eye movement desensitization and reprocessing (EMDR) is a type of trauma therapy that was discovered by francine shapiro in the late 1980s. EMDR aims to alleviate the distress associated with traumatic memories and facilitate the integration of new, positive beliefs.
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What Is EMDR Therapy?
EMDR is a type of trauma therapy that was discovered by francine shapiro in the late 1980s. Dr. shapiro noticed that certain repetitive eye movements, when paired with distressing thoughts, would reduce the intensity of those thoughts. She observed her own behavior when thinking of upsetting thoughts, and she noticed that her eyes naturally began to move quickly back and forth. She hypothesized that when a person is faced with a traumatic situation, they may feel overwhelmed, and their normal coping mechanisms may not work. when this happens, distressing thoughts and memories may be stored in the brain as a sensory memory rather than a factual memory. Since traumatic sensory memories may continue to overwhelm an individual, she suggested that EMDR therapy would help remove the emotionality associated with these memories, and the brain would be able to store the event in a more logical form. By removing the feelings and sensations associated with the traumatic memory, the person would be able to recall the event alone without the distressing emotions. EMDR is often used in the treatment of post-traumatic stress disorder, trauma, or phobias.
How Does It Work?
EMDR is based on the adaptive information processing model, which posits that negative thoughts and feelings are due to unprocessed memories (shapiro, 2002; shapiro, 2007; van den hout & engelhard, 2012). Bilateral stimulation is paired with distressing memories to change beliefs about the event by alternately activating each half of the brain in order to create new neural connections (van den hout & engelhard, 2012). Although EMDR originally began with eye movements, now several types of bilateral sensory input may be used (parnell, 2013). These may include asking a client to follow the practitioner’s moving finger with their eyes, a machine with lights that move back and forth, alternate taps to the client’s knees, or handheld vibrating pods that alternate the vibration and have adjustable speeds and intensities. The type of bilateral stimulation usually depends on the practitioner and client preference.
The adaptive processing model suggests that the body has a natural inclination to heal itself, like a wound forming a scab. However, traumatic memories may be stored in a raw sensory form in the limbic system, rather than as a semantic memory (shapiro, 2002; van den hout & engelhard, 2012). As long as the memory is stored in its raw form, the person will continue to feel distressed. When the sensory memory is paired with bilateral stimulation of the body, it lowers physiological arousal and allows the body to move the memory from an emotional form to a more logical form (van den hout & engelhard, 2012). After EMDR treatment, a client should be able to remember the facts of a traumatic memory without feeling the previously associated distressing sensations, thoughts, or feelings.
Clients report starting a course with a low sense of self, due to feelings of hopelessness and a loss of control over the traumatic event. After EMDR therapy treatment, clients often report a greater sense of control and higher self-worth (shapiro, 2002; shapiro, 2007; van den hout & engelhard, 2012).
Is EMDR Effective? A Look at the Research
Since it is a relatively new treatment model, there is still some question as to the efficacy of EMDR. Current research suggests that EMDR is as effective as some types of exposure therapy, as effective as trauma-focused cognitive behavioral therapy, and more effective than selective serotonin re-uptake inhibitors alone (van der kolk et al., 2007; seidler & wagner, 2006). Currently, the international society for stress studies, the us substance abuse and mental health services administration, and the us departments of veterans affairs and defense, all recommend EMDR for the treatment of PTSD.
Are There Dangers or Side Effects?
EMDR must be administered by a trained and certified practitioner to reduce the potential for side effects. Potential side effects include vivid dreams or nightmares after a session, since the mind may continue processing the information during the rem stage of sleep (parnell, 2013). Clients should be warned of the possibility of vivid dreams. Other potential dangers include emotional distress during a session when the client is re-experiencing the traumatic event (taylor et al., 2003). Some emotional distress is expected in similar types of exposure therapy, and the distress is usually short lived. During an EMDR session, a client may feel temporarily worse, but a skilled practitioner will be able to use the installed safety protocols to avoid overwhelming distress in the client.
EMDR sessions tend to be twice as long as traditional therapy sessions so that a client has time to fully process a memory during one session (shapiro, 2002). A client should leave each session feeling more empowered and calmer than they initially felt.
Does It Work for Children?
EMDR works very well for children, with some adaptation. Clinicians must explain the process in a developmentally appropriate way. However, since EMDR is a sensory-based therapy, it can be used even with nonverbal children or those diagnosed with autism spectrum disorders (gomez, 2012; shapiro, 2007). Clinicians who are interested in EMDR for children should consider reading EMDR therapy and adjunct approaches with children: complex trauma, attachment, and dissociation by dr. ana gomez (2012).
How to Do an EMDR Session + Process
EMDR is an eight-phase treatment model (shapiro, 2002; shapiro, 2007; parnell, 2013). Sessions often last 90 minutes, rather than the traditional 45-minute psychotherapy session. Some clients may feel relief in as few as six EMDR sessions (shapiro, 2007). The treatment model includes client history taking, client preparation, assessment, desensitization, body scan, closure, and re-evaluation of the treatment (shapiro, 2002; shapiro, 2007). During the client preparation phase, the clinician will be sure to address the EMDR safety protocols by establishing images or memories that the client may return to whenever the trauma therapy becomes overwhelming (parnell, 2013).
Phase one
The first phase is taking a client’s history and planning the course of treatment (shapiro, 2002; shapiro, 2007; parnell, 2013). The clinician is looking for a suitable target to begin the EMDR therapy and any background information that may be causing the maladaptive behavior to continue (secondary gains). The clinician will want to identify the most distressing memory and target that first, whether it’s an early childhood memory or a current trauma. EMDR works as sequential processing, so when the correct target is processed, subsequent stressors will also be addressed.
Phase two
The second phase is about client preparation (shapiro, 2002; shapiro, 2007; parnell, 2013). Since EMDR is a type of trauma therapy, the therapeutic alliance between the clinician and client is crucial. This is the phase when the clinician will engage the client in the therapeutic process and establish a rapport.