Just as the body has a natural process for healing physical injuries, the brain has a natural healing process for treating psychological injuries. The brain functions as an information processing system, and it is remarkably effective at making sense of the world. It combines present sensory input with memories, thoughts, and feelings to create an experience that minimizes distress and keeps cognition running smoothly. However, according to Dr. Francine Shapiro’s information processing theory, various traumas and thinking patterns can cause “blockages” within the brain that can disrupt the natural healing process. These blockages can result in maladaptive thoughts, feelings, and behaviors. As a result, the line between what is true and what is not true in the past, present, and future becomes fuzzy.
Eye Movement Desensitization and Reprocessing (EMDR) aims to break this maladaptive cycle by clearing these blockages for new healing networks to take place. The goal of treatment is to lessen the patient’s distress associated with trauma and stressors and allow room for new insight and perspectives. Additionally, treatment may help an individual develop a sense of self-esteem regarding their capabilities.
While EMDR was initially developed to treat PTSD, research has found that it is also effective in treating depression, anxiety, panic disorder, sexual assault, childhood trauma, eating disorders, and more. The treatment utilizes bilateral eye movements, hand tapping, and audio stimulation combined with a vivid recollection of trauma and any associated thoughts, feelings, physiological responses, and belief systems.
Francine Shapiro, Ph.D., an American Psychologist, was taking a walk through a forest in 1987 when an onslaught of distressing thoughts and memories suddenly began to disturb her. She noticed that her distress was significantly reduced and that the triggering material was desensitized while moving her eyes from side to side. This insight led Shapiro to combine eye movements with a cognitive component, and Eye Movement Desensitization (EMD) was born. A case study was conducted and showed a positive correlation between EMD and reduced anxiety surrounding distressing memories. Over the next couple of years, Shapiro continued to refine EMD based on feedback from patients and fellow clinicians. She quickly realized that, in addition to desensitizing stressors, the treatment had the potential to reframe, rewire, and reprocess trauma. Shapiro incorporated these cognitive components that were apparent within the treatment. In 1991, she changed the name of the therapy to Eye Movement Desensitization and Reprocessing (EMDR), which she thought better reflected the Theory of Information Processing that she believed to be the key in remapping trauma within the brain. In 1995, after multiple controlled studies were published, EMDR officially became a published procedure and was one of the first posttraumatic stress disorder (PTSD) treatments.
Shapiro’s information processing theory describes the evolution of mental disorders and other psychological problems within the brain. A network of thoughts, images, feelings, and other impressions underlie the formation of memories. Learning can be described as the merging of new input with preexisting material stored in memory. When trauma occurs, the brain’s normal pattern of information processing is disrupted. This disruption can result in an obstruction in assimilating new input with previously stored information. For example, an adult may know that their experience of childhood neglect was not their fault. Still, this knowledge interferes with the belief that they could have prevented the neglect had they behaved differently. This interference results in improperly stored memories with maladaptive and inappropriate connections. The line between what is true and what is not true is blurred, and when an individual thinks about the trauma, they may begin to relive it or have strong physical and/or emotional reactions.
EMDR aims to bypass the “fight, flight or freeze” response to allow the brain to heal properly. The goal is to reconnect an individual with traumatic memories or thoughts and their accompanying feelings, sensations, and images. This allows the brain to begin its natural healing process by removing blockages and barriers that were previously overwhelming and, thus, could not be processed. The EMDR facilitator creates a safe and controlled environment to reprocess the trauma so that the client can review details of the distress while focusing on bilateral stimuli such as eye movements, audio tones, or finger tapping. New and old beliefs about traumas are reviewed constantly for positive reinforcement and to strengthen communication between different brain areas.
It has been theorized within EMDR research that the techniques within this therapy ,such as finger tapping and bilateral eye movements, can “unstick” the part of the brain that has maladaptively cemented around trauma and memory. Thus, by bypassing this area, the individual can develop new thoughts and insights as they reprocess the trauma, which results in newly formed patterns.
EMDR is achieved through 8 phases focused on the past, present, and future.
Phase 1: History Taking
In this phase, the therapist will take a complete history of the individual’s present stressors and presenting symptoms, past experiences, underlying causes of their distress (if known), and other relevant background information.
Phase 2: Preparation
The therapist will help the client to identify ways to manage triggers and anxiety on a daily basis. Since this form of therapy requires talking about traumas and stressors in-depth, the therapist will use this phase to ensure that the client has tools and exercises to utilize as needed.
Phases 3–6: Assessment, Desensitization, Installation, & Body Scan
These phases are grouped together because they are the phases in which everything discussed or identified in Phases 1 and 2 are put into practice, from identifying the target to utilizing EMDR procedures
Phase 3: Assessment. The aim of Phase 3 is to identify traumas, thought patterns, or behaviors from Phase 1 to focus on.
Phase 4: Desensitization. The client is prompted to think in-depth about the targeted material while describing aloud every physical sensation, thought, feeling, image, or impression that they are feeling. In this phase, the goal is to uncover the filter and say whatever comes to mind.
Phase 5: Installation. The client will attribute a negative and positive belief about themselves associated with this material and rating them on a scale of how true they are. These beliefs will be revisited towards the end of the session.
Phase 6: Body Scan. Observing physical changes and bringing awareness to the parts that may still be reactive while thinking about the identified material.
Throughout phases 3–6, the EMDR stimulation occurs while the client is still focusing on traumatic memories and associated feelings. The therapist will hold up two fingers and move them bilaterally (side-to-side and up-and-down). In addition, finger tapping and/or a headset playing binaural tones (i.e., tones alternating from the left to right ear) may be utilized.
Phase 7: Closure
In this phase, the client and therapist will review progress to see what can be done for continued positive reinforcement. All of the material from steps 3–6 will be revisited in a more conversational format to help develop insights in a cohesive manner.
Repetition is vital within EMDR until positive feelings and new associations have been developed. The steps above will be repeated for positive reinforcement until new thought patterns and associations become fixed.
Phase 8: Reevaluation
The goal of this phase is to reevaluate advancement, goals, and progress. The previous positive and negative beliefs about yourself as identified in phases 3–6 will be reviewed. If the beliefs no longer hold, alterations to the statements will be made to reflect the remapping of the trauma. These new beliefs will be revisited, along with eye movements, if distress occurs in the future.
Lastly, the focus will be shifted to any other areas identified in Phase 1 that still need to be worked on.
EMDR sessions typically last 60–90 minutes. Homework assigned alongside therapy sessions can include visualizations (e.g., imagining a peaceful environment to promote calmness, imagery desensitization, or imagining facing your fears and how that would turn out) and daily journaling to record any new feelings or progress with old feelings and which techniques you used that day.
Over 30 gold standard studies support the effectiveness of EMDR as a treatment for a variety of disorders, such as PTSD, childhood trauma, combat trauma, rape and sexual abuse, eating disorders, depression, anxiety, and substance abuse. This treatment has been endorsed by the American Psychiatric Association (APA), the World Health Organization (WHO), the Department of Defense, and the International Society for Traumatic Stress Studies (ISTSS) as an effective treatment.
Efficacy of Eye-Movement Desensitization and Reprocessing for Patients with Posttraumatic-Stress Disorder: A Meta-Analysis of Randomized Controlled Trials.
This study was a meta-analysis of 26 randomized control trials studying EMDR and PTSD from the years 1991 – 2013. The results confirmed that treatment with EMDR significantly reduced symptoms of PTSD, anxiety, depression, and intrusive thoughts.
Link: Efficacy of Eye-Movement Desensitization and Reprocessing for Patients with Posttraumatic-Stress Disorder: A Meta-Analysis of Randomized Controlled Trials (plos.org)
The Efficacy of Eye Movement Desensitization and Reprocessing for Post-Traumatic Stress Disorder and Depression Among Syrian Refugees: Results of a Randomized Controlled Trial.
Refugees with a diagnosis of PTSD were assigned to either EMDR treatment or a wait-list control group. Both groups were assessed pre-intervention and at week-1 and week-5 post-intervention follow-up. Forty-nine percent (49% ) of the patients were no longer diagnosed with PTSD at the week-1 post-intervention follow-up, with the same results persisting at the week-5 follow-up well. Thus, the study concluded that EMDR is an effective treatment option for PTSD and depression, particularly among refugee populations.
Link: The efficacy of eye movement desensitization and reprocessing for posttraumatic stress disorder and depression among Syrian refugees: results of a randomized controlled trial – PubMed (nih.gov)
EMDR versus CBT For Children With Self Esteem and Behavioral Problems: A Randomized Controlled Trial.
Twenty-six children with behavioral or self-esteem challenges were randomly assigned to one of two types of treatment. The behavioral and self-esteem challenges were analyzed before and after four sessions of either CBT or EMDR. Results showed both EMDR and CBT had significant positive effects, and the difference in positive results between the two was small. However, when measuring specific targeted behavior changes, EMDR was significantly more effective than CBT. Therefore, the results support EMDR as an effective treatment for behavioral and self-esteem challenges in children.
Link: (PDF) EMDR Versus CBT for Children With Self-Esteem and Behavioral Problems: A Randomized Controlled Trial (researchgate.net)
For more related research: Research Overview – EMDR Institute – EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY.
EMDR has remained a controversial treatment since it was first developed, with some professionals disregarding it as pseudoscience. There is a large variability from patient to patient; some propose this may be because most results are self-reported or that it might be based on an individual’s ability to be vulnerable. While self-reporting is one of the most important aspects of therapy, there is a lack of clear evidence as to exactly how and why this treatment seems to work. Physiological measurements (e.g., heart rate, sweat) are not as clear-cut and conclusive. One theory is that EMDR’s positive results are more due to the imaginal exposure to the trauma (i.e., talking about it and facing it) and less due to the eye movements.
EMDR is a complex technique, so it may require multiple sessions and difficult psychological work. In addition, being asked to think and talk in-depth about traumatic events can be very distressing. Although in a safe and comfortable setting, reexperiencing trauma may leave you feeling drained, so it is important to practice self-care and be gentle with yourself after each session.
While the therapist will guide you through each of the eight phases listed above, you will be doing most of the communicating. EMDR is not a traditional form of talk therapy. Instead, it has the specific aim of guiding the client through reprocessing their trauma(s). Throughout this process, you will begin to decipher what is true and what is not.
A major component of EMDR is to relax the mind and body to a point where the “fight, flight, or freeze” response is bypassed to access deeper levels of thinking. Therefore, after you access an adequate level of meditative relaxation through the EMDR stimulation, you may feel less alert yet able to talk about what’s going on in your mind more freely. You will be asked to describe all thoughts, feelings, sensations, and images that arise in detail. It is important to remember that you are in control of the session. If reexperiencing the trauma becomes too overwhelming at times, you can stop at any time. Your therapist will give you exercises and advice on coping strategies for use during and after the session.
Approaching EMDR with an open mind will help break down barriers and work towards the positive reinforcement of new thought patterns. In some cases, individuals have reported a heightened awareness of thoughts and feelings even after the final session of EMDR. An amplified sensitivity to interactions, changes in sleep, and increase in vivid dreams were some of the effects reported.
As with many forms of therapy, it is vital to find a therapist you will feel comfortable and safe sharing intimate details and traumatic experiences with. For EMDR to work effectively, transparency and vulnerability are necessary. A good therapist will work with you to find ways to cope with trauma and stress as they arise. EMDR should only be utilized by properly trained and licensed mental health professionals. Training programs through the EMDR Institute and/or EMDR International Association are the standard.
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EMDR Foundation. n.d. Research Lists | EMDR Foundation | EMDR Therapy. [online] Available at: <https://emdrfoundation.org/emdr-info/research-lists/#1519187597513-e5295809-fde7> [Accessed 19 January 2021].
EMDR International Association. n.d. Experiencing EMDR Therapy | EMDR International Association. [online] Available at: <https://www.emdria.org/about-emdr-therapy/experiencing-emdr-therapy/> [Accessed 20 January 2021].
Emdr.com. n.d. Research Overview – EMDR Institute – EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY. [online] Available at: <https://www.emdr.com/research-overview/> [Accessed 19 January 2021].
EMDR Therapy: Understanding Eye Movement Desensitization & Reprocessing.Available at: <https://www.youtube.com/watch?v=r_ORTtqrm9o> [Accessed 20 January 2021].
Francine Shapiro Ph.D. EMDR Webinar “The Past Is Present”.Available at: <https://www.youtube.com/watch?v=lsQbzfW9txc&feature=emb_logo> [Accessed 21 January 2021].
Riddle, J., n.d. EMDR Therapy For Anxiety, Panic, PTSD And Trauma. [online] Psycom.net – Mental Health Treatment Resource Since 1996. Available at: <https://www.psycom.net/emdr-therapy-anxiety-panic-ptsd-trauma/> [Accessed 21 January 2021].