EMDR Therapy Explained
EMDR is a well-established and evidence-based treatment approach that is effective in helping individuals who have experienced trauma, process and integrate their memories in an adaptive way.
What is EMDR?
EMDR is a fairly new, non-traditional type of psychotherapy with a strong evidence base. First developed in the 1980s by psychologist Francine Shapiro PhD, EMDR is growing in popularity, particularly for treating trauma and post traumatic stress disorder (PTSD), including childhood trauma.
In EMDR, the therapist uses eye movements or rhythmic tapping with the client. These swift eye movements or tapping movements are said to loosen knots in the person’s memory and allow negative thoughts and distressing memories to be favourably reprocessed with minimal guidance from the therapist. Some have thought the process is similar to REM sleep, where eye movements accompany the digestion of daytime memories.
How does EMDR help treat trauma?
EMDR is based on the hypothesis that negative thoughts, feelings, and behaviours result from unprocessed memories and experiences stored in the brain. These memories can often be triggered, leading to emotional distress and physiological symptoms. These unprocessed memories can be the underlying cause of the symptoms of PTSD, depression, anxiety and a range of other psychological conditions.
It is a treatment approach that has been found to be effective in helping individuals who have experienced trauma, complex trauma, PTSD and a broad range of psychological issues that can arise from trauma, such as depression and anxiety. EMDR is one of the therapies recommended for treating PTSD outlined in The Australian PTSD Treatment Guidelines 1, and has been found across a broad range of studies to be as equally effective as Trauma Focused CBT 2.
1 The Australian PTSD Treatment Guidelines (Phoenix Australia, 2020)
2 (Bisson et al., 2007; Cuijpers et al., 2020; Cusack et al., 2016; Lewis et al., 2020; Roberts et al., 2019)
The goal of EMDR therapy
The goal of EMDR is to help you adaptively process and integrate these memories, leading to decreased emotional distress and improved functioning. This is achieved through the use of eye movements or other tasks that tax your working memory.
The theory behind EMDR is that the brain has a natural healing process that can be activated through these techniques.
The technique involves focusing on specific aspects of the distressing memory and simultaneously engaging in eye movements or a task that taxes working memory. Due to the limited space in working memory, engaging in multiple tasks while thinking about the distressing memory can result in the memory becoming degraded. This results in the distressing memory becoming less vivid and less clear and less impactful.
How does EMDR therapy work?
EMDR is typically administered in a series of sessions, with the number of sessions needed depending on the individual’s specific needs and goals.
Overall, EMDR is a well-established and evidence-based treatment approach that is effective in helping individuals who have experienced trauma, process and integrate their memories in an adaptive way. It is important to work with a trained and experienced EMDR therapist to ensure the best possible outcome.
Outline of the Eight Phases of EMDR (Shapiro, 2018)
EMDR usually follows 8 phases outlined below. The number of sessions required to complete the 8 phases is dependent on the client and the trauma being processed (Shapiro, 2018). An experienced EMDR therapist will guide you through this process, in a seamless way.
| Phase | Phase Title | Phase Descriptor |
|---|---|---|
|
Phase 1 |
Client History, Collaborative Formulation & Treatment Planning |
A detailed assessment is undertaken, including a detailed chronological history focusing on any childhood/adult traumatic events experienced. Then a collaborative formulation is undertaken with the client, and an agreed-upon treatment plan is developed. |
|
Phase 2 |
Psychoeducation & Preparation |
The preparation phase is the therapeutic start of EMDR and includes psychoeducation about EMDR and the role of Eye Movements or other tasks that tax working memory. Focus is also placed on enhancing the client's capacity to manage emotions and manage the distress that may occur during trauma processing or distress the client may experience between sessions. |
|
Phase 3 |
Trauma Identification & Assessment |
Trauma memories are then identified for trauma processing. While imagining the single worst moment of the trauma memory, the client is asked to provide several pre-treatment baseline measures: 1. a negative self-belief that best describes them in relation to the traumatic event; 2. a positive self-belief that could apply in that traumatic moment; 3. a rating of how strongly they believe this positive statement on the 1-7 Validity of Cognition Scale (VoC, Shapiro 1989a), where 1 represents completely false and 7 represents completely true; 4. a rating of the distress generated by imagining the traumatic memory and identification of associated body sensations, including a rating of the level of distress currently experienced on a 0 – 10 Subjective Units of Distress Scale (SUDS, Wolpe, 1991), where 0 represents calm and 10 represents the worst distress possible. |
|
Phase 4 |
Desensitisation |
In this phase, the client is asked to focus on the worst part of the trauma, the associated negative cognition and body sensation, whilst simultaneously completing Eye Movements or any tasks that taxes working memory. At the end of each set of Eye Movements or tasks (approximately 30 seconds), the client is asked to report what they have spontaneously noticed. The client can freely explore their thoughts, feelings and body sensations during processing, which has been reported to enhance trauma memory processing (Rogers & Silver, 2002). When recounting the original trauma memory, these steps are repeated until the client achieves a reported distress (SUD rating out of 10) of 0. |
|
Phase 5 |
Positive Cognition Installation |
Then the positive cognition that the individual would like to believe about themselves when thinking about that traumatic event is installed with Eye Movements or other tasks that tax working memory. This is repeated until the client rates the positive cognition on the VoC as believable (7 out of 7). |
|
Phase 6 |
Body Scan |
This phase involves the client imagining the most distressing part of the traumatic memory and thinking about the positive cognition while they explore if they have a body reaction. Any body reaction is further processed with additional sets of Eye Movements or tasks that tax working memory until resolved. |
|
Phase 7 |
Closure |
The client is brought back to an emotionally calm state before they leave the counselling room. |
|
Phase 8 |
Re-evaluation |
In the following session, the last processed traumatic memory is discussed to assess the permanency of processing. The process is then repeated for any additional traumatic memories. |
Acute Stress Disorder
During Phases 3 and 4 of EMDR sessions, the therapist will work with you to identify specific memories or experiences that could be underlying the current symptoms you are experiencing. The therapist will then guide you through a set of eye movements or other tasks that tax working memory while you focus on the distressing memory. The therapist may also ask you to identify any negative thoughts or beliefs about yourself concerning the memory and any positive thoughts or beliefs they would like to replace them with.
As you focus on the memory and the associated thoughts and beliefs, the therapist will continue to guide you through the eye movements or other bilateral stimulation techniques. The idea is that the brain will naturally process and integrate the memory, reducing the negative feelings and behaviours associated with them.
Adjustment Disorder
Adjustment disorder usually occurs in response to stressful life event(s) such as: divorce or relationship breakup; termination of employment, changing jobs, transitioning to high school; having experienced a permanent injury; or life changing disability. As a result you may experience a range of symptoms which could present in emotionally, physiological or behavioural. The symptoms caused by the stressor are generally more severe or more intense than what would be reasonably expected for the type of event that you were experiencing.
Symptoms can include: feeling tense; sad or hopeless; withdrawing from other people; acting defiantly; or an inability to control impulsive behaviours; or physical symptoms like: tremors; palpitations; or headaches. The symptoms cause significant distress or problems functioning in key areas of your life, for example, at work, school or in social interactions.
Disinhibited Social Engagement Disorder
Disinhibited social engagement disorder occurs in children who have experienced severe social neglect or deprivation before the age of two. Similar to reactive attachment disorder, it can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.
Disinhibited social engagement disorder involves a child engaging in overly familiar or culturally inappropriate behaviour with strangers or adults they barely know. For example, the child may often approach and talk to strangers and may be willing to go off with a stranger with no hesitation. Developmental delays including cognitive and language delays often co-occur with this disorder. Caregiving quality has been shown to dramatically improve the course of this illness. Yet even with improvements in the caregiving environment some children may have symptoms that persist through to adolescence.
Reactive Attachment Disorder
Reactive attachment disorder occurs in children who have experienced severe social neglect or deprivation during their first years of life. It can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments. Children with reactive attachment disorder are emotionally withdrawn from their adult caregivers. They rarely turn to caregivers for comfort, support or protection or do not respond to comforting when they are distressed. During routine interactions with caregivers, they show little positive emotion and may show unexplained fear or sadness. The problems appear before age 5. Developmental delays, especially cognitive and language delays, often occur along with the disorder.
Practitioners experienced in EMDR therapy
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