Eye Movement Desensitization and Reprocessing Therapy
What Is EMDR?
Eye movement desensitization and reprocessing (EMDR) is a therapeutic style originally developed to address stress, anxiety and depressive symptoms related to traumatic events and memories.
It is used to treat posttraumatic stress disorder (PTSD) and has been shown to be effective in this area since its inception. In fact, depending on the level and complexity of trauma, EMDR is known to be effective in as little as one session. It is important to note, however, that there is still some debate among scholars and clinicians in regards to the validity EMDR research and its effectiveness.
The world of psychotherapy is filled with talk therapies like cognitive-behavioral therapy (CBT), rational emotive behavior therapy (REBT), motivational interviewing (MI), person-centered therapy, reality therapy, acceptance and commitment therapy (ACT), and others. These all share the similarities of a having a dialogue between the therapist and the client, but EMDR differs from these. It involves active physical participation on behalf of the patient, namely the purposeful direction of therapist-guided eye movements, in conjunction with therapist-patient dialogue.
EMDR believes that the problematic thoughts and behaviors occur because the traumatic life events were not appropriately processed when they occurred. This lack of processing leads to the events being stored as harmful memories that later disrupt cognitive, emotional, and social functioning.
The goal of EMDR is to reprocess these undesirable memories and experiences. A therapeutic style like CBT would be geared toward exposing the patient to the traumatic thoughts and feelings through imaginary scenes, or, perhaps, by re-confronting the traumatic situation (if possible). EMDR takes a different approach to working with these neurocognitive systems.
The idea behind EMDR is that reprocessing the memories allows them to be assimilated and accommodated in the brain. The act, called adaptive information processing, is at the core of the therapy. The eye movements are reported to aid in the way the information is accepted into the brain’s networks.
Credit: Michael Burns
Course of Treatment
EMDR has a specific, formulaic approach to treatment based on an 8-phase approach. The therapist will lead the client through each of the phases at a pace that is appropriate for the client’s needs with some sessions accomplishing multiple phases and some phases requiring multiple sessions.
The 8 Phases of EMDR
Phase 1: History and planning. In this phase, the therapist will gather information related to the need for treatment. Current symptoms, past issues, triggers, and unwanted behaviors will be discussed to gain an understanding of the factors involved. An interesting facet of EMDR is that the information does not need to be exhaustive or detailed. At this point, the events can be vague and general as long as they yield targets for EMDR to address.
Phase 2: Preparation. Phase 1 may take a session or two, but phase 2 can take as many as four sessions. A major focus of this stage is building a trusting rapport between the client and the therapist. The relationship is needed so the client will have the comfort to express their feelings to the therapist later in treatment to ensure the best possible outcomes. Along with the trust building, the therapist will discuss the fundamentals of EMDR, the course of treatment, and needed relaxation techniques to use when emotional experiences arise.
Phase 3: Assessment. This phase involves looking at the established targets from phase one. The client will develop a mental picture of that traumatic event, a negative statement from the event, and a positive statement that is the goal belief. So, if the traumatic situation was a car accident, the picture might be broken glass in the car. The negative statement is “cars are dangerous.” The positive statement is “cars are safe most of the time.” Finally, in this phase, clients are asked to rate how strongly they hold these beliefs and their physical and emotional reactions to these ideas.
Phase 4: Desensitization. This phase marks the onset of the reprocessing. Here, the client is asked to become aware of disturbing images, thoughts, feelings, and physical sensations while the therapist utilizes stimulation in the form of instructing the client to shift their eye movements by following the therapist’s hand (though sounds and physical tapping can be used). The client reports the present elements in generalities, and the therapist continues to use the stimulation until the client reports lower ratings of distress.
Phase 5: Installation. Now that the negative image and statements are no longer provoking, the focus can turn towards the positive statement from phase 3. The new belief is given attention while the therapist continues to provide the stimulation in the form of the client’s eye movements, tapping, or sounds. The phase ends when the client reports having a full belief in the positive statement.
Phase 6: Body scan. This phase checks the efficacy of the previous two phases by asking the client to note any negative elements remaining from the target. If the target is unresolved, phase 4 will be restarted to yield the desired results.
Phase 7: Closure. The goal of EMDR is leaving the client feeling better than when she arrived. The therapist will lead the client through some of the relaxations and calming exercises previously learned. Additionally, the therapist will provide information on what the client may expect in between sessions regarding the continued processing of targets.
Phase 8: Reevaluation. The final phase actually occurs at the beginning of the next session. The therapist checks in to ensure that the results noted from the body scan continue. When all targets have been addressed and reevaluation shows no disturbing issues remaining, treatment will end.
The trauma-related use of EMDR can be applied to many situations including:
- Sexual abuses like rape and molestation.
- Physical injuries stemming from a range of accidents or intentional violence.
- Emotional abuse in the form of conflictual relationships.
- War-related trauma and post-traumatic stress.
It is important to remember that the traumatic events can be experienced directly or to someone close to you. If someone you love was in a dangerous or life-threatening situation, you can develop posttraumatic stress disorder, as well.
EMDR for Addiction
When the model of treatment was created in the late 1980s and early 1990s, EMDR was used exclusively for trauma. How does this fit with addiction treatment? Many people dealing with substance abuse, addiction, and dependence have problems related to trauma.
For some, past trauma is a contributor to addiction, as substance abuse can be a means of self-medication to block out or escape from the harmful memories.
For others, they have experienced trauma during their use. For example, an addict may have been sexually assaulted while under the influence. In such case, the substance use is likely to continue unless the trauma feeding the addiction can be addressed.
Over the years, people have worked to expand and modify EMDR to treat other issues. One such example is called the feeling-state addiction protocol (FSAP). This therapy style is based on the foundations of the therapy but applied to issues related to addiction and compulsion. With EMDR, there is the focus on the negative experience that creates trauma. In FSAP, the focus is on the intense positive experiences associated with destructive, compulsive behaviors that create and maintain addiction. EMDR tries to replace the negatives with positives.
FSAP tries to:
- Break the connection between the positive feeling and the destructive behavior.
- Process the negative beliefs associated with the compulsion.
FSAP is believed to be effective in the treatment of:
- Behavioral addictions including gambling, sex, addictive overeating, compulsive shopping, and shoplifting.
- Substance use disorders including addictions to alcohol, legal drugs like tobacco, prescription drugs, and illicit drugs.
- Co-dependent and abusive relationships.
Reports state that over 100,000 EMDR therapists are available around the world with available databases to find ones near you. Therapists are able to receive a certification in the therapy that signifies their ability to accurately utilize the skills.
It is used as a standalone treatment in many situations, but it can also be used in combination with other therapeutic interventions. For example, if a client has issues with depression, addiction, and trauma, the clinician may choose to begin treatment by using EMDR to address the trauma in hopes that reprocessing this information will reduce the other symptoms. If the symptoms do not alleviate completely, the therapist may shift focus by bringing in other treatment options including:
- CBT, which is used with good results for a range of symptoms related to depression and anxiety.
- Motivational interviewing, which helps reduce ambivalence related addiction while fostering a greater sense of control in the client.
- Medication management, which will help limit the symptoms of mental health disorders and reduce cravings associated with the addiction. Medication may not be appropriate during the phases of EMDR, though.
In the world of counseling for mental health concerns, EMDR stands out for its unique view of treatment and the methods of improvement. It is not without its detractors, though, that claim the eye movement portion of EMDR is not essential. Regardless, it has a foundation of evidence to support its role as a helpful method of therapy.
- EMDR Network. (n.d.). Retrieved November 12, 2015, from http://www.emdrnetwork.org/description.html
- What is EMDR? | EMDR Institute – EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY. (n.d.). Retrieved November 12, 2015, from http://www.emdr.com/what-is-emdr/
- FSAP. (n.d.). Retrieved November 12, 2015, from http://www.fsaprotocol.com/