EMDR therapy: definition, application, and effectivity
Eye movement and desensitization and reprocessing (EMDR) therapy is a comprehensive psychotherapy technique that aims to reduce upsetting memories and emotional distress associated with traumatic experiences.
Although it was initially developed for the treatment of post-traumatic stress disorder (PTSD), EMDR therapy is now also being used in treating many other psychological disorders, such as anxiety, depression, panic attacks, eating disorders, obsessive-compulsive disorder (OCD), and substance use disorders.
The body of evidence supporting the effectiveness of EMDR shows that it is generally a safe and helpful treatment for a wide array of mental health disorders.
What is EMDR therapy?
EMDR therapy is a psychological treatment designed to reduce the power of traumatic memories by helping people process the negative thoughts, feelings, and emotions that are related to their trauma.
It is a form of trauma-focused cognitive behavioral therapy (CBT) that involves visual bilateral stimulation or moving your eyes from side to side, which is associated with eliminating negative responses to trauma-related fear and pain.
As with other types of cognitive behavioral therapy, EMDR therapy also begins with establishing a supportive relationship between the therapist and the patient. And although eye movements are a key part of EMDR, the method also includes CBT and mindfulness components.
Who created EMDR therapy?
EMDR therapy was created in 1987 by Dr. Francine Shapiro, an American psychologist and educator. The EMDR proponent was walking in a park in Los Gatos, California, when she realized that moving her eyes from one side to another seemed to affect her own disturbing thoughts.
From this, she explored the potential desensitizing effect of eye movements and found that other individuals also had similar responses to eye movements. In the process, however, it became apparent that several factors were involved in achieving similar reductions in negative emotions associated with distressing memories in different persons. As a result, Shapiro kept on adding other treatment elements to her theory until she was able to develop a comprehensive therapy technique that she called Eye Movement Desensitization and Reprocessing (EMDR).
When did EMDR therapy become popular?
EMDR therapy became popular in 1989 when Dr. Francine Shapiro first published a study about the psychotherapy treatment that she developed. Since then, EMDR has been the subject of countless investigations and different presentations at professional conferences.
It was also between 1989 and 1991 when certain changes were made in the conceptual model and standard procedural steps of EMDR therapy due to several factors, including a demand for an explanation of the underlying principles that produced the results of Shapiro’s study.
How common is EMDR therapy?
EMDR therapy is very common, both in the United States and around the world. Multiple global organizations, such as the American Psychiatric Association, the U.S. Department of Veterans Affairs, the Department of Defense, the United Kingdom’s National Institute for Health Care and Excellence (NICE), and the World Health Organization (WHO), all vouch for the effectiveness of EMDR therapy.
It is also estimated that in the U.S. alone, over 60,000 practitioners have undergone formal training on using EMDR and EMDR techniques are also estimated to have been administered to more than two million clients.
Who requires EMDR therapy?
EMDR therapy can be used to treat various people with mental health concerns, such as post-traumatic stress disorder (PTSD), anxiety disorders, depression, schizophrenia, eating disorders, panic attacks, substance use disorders, and even psychological stress due to cancer.
Although EMDR therapy was originally developed to treat PTSD, it has also been proven effective for a host of other conditions, especially those intertwined with past trauma.
Where is EMDR therapy used?
EMDR has been endorsed by many health organizations as an effective treatment option for victims of trauma, and for the right reasons. Mental health conditions that could benefit from EMDR therapy are listed below.
1. Anxiety disorders
Anxiety disorders that can be addressed by using EMDR include generalized anxiety disorder, panic disorder, social anxiety disorder, and phobia. EMDR therapy helps anxiety disorders by using eye movements while the therapist asks the patient to notice any negative body sensations, images, beliefs, and emotions that may come up and help them process these intense emotions. Afterward, the patient’s attention is slowly shifted away from the negative thoughts toward more positive ones, reducing their anxiety levels. A theory exists that the eye movements used in EMDR serve to reduce anxiety reactions in the brain. Moreover, it has also been proven to reduce a handful of somatic symptoms that are related to anxiety disorders, including headaches, stomach cramping, heart palpitations, and sweaty hands. Addressing anxiety usually takes six to 12 sessions, with the phases of EMDR divided into eight.
2. Depressive disorders
Depressive disorders are characterized by feelings of sadness that are persistent or severe enough to interfere with daily functioning. They may come in different forms, such as major depressive disorder, persistent depressive disorder, or depressive disorder due to another medical condition. Rapid eye movement therapy helps patients work through depression by targeting their negative thoughts or beliefs that trigger depressive symptoms and identifying the traumatic memories and experiences that led to the development of those beliefs. Symptoms of depression are reduced by processing these underlying life events. Individuals who suffer from depressive disorders often notice a significant reduction in their symptoms after six to eight EMDR sessions.
3. Dissociative disorders
Dissociative disorders describe a persistent mental state that involves being detached from reality and experiencing a disconnection between thoughts, identity, and memories. The International Society for the Study for Trauma and Dissociation (ISSTD) recommends EMDR as an effective treatment for dissociative disorders when used as a part of a treatment plan. The organization, however, recommends that certain adjustments should be made to the standard EMDR protocols when catering to the needs of dissociative survivors, as it may prove difficult for some patients. But when EMDR is effectively used, it reduces patient symptoms, allows them to feel safer, and increases their distress tolerance. The frequency of EMDR sessions may vary greatly depending on the patient’s functional status and stability.
4. Eating disorders
Individuals suffering from trauma have an increased likelihood of developing eating disorders than those without trauma. Disordered eating can become an unhealthy coping mechanism to suppress unwanted emotions, thoughts, or feelings. And although EMDR therapy helps with eating disorders, it is important to note that not everyone who suffers from these conditions is a good candidate for the EMDR process. Certain conditions must be met first before using rapid eye movement therapy on a patient with an eating disorder, such as making sure that the person has a structure of support around them. EMDR is useful in addressing eating disorders because it finds out irrational beliefs the client may be harboring, which may be causing them to engage in unhealthy behaviors around food. Patients often find positive changes in their thoughts and body image after an average of 5.4 sessions.
5. Gender dysphoria
Gender dysphoria is a condition that causes uneasiness and discomfort in people whose gender identity does not align with the sex they were assigned at birth. Transgender and gender-diverse people are the ones who frequently experience gender dysphoria and may believe that they are unlovable because of who they are or that they are not good enough. EMDR therapy can help with these thoughts and beliefs by developing clients’ sense of self-worth and resilience. In this way, patients can shift their mindset and free themselves from the beliefs their traumatic memories have put on them.
6. Obsessive-compulsive disorders
Evidence exists that a huge percentage of individuals with obsessive-compulsive disorders have experienced a stressful life event that triggered the development of their condition. This is why EMDR therapy is also an effective therapy for OCD – because it can also be rooted in trauma. EMDR helps with OCD by processing the trauma that is at the heart of their obsessions. In studies that compared the use of EMDR with the use of SSRI medications, results showed people who received EMDR therapy alone had a larger decrease in their OCD symptoms 12 weeks into treatment than those who only used medications. EMDR is also proven effective for people with OCD
7. Personality disorders
Rapid eye movement therapy can also be an effective treatment for individuals with personality disorders, such as borderline personality disorder (BPD). Since they are also likely to have a history of traumatic memories that may have contributed to their condition, it only makes sense that EMDR therapy can be used to ease the intrusive thoughts and memories associated with it. In studies that observed the use of EMDR for BPD, patients often complete around 20 to 40 sessions, which may last for six months to one year.
What is the process of EMDR therapy?
The process of eye movement and desensitization reprocessing (EMDR) therapy mainly involves an eight-phase treatment method. The eight phases of EMDR therapy are history taking, client preparation, assessment desensitization, installation, body scan, closure, and reevaluation.
The first phase of EMDR is a history-taking and treatment-planning session. This involves your therapist gathering information about your symptoms, dysfunctional behaviors, and health history. This helps them determine your readiness or if EMDR is the right therapy for your mental health needs. Once you and your therapist have worked together in identifying possible targets for EMDR therapy, they will develop a treatment plan that is tailored to your needs.
The second phase is client preparation, in which your therapist orients you on what to expect during EMDR sessions. They will also teach you techniques on how to handle emotional distress to help you feel stable during the sessions.
Assessment is the third phase of EMDR treatment, and it involves your therapist guiding you in identifying the target memory as well as the intrusive thoughts and negative emotions associated with them. They will help you process your negative beliefs and see the irrationality in them, and introduce positive beliefs that contradict with your emotional experiences.
Phases four to seven are where your therapist starts using EMDR techniques. These four stages include desensitization, installation, body scan, and closure. In desensitization, your therapist will ask you to identify negative images while guiding you in making eye movements or even tapping. After the eye movements, they will ask you to pause and empty your mind for a while and help you notice if any new thoughts or feelings come up. Depending on your response, your therapist may ask you to focus on that specific memory again or move on to another one.
Then there is installation, where you will install a positive thought or image that is supposed to replace the negative one you identified during the assessment phase. What comes next is a body scan, where your therapist will ask if the targeted event triggers any uncomfortable physical sensations. If it does, this body sensation will be targeted for further processing.
The next phase is closure, which is done after every session. In this part of the process, the self-control techniques previously taught are used, and other coping strategies are also taught to bring you back to stability. Your therapist will not end the session unless you feel calm and safer.
Lastly, the eighth phase of EMDR therapy is reevaluation, wherein your therapist tracks your progress and improvements. They will also check for additional targets to see if you need more sessions. If not, they will talk to you about how you would handle stressful events in the future using what you have already learned during your EMDR treatment.
How many sessions are required for EMDR therapy?
EMDR therapy is usually delivered anywhere between six and 12 sessions. However, it is important to note that the duration of therapy may vary from person to person, as each client reacts differently to EMDR.
That said, while some people may experience positive changes in just a few sessions, others may need eight to 12 sessions, or sometimes more, to reprocess their complex traumas. The EMDR protocol also indicates that sessions are done once or twice a week and may last from 60 to 90 minutes.
How is EMDR therapy done?
EMDR therapy is done by helping the client focus first on the negative thoughts or images while using sets of bilateral stimulation, which may include eye movements, taps, audio tones, or blinking lights, both at the same time.
After each set of stimulation, the therapist instructs the client to allow their mind to go blank and to observe whatever image or thought comes up next. This pause may occur a few times during the session and if the client experiences difficulty in progressing or handling their emotions, the therapist will help them stabilize using self-control techniques.
If the patient reports no distress associated with the targeted thoughts or memories, they will be asked to replace negative thoughts with positive ones.
What does an EMDR therapist do?
An EMDR therapist guides patients with different conditions and goals throughout treatment sessions. During this, they use their high-quality assessment skills to determine the patient’s current state and to rapidly create an evidence-based treatment plan that is tailored to the mental health needs of their patients.
An EMDR clinician also makes use of their strong communication skills to inspire trust and build rapport with their clients professionally. During each session, patients are also asked to relive traumatic moments, so someone expert in rapid eye movement therapy needs to be able to manage sensitive subjects and help the patients process them diplomatically and professionally.
Is EMDR therapy effective?
Yes, EMDR therapy is effective. Although relatively new, EMDR has been the subject of many studies and clinical trials since the first study on it was published. And since then, over 30 controlled outcome studies on EMDR therapy have demonstrated its positive effects, with as many as 90% of trauma survivors having no PTSD symptoms in as little as three sessions.
Evidence also exists that several studies showed very positive outcomes for a large percentage of participants after the standard EMDR therapy duration of six to 12 sessions. EMDR has also gained worldwide recognition as an effective treatment of trauma from organizations such as the American Psychiatric Association (APA), the World Health Organization (WHO), and the Department of Veterans Affairs.
