Understanding EMDR Therapy

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What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) therapy is “an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. EMDR is a set of standardized protocols that incorporates elements from many different treatment approaches” (www.emdria.org). EMDR essentially makes traumatic material less powerful. For example, if you have ever had a physical injury you may remember what it felt like, but you don’t feel it every time you recall the injury. For many with trauma, they still feel a response when they recall the trauma–sometimes as if it is still happening.  Their heart might race; they may feel nauseous. In addition, they may have a negative belief about themselves related to the trauma (i.e. I am a bad person), and they may apply this belief to other life circumstances. EMDR aims to reduce the physical activation related to the trauma AND rewrite the thoughts connected to the trauma (i.e. “this happened but I am a good person”). It does not erase or alter the memory.

The Process

EMDR has 8 phases of treatment and many of these phases will incorporate elements of other valuable therapy models. The phases of treatment are: 1. History taking 2. Preparation 3. Assessment 4. Desensitization 5. Installation 6. Body Scan 7. Closure, and 8. Reassessment. Phases 4 through 7 are known as the trauma protocol. The trauma protocol is what most people (clients and clinicians) think of when they think of EMDR.

How it works

EMDR works through bilateral stimulation (BLS) which is also known as dual attention stimulation (DAS). BLS originated as eye movement in which the client will follow the clinician’s hand back and forth across the plane of vision with their eyes while keeping his or her head steady. BLS can also be facilitated through touch or sound. It is NOT hypnosis. Again, EMDR will not create, erase, or alter memories.

During the preparation phase, BLS will be used to strengthen positive feelings and resources, both internal and external. For example, the client might be directed to think of a place they feel safe or recall a time they felt supported. BLS is also used during preparation to increase a client’s tolerance for distress. This is done through what is called “pendulation” or “titration”. In this exercise, the client will “visit” distressing information but will not process it. This allows the clinician to assess whether or not the client is able to safely tolerate distress. Pendulation also allows the client to increase his or her skills for tolerance through practice. This can give the clinician and client valuable information on the best course of treatment.

During the trauma protocol, BLS is used to desensitize traumatic or distressing information and install a new, healthier belief. To do this, the clinician will ask a series of questions to “light up” the memory or other target. This can be difficult and emotional at times. As BLS is applied, the memory becomes less distressing, although this process is not always linear, and the client will likely experience waves of intensity followed by relief. During processing, the clinician makes sure the client is grounded and aware they are in the present moment. The clinician will check in between sets of BLS and invite the client to share what he or she notices. The client can give as much or as little information as he or she chooses. Sometimes, the information is not verbal and the client will only describe a sensation or nothing at all, and this is normal. The clinician avoids engaging in “talk therapy” as this can interrupt the process. During closure, the clinician and the client will have a chance to debrief if it is helpful.

So how does this work? Well, we don’t know exactly what makes EMDR so effective. I believe it is evidence of how amazing our brains are designed. Some clinicians theorize that the process is similar to what takes place during REM sleep. Evidence suggests that EMDR “moves” information in the brain to consolidate traumatic memories and put them in the past—like other narrative, biographical memories. You can learn more about various research at www.emdria.org.

Risks and Barriers

Like any therapy, EMDR has risks. It can be more intense than other types of therapy. If a client is not prepared or is unable to tolerate distress, then EMDR can make symptoms worse—even inducing a flashback. For any therapeutic model, distress tolerance is extremely important. When we don’t tolerate distress well we may numb through substance or behavior, engage in fight or flight, panic, or shut down completely. EMDR is only appropriate if the client is highly motivated for change AND has the skill set to tolerate distress. For this reason, the clinician and client may stay in preparation for several weeks to build these skills.

EMDR is not for everyone. It has a reputation for being a quick fix and this is sometimes true. EMDR often works very fast for an adult with single incident trauma. However, for those who have complex trauma, or where there were multiple incidents, EMDR is slow work and the trauma protocol may or may not be appropriate. In fact, things like dissociation, secondary gains, or blocking beliefs can create barriers to effective EMDR and will need to be addressed prior to trauma work. This one of the reasons to consider a certified EMDR professional who is trained to recognize the nuances of complex cases.

Have more questions? Feel free to ask in the comments below. Remember to take care of you!

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