What is EMDR?
EMDR stands for Eye Movement Desensitisation and Reprocessing. It is a treatment for Trauma and Post-Traumatic Stress Disorder (PTSD). It was developed in the 1980s by a psychologist, Francine Shapiro, following her study of Neuro-Linguistic Programming (NLP).
EMDR its based on the recognition that troublesome memories can be neutralised by interrupting the brain’s ability to recall and process them. The main technique involves distracting clients’ eye movements as they recall specific memories linked to the original traumatic event.
EMDR can also be employed on phobias, and also on other types of emotionally disturbing memories.
How does EMDR work?
EMDR identifies, isolates and targets the traumatic event that triggered PTSD. Along with the imagery, thoughts, sensations, sounds and beliefs that accompany it. For example, the client’s memory of a car crash may manifest as images of the car out of control on a motorway; thoughts that one is about to die; sensations of freezing and terror; the sounds of impact on a crash barrier; and the belief that one is helpless to save oneself. The whole experience is recalled as if it were a cinematic clip lasting a few minutes.
However, clients are asked not to look at the ‘movie’ directly, but as if it were in the background as their eyes are distracted by random movements made by the therapist’s fingers. As recall unfolds the therapist may also call out the thoughts and ideas that are associated with the memory. This process typically takes a minute or two, and may be repeated 1-3 times. For a short video on the process see here.
The EMDR process is repeated until the emotional distress attached to the memory is neutralised.
The 6 Phases of EMDR treatment
EMDR therapy consists of six phases to assist reprocessing and desensitisation:
- Assessment and Treatment Planning
The first phase involves the therapist gathering information about patients’ mental health, their experience with trauma, and the effects this has had on them. An initial body scan is taken to elicit a score of 1-10 measuring Subjective Units of Distress (SUDs) for the experience of recall. Most traumatic memories will have a score of at least seven. A treatment plan for the use of EMDR is developed so as to address the imagery, thoughts, sounds, feelings, sensations and beliefs associated with a specific traumatic memory. Finally, helpful replacement beliefs are identified as substitutes for the old, traumatic beliefs.
The next phase prepares the client for the EMDR process itself. The protocol is explained, and instructions given. The client is also instructed in the use of relaxation techniques during the process.
In the next phase reprocessing takes place as explained in the previous section.
On completion of the process the client is dissociated from the memory and re-oriented back to the room. Closure is complete when the client is in present moment awareness, and in contact with the therapist. The therapist checks that the client is comfortable and safe.
After a pause the client is asked to briefly recall the memory and check for the current SUD score, and for any changes to the memory itself. For example, following EMDR memories may break up, shrink, white-out, become slippery or hard to recall. At this point the therapist may adjust the protocol to allow for changes during the next repetition of the process.
After each repetition therapists and clients discuss changes to the way the client perceives and experiences the memory. Changes to the client’s beliefs and judgments about their past experiences are also defined and enhanced.
Research into EMDR Therapy
EMDR therapy has been the subject of numerous studies, and the research shows that it is an effective treatment for PTSD. A 2014 meta-analysis of 26 randomised controlled trials found that EMDR therapy resulted in significant reductions in distress for patients receiving EMDR for trauma.
Other studies have reported success in EMDR treatments for anxiety conditions (phobias) and depression.
Advantages of EMDR Therapy
EMDR has several benefits that make it an effective treatment for PTSD. The therapy is non-invasive, and the patient does not have to talk about the traumatic event in detail. This reduces the likelihood that recall will re-traumatise the client.
EMDR therapy is a brief form of therapy, and most patients experience significant improvement in their symptoms after a few sessions.
The process can be applied to multiple types of trauma: terrorist incidents, assault, abuse, natural disasters and accidents.
EMDR can be adapted to any mental health problem related to distressing memories.
Limitations of EMDR Therapy
EMDR therapy may not be suitable for people who have a history of seizures or related neurological disorders. The therapy may not be effective for people who have co-occurring mental health disorders – such as psychosis – that complicate memory retrieval.