EMDR

 

Eye Movement Desensitization and Reprocessing (EMDR) for PTSDLike many scientific advances, EMDR originated with a chance observation. One day in 1987 psychologist Francine Shapiro was walking through a park, preoccupied with some painful memories, when she noticed that rapid eye movements produced a dramatic relief from her distress. How could a major treatment modality grow from such a brief experience? How is it possible that such a simple process had not been noted before? Initially skeptical about her observation she subjected her method to years of experimentation and research, gradually building it into a standardized procedure that could be taught and tested in controlled studies.

The goal of EMDR therapy is to process completely the experiences that are causing problems, and to include new ones that are needed for full health. “Processing” does not mean talking about it. “Processing” means setting up a learning state that will allow experiences that are causing problems to be “digested” and stored appropriately in your brain. That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded. Negative emotions, feelings and behaviours are generally caused by unresolved earlier experiences that are pushing you in the wrong directions. The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviours and interactions.

So what actually happens in an EMDR session? Generally there are 8 phases to any treatment:

Phase 1: History and Treatment Planning

In the first phase of EMDR treatment, we would discuss the specific problems that have brought you into therapy. With this information, we will develop a treatment plan that defines the specific targets on which to use EMDR. These targets include the event(s) from the past that created the problem, the present situations that cause distress, and the key skills or behaviours you might need for your future well-being. One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of their disturbing memories in detail. So while some individuals are comfortable, and even prefer, giving specifics, other people may present more of a general picture or outline. When the therapist asks, for example, “What event do you remember that made you feel worthless and useless?” the person may say, “It was something my brother did to me.” That is all the information I would need to identify and target the event with EMDR.

Phase 2: Preparation

In this phase, we would set you up to be able to deal with any emotional disturbances that may arise in the treatment. This would include a variety of relaxation and emotion regulation techniques for calming yourself in the face of any emotional disturbance that may arise during or after a session.

Phase 3: Assessment

Here we would identify the aspects of the target memory to be processed. Usually, we would do this by focusing on the memory and then choosing a statement that expresses a negative self-belief associated with the event. These negative beliefs might be seen as verbalizations of the disturbing emotions that still exist. Common negative cognitions include statements such as “I am helpless,” ” I am worthless,” ” I am unlovable,” ” I am dirty,” ” I am bad,”

Phase 4: Desensitization

Here, you will be led the into sets of eye movements (moving the eyes from right to left a number of times,) with appropriate shifts and changes of focus until some of the distress generated by these thoughts and images starts to reduce. Other memories and sensations can also arise at this point in the treatment.

Phase 5: Installation

The goal of the fifth phase is to concentrate on and increase the strength of a healing belief that the we have identified to replace the original negative belief. For example, someone might begin with a mental image of being beaten up by their father and a negative belief of “I am powerless.” During the Desensitization Phase we will have reprocessed the terror of that childhood event and realized that as now an adult he now they have strength and choices they didn’t have when they were young. During this fifth phase of treatment, the positive cognition, “I am now in control,” will be strengthened and installed. Fortunately, just as EMDR cannot make you shed appropriate negative feelings, it cannot make you believe anything positive that is not appropriate either. So at this point, we may also need to look at the learning of certain life skills such as self-defense training, in order to be truly in control of the situation. The validity of his positive belief will rise only to the corresponding level if we feel we have the means to carry it out.

Phase 6: Body scan

After the positive cognition has been strengthened and installed, I would ask you to bring the original target memory to mind and see if you notices any residual tension in you body. If so, these physical sensations are then targeted for reprocessing. Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in motoric (or body systems) memory, rather than narrative memory, and retains the negative emotions and physical sensations of the original event. When that information is processed, however, it can then move to narrative (or verbalizable) memory and the body sensations and negative feelings associated with it disappear. Therefore, an EMDR session is not considered successful until you would  be able to bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level. This also helps to explain why standard CBT can sometimes fail to alleviate stress originating in traumatic memories.

Phase 7: Closure

Closure ensures that you leave at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, we will make sure that you regain a sense of equilibrium before leaving. Throughout the EMDR session you are always completely in control. It is not a form of hypnosis. It is okay to raise your hand in the “stop” gesture at anytime and share what is going on for you. You will also be briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and which techniques you might use on your own to help you feel more calm.

Phase 8: Reevaluation

At the beginning of subsequent sessions, I will check to make sure the the positive results from the last session have been maintained. We will also identify any new areas that need treatment, and continues reprocessing the additional targets.

As you can see, unlike conventional exposure treatment, EMDR spends very little time revisiting the original trauma. EMDR uses the fact that memories evolve and change. Immediately after a memory is laid down, it undergoes a lengthy process of integration and reinterpretation—a process that automatically happens in the mind/brain without any input from the conscious self. When the process is complete, the experience is integrated with other life events and stops having a life of its own. Unfortunately, with traumatic memories this process fails and the memory remains stuck—undigested and raw.

EMDR focuses not only on regulating the intense memories activated by trauma but also on restoring a sense of agency, engagement, and commitment through ownership of body and mind.

IN A NUTSHELL:

  • EMDR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past. This helps them put the traumatic experience into a larger context or perspective.
  • People may be able to heal from trauma without talking about it. EMDR also makes space for talking, but even more importantly EMDR enables us to observe our experiences in a new way. Sometimes talking about an experience only embeds our reactions and feelings about it more deeply into our consciousness without actually alleviating us from the pain of the experience.
  • EMDR can help even if the patient and the therapist do not have the trusting relationship that can sometimes take years to develop. This is particularly useful if one is seeking alleviation of distress quite soon after starting a treatment, and also because trauma, understandably, rarely leaves people with an open, trusting heart.

Please feel free to get in touch either by email or telephone (07804197605) if you would like to find out anything else about EMDR treatments or to book a consultation.

 

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