EMDR stands for Eye Movement Desensitisation and Reprocessing. It is a psychotherapy used to help people recover from distressing and traumatic events and the problems they cause, including flashbacks, upsetting intrusive thoughts or images, anger and agitation. EMDR therapy was initially developed for the treatment of posttraumatic stress disorder (PTSD) but is now also used with other clinical conditions, including anxiety and depression.
EMDR is an individualised structured therapy that encourages a client to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (such as side-to-side eye rapid movement or hand tapping), which is associated with a reduction in the vividness and emotion associated with traumatic memories.
How does it work?
When a person experiences trauma, they can feel overwhelmed and their brain may be unable to fully process what is happening. Because of this, the trauma gets locked in the brain’s inbuilt alarm system along with the original picture, sounds, thoughts and feelings. This can be likened to a needle getting stuck on a record player (or laser on a CD). Without the needle being removed it plays the same noise (trauma) over and over again. This increases arousal and can have a lasting negative effect on the way a person views themselves, the world and others around them. With this, the brains filter system, which tells you what to pay attention to and what you can safely dismiss, becomes severely disrupted.
When the above happens, problems worsen over time and can adversely impact specific parts of an individual’s functioning (i.e. their ability to maintain healthy relationships; work, etc) or it may become all-encompassing, dominating all domains of an individual’s life. As a way of coping, people may engage in behaviours used to decrease or escape internal thoughts and feelings including substance abuse, over/under eating; gambling and self-harm. Over time these behaviours aggravate problems and lead to a reduction in a person’s overall quality and enjoyment of life (i.e. reduced pleasure, excitement and connection with others).
EMDR is thought to work in a number of different ways including:
- It helps the brain ‘unstick’ the traumatic memory from the alarm system (removing the needle from the record/laser from the CD) through bilateral movements (i.e. eye movements, tapping), by interrupting the ability to focus on the disturbances associated with trauma. When the brain is not giving its full attention to processing the trauma, the reaction to it starts to become less distressing. This allows the person to distance themselves from the event and begin to respond in a more manageable way.
- It imitates what the brain does naturally during dreaming or REM (Rapid Eye Movement) sleep, when your eyes move rapidly from side-to-side as the brain processes the events of the day. In this way, EMDR can be thought of as an innate natural therapy which facilitates the brain to work through distressing material.
- It activates the left and right side of the brain to work together to reprocess memories properly.
- It connects old memories stored in the brains alarm system to more adaptive parts of the brain (prefrontal cortex). This enables the brain to start building bridges (forming new neural networks) with existing resources (Adaptive Processing Model). This provides new information, insights and viewpoints to the trauma helping to promote greater perspective and self-compassion.
Following successful EMDR treatment, the traumatic experience can still be recalled but it is less distressing. More adaptive neural pathways are formed in the brain and an individual can feel more positively about themselves and the world around them.
Who is it for?
EMDR is an empirically supported treatment for trauma, and is recognised as an effective treatment for PTSD (post-traumatic stress disorder) by NICE (the National Institute for Health and Care Excellence) and the WHO (World Health Organisation).
Research has shown that EMDR can often help people to heal much more quickly after a distressing experience, with long lasting effects. There is a wide body of controlled studies supporting the treatment of stress and trauma disorders with EMDR. Overall, EMDR is a highly effective and efficient method of treatment.
EMDR is an individual therapy typically delivered once a week for a total of 6-12 sessions (though this is variable dependent on factors including the severity of the trauma). EMDR involves much less talking than many other forms of therapy.
What is involved?
The clinician will talk about the process involved in EMDR including how it works; what can be expected during this process and what the desired outcomes are. With your consent, your clinician will carry out an in-depth assessment with you to understand your problems (including distressing events and triggers that elicit emotional disturbance) in order to develop a treatment plan tailored to your needs. This will help shape a clear understanding of the areas that should be prioritised within therapy.
Exploring past traumatic events can be difficult so the clinician will ensure that you’re supported to manage emotional stress and understand your capacity to ‘disassociate’. Some of the skills and techniques involved in this process include resourcing (accessing internal strengths and positive memories) and emotional regulation (including breathing techniques).
Resource development helps to develop and strengthen the brain’s neural networks associated with positive sensations, emotions and cognitions. This can help an individual to develop tolerance for processing traumatic memories during treatment. An example of resourcing is to create a ‘Safe place’ in your mind which can provide an internal site of stability and refuge from distressing emotions and thoughts. It can be an imaginary place, or a place where you feel safe and secure.
Emotional regulation skills are a key requirement for tolerating the emotions associated with thinking about traumatic events. An example of an emotional regulation skill is box breathing. This technique involves breathing in slowly through your nose whilst counting to four (this time can be extended or reduced). Holding the breath whilst slowly counting to four, before exhaling gently for four seconds. Keep the lungs empty for four seconds before continuing to repeat the process in sets. The ability to consciously regulate breathing tells the brain that you are calm and this helps to regulate the production of stress hormones and restore the body to a relaxed state.
During the next phases of EMDR therapy, you will be asked to focus on a specific event, thought, image or memory. You will identify the most vivid visual image related to the trauma (if available), a negative belief about yourself such as ‘I am worthless’, related emotions and body sensations. While you do this, your therapist will engage you in bilateral stimulation (eye movements, tapping, etc). You will complete these in sets of a few minutes at a time and have a break in between where your clinician will guide you to notice what is coming to mind after each set. Depending on what you noticed, you will be guided to the next focus of attention from that thought. This process is repeated until the point where you feel no distress in relation to the traumatic memory. You have full control to stop the therapy at any point, if needed.
The focus then turns to installing a positive belief (identified during the assessment phase) that you would like to hold about yourself such as ‘I am safe now’, whilst engaging in sets of bilateral stimulation. This process is continued until the client generates increased confidence in their positive belief. The therapist checks with the client regarding body sensations. If there are any negative feelings, these are explored and processed as above. If the bodily sensations are positive, then they are reinforced further.
EMDR works best when the client allows their mind to flow freely during therapy. It is important to remember that it is your own brain that will be doing the healing and that you are the one in control, while the therapist supports you. The number of therapy sessions required can range from 4 to 12 but this will vary according to the number of traumas and the level of distress these cause.
Where can I access it?
EMDR can be accessed via a referrals from your GP. Individuals can also pay for this service privately via AnonyMind, providing they meet the necessary criteria.