EMDR (Eye Movement Desensitization and Reprocessing). Introduction
EMDR (Eye Movement Desensitization and Reprocessing) is the state-of-the art treatment method for PTSD (Post Traumatic Stress Disorder). EMDR was originally developed for treating war trauma; however, today it can be effectively applied for therapy of other traumatic events such as violent incidents, airline crashes, and auto accidents.
Apart from EMDR main indication as trauma therapy, psychologists use EMDR also for treatment of anxiety, depression, and behavioural problems.
Origins of EMDR
EMDR therapy was developed by Francine Shapiro Francine in the late eighteens. She moved her eyes back and forth and experienced significant relief from anxiety and depressive thoughts related to her cancer diagnosis. She discovered the connection between eye movements and flash-back memories. Francine Shapiro came up with the idea to test and study this method by chance while walking in the park. She moved her eyes back and forth and experienced significant relief from anxiety and depressive thoughts related to her cancer diagnosis.
Unique Therapeutic Approach of EMDR
EMDR therapy for depression, anxiety, and PTSD depends on a dual focus—eye motions or other diversions—while emphasizing the unpleasant memory. This method connects the displaced traumatic memories stored in the unconscious with the consciousness. The opaque “wall” separating the unconscious from awareness becomes semi-transparent. Over time, the “destructive energy” of the encapsulated traumatic events can be reduced and then resolved.
What Conditions Does EMDR Treat?
EMDR is a therapeutic method applied widely in clinical settings. While treating mental diseases, especially PTSD, EMDR therapists also treat depression, social anxiety, panic attacks, adjustment problems, OCD, and eating disorders.
For people without mental health issues either, EMDR therapy helps reduce stress, subjective pain, and anger.
Therapeutic Phases of EMDR
EMDR therapy typically takes place in structured 60-minute sessions. The therapy is structured around eight distinct phases. These phases guide the therapeutic process, ensuring a comprehensive approach to healing.
Phase 1: History Taking and Treatment Planning
EMDR treatment starts with history-taking. The therapist obtains data during this phase to produce an Adaptive Information Processing (AIP) needed for guided case specific treatment plan. After establishing a therapeutic alliance with the patient, the therapist chooses which memories to target for reprocessing.
The therapist’s main goal in this phase is comprehension of the patient’s clinical problems. Poorly handled memories from daily life, or, in the case of PTSD, the absorption of “unfiltered” trauma memories, are what cause the patient’s symptoms. The success of this phase depends critically on the therapist’s capacity to moderate the intensity of history-taking and tune to the patient.
Usually, only a few sessions are needed in this phase for patients with PTSD or adjustment difficulties. Phase 1 may take more time, nevertheless, for patients experiencing dissociation, multiple symptoms, or personality problems.
Phase 2: Preparation
In the preparation phase, the therapist guides the patient through the EMDR treatment plan, terminologies, and therapy aims. Establishing a solid therapeutic partnership, this phase answers the patient’s enquiries and concerns.
The therapist evaluates the patient’s readiness for processing and details how the treatment will be given – including bilateral stimulation, seated positions, and, when necessary, a stop signal. If necessary, the therapist also provides resourcing interventions. Such interventions might be applied for patients with complicated symptoms.
Different numbers of sessions might be required depending on the treated disorder, the severity of the symptoms, and the patient’s personality. Especially for PTSD sufferers, the setting’s safety and a pleasurable experience during the therapy encounter are important for a good treatment result.
Phase 3: Assessment
The main condition for effective EMDR therapy is that, throughout the evaluation phase, patients access each target memory in a controlled and consistent manner. In this phase, the therapist identifies the main targets to be worked on. First, the patient chooses a particular, well-memorized picture from the target event. Later, he identifies a negative self-confidence comment about the event. The patient may have intellectual awareness of the falsehood of the statement, but this does not indicate emotional integration. These negative beliefs verbalize persistent, disturbing feelings. The patient should select a positive self-statement, such “I can do it,” that communicates an inner sense of control related to the negative memory.
Cognitive Validation
The anxiety is imprisoned in memory, even if the risk has passed. Positive attitudes should mirror what is pertinent right now. Using a 1 to 7 Validity of Cognition scale, the therapist asks the patient to score the truth of the positive beliefs: “1” is “completely false,” “7” is “completely true.” The soundtrack should capture the person’s emotions instead of ideas.
Subjective Disturbance
Logically understanding a problem does not necessarily coincide with its feel. Along with physical sensations like cold hands or stomach tightness linked to the goal, the assessment phase also notes negative emotions, including dread or rage. Using the Subjective Units of Disturbance (SUD) scale, which spans 0 (no disturbance) to 10 (highest disturbance), patients score their unfavourable beliefs. In the following phase of EMDR, the aim is to lower the SUD score for diseases and raise the VOC score, which measures the strength of the patient’s positive beliefs.
Phase 4: Desensitization
During the desensitising phase, the therapist leads the patient through bilateral stimulation to pinpoint undesirable ideas, memories, and emotions. Should the emotional trigger be absent, the therapist could reflect on the traumatic experience or proceed elsewhere. After every series of bilateral stimulation, the patient reports changes. The implantation of good beliefs starts after negative ideas and emotions are recognised.
Bilateral Stimulation Techniques
“Eye movement,” in which therapists employ side-to-side eye motions, is the most efficient approach. Usually quick, one movement every second defines the speed. These movements resemble those of fast eye movement (REM) sleep, the condition seen during dreaming. Should eye movement be difficult, therapists may substitute it by tapping, auditory pulses, or blinking lights.
Phase 5: Installation
The installation step starts upon complete desensitisation. During the appraisal process, positive views take place instead of the initial negative ones. The patient reinforces good ideas related to the chosen traumatising incident.
Desensitizing clients helps them process painful memories and recover a sense of power and control. These encouraging concepts support one in overcoming the past. Progress can be made when the following actions are envisioned and executed; from this point on, better emotions and self-confidence grow and get absorbed inside.
Phase 6: Body Scan
In this phase, the therapist advises the client to consider the original traumatic memory and focus on any physical sensations that show up. Trauma can remain biologically stored and manifest itself as pain, numbness, or a racing heart.
Knowing the rationale behind the body scan allows the patient to link emotions with their physical body. The body scan determines whether or not levels of discomfort have reduced or neutralised themselves. Achieving no bodily impact when the experience is recalled guarantees the resolution of the encapsulated trauma both mentally, emotionally, and physically. Should one report uncomfortable sensations, more processing takes place until the discomfort passes. Reversing symptoms marks the end of reprocessing.
Phase 7: Closure
When a memory is not completely processed, closure becomes crucial. Trauma’s intricacy means that EMDR’s resolution of a memory could take different times. While some people need numerous sessions for one memory, others can handle several memories in one session.
Sometimes the therapist and the patient end the session without fully processing a memory. Under such circumstances, the therapist uses exercises to help the patient get back into a calm mental state. The phase of closure guarantees the patient can go back to regular life free from trauma.
Phase 8: Re-evaluation
Re-evaluation follows the previous visit. The therapist checks whether fresh memories have surfaced and whether the beneficial effects have been preserved. To ascertain the efficacy of the treatment over time, re-evaluation is absolutely vital. Past events causing the condition will be addressed when EMDR is finished. The therapist also addresses present circumstances that create anxiety and notes the future skills required. Although EMDR might provide relief almost right away, finishing all eight steps is absolutely necessary.
Understanding How EMDR Works
The exact mechanism by which EMDR therapy works remains unclear. However, it is believed that several mechanisms are at play, making the treatment effective in reducing and even eliminating distressing symptoms. Our brains have a natural ability to recover from traumatic memories and events. While traumatic experiences often resolve naturally, some individuals struggle to manage the consequences without professional help. The fight-or-flight response is an innate reaction to stress, and when disturbing memories remain unprocessed, they can create overwhelming feelings of being back in the moment. EMDR therapy helps process these memories and allows natural healing to resume. Successful EMDR therapy does not erase traumatic memories, but it enables individuals to remember the trauma without triggering the fight-or-flight response.
Psychoanalytical Model
Psychoanalytic theory understands human behaviour as an effect of dynamics between the mental parts of the psyche, including the Id, Ego, and Superego. Under normal circumstances, external stimuli stored in the memory are being scanned by the Super-Ego. Those with unacceptable content are “filtered” using so called “defense mechanisms”.
The Collapse of Psychic Defense in PTSD
EMDR therapy allows the brain to resume its natural healing process and “clears” unprocessed trauma memories. EMDR therapy facilitates the brain’s natural healing process, allowing it to clear these unprocessed trauma memories. By doing so, EMDR therapy helps individuals regain control over their emotions and reactions, promoting a healthier and more balanced psychological state.
Examining the human psychological structure closer by using psychoanalytical concepts can help us grasp the development and evolution of PTSD. In PTSD, the psychic trauma shows up abruptly and disturbs the psychic equilibrium. Traumatic occurrences of a strong influx surpass human capacity for facing or integrating emotions. Trauma in PTSD creates a breakdown of psychic defence. Traumatic situations, including accidents, abuse, and disasters, challenge the Ego protection systems. People thus save painful memories in their unfiltered form.
EMDR therapy lets the brain heal naturally, enabling it to eliminate unprocessed trauma memories. EMDR treatment enables people to recover control over their emotions and reactions, therefore encouraging a better and more balanced psychological state.
Neurobiological Model. Foundational Concepts of EMDR
Three central concepts that underpin EMDR therapy are:
- memory networks
- memory processing and
- associative channels
EMDR therapy emphasizes the importance of addressing culturally specific traumas that may not align with traditional Western definitions.
Memory Networks
The EMDR theory holds that mental health and illness are derived from memory networks. Traumatic or upsetting situations can break down the information processing in the networks of the brain.
Many mental health conditions start with unprocessed memories from traumatic events and other negative life events, including dysfunctional childhood upbringing, abandonment, and humiliation. This does, however, exclude organic reasons such genetic flaws or harmful exposures.
Usually accompanying such maladaptive stored memories are bodily feelings and emotions experienced during the occurrence. Separated, these upsetting memories find it difficult to link with more flexible knowledge, which causes different symptoms.
Memory Processing
Processing memories or storing knowledge requires creating functional connections between brain-stored information networks. Encoded memories, including ideas, physical sensations, and emotions, with similar information, are kept in such networks. An EMDR therapist uses related images, ideas, sensations, and body language to evaluate disturbing memories. EMDR treatment seeks to open these associative channels, thus locating related memory networks. EMDR treatment seeks to open these associative channels by locating related memory networks.
Using standardised dual attention bilateral stimulation techniques – such as tones, eye movements, or taps – EMDR helps traumatic events be consciously accessible and connected to adaptive information.
Associative Channels
Encoded memories are stored in networks with brain connections to events with similar information (e.g., ideas, physical experiences, senses, emotions and perspectives). EMDR treatment seeks to open associative pathways and find linked memory networks. Processing then causes learning and the creation of positive associations – that is, new connections to suitable memory networks.
Healing Through EMDR: Reprocessing Negative Memories
Negative experiences, including traumatic events and everyday adversities like household disruptions and rejections, interfere with the processing system. These experiences become stored in a manner that prevents them from linking with adaptive information, hindering learning and growth. When current events trigger dysfunctional memory networks, unprocessed adverse memories resurface, affecting emotions, perceptions, and behaviors. This leads to relationship difficulties, reduced self-esteem, and psychiatric comorbidities like depression, anxiety, and insomnia.
EMDR therapy in India addresses these challenges, offering a therapeutic approach that bridges cultural and societal gaps. By facilitating the integration of maladaptive memories into adaptive networks, EMDR therapy empowers individuals to overcome past traumas and build a healthier future.
Adaptive Information Processing Model
The Adaptive Information Processing (AIP) model is central to EMDR therapy, suggesting that successful treatment involves integrating dysfunctional memories into a broader network of life experiences. AIP considers unprocessed memories of traumatic or adverse events as the primary cause of pathology, excluding organic factors like toxicity, injury, or genetics. Memory mechanisms physically encode life experiences, storing them in associative neural networks. These networks significantly influence a person’s perception of new experiences, affecting interpretations, feelings, and behaviors.
Under normal circumstances, the brain’s information processing system integrates new experiences with past memories, retaining beneficial information and discarding the rest. Interconnected memory networks store this information, guiding future actions based on emotional states. However, heightened emotional disturbance from negative experiences can disrupt this processing system, leaving memories unprocessed with accompanying emotions and attitudes.
In the Indian context, EMDR therapy’s focus on reprocessing memories offers hope for individuals affected by societal issues like poverty, social inequality, and communal violence. Addressing these culturally specific challenges is crucial for EMDR’s success in India.
Search and Find EMDR Therapist
Searching for a qualified EMDR therapist could be a difficult task. First of all, your therapist should be licensed, certified in applying this therapy technique, and a psychologist who is also EMDR educated.
Safety and compatibility constitute the second key factors. Search for a therapist you feel comfortable with, you can trust, and you can develop rapport with. This entails searching for a qualified EMDR therapist with a personality fit for you, cultural fit, and skill in the problems you are experiencing.
Before beginning EMDR treatment, it is advisable to consult a qualified medical practitioner – including an EMDR therapist. They can address any queries you might have and offer more details.