What is EMDR therapy?
EMDR stands for Eye Movement Desensitization and Reprocessing. EMDR therapy has recently entered the cultural lexicon—from Prince Harry’s televised EMDR therapy session to one of the Real Housewives processing PTSD from a home invasion. Unconventional? Perhaps. But the timing is overdue. Created in the late eighties by Dr. Francine Shapiro, EMDR is a highly effective evidence-based therapy. EMDR is recommended by the World Health Organization and American Psychiatric Association as a first-line treatment for PTSD. While EMDR efficacy studies are based on PTSD, EMDR can be beneficial for other issues including recent trauma, anxiety, depression, grief, addiction, eating disorders and personal growth. EMDR can also have somatic benefits such as relief from stress-induced back pain, headaches and fibromyalgia.
EMDR Therapy
How does it work?
EMDR was discovered by chance. In the spring of 1987, Francine Shapiro was taking a walk when a disturbing memory came to her mind. Shapiro noticed the thought seemed to “disappear” on the walk and when she thought about it again, it wasn’t as upsetting. When Shapiro reviewed what had occurred, she noticed during the walk, her eyes had spontaneously moved from side to side on the path. To experiment, she began to make eye movements deliberately, paired with other disturbing thoughts and memories. They, too, lost their emotional charge. She decided to try it with friends and colleagues who reported various “nonpathological” problems, from early childhood embarrassments to present-day frustrations. Eventually, Shapiro formalized her experiments, resulting in the fine-tuned protocol supported by randomized control trial outcomes that we know today.
EMDR uses bilateral stimulation (BLS) while reviewing a disturbing memory. This can include small hand pulsators, alternating audible cues from headphones, taps (butterfly hug) or horizontal or diagonal eye movements. EMDR is different from other desensitizing therapies in that it doesn’t review traumatic material for extended periods of time. In EMDR, the isolated memory is paired with BLS for about 20 to 30 seconds and is regularly interrupted by the therapist’s scripted intervention. (“What are you noticing now?”; “Go with that.”) The tight script is designed to facilitate the brain’s adaptive processing. These check-ins by the therapist can include “cognitive interweaves” that help the client further distance from the traumatic memory. For example, an adult client may recall being abused as a child and report a sense of guilt for not having stopped the abuser. (Therapist: “When you see a 5-year-old today, do they look capable of stopping an adult?” Client: “No. Some can’t even tie their shoes yet. Therapist: “Go with that.” Bilateral stimulation continues.) Clients can even elect to not go in-depth about the memories that come up. The adaptive processing continues within the brain. This can be particularly useful for incidences that involve a sense of shame or guilt.
Can EMDR Therapy help you?
Anyone can benefit from EMDR—adults, adolescents and children. It is safe and easily administered remotely, allowing clients to process difficult memories in the comfort of their own home. And there is no homework. The brain does the work for you between sessions, reshuffling old thoughts with new adaptive beliefs. For example, while cognitive behavioral therapy (CBT) uses prolonged (in-vivo) exposure with new thoughts and skills to manage symptoms, EMDR focuses on neutralizing the source of the disturbance while installing adaptive beliefs. Put plainly, CBT is like diligently painting over surface damage of an ongoing water leak (the symptoms.) EMDR is hiring a plumber to fix the pipe.
What happens during an EMDR Therapy session?
EMDR sessions can be performed in 60 to 90 minutes. There are 8 phases of EMDR. (Clinicians don’t always overtly outline the phases as they progress with the client, but this is the sequence we follow. The part most associate with EMDR, the bilateral movement, doesn’t begin until phase 4.) Most client report relief in a few sessions, but every client’s history is different.
Here are the 8 phases and how they translate in a typical EMDR therapy session.
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This is a collaborative phase that usually takes one to two sessions. The client and therapist discuss what brings the client in, review general history and the current symptoms that arise because of the problem. A treatment plan also involves the skills needed for future success. Unlike other therapies, the client does not need to discuss events in detail. A client can simply say, “It’s something that happened when I was 4.” That’s enough information for targeted adaptive processing.
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In this phase, clients are resourced by the therapist so they can manage the emotional distress that can occur during EMDR treatment. A “calm place” with a cue word is installed with bilateral stimulation. A mental container or “file cabinet” is also used to store away or set aside unwanted images when the session closes.
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When the target is isolated, the client is asked to take a mental image or snapshot that best represents the worst part of the memory. A baseline is established with the measurement of the Subjective Units of Disturbance (SUDs) from 0-10. This number represents how disturbing the memory feels to the client now as they sit in the thought. This measurement is used throughout EMDR for the client and therapist to measure progress. The client then choses a negative self-belief related to the event. While they may know logically the belief is not true, due to the unprocessed trauma, the brain may not completely buy in. This is what causes symptoms or other unwanted behaviors. Common negative cognitions include, “I am shameful”, “I am unwanted”, “I am worthless.” Then the client selects a positive cognition or positive belief they prefer that is appropriate to the present. (For example, “I am unsafe” may become “I am safe” if the client is safe today.) The therapist will then ask the client how true the statement feels (the Value of Cognition or VOC) scaled from 1 (false) to 7 (completely true.) It is important for the client to distinguish between feels and thinks. If the client could simply intellectualize the concept, they wouldn’t suffer needlessly.
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This is the phase most people recognize as EMDR. Bilateral stimulation and the memory are paired, and the clinician follows the scripted structure: What are you noticing now? Go with that…This may bring up other events that are associated with the target that can be resolved at the same time. A SUDs rating is measured throughout.
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Installation focuses on the client’s increasing strength and replacing the negative belief with a positive one. During desensitization, the client may view childhood abuse by a relative in a new light. (“I’m an adult and no longer powerless.”) The positive belief is paired with the memory and bilateral stimulation to complete the installation. (“I am resilient”, “I am safe.”) This is the Value of Cognition (VOC.) It is measured from a 1 (false) to 7 (completely true.) EMDR cannot make a client believe something that is unrealistic or untrue so it’s important the client consider the context of the new adaptive belief.
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The client is asked to hold the memory and the positive belief and to scan the body for any residual tension related to the memory. When the body scan is clear, we continue to the next phase.
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If a session is complete or incomplete, the therapist will lead the client through the calming exercises, so the client leaves the session feeling better than when they began. The therapist will advise the client to take note of any changes between session including sleep patterns and general mood. Reprocessing is complete when the memory is at a SUDs of 0 (neutral) or 1 to 2 if appropriate to the situation, and the positive belief is at a 7 (from 1 to 7) and there is a clear body scan.
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This phase occurs at each session and is review of the original memory (SUDs check in ) and any residual charge that may be left over.
What will I notice after EMDR Therapy?
Immediately after, you may be tired. EMDR is best done at the end of your day or when you can have an hour or so to rest. Clients sometimes report feeling worse the week after, then symptoms suddenly lift. Or a new helpful revelation about the memory hits them out of the blue. Other times, clients report feeling “far away” from the memory. While they don’t forget what happened, it no longer has an activating punch it did before. Certain people and situations no longer trigger them. The ability to feel joy returns or they feel safe connecting with loved ones again.
Common misconceptions about EMDR Therapy…
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EMDR’s extended preparation and resourcing phase, shorter internals and constant clinician support is how it differs from exposure therapy. Bilateral movements paired with the intrusive memory can sometimes be less than 10 seconds. If the entire memory is too intense, one part can be selected for processing.
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EMDR is not a carnival ride or a mechanical bull. (There is even a specialized protocol designed for recovery from heart attacks.) While emotional activation is possible, when appropriately administered, built-in resourcing exercises help with in-session regulation. And clients always have a “stop” signal they can utilize at any point in the treatment. A well-trained EMDR therapist is skilled in knowing when to push and when to pause.
How do I find the right EMDR therapist today?
Only EMDRIA-trained therapists can ethically use EMDR. EMDRIA is the EMDR International Association, the national organization that holds therapists to the highest standard of EMDR practice. And for an evidence-based therapy, this is important. Modification of the standardized protocol corrupts its efficacy. You can visit www.emdria.org and click “About EMDR Therapy” to learn more. Contact us to book a consultation with one of our EMDIA-approved therapists.
