Eye Movement Desensitization and Reprocessing (EDMR)

How does EMDR work?

Much like how our physical body reacts to bumps and bruises, our mind and emotional well-being is constantly attempting to heal itself. Eye Movement Desensitization Reprocessing (EMDR) therapy is a means by which you can accelerate your natural emotional healing that would otherwise take much longer. Through its desensitization and reprocessing phases, your emotional wounds are transformed to a state of emotional resolution.

The “Processing” part of EMDR does not mean talking about a traumatic experience. “Processing” means setting up a learning state that will allow experiences that are causing problems to be “digested” and stored appropriately in your brain. That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future.

The eye movement aspect of the process speeds up the process of therapy and it’s these left to right eye movements that makes EMDR so unique. Some therapists use alternatives to finger movements, such as hand or toe tapping, light beams or musical tones, but they’re thought to replicate the REM part of sleep where the brain processes memories.

Neurological research show that the rhythmic horizontal eye movements used in EMDR reduce the activity in the brain’s fear circuits. It’s the eye movements that allow our brain and our nervous system to do the healing work they are capable of.

‘In the Rapid Eye Movement portion, the client focuses on a troubling memory and identifies the belief he has about himself connected to this negative memory (for example, in dealing with a rape, the person may believe “I am dirty”). The individual then formulates a positive belief that he would like to have about himself (“I am a worthwhile and good person in control of my life.”). All the physical sensations and emotions that accompany the memory are identified. The individual then goes over the memory while focusing on an external stimulus that creates bilateral (side to side) eye movement. This is most often achieved by watching the therapist moving a finger. After each set of bilateral movements, the individual is asked how he feels. This process continues until the memory is no longer disturbing.

The individual is processing the trauma with both hemispheres of the brain stimulated. The chosen positive belief is then installed, via bilateral movement, to replace the negative one. Each session normally lasts for about one hour. It is believed that EMDR works because the “bilateral stimulation” by-passes the area of the brain that has become stuck due to the trauma and is preventing the left side of the brain from self-soothing the right side of the brain.

During this procedure, clients tend to “process” the memory in a way that leads to a peaceful resolution. This often results in increased insight regarding both previously disturbing events and long-held negative thoughts about the self that have grown out of the original traumatic event. For example, an assault victim may come to realize that he was not to blame for what happened, he is now safe, that the event is really over, and, as a result, he can regain a general sense of safety in his world.

While EMDR should never be thought of as “a quick fix”, many clients are amazed at how rapidly they are able to fully process a painful or upsetting memory. The memory of what happens still exists, but there is no longer a ‘charge’ of emotions, or physical effect from thinking about it.

The Science of EMDR

Brain scans have clearly demonstrated changes after EMDR therapy, returning the brain to more ‘normal’ functioning. The bottom line of EMDR outcome research is that clinical change can be both profound and efficient.

Research has also found that during EMDR sessions the brain is more active. The specific areas of the brain that are in this active state include the prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex.

This is important because:

The prefrontal cortex is responsible for planning, organizing, focusing, personality, and impulse control.
The orbitofrontal cortex controls your emotions and how you interact with other people.
The anterior cingulate cortex also works to regulate impulse control, as well as empathy and judgment

Therefore, your brain isn’t just sitting idly by during an EMDR session. Instead, it is actively working to process and resolve the trauma and its connected emotions.

How effective is EMDR?

Research has shown that EMDR can be very effective, very quickly in treating PTSD and C-PTSD and the symptoms they bring.

Several studies have looked at the effectiveness of EMDR for both PTSD and C-PTSD:

One study showed up to 90% of single-trauma victims no longer have PTSD after only 3 90-minute sessions.
Another study, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions.
In another study, 77% of combat veterans were free of PTSD in 12 sessions.

As with all treatments and therapies, there has been a huge amount of research placed upon looking into the efficacy of EMDR just like the studies mentioned above – and although there still seems to be some debate (some health practitioners’ debate EMDR’s effectiveness), it has been, and is continually, clinically validated by a number of randomized, controlled studies from all over the world.

EMDR is endorsed by organizations such as:

The National Institute for Health and Care Excellence (NICE)
The World Health Organization (WHO)
United Kingdom Department of Health
American Psychiatric Association
International Society for Traumatic Stress Studies
US Department of Veterans Affairs & Department of Defense,
amongst many others.

What Happens in an EMDR Therapy Session?

Information Gathering:

Before any EMDR therapy begins, your therapist will do an in-depth assessment to help guide your work together and to develop your treatment plan. They’ll spend one or two sessions discussing your history, and they’ll talk about your life and relationships. You’ll then look to discuss ‘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 behaviors that will be needed by the client in future situations.

You’ll also talk about how EMDR works, and may discuss at this stage if you’d prefer to use a light bar, the therapists’ fingers or even tapping or music to induce the left to right eye movements during the later sessions.

Setting a Safe Place

The next sessions are designed to help you feel calm and balanced, ensure that you’re capable of handling emotional stress, understand your capacity to ‘disassociate’ – and help you find your ‘safe place’ and good coping mechanisms. If further ‘stabilization’ is required, or if additional skills are needed, you’ll work together until you can find these. During these sessions, your therapist will get you used to the left/right eye movements initially combined with calming imagery and thoughts.

Your ‘Safe place’ (also called Peaceful Place, Happy Place, or Calm Place) can be thought of as an ‘emotional sanctuary where a person can internally go to recover stability when feeling stressed’. The main purpose of the Safe Place is to teach and demonstrate that you can ‘move from distressed to calm (make a state change) within a short period of time. This is a key skill needed for emotion regulation and healthy self-soothing but also a requirement before processing of traumatic events. It can be an imaginary place, or a place where you feel safe and secure (ideally not linked to any past traumatic experiences or people who were part of these).

Jacqui said of her ‘safe place’: “For me and my overactive hypervigilant mind, nowhere was safe to me, so I developed an imaginary tropical beach with all my friends forming a human chain around me to keep me safe, my cat jumping around and my husband making me laugh. I could use this ‘space’ anytime I needed to during a session, or even at home in the midst of a panic attack. I would concentrate on the beach, on each person’s face, or what they would say to me, and get involved in that moment which would calm me down when I needed to.

If at any point during the forthcoming sessions, things got too much or I had a non-controlled flashback, I went back to that safe place in my mind. I know that some people use this ‘space’ during EMDR a fair bit, and it all depends on the individual, but luckily, I only ever needed to visit my safe place a few times.”

Having this ‘safe place’ and the stress reducing techniques established means that you can go there whenever you need to – during or between sessions.

Processing Memories

When ready for the next phases of EMDR therapy, you will be asked to focus on a specific event, thought, image or memory. You will identify the most vivid visual image related to the trauma (if available), a negative belief about yourself, related emotions and body sensations. While you do this, your therapist will reintroduce the same kind of gentle, rhythmic eye movements that you used before. They 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.

Gradually, the therapist will guide you to shift your thoughts to more pleasant ones. You’ll think of a ‘preferred positive belief (for example ‘I am strong and in control of this situation’).

Throughout the process, you are awake, alert and in control at all times. No trance state is induced, no suggestions are made, and the changes that occur are the result of the client’s own natural brain functions.

You’ll do this in sets of a few minutes at a time. Each with a break in between where your therapist will check in with you. You’ll be guided to notice what comes to mind after each set. Depending on what you noticed, you’ll be guided to the next focus of attention from that thought. This is repeated throughout the session. When you feel no distress in relation to that memory, you focus on the positive, preferred belief, whilst still doing 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.

During this time, you have full control to stop the therapist at any point if needed, but you’ll continue until the event becomes less disturbing. ‘The inappropriate emotions, beliefs, and body sensations will be discarded. Negative emotions, feelings and behaviors are generally caused by unresolved earlier experiences that are pushing you in the wrong directions. The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviours and interactions.

Closure and Re-evaluation

In your final sessions, you may be asked to keep a journal in between sessions. This is just so you can discuss anything that came up throughout the week with your therapist, and to remind yourself that the self-calming activities were working.

At this stage, you’ll likely discuss your memories that have been processed to ensure they don’t elicit any distress, and discuss future scenarios, and how you might handle them.

‘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.’ There may also be a strong sense of relief, a feeling of openness or simply just a relaxed contentment with the world – a feeling that many people with PTSD have missed greatly.

Things to know before starting EMDR therapy

Over 100,000 medical professionals throughout the world use EMDR therapy. Millions of people have been treated successfully over the past 25 years. It’s an incredibly effective treatment for PTSD and C-PTSD.

Despite that, it’s important for individuals with PTSD or past trauma experiences to go into EMDR therapy with an full understanding of what the treatment requires and entails.

‘Revisiting’ your trauma

You might be concerned that EMDR therapy will make you “confront” your worst moments in life. But your therapist will guide the pace of your work together so it is as comfortable for you as possible. One therapist said ‘The process of EMDR psychotherapy is often very comfortable for many patients. Clients regularly comment to me that they are surprised at how this work is easier than they thought it would be.

Unlike some other therapies, ‘EMDR therapy clients are not asked to relive the trauma intensely and for prolonged periods of time. In EMDR therapy, when there is a high level of intensity it only lasts for a few moments and then decreases rapidly. If it does not decrease rapidly on its own, the clinician has been trained in techniques to assist it to dissipate. The client has also been trained in techniques to immediately relieve the distress.

Patients will be instructed to revisit their trauma multiple times during treatment – but that doesn’t always mean talking about it, something which many people find very appealing when looking at therapy options.

Still, the process can be mentally and emotionally stressful on patients and can trigger negative responses in the early stages of treatment. The intense mental focus that occurs during therapy may linger for a while after a session has ended. This may cause the patient to feel faint or experience lucid dreams. While these side effects may be challenging at times, they are typically more favorable than those caused by medicinal treatment. Also, EMDR therapy typically results in a better outcome with longer-lasting relief.

Sleep and Dreams

Following an EMDR session, it’s not unusual for sleep to be impacted. Vivid dreams are common as well as feeling more sensitive to interactions with others and to external stimuli.

Temporary Increase in Emotional Distress

As with any form of psychotherapy, there may be a temporary increase in distress, but your therapist will provide you tools and techniques to help with these. For some people, distressing and unresolved memories may emerge in between sessions, some may experience reactions during a treatment session that neither they nor their therapist may have anticipated, including a high level of emotion or physical sensations (again, setting your ‘safe place’ can really help with these) and in between treatment sessions, the processing of incidents may continue, and therefore other dreams, memories and feelings, may emerge. Your therapist will ensure you are equipped to deal with all of these events if they occur.

In the end, EMDR therapy really does hold the promise of finding relief from PTSD and complex trauma symptoms. There’s nothing “magic” about it. But it’s been scientifically shown to work and have lasting results. Working with a skilled and experienced trauma treatment expert can be life changing.

Please remember, these are not medical recommendations. Be sure to work with a professional to find the best methods for you. EMDR should always be delivered by properly trained therapists.

The EDMR Institute