The human psyche is incredibly resilient and adaptive most of the time. However, a traumatic situation or event can overwhelm it, rendering a person emotionally stuck – unable to recover from the impact. We often see this manifest in the form of posttraumatic stress disorder (PTSD). While not everyone develops PTSD in the aftermath of trauma, many suffer from some degree of emotional scarring that plays out in other ways in their lives.
While there are many different types of psychotherapy that can help people recover from traumatic memories and the emotional distress that accompanies them, one that stands out in terms of both effectiveness and brevity is EMDR. EMDR is an acronym for “eye movement desensitization and reprocessing”. The primary goal of EMDR is to help people reprocess these painful, unresolved memories in a way that frees them from their intense and unhealthy grip.
When treatment with EMDR is successful, the troubling symptoms subside. With PTSD, these symptoms include things such as nightmares, flashbacks, severe anxiety, and other highly distressing experiences and emotions related to the trauma that triggered the PTSD.
Two things that set EMDR apart from almost all other forms of therapy are 1) how quickly it works and 2) the use of “bilateral stimulation”, typically in the form of side to side hand movements.
History of EMDR
Compared to more traditional types of psychotherapy, EMDR is relatively new. It was developed back in the late 1980s by an American psychologist, Francine Shapiro. Dr. Shapiro discovered the powerful effect of bilateral eye movements by accident. While taking a walk one day, she noticed the positive effect of specific eye movements on unpleasant emotions related to trauma in her own past. She tried out her theory on others, who felt similar relief with these particular eye movements. She followed these preliminary tests with more research, and eventually developed the eight-phase treatment approach now known as EMDR.
It wasn’t long before psychologists and other mental health professionals began to see the power of EMDR, learn the techniques, and utilize it in their own practice. PTSD clients – including those who had not responded well to other types of therapy – often made amazing progress with EMDR in just a few sessions. Researchers have also been able to show the efficacy of EMDR in numerous controlled clinical trials.
Since the development of EMDR back in the 80s, thousands of therapists have gone through the training. Although initially developed to treat PTSD and problems specifically related to traumatic memories, many therapists have applied the tenets of EMDR to treat a variety of other psychiatric disorders, health conditions, and other problems that cause people to seek therapy.
What to Expect
Compared to many forms of psychotherapy which may involve anywhere from twenty hour-long weekly sessions to one or two years (or even longer, depending on the severity of symptoms and multiple other factors), EMDR is very cost-effective due to its very short-term nature. Many EMDR clients experience substantial relief after very few sessions.
In a typical EMDR session, the clinician will have you focus your thoughts on a distressful or traumatic event in your life, including any physical sensations (e.g. increased heart rate or knots in the stomach) and negative emotions that accompany it. While you’re reflecting on this event, the therapist will have you track her fingers with your eyes as she moves her hand back and forth in front of you. (Some therapists use other forms of bilateral stimulation in place of moving their hands, such as musical tones or hand taps.)
At some point, the therapist will instruct you to begin thinking about something pleasant – while you’re still tracking the movement of her fingers back and forth. At the beginning and end of the session, as well as during the session at times, you’ll be asked to rate the level of distress or anxiety you’re experiencing.
The term “processing” (or “reprocessing”) in the context of PTSD and EMDR doesn’t refer to talking about the traumatic event or its impact. Rather, it refers to what is taking place in your brain during the procedure described above. Your brain is “reprocessing” the traumatic memories as you focus on various aspects of the trauma, track the therapist’s fingers as they move back and forth, and then shift to a more positive thought or belief.
Perhaps an overly simplistic analogy is to picture a closet stuffed with clothes, shoes, and other miscellaneous items. Everything was just thrown in haphazardly, making the closet a constant headache because nothing was in its proper place. Once everything is taken out and put back in – hung up or neatly folded – in an organized manner, the closet is no longer a problem. Everything is now properly stored. This is, essentially, what EMDR allows you to do with the traumatic memories that had previously been improperly stored and, as a result, were causing so many problems in your life. Now that they’ve been “reprocessed”, they’re properly stored and no longer cause distress.
Another way to think about the reprocessing aspect of EMDR is to consider a young man who’d been physically and emotionally abused as a child. Prior to treatment, he may have struggled with a deep sense of shame and profound feelings of worthlessness. Reprocessing these traumatic memories and emotions can enable him to see himself as strong, courageous, and a worthwhile person. His former self-perception is paralyzing, demotivating, and depressing. The latter self-perception is empowering, optimistic, and uplifting. That shift in self-perception is powerful, and can make a drastic impact on the trajectory of a person’s life.
The 8 Phases of EMDR
To better understand the practice of EMDR, it’s important to take a brief look at the eight phases of treatment:
Phase 1: This initial treatment phase involves obtaining a history of the client. This allows the clinician to determine if the client is ready treatment and, if so, to create a treatment plan tailored to the client. It is during this phase that the client and therapist discuss the traumatic memory to target with treatment. While some individuals will have only a single trauma on which to focus, others will have two or more. Those with multiple incidents may require more sessions overall than those with only one.
Phase 2: In the second phase, the therapist makes sure that the client is stable enough to handle thinking and talking about the trauma (as doing so may elicit intensely painful emotions and strong reactions). The therapist may teach the client some coping and relaxation techniques to use, such as deep breathing exercises or imagery. The client can use these self-soothing strategies both during and in between therapy sessions.
Phases 3 – 6: During these 4 phases, the client is instructed to identify a vivid image related to the trauma, a negative belief about himself, and any feelings and physical sensations related to the traumatic memory. He is also instructed to identify a positive belief (e.g. “I am strong”) or perspective about himself and the traumatic event. This will be used to replace the negative ones identified initially. Initially, he’ll focus on the first three (negative) things while tracking the therapist’s fingers moving in front of him.
This part typically involves multiple mini-rounds, each lasting up to 30 seconds. These mini-rounds are repeated until he is able to recall the negative images, feelings, and sensations without experiencing any distress. At that point, he will be instructed to focus on the positive belief. The positive belief can be used in future rounds (and altered as necessary) to replace distressing thoughts as they occur.
Throughout these 4 phases, the client is also instructed to pay attention to any spontaneous reactions to the process that he experiences. Those reactions (e.g. body sensations or emotions) will help determine what to focus on next.
Phase 7: The goal of the seventh phase is to provide closure for the client (for that session), so the client leaves the session feeling better than he did at the start of the session. The client may utilize the self-soothing techniques he learned in the second phase. He is also encouraged to keep a journal or log of his experience.
Phase 8: Phase eight takes place in the next treatment session. During this phase, the progress the client has made – and any changes he has experienced – are discussed and evaluated. How the client fared in between sessions is also discussed in this phase. At this time, the therapist will determine whether to continue working on prior treatment targets, or begin working on a new target.
Benefits and Advantages of EMDR
Although EMDR is still considered questionable and controversial by some mental health professionals, other therapists – as well as clients and researchers – have reported many benefits and advantages of this particular type of therapy. They include the following:
- Healing from trauma and emotional pain doesn’t have to take years; it can happen very quickly for many individuals when treated with EMDR. According to the EMDR Institute website, research has shown that between 84% and 100% of PTSD victims who had experienced a single trauma recovered fully after 3 to 6 sessions. Over three-fourths of those who had experienced multiple traumas recovered fully in just six 50-minute sessions. Combat veterans have also found fast results, with more than 3 out of 4 recovering fully after just 12 therapy sessions.
- The brevity of EMDR makes it a much more affordable type of treatment for most people than more traditional types of therapy.
- This treatment can be used to heal non-trauma-related painful memories that negatively impact individuals in a variety of ways. For example, individuals who developed low self-esteem or other negative self-perceptions, due to growing up in dysfunctional homes, may also benefit from the strategies used in EMDR.
- It helps individuals recover from trauma without avoiding all the things they associate with the traumatic event. Avoidance is a common coping mechanism in individuals with PTSD.
- It helps restore a positive future outlook and enhance the ability to feel pleasure and make emotional connections in individuals with PTSD.
- It helps reduce the depression and anxiety that trauma victims typically experience.
- The techniques used in EMDR are not limited to the treatment of PTSD and other issues related to trauma. They can and have been used in the treatment of a wide array of other psychiatric disorders, physical health issues, and other common emotional problems and life challenges (e.g. low self-esteem and performance anxiety).
- Individuals who undergo treatment with EMDR often gain valuable insight about their negative beliefs and the trauma they experienced. For example, a rape victim may finally understand that it wasn’t her fault, and that it truly was an isolated incident that is now in the past. Those insights will help her to regain her sense of self-worth and let go of the constant sense of fear and dread triggered by the violent event.
Potential Disadvantages of EMDR
One of the potential downsides of any type of therapy is that it requires opening up old wounds and confronting painful thoughts and feelings. Naturally, this can temporarily make things worse before they start getting better. It’s akin to cleaning an infected cut on your hand in order to enable it to heal properly. Unfortunately, removing the bandage and cleaning the wound can be quite painful. As a result, many people who start EMDR may initially feel more distressed than ever as they start talking about and confronting the pain and horror of past trauma.
Another potential disadvantage of EMDR (which is also true of other type of psychotherapy) is that it’s impossible to anticipate the powerful emotions, sensations, or other negative reactions that the process may elicit.
Other potential disadvantages of EMDR include:
- After an EMDR session, some clients continue to process things related to the trauma, which can be distressing (and which is why having some coping strategies in place, such as relaxation techniques, that can be used to calm the anxiety).
- It doesn’t work for everyone. Research suggests that at nearly one-fourth to one-third of those who are treated with it don’t experience any benefits.
- Even though EMDR has been known to bring substantial results in a relatively short amount of time, it’s not necessarily the best type of treatment for some disorders.
- It’s still regarded by some mental health professionals as a controversial form of treatment, and even outright quackery by a small percentage.
Disorders, Issues, and Conditions that can benefit from EMDR
Eye movement desensitization and reprocessing can be effectively used without limitations based on a client’s age, cultural background, or gender.
EMDR practitioners have used its primary tenets to treat a fairly wide range of other disorders and issues that impact many people. Studies have shown the use of EMDR to have some or many positive effects when used in the treatment of various disorders, challenges, and issues, including the following:
- Acute stress disorder
- Treatment resistant PTSD in combat veterans
- Generalized anxiety disorder
- Eating disorders
- Obsessive compulsive disorder
- Borderline personality disorder
- Body dysmorphic disorder / negative body image
- Specific phobias
- Panic disorder
- Substance abuse and addiction
- Unresolved or excessive grief and loss
- Childhood and adolescent depression due to distressing events
- Trauma caused by sexual assault or abuse
- Trauma caused by disasters (both manmade and natural)
- Compulsive gambling
- Sex addiction
- Dissociative identity disorder and other dissociative disorders
- Performance issues and / or anxiety in sports, business, academics, and the performing arts
- Somatoform disorders and somatic symptoms
- Phantom limb pain
- Chronic pain
- Somatic digestive complaints
- Migraine headaches
- Work-related stress in fire fighters and law enforcement officers
- Emotional and / or physical trauma related to accidents or surgical procedures
- Emotional and physical trauma in burn victims
- Personality disturbances due to trauma
- Chronic fatigue syndrome
- Psychogenic nonepileptic seizures
Other conditions and issues in which EMDR may have potential benefits include:
- Attachment disorder
- Marital conflict
- Social anxiety disorder
- Anger issues
- Teeth grinding (bruxism)
- Sleep disturbances
- Skin disorders
- Sexual dysfunction
It should be noted that, while EMDR has shown or may show positive effects in the treatment of various disorders, problems, and conditions listed above, the greatest benefits sometimes occur when it’s used as an adjunct treatment. It is also sometimes used with hypnotherapy very effectively.
Where to Find a Qualified EMDR Therapist
If you’re considering EMDR as a potential form of treatment, it’s imperative that you find a therapist who has been properly trained and certified in EMDR. Two websites that provide lists of EMDR therapists by location are:
The EMDR International Association website – emdria.org
The EMDR Institute website – emdr.com
You can also do a general search online for “EMDR Therapist [your city]” or “EMDR therapy [your city]” (and similar searches) to find a therapist in your area.
EMDR can be a relatively fast and effective treatment for PTSD and other disorders or issues that sometimes last for years or even decades. As with all forms of treatment, it’s not always beneficial, nor is it the most appropriate form of treatment for everyone. A consultation with a qualified EMDR therapist is the best place to start if you’re interested in pursuing this particular form of therapy.