I have been trained in EMDR since 2011 and have found it to be a successful therapy in helping my clients move through their dysregulation from trauma and anxiety. I often get asked about EMDR, as it looks different from traditional talk therapy. Here are a few of the Frequently Asked Questions I often hear about EMDR.
What is EMDR?
EMDR stands for Eye Movement Desensitization and Reprocessing, and it is a type of therapy used in treating trauma, anxiety, and a wide variety of other disorders. EMDR was created in 1989 by Francine Shapiro as a therapy for treating trauma, particularly trauma from a single event. In a single-event trauma (like a car accident or a one-time assault), the therapist and client work to target the beliefs, emotions, sensations, and distress that go with the event of the trauma. The therapist guides the client through sets of bilateral stimulation (done by methods such as eye movements or using tappers) while the client focuses on the targeted material. The client’s brain processes the traumatic event and moves through change until the distress around the trauma clears up and the client gains a new perspective on the trauma. Since 1989, EMDR protocols have been expanded to address multiple traumatic events.
What is the theory behind EMDR?
EMDR comes out of the Adaptive Information Processing Model. According to this model, all people have multiple, adaptive ways of processing the events in their lives. For instance, when a person has a fun time hanging out with a friend, they can take in the narrative of that event in a logical and balanced way and assimilate the elements of that event into what they have already experienced. They also get a sense of when the event occurred and that they are not still living it two weeks later.
While the human brain is very adaptive, sometimes traumatic material can get stuck, forming a “maladaptive neural network.” When that neural network is triggered, the person does not feel their same resourcefulness and may replay the thoughts, feelings, and sensations of the event as if it is happening currently. They may experience core negative beliefs about their worth, their guilt, their safety, or their ability to have control.
The Adaptive Information Processing Model holds that our brains are highly adaptive and can move through trauma to new learning with a little guidance. To work, the person must have connection to the elements of their trauma and move through change to a place of new learning where they can hold a new positive core belief and feel the distress level go down in their body. In this way, the maladaptive neural network gets integrated back into the adaptive networks of the brain.
What is bilateral stimulation?
Bilateral stimulation refers to the process of stimulating both sides of the brain and body, in an alternating manner. Bilateral stimulation started off in the form of eye movements. The client follows the therapist’s finger or a path of light in a horizontal manner back and forth a number of times. While eye movements work for most people, a therapist may also suggest other methods such as tappers or headphones that alternate sensation or sound from one side of the body to the other.
Bilateral stimulation seems weird--why is it used?
It does seem a little weird, and it is essential to EMDR. We do not know exactly why it works, but research on EMDR effectiveness indicates that the process does not work when bilateral stimulation is removed.
As I mentioned, we don’t know why it works, but there are lots of theories. I tend to gravitate toward the idea that the bilateral stimulation functions a lot like the process of REM (rapid eye movement) sleep stages. During REM, we consolidate and make sense of the material in our brain, and we even get “smarter” in that we are better able to remember things after REM sleep. In EMDR, we do the same thing, in that we consolidate and integrate the dysregulated material into our bigger, and more adaptive, selves.
What are the steps to EMDR?
EMDR has eight stages or steps:
1. History taking. The therapist and client work together to get a thorough history of the trauma that the client has experienced. The therapist will look for patterns and key events that indicate the start of the trauma.
2. Preparation. The therapist and client further go over the process of EMDR, and the therapist may suggest ways to ground or lower distress that may occur during sessions. For instance, I often do an exercise called Safe Place, which helps the client to connect to a place where they feel competent and relatively safe. We use a few rounds of bilateral stimulation during this exercise, so I get information on how eye movements or tappers feel for a client before we start processing the traumatic material.
3. Assessment. In this phase, the client and therapist bring up the selected traumatic event, and the clinician helps the client to become more aware of the beliefs, distress, emotions, and sensations around this event.
4. Desensitization. Once the targeted materials is brought up in assessment, the client is ready to process it. The therapist has the client notice their beliefs, emotions, and how the client feels in their body, and then starts with a set of bilateral stimulation. The therapist pauses at points to ask what the client is noticing and then returns to “sets” of bilateral stimulation. The client’s brain is moving through the material with each set, and the therapists makes note of the change. The therapist can also gently guide if the processing is stuck, but the therapist makes as few interventions as possible. The idea is that the client’s brain is integrating the stuck and walled-off information, bringing it back into the mainstream of the brain. This phase continues until the client’s distress decreases to what I call “as neutrally as one can feel about a bad event in the past.”
This phase can be as short as part of a session, or can last over multiple sessions.
5. Installation. Once the client’s distress is down, the client checks out how true their intended positive belief is now. For instance, a positive world belief might be “I am safe now” or “I am able to makes changes in my life.” The therapist and client make sure that the appropriate belief feels completely true.
6. Body Scan. The client scans through the body for any lingering distress that may be at the sensation level of the body. If there is lingering distress, the therapist and client work to process it until the client feels neutrally.
7. Closure. This stage is used to reorient the client after a session, including a session that is still in stage 4. The therapist may help the client to reorient or do a relaxation or containment exercise so that the client feels more regulated before leaving the therapist’s office.
8. Reevaluation. After a target is completed, the therapist makes sure that the positive results from completing a target are still in place before moving on to other past traumatic events, present-day triggers, or how the client may face future events that might be related to the traumatic material.
Are there risks or times when it is not used?
As with any intervention, there can be risks associated with EMDR, especially under certain conditions. Some common risks are:
Feeling temporarily distressed as you come back into contact with the traumatic material. After an EMDR session, some of my clients have felt this increase in distress, and may report feeling lower mood, more hypervigilant, increased irritability, or difficulty sleeping. In my experience, this lasts 1–2 days max, happens rarely during the client’s course of EMDR, and does not significantly interfere with functioning. I always want my clients to contact me sooner if they are experiencing marked distress after EMDR, but I have not found that clients have needed to make that contact.
You should let your therapist know if you have migraines, seizures or other neurological disorders, heart disease, or eye conditions. While that may sound odd, it is helpful to know about these conditions so that the therapist can appropriately coordinate with your other care providers. In addition, the therapist may want to alter the type of bilateral stimulation because eye movements can trigger seizures or neurological symptoms if someone already experiences them.
EMDR is not recommended when people are psychotic, cannot soothe themselves, or have a severe dissociative disorder. EMDR would be overwhelming and potentially harmful in these circumstances. EMDR therapists are trained to screen for these conditions during the history taking and preparation stages.
EMDR is a highly effective treatment for moving through trauma and integrating places where you feel stuck. For more information about how EMDR can be helpful for you, please contact me, so that we can talk further.