What is Eye Movement Desensitisation Reprocessing (EMDR)
What is EMDR: Eye Movement Desensitation Reprocessing
The mind and body are fundamentally connected, and just like the body, we are increasingly discovering the mind can heal itself naturally, which is called neuroplasticity. Much of this natural coping mechanism occurs during sleep, particularly during rapid eye movement (REM) sleep. EMDR uses bilateral stimulation to simulate REM throughout therapy to target, diffuse, and reprocess past negative disturbing experiences that contribute to distressing mental health conditions, into a more updated positive experience in the present moment. EMDR utilises a natural process of the brain to heal the mind.
The Development of EMDR
The Development of EMDR is an interesting story of how the brain and body heal themselves. The American Psychologist and educator, Francine Shapiro developed Eye Movement Desensitisation and Reprocessing (EMDR) in 1987. As reported by Shapiro (1989) during a walk in the park, and using careful self-examination she noticed how recurring, disturbing thoughts arose and ceased involuntarily, concurrently when her eyes were involuntarily making rapid jerky movements as disturbing thoughts arose. Then when she intentional recalled the distressing thought it was less distressing, then the thoughts disappeared completely and then when she deliberately retrieved they were no longer upsetting. This began her research and development of EMDR therapy. Today EMDR is one of the most widely utilised and high researched evidence-based interventions in the western world, that successfully treats and reduces symptoms of trauma and other difficult mental health conditions.
What does EMDR heal
EMDR utilises this natural process in order to successfully treat conditions from mild distressing experiences to other more severe conditions such as Post-traumatic Stress Disorder (PTSD). EMDR can be used to treat disturbing experiences that are as normal as public speaking, through to exposure of war veterans and emergency services first attenders to prolonged and acute extreme trauma. In addition to its use for the treatment of Post-traumatic Stress Disorder, EMDR has been successfully used to treat:
· anxiety and panic attacks
· stress
· phobias
· sleep problems
· complicated grief
· pain relief, phantom limb pain
· self-esteem and performance anxiety
What is Trauma and How Does EMDR Work
The brain and body records and stores information and experiences without you being aware of it. However, when something out of the ordinary occurs and you are traumatised by an overwhelming event (e.g. a car accident) or by being repeatedly subjected to distress (e.g. childhood neglect or abuse), your natural coping mechanism, the ability to regulate and process emotions and experiences, can become overwhelmed. This overwhelm can result in disturbing experiences remaining frozen in your brain or being "unprocessed". Such unprocessed memories and feelings are stored in the left hemisphere, limbic system of your brain, in emotional ‘raw’ form, rather than in a verbal ‘story’ mode. This limbic system maintains traumatic memories in an isolated memory network that is associated with emotions and physical sensations, and which are disconnected from the brain’s frontal cortex, the rationale thinking part of the brain that utilises language and stores memories of experiences consciously in real time. Because memories stored in the limbic system are not given an ‘updated time stamp’, the memories in limbic system can be continually triggered when you experience events or sensations that are remotely similar to the difficult experiences you have been through. Often the memory itself is long forgotten, but the painful feelings such as anxiety, panic, anger or despair are continually triggered in the present. Your ability to live in the present and learn from new experiences can therefore become inhibited. EMDR helps create the connections between your brain’s memory networks, by using bilateral stimulation to retrieve memories from the limbic system, enabling your brain to re-process and update the traumatic memory in the present in a very natural way.
Is EMDR for everyone?
EMDR can accelerate therapy by resolving the impact of your past traumas and allowing you to live more fully in the present. It is not, however, appropriate for everyone. The process is rapid, and any disturbing experiences, if they occur at all, last for a comparatively short period of time. Nevertheless, you need to be aware of, and willing to experience, the strong feelings and disturbing thoughts, which sometimes occur during sessions.
Contraindications for EMDR (Eye Movement Desensitization and Reprocessing) therapy are specific situations where the therapist should not use EMDR with a client. Here are some common contraindications:
Acute trauma: EMDR is not recommended for individuals who have experienced a traumatic event within the past 30 days. This is because EMDR may exacerbate the trauma and interfere with the individual's ability to process the experience.
Unstable mental health: EMDR is not recommended for individuals who are experiencing severe mental health symptoms, such as suicidal ideation, psychosis, or severe depression. EMDR may not be effective in addressing these symptoms, and it may even exacerbate them.
Mental health disorders: Certain mental health disorders, such as dissociative disorders, personality disorders, or eating disorders, may require specialised treatment and may not be suitable for EMDR therapy.
Substance abuse: EMDR is not recommended for individuals who are actively using substances or have a history of substance abuse. The client may not be able to process the trauma effectively while under the influence of substances.
Cognitive impairment: Individuals with significant cognitive impairments, such as those with dementia or severe intellectual disabilities, may not be able to fully understand and participate in EMDR therapy.
Neurological conditions: Certain neurological conditions, such as seizure disorders, brain injuries, or neurological diseases like Parkinson's disease, may affect the client's ability to process information and participate in EMDR therapy.
Young children: EMDR is not recommended for children under the age of 6 or 7 years old, as their cognitive and emotional development is still evolving and they may not be able to fully understand and process the trauma.
Unstable relationships: EMDR is not recommended for individuals who are experiencing unstable or abusive relationships, as the client may not be able to maintain a safe and stable environment outside of therapy that is necessary for processing trauma.
Limited emotional regulation: Individuals who struggle with emotional regulation may find it challenging to manage their emotions during EMDR therapy, which can lead to negative outcomes.
Lack of adequate support: Individuals who lack a supportive network of family, friends, or other resources may not have access to the necessary support system to help them process and integrate their traumatic experiences.
It's essential to note that these contraindications are not absolute and may vary depending on the individual's specific circumstances. A trained therapist will assess each client's situation and make a decision about whether EMDR therapy is appropriate based on their unique needs and circumstances.
How long does EMDR treatment take?
EMDR can be brief focused treatment of a few minutes, or can be for 50 to 90 minutes. EMDR can be incorporated as part of a longer psychology treatment programme and used in combination with other therapies such as Somatic Mindfulness Therapy, CBT, and general counselling, depending on what is needed.
A session will be guided by a trained psychologist to identify thoughts, emotions and sensation that are disturbing, and also to identified more positive alternative thoughts about the disturbance. The therapist will guide you when and how to focus your eyes on a moving object (pointing with fingers or pointer), interspersed with focussing on the thoughts, emotions and sensations associated with the disturbance. Through the repetition of this process the level of intensity of the disturbance is defused, thoughts, beliefs, memories are reprocessed, and the positive alternative thought is consciously implanted into experience, replacing the thoughts, beliefs, emotions and sensations that were difficult.
During a treatment you will remain conscious, fully alert and capable. Throughout the session, the therapist will support and facilitate your own self-healing and intervene as little as possible, although they are there to support you at all times with the process. Reprocessing is usually experienced as something that happens spontaneously, and new connections and insights are felt to arise quite naturally from within. As a result, most people experience EMDR as being a natural and very empowering therapy.
What Does an EMDR Session Look Like?
An EMDR session can in real life vary depending on your presenting problems, circumstances, and goals, and is unique just like all our individual experiences are. An EMDR session may take 30-40 minutes or it may take 1-2 hours. The structure and theory of an EMDR session is follows these phases:
Phase 1: Information gathering and sharing: This includes a conversation about why you’ve come to therapy and some information about your personal history. You and your therapist will develop a treatment plan which targets your concerns and goals.
Phase 2: Preparation: The therapist explains how EMDR works and how to manage hard or upsetting emotions that may come up during sessions, they will support you to develop and access a practical and tangible sense of ease and safety that you can return to at any time during reprocessing.
Phase 3: Assessment: You and your therapist identify and target memories, beliefs and other distressing symptoms, that you want to reprocess during therapy. This may include talking about details of the events and the emotions around them, as well as ideas about how you would like to think and feel about them in the future. Although often a great deal of talking through past experiences may not be necessary as is done in a way that is not distressing or re-traumatising.
Phase 4: Desensitization: You focus on the target memory, thoughts and sensations in the body, while your therapist leads you through eye movements. You also share any new thoughts or feelings about the source of your trauma.
Phase 5: Installation: This is a key part of therapy. It’s when you start to attach positive feelings and thoughts to a memory that has previously been tied to traumatic or unpleasant memories, thoughts and emotions.
Phase 6: Body scan: As you think about a memory that is the target of your therapy, you pay close attention to any physical responses you have. The goal is that as therapy goes on, you will have fewer and fewer negative physical symptoms until you have none at all.
Phase 7: Closure: You and your therapist talk about how the target memories have been processed and how you feel about them now with a positive frame. Your therapist also gives you ways to manage any emotional challenges that may come up between sessions.
Phase 8: Re-evaluation: You may often end of begin a session with a new positive frame of mind and body response to therapy. You and you therapist talk about any new memories, feelings, or thoughts and meanings for you going into the future.
How Many Sessions of EMDR are Required?
If you're getting EMDR treatment to deal with one traumatic event or memory, you might have between three and six sessions. If the disturbing event is more complicated or happened over a long period of time, you might need eight to 12 sessions, or even more.
EMDR has been utilised hundreds of thousands of times, all over the world to turn traumatic experiences and distressing mental states around to help people recover and go on to live life with ease. We offer EMDR therapy at our Brain Care clinic located in Tweed Heads, on the Gold Coast.
Written by Jane Stevens, Registered Psychologist and EMDR Practitioner at Brain Care - Tweed Heads, Gold Coast, Northern NSW.
References
M. Rosen, G. Revisiting the Origins of EMDR. J Contemp Psychother 53, 289–296 (2023). https://doi.org/10.1007/s10879-023-09582-x
Shapiro, F. (1989). Efficacy of the Eye Movement Desensitization procedure in treatment of traumatic memories. Journal of Traumatic Stress, 2, 199–223.
WebMD. (2023, September 22). EMDR: Eye Movement Desensitization and Reprocessing. https://www.webmd.com/mental-health/emdr-what-is-it