What is EMDR (Eye Movement Desensitization & Reprocessing)?
EMDR is an evidence based, 8-phase approach to psychotherapy, that is proven effective in the treatment of trauma, anxiety and other disorders.
The 8 Phases of EMDR are:
- History Taking (Getting an understanding of why you’re coming in for treatment, how trauma is currently affecting you and what your goals are for a successful outcome.)
- Resourcing (Also known as the Preparation stage / stabilization)
- Target Assessment (quickly preparing the memory to be worked on)
- Reprocessing (this is the part when you are actually doing eye movements or tapping)
- Installation (reinforcing the “good stuff”, such as new positive thoughts about the memory)
- Body Scan (making sure there is no leftover tension in the body)
- Closure (this happens at the end of every session, even if we’re not done working on that memory, so you can leave my office feeling calm and collected)
- Reevaluation (this happens at the beginning of every session, so we can see what has processing in between sessions and where we need to pick up)
A very common question that comes up for individuals seeking EMDR Therapy is how long does it take? The short response is, we don’t know. Every single individual is different, with their own experiences, perceptions, and needs. You can get a more accurate answer to this question once History Taking is under way, so you have a better understanding of the amount of work that needs to be done.
For a single incident trauma, the treatment can be quicker. For complex trauma, such as a history of emotional neglect or childhood trauma, it can take longer. For most clients, you will begin to notice a shift in 4-6 sessions, once the reprocessing stage begins. Keep in mind, though, just because you are not doing eye movements or tapping does NOT mean you are not doing EMDR. The eye movements are only 1 part of the overall treatment.
Why & How does EMDR Work?
EMDR is a research-based therapy with over 20 years of scientific validation. EMDR is currently a top-rated treatment for trauma, both single incident (car accident, natural disasters) and complex (chronic childhood deprivation and abuse). Brain research has shown that trauma significantly alters not only brain chemistry but also brain structure. Think of PTSD as BRAIN INJURY rather than a mental illness. PET brain scans have shown that EMDR helps to repair the parts of your brain that were injured by the trauma.
EMDR uses the two sides of the brain - the right and left hemispheres – in a process called Bilateral Stimulation. BLS mimics Rapid Eye Movement (REM) sleep patterns.
Because EMDR mimics REM sleep through the moving of the eyes back and forth in a rapid manner, “EMDR should be able to take advantage of sleep-dependent processes, which may be blocked or ineffective in PTSD sufferers, to allow effective memory processing and trauma resolution” (Van Der Kolk, p. 263)
MEMORY RECONSOLIDATION: Key To Transformational Change in Psychotherapy -- Bruce Ecker, LMFT
EMDRIA (The EMDRIA International Association) has lots of information and helpful videos that can further explain how EMDR works.
EMDR video links can be found at:
When danger is perceived (from the environment or from worries in our minds), the body is wired to respond automatically in these ways:
- The sympathetic nervous system goes into full alert sending stress hormones to the respiratory system, cardiovascular system, and muscles preparing us to either fight or flee.
- The neo-cortex (thinking part of the brain) shuts down, including the Broca's area for speech. This is because instinct is faster than thought, and in a dangerous situation, creating words and taking time to thoughtfully consider our next steps is not in our wheelhouse. This is also why when we feel threatened, it is hard to communicate, both hearing information accurately as well as finding the right words to use.
- If we cannot fight or flee, all mammals, including humans prepare to die; this is called the freeze response. Endorphins are released to manage pain and the mind dissociates from the body and from the experience.
This means that the trauma has overwhelmed our resources to cope. The trauma does not have to be from physical violence or natural disaster; it can be anything that causes the mind/body/spirit to be overwhelmed and shut down.
When this happens, the traumatic experience is encoded in implicit memory. This means that instead of in words and story, the memory is laid down in the brain in fragments - pieces of images, thoughts, sounds, smells, physical sensations, and with highly charged emotions.
When the threat has ended, all mammals, including humans, need to discharge the energy physically by shaking, pacing, running, or crying. (Waking the Tiger, by Peter Levine, is a GREAT book that explains all this.)
Humans have the added task of moving the experience from implicit memory into explicit memory by adding words and creating a meaningful narrative/story that describes not only the experience, but also how we see ourselves - what we believe about life and ourselves after the event.
Implicit memory has no sense of time; this means that every time something reminds us of a traumatic incident, it is not just remembered, it is re-experienced. These experiences are also known as "relivings".
Stress hormones, such as cortisol and adrenaline, are released again. The sympathetic nervous system goes into “alarm mode” causing the heart to race, muscles to tense, and the thinking brain to go “offline”. Instead of remembering the past, it feels like it is happening in the present. This is what defines a traumatic memory and causes you to feel dysregulated. We are out of our Window of Tolerance. See graph using link below.
Traumatic memory is the result of a traumatic experience being blocked from moving out of implicit into explicit memory; this is especially likely if the freeze response occurred.
We cannot process something if we are constantly dysregulated and outside of the window of tolerance whenever something reminds us (consciously or subconsciously) about our traumatic experiences.
The mind continues to attempt to heal by “knocking on the door” of the conscious verbal brain; however when that part of the brain “looks out the window” it sees a bunch of neural memory networks filled with upsetting information, so it barricades the door and hides instead of inviting them in. (Reference: Dr. J. Eric Gentry, International Association of Trauma Professionals). This is why trauma survivors report feeling stuck.
These are often implicit memory “knocking”; avoidance symptoms like dissociation, self-destructive behaviors, isolating, and denial are the neo-cortex trying to ignore the “unwelcome visitors”.
It takes an enormous amount of psychological and physical energy to keep this door shut and guarded. EMDR works by helping implicit and explicit memory talk to one another while keeping the body relaxed. The traumatic incident(s) become narrative history instead of wordless terror without end.
Research shows writing/journaling also helps people heal; however, for many trauma survivors this is often too painful to do. Trauma and grief both are most effectively resolved when the story is shared with at least one other person; we seem to be wired to need a supportive other person to bear witness.
Sadly, trauma often renders survivors unable to talk about their experience, which can add isolation and loneliness to their pain.
After EMDR, people report feeling both at peace with themselves and more connected to others.
What to Expect During EMDR Sessions
People have different experiences of EMDR. Some say it is like rapid daydreaming; some describe it as watching scenery go by from the window of a train; others liken it to watching a DVD or snapshots in a slide show; some compare it to prayer, active daydreaming, or meditation. Most people have commented that it is like going into a painful memory and bringing along the sensation of comfort, like being rocked and soothed when distressed. Sometimes people cry, releasing strong emotions, and sometimes people experience physical sensations as their body releases its sensory experiences. You always remain in control and able to stop, ask questions, or have my help in figuring out and getting what you need.
Unlike exposure therapy, the experience of EMDR is NOT a moment-by-moment reliving of a painful life event; instead the traumatic memory links up with positive, useful information and resources that are also stored in your brain.
EMDR creates “dual awareness” which means that instead of getting fully pulled into a memory, the gentle buzzing in your hands, eye movements, and auditory tones anchor the mind and body to stay oriented to the present time and place while simultaneously remembering the distressing experience. As with all trauma work, EMDR can be emotionally intense. At all times I will be there to help you know you are safe in my office and to gently coach you through any difficult parts of the process.
EMDR does not make people forget their painful experiences or stop being sad sometimes about them; however, the memories will become just that: memories. They will become less upsetting because they will be filed in the brain as something that happened in the past, instead of being relived over and over in the present; you will be able to recall them but without the painful emotional charge.
Because the part of the brain that communicates in images works faster than the part of the brain that communicates in words, I will encourage you to talk less than traditional therapy.
After each set of bilateral stimulation (eye movements or tapping), I will ask you what you are noticing and then tell you to “go with that”. If at any time you feel overwhelmed or “stuck” please let me know; there are many things I can do to help.
EMDR works by enhancing your body’s own natural healing processes. It is your brain’s neural networks and channels of associations that control the EMDR desensitization process. The bilateral stimulation simply helps you move your own eyes and awareness back and forth across the midline of your body so that the hemispheres of your brain talk to each other more efficiently.
You cannot do EMDR wrong, everyone’s process is wonderfully unique.
AFTER AN EMDR SESSION
EMDR facilitates deep and lasting changes. During an EMDR session your mind will move quickly from one memory/scene to the next to the next; this process will continue between sessions as your mind-body-spirit continue to move toward healing.
It is NORMAL for people to discover new information, make unexpected connections, and to experience strong positive as well as strong negative emotions between sessions. It is also normal for the changes to be more subtle and gradual.
Usually unexpected positive resources also spontaneously come to mind or in dreams. I encourage you to spend time between sessions practicing and strengthening the positive resources you have developed.
Most people find this a very pleasurable, empowering, and comforting part of EMDR. It can be helpful to write down what happens for you between sessions.
EMDR is a wonderful therapy that has helped so many individuals overcome years of trauma. Making the decision to choose this approach will help finally get unstuck, so that you can move past your trauma and move on with your life.
If at any point during the process that things become confusing or overwhelming, please let me know. You are in control of the journey; as a therapist, I am simply a guide to help you along the way.