In the 1980s, a literature professor named Francine Shapiro had received a diagnosis of cancer, triggering significant psychological shock. Anyone diagnosed with a life-threatening condition like cancer may be unable to cope with the stress that accompanies the diagnosis. When the stress following an event (in the case of Francine it was a diagnosis) becomes so severe that it is deemed traumatic, an individual is said to experience “PTSD” or Post-Traumatic Stress Disorder.
Francine felt completely hopeless to her diagnosis and the stress-response being produced by her body. By complete accident she noticed that by moving her eyes back and forth, she felt more relaxed and less stressed about her situation. Specifically, she noticed that if she moved her eyes side to side (laterally) or diagonally, she experienced a greater degree of relaxation.
Her self-discovered biohack of rapid-eye movement to cope with a traumatic experience would evolve into a psychotherapy technique known as “EMDR” – an acronym for Eye Movement Desensitization and Reprocessing. As a result of her own healing with EMDR, Francine felt it necessary to share with others. Since her initial accidental discovery in the 1980s, the technique is now regarded as a highly effective treatment for PTSD.
What is EMDR (Eye-Movement Desensitization & Reprocessing)?
EMDR is regarded as a form of psychotherapy developed by Francine Shapiro in the late 1980s, primarily for the treatment of PTSD (post-traumatic stress disorder). She believes that when we are faced with trauma, our brain is unable to process the event. In other words, the traumatic experience overrides our ability to cope and the brain becomes “stuck” as a result of the trauma.
The memory of the traumatic experience isn’t fully processed, and as a result, remains latent in our memory networks. This unprocessed, latent traumatic memory continues to wreak havoc upon the brain and physiology. An individual remains psychologically “primed” to any stimuli related to the trauma that they’ve endured.
The goal of EMDR therapy is to help an individual process their latent memories, thereby reducing their neural and physiological impact. By fully processing memories of the traumatic experience, an individual’s brain and nervous system are able to heal. This means that after the traumatic memory is processed, the parasympathetic relaxation response is able to properly function again.
8 Phases of EMDR (Eye-Movement Desensitization & Reprocessing)
EMDR isn’t a technique that can be done upon first visit with a therapist. Those that are interested in EMDR will need to find a licensed EMDR practitioner and work with them to determine whether they are a good fit for the procedure. Assuming the individual could benefit from the process, there are 8 phases of treatment to be conducted.
Each specific phase of the EMDR is regarded as having specific intentions. Most people think of eye movements back and forth with the procedure, but that’s just one of the eight phases. Think of the other phases as either preparation phases or reflection phases.
Phase 1: History and Treatment Planning
In the first phase of EMDR, a therapist will thoroughly evaluate a client’s history. They will collect data regarding the client’s psychological health and determine how long a they’ve held the trauma. Typically an in-person interview will be conducted by the therapist, allowing them to gather as much information as possible from the client.
This may span over the period of several therapy sessions to help a therapist get a better picture of what the client is dealing with. The therapist will take note of any troubling memories, particularly those that are related to the trauma. They will also note any other significant complaints made by the client – as these may become targets of memory processing.
The client will be informed of the treatment plan and the therapist will discuss the technique with the client. Various personal targets for the EMDR will become apparent to the therapist such as: disturbing events, trauma, unsettling emotions, or uncomfortable memories. In some cases, maladaptive beliefs are also identified (e.g. “I can’t trust anyone”).
Phase 2: Preparation
To better prepare for the later phases of EMDR, a psychotherapist will come up with some immediate coping techniques for the client. These coping techniques should help reduce the individual’s stress response or hyperactivation of the sympathetic nervous system. Examples of tools that can be used to help the client prepare for the later phases of treatment include: guided imagery, self-hypnosis, visualization, meditation, or other relaxation exercises.
This is an important phase of EMDR due to the fact that the individual is likely overstimulated to the point that they are not ready for the later phases. By slowly toning down the sympathetic nervous system, the individual with PTSD will have a better chance of reprocessing the memory. The preparation phase may take awhile, and progress may halt until a therapist can see that the client is adhering to the preparation instructions.
In some cases, a client may be asked to identify a “safe place” or “safe symbol” that represents peace, safety, and comfort. This “safe place” can be used in a later session to help trigger feelings of safety and calmness when a patient is attempting to tackle a highly unsettling trauma.
Phase 3: Assessment
Imagery: In the assessment phase, a therapist will ask a client whether they can visualize an image or scenery that resembles the disturbing event. This image should be a “snapshot” of the disturbing event and will be the primary subject of focus for the EMDR. For example, if a client was at war, they may visualize the combat vehicle that they were riding in during the trauma.
Cognition: As the client describes the particular image they’re visualizing, a therapist will ask the client to describe their specific thoughts about their visualized image. During this process, a therapist will note all negative thoughts or “negative cognition” (NC) related to the image of visualization. The same image is then held, and the client is then instructed to formulate positive thoughts or “positive cognition” (PC) related to it.
This portion of the EMDR may be distressing due to revisiting imagery associated with the trauma and the fact that many people fail to generate any positive cognition associated with the event. The goal is to come up with some degree of positive cognition related to the imagery that the patient fully believes. A therapist will ask on a scale of 1 to 7 how strongly the client believes their positive thoughts related to the image to be true.
If the client says “7” – it signifies 100% truth, whereas if the client says “1” – it signifies 0% truth. This 1 to 7 scale is referenced as a “Validity of Cognition” (VOC) scale and is considered successful in determining whether their thoughts are valid or invalid related to the image.
Emotional distress: Following the Validity of Cognition (VOC) ratings, a therapist will discuss the client’s emotions. The emotional distress is measured on another scale called the “Subjective Units of Distress Scale” (SUD). This scale takes measurements from 0 to 10 – with 0 meaning “zero” distress and 10 signifying maximum possible distress.
Body scan: The client is asked by the therapist to identify areas of their body in which they sense feelings of distress. Some individuals may feel choked up in their neck, a tight chest, or completely tense everywhere. Others may note a significant headache or other sensations related to the stressful emotions.
Phase 4: Desensitization
When most people think of EMDR, they think of the desensitization phase. This is the stage where the accidental discovery by Francine Shapiro comes into play. During the “desensitization” phase, a client will focus on a disturbing memory (related to their trauma), negative cognition, and bodily sensation related to the trauma for short bursts of 15 to 30 seconds.
During these short-bursts of focus on the disturbing memory, negative cognition, and emotional sensations – the client will simultaneously fixate their attention to a stimulus that initiates rapid, lateral eye movement. This secondary stimulus may be a pulsing bright light machine specifically engineered for EMDR or a therapist may wave his or her fingers in front of the client’s eyes. The goal is to initiate rapid-eye movement that aids in the reprocessing of the disturbing image.
The imagery is getting reprocessed as a result of the rapid, lateral eye movement. After each burst of exposure to “dual stimuli” (e.g. the disturbing memory and the lateral pulsing light), the client will be asked to give a subjective report of their experience. In other words if any thoughts, memories, emotions, physical sensations, or imagery surfaces – they will discuss it with the therapist.
Following the newly surfaced thoughts or sensations, the client will then be instructed to hold those particular thoughts for another burst of rapid, lateral eye movements. In some cases though, the newly surfaced thought will not be a target for another set of eye movements, rather the client will be instructed to revert back to the foundational imagery or target memory.
Throughout the process, a therapist will inquire about the client’s level of distress related to the foundational imagery or target memory. The desensitization phase is considered “complete” when a client answers with a “0” or “1” on the 1 to 7 subjective unit of distress (SUD) scale; indicating that the patient has experienced recovery.
Phase 5: Installation
As this phase is reached, a therapist will ask the client whether their positive cognition related to the trauma is still valid. After the “desensitization” phase, many clients may notice that their perspective of the traumatic event has changed, in some cases significantly. In some cases a client may need to generate a new positive cognition (PC) related to the event.
The newly generated positive cognition and the imagery of the event is then “held” and the therapist will ask how they feel. More specifically, the therapist will ask how “valid” the positive cognition is based on the Validity of Cognition (VOC) scale; “7” signifies 100% validity and is considered an optimal answer. During this installation phase, further bilateral eye movements are conducted.
This phase of “installation” is only regarded as being complete when the client feels as if their positive cognition is fully believed on the Validity of Cognition (VOC) scale. In other words, their positive cognition related to the event should have jumped to a full “7” signifying 100% truth related to their positive thoughts.
Phase 6: Body Scan
At this juncture of EMDR, a therapist will ask a client whether they feel any disturbing bodily sensations while fixating their attention on the target memory and positive cognition. A client may still feel: pain, distress, and/or discomfort throughout the body. The goal of the therapist is to pinpoint any lingering, unsettling sensations that remain.
Even simple feelings of tension and tightness related to the event should be reported by the client. The same bilateral, rapid eye movement technique is then used to effectively diminish the intensity of these sensations. In other words, should any feelings of discomfort remain, the client will fixate their attention on them while simultaneously engaging in the bilateral stimulation.
The body scan phase is complete when a client no longer experiences any surges of negative thoughts, unsettling emotions, or physical sensations related to the traumatic event. They should also now have established significant positive cognition (PC) without any discomfort.
Phase 7: Debriefing
During the debriefing phase, a therapist will give the client any additional support necessary to facilitate their recovery. The EMDR procedure may be discussed more in-depth as well as the client’s psychological state. The therapist will generally let the client know that they have successfully completed various phases of the procedure.
They may discuss the degree of progress the client has managed to make with their EMDR therapy. The client may reflect on how far he or she has come since initially enrolling in therapy. Often times the contrast of pre-EMDR and post-treatment is of immense benefit to the individual.
Phase 8: Re-Evaluation
A client may be instructed to keep a journal of their experience and/or review their week or weeks following the EMDR procedure. If any new sensations, emotions, or thoughts arise – they will be discussed with the therapist. The therapist may also want to reassess the level of disturbance related to the trauma once again to evaluate whether they have sustained their recovery.
In some cases, the initial trauma will warrant revisiting and another round of EMDR. Other individuals may find that EMDR helped immensely for one trauma, but they still have other traumatic experiences that remain unresolved. In other cases, certain individuals may find that EMDR just didn’t pan out as well as they had hoped.
This is why it is important to work with your therapist and come up with a plan of action for the future. If you feel completely recovered from your traumas and as if the EMDR was successful, you may not require any additional therapy. Both you and your therapist should work together to assess your psychological health.
Possible Mechanisms of EMDR
Below are some mechanisms by which EMDR is thought to elicit an effect upon both the brain and nervous system.
Brain activation: Some research suggests that traumatic events trigger significant arousal from the limbic system. Overactivation of the limbic regions corresponding to the prefrontal and orbitofrontal corticies explain the emotional arousal stemming from the traumatic event. Following EMDR therapy, activity in the limbic system and prefrontal and orbitofrontal correlates is minimized, while activity in the parietal-temporo-occipital regions increases.
Brain waves: The technique may alter electrical activity in the brain as a result of rapid-eye movement as well as revisitation of the traumatic experience. In a highly stressed state, it is believed that an individual has too much beta activity and insufficient alpha activity. It may be likely that slower brain waves may emerge upon resolution of the traumatic memories, leading to feelings of relaxation and inner peace.
Coping mechanisms: A therapist may help the client learn some ways in which he or she can cope with the traumatic experience and negative cognition. It is possible that teaching complementary coping skills may improve EMDR treatment outcomes. It is known that therapy can change the brain, and certain coping mechanisms (e.g. deep breathing) may change physiology.
Desensitization: At a certain point during EMDR therapy, a patient may become desensitized to the traumatic memory. In other words, thinking about the memory doesn’t initiate the stress-response that it used to. There is no surge of adrenaline or sympathetic overactivation characterized by bodily discomfort and negative emotion when an individual reflects on the trauma. This desensitization goes hand-in-hand with neurophysiological alterations.
Eye-movement: Inventor of the technique speculated that EMDR’s efficacy was related directly to the rapid-eye movement portion. Rapid-eye movement during EMDR is considered similar to rapid-eye movement experienced during sleep. Researchers speculate that the rapid-eye movement experienced during EMDR may induce a neurological state similar to that experienced during REM sleep – which aids in the processing of traumatic memories.
Parasympathetic activation: In the early phases of EMDR, a client is often instructed to engage in relaxation exercises. These relaxation exercises may involve things like guided imagery to facilitate a relaxation response. This targets a physiological component of stress and trauma by toning down activity in the sympathetic nervous system.
It is known that overactivation of the sympathetic nervous system is a hallmark of those that have endured trauma. This may simultaneously help slow brain waves and ultimately prepare our physiology to overcome the trauma. Throughout the entire EMDR technique, it is thought that the parasympathetic nervous system becomes more active; thus facilitating a relaxation-response.
Positive cognition: During the EMDR technique, a client is instructed to incorporate “positive cognition” (PC) associated with the traumatic experience. The positive cognition may be difficult to incorporate at first, but by gradually increasing positive thoughts about the experience, the patient is able to reframe the experience. The positive cognition may result in a substantial shifting of neural activity.
Reprocessing: As the traumatic memories are reprocessed during the EMDR therapy, activity in the amygdala is reduced. This is thought to be accomplished via interaction between the hippocampus and amygdala. As the hippocampus reprocesses the traumatic memory or experience, we no longer feel as much fear. This reduction of fear during the reprocessing significantly reduces amygdala activation.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/12115716
- Source: http://www.ncbi.nlm.nih.gov/pubmed/11748597
- Source: http://www.ncbi.nlm.nih.gov/pubmed/22622274
- Source: http://www.ncbi.nlm.nih.gov/pubmed/10225499
EMDR Therapy: The Research
Eye-movement desensitization and reprocessing emerged in the 1980s as a result of Francine Shapiro. However, it wasn’t immediately accepted by the mainstream as an effective treatment for trauma and other psychological disturbances. There is still some controversy in regards to whether it’s actually effective or nothing more than an anecdotal, placebo-esque hoax.
Evidence suggesting EMDR is effective
Below is some scientific evidence suggesting that EMDR is an effective intervention for PTSD and other negative life experiences.
2015: A publication in 2015 hypothesized the efficacy of EMDR for individuals involved in motor-vehicle accidents (MVAs). Those involved in motor vehicle accidents often experience PTSD and other negative emotion related to the experience. The post-traumatic stress resulting from the accident changes brain functioning.
The most notable neural alteration following an accident is the anterior cingulate cortex (ACC). The anterior cingulate cortex was found to experience the most pronounced change based on findings from fMRI meta-analyses of individuals in accidents. EMDR is thought to elicit significant benefit by altering the limbic system and ultimately altering fear-mechanisms stemming from the anterior cingulate cortex.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/25954183
2014: A study published in 2014 and authored by technique-creator Francine Shapiro highlighted EMDR’s clinical efficacy. This research evaluated 24 randomized, controlled trials suggesting that EMDR is beneficial for the treatment of emotional trauma and other adverse life experiences. In 10 studies comparing EMDR to trauma-focused cognitive therapy, EMDR was found to be more effective for treating emotional trauma.
Another 12 randomized studies of just the “eye movement” component discovered significant decreases in negative emotions as well as vividness of disturbing images. Other evidence suggested that EMDR provides relief from somatic symptoms (e.g. bodily sensations) related to the trauma. Shapiro’s analysis suggested that clinicians should consider EMDR as an efficient treatment for both psychological and physiological symptoms related to adverse life experiences.
- Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951033/
2014: A study compared the efficacy of EMDR with Prolonged Exposure (PE) among 74 adult female rape victims. Both techniques were also compared to a control group. To gauge the degree of improvement from these interventions, PTSD was assessed by blind independent assessors.
It was determined that improvements in PTSD symptoms were most notable in those who completed EMDR therapy or Prolonged Exposure (PE). There was no significant difference in efficacy comparing EMDR to Prolonged Exposure. This provides more evidence in support of EMDR as a treatment for PTSD.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/16382428
2012: A study published in 2012 compared the efficacy of EMDR to psychopharmacological therapy (psychotherapy + an SSRI) for the treatment of PTSD. Participants were separated randomly into groups: one group was treated with EMDR once per week, the other was treated with Sertraline (Zoloft) plus psychotherapy. Symptoms of PTSD were evaluated with the Clinician Assisted PTSD Scale (CAPS).
Results from the study confirmed previous findings that EMDR and Sertraline are clinically effective for reducing PTSD symptoms and subjectively reported levels of suffering. That said, the number of individuals that fully recovered from the PTSD diagnosis was significantly greater among those that were treated with EMDR. Researchers note that EMDR may be more effective than psychopharmacological therapy among those with PTSD.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/22622278
2008: A condition associated with significant psychological trauma is losing a limb. Loss of a limb can result in a condition known as “phantom limb pain” during which an individual reports painful sensations where their missing limb exists. A 2008 report analyzed the effect of EMDR on the treatment of phantom limb pain.
This small-scale study incorporated 5 patients with phantom limb pain spanning from a period of 1 to 16 years. EMDR was utilized on an in-patient or out-patient basis for each of these 5 patients. Prior to treatment with EMDR, it was noted that all patients were taking medications to treat their phantom limb pain.
Between 3 and 15 sessions of EMDR were conducted as an intervention for the phantom limb pain. Researchers evaluated: medications, pain intensity/frequency, psychological trauma, and depression. Results from the study determined that EMDR significantly: decreased (or eliminated) phantom pain, reduced depression, reduced PTSD symptoms, and reduced (or eliminated) usage of medications.
Despite the fact that this was an extremely small-scale study, the significant improvements cannot be dismissed. Researchers suggest that the EMDR was successful as a result of its ability to target memory storage accompanied by pain sensations. By reprocessing memories related to the trauma, researchers speculate that this leads to significant symptomatic improvement.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/18254770
2007: In a study published in 2007, the short-term efficacy and long-term benefit of EMDR was compared to a psychopharmacological intervention (an SSRI + psychotherapy). A total of 88 individuals diagnosed with PTSD (based on DSM-IV criteria) received 8 weeks of treatment. Some individuals received EMDR therapy, others received Fluoxetine (Prozac), and others received a placebo pill.
After 8 weeks of treatment, they were analyzed by a group of blind raters. These same raters evaluated patients at a 6-month follow up checkpoint. The Clinician-Administered PTSD Scale (CAPS) was administered to determine the short and long-term efficacy of the treatments, and the Beck Depression Inventory (BDI) was used as a secondary measure.
Results of the study suggested that psychotherapy was significantly more effective than the Fluoxetine (pharmacological therapy) in achieving sustained reductions in both PTSD and depressive symptoms. However, the notable caveat was that the sustained benefit only occurred among adult-onset trauma survivors. At 6-month follow-ups, approximately 75% of adult-onset trauma survivors receiving EMDR were asymptomatic.
Among childhood-onset trauma survivors, only 33.3% receiving EMDR were asymptomatic. By comparison, none of the individuals receiving Fluoxetine were asymptomatic at 6-month follow-ups. The study suggests that EMDR is effective and can reduce both PTSD and depression better than pharmacological treatment among those with adult-onset trauma.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/17284128
2001: A study published in 2001 analyzed 34 studies involving EMDR therapy. EMDR was found to be an effective treatment when compared with “no treatment” and “non-exposure” therapies. Despite the findings that EMDR was an effective treatment, it wasn’t found to be any more effective than other exposure techniques.
Furthermore, researchers compared success rates of the technique with “eye movement” and a revised version without the eye movement. They determined that the efficacy was the same, regardless of whether the technique incorporated the eye movements. Researchers concluded that the eye-movement portion of treatment may be unnecessary in regards to efficacy.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/11393607
Is there any evidence suggesting EMDR is ineffective?
For the treatment of PTSD, there’s a significant amount of evidence suggesting that EMDR is highly effective. In fact, EMDR is thought to be even more effective than first-line pharmaceutical options (e.g. an SSRI) in reducing symptoms of PTSD and depressive symptoms related to the trauma. While some studies suggest that certain components of the technique do not contribute to its efficacy (e.g. eye movements), the technique as a whole is scientifically supported.
That said, it is important to realize that like any intervention, EMDR may not work for everyone. There may be individuals with PTSD or negative memories that derive little or no benefit from the technique. Furthermore, it should not be assumed that EMDR is significantly more effective than other proven exposure interventions for the treatment of PTSD; they should be regarded as having equal efficacy.
Why you may want to try EMDR for PTSD…
There are a few obvious reasons why you may want to try EMDR for any sort of trauma or PTSD. Most notably, some studies suggest that EMDR is superior in efficacy to medication for treating trauma, especially if the traumatic experience was endured as an adult. Additionally the treatment is relatively low-risk and targets the root of the problem, rather than acting as a pharmaceutical “patch” (e.g. SSRI).
- Low risk: The risk associated with trying EMDR is extremely low. You aren’t shoveling pills down your throat, you don’t have to worry about dangerous side effects, and you won’t go through withdrawals. The only risk associated with this treatment is revisiting repressed memories and perhaps emotional upheavals – both of which are usually necessary for healing.
- May help a little: Some people may find that EMDR gives them a little benefit, but nothing substantial. In the case of PTSD, even a little bit of benefit can be a step in the right direction. Sometimes a “little” benefit may mean the difference between having a few “good days” per week versus all “bad days.”
- May help a lot: Other individuals will experience such a profound change as a result of EMDR therapy, that they feel like a completely new person after therapy. Many people are skeptical prior to their treatment and don’t believe that it’s going to help. After treatment commences, they feel significantly better and may no longer fit diagnostic criteria for PTSD.
- Clinical efficacy: If you are determined to overcome PTSD, this is a proven way to do it. Many people end up fully recovering or have minimal symptoms compared to they did pre-treatment. The clinical efficacy for EMDR is well-established and evidence in support of this therapy continues to accumulate.
- Another tool/adjunct: Those with severe PTSD will want to throw “everything but the kitchen sink” at their problem to improve their ability to function and performance. Impaired function including: social impairment, cognitive impairment, and occupational impairment – are all too common among PTSD sufferers. Giving EMDR a legitimate shot could end up making a significant difference in your prognosis.
Potential drawbacks of EMDR
There are several potential drawbacks associated with EMDR. These drawbacks should be considered before engaging in treatment.
- Seizures: Although experiencing seizures as a result of EMDR is extremely rare, it is possible. Those who are susceptible to seizures may want to consider the fact that rapid-eye movement, especially when accompanied with bright pulsing lights – may trigger a seizure.
- Trauma: All repressed memories and associated emotions may be brought to the forefront of your consciousness during EMDR. This may result in emotional upheavals and extreme discomfort. If you are not prepared to overcome this trauma, you may be tempted to throw in the towel and quit the EMDR therapy.
- Feeling worse: Quitting EMDR without finishing may leave you feeling worse than before you started. In other cases, you may even finish the EMDR and end up feeling worse as a result of revisiting your trauma. If the EMDR doesn’t desensitize you to the trauma and/or help you reprocess it, you may walk away from the therapy feeling worse; this is considered rare.
- Waste of money and time: Those that don’t derive any significant benefit from EMDR may feel as if they’ve wasted a lot of money and time. It can take a long time for you to complete all eight phases of therapy. Even after you are complete, you may need to revisit certain portions of the therapy if you fail to experience improvement. Those that don’t respond well to the technique may feel as if they’ve been scammed.
Personal Experience with EMDR
In 2006, I worked with a psychotherapist licensed to conduct EMDR. At the time, she was adamant about me trying EMDR and we followed the 8-steps. She gave me a bunch of paperwork, but I honestly didn’t read it, so didn’t know what to expect. I was highly skeptical of the technique and since it didn’t involve swallowing a pill, an injection, or hooking electrodes up to my brain – I remained highly skeptical.
Over time, we established a good rapport and she gradually helped me reduce activation of my sympathetic nervous system or “fight-or-flight” response. For me, I believe that the single most important aspect of the EMDR was the psychotherapy along with the suggested relaxation techniques. When I reached the phase of the “pulsing lights” moving back and forth, I actually enjoyed the experience.
Revisiting the trauma helped significantly, and the technique provided me with some degree of benefit. It didn’t cure my PTSD – overcoming it required several more years worth of effort without any further EMDR. However, EMDR did help lessen the psychological distress associated with the traumatic memory.
To say that EMDR did nothing would be shortsighted, but to suggest that it was super effective is an exaggeration. My therapist and CBT helped significantly more than the EMDR technique, but I don’t regret going through the process. I like to think of EMDR as another tool for promoting recovery and healing.
Conditions that may benefit from EMDR
Below is a list of conditions that may benefit from Eye-Movement Desensitization and Reprocessing.
- PTSD: Most evidence suggests that EMDR is highly effective for the treatment of PTSD.
- Anxiety disorders: Certain types of anxiety disorders may also benefit from EMDR.
- Panic disorders: Individuals with panic attacks may find that EMDR reduces the number of panic attacks they experience or the intensity of the panic.
- Public-speaking anxiety: Some researchers believe that EMDR may even help individuals with anxiety related to public speaking.
Have you tried EMDR?
If you have experience with Eye-Movement Desensitization and Reprocessing (EMDR), feel free to share your experience. Mention whether you noticed significant benefit, found it to be ineffective, or whether it may have made things worse (another possibility). If you’d like, you could also compare EMDR to other interventions and mention how they compared in regards to efficacy.
For those that derived benefit from EMDR, how can you be sure that it was in fact the technique or another variable such as psychotherapy? To help others better understand your experience, mention how long the EMDR process took (e.g. number of sessions). Understand that some people may get significant benefit from this technique and most scientific evidence highlights its efficacy over a placebo.
I have an extensive childhood history of complex trauma and have found EMDR to be nothing short of miraculous for me. In the last 15 years, I’ve engaged in a number of evidence-based treatments, including prolonged exposure therapy, and I have found something beneficial in all of them.
Prolonged exposure permanently reduced my hypervigilance by about 80%. (nine years ago and still going strong.) But nothing helped me resolve my complicated emotional attachment to my mentally ill, abusive mother the way EMDR did. When you’ve been in therapy for years rehashing the same obsession (I love my mother, I have to protect my mother from herself, I have an obligation to my mother because I got out of the trauma cycle and she didn’t, she’s mentally ill, she’s a victim), you stand up and take notice when something makes a difference.
Just so we’re crystal clear about the level of trauma I’m referring to, one of the issues we dealt with is she orchestrated opportunities for me to be sexually abused by her husband when she first suspected it at age 11, and then abused me for years as punishment, and then abused me more for finally telling the truth when I was 17.
This woman made my life a living hell for something she allowed to happen to me. I’m not talking about some minor one – off trauma, but a profoundly unhealthy relationship that haunted me my entire life. She was egregiously emotionally abusive and threatened to kill me multiple times, yet I loved her. Oh, how I loved her. I was the only one who really understood her.
In 2016 I decided to try EMDR. My expectations were low, I was skeptical about the theoretical murkiness, and I was concerned I might destabilize and lose my job. But we (husband and I) decided to risk it because my grief and guilt about my Mom was taking over my life. I was crying every day. This is going to sound infomercial absurd, but for me it was as easy as speaking a new truth and instantly believing it.
The weird thing about EMDR is you’re the one making all the mental connections. It’s just happening really really fast. I felt like I did the work myself. It was all just in there waiting to be put together. I did two three-month stints about one year apart (new information came to light that I needed to process.)
I realized: 1. I wasn’t crazy, my childhood was exactly as messed up as I perceived it to be, and 2. My mother is not just a person with diagnosed Borderline personality disorder, she’s also paranoid delusional. I’ve been trying to be understood and accepted by a person with no concept of what is real. That was easy enough for me to accept, as her brother was schizophrenic and it explained soooo much about my childhood.
Once I realized that, I stopped taking my failure to get through to her so personally. I stopped taking her abuse personally. I haven’t spoken to my mother in two years. I used to feel outrageously guilty about that. The other day my Aunt was telling me about the latest thing my Mom was doing to make the family miserable, and I just thought, “Huh. Have fun with that,” and moved along with my day.
I don’t wish her ill and I don’t think what I felt for her was love. It was Stockholm Syndrome. Here I am, age 35, free at last, because of EMDR. I’m going back in two weeks to deal with the stuff I’ve been avoiding completely. The part I’ve been telling myself for years is not the real problem. I have to face what my stepfather did to me for all those years.
I’m afraid, but I’ll be okay. One of the things that came out of my first round of EMDR is the ability to trust my own judgment about what I need. My case is unusual, but it’s real. I asked the therapist why he thought it was working so well for me.
He said you have to have a willingness to go into those dark places, you have to have a lot of self insight, and you have to be able to draw connections between various areas of your life. I think you have to have a certain innate skill set to begin with. You have to be ready. I guess I’m ready.
Speaking from personal experience, EMDR has been integral in my treatment of Complex PTSD. Yes, my relationship with my therapist is paramount, as she is my guide through the wilderness of long-held trauma and its merry band of long term effects.
No, it’s absolutely not a quick fix, agreed. There is no such thing as a quick fix when it comes to re-integration, but that’s not the point. The point is that if therapy supplemented with EMDR helped me, it’ll likely help someone else too, and that’s something of incalculable worth.
I was never lead to believe that EMDR would be an easy fix, and that’s good, because god knows it hasn’t been. Hardest work of my life, I swear, but I’ve never known anything to be so rewarding. EMDR is an important part of that. No, it’s definitely not as important as my commitment to myself, nor as important as the skill and kindness my therapist wields when helping to parse through what EMDR opens up.
Still, it should not be discounted simply because it’s not yet fully understood and all too often administered by those who have no business doing so. “The best EMDR can offer is when people think of their trauma once they are cured by using EMDR they are not triggered and do not particularly feel any strong feelings either way about what happened to them.”
To address this point directly, allow me to showcase the diplomacy skills I’ve worked so hard to cultivate. As a statement, that’s upside down and backwards. I’ve processed some big, nasty, horrifying stuff, I mean, think “torture” and you’ll get close. When I think back on the memories associated with that particular cluster, you bet I’ve got some strong feelings.
How could I not? Difference is, those feelings are properly understood on a cognitive and emotional level to be about an event in the past. Thus, they lose a lot of poison, a lot of gravity, and thus there’s no more dissociation and no more flashbacks. No, it’s not easy to think about, yes it’s still painful, but it’s a whole other animal than the violence it held before processing.
Living day to day with untreated PTSD is like pushing a boulder up an ever increasing incline, and I’d like to not be one more obstacle of “invalidated” of “unfixable” of “jargon and statistics” along the way to someone finding the help they need and deserve. If you have PTSD, it’s worth it to find yourself a good therapist, one you trust, and don’t wholesale dismiss EMDR right out of the gate.
Maybe it’ll mean something to you, and maybe it’ll help you in a way that’s real. Who knows. Everyone’s brain has its own sort of schematics when it comes to the effects of PTSD and how to navigate and re-integrate therein. You won’t know if you don’t find out for yourself, but I think it’s worth at least a little exploration.
I don’t know if anyone with PTSD is reading this. If there is though, listen to me. There are things out there that work, that will work for you and there are people out there who get it and who care. Believe it or not, there’s also hope.
I forgot one note about my personal experience with processing traumatic memories that I think needs to be made. I’ve experienced profound shifts of understanding toward myself that have reshaped and enriched the way I’m able to view my past, present and future. Aided in part by EMDR. I have discovered deep compassion and respect for myself and what I have survived.
This is what recovery looks like: Seeing your strength and your humanity side by side and knowing whatever the future throws at you, you’ll be fine because you already know you’re made of tough stuff. Emotional upheavals, check. Extreme discomfort, oh yeah. Repressed memories coming back into focus, like you would not believe. It’s all been worth it. I can’t tell you how worth it.
Therapies as a whole that introduce quick fix solutions like EMDR and EFT are just the placebo effect working at it’s best. It is quackery that some people will buy into and so it will have amazing effects. The main role of any therapy is the healing relationship between a therapist and the client, the modalities used are almost inconsequential.Let me explain: if one uses the principles of Neuroplasticity referring to the brain’s ability to reorganize itself by forming new neural connections throughout life, this ALWAYS works.It doesn’t work for some people and not for others which is how quack therapies work. Even when a person engages in Mindfulness (for example) for a short period of time this creates changes in the neural pathways. Again if done even for short bursts of time it creates changes in the brain that are stable and permanent . This is science and not quackery.
So when Trauma occurs the body-mind gets overwhelmed and it is believed that this creates a short circuiting in the brain. What happens is that unless the nervous system is well calibrated and fundamentally healthy, the person experiencing the trauma will not bounce back (this is the reason why some people deal with trauma better than other and some people go onto have PTSD while others do not). When those that do not bounce back because their nervous systems were overstimulated to start off: the brain starts rewiring itself.
Which is where the PTSD symptoms come in. It’s essentially the brain becoming way too sensitive and hyper active. This rewiring can be changed by not feeding into the compulsion of fear as this will allow PTSD symptoms to persist and get worse over time. This does mean consciously re-wiring the brain to not respond to over sensitivity. Alongside this is the need to practice some form of relaxation that will calm the nervous system.
This is obviously NOT the quick solution that EMDR promises, but it WORKS every single time, and the results are permanent. It also sets an important foundation to trauma proof you for possible future traumas, something EMDR does not do. The integration that EMDR promises cannot be had by simple movement of the eyes. Integration to be permanent and effective is a body-mind acceptance and understanding and most importantly re-arranging and making sense of the trauma that fits into a person’s post-trauma life narrative that becomes empowering and allows the person to feel like they are stronger and better equipped to deal with future difficulties.
The best EMDR can offer is when people think of their trauma once they are cured by using EMDR they are not triggered and do not particularly feel any strong feelings either way about what happened to them. I have never heard of anyone cured by EMDR having experienced any visceral shifts that result in permanent integration.Or even a profound sense of understanding of what happened to them and a sense of overcoming that is typical of integration that happens the way the body-mind intended it to. There is a role for therapies of all sorts: the most important being the healing relationship between the patient and the therapies whatever other modalities work is almost inconsequential.
But true recovery takes time. The person in recovery has to be patient and dedicated to making a full recovery. I am always weary of people offering therapies that offer short cuts because these never offer permanent solutions. If anything the reason EMDR took off is because it offered respite of not being intrusive on patients that were previously being re-traumatized by their therapists in order to get better. We now know that re-traumatizing patients is not only unethical but unnecessary as this simply hardwires the brain more deeply into the trauma creating so many unwelcome complications.
For the record I tried EMDR and EFT and it had absolutely no effect, but it seems like I am not alone. However these cases are rarely read about online as it does not seem to fit in with the overwhelming bizarre distribution of so many articles talking about trials that strangely attest to EMDR being highly effective most if not all of the time.
“The main role of any therapy is the healing relationship between a therapist and the client, the modalities used are almost inconsequential.”
You’re speaking to a profound cultural rift in approaches to psychotherapy and the line you’re drawing is really more about dogma than evidence. The therapeutic relationship accounts for a modest portion of the variance in mental health outcomes but I think you are quite minimizing how important the treatment modality itself is.
Why can’t both matter? My husband is a behavioral psychologist. He’s also really good with people. You know what happens when you combine an excellent therapeutic relationship with a solid evidence based treatment? More people get better than if you only have one or the other. When you act as if evidence based treatments and therapeutic relationships are mutually exclusive concepts, you undermine the field as a whole.
Never heard of anyone radically viscerally changed by EMDR? Now you have. I was also radically viscerally changed by prolonged exposure, which has one of the single most robust evidence bases among all of these treatments. I barely remember the therapist who did that for me, in fact we didn’t have much of a relationship at all, but bless her forever for bearing witness.
I assume by “retraumatizing” that was an unfounded shot at exposure therapy. EFT isn’t an evidence based treatment so I don’t know why you would mention it in the same breath as EMDR. The only problem I have with EMDR is the theoretical underpinnings aren’t clear, which means we don’t know why it worked so well for me, but not for you.
I have found every explanation for its efficacy thus far unsatisfying. I hate that. But I can’t deny the clear evidence in favor, nor how it radically changed me personally. In fact I’m much better at handling new emotional events ever since I did the therapy. It’s like my brain learned how to do it all by itself, in rapid time.
Certainly there are other paths to integration, I’ve done those too. But that’s what blew me away about EMDR. It did in three months what talk therapy couldn’t do in ten. Same for exposure. You have to be really brave to do exposure though. EMDR was cake after what I went through with prolonged exposure.
EMDR is a much lower daily time commitment (exposure was 2 hours a day every day), and much less distressing (the goal in exposure is getting your SUDS to 100.) Exposure helped significantly with my pervasive feeling of danger. I’m no longer hypervigilant or hyperaroused most hours of the day, and it has been, again, nine years since I did that treatment.
But exposure therapy was dealing specifically with parts of the abuse where my life was at risk, and I thought I was going to die. EMDR is more about the emotional aftermath of the abuse. EMDR also seems to have a much lower risk of backfiring. If you quit prolonged exposure without first desensitizing, you really can make it worse.
I got much, much worse in the short term and my faith in science is what got me through it. That’s why it’s critical to do this kind of work with trained mental health professionals. I was very lucky that I had it done at the research clinic of Edna Foa in Philadelphia. There is no better place in the world to do prolonged exposure for PTSD.
Reasons research results often look better than real world results is: (1) mediating factors such as comorbid disorders, poverty, cultural differences among populations, etc and 2) therapists doing it outside of clinical settings may not be effectively trained. Pretty much anyone in the field can call themselves an expert at anything, doesn’t mean what they are doing is what was done in the studies.