Eye movement Desensitization and Reprocessing (EMDR) Therapy

EMDR stands for Eye-Movement Desensitization and Reprocessing, a leading Psychotherapy technique widely used by trained mental health professionals to help individuals reprocess traumatic events, PTSD (Post-traumatic stress disorder) and other unsettling experiences. It follows a structured pattern and a humanistic approach, that the clients possess everything within themselves to facilitate their healing process. We will be diving deeper into the entire and step-by-step procedure of EMDR therapy but first, let us look back at the history of EMDR Therapy.

History of EMDR Therapy

Developed by Dr. Francine Shapiro in 1987. Shapiro, accidentally discovered this technique while walking in a park. She was contemplating her own unsettling experiences and noticed her eyes moving back and forth spontaneously. As a psychologist, she got curious as to what had happened and later noted that recalling upsetting events along with moving her eyes, enabled her to cope with disturbing thoughts and it became less overwhelming. Then she began to experiment with what was found and came up with a structured therapeutic tool, the EMDR Therapy.

The Dynamics of Trauma

Traumatic events overwhelm our brains and impact our capacity and ability to make sense of what has happened. It disrupts the complete procedure of processing the event. Due to this, the memory of traumatic experiences is stored in our body differently in comparison to our other life experiences. Since the processing of the traumatic event was affected, our brain does not process that event fully. Now, on a fine day, when we encounter any stimulus that is similar or serves as a reminder of our past traumatic experience, then those experiences get activated in the form of flashbacks, bad dreams, physiological arousal like sweating, racing heart or intense feelings of emotions.

How EMDR Works

Like any other therapy, EMDR also requires establishing a therapeutic relationship with the client where the individual is provided with a safe space to express themselves and their experiences freely. EMDR helps the brain to process the traumatic memory in chunks by focusing on different aspects of the memory gradually, rather than focusing on the overall memory at once.

It is also important to ensure that the client will make a good match for this therapy technique as it involves recalling past experiences and reliving the trauma for a while. Therefore, the client must have access to resources like social support, positive life experiences, etc so they can rely on them when they feel overburdened. EMDR involves 8 distinct phases of treatment

1. History Taking and Treatment Planning

The therapist gathers information about the client’s history, trauma, and current problems faced and then specifies which memories, emotions and negative beliefs must be targeted and reprocessed during the treatment. For example- A woman had a traumatic experience of a car accident. The therapist will gather information on what happened on that day, which aspect of that day terrifies her the most, and what she feels whenever she sees a car.

2. Preparation

The client is provided with complete details about the EMDR process. The individual is also taught coping and relaxation strategies which can be used during and in between the sessions to ensure a sense of safety and security. A few relaxation strategies that can be helpful

• Visualizing a Safe Place: In this technique, the client is asked to mentally visualize a safe spot for them either during the sessions or outside the therapy room. This spot can be real or imagined. The therapist guides the client to create a detailed mental image of how they would want their safe place to be, like what all would be there (their pet, something warm to drink, sitting tucked in between their loved ones), what would be the colour of the walls, curtains, what will they feel in that place and so on. If any sort of distress occurs during or after the session, then this would help the client to self-regulate their emotional state, stay grounded, and get relaxed.
• Grounding Techniques: When the therapist feels that the client is getting swept away by the feelings of intense emotions, they guide the client to indulge in grounding techniques which would aid them to revert from experiencing traumatic memories and focus on the present. Common grounding techniques are- focusing on the feelings of the feet on the ground or describing the details of the therapy room. 
•  Progressive Muscle Relaxation (PMR): This involves, systematically tensing the muscles first and then relaxing them. Helps the client to be aware of the areas of muscle tension in their body and then to release them mindfully. The therapist guides the client to focus on one group of muscles at a time like- hands, arms, feet, legs, and shoulders, tightening the muscle and then letting go of the muscle tension. 
• Positive Self-Talk: The therapist asks the client to list the negative beliefs that are attached to the trauma and themselves, and then guides the client to replace those negative beliefs with positive ones. For example- Shifting from the negative belief “I am vulnerable and I can’t protect myself” to a positive one “I am in control and possess everything within me to heal myself.
• Deep Breathing: This technique is often used in EMDR to set the body free from the fight-or-flight mode and help the body to relax, recover and conserve energy by activating the Parasympathetic Nervous System. In this, the client inhales deeply through the nose, letting their belly rise, holding their breath for a few seconds, and then exhaling slowly through the mouth.

3. Assessment

The therapist asks the client to focus on disturbing aspects of memory, including visual images, emotions, and physical sensations along with positive aspects which they would like to adapt. If the woman feels that she is powerless and lost control then the therapist helps her to adopt a positive aspect that she is in control of her safety. (The client is asked to rate their level of stress on a scale of 0-10 while recalling the negative aspects.)

4. Desensitization

This is the process of making someone less sensitive or reactive to something and is very crucial as it aims to change our relationship with the traumatic event.
In this process, the therapist guides the client to recall the traumatic memory while engaging in bilateral stimulation (stimulating both sides of the brain alternately). This can be performed by moving eyes from one side to the other, tapping, or through therapy devices like the Thera tapper.

This process provides dual awareness, as the client recalls the past event and at the same time the interference of bilateral stimulation, allowing the client to be in the present, providing them with a sense of relief and comfort that they are in a safe place, with their therapist. Gradually, the intensity of the stress attached to the trauma reduces, allowing the brain to heal and process the memory. The therapist asks the client to rate the level of stress again. This process goes on till the stress level is reduced.

5. Installation

Next, the focus is on strengthening the positive belief by using bilateral stimulation to reinforce it. While engaging in bilateral stimulation the woman would focus on thoughts like she is in control of her safety, she is completely safe now and is grateful.

6. Body Scan

After the memory has been processed, the therapist asks the client to scan the body for any physical tension like soreness of muscles, stiffness, or pain in any specific part of the body.

7. Closure

At the end of the session, the therapist assists the client in regaining emotional stability and ensuring that they are at peace before leaving the therapy room.

8. Re-evaluation

In subsequent sessions, the therapist assesses if the client’s relationship with the traumatic event has changed, how the client now feels about the past event and if further sessions of processing are required or not.

Effectiveness and Research

EMDR therapy is a top-tier recommended therapy for trauma and is found to be extremely effective. Individual differences are also found as some did not find it effective. Organizations like the American Psychological Association (APA) and the World Health Organization (WHO) recognize EMDR as a valid treatment. Scientific explanations as to why EMDR is effective:

• Moving eyes side to side during EMDR, activates the brain’s natural memory processing mechanism which is the same that gets activated during Rapid Eye Movement or REM sleep (the stage of deep sleep). This is when we dream and at this hour our brain processes memories and experiences. Thus, we tap into our brain’s built-in capacity to process and make sense of memory in EMDR.
• Following a holistic approach of focusing on both emotional and physiological distress, EMDR allows individuals to release the trauma stored in their minds and body, helping them to feel more in control
• EMDR facilitates a reduction in the overactivity of the Amygdala (the brain’s fear centre) which makes people less impulsive and reactive while recalling past experiences.
• It promotes increased function in the Prefrontal Cortex, the part of the brain that oversees rational thinking and emotional regulation. 
• Through desensitization, we repeatedly expose ourselves to feelings of distress and discomfort, making it less overwhelming with time. 
• As the influence of overwhelming emotions weakens, people naturally have a more positive and realistic outlook about the traumatic event. 

Side Effects of EMDR

• The process of EMDR can be overwhelming as it exposes us to physical and emotional distress which can wear us down and cause fatigue, headache, dizziness, etc.
• Emotional response to EMDR Therapy is not confined solely to the therapy sessions. It can surface and catch us off guard even after a few hours or days after the last session.
• It can cause temporary emotional distress while recalling past events. At this time the emotions are intensified.
• Physiological arousal like a racing heart, sweating, panicking, and uncontrollable cries can occur as well.
• It can lead to increased awareness of past memories and temporary worsening of symptoms.
• If not conducted by a trained and experienced professional then one can get retraumatized.
• Some people can also experience nightmares.

Some common Myths about EMDR

1. EMDR creates False Memories: It helps to reprocess only those memories that already exist.
2. EMDR is only for Adults: It can be administered and can produce effective results on children and adolescents as well.
3. EMDR is like Hypnosis: EMDR is very different from hypnosis as in EMDR the client is fully present in the moment and has full knowledge and control over what is going on.
4. EMDR is too basic to yield results: The process of EMDR can seem very simple, although it is a complex psychological process that has been recognized to produce effective and remarkable results.
5. EMDR only uses Eye-Movements: Originally, EMDR started with Eye-Movement but now other forms of bilateral stimulation are used as well, like- hand tapping, auditory stimulation, Thera Tapper etc.
6. One cannot use EMDR if they are on Medication: It is important to note, that EMDR does not provide any medication but it can be used on an individual who is undergoing medication for mental health issues.
7. EMDR erases Traumatic Memories: EMDR does not erase the memories that cause us distress and discomfort. It works on reducing the emotional intensity attached to the trauma, making it easier to manage.
8. The effectiveness of EMDR fades away: EMDR has been researched on extensively and continuously since its emergence in the late 1980s and has established a reputation for providing long-term and lasting results.
9. EMDR requires a Detailed Description of Trauma: It is completely alright to not get into the depth of the incident. Merely describing your thoughts, feelings, and emotions can also facilitate the desensitization process.
10. EMDR gives Instant Results: The effectiveness and duration of recovery is a highly personalized experience. For some, only a few sessions can lead to transformational results whereas for some it can take a bit longer.
11. EMDR is Effective for all: The effectiveness of EMDR also depends on how and on whom it is conducted. A mental health professional must be well-trained in practising EMDR and should be able to recognize who can benefit from it.
12. EMDR cannot be conducted Online: The EMDR International Association has found that EMDR can also be administered online and can be effective if the therapist is well-trained and a strong therapeutic relationship has been established with the client.
13. EMDR is only Effective for Trauma: Though EMDR is highly effective for those who have experienced a single trauma or a single type of trauma, it can also be beneficial for individuals with depression, anxiety, grief, panic attacks and even for performance-related issues.
14. EMDR can be Self-Administered: Few individuals try to explore EMDR by themselves which can be really challenging and can cause harm due to lack of safety and support. Also, it is the work of two people to conduct bilateral stimulation effectively which is one of the core essences of EMDR to ensure a successful result.
15. The therapist is always in the Driver’s Seat: It is believed that the entire work is done by the therapist and they have complete control over the therapy sessions without letting the client have any say. EMDR is more like having the client in the driver’s seat and the therapist sitting next to the client, navigating through the past experiences together. The client has complete freedom over when to start the engine, when to take a break and when to get down of the car all together. A therapist would be just guiding the client on which turns to take and let them know if they are going down the wrong lane.

Conclusion

EMDR is a powerful and impactful therapeutic technique, allowing us to reprocess and desensitize the traumatic event in short tolerable amounts, which enables our brain and body to remove the mental blocks so that the healing principle may be released and we revive our inner state of harmony. For EMDR to be effective, it must be administered by a mental health professional specially trained in this domain as a little negligence can worsen the condition and retraumatize the client.

EMDR has been influential since the 1980s and now it is widely recognized, accepted, and celebrated as one of the top-notch techniques to deal with and manage stressful life experiences. It might come out as a strong and scary process, but if we put some thought while keeping our fears and negative beliefs aside then we will come to realize that the primary focus of this therapy is to make friends with what terrorizes us and not surrendering ourselves solely to our fears. It helps us to accept and make peace with what has happened, understand that it was a “part” of our life and is not “life” in itself and look beyond and towards what more our life has to offer us and what more we can offer to our life.

EMDR is not about reliving the trauma, but rather about learning to live beyond it.

M. M. H. Kauffman