Evidence-based EMDR Therapy

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EMDR therapy is recognized world-wide as an evidence based, 8 phase process that helps clients and clinicians to more effectively get to the root of maladaptively held memories and beliefs that cause emotional triggers, depression, anxiety, even post traumatic stress disorders. 

Through a total of 8 phases, clients are guided to build resources that create more positive neural networks and adaptively process traumatic and disturbing memories that was previously maladaptively stored in the brain.  The result is rewiring the brain and thought patterns for optimal mental and emotional wellness.

EMDR stands for Eye Movement Desensitization and Reprocessing. 

EMDR was first developed by Francine Shapiro in 1974. During a walk in the park, Francine noticed that making certain eye movements seemed to decrease the negative emotions she was feeling at the time. Based on the assumption that eye movements might have a desensitizing effect, she then developed a treatment procedure that included other components alongside the eye movements.  

A few early tests and controlled studies quickly showed her that individuals treated with the first versions of the EMDR protocol showed significantly higher reductions in distress than those in the control condition. From there, EMDR has continued to grow and develop as a treatment modality until today. 

EMDR therapy is officially broken down into eight phases. They are the following:

1. History & Therapy Planning: Overview of history, identification of past traumas, triggering memories, current distress, etc.
2. Preparation: Preparation for treatment, Answering of any questions/concerns, Practice of eye movement, etc.
3. Assessment: First activation of targeted memories or triggers to understand the trigger better
4. Desensitization: Eye movements stimulation & processing/desensitization of material that comes up as a result of activation
5. Installation: Replacement of traumatic memories with more positive images, emotions, thoughts, etc.
6. Body Scanning: Body Scan to finish off the processing and assess any residual stress or tension
7. Closure: Space to calm back down and return to regulated state
8. Re-Evaluation: Beginning of next session that allows the therapist to assess the impact of the previous session and your overall psychological state 

This 8-stage process is repeated in each session with your therapist until you’ve significantly reduced or even eradicated any negative impacts or reactions to the original trauma. Each session usually lasts about 60-90 minutes.

In the past, EMDR therapy has most commonly been used for people with PTSD and trauma. However, the treatment can actually have benefits for a wide variety of conditions, disorders and mental health concerns, including:

• Anxiety, panic attacks, and phobias
• Chronic Illness and medical issues
• Depression and bipolar disorders
• Dissociative disorders
• Eating disorders
• Grief and loss
• Pain
• Performance anxiety
• Personality disorders
• Stress-related issues
• Sexual assault
• Sleep disturbance
• Substance abuse and addiction
• Violence and abuse

When people fully understand what EMDR is, it is easier to understand that it is a framework that permits all other forms of therapy to happen within its 8 phases, from talk therapy to somatic therapies, to CBT and DBT and ACT, mindfulness based stress and anxiety reduction, etc.  We can’t say that EMDR therapy or traditional therapy, for that matter, work for everyone.  However, in terms of efficacy, EMDR has the largest body of empirically validated research over the last 30 years. 

EMDR therapy has the most empirically validated research, including more than 30 positive controlled outcome studies and over a dozen studies using brain imaging (MRI) to document how EMDR changes the brain.  

You can find a great overview of available EMDR research here. 

Results depend on the individual, but it isn’t uncommon for clients to report feeling shifts in their primary complaint within the first 2-4 sessions.  Identifying the core issue with a therapist and beginning to reprocess the maladaptively held memory or negative belief about self can provide some relief. 

In studies including follow ups of 6 months and more, results were consistent. EMDR treatment has also been shown to support resilience against future occurring traumas and challenges. 

Preparation for EMDR is optional.  Some clients have been working with a talk therapist and may enter EMDR therapy with a list of specific memories, traumas or negative beliefs about self to be worked on.  If you are new to EMDR, your therapist will guide you through the process with a complete intake and history gathering process, educating you about the process as you begin.  

If you are an avid reader, Getting Past  Your Past by Francine Shapiro, the woman who developed EMDR therapy, is written as a self help guide that some clients find useful 1. to better understand the process and 2. to organize their thoughts about what to work on. This is all optional. 

EMDR therapy has 9 Phases, so it looks different at each step of the process.  

The initial phases may feel like regular talk therapy as your therapist gathers a complete history and gets to know you.  Generally, you may not recognize that you are in EMDR therapy or that EMDR therapy differs from talk therapy until you are in Phases 3 and 4 of the process.  These phases are where you and your therapist begin to look at how your brain may have maladaptively stored traumas or memories from the past. 

Phase 4 is where bilateral stimulation is introduced, which looks like back and forth movements of the eyes, tactile back and forth tapping on the shoulders of collar bones, or other audio methods of back and forth stimulation. This is called the reprocessing phase.  Once this phase is complete, there are somatic practices like a body scan and the process of establishing templates for the future, followed by closure and reevaluation. 

After an EMDR session, the therapist may ask the client to keep a journal of thoughts or relevant memories or dreams that may arise.  Resources learned in session may be practiced to support feelings of well being and to build adaptive memory networks as homework. Homework is not necessary for the overall success of EMDR therapy. 

Each individual is unique and should be guided by their EMDR therapist in the way and at the pace that is safe and comfortable for them. If guided safely through the 8 phases of EMDR, there are no “side effects”, however, one may continue to reprocess the target memory between sessions and is encouraged to keep a journal of these thoughts or memories for the next session. 

If a client is experiencing anything uncomfortable from the process of EMDR, they would want to discuss with their therapist and it could be determined that they may require additional resourcing or slowing down of the process. Establishing safety and building resources is always the goal prior to resourcing. 

Each client has an individual treatment plan, based on their presenting issues.  Single incident traumas or memories may be quicker to treat than complex or multiple incident traumas.  Similarly, traumas or negative beliefs that were formed in childhood may be more complex to treat than traumas or negative beliefs that occurred in adulthood.  

Based on these research findings and the client’s presenting issues, the therapist and client will develop an estimated length of treatment.  It is important to provide feedback to the therapist and to be sure there is a collaboration around the treatment goals and course of therapy

CBT is a treatment modality and EMDR is a complete 8 phase treatment.  In a nutshell, Cognitive Behavioral Therapy or CBT is a type of talk therapy that supports clients with verbalizing their thoughts and gaining active understanding of their thought process with tools provided to interrupt disruptive thought patterns.  

EMDR therapy involved a somatic component and is considered a bottom - up therapy because it involved the brain, mind and body, whereas CBT involves the mind.  EMDR uses eye movements or tactile back and forth movements to reprocess maladaptively held memories of traumas or negative beliefs about self.  The tools of CBT can fit into the 8 phases of EMDR.

Yes, EMDR is safe and effective online.  Your therapist will guide you to discover the best method for reprocessing (visual, tactile or audio).  Your therapist will also support you with setting up your computer in a manner that is the most conducive to successful EMDR. 

Getting Past Your Past by Francine Shapiro is a book that was written as a self help book, for those who may not have access to traditional EMDR therapy or who are motivated to learn more outside of sessions with their therapist.  I encourage anyone who is interested in this process to read this book. Reprocessing should ideally be supervised by a therapist when there is trauma or potential dissociation present.