What is EMDR?
EMDR (Eye Movement Desensitization and Reprocessing) is a comprehensive psychotherapy based on a series of assumptions about the nature of trauma and its impact on the human experience, including its neurophysiology.
At its core, EMDR asserts, that within each person, there exists a physiological information processing system, which brings new experience and information to an adaptive state. All information, positive and negative, is stored in memory networks. Both traumatic events, which could occur at any point in the individual’s life, along with the memories of persistent unmet emotional needs during developmentally crucial times are stored in these networks.
Any and all of these distressing memories can block the natural adaptive processing mechanism, thereby freezing these events in time. This blockage can occur either when the disturbance is too large for the individual to process, or if it persists over time, and thus disallows the normal adaptive processing.
The “traumatic event” lives, therefore, undisturbed in the person’s brain, in its original form, generating negative beliefs and perceptions, and containing all the smells, sounds, feelings and sensations associated with it.
With successful EMDR treatment, the natural adaptive processes are resumed and the person moves on and through this memory or sets of memories. They still recall what has happened, but it is no longer upsetting, disturbing or negatively influencing their current life. The disturbing memories become part of their story, as opposed to the meaning of their story.
EMDR uses a three-pronged-protocol of past, present and future. This allows the client to proceed by first reducing the impact of the past, forging new positive links with the old disturbing memories, followed by clearing the current triggers and associations, that are affecting their present-day behaviors and sense of self. Finally, a future template is created where they can envision their life more fully.
When Do I Start Doing EMDR?
The time period between an initial session and the first processing EMDR session could vary a great deal, depending on the particular individual and the nature of their distress. For some clients, it is most appropriate to spend extended time creating a safe context, so that they can tolerate the increased emotional affect that could occur during an EMDR session.
In general, the more enduring the trauma, and the earlier that it occurred, the more preparation may be necessary. Whenever the client and the therapist determine that EMDR reprocessing is appropriate, they will begin.
How Many EMDR Sessions Are Needed?
There are vast differences in each individual’s trauma history. Some people may have experienced a single incident trauma (e.g. an automobile accident) while others have several events or a long term history of trauma as is the case in abuse or neglect. An EMDR session with single incident trauma may be completed in as few as 5 sessions (with 2-3 EMDR 90 minute therapy sessions), while EMDR with clients who have a more complex trauma history may take longer.
What is an EMDR Session Like?
In general, an EMDR session begins with an assessment of a particular disturbing memory or incident. The client is asked to bring to mind the disturbing issue or event, and indicate what is seen, felt, heard, thought, etc., as well as what thoughts, beliefs and feelings they currently hold about themselves.
When the assessment is complete, the therapist facilitates the directional movement of the eyes or other bilateral stimulation, while the client focuses on the disturbing material. The client is instructed to just notice what comes up during that process and report briefly about it to the therapist in between sets. There will be little to no attempt to manage the material; the client will be just directed to “notice it.”
Although each person experiences the material differently (e.g. some have more visions and memories, while others tend to have more bodily experiences), in general the movement is in a positive direction. The memory becomes less disturbing and may become increasingly more associated with positive thoughts and self-beliefs.
Effectiveness of EMDR
Approximately 20 controlled studies have investigated the effects of EMDR and have consistently demonstrated that use of EMDR effectively eliminates/decreases the symptoms of post traumatic stress (PTSD) for the majority of clients.
There are also reports of significant improvement in other disturbances, although, there is not sufficient research in those areas to warrant the same level of claims of efficacy. However, many clinicians report success in treating the following areas of disturbance:
- Eating disorders
- Panic attacks
- Complicated grief
- Dissociative disorders
- Pain disorders
- Performance anxiety
- Sexual and or physical abuse
American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines
-SSRI’s, CBT, and EMDR recommended as first-line treatments of trauma.
Bleich, A., Kotler, M., Kutz, I., & Shalev, A. (2002). A position paper of the (Israeli) National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community. Jerusalem, Israel.
-EMDR is one of three methods recommended for treatment of terror victims.
Chambless, D.L. et al. (1998). Update of empirically validated therapies, II. The Clinical Psychologist, 51, 3-16.
-According to a taskforce of the Clinical Division of the American Psychological
Association, the only methods empirically supported (“probably efficacious”) for the
treatment of any post-traumatic stress disorder population were EMDR, exposure therapy,
and stress inoculation therapy. Note that this evaluation does not cover the last decade
CREST (2003). The management of post traumatic stress disorder in adults. A publication of the Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, Belfast.
-EMDR and CBT were stated to be the treatments of choice.
Department of Veterans Affairs & Department of Defense (2004). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Washington, DC: Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense. Office of Quality and Performance publication 10Q-CPG/PTSD-04; updated October 2010.
-EMDR was placed in the "A" category as “strongly recommended” for the treatment of
Dutch National Steering Committee Guidelines Mental Health Care (2003). Multidisciplinary Guideline Anxiety Disorders. Quality Institute Heath Care CBO/Trimbos Intitute. Utrecht, Netherlands.
-EMDR and CBT both designated as treatments of choice for PTSD.
Foa, E.B., Keane, T.M., Friedman, M.J. & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press.
-EMDR was ranked as an evidence-based, Level A treatment for PTSD in adults..
INSERM (2004). Psychotherapy: An evaluation of three approaches. French National Institute of Health and Medical Research, Paris, France.
-EMDR and CBT were stated to be the treatments of choice for trauma victims.
National Insititute for Clinical Excellence (2005). Post traumatic stress disorder (PTSD): The management of adults and children in primary and secondary care. London: NICE Guidelines.
-Trauma-focused CBT and EMDR were stated to be empirically supported treatments for choice for adult
Therapy Advisor (2004-7): http://www.therapyadvisor.com
-An NIMH sponsored website listing empirically supported methods for a variety of
disorders.EMDR is one of three treatments listed for PTSD.
United Kingdom Department of Health (2001). Treatment choice in psychological therapies and counseling evidence based clinical practice guideline. London, England.
-Best evidence of efficacy was reported for EMDR, exposure, and stress inoculation
In 2000, after the examination of additional published controlled studies, the treatment guidelines of the International Society for Traumatic Stress Studies gave EMDR an A/B rating and EMDR was found efficacious for PTSD.
For further information, and for details of research studies available, contact EMDRIA, EMDR and David Baldwin’s trauma pages.