By Elizabeth Kowalik, MSW, LCSW, CCTP
In recent years, more and more individuals are reaching out asking for EMDR…but many
people do not know what it is or how it works. The aim of this article is to provide some
introductory information about this relatively new, and very effective treatment.
What’s the Big Idea?
Pioneered by Francine Shapiro in 1989, Eye-Movement Desensitization and Reprocessing
(EMDR) utilizes an Adaptive Information Processing model to bring adaptive resolution to
distressing life experiences. After completed, EMDR treatment distress is relieved,
hyperarousal to the world is relieved, and negative beliefs are reformulated. Using an external
stimulus the memory network of the brain becomes malleable and receptive to processing new
information. The EMDR protocol offers purposeful organization of memories to create more
adaptive associations between a “stuck point” and the healthier, more positive information
gathered through life experiences. These new associations result in complete event
processing, new cognitive insights, successful emotional regulation, and an increase in distress
tolerance.
The mind can heal itself just like the body does by utilizing the healing properties of rapid eye
movements (REM) sleep cycles. The new information and experiences gathered throughout the
day are separated and categorized without you even noticing during the REM sleep cycles
throughout the night.
When something out of the ordinary happens like an unexpected and intense event (being bit by
a dog) or repeated exposure to stressful events (being bitten by a dog every time you go
outside) your natural ability to cope can be overloaded and ‘freeze’ as your brain prioritizes
survival over thought organization. This can lead to traumatic situations we have experienced
throughout our lives remaining ‘unprocessed’. Trauma can become isolated in the primal parts
of our brain storage. This part of the brain is intertwined with raw emotional and physical
reactions. It is absent of connection with the higher order thinking we use to reconcile our
feelings, thoughts, and behaviors with rationality and reasoning. Sometimes we aren’t even
capable of recalling the unprocessed events of our past, but the associated reactive emotions
like anxiety, panic, fear, and anger, are triggered by otherwise benign interactions. This of
course, inhibits our ability to live presently, engage with the world effectively, and feel safety.
EMDR helps create new connections between memory recall and emotional processing in the
brain by mimicking a natural REM sleep cycle and offering a “do-over” to assist the brain in
healing correctly.
To access the appropriate memory storage, the therapist has to use bilateral stimulation. This
means waking up both sides of the brain by alternating stimulation in rapid back and forth to a
specific sense. EMDR began using visual stimulation (moving the eyes from side the side).
Some therapists will use sounds where speakers on either side of the body alternate tones. A
more widely used technique recently is activation through the sense of touch where you’ll hold a
small device in each hand that sends alternating pulses or (completely painless and harmless)
buzzes.
This seems like hypnosis. Is this hypnosis?
No, EMDR is not hypnosis. During an EMDR session, you will remain completely alert and in
control. You can keep your eyes open; you can stop the process at any time, and there are very
low risks. Throughout the session the therapist will allow your natural healing system to take the
lead, intervening to keep your thoughts focused on the components of healing. New insights
and connections arise naturally, and most people find EMDR to be an incredibly empowering
therapy.
There are 8 phases of EMDR work which focus on building rapport and trust with your therapist,
gathering information about your history and present circumstances, assessing, and developing
effective coping strategies, and sense activation.
1) History Taking: This process involves the therapist understanding you! It’s imperative
that a therapeutic alliance is built between the therapist and the person seeking EMDR
treatment. Where you came from and where you are now are huge parts of your story
which will provide context as your brain rewrites your story.
2) Preparation: The therapist needs to know you have the resources to manage any
emotions EMDR might surface. You and your therapist will agree on a “window of
tolerance” to guarantee you feel safe throughout the process. You’ll talk about the skills
you already have and you’ll learn more helpful exercises to ensure you maintain
emotional safety through treatment.
3) Assessment: During this phase the EMDR candidate and the therapist agree on 3
distressing experiences targeted for reprocessing. This doesn’t mean going in depth of
the details, but rather listing the events and experiences in a way that is meaningful and
specific enough to resurface it into working memory.
4) Desensitization: This is the meat and potatoes of EMDR. Your therapist will ask you to
bring up the information related to the targeted memory and you’ll focus on that memory
while the therapist adds bilateral stimulation.
5) Installation: Once the targeted memory is no longer triggering, the therapist will guide
you through installing the positive cognition associated with the distressing experience.
Bilateral stimulation is continued throughout this process.
6) Body Scan: Your therapist will want to confirm there isn’t residual distress in your body.
You’ll think of both the targeting memory and the installed memory at the same time
while simultaneously scanning your body, noticing and reporting any sensations.
7) Closure: This phase is incredibly valuable as some memories are so intense that they
won’t reach reprocessing in a single session (although, equally, some do). During
closure your therapist will guide you through containment of the memory to ensure you
remain grounded and calm before leaving the session.
8) Reevaluation: You and your therapist will discuss what you are noticing in general and in
relation to the memory. You may decide to keep a journal of new memories that come
up between sessions or the benefits you notice in your daily life. You’ll have a
conversation about what’s working and also a possible redirection.
So, what’s all the buzz (pun intended) about?
It works. The reliability and validity of EMDR has been supported through rigorous research. It is
the most thoroughly researched method in the treatment of trauma and is endorsed by The
American Psychiatric Association, American Psychological Association, Department of Defense,
Veterans Administration, and the International Society for Traumatic Stress Studies.
It works faster. People tend to notice the benefits of EMDR much sooner than more
traditional therapy methods.
Less homework. Other forms of therapy can require journaling or some sort of guided
reflection. EMDR continues to make new connections even after the reprocessing session has
ended and you’ll only be expected to write down another memory you want to work on next
session (if something comes up).
Less stress. EMDR requires little description or reliving of negative experiences. The focus is to
process and move past the trauma by strengthening healthy bonds between the memory itself
and your brain’s reactions to that memory.
But I don’t think I have trauma.
EMDR has been used to effectively treat symptoms in addition to post-traumatic stress
including : anxiety, depression, addictions, phobias, anger, grief and loss, sleep
problems, intrusive thoughts, and low self-esteem. Ongoing studies continue to
support the probability of this list growing much longer.