EMDR Therapy: How Does It Work?
What is EMDR?
EMDR (eye movement desensitization and reprocessing by its technical name) is a relatively new form of therapy being used in treating many kinds of anxiety and stress disorders. It's showing great promise for all age groups.
It's also being used to treat things like depression, anger management and posttraumatic stress disorder. But more on that in a bit.
To describe this therapy technique briefly, it involves stimulating the right brain and the left brain simultaneously through eye movement. This in effect helps to restore harmony in the central nervous system, which is where anxiety and stress feelings can become trapped.
The concept of EMDR is that by recalling the events that have become trapped in our nervous system that make us anxious, cause us to have phobias, or to react badly to certain things, we will be able to process them in a positive way and finally resolve the negative feelings. This results in loss of the anxiety that we have experienced and teaches us a new way to handle the stressor.
It should be pointed out that this is a therapy that has eight different phases. Even though that seems like an enormous amount of time to put into curing for instance one problem, it really isn't. Even if a therapist trained in EMDR focuses on only one painful or stress producing memory, it's worth the effort to go through the process. Why? Because it teaches your mind and thus your body to handle stresses differently in the future. The concepts are easily applied to other incidents in life that perhaps might be similar, whether they are past, present or future.
In order to receive the full benefit of EMDR, it's necessary to go through the preliminary stages before getting to the real meat and potatoes of the therapy itself.
EMDR is being used to treat many disorders like PTSD successfully. You can even learn to self-administer EMDR therapy in any situation.
Phases of Treatment in EMDR
Treatment with EMDR actually consists of 2 different elements--a preparatory phase and then an actual physical part where the stimulation and reprocessing begin.
You must complete step 1 to be ready to go on to the more involved 6-part therapy of step 2.
Step 1: Before therapy begins
- Obtaining a history and creating a treatment plan
- Preparation and relaxation techniques
Step 2: Therapy begins
- Assessment - selecting image and describing feeling associated with it
- Desensitization - tapping/buzzing/left and right brain stimulation begins
- Reprogramming - replacing negative thought/feelings with positive
- Body check on how anxiety level is
- Closing the door to feel better at the end than at the beginning
- Reevaluating what was processed
Each step in the process of the treatment plays a vital role in the overall plan of therapy.
-History and Treatment Outline
In order for EMDR to be effective, no matter what the type of anxiety it is being used to treat, there must be an outline complete with images that the therapist will target. This takes some time to develop, as the client must be forthcoming in the disturbing events that he or she wishes to eradicate.
-Relaxation Training and Readiness
To participate in an EMDR session, it's necessary to have certain relaxation techniques in place and to have a "safety valve." For some people, revisiting unpleasant scenes and recalling horrific images could potentially overload their system and their psyche. In anticipation of the possible anxiety that can be evoked during a session of actual EMDR stimulation, it's important to know ways of "coming back."
These can include deep breathing exercises, visualizing a pleasant place, a safe place, or mentally opening a drawer and putting the image into it, closing it temporarily.
Another technique that's helpful in promoting self confidence for someone during an EMDR session is to have a visual circle of support. The therapist may ask the client to name people in his or her life who have always been there for them and to visually construct a welcoming circle should they need to enlist someone's help during stressful moments.
These two phases are necessary before moving ahead with the actual visualization of the images causing the stress or anxiety. At any time during the next four phases, should the client experience difficulty, he or she has only to hold up a hand or say "stop." There is no pass or fail with EMDR therapy.
-Looking at the Image
When this part of the treatment begins, it is not a discussion of it that occurs. The client is asked to mentally "go back there" and revisit the painful moment. This is the only way to pry the unwanted feelings loose.
The therapist will ask the client to also vocalize the feeling associated with the image. If it is sexual abuse for instance, the client might say "I'm dirty" or "I'm helpless." Over the course of the next few minutes, the client is asked to stay with the feeling while the tapping or alternating stimulation begins.
Physical reactions are not uncommon; for instance, fast breathing, sweaty palms, tears, fright. The client is in fact "in the moment" again. The therapist will ask the client to validate what the level of the stress is on a scale of 1-7 (Validity of Cognition or VOC scale). This means how deeply is the image being perceived.
-Desensitization - Right/Left Brain Stimulation
This is where the actual release begins. The negative feelings that are trapped inside the nervous system are felt by the client but through a series of repetitions of sounds, movements, or physical taps, the client is led gradually from a bad image to a better image.
For instance, stepping outside the image and watching it, as if on a moving train, or perhaps looking in a window at it as an observer rather than as a participant. This is when the circle of support can be very helpful as they can mentally offer advice or encouragement to the sufferer.
-Reprogramming - Installing a New Cognition
A positive cognition (thought) is also used to replace the bad feeling or thought. The "I am dirty" or "I am helpless" is replaced with "I am fine just how I am, I am good" or "I am strong and no one can hurt me anymore." The therapist keeps repeating the above steps until the SUD (Subjective Units of Disturbance) scale is close to 0.
Note: For some people, it might stay at a 1 or 2 even after trying multiple times. That is not unusual and is a marked improvement from the high level of anxiety at the beginning. With time and more work, it can be reduced to 0 but in some cases, might remain at a 1 or 2. The goal of the therapist is to get to a 0 every time, however.
The therapist will suggest that the client look at things in a different light or ask him or her to disengage from how they previously felt during the episode. This image can oftentimes effectively "change" the old image into a newer improved image during the stimulation.
The important thing to remember is that honesty is the only policy here. The client should be forthcoming about any reaction that he or she is having and about the resolution of those feelings on an accurate scale.
-Comfort Level - Body Scan
An EMDR session cannot end with the client still trapped in the bad feelings or tied up with the negative cognition.
This means that peace has to replace the anxious or stressful feeling. By working through the exercise, when the client recalls the image now, it is not with anxiety or distress. Instead, they may have a rather detached feeling about it.
Their body will also feel subjectively normal again, meaning it is free of tension. If there was a burning sensation in the stomach, it is replaced by a warm feeling. If there was stress in the chest at the beginning of the treatment, it has now eased. Breathing is back to normal and pulse rate has returned to normal.
-Closure of the Session and the Image
Someone who has worked with EMDR cannot just turn on and off like a light switch. There has to be some processing and decompression time after the actual therapy to get one's bearings. The therapist will ask how the client is feeling and even ask some cognitive questions to make sure the person is back in the "now" and not trapped somehow in the past.
He or she may ask what your plans are for the rest of the day or evening or what you plan on doing. He or she may even toss you a ball to make sure your coordination is alright before leaving the office.
-Evaluation or Reevaluation
Talking over the exercise and what insights the client gained is also common or thinking forward to applying it to other situations might come up. The therapist will probably advise the client that the work is sometimes not completed during the session. This means that the client can experience dreams or thoughts about the image after the session is over, but the rules during the session still will apply.
For instance, if there is a resurgence of the image or bad feelings, the breathing techiques or relaxation exercises can be recalled by the client. The circle of support is still there for the person going through EMDR and they can be called upon at any time to mentally step in.
Does EMDR Work?
This treatment is showing much promise and in a relatively short period of time.
Here are just some of the targets for EMDR therapy:
- Loss of an arm or leg
- Drug addiction/alcoholism
- Anger management
- Violent behavior
- Fears and phobias such as fear of flying and agoraphobia
- Violent crimes such as rape/assault/robbery
- Traumatic childhood events
- Serious accidents
- Child abuse
- Sexual abuse
- Low self esteem
- Panic attacks
Certain problems can be cured by relatively few sessions while other, more severe traumas may take longer to heal. However, it is a psychotherapy technique that seems to be working in many avenues to rid people of unwanted baggage.
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