Whether we’ve experienced small setbacks to major traumas, we are all influenced by our memories and by experiences we may not completely remember or fully understand. Different types of therapies focus on different processes, for example, Cognitive Behavioural Therapy is orientated towards identifying problematic thoughts and behaviours, and learning skills to change them. ACT (Acceptance and Commitment Therapy) is focussed on teaching psychological skills to deal with thoughts and feelings effectively whilst encouraging us to accept what it out of our personal control and committing to actions that will improve and enrich life. EMDR, on the other hand taps into the memories that affect our present experience, using bilateral stimulation to reprocess traumatic memories in an adaptive way. EMDR has been supported as an effective treatment with more than 30 positive controlled outcome studies having been completed. Studies have shown that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been enough research on EMDR therapy that it is now recognized as the gold standard form of treatment for trauma and other disturbing experiences by organizations such as the World Health Organization. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the sometimes less overtly traumatic memories that can lead to low self-esteem, feelings of powerlessness, and other difficulties. Two of our clinicians, Michael and Lucy, recently attended a course which has given them specific training in this area of therapy. Therefore we wanted to share with you in a little more detail, what EMDR is, how EMDR works and how it can benefit you.
So, what actually is EMDR?
EMDR stands for Eye Movement Desensitization and Reprocessing. Dr Francine Shapiro stumbled across EMDR when she made a discovery about eye movements. One day in 1987 she was taking a walk through the park and she suddenly noticed that some disturbing thoughts she was having had disappeared. She described them as the kind of niggling, nagging thoughts about a problem that you generally have to do something deliberate about to get them to change. However after her moment in the park when her negative thoughts “disappeared”; she found that when she tried to recall them, they just didn’t have the same impact anymore and didn’t really bother her. Intrigued, Dr Shapiro decided to explore what may have caused this reaction. So as she continued to walk along, she began to pay closer attention. What she did notice is that when a disturbing thought popped into her head, her eyes would move rapidly back and forth diagonally in a certain way. She then realized that the thought had shifted from her consciousness and when she recalled it, all its power was lost. As she became more intrigued, she began doing it deliberately. She would bring something up that bothered her, begin doing the eye movements, and then she noticed that the same thing would happen; her feelings would change. Dr Shapiro’s discovery was a complete chance discovery; however her discovery of this groundbreaking therapy has gathered support in recent times and is now widely used in psychotherapy.
How does EMDR work?
EMDR as a process is complex, and if you want a full, very scientific and academic description then a good place to start would be Dr Shapiro’s book – Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. However, this is more of an intensive clinician’s guide, and we want to give you an introductory explanation, so you can understand how it works and also its benefits.
EMDR therapy involves attention to three time periods: the past, present, and future. Focus is given to past disturbing memories and related events. Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions. With EMDR therapy, these items are addressed using an eight-phase treatment approach. We’re going to talk you through it as it would happen in treatment, so if you do ever find yourself coming in for EMDR you know exactly what to expect.
Phase 1: The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviours that will be needed by the client in future situations.
Initial EMDR processing may be directed to childhood events rather than to adult onset stressors or the identified critical incident if the client’s problems initially developed from childhood. Clients generally gain insight on their situations, the emotional distress resolves and they start to change their behaviours. The length of treatment depends upon the number of traumas and the age of PTSD onset. Generally, those with single event adult onset trauma can be successfully treated in less than 5 hours. Multiple trauma victims are likely to require a longer treatment time.
Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of managing emotional distress. The therapist may teach the client a variety of cognitive, imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.
Phases 3-6: In phase’s three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying three things:
1. The vivid visual image related to the memory (and/or other sensory modalities)
2. Related emotions and body sensations
3. A negative belief about self
In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones. The type and length of these sets is different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneously happens.
After each set of stimulation, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client’s report, the clinician will choose the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.
When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session. At this time, the client may adjust the positive belief if necessary, and then focus on it during the next set of distressing events.
Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.
There you have it, a quick low down on EMDR therapy. We know EMDR can provide rapid treatment effects, and combined with a noted long lasting effect, it’s an amazingly helpful therapeutic technique to use. Michael and Lucy will be using EMDR more in their sessions, where it is deemed to be helpful or necessary. As mentioned, EMDR is especially useful for the treatment of trauma and disorders such as PTSD, as well as events that have seared an unhelpful belief about ourselves into our minds, causing low self-worth, etc.. So if you’re struggling to find an effective therapy, perhaps it’s time to give EMDR a go.