Eye Movement Desensitization and Reprocessing (EMDR) is a modern, interactive psychotherapy modality that was specifically developed to alleviate psychological distress associated with traumatic memories.
EMDR combines side-to-side eye, bilateral hand stimulation, or cross-body tapping movements with talking therapy in a structured and controlled environment. EMDR can help people process the negative or distressing images, body sensations, and emotions that are connected to a traumatic memory. This gets to the root of the issue and can alleviate symptoms associated with the trauma.
EMDR has been extensively researched as an integrative psychotherapy approach and is proven to be highly effective for the treatment of trauma.
How does EMDR Therapy Work?
EMDR therapy works by reprocessing and changing the way that traumatic memories are stored in your brain until they are no longer psychologically disruptive. There are eight phases to this process.
Phase 1: Evaluation
In the first phase of treatment, there will be an assessment to ensure that the client is ready to engage in EMDR therapy and develop a treatment plan. This could last for a few sessions, depending on your symptoms, your understanding of events that are causing disruption in your life, and which experiences or relationships you would like to target. These targets will include both past and present memories and situations that have been causing or are still causing distress.
Phase 2: Preparation and Resourcing
After you have engaged in talk therapy and identified the issue you wish to address, the therapist will ensure that you have the resources to deal with the emotional or psychological stress that may arise during the EMDR process. Generally, the therapist will explore a range of grounding techniques to identify those that work well for you personally. They will also teach a variety of relaxation and stress management techniques that include deep breathing to regulate the nervous system and mindfulness exercises.
Phase 3: Assessment and Selection
During this phase of EMDR therapy, you will select a specific memory related to the experience that you would like to target, which is likely to include:
- A vivid visual image related to the memory
- A negative self-belief
- Emotions and body sensations related to the memory
It is also helpful to identify a positive memory or feeling that the therapist will ask the client to focus on at certain points or use as a comparison when rating the disruptive memory and attached feelings.
Phase 4: Desensitization
The therapist will ask you to focus on the negative memory while guiding you through bilateral stimulation (BLS). This involves being guided by the therapist to make side-to-side eye movements, listening to a repetitive noise in headphones that alternates from one ear to the other, or gently tapping either side of your body with the opposite hand. The desensitization process can differ slightly depending on the type of trauma you have selected to desensitize and reprocess, but most people will be asked a series of questions by the therapist, and the client will share what memories or feelings come up during each stage.
Phase 5: Installation
When desensitization is complete, the installation phase begins. During this phase, the client associates the positive belief with the memory they are targeting and works on strengthening it until it feels completely true. The side-to-side eye movements or bilateral stimulation during this phase are generally much faster.
Phase 6: Body Scan
At the end of each EMDR action, such as tapping each side of the body and while thinking of the incident or experience, the client will scan their body for uncomfortable physical sensations to check for lingering somatic distress. This is also done after installation, until any disturbance in the body is reprocessed.
Phase 7: Closure
Every EMDR session will end in closure, where the client is brought back to a state of calm, regardless of whether the reprocessing is complete, and this can be continued in the next session. The therapist will take time to explore your experiences throughout the session, discuss your progress, and may ask you to journal and keep a diary throughout the next week or two until your next session to record any moments that they noticed feeling distressed or felt anything related to what they have been working on with the therapist. Reprocessing of an event is complete when the client feels neutral about the event or memory, when the positive belief that they installed feels completely true, and when the body is completely clear of somatic distress or disturbance.
Phase 8: Re-evaluation
At the beginning of the next session, the EMDR therapist will invite you to think about the memories and feelings you addressed in the previous session so that you can rate the level of disturbance felt and examine your progress.
Research on EMDR Therapy
The EMDR protocol – the standardized eight-step process – addresses past events that formed the issue that a client is dealing with. This issue or memory may not always be a traumatic one, and there may be several memories or issues that are causing disruption. In addition to memories, specific feelings or reactions can also be targeted and reprocessed.
Research on EMDR therapy is incredibly promising; around twenty controlled studies have validated its effectiveness in the treatment of PTSD, and numerous other studies demonstrate EMDR’s efficacy with a wide range of disorders, including anxiety disorders and phobias.1
The theory currently used to explain EMDR therapy treatment effects is called the AIP model, which is a model of pathogenesis and change developed to explain the shift towards positive outcomes that result in EMDR memory reprocessing.2 The AIP model posits that trauma can become stuck in our brain’s neural network, causing memories of a traumatic event to elicit the negative emotions, sensations, and cognitive or behavioral responses associated with it. The goal of EMDR is to reprocess these memories by adding adaptive emotions to the neural network through bilateral stimulation, which creates new neural pathways in the brain and enhances one’s ability to access the stored or stuck trauma. The repetition of this process allows the trauma to be reprocessed. Associated emotions and stress are reduced, new associations with the traumatic memories are created, and healthy adaptive behaviors take their place.
Sources:
[1] Oren, E & Solomon, R. (2012) EMDR therapy: An overview of its development and mechanisms of action. European Review of Applied Psychology, Volume 62, Issue 4. https://doi.org/10.1016/j.erap.2012.08.005
[2] Hase, M. (2021). The structure of EMDR therapy: A guide for the therapist. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.660753
[3] The AIP model. EMDR European Association. Retrieved November 15, 2022, from https://emdr-europe.org/about/the-aip-model/
