EMDR (Eye Movement Desensitization and Reprocessiong)
EMDR is an integrative therapy acknowledged by many national and international organizations as an effective mental health treatment for trauma (the American Psychiatric Association, the International Society for Traumatic Stress Studies, the Substance Abuse and Mental Health Services Administration, the U.S. Dept. of Veterans Affairs/Dept. of Defense, The Cochrane Database of Systematic Reviews, and the World Health Organization.)
Dr. Francine Shapiro developed the foundation of EMDR while thinking about something disturbing in her life while on a walk and noticing that certain eye movements reduced the intensity of that inner disturbance. She then conducted a scientific study with trauma victims in 1988 and the research was published in the Journal of Traumatic Stress. Her hypothesis was that when a traumatic or distressing experience occurs, it may overwhelm normal coping mechanisms, with the memory and associated stimuli being inadequately processed and stored in an isolated memory network.
Since the late 1980s, Dr. Shapiro enhanced the technique into a full treatment protocol and many more research studies including metanalyses supported its efficacy. The 2009 International Society for Traumatic Stress Studies practice guidelines categorized EMDR as an evidence-based level A treatment for PTSD in adults. Posttraumatic Stress Disorder (PTSD) is the diagnosis which often follows experiencing or witnessing a traumatic event and reexperiencing that event with upsetting memories, nightmares, flashbacks, emotional distress, and physical reactivity. Trauma can be what is called “Big T” trauma (car accidents, sexual assaults, the unexpected death of a loved one) or “Little T” trauma (the accumulation of adverse life experiences such as being bullied, feeling less than, having high performance standards imposed by parents.) The latter subcategory of trauma is often referenced as “complex trauma.”
In addition to treating PTSD, EMDR has been shown to decrease symptoms associated with anxiety, panic disorder, depression, addiction, chronic pain, performance anxiety and somatic complaints. The model on which EMDR is based, Adaptive Information Processing (AIP), posits that mental health concerns arise from the maladaptive encoding of and/or incomplete processing of traumatic or disturbing adverse life experiences. Traumatic memories, thoughts, emotions and body sensations get frozen in the brain, and this impairs one’s ability to integrate these experiences in an adaptive manner. Any trigger might activate the frozen trauma even if it is illogical, not based in reality, or happened long after the trauma is over. An example is a Veteran who cowers in the corner on the 4th of July hearing fireworks that his frontal cortex “knows” is not a sign of danger, but his senses still activate the unprocessed trauma of gun artillery during Vietnam.
The eight-phase, three-pronged process of EMDR facilitates the resumption of normal information processing and integration. This treatment approach, which targets past experience, current triggers, and future potential challenges, results in the alleviation of presenting symptoms, a decrease or elimination of distress from the disturbing memory, improved view of the self, relief from bodily disturbance, and resolution of present and future anticipated triggers.
Through EMDR, resolution of traumatic and disturbing adverse life experiences is accomplished with a unique standardized set of procedures and clinical protocols which incorporates dual focus of attention (past and present) and alternating bilateral visual, auditory and/or tactile stimulation. This process activates the components of the memory of disturbing life events and facilitates the resumption of adaptive information processing and integration.
MORE THAN JUST EYE MOVEMENTS:
If your EMDR therapist is talking only about eye movements and nothing else, it’s not EMDR. EMDR consists of eight distinct phases, outlined below.
– The beginning stage of therapy is when you provide your history including your presenting problem, family of origin information, present day stressors as well as inner and outer resources and strengths. From your history, you will identify traumatic or disturbing memories that will be processed in desensitization phase of treatment .
Preparation – The preparation stage is when you will learn new ways of coping with distressing emotions, thoughts and somatic sensations. Mindfulness strategies will be taught and incorporated into your daily practice. Different modes of bilateral stimulation will be decided upon by you as the client (light bar, tapping, auditory pings, following fingers, or some combination of these.)
Assessment – You identify each session which distressing memory you feel ready to face—this can be memories from the past or recent issues. It is always good to start at early childhood memories and fully process a memory before moving to the next but this is a collaborative process between you and the therapist. After identifying the memory, you talk about negative beliefs associated with the memory, positive ways you hope to resolve the distress, emotions and body sensations you notice while talking about the memory now. You will often rate your distress on a scale to determine how well you are moving material through your system.
Desensitization – This is the active phase of EMDR when bilateral stimulation is used while you freely associate and activate all of your senses. Your psyche knows how to heal itself no different than a cut or broken bone as long as the client and therapist stay out of the way of the natural healing process. (I.e. don’t analyze what is happening, just “go with that.”)
Installation – Once the disturbing memory lowers enough, you install positive beliefs about yourself to replace negative beliefs and affects associated with memories until they feel fully integrated.
Body Scan – The body scan is when you eliminate any remaining physiological symptoms with further bilateral stimulation.
Closure – Closure happens no matter if a client fully completes an EMDR target or memory. There is no goal to finish in any set amount of time, and often clients report feeling activated during a session so returning the client to a safe calm equilibrium as the session ends is important.
Re-evaluation – Before moving to another memory, the therapist will check that all aspects of memory have been fully processed.
How is EMDR therapy different from other therapies?
EMDR therapy does not require an extensive assessment meaning we don’t need to know everything in minute detail about your life to get started. The only criteria to being a good candidate for EMDR is to be able to go from a heightened state of emotional arousal to a more relaxed state. Heavy alcohol or drug use will get in the way of your treatment as will benzodiazepine and opioid pain medications. You need to be able to feel your feelings in order for them to find their natural course. I liken this to a water hose that is kinked—until you let the sadness flow, you cannot feel the joy which is on the other side. Until you feel your fear, this cannot convert into faith.
During EMDR you also do not have to talk in detail about the distressing issue or complete homework between sessions. (This is different than other exposure therapies which often retraumatize people unwittingly.) If you don’t want to say something out loud, all you have to do is think about the distressing image and the therapist will guide the rest. EMDR therapy, rather than focusing on changing the emotions, thoughts, or behaviors resulting from the distressing issue, allows the brain to resume its natural healing process. This in essence is activating what we referenced earlier as the Adaptive Information Processing Network (AIP). This network often lies dormant underneath trauma and just needs to be reawakened to heal.
How does EMDR therapy affect the brain?
Through the AIP, our brains have a natural way to heal from traumatic memories and events. This process involves dialogue between the amygdala (the alarm signal for stressful events), the hippocampus (which assists with learning, including memories about safety and danger), and the prefrontal cortex (which analyzes and controls behavior and emotion). While many times traumatic experiences can be managed and resolved spontaneously, they may not be processed without help. An example is someone who comes close to crashing on the interstate may feel her heart pounding for a few minutes after the experience but be OK by the time she gets home, whereas another person who had a serious accident in the past may not be able to get home at all due to a freeze response from the unprocessed past trauma.
Stress responses are part of our natural fight, flight, or freeze instincts. Animals in the wild survive being eaten by predators from having stress responses. Stress responses help us achieve our goals in sports or at work. When distress from a disturbing event is too much for someone (and this capacity is different for all people in all situations), the upsetting images, thoughts, and emotions may create feelings of overwhelm, of being back in that moment when the trauma occurred, or of being “frozen in time.” EMDR therapy helps the brain process these memories, and allows normal healing to resume. The experience is still remembered, but the fight, flight, or freeze response from the original event is resolved and the unexpected triggers lessen or go away.
How to pick your therapist:
EMDR should only be offered by properly trained and licensed mental health clinicians. A clinician who is EMDRIA Certified in EMDR is licensed or certified in their mental health professional field for independent practice, has completed an EMDRIA approved training program in EMDR therapy (Level 1 and Level 2), has conducted a minimum of fifty clinical sessions in which EMDR was utilized, and has received twenty hours of consultation in EMDR by an Approved Consultant. In addition she must complete twelve hours of continuing education in EMDR every two years. Don’t settle for less and call today to get the help you deserve!