What is EMDR Therapy? Treatment Overview and Phases

What is EMDR therapy? The acronym stands for Eye Movement Desensitization and Reprocessing and is a treatment for the symptoms associated with traumatic experiences. It is often utilized within treatment for individuals who have post-traumatic stress disorder, anxiety disorders, and depression.

At the heart of EMDR is the belief that traumatic memories are held in the body and that the brain can heal as it adapts and integrates these memories and events through reprocessing. EMDR can be done in conjunction with talk therapy and other therapy modalities or be a stand-alone treatment course.

Bessel Van Der Kolk, renowned trauma researcher, articulated in his seminal book, The Body Keeps the Score, that “As long as you keep secrets and suppress information, you are fundamentally at war with yourself…The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage” (Van Der Kolk, 2015).

Within EMDR treatment, the individual can access traumatic memories and to integrate them into their experience. This is important because traumatic experiences that are unprocessed correlate with numerous mental health and physical conditions.

History of EMDR therapy.

The treatment was initially called EMD (Eye Movement Desensitization) and was developed by Francine Shapiro, Ph D. in 1987.

“Shapiro was walking in the park when she realized that eye movements appeared to decrease the negative emotion associated with her own distressing memories. She assumed that eye movements had a desensitizing effect, and when she experimented with this, she found that others also had the same response to eye movements” (Institute, 2022).

Further research demonstrated that the treatment was more effective when combined with cognitive interventions. Consequent research focused on EMDR as a treatment for alleviating symptoms not only associated with post-traumatic stress disorder, (PTSD) but also anxiety and depression.

Currently there is an institute for EMDR, and many psychologists are trained to follow the protocol of intervention. Furthermore, research within the effectiveness of EMDR in comparison to other treatment modalities demonstrated it is highly effective not only in immediate relief of symptoms, but also in the long-term maintenance.

One study found that EMDR alone resulted in sustained reduction of symptoms of PTSD, depression, and anxiety. Within this study for participants with adult-onset trauma at a six-month follow-up, 75% of participants continued to have no symptoms, while 33% of childhood trauma survivors continued to have a reduction of their symptoms (Van der Kolk & Spinazzola, 2007).

What is EMDR therapy?

Present research establishes EMDR therapy as a highly effective treatment for survivors of traumatic experiences as well as those with depression and anxiety.

Within “EMDR therapy the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Therapist directed lateral eye movements are the most commonly used external stimulus but a variety of other stimuli including hand-tapping and audio stimulation are often used (Shapiro, 1991)” (Insitute, 2022).

The lateral eye movements can be facilitated in a variety of ways such as watching sensors that light up, following the clinician’s finger, or holding sensors that vibrate while also lighting up. EMDR can be done in person or through telehealth.

Treatment protocol of EMDR therapy.

EMDR therapy uses a three-pronged protocol, this means that there are several facets of intervention included in the trajectory of the treatment. It must be noted that while these prongs can be done in sequential order, often there are components of the latter two within the first as the individual makes new associations and as the treatment continues.

The general overview of EMDR treatment includes:

“(1) First, the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information;

(2) the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized.

(3) imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning” (Insitute, 2022).

In other words, treatment will often begin with the clinician and the client reviewing the client’s history—events in their story that are self-identified as traumatic or disturbing to them. At the same time, they will work together to identify coping strategies and self-care as they begin treatment.

Through EMDR sessions the events are reprocessed and integrated in adaptive ways for the client. Next, the client and clinician identify potential future triggers and follow EMDR procedures to develop adaptive associations to promote new responses to events that could arise in the future.

Overview of individual sessions.

EMDR therapy is an eight-phase treatment.  Throughout all phases of treatment, there is a general framework for the sessions.

For instance, “Eye movements (or other bilateral stimulation) are used during one part of the session” (Insitute, 2022). Eye movements may be facilitated by the individual following sensors that light up in a pattern.

Other bilateral stimulation as stated above can include movements that involve both hemispheres of the body such as tapping each shoulder with crossed arms. The clinician then “asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand (or other bilateral simulation) as it moves back and forth across the client’s field of vision…As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings” (Institute, 2022).

These rapid eye-movement or bilateral stimulation sessions are done multiple times within an individual session and at the end of a sequence (timed by the clinician) the individual is asked to state what they are noticing, including what thoughts were coming to mind, what emotions they were feeling, and where they felt the emotions in their body. The clinician may direct a client to focus on a particular aspect of their recall, and then the sequence will repeat.

Treatment sessions often end with calming, grounding, and other emotional regulation exercises.

Phases of intervention.

The first phase of EMDR involves history taking/identifying targets.

The second phase is focused on stress reduction. In this component effective adaptive coping strategies are developed for the client.

Phases 3 through 6 are when traumatic targets are identified and reprocessed.

Phase 3—the vivid visual image related to the memory is focused on at the onset of reprocessing.

Phase 4—A negative belief about self that is correlated with the traumatic memory is determined by the client and clinician. Often these are “I am” negative-belief statements such as “I am broken,” “I am flawed,” “I am bad,” or “I am unlovable.”

Phase 5—Related emotions and body sensations. In this phase the client works on identifying emotions tied to the event as well as where they feel these emotions in their body. Additionally, the client is asked to identify on a scale of 0-10 how disturbing this event feels to them—0 being no disturbance and 10 being unbearable.

Phase 6—A positive belief about the self in relation to the traumatic memory is determined. These often correlate/are the inverse of the negative belief. For example, “I am healed,” “I am okay just the way I am,” “I am good,” or “I am loveable.” The client rates how true the new statement feels to them in that moment on a scale of 1-7, with the goal being 7, completely true.

Phase 7—Closure. In this phase the therapist asks the client to keep a log during the week.  The log should document any related material that may arise.  It serves to remind the client of the self-calming activities that were mastered in phase two.

Phase 8—Reflection on progress and future targets/goals of treatment.  The EMDR treatment processes are reflected upon, and focus is on current incidents that elicit distress, as well as future events that will require different responses.

So, what is EMDR? EMDR is a highly effective treatment modality utilized to support the reduction of symptoms associated with traumatic events and memories. It has been proven to facilitate lasting change and healing for many survivors.