral and cognitive reactions in present day.
Memories that are stored dysfunctionally are believed to cause future maladaptive responses. An individual’s perception of their current situation may still be linked with the associated memory networks. These unprocessed memories are thought to contain the emotions, thoughts, beliefs and physical sensations that occurred at the time of the event.
The Phases of EMDR
1. History taking and treatment planning
In this phase, the therapist works with the client to gather information related to the client’s history as it relates to their issues in present time. Both the therapist and client will collaborate on identifying targets for treatment. Targets include past memories, current triggers and future goals. The client will also get a chance to connect with the therapists and learn more about the EMDR therapy process.
2. Preparation
In the second phase, the therapist offers an explanation for treatment. They will ensure that the client has several different ways of handling emotional distress. Some of the techniques the therapist will teach include grounding skills, stress-reduction techniques and imagery. Often, a safe/calm place exercise will be introduced. This will include the practice of using eye movement and or other bilateral stimulation (BLS) components.
3. Assessment
In this phase, the client will be asked to access each target in a standardized way so it can be processed effectively. “Processed”, however, does not mean talking about it. Assessment activates the memory that is being targeted in session by identifying and assessing each of the memory components. These components are: image, affect, cognitions and body sensations.
The client will select a specific image or mental picture from the target event that best represents the memory. The therapist will then ask the client to identify both a positive and negative statement or emotion to describe how they feel about the event. It is believed that the negative beliefs are verbalizations of the distressing emotions that still exist. Common negative cognitions include statements such as “I am a failure”, “I am not safe” “I am useless” etc. The client then picks a positive self-statement that they would rather believe. Common positive statements include “I am lovable”, “I am worthwhile”, “People like to be around me” etc. The positive cognition should reflect what is actually appropriate in the present.
The client will then be asked to rate the positive statement and negative statement. Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale are used here. Using the SUD, the client will rate the negative belief on a scale of 0 (no disturbance) to 10 (worst disturbance you can possibly imagine). Using the VOC, the client will be asked to estimate how true the positive belief feels on a scale of 1 -7 where “1” equals completely false and “7” equals completely true.
The goal of EMDR therapy, in the following phases, is for SUD scores of disturbance to decrease while the VOC scores of positive beliefs increase.
4. Desensitization
During this phase, the client focuses on the disturbing event while participating in eye movements or other BLS. The client is asked to attend to both the target image and eye movement simultaneously. They will be encouraged to be open to whatever happens. Through desensitization, the client will be led through sets until their SUD-scale levels are reduced to zero or no longer distressing .
5. Installation
In this phase, the goal is to focus on the strength of positive cognition that was chosen to replace the original negative belief. Your belief that this positive statement is true will be measured using the VOC scale. The goal is to fully accept the full truth of your positive belief, reaching a score of 6 or 7. By the time this stage is completed, the client has processed the trauma to some level of resolution.
6. Body Scan
After the positive cognition has been installed, the client is asked to hold the target event in mind and note any lingering tension in their body. This phase will help to identify any residual disturbance. Somatic feelings are reprocessed, allowing dysfunctional material to dissolve.
7. Closure
EMDR sessions end with closure to ensure that the client feels safe when the session is over. If the traumatic target is not complete, the therapist will use grounding techniques before ending the session. The client is informed that they may experience continued processing of material for days following a session. This may include new insights, dreams, strong emotions or recall of past experiences. Clients will be briefed on what to expect, and the therapist will ensure that these experiences are considered normal and part of the healing process.
8. Reevaluation
This phase is the start of every new session. The therapist and client will examine the progress made, as well as future issues that require processing. Processing may include all related historical events, current stressors and future events that require different responses.
How Long Does the Process Take?
The process of EMDR is different for everyone. The number of sessions depends upon several factors including the particular problem and client history. For a single incident trauma (example- one isolated incident such as car accident or assault), treatment can last between 8-12 sessions. However, consistent controlled studies have shown that a single trauma can be processed within 2-3 sessions in 80-90% of the participants. Longer duration of EMDR therapy is more common as client’s targeted memory or event(s) often trigger earlier life experiences that have been laid dormant. These life experiences most likely have had a lasting effect on one’e life but they have not been in the conscious mind.
At the end of EMDR therapy, previously distressing memories and present situations should no longer be causing problems, and new, healthier responses should develop.
By releasing blocked emotions, you can begin to reprogram your brain. It is possible to heal from the fear associated with trauma and emotional duress. You can gain new perspective, improve your relationships and enhance your personal beliefs about yourself and your life.