EMDR is an abbreviation for Eye Movement Desensitisation and Reprocessing, an approach founded by Dr Francine Shapiro in 1987. At first glance, this form of psychotherapeutic intervention can seem to approach psychological issues in a rather unusual way. It does not rely on much need for talking, it uses no medication, and instead uses the natural function of Rapid Eye Movement (REM) at its foundation.
Our understanding is that during REM sleep, the mind is able to process daily emotional experiences. Where there has been extreme trauma - which was the original focus for EMDR work - this process is thought to breakdown and the body does not experience the usual relief from distress.
The EMDR process is thought to produce an advanced stage of REM processing, without the individual needing to be asleep. As the brain processes troubling images and emotions via the dual processing of eye movements, some resolution can be achieved by dampening down the associated emotionally charged memories (PTSD UK, 2019).
EMDR usually begins in a similar way to other talking therapies and essentially holds eight phases of treatment. A trusting and safe therapeutic relationship is always at the heart of it, and there will need to be some understanding of the background or context of what has brought the individual to the therapist initially.
A therapist might use several approaches for this. I personally like to draw a genogram - or family tree - early on in our sessions to find out some of the history and social context surrounding the individual who has come along to work with me.
EMDR also keeps in mind three prongs of treatment: the past, present, and future. Presenting problems are there because of difficulties that have been encountered in the past. Present experiences (triggers) which contain maladaptive information are targeted for processing. And finally, future templates are developed and encoded into memory to meet the person’s demands in the future.
In the second phase of treatment, there is a development of resources that can help with the adaptive shift of information over time. Examples of this might include developing a ‘calm’ or ‘safe’ space with your therapist that you can access whenever needed.
As part of this exercise, there will be an introduction to bilateral stimulation which are usually eye movements. However, EMDR can also be carried out using sound or touch. You might also consider a hypothetical ‘resource team’ of individuals with certain qualities that you can hold in mind. This phase is known as the preparation phase.
In the third phase of treatment, a target is identified for processing. This needs to have a clear visual memory associated with it, and there will be an assessment of the worst moment of this picture, and the negative belief this memory evokes.
An example might be the thought, “I am in danger” alongside the related emotions, and body sensations. This phase will also assess what the individual would like to believe about themselves now. An example might be, “it’s over, I am safe now”. How true this positive belief feels is also rated alongside the intensity of the negative emotions.
Phase four is the desensitisation phase. This is where your therapist will move their fingers or light beam (or through sound or touch) rapidly from side to side in front of your eyes and you will follow these movements by tracking them with your eyes. At the same time, your therapist will have instructed you to recall the disturbing image you are targeting and to pay attention to the emotions and accompanying body sensations associated with it.
It’s important to remember that you are in a safe place and that any memories or images that are recalled are in the past and cannot hurt you in the present. You will be instructed to simply notice whatever happens. Your therapist will check-in with you every now and then to see what has come up. This helps your therapist direct you for the next set of eye movements.
This process is usually repeated several times and it’s normal to experience changes in pictures, thoughts, emotions, and body sensations along the way. Sometimes there may be no changes at all, particularly when you first get used to following the eye movements. And that’s OK too. Your therapist will guide you and assist with all of this process.
Phase five is known as the installation phase. When you reach a point that you no longer feel any distress associated with the targeted memory, your therapist will ask you to think about the positive belief that you identified at the beginning of the session. The aim here is to focus on this along with the visual memory of the incident, whilst once again engaging in the eye movements with your therapist. After several sets, individuals usually report increased confidence in this belief.
Phase six is known as the body scan. Here the therapist will ask you to scan your body mentally for any residual body sensations. If there are any negative sensations, these will be targeted and processed as above. Positive sensations can also be further enhanced in a similar way.
Phase seven is about closure. As the session closes, if emotional distress has lessened and the positive belief has been enhanced, then there will be a discussion around the session and what you experienced. Your therapist will encourage you to take note of any processing that happens after your session - thoughts, dreams or new insights that come to you. That way, you can discuss them together in your next session.
If you’re still feeling a high level of emotional distress during your session, then your therapist will work on the bringing the session to a close at an appropriate moment. Your therapist will always focus on making sure you feel comfortable and in a safe emotional space before leaving your session. Again, you will be encouraged to note down any insights, dreams or observations so you can talk them through at your next session.
The next session will begin with phase eight, which will be a re-evaluation of the previous work and a discussion around anything that has come up in between your sessions. After this, there’s usually a revisiting of the previous phases of processing.
Using EMDR for mood and anxiety disorders, including depression (Hase, Balmaceda, Hase, Lehnung, Tumani, Huchzermeier, and Hofmann, 2015), phobias (Doering, Ohlmeier, de Jongh, Hofmann, and Bisping, 2013), and panic disorder (Faretta, 2013) has been growing steadily in recognition.
As with the phases above, in an EMDR session for anxiety, your therapist will ask you to hold the image or memory of the anxiety provoking situation in your mind and combine this with the eye movements (or touch or sound).
During this process you will be guided through each of the stages, with a view to allowing processing to bring about an adaptive resolution of the information you have been storing into the appropriate memory networks.
If experiences have previously been accompanied by high levels of disturbance, they may be stored in the implicit/non-declarative memory system. These memory networks contain the perspectives, emotions, and sensations of the disturbing event and are stored in a way that does not allow them to connect with adaptive information networks.
As the processing happens, there is a shift from implicit/non-declarative memory to explicit/declarative memory. There may be an initial increase in emotions as the processing starts, but clients usually begin to feel a decrease in emotional distress as they move through the session.
EMDR can be especially useful in helping people overcome blocks or barriers they might have experienced in previous treatment by accessing parts of the associated image that may have otherwise been hard to reach.
You can book a session with Sarah by clicking on her bio below.
*Doering, S., Ohlmeier, M., de Jongh, A., Hofmann, A., & Bisping, V. (2013). Efficacy of a trauma-focused treatment approach for dental phobia: A randomized clinical trial. European Journal of Oral Sciences, 121, 584-593.
Faretta, E. (2013). EMDR and cognitive behavioral therapy in the treatment of panic disorder: A comparison. Journal of EMDR Practice and Research, 7, 121-133.
Hase, M., Balmaceda, U.M., Hase, A., Lehnung, M., Tumani, V., Huchzermeier, C. & Hofmann, A. (2015). Eye Movement Desensitization &Reprocessing (EMDR) therapy in the treatment of depression: A matched pairs study in an inpatient setting. Brain and Behaviour doi: 10, 1002/brb3.342.
PTSD UK (2019). Eye Movement Desensitisation Reprocessing (EMDR). https://www.ptsduk.org/treatment-options/eye-movement-desensitisation-reprocessing-emdr/?gclid=Cj0KCQiAgHhBRDNARIsAGHLV531s-3G6O0IhkWmaHwA48zX7ho2agEEDaW1ts7HY8jsrytc8rsjAaAssEEALwwcB (accessed 14 January 2019).*