Eye Movement Desensitisation and Reprocessing (EMDR) is a powerful psychological treatment that was developed in the 1980s by an American clinical Psychologist, Dr Francine Shapiro. EMDR treatment is based on the idea that a traumatic or distressing experience may overwhelm the brain’s coping mechanisms and the memories, beliefs, emotions, images and physical sensations associated with the experience gets stored or ‘frozen in time’ within an isolated memory network. As a consequence, the brain is unable to adequately process the experience, which in turn causes an imbalance or block in the nervous system resulting in ongoing psychological disturbance. And it is not just major traumatic events that can cause problems; EMDR has revealed that even common childhood humiliations and disappointments can also have similar long lasting negative effects on our mental health.
In the same way that the body works to heal a physical injury such as a cut or wound, the brain is believed to have a similar system that facilitates mental health. This Adaptive Information Processing System is designed to relieve emotional pain and promote psychological wellbeing. EMDR therapy aims to stimulate this natural healing process by accessing and unblocking the distressing memories and their associated negative emotions, thoughts and sensations.
A key component of EMDR treatment involves the use of procedures to stimulate rapid eye movements, which usually entails the client following the therapist’s hand moving rapidly across their visual field. Although the precise mechanisms of how EMDR works are not fully known, it is believed that the eye movements mimic what happens when we dream (i.e. REM sleep), during which time the brain processes or ‘makes sense’ of events and experiences that have happened during the day. Successfully processed material is integrated with other stored material and loses the ‘emotional charge’ it once held for the person. As a consequence, the person is able to learn what is useful from the negative experience and let everything else go.
EMDR treatment does not involve hypnosis, inducing a trance state or any kind of auto-suggestion. Clients are fully awake during treatment sessions.
EMDR has been used successfully to treat psychological trauma related to:
Although originally developed to treat adults with PTSD, EMDR has been shown to be helpful in treating children and other conditions such as phobias, anxiety disorders, low self-esteem, and as well as performance anxiety.
EMDR is an evidence-based treatment recommended by the National Institute for Health and Care Excellence (NICE). Extensive research has demonstrated that EMDR can speed up the healing process following a traumatic experience and that the effects of treatment endure over time. Currently, EMDR treatment of post-traumatic stress disorders has been more thoroughly researched than any other form of psychological therapy. EMDR has been shown to be highly effective and it often works within a shorter period of time than other therapies.
EMDR treatment requires focusing on three time periods: the past, present, and future. This means that attention is given to past disturbing memories and related events, to current problematic situations, and also to assisting clients to develop the skills and attitudes needed for positive future actions and wellbeing. This is accomplished during eight essential phases, although the number of phases included in an EMDR session and the specific number of sessions devoted to each phase is likely to vary from client to client. The eight phases are as follow:
Phase 1: This phase involves taking a detailed history of the client’s problems, assessing their readiness and suitability for EMDR treatment as well as developing a treatment plan (e.g. identifying possible distressing memories and present situations that are problematic).
Phase 2: A crucial aspect of EMDR treatment involves ensuring the client is prepared to cope with the possibility of emotional distress that may arise during and after treatment sessions. Clients are taught a variety of stress reduction techniques and different ways to handle emotional distress so that they do not become overwhelmed during or between sessions.
Phases 3 to 6: Phases 3 to 6 involve selecting a memory for processing using EMDR procedures. The client identifies a vivid visual image related to the distressing memory, a negative belief about self (e.g. I’m worthless; I’m not safe), as well as related emotions and body sensations. The client is also assisted to formulate a new positive belief (e.g. I am a worthwhile person; I am safe) to replace the negative belief. Processing involves the client focusing on the memory, negative thought and their body sensations during sets or rapid eye movements (or other forms of bilateral stimulation such as tones). Processing continues until the client’s distress associated with the target memory has diminished, at which point the positive belief is processed and strengthened.
Phase 7: Phase 7 is about closure. At the end of each session the client is assisted to return to a state of emotional equilibrium following the reprocessing that took place, and advised that processing may continue between sessions and that this is a positive sign. Clients are also advised to keep a log or diary to keep a record of any material or new insights that arises and to practice the stress-reduction techniques that they have learned in phase two for treatment.
Phase 8: Phase eight takes place at the beginning of each new session and consists of a re-evaluation of previously processed memories and the client’s progress so far. New material may be targeted for processing at this stage, but only after the previously identified disturbances have been fully resolved.
Successful EMDR treatment is determined by the extent to which clients have not only resolved painful emotional material but also transformed its meaning. It is not uncommon for clients to report feeling empowered by past traumas and to have developed new and more adaptive ways of thinking, feeling and behaving.
This depends on a variety of factors such as the number of traumatic experiences the client has had and the length to time the person has suffered from PTSD or traumatic stress. On average, an adult who has experienced a single trauma is likely to be successfully treated with 5 hours of therapy, whereas an individual who has been through multiple traumas may require more hours of treatment.
EMDR is a complex therapy and practitioners must have a background in mental health prior to undertaking EMDR training. Dr Joe Armstrong is an Accredited Cognitive Behavioural Therapist and a Registered Mental Health Nurse who has successfully completed accredited training in EMDR, which allows him to use this therapy in practice.
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