Eye Movement Desensitization and Reprocessing (EMDR)

History of EMDR therapy

• EMDR therapy was developed by Dr. Francine Shapiro in 1987.

• The story goes that she was walking in a park and noticed that her negative thoughts were less distressing when her eyes moved rapidly.

• Intrigued, she conducted further research and refined her techniques, leading to the establishment of EMDR as a structured therapeutic approach.

• EMDR has since become a widely recognized and validated treatment for trauma.

EMDR therapy

• It’s primarily used to treat PTSD and other trauma-related conditions.

• The core concept is that traumatic memories are inadequately processed and stored dysfunctionally, causing distress.

• EMDR helps reprocess these memories so they can be integrated healthily.

• EMDR build new neural pathways and changes the structures of your brain

What does EMDR stand for?

Eye Movement Desensitization and Reprocessing

How does EMDR therapy work?

• The key mechanism of EMDR therapy is bilateral stimulation (BLS), typically through eye movements, but can also be taps or tones.

• The hypothesis is that BLS stimulates the brain’s information processing system, similar to the mechanisms involved in REM sleep.

  • The goal is to reduce the emotional distress associated with traumatic memories and to reframe negative beliefs.

Training and certification of EMDR

•       To practice EMDR, one must undergo accredited training by EMDR International Association (EMDRIA).

•       Training involves two parts: Basic Training Part 1 and Part 2.

•       Certification requires additional consultation hours and case studies.

•       Mental health professionals must be Master’s prepared to take the training

Brain changes with EMDR

Decreased activation in the Amygdala

• Increased activity in the prefrontal cortex.

• Enhanced connectivity between brain regions responsible for memory and emotion regulation

  • Neuroplasticity

Basics of standard EMDR processing:

•       Following resourcing, EMDR therapy follows an eight-phase protocol.

•       These phases ensure a structured and comprehensive approach to reprocessing traumatic memories.

Resourcing in EMDR

Resourcing is an essential part of EMDR therapy, especially in the preparation phase.

• It helps enhance the client’s ability to cope with distressing emotions.

• Techniques include creating a Safe/Calm Place, developing positive imagery, and using soothing methods like tapping.

  • These resources are used throughout therapy to help clients feel more in control.

Phase 1: History taking

• The first phase involves gathering the client's history and identifying target memories for EMDR processing.

• This phase is crucial for understanding the client's symptoms, triggers, and trauma history.

Phase 2: Preparation

the therapist prepares the client for EMDR processing.

• This includes establishing trust, explaining the EMDR process, and teaching the client self-soothing techniques (resourcing).

  • These skills are essential for managing distress that may arise during processing.

Phase 3: Assessment

During assessment, the therapist identifies the specific target memory for processing.

• Key components include the image, negative cognition, positive cognition, emotions, and physical sensations associated with the memory.

•       The therapist also uses scales like the Subjective Units of Distress (SUD) and the Validity of Cognition (VOC) to measure baseline distress and belief strength.

Phase 4- Desensitization

• The desensitization phase is where the actual reprocessing happens using bilateral stimulation.

• The client focuses on the target memory while engaging in BLS.

  • The goal is to reduce the distress level associated with the memory, as indicated by decreasing SUD scores.

Dissociation

a mental process that causes a lack of connection in a person’s thoughts, memory, and sense of identity.

•       It can range from mild detachment from surroundings (daydreaming) to severe forms such as dissociative identity disorder

•       Dissociation is common when doing trauma-related work (most pronounced in phase 4 of EMDR therapy)

Links to trauma:

•       Dissociation often arises as a coping mechanism in response to traumatic experiences, especially when the trauma is overwhelming or prolonged (e.g., childhood abuse, combat).

•       It allows individuals to "escape" psychologically from painful experiences, creating a form of mental protection.

3 Types of dissociation

1. depersonalization

2. derealization

3. amnesia

Depersonalization

Feeling detached from one’s own body.D

Derealization

feeling detached from the external world

Amnesia

gaps in memory of personal history or traumatic events

Techniques in EMDR for managing dissociation:

• resourcing

• use of TICES

• mindfulness and grounding techniques

• pacing the therapy 

Resourcing

 Preparing clients by strengthening coping skills before trauma processing. Techniques include grounding exercises, creating a "safe place" visualization, and establishing dual awareness (being present in the here-and-now)

What does TICES stand for?

Triggers, Images, Cognition, Emotions, Sensations

Use of TICES

Helps clients stay aware of current experience while processing past memories.

Mindfulness and Grounding Techniques

Used throughout EMDR sessions to help clients reconnect with the present moment if they start to dissociate.

Pacing the Therapy

EMDR therapists work at the client’s pace to avoid overwhelming them, especially when dissociative symptoms are severe (e.g. start with a 3/10 instead of a 10/10 on the disturbance scale)

Phase 5: Installation 

• Installation aims to strengthen positive beliefs related to the target memory.

• The client focuses on a positive cognition while engaging in BLS.

  • The goal is to increase the validity of this positive cognition, which is reflected in rising VOC scores.

Phase 6: Body scan

• In the body scan phase, the therapist checks for any residual physical tension associated with the target memory.

• The client scans their body for any discomfort or tension and processes these sensations with BLS.

•       This ensures that both emotional and physical aspects of the trauma are addressed.

Phase 7: Closure

• Closure is crucial to ensure the client is stable and grounded before leaving the session.

• The therapist uses self-soothing techniques and debriefing to help the client return to a state of calm.

  • This phase ensures the client feels safe and supported.

Phase 8: Re-evaluation

 involves assessing the client’s progress in subsequent sessions.

• The therapist reviews changes in distress levels and cognitive shifts.

  • This phase helps in planning future sessions and identifying any new target memories.