What is EMDR or Eye Movement Desensitisation and Reprocessing
EMDR therapy or Eye Movement Desensitisation and Reprocessing therapy is an extensively researched, effective psychotherapy method proven to help people recover from trauma and other distressing life experiences, including PTSD, complex trauma, anxiety, grief and loss and panic disorders. EMDR therapy is a form of psychotherapy developed by Francine Shapiro in 1988.
EMDR therapy is recognised and endorsed as an effective treatment by many national and international organisations, including the World Health Organisation, the American Psychiatric Association, and Phoenix (The Australian Centre for Posttraumatic Mental Health).
EMDR is based on the concept that psychopathology is a disorder of memory. As you resolve the memory, you resolve the psychopathology. It is less focused on talking and relies on the person being treated bringing an internal awareness to the distressing memory.
The therapist then directs the patient to a form of bilateral stimulation which might include side-to-side eye movements or hand tapping. This therapy [EMDR] is based on an understanding that negative thoughts, feelings and behaviours are the result of unprocessed memories and the intervention accesses the brain’s natural processes to support its ability to resume its inherent healing processes.
This process is activated through standardized procedures that include focusing simultaneously on:
- spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and;
- bilateral stimulation that is most commonly in the form of repeated eye movements.
For many clients, EMDR therapy can be completed in fewer sessions than other psychotherapies.
How Does EMDR Work?
There are a number of theories about how EMDR works but the one that makes most sense to me, goes like this:
When we experience something very overwhelming, the level of emotional distress causes the event to be stored in a part of the emotional brain activated by “threat” ( amygdala-hippocampal ). This is the part that reacts with fight, flight or freeze as an instinctual ( survival ) response to a dangerous world. When the trauma memory is triggered by some reminder of the overwhelming event, the emotional brain is activated, shutting down the rational, thinking part of the brain which is oriented to the present.
This explains why when we get triggered, we can’t think, we feel overwhelmed and the traumatic event continues to affect us — with nightmares, flashbacks, and feelings that the trauma is happening again — long after the actual event:
Because the thinking, rational brain has been forced offline, we are unable to tell the difference between “then” and “now” and act as if we are still in danger. “Stuck” memories are thought to be unprocessed and maladaptively stored.
During sleep, we naturally process and consolidate memories from the hippocampus to the neocortex. Normal, less traumatic memories, don’t get “stuck”, because at night when we dream (Rapid Eye Movement or REM sleep), these are moved out of the amygdala-hippocampal and processed by the adaptive information system of the brain resulting in fully processed memories. This is one of the reasons we feel so much better after a good night’s sleep.
Neuroscientists propose that EMDR mimics the process that occurs during REM sleep (when we are dreaming).
During EMDR, the therapist uses bilateral stimulation to move your eyes from side to side while getting you to focus on a part of the traumatic memory or emotion: Much like when your eyes move from side to side when you dream.
This suggests that during EMDR therapy the traumatic memories are continuously reactivated, replayed and encoded into the adaptive memory networks of the prefrontal cortex. In other words, it helps traumatic memories become “unstuck” and processed like normal, non traumatic memories. Once this occurs, the traumatic event loses the intense, emotional reactions that characterize post-traumatic stress or trauma and you are able to choose your actions rather than feeling powerless over your reactions.
What kinds of conditions can benefit from EMDR therapy?
While EMDR has become a world leading evidence based treatment for trauma, ongoing studies are demonstrating its effectiveness as a treatment for many mental health problems where physical symptoms may be resulting from unprocessed memories of traumatic events.
One area of growth is the treatment of anxiety and anxiety related issues such as panic attacks and phobias. While many anxiety treatments help you deal with the symptoms of anxiety, EMDR therapy can help you address the root cause of your anxiety or fear.
When utilized as an add-on treatment, there is also proof that EMDR therapy can help with comorbid symptoms and chronic pain, including depression, mood swings and addiction.
Some of the important areas that EMDR therapy has been demonstrated to be helpful include:
- Childhood trauma or complex trauma (multiple, often related traumatic experiences)
- Trauma or PTSD
- Chronic Pain
- Unresolved grief
- Social Anxiety
- Addiction including eating disorders where changing the narrative/inner dialogue you have about your self, actions and choices is a fundamental feature underlying the disorder.
- Phobias or fears
Who is EMDR most recommended for? Is EMDR suitable for everyone?
EMDR was created for use as a trauma therapy and as such focuses on intensely stressful subjects. Your ability to notice and attune to your thoughts and feelings is an important part of the therapy. Stabilisation and the development of resources including emotional regulation skills are an essential early phase of EMDR treatment.
Your commitment to developing the skills and resources you need to do the work, will be necessary to support the EMDR treatment protocol.
Other considerations include:
- If you are abusing alcohol or drugs to feel numb or create an altered state, are neurologically impaired, suicidal, experiencing psychosis or have a severe dissociative disorder, further assessment will be required and additional stabilization processes engaged prior to commencing EMDR treatment.
- It is possible that EMDR may impair testimony in legal cases due to changes in the way the memory is more adaptively processed following successful EMDR treatment.
How does EMDR therapy compare with Prolonged Exposure ( PE ) therapy and Cognitive Processing Therapy ( CPT )? And what is its place in therapy?
Besides EMDR, there are two additional trauma-focused treatments that experts commonly recommend for adults. These are exposure-related cognitive therapies which involve Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT).
All three therapies are considered evidence-based, which means multiple studies have found them to be effective in the treatment of Trauma and/or PTSD. ( Source: EMDR Institute )
While PE and CPT have many similarities with EMDR, there are also some key differences. Unlike cognitive therapies, EMDR was developed with body and brain equally in mind. For example, throughout the treatment session, your therapist will be checking in with your thoughts, feelings and body sensations.
Although these elements are also part of cognitive therapies, they are not as integrated in the therapy. In CPT and PE, you mainly focus on your thoughts and beliefs about yourself but usually there is less focus on how your emotions present in the body.
With EMDR, you will be purposefully activating important parts of your brain related to the trauma and its healing. This is done through the use of bilateral stimulation which research has shown to make trauma processing faster.
Talking about your trauma multiple times is also a feature of the exposure therapies. For example, in PE, the protocol involves repeating the trauma story in session over several weeks. In CPT, you may be asked to write about and read your trauma story to your therapist. With EMDR, you can share detailed accounts of your thoughts and feelings but this is not an essential part of the process. In EMDR therapy, you hold your trauma memory in mind without needing to verbalise what actually happened.
Exposure therapies use one to two hours of daily homework to embed new, more adaptive patterns of response to your trauma. This is not a feature of EMDR. ( Source: EMDR Institute )
EMDR therapy may be used within a standard talking therapy as an adjunctive therapy, or as a treatment by itself.
How many sessions will I need?
The number of EMDR sessions required to address your symptoms will vary depending on the complexity of your psychopathology and the degree of protective factors available to you.
For example, EMDR treatment can work very rapidly for the client who has only experienced a single incident trauma. A psychologically healthy person who has had a supportive childhood, no history of drug or alcohol abuse, and generally happy intimate relationships with loved ones, is likely to respond to treatment very quickly.
However people who have been exposed to multiple, often interrelated forms of traumatic experiences, as in complex trauma, will generally require longer treatment. Adults presenting with trauma that began in childhood, who were perpetrated by persons within formative attachment relationships and whose trauma was compounded by co-morbidities of mental illness, addiction, domestic violence and a host of other stresses are likely to need s longer therapy. Good therapy helps your brain and your nervous system to learn, develop insights and problem solve. But a brain that is dealing with a multitude of stressors will often take longer to achieve these developed capacities.
How long are the EMDR sessions?
Each individual responds differently to EMDR therapy, but as a general rule, a typical session will last anywhere between 50-90 minutes. 90 minute sessions are beneficial because the process of fully “tapping into” a traumatic memory in accordance with the strict protocols of EMDR, takes time. Once this process is underway, it is best practice to process the targeted memory to resolution rather than leaving it partially processed between sessions.
Because it is a therapy that works with memory networks, the processing of specific memories in EMDR may bring up other repressed memories which may also need addressing.
These elements support sessions that are a little longer than the standard 45-50 minutes.
What kind of success rate does EMDR therapy have?
According to the EMDR Research Foundation, over 30 studies over the last 30 years have recorded the success of EMDR therapy for treatment of sexual abuse, PTSD, rape, childhood trauma, life-threatening accidents, anxiety, substance abuse, and depression. A 2014 research study looking at 24 randomized controlled trials, empirically validated the effectiveness of EMDR therapy as a trauma treatment. Seven of 10 studies reported EMDR therapy to be more rapid and/or more effective than trauma-focused cognitive behavioral therapy and more effective than CBT. ( Source: Medical News Today )
Some studies by EMDR Institute, Inc. revealed that after only three 90-minute sessions, 84% to 90 % of single-trauma victims no longer had PTSD.
A study conducted in 2010 revealed that EMDR improves the cognitive processing of emotions and the structure of concepts in long-term memory storage. ( Source: EMDR Healing )
What kind of training does an EMDR therapist have?
EMDR therapy is a mental health intervention. As such, it should only be offered by properly trained and licensed mental health clinicians.
The Eye Movement Desensitisation and Reprocessing Association of Australia (EMDRAA) sets the standard for EMDR Training in Australia to identify properly trained clinicians for membership to the Association.
Full Membership status as an EMDR therapist on the EMDRAA website indicates that a mental health practitioner has completed their basic training. Only once a person has gained Full Membership may they list on the EMDRAA’s “Find a Therapist” service. To be eligible for full membership you must have completed 50 hours of training (20 lecture hours in person or by internet), 20 hours of face to face practice and 10 hours of consultation with an EMDRAA Accredited Consultant.
Upon completing Basic Training, practitioners can work towards Accreditation as an EMDRAA Accredited Practitioner through consultation on their EMDR practice. Whilst there will be a requirement to attend for consultation, accreditation is awarded based on competence in all areas of EMDR practice. EMDRAA Consultants differ from Practitioners in that they are also accredited to provide consultation to individuals who are working towards becoming Accredited Practitioners.
Mind Wellness Therapy provides EMDR therapy and psychological expertise in the treatment of anxiety, PTSD, trauma, grief, stress management, depression and more.