Eye Movement Desensitization and Reprocessing (EMDR) Therapy (2022)

A structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories.

Introduction to EMDR

Eye Movement Desensitization and Reprocessing (EMDR) therapy (Shapiro, 2001) was initially developed in 1987 for the treatment of posttraumatic stress disorder (PTSD) and is guided by the Adaptive Information Processing model (Shapiro 2007).EMDR is an individual therapy typically delivered one to two times per week for a total of 6-12 sessions, although some people benefit from fewer sessions. Sessions can be conducted on consecutive days.

The Adaptive Information Processing model considers symptoms of PTSD and other disorders (unless physically or chemically based) to result from past disturbing experiences that continue to cause distress because the memory was not adequately processed. These unprocessed memories are understood to contain the emotions, thoughts, beliefs and physical sensations that occurred at the time of the event. When the memories are triggered these stored disturbing elements are experienced and cause the symptoms of PTSD and/or other disorders.

Unlike other treatments that focus on directly altering the emotions, thoughts and responses resulting from traumatic experiences, EMDR therapy focuses directly on the memory, and is intended to change the way that the memory is stored in the brain, thus reducing and eliminating the problematic symptoms.

During EMDR therapy, clinical observations suggest that an accelerated learning process is stimulated by EMDR’s standardized procedures, which incorporate the use of eye movements and other forms of rhythmic left-right (bilateral) stimulation (e.g., tones or taps). While clients briefly focus on the trauma memory and simultaneously experience bilateral stimulation (BLS), the vividness and emotion of the memory are reduced.

The treatment is conditionally recommended for the treatment of PTSD.

Using EMDR to Treat PTSD

EMDR therapy uses a structured eight-phase approach that includes:

  • Phase 1: History-taking
  • Phase 2: Preparing the client
  • Phase 3: Assessing the target memory
  • Phases 4-7: Processing the memory to adaptive resolution
  • Phase 8: Evaluating treatment results

Processing of a specific memory is generally completed within one to three sessions. EMDR therapy differs from other trauma-focused treatments in that it does not include extended exposure to the distressing memory, detailed descriptions of the trauma, challenging of dysfunctional beliefs or homework assignments.

The Phases of EMDR

History-taking and Treatment Planning

In addition to getting a full history and conducting appropriate assessment, the therapist and client work together to identify targets for treatment. Targets include past memories, current triggers and future goals.

Preparation

The therapist offers an explanation for the treatment, and introduces the client to the procedures, practicing the eye movement and/or other BLS components. The therapist ensures that the client has adequate resources for affect management, leading the client through the Safe/Calm Place exercise.

Assessment

The third phase of EMDR, assessment, activates the memory that is being targeted in the session, by identifying and assessing each of the memory components: image, cognition, affect and body sensation.

(Video) What is Eye Movement Desensitization Reprocessing Therapy?

Two measures are used during EMDR therapy sessions to evaluate changes in emotion and cognition: the Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale. Both measures are used again during the treatment process, in accordance with the standardized procedures:

Validity of Cognition (VOC) scale

The clinician asks, "When you think of the incident, how true do those words (repeat the positive cognition) feel to you now on a scale of 1-7, where 1 feels completely false and 7 feels totally true?"

Completely false

1

2

3

4

5

6

7

Completely true


Subjective Units of Disturbance (SUD) scale

After the client has named the emotion he or she is feeling, the clinician asks, "On a scale of 0-10, where 0 is no disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does it feel now?"

No disturbance

1

2

3

4

5

6

789

10

Worst possible

Desensitization

During this phase, the client focuses on the memory, while engaging in eye movements or other BLS. Then the client reports whatever new thoughts have emerged. The therapist determines the focus of each set of BLS using standardized procedures. Usually the associated material becomes the focus of the next set of brief BLS. This process continues until the client reports that the memory is no longer distressing.

Installation

The fifth phase of EMDR is installation, which strengthens the preferred positive cognition.

Body Scan

The sixth phase of EMDR is the body scan, in which clients are asked to observe their physical response while thinking of the incident and the positive cognition, and identify any residual somatic distress. If the client reports any disturbance, standardized procedures involving the BLS are used to process it.

Closure

Closure is used to end the session. If the targeted memory was not fully processed in the session, specific instructions and techniques are used to provide containment and ensure safety until the next session.

Re-evaluation

The next session starts with phase eight, re-evaluation, during which the therapist evaluates the client's current psychological state, whether treatment effects have maintained, what memories may have emerged since the last session, and works with the client to identify targets for the current session.

Special thanks to Louise Maxfield, PhD, and Roger M. Solomon, PhD, for their contributions to this description.

Case Example

Mike, a 32-year-old Iraq War veteran

Mike was a 32-year-old flight medic who had completed two tours in Iraq. He had been discharged from the Army due to his posttraumatic stress disorder (PTSD) and was divorced with a 2-year-old son. The Army psychologist referred Mike for treatment of his PTSD with Eye Movement Desensitization and Reprocessing therapy.

Case Example

Phillips, K.M., Freund, B., Fordiani, J., Kuhn, R., & Ironson, G. (2009). EMDR treatment of past domestic violence: A clinical vignette. Journal of EMDR Practice and Research, 3(3), 192-197.

(Video) Eye Movement Desensitization and Reprocessing (EMDR) for PTSD

Case Example

Kullack, C., & Laugharne, J.. (2016). Standard EMDR protocol for alcohol and substance dependence comorbid with posttraumatic stress disorder: Four cases with 12-month follow-Up. Journal of EMDR Practice and Research, 10(1), 33-46.

Case Example

Buydens, S. L., Wilensky, M., & Hensley, B. J. (2014). Effects of the EMDR protocol for recent traumatic events on acute stress disorder: A case series. Journal of EMDR Practice and Research, 8(1), 102-112.

Case Example

Pagani, M., Di Lorenzo, G., Monaco, L., Niolu, C., Siracusano, A., Verardo, A.R.,...Ammaniti, M. (2011). Pretreatment, intratreatment, and posttreatment EEG imaging of EMDR: Methodology and preliminary results from a single case. Journal of EMDR Practice and Research, 5(2), 42-56.

(Video) EMDR Therapy: Understanding Eye Movement Desensitization & Reprocessing

Case Example

Rost, C., Hofmann, A., & Wheeler, K. (2009). EMDR treatment of workplace trauma: A case series. Journal of EMDR Practice and Research, 3(2), 80-90.

References & Resources

Book

Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols and procedures.(3rd ed.). New York, NY: Guilford Press.

(Video) Eye Movement Desensitization and Reprocessing (EMDR)

Website

EMDR International Association
A professional association for EMDR practitioners that maintains information about training and certification in the provision of EMDR.

Website

EMDR Institute
Founded by Dr. Francine Shapiro, the developer of EMDR, and provides information about research and training in EMDR.

Updated July 31, 2017

Date created: May 2017

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(Video) Eye Movement May Be Able To Heal Our Traumas | Tricia Walsh | TEDxUCDavisSF

FAQs

How effective is eye movement desensitization and reprocessing? ›

More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions.

What is the success rate of EMDR therapy? ›

Several studies have shown that Eye Movement Desensitization and Reprocessing (EMDR) is incredibly effective for those suffering from PTSD, with some showing as much as a 77% success rate.

Why is EMDR controversial? ›

EMDR therapy is a trauma therapy that is sometimes considered controversial. The reasons someone might think it is a controversial therapy option are the potential adverse side effects and the lack of long-term research. EMDR is safe and effective, but there are some risks associated with the therapy.

Does EMDR work if you can't remember? ›

will emdr work if i don't remember everything? If you're interested in EMDR therapy, you might wonder whether it will work if you don't have a clear recollection of events or remember a lot of details from your past. The good news is that you don't need to fully remember something vividly to process it!

Who is not a good candidate for EMDR? ›

If you're emotions feel overwhelming or if you tend to shut down when you feel an emotion you may not be ready for EMDR treatment. EMDR therapy relies on your body and mind's ability to process through your thoughts and feelings. If you're unable to process in that way, EMDR therapy may not be effective.

How long does it take for EMDR to work? ›

Each individual reacts differently to EMDR therapy, but as a general rule, a typical session will last anywhere between 60-90 minutes. Getting to the bottom of a traumatic memory and completely rewiring your brain can take anywhere between three to twelve sessions.

Videos

1. What is Eye Movement Desensitization And Reprocessing (EMDR) [for posttraumatic stress disorder]?
(Veterans Health Administration)
2. PTSD treated with rapid eye movement therapy
(FOX 13 Tampa Bay)
3. Eye Movement Desensitisation and Reprocessing (EMDR) with North Tyneside Talking Therapies
(NorthumbriaNHS)
4. What Is Eye Movement Desensitization and Reprocessing Therapy?
(brainline)
5. EMDR Therapy: Demonstration & Step-by-Step Walkthrough
(The Lukin Center)
6. Introduction to EMDR Therapy
(EMDR International Association)

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