Victims of trauma can face a long road to recovery. What works well for one individual will not work well for another, but many clinicians have found success using a technique called EMDR therapy.
EMDR stands for eye movement desensitization and reprocessing, and it was originally developed to help people cope with the distress of reliving traumatic memories. EMDR is a fairly new therapy, and it is becoming more mainstream as research begins to demonstrate its effectiveness. It seems to be particularly valuable as a treatment approach for PTSD, which can occur after experiences such as military combat, car accidents, or physical or sexual assault.
EMDR is both unique and nontraditional; it does not approach a psychological issue with medication or counseling. Instead, EMDR relies on a patient’s own eye movement to dampen the memories associated with traumatic events. Specific techniques allow the brain to effectively process the traumatic information, so it does not create emotional disturbance. Combined with other forms of therapy, EMDR can help victims of trauma recover from their experiences and improve quality of life.
When Is EMDR Used?
EMDR primarily treatments post-traumatic stress disorder (PTSD), a condition that results from experiencing a trauma. PTSD is a common phenomenon in the United States, affecting around 3.5% of the population at any given time. An estimated one in 11 individuals will receive a diagnosis of PTSD in their lifetime. Women are far more likely to develop the condition than men.
PTSD causes intense, disturbing thoughts that can be difficult to escape, related to the experience that caused the diagnosis. People with PTSD experience flashbacks and nightmares that contribute to emotional instability, insomnia, and even estrangement. Treatment is often required to improve quality of life and alleviate symptoms. EMDR is a promising new therapy for the treatment of victims of trauma. Given its success in this realm, practitioners are also starting to apply its methods to the treatment of other mood disorders such as anxiety and depression, phobias, and panic disorders.
How Effective is EMDR?
Extensive research demonstrates the effectiveness of EMDR therapy. A systematic review of the literature revealed that 84-90% of victims of a single episode of trauma no longer have a diagnosis of PTSD after as few as three 90-minute sessions. In another study funded by Kaiser Permanente, all victims of single-episode trauma and over 75% of victims of multiple traumas no longer met the diagnostic criteria for PTSD after six 50-minute sessions.
The research on EMDR has been so promising that the American Psychiatric Association, World Health Organization, and Department of Defense all recognize it as an effective treatment for trauma. In its over 25 years in practice, millions of people have benefited from EMDR treatment.
What Is an EMDR Session Like?
People just learning about EMDR may experience some apprehension about the process involved. The experience is painless, but it is good to know what to expect before a session. In general, an EMDR session has eight phases.
Phase #1 – History Taking
During the first stage of an EMDR session, a therapist will take the time to learn about you and your history. This is often the time where you will have an opportunity to share your story, and your therapist may use some standard assessments to guide the treatment plan. The point of history taking is to set up a target sequence plan, or an overview of what affects you from your past, and how it may have bearing on your future. An important aspect of history taking is learning more about touchstone events, or the experiences that contribute to your PTSD symptoms. Often, a therapist will ask how disturbed you are by these touchstone events on a scale of one to 10.
Phase #2 – Preparation
In the next phase, your therapist will acquaint you with the process of EMDR. You will learn stress reduction skills, and state changing skills. Your therapist will guide you through the creation of a “safe place image,” or a place where you can disappear mentally in order to regain a sense of calm.
Your therapist may also administer a short inventory to see if you experience dissociation. Ideally, your therapist will give you a rundown of the process and explain how bilateral stimulation (BLS) of the eye allow your right and left-brain hemispheres process the traumatic material, ultimately activating the adaptive information processing (AIP) system in the brain.
Phase #3 – Assessment
During the third phase, your therapist will work with you to decide what memories and negative images you want to target in the subsequent phases. For example, your therapist may ask you to recall a negative memory and rate your disturbance from one to 10, and a positive experience, rating it from one to 10. You may be asked to describe how you feel as you recall both positive and negative images to provide a baseline from which to measure improvement.
Phase #4 – Desensitization
The process of desensitization is where the EMDR occurs. You and your therapist will engage all your senses as you process the disturbances that you target. Your therapist will remain silent throughout this phase, letting the brain work through the BLS. After a few moments, you will have a check-in to see how you are tolerating the treatment; then the EMDR will continue.
True EMDR will consist of moving your eyes back and forth, hearing tones, and feeling taps. The idea is to allow both sides of the brain to communicate more effectively, activating your AIP so your brain can process the traumatic information more effectively. Generally, you complete BLS in sets.
Between sets, your therapist will offer things for you to think about, called cognitive interweaves. You will be asked to rate these thoughts from zero to 10 in terms of disturbance. When you reach a level of 0 and your target cognition is no longer disturbing, desensitization is complete.
Phase #5 – Installation
During the installation phase, you will be asked to recall the positive cognition you recalled in phase three. Using the same assessment tools, you will rate your positive cognition from a scale of one to seven. This time, your BLS sessions will target the “trueness” of your positive cognition and will continue until you reach a self-assessment of seven.
Phase #6 – Body Scan
As the name implies, phase six of EMDR asks you to mentally scan your body and perform a self-assessment of any lingering sensations or tension that may signal that your brain is still stuck on the negative cognition, or it is not processing it effectively. If so, your therapist will administer additional sets of BLS.
Phase #7 – Closure
Each EMDR session will feature a closure aspect, where you mentally shut down the material and check yourself. Your therapist will walk you through guided imagery to contain any information that’s not fully processed, so you can work on that in additional sessions. Examples of closure may include returning to your safe image or creating a mental container to hold any information that may continue to be a source of distress.
Phase #8 – Reevaluation
The final step in EMDR is the act of coming full circle. Your EMDR therapist will check in on you, just as they did in the beginning of the session and learn more about your level of disturbance from the target.
If the disturbance is still neutral, you can begin a new target. If you still experience a level of disturbance from the target, you move back to phase four. The cycle of EMDR continues until you have tackled all your targets and they no longer cause disturbance. It may take several sessions of EMDR to achieve neutrality, but most people find that EMDR helps alleviate their PTSD symptoms.
Who Can Administer EMDR?
Administration of EMDR requires a specialized certification and licensure:
- Medical Doctors (M.D., D.O.) must be fully licensed to practice medicine in their state
- Advanced Practice Nurse Practitioners must have a Master of Science in Nursing or higher, a specialization in psychiatric mental health nursing, and must hold an active license through their state board.
- Mental health clinicians must hold a master’s degree in an applicable discipline (counseling, psychology, social work, psychotherapy) and must be licensed through the state board to practice.
In addition to the prerequisite criteria outlined above, a practitioner of EMDR must complete an accredited training course in order to become certified to administer the treatment. Once certified, the practitioner will be able to administer EMDR in a clinical setting.
EMDR is a relatively new treatment approach for the individualized treatment of trauma. However, it already has a robust body of evidence supporting its efficacy. As an evidence-based treatment, EMDR can help victims of traumatic events process information more effectively and experience symptom relief.
Many patients can reduce or eliminate their symptoms of PTSD in a handful of sessions, though a dedication to the process is necessary to make it successful. Acceptance Recovery Center offers EMDR and a host of other trauma recovery services that help improve quality of life.
Dr. Greg Gale has been practicing and providing leadership in the field of psychiatry, substance use, and integrated care in the Phoenix metropolitan area for over 11 years. He joins us from his role as a national medical director overseeing behavioral health, substance use, and integrated care services for Humana Behavioral Health. Previously, he was CMO and VP of Clinical Services at Partners in Recovery, a not-for-profit behavioral health and substance use service organization, which operates five clinics throughout Maricopa County.