EMDR
Eye Movement Desensitisation Reprocessing
Eye Movement Desensitisation and Reprocessing (EMDR) approaches distress differently from most therapies. It doesn’t rely on talking through an event in detail, and it isn’t a medication. It works instead with how a memory is stored.
The model behind it is Adaptive Information Processing: the idea that the brain has a natural system for making sense of experience, and that an overwhelming event can leave a memory stored unprocessed — still carrying its original images, emotions and body sensations. EMDR uses bilateral stimulation, most often guided eye movements, to reactivate that processing so the memory can settle into something that can be remembered without being relived. Exactly why bilateral stimulation helps is still debated: proposed explanations include a link to REM sleep and the taxing of working memory. The clinical effect is well established even though the mechanism is not settled.
In the UK, NICE recommends EMDR for adults with PTSD following non-combat trauma, typically over 8 to 12 sessions, and more where someone has experienced multiple traumas. For children and young people aged 7 to 17, NICE recommends considering EMDR where trauma-focused CBT has not worked or the young person has not engaged with it.
EMDR therapy is not limited to simply taking symptoms away. It addresses the past, present and future.
It is important to note that before treatment begins, you and your therapist will create a ‘safe place’ – somewhere your mind can drift to if, during your treatment, you become distressed at recalling the event.
WHAT HAPPENS IN A THERAPY SESSION?
Your therapist will move his or her fingers back and forth in front of your face and ask you to follow these hand motions with your eyes. At the same time, the EMDR therapist will have you recall a disturbing event. This will include the emotions and body sensations that go along with it.
Gradually, the therapist will guide you to shift your thoughts to more pleasant ones. Some therapists use alternatives to finger movements, such as hand or toe-tapping, light beams or musical tones.
Throughout the process, the client is awake, alert and in control. No trance state is induced, no suggestions are made, and the changes resulting from the client’s innate processes.
EMDR weakens the effect of negative emotions and the ‘charge’ behind emotions when recalling the event. Before and after each EMDR treatment, your therapist will ask you to rate your level of distress. The hope is that your disturbing memories will become less disabling.
After an EMDR session, there may be a strong sense of relief, a feeling of openness or even euphoria.
HOW MANY EMDR SESSIONS WILL I NEED?
As with any treatment or therapy, each person is different. The number of sessions varies according to the complexity of the issues being dealt with. Generally, the more isolated the traumatic memory being treated, the shorter the treatment tends to be. For individuals with a history of multiple painful experiences and years of feeling bad about them, several EMDR sessions in conjunction with cognitive therapy or schema-focused cognitive therapy may be needed.
Generally speaking, there are roughly eight steps to completing treatment:
The first phase is a history-taking session during which the therapist assesses the client’s readiness for EMDR and develops a treatment plan. The client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviours that the client will need in future situations.
During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills and is relatively stable. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client can then use stress-reducing techniques during or between sessions. However, one goal is not to need these techniques once therapy is complete.
A target is identified and processed in phases three to six using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief (for example, ‘I am strong and in control of this situation). The validity of the positive belief is rated, as is the intensity of the negative emotions.
After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth, following the therapist’s fingers (or light beam) as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client.
The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client’s report, the clinician will facilitate the next focus of attention. In most cases, a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.
In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities mastered in phase two.
The next session begins with phase eight, a re-evaluation of the previous work and progress since the previous session. EMDR treatment ensures processing all related historical events, current incidents that elicit distress, and future scenarios that require different responses. The goal is to produce the most comprehensive and profound treatment effects in the shortest period while maintaining a stable client within a balanced system.
After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated or greatly decreased and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioural and personal change, further enhanced with standard EMDR procedures.
HOW EFFECTIVE IS EMDR?
More than 20,000 practitioners have been trained to use EMDR since psychologist Francine Shapiro developed the technique in 1989. While walking through the woods one day, Shapiro noticed that her negative emotions lessened as her eyes darted from side to side. Then, she found the same positive effect on patients.
THE SCIENCE OF EMDR
Brain scans have demonstrated pre-post changes after EMDR therapy, including increased hippocampal volume, which have implications for memory storage. The bottom line of EMDR outcome research is that clinical change can be profound and efficient.
(Source: https://www.ptsduk.org/treatment-options/eye-movement-desensitisation-reprocessing-emdr/)
