What is EMDR?
Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy typically applied to those experiencing PTSD and other stress-related conditions. A traumatic event can potentially give rise to a series of severe mental disorders; several solid pieces of evidence support this theory. EMDR therapy is, therefore, not only useful for PTSD but is also quite beneficial for other comorbid psychic illnesses. [1]
A traumatic experience results from unprocessed and unresolved memories from a horrific past. The main idea behind devising this technique is to resolve the unprocessed memory, which stems from negative emotions and causes distress. Various research studies suggest that EMDR therapy yields a rapid positive response compared to other psychotherapies, including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).
Besides its remarkable clinical outcomes, some additional pros of EMDR psychotherapy include reducing medical costs and patient load.
EMDR therapy is an evidence-based therapy applied to adults and children experiencing PTSD. [2, 3]
A comprehensive EMDR therapy comprises a three-tier protocol and 8-phases to produce the most productive results. [4]
It seems to be an easy DIY practice; however, seeking professional help is the best way to administer EMDR, surpassing potential risks.
History of EMDR
In 1987, while roaming about the nearby garden, Francine Shapiro, an eminent American psychologist, discovered that her stress relieves when she moved her eyes. She concluded that bilateral focus directly connects with negative thoughts. Francine then collected evidence based on her experiments, and to her surprise, all cases involved in her experiments supported her hypothesis. People realized the same distress reduction with the bilateral movement of their eyes. Francine then established a standard protocol, namely EMD – Eye Movement Desensitization, adding cognitive elements and other therapies. [5, 6]
In 1989, Francine introduced this eye movement desensitization and reprocessing therapy by publishing randomized controlled trial research, where she assessed its effectiveness on traumatic patients.
According to a report [7], By 2008, there were not enough studies on PTSD (post-traumatic stress disorder) being successfully treated by EMDR, pharmacotherapy, or cognitive therapy. Since then, several randomized controlled studies have been performed with PTSD patients explaining the positive effects of EMDR in more detail.
Abundant research and data helped the authorities, such as the World Health Organization, The American Psychiatric Association, and The Department Of Defence, to declare EMDR as the primary treatment for patients of trauma. [8]
How is EMDR therapy different from other therapies?
EMDR differs from other exposure therapies that require the patient to re-experience their trauma, either by imagining or in-vivo exposure. In exposure therapies, the therapist may ask the patient to pen down his fears and then rate them in most to least fearful situations.
The whole idea of exposure therapy is to normalize the trigger for the victim. For instance, revisiting the area, re-smelling the scent, or imagining the situation the victim has been avoiding since a traumatic incident, helps them dissociate their emotions from that incident. This form of therapy involves the victim’s confrontation with their fears. On the contrary, EMDR does not require the victim to relive the traumatic event.
In EMDR, the eye movement from left to right often termed bilateral stimulation, allows the victim to process trauma with the brain’s left and right hemispheres. Patients experiencing EMDR therapy are then subjected to replacing their negative belief with a desired positive one, allowing the brain’s left side to regulate the self-soothing mechanism.
In this way, the patient gets a deeper insight into the traumatic situation and his or her negative self-image, which stems from the trauma. The entire course of therapy results in the improvement of the patient’s trauma response. [9]
The effect of EMDR therapy on the brain
The stress response to traumatic events is pretty much natural and mostly subsides. However, in some cases where trauma-related information is inappropriately stored, seeking professional help is crucial.
Bitter memories from an unpleasant event may continue to cause distress by constantly appearing in our imaginations unless the negative emotions associated with that event are reprocessed into positive emotion.
EMDR therapy helps the victims to rewire their brain cells and reprocess the maladaptive information, resulting in a peaceful resolution. In other words, the traumatic situation from the past remains in the brain, but the negative emotions stemming from it will no longer be there after successful EMDR therapy. [10, 11]
Who is EMDR therapy for?
The uniqueness of EMDR therapy is attributed to its ability to resolve trauma distress without needing the client to speak much about his or her dreadful past. EMDR can therefore be the first choice of psychotherapy for reticent individuals.
Psychological conditions for which EMDR can be of great help include,
- PSTD and other stress disorders.
- Addiction withdrawal
- Depression
- Different forms of anxiety, including performance anxiety, panic attacks, and phobias
- Pain, Narcissistic abuse, verbal abuse, violence, Sexual abuse
- Personality disorders, including borderline personality disorder
- Chronic medical conditions
- Dissociative disorders
- Losing a loved one [12, 13]
Before trying EMDR therapy, read this.
EMDR is undoubtedly the most effective form of psychotherapy for trauma-related stress disorders, but it is also essential to look for some of the short-term side effects of EMDR.
Once you are introduced to the lasting benefits of EMDR therapy, you must know a few other facts before booking an appointment with your psychotherapist. [14]
- More than one session is needed. You will have to take several sessions in order to come out stress-free.
- Initially, EMDR therapy can be immensely triggering to some emotionally vulnerable individuals. However, the awareness of its long-term benefits makes it easier to endure the temporary discomfort.
- Due to the installation of positive emotions, an EMDR therapy session may result in heightened awareness which goes away spontaneously.
- An unexpected emotional response may arise during an EMDR session due to unresolved memories.
Why EMDR should not be self-administered
Seemingly an easy peasy technique that anyone could think of self-administering, EMDR, in reality, is not ONLY about bilateral eye movements.
Why consult an EMDR therapist?
An EMDR therapist follows the standard protocol of EMDR therapy and takes you through the 8-phases of EMDR therapy utilizing his or her professional understanding to deal with uninvited emotional stress. A step-by-step process administered by a trained and experienced EMDR therapist ensures the maximum effectiveness of the therapy.
The therapist develops a cordial bond with the client to ease his or her pain, which is a prime concern while performing a psycho-therapeutic technique.
Some of the dangers associated with self-administration of EMDR are listed below,
- Reverting to the trauma
- Not having professional support while experiencing intense negative emotions may result in more stress.
- No motivation to continue the therapy till the 8th phase.
- Inability to patiently work through the entire standard EMDR protocol.
Self-administration of EMDR may present even worse complications for individuals with a history of early-age trauma, sexual abuse, narcissistic abuse, suicidal tendency, war trauma, or other forms of complex traumatic experiences.
Experiencing EMDR
The EMDR technique works by having you focused on your negative and positive belief systems so you can ditch the negative one and adapts to the positive one. It is vital to guard against the resurgence of psychological stress and negative self-beliefs.
During an EMDR session, the therapist helps you revisit those painful memories while asking you to focus on the bilateral movement of his or her fingers, hand tapping, or sound. It stimulates both your brain’s hemispheres.
Once the EMDR stimulation is over, the therapist would ask you about how you feel and what thoughts are occupying your mind at that very moment.
Depending on your current feeling, the therapist may repeat the entire stimulation process or resume strengthening the installed positive belief. If you are still experiencing negative physical sensations, EMDR stimulation will be performed again by the therapist.
Professional therapists often assign homework to their clients to keep track of their progress between sessions. It includes keeping a journal, recording any negative self-belief that may reoccur and coping techniques that were implied, and practicing imagery desensitization to help the clients confront their fears. [15]
Protocol of EMDR
The EMDR protocol typically includes a three-tier protocol.
- Keeping the memory of the PAST event
- Learning a lesson in PRESENT
- Guiding path for the FUTURE
This three-tier EMDR protocol is devised to process the unresolved emotions from past experiences without persuading the victim to express minute details about the incident. It helps the victim rationally absorb the required information from a particular event, shed off the excess emotional weight of negative beliefs, and avoid any possibility of getting into the same toxic experience.
Since everyone coming to the clinic holds a distinct past, varying intensity of trauma response, and unique physiological orientation, treatment durations differ as per the individual need.
The eight phases of EMDR therapy treatment
Phase 1: History Taking & Plan Construction
In the first phase, an EMDR therapist constructs a discrete therapeutic plan after taking a complete history of the patient. It is crucial to understand that history taking does not necessarily involve recording every minor detail about the patient’s past experiences; instead, it revolves around what brings him to the therapy.
The patient may reveal what he or she has been feeling and what triggers his or her negative emotions.
As explained earlier, the therapist then devises a treatment plan based on the three-tier EMDR protocol, encompassing,
- A complete picture of the past event, factors involved in letting it happen, history of childhood trauma, and other one-liner relevant information.
- What is now troubling the patient? What impacts of that unfortunate event are still there?
- What measures are necessary to take in order to avoid further distress in the future?
Since EMDR therapy is equally effective for those, who are uncomfortable sharing every detail related to their past, very little information about history works too. This phase may take 1 or 2 sessions to complete; that being said, on some occasions, the therapist may revert to this phase.
Phase 2: Preparation
In this phase, the EMDR therapist builds trust with clients allowing them to open up about their feelings and emotions. If the client is uncomfortable with the therapist, he or she may skip some beneficial information needed to make the most of EMDR therapy. The trust must be well-formed between therapist and client before the therapy begins.
The prime goal of this phase is to equip the patient with the best self-relaxing techniques in case any undesired stress takes over during or after the therapy.
An EMDR specialist educates the client about what to expect from this therapy, initial short-term setbacks, and how this therapy will work for them in the long run. This strengthens the client’s trust in their therapist, allowing uninterrupted expression of their true feelings.
Usually, this phase consists of 1-4 sessions; however, in some extremely sensitive cases, it may take more sessions to prepare the client and win their trust.
Phase 3: Assessment
In this phase, the therapist asks the client to think about the most disturbing part of that particular distressing event of the past. The client is then prompted to express his negative beliefs about the target event. Negative beliefs may include, “I deserve sadness,” “I am cursed,” etc.
The client is then asked to rate the distress level on the SUD scale, which measures the intensity of disturbance caused by negative self-belief.
SUD (Subjective Units of Disturbance) is indicated on a 0-10 scale, where 0 represents “no disturbance,” and 10 represents “worst disturbance.”
The therapist may now ask the client to think about the contrary, the optimistic belief that he would like to feel, e.g., “I deserve to be happy,” “I am blessed,” etc.
The client is then presented with another scale named VOC (Validity of Cognition) to measure how true he thinks his positive belief is.
VOC Validity of cognition is determined on a scale of 1 to 7, where if the patient selects 1, it means the positive cognition is false; similarly, selecting seven means the positive cognition is true.
This phase takes almost three sessions to obtain enough information to continue the therapy effectively.
Phase 4: Desensitization
In this phase, the therapist is more concerned about all the disturbing emotions of the client associated with the target event. The client may begin with a terrifying event and associate more similar events to it. This phase aims to consider all negative emotions, memories, and imaginations that may arise during this phase and resolve them.
In the desensitization phase, the therapist performs all the required techniques, including eye movements, hand tapping, sound stimulation, and appropriate shifts to get both hemispheres of the brain to work.
The process continues until the SUD rating is decreased to 0 or close to 0, showing that this targeted event is no longer disturbing to the client.
Phase 5: Installation
In the installation phase, as the name depicts, a positive belief is installed after the alleviation of negative belief in the previous phase. It is pivotal for strengthening the client’s belief in himself, without which his negative belief may reappear.
The validity of cognition VOC measures the client’s acceptance of a desired positive cognition. The client is asked to keep rating his feelings while the therapist continues to perform EMDR techniques until the VOC rating rises to 7.
The phase completes only when the client regards his or her positive cognition as entirely accurate, i.e., seven on the VOC scale.
Phase 6: Body Scan
In phase 6, the client is asked to memorize that tragic incident again and see if it stresses his or her body. It is to check if any residue is left from that traumatic event; if yes, then the next thing an EMDR therapist performs is reprocessing.
Evaluating body tension by the end of phase 5 is necessary to consider the EMDR session successful, as body tension is the response to unresolved memories.
Phase 7: Closure
By the end of the 6th phase, before leaving the therapist’s office, the client must be briefed about what may happen between sessions and what to do if any triggering situation arises.
In the 7th phase, the therapist guides the client to stay calm even after the therapy ends so that the distress will not return.
This phase ensures that the client feels safe and relaxed outside the therapist’s office and knows how to self-soothe.
In this way, clients become aware of their triggers and how to tactfully cease any negative beliefs using the calming techniques taught by the therapist.
Phase 8: Reevaluation
This phase helps the therapist to re-evaluate the treatment plans on the basis of the client’s progress. It is essential to keep track of the entire EMDR therapy through all phases to achieve maximum benefits. [16]
What to expect after EMDR therapy
The whole purpose of EMDR therapy is to enable the client to understand their emotions, perspectives, and reaction patterns by themselves and self-soothe.
Unresolved traumatic memories cause distress unless processed in a strategic way that leads to healthy social and emotional behavior.
An effective EMDR therapy results in well-processed thoughts and no more distress associated with a past event. [17]