Eye Movement Desensitization and Reprocessing (EMDR) therapy is an innovative treatment primarily used for individuals experiencing post-traumatic stress disorder (PTSD). Developed by Francine Shapiro, EMDR has gained widespread recognition and validation over the years, with ongoing research supporting its effectiveness (Landin-Romero et al., 2018). Shapiro's initial clinical trials demonstrated that participants who underwent EMDR therapy experienced a significant reduction in distressing memories, with these improvements sustained in follow-ups at one and three months (Landin-Romero et al., 2018).
Additionally, participants reported enhanced self-beliefs, further highlighting EMDR's potential benefits for those with PTSD (Landin-Romero et al., 2018). For eligible patients, EMDR can offer a meaningful and effective psychotherapy option, providing hope in challenging times.
Exploring Negative Thoughts
EMDR uses a technique called bilateral stimulation to help patients process trauma. This can involve several methods: moving the eyes back and forth, tapping on the shoulders or knees, listening to auditory tones through headphones, or using handheld buzzers. Most often, this stimulation is delivered through online platforms, where patients follow a red dot moving left to right on a screen. The goal of this bilateral stimulation is to help patients distance themselves from negative beliefs associated with their trauma (Gainer et al., 2020). By doing so, EMDR therapy helps patients shift towards more positive beliefs while keeping the negative thoughts present but less disruptive.
Shapiro, interested by the experiences of Vietnam War veterans, sought a method to address trauma without needing to cause the patient to relive the distressing memories. She discovered that eye movements could help hold a memory in place without provoking the associated intense anxiety (Gainer et al., 2020).
Although the exact mechanisms behind EMDR's effectiveness remain unclear, two prominent hypotheses offer possible explanations. The first hypothesis suggests that bilateral stimulation facilitates communication between the brain's left and right hemispheres, enabling the integration of traumatic memories without the adverse physiological effects (Gainer et al., 2020). The second hypothesis suggests that EMDR therapy impacts working memory, occupying it with bilateral stimulation and thereby reducing the physical effects of traumatic memories (Gainer et al., 2020).
Adaptive Information Processing (AIP)
The Adaptive Information Processing (AIP) model suggests that memories, both traumatic and non-traumatic, are stored differently in the brain. Non-traumatic memories are processed smoothly and are linked with other memories, contributing to our complex cognitive network (EMDR Therapy). In contrast, traumatic memories often experience disruptions, preventing full processing. This can lead to these memories becoming linked with new experiences or resurfacing inappropriately (EMDR Therapy).
Just as a physical injury might react sensitively to new stimuli, unprocessed traumatic memories can become hypersensitive, manifesting many of the symptoms seen in PTSD (EMDR Therapy). Individuals with PTSD frequently experience flashbacks or the sensation of reliving traumatic events. These episodes can be triggered by various stimuli, such as sights, sounds, or smells, causing the traumatic memory to reemerge even if only indirectly related to the external trigger (EMDR Therapy).
The Phases of EMDR Therapy
EMDR therapy is conducted across multiple sessions, with one session often involving parts of several phases. For a single disturbing event, treatment usually requires between three and six sessions, whereas more complex or long-term traumas may need eight to twelve sessions or more (EMDR Therapy). The eight phases of EMDR therapy are:
History and Treatment Planning: This initial phase involves collecting detailed information about the patient’s past, including upsetting or disturbing events, and setting therapy goals. This helps the therapist determine if EMDR is an appropriate treatment and which aspects to focus on (EMDR Therapy).
Preparation: The therapist explains the treatment process and introduces the client to EMDR procedures, including eye movements or other bilateral stimulation components. The therapist ensures the client has adequate resources for managing emotions, often leading them through the Safe/Calm Place exercise to establish a sense of security (Maxfield & Solomon, 2017).
Assessment: This phase activates the targeted memory by identifying and assessing each component: image, cognition, affect, and body sensation. The Subjective Units of Disturbance (SUD) scale measures the level of emotional disturbance, while the Validity of Cognition (VOC) scale assesses how true the positive beliefs about the memory feel to the client (Maxfield & Solomon, 2017).
SUD Scale: Measures the disturbance level on a scale from 0 (no disturbance) to 10 (worst possible disturbance).
VOC Scale: Evaluates the believability of positive cognition on a scale from 1 (completely false) to 7 (completely true).
Desensitization: The client focuses on the memory while engaging in eye movements or other bilateral stimulation. The therapist uses standardized procedures to determine the focus of each set of stimulation and adjusts as needed until the memory is no longer distressing (Maxfield & Solomon, 2017).
Installation: This phase strengthens the preferred positive cognition related to the memory (EMDR Therapy).
Body Scan: The client observes their physical response while thinking of the incident and the positive cognition. Any residual somatic distress is addressed using bilateral stimulation techniques (EMDR Therapy).
Closure and Stabilization: This phase is used to end the session and ensure the patient feels calmer and safe before leaving. The therapist provides instructions and techniques to help the patient manage any negative thoughts or feelings that may arise between sessions. Patients may also be asked to document any new thoughts for discussion in future sessions (EMDR Therapy).
Reevaluation and Continuing Care: At the beginning of subsequent sessions, the therapist reviews the patient’s progress and current psychological state. This phase involves assessing whether previous treatment effects have been maintained, addressing any new memories or issues, and adjusting therapy goals and expectations as needed (EMDR Therapy).
Therapists like Marianne Silva, LCSW, emphasize that EMDR therapy is designed to be time-limited, helping individuals heal from trauma in a relatively short period (What Is EMDR Therapy and Why Is It Used to Treat PTSD?, 2023). The goal is to integrate new, adaptive information into the traumatic memory, allowing patients to recognize their current safety and overcome feelings of guilt or self-blame associated with the trauma (What Is EMDR Therapy and Why Is It Used to Treat PTSD?, 2023).
Evidence and Effectiveness
More than 30 positive controlled outcome studies have demonstrated the effectiveness of EMDR therapy. Research indicates that 84%-90% of single-trauma victims no longer have PTSD after just three 90-minute sessions (What Is EMDR?, 2015). A study funded by Kaiser Permanente showed that 100% of single-trauma victims and 77% of those with multiple traumas were free of PTSD after six 50-minute sessions (What Is EMDR?, 2015). Additionally, 77% of combat veterans were PTSD-free after 12 sessions (What Is EMDR?, 2015).
A 2018 study by Gil-Jardiné et al. evaluated individuals who visited an emergency room following a traumatic event. The study found that 20% of these subjects would go on to experience lifelong post-traumatic stress symptoms, including post-concussion-like symptoms (PCLS). Of 130 subjects at high risk for PCLS, those receiving EMDR had the lowest rates of PCLS (18%) and PTSD symptoms (3%) three months after their initial visit compared to control (65% PCLS, 19% PTSD) and reassurance groups (37% PCLS, 16% PTSD) (Gil-Jardiné et al., 2018).
A 2020 study by Proudluck and colleagues found that the majority of patients who had experienced at least one traumatic event required fewer than 10 EMDR sessions to return to a stable mental state, with no need for additional psychological treatment (Proudlock et al., 2020). Additionally, EMDR has shown promising results among female cancer patients, with significantly lower rates of PTSD, anxiety, and depression compared to a control group in a 2018 randomized controlled trial (Gainer et al., 2020).
EMDR therapy is also flexible in its application. A study on varying EMDR formats for veterans with PTSD found that both weekly one-on-one sessions and intensive 10-day daily group sessions were equally effective, with significant treatment outcomes sustained at one-year follow-up (Gainer et al., 2020).
EMDR therapy is widely recognized as an effective treatment for trauma and related experiences by organizations including the American Psychiatric Association, the World Health Organization, and the Department of Defense (What Is EMDR?, 2015). This extensive body of research supports EMDR’s efficacy not only for severe trauma but also for addressing everyday issues that contribute to low self-esteem, feelings of powerlessness, and other psychological difficulties.
Who Can Benefit from EMDR?
EMDR therapy is beneficial for individuals who have experienced various forms of trauma, whether from single events or a series of negative experiences. This includes physical or emotional abuse, sexual assault, combat experiences, natural disasters, and the sudden loss of a loved one. Even long-standing emotional neglect or witnessed traumatic events can be addressed through EMDR (What Is EMDR Therapy and Why Is It Used to Treat PTSD?, 2023).
The therapy is effective not only for recent traumas but also for those carrying the weight of traumatic memories from years or even decades ago (What Is EMDR Therapy and Why Is It Used to Treat PTSD?, 2023).
Moving Forward
Eye Movement Desensitization and Reprocessing (EMDR) therapy stands out as a promising and effective treatment for PTSD and a range of other trauma-related conditions. Its ability to help individuals process and integrate traumatic memories offers hope and relief for many.
The therapy's structured approach, encompassing eight distinct phases, ensures a comprehensive treatment process. For those struggling with PTSD or other trauma-related disorders, EMDR represents a valuable option to explore. Discussing this therapy with a trusted mental health professional can help determine if it aligns with your specific needs and goals.
While EMDR is a promising treatment, it may not be suitable for everyone, and that’s perfectly fine. Each individual's journey with trauma is unique, and it’s essential to prioritize your emotional well-being when considering new treatments.
As the field of trauma therapy continues to advance, the developments and successes associated with EMDR are both exciting and hopeful. They represent a significant step forward in our understanding and treatment of PTSD and related disorders. With ongoing research and innovation, the future holds the promise of even more effective and tailored treatments for those in need.
Citations
EMDR Therapy: What It Is, Procedure & Effectiveness. (n.d.). Cleveland Clinic. Retrieved September 2, 2024, from https://my.clevelandclinic.org/health/treatments/22641-emdr-therapy
Gainer, D., Alam, S., Alam, H., & Redding, H. (2020). A FLASH OF HOPE: Eye Movement Desensitization and Reprocessing (EMDR) Therapy. Innovations in Clinical Neuroscience, 17(7–9), 12–20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839656/
Gil-Jardiné, C., Evrard, G., Al Joboory, S., Tortes Saint Jammes, J., Masson, F., Ribéreau-Gayon, R., Galinski, M., Salmi, L.-R., Revel, P., Régis, C. A., Valdenaire, G., & Lagarde, E. (2018). Emergency room intervention to prevent post concussion-like symptoms and post-traumatic stress disorder. A pilot randomized controlled study of a brief eye movement desensitization and reprocessing intervention versus reassurance or usual care. Journal of Psychiatric Research, 103, 229–236. https://doi.org/10.1016/j.jpsychires.2018.05.024
Landin-Romero, R., Moreno-Alcazar, A., Pagani, M., & Amann, B. L. (2018). How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action. Frontiers in Psychology, 9, 1395. https://doi.org/10.3389/fpsyg.2018.01395
Maxfield, L., & Solomon, R. (2017, July 31). Eye Movement Desensitization and Reprocessing (EMDR) Therapy. Https://Www.Apa.Org. https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing
Proudlock, S., & Peris, J. (2020). Using EMDR therapy with patients in an acute mental health crisis. BMC Psychiatry, 20(1), 14. https://doi.org/10.1186/s12888-019-2426-7
What is EMDR? - EMDR Institute - EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY. (2015, February 15). https://www.emdr.com/what-is-emdr/
What is EMDR therapy and why is it used to treat PTSD? (2023, December 21). https://www.apa.org. https://www.apa.org/topics/psychotherapy/emdr-therapy-ptsd
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