EYE MOVEMENT DESENSITIZATION REPROCESSING THERAPY (EMDR)
WHAT IS EYE MOVEMENT DESENSITIZATION REPROCESSING THERAPY?
EMDR stands for Eye Movement Desensitization and Reprocessing. It is a form of therapy, a powerful, manualized and protocol-based approach (i.e., relying on the eight-phase treatment procedure), that has helped over an estimated two million people of all ages relieve many types of psychological distress.
EMDR has been extensively researched and has demonstrated effectiveness for trauma. EMDR has been recognized as an effective treatment by the American Psychiatric Association, the World Health Organization, the U.S. Department of Veterans Affairs and Department of Defense, the U.S. Department of Health and Human Services and many other national and international organizations.
HOW WAS EMDR DEVELOPED?
In 1987, psychologist Dr. Francine Shapiro made the chance observation that eye movements can reduce the intensity of disturbing thoughts, under certain conditions. Dr. Shapiro studied this effect scientifically, and in a 1989 issue of the Journal of Traumatic Stress, she reported success using EMDR to treat survivors of trauma. Since then, EMDR has developed and evolved through the contributions of therapists and researchers all over the world. Today, EMDR is a set of standardized protocols that incorporate elements from many different treatment approaches.
WHAT KIND OF PROBLEMS CAN EMDR TREAT?
Scientific research has established EMDR as effective for trauma related stress. Trauma can include a wide range of experiences from major life-threatening life events, experiences of neglect or abuse, through anything that undermines an individual’s sense of self-worth, safety, ability to assume appropriate responsibility for self or other, or limits one’s sense of control or choices. Over time, EMDR has proven successful in the treatment of a wide range of challenges and conditions:
Anxiety, panic attacks, and phobias
Depression and bipolar disorders
Chronic illness and medical issues
Grief and loss
Body dysmorphic disorders
PTSD and other stress related issues
Violence, abuse, sexual assault
HOW DOES EMDR WORK?
No one knows how any form of psychotherapy works neurobiologically or in the brain. However, we do know that when a person is very upset, their brain cannot process information as it does ordinarily. Trauma causes a disruption of normal adaptive information processing. This results in unprocessed information being dysfunctionally stored in memory networks. One moment becomes locked in the brain, “frozen in time,” and it continues to be triggered whenever a reminder comes up. Remembering a trauma may feel as bad as going through it the first time because the images, sounds, smells and negative feelings (e.g., fear, helplessness) haven’t changed and we do not seem to be able to control them.
Maladaptively stored information has a lasting negative effect that interferes with the way a person sees the world, the way they relate to other people, their healthy development of self-worth and sense of safety, and it increases their vulnerability to anxiety, depression, and post-traumatic stress. Adaptive (i.e., positive) information, resources, and memories are also stored in memory networks. These become activated with EMDR. EMDR can be thought of as physiologically based therapy that helps a person see disturbing material in a new and less distressing way. EMDR seems to have a direct effect on the way that the brain processes information. The eye movements, tactile taps or auditory tones (i.e., Bilateral Stimulation) used in EMDR seem to unlock the system and allow the brain to process the experience and activate the internal resources. That may be what occurs naturally during our most intense dreaming or REM (i.e., rapid eye movement) sleep (i.e., the eye movements appear to be involved during the processing of unconscious material). Following a successful EMDR session, a person no longer relives the images, sounds and feelings when the event is brought to mind. They still remember what happened, but it is less upsetting.
WHAT IS THE ACTUAL EMDR SESSION LIKE?
During EMDR, the therapist works with the client to identify a specific problem as the focus of the treatment session. The client is asked to focus on a specific event. Attention is given to a negative image, belief, and body feelings related to this event, and then to a positive belief that would indicate that the issue was resolved. While the client focuses on the disturbing issue or event (i.e., what was seen, felt, heard, thought, etc., and what thoughts and beliefs are currently held about that event), the therapist facilitates the dual attention stimulation of the brain (i.e., eye movements, tactile taps, and/or auditory tones). After each set of bilateral stimulation, the client is guided to notice what comes to mind without making any effort to control direction or content. They may experience shifts in insight or changes in images, feelings, or beliefs regarding the event. Each person processes information uniquely, based on personal experiences and values. Sets of bilateral stimulation are continued until the memory becomes less disturbing and is associated with positive thoughts and beliefs about oneself.
Even though during EMDR, the client may experience intense emotions, by the end of the session, most people report a great reduction in the level of disturbance. The client’s comfort and safety are the priority, therefore the client has full control to stop the therapist at any point, if needed.
HOW LONG DOES EMDR WORK?
One or more sessions are required for the therapist to understand the nature of the problem and to decide whether EMDR is an appropriate treatment option. The therapist also discusses EMDR more fully and provides an opportunity to answer questions about the method. Once the therapist and client have agreed that EMDR is appropriate for a presenting problem, the “actual” EMDR therapy may begin. A typical EMDR session can last from 60 - 90 minutes. The type of problem, life circumstances and the amount of previous trauma will determine how many treatment sessions are necessary. EMDR may be used within a standard “talking” therapy, as an adjunctive therapy with a separate therapist, or as a treatment all by itself.
IS EMDR EFFECTIVE?
Approximately 20 controlled studies have investigated the effects of EMDR. These studies have consistently found that EMDR effectively decreases/eliminates the symptoms of post-traumatic stress for the majority of clients. Clients often report improvement in other associated symptoms such as anxiety. The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for post-traumatic stress. The national registry (NREPP) of the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Department of Health and Human Services (HHS), cites EMDR as evidence-based practice for the treatment of PTSD, anxiety and depression symptoms. Research has also shown that EMDR can be an efficient and rapid treatment.
Current research bibliographies are maintained on EMDRIA’s website.
HOW IS EMDR DIFFERENT FROM OTHER THERAPIES?
EMDR therapy does not require talking in detail about the distressing issue, or homework between sessions. EMDR, rather than focusing on changing the emotions, thoughts, or behaviors resulting from the distressing issue, allows the brain to resume its natural healing process. EMDR therapy is designed to resolve unprocessed traumatic memories in the brain. EMDR involves bilateral stimulation of the brain (i.e., applying eye movements, sounds, or taps). For many clients, EMDR therapy can be completed in fewer sessions than other psychotherapies.
HOW CAN EMDR THERAPY HELP WITH THE HEALING PROCESS?
Our brains have a natural way to recover from traumatic memories and events. This process involves communication between the amygdala (the alarm signal for stressful events), the hippocampus (which assists with learning, including memories about safety and danger), and the prefrontal cortex (which analyzes and controls behavior and emotion). While many times traumatic experiences can be managed and resolved spontaneously, they may not be processed without help. Stress responses are part of our natural fight, flight, or freeze instincts. When distress from a disturbing event remains, the upsetting images, thoughts, and emotions may create feelings of overwhelm, of being back in that moment, or of being “frozen in time.” EMDR therapy helps the brain process these memories and allows normal healing to resume. The experience is still remembered, but the fight, flight, or freeze response from the original event is resolved.
* Adapted from EMDR International Association website
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