EMDR – The main things you need to know

Dr Gurpreet Kaur, Chartered Clinical Psychologist, Surrey Psychology

Posted 14.06.2023

EMDR, or Eye Movement Desensitization and Reprocessing, is a therapeutic approach which helps individuals work through traumatic experiences, anxiety, and other emotional difficulties. Here’s some information to help you understand the origin of EMDR and how it works.

What does it involve?

There is an 8-phase treatment plan, which provides transparency to the process. The protocol enables both the client and clinician to be guided along the EMDR journey. The experience of the protocol is far from rigid though. Instead, it can be likened to a motorway drive:

The therapy journey is like planning a motorway route from A to B. You know that there are a certain amount of service stations along the motorway to stop at if needed.  These are the 8 points of the protocol. They are like check points to assess where about you are on your journey and whether you need to refuel – either the car or yourself. You can go back one or two stops if needed, but most of the time they are a good way of simply checking in. The EMDR therapist will start to drive you to your destination and talk you through the journey, but they need you to help navigate by being transparent about what you are noticing and how you are feeling.  You may find yourself feeling lost, fed up or even stressed along this journey, but as long as you keep communicating to the therapist you will both be able to steer successfully through the traffic and difficult weather conditions to reach the next service station. The success of the journey will depend on your willingness to take part and communicate and your therapist’s skill and expertise. The great thing to know is that you can actually stop at any time on the hard shoulder. This is like the end of each session for example, stopping temporarily until the session continues the next time. 

In EMDR therapy, both the client and the therapist play important roles in the treatment process.

The therapist is broadly responsible for:

– Creating a safe and supportive environment

– Providing explanation, guidance and structure for the EMDR process

– Interpreting the client’s responses during the therapy

– Guiding the therapy to points which can lead to meaningful change

The client is broadly responsible for:

– bringing up the traumatic memories or distressing experiences that they wish to work on

– participating in the EMDR process by following the therapist’s guidance

– letting the clinician know if and when it is too distressing

– working on therapy goals/tasks between sessions

– being transparent about how they are finding the process and the impact of the therapy on them

Both the therapist and the client need to work together to achieve the treatment goals. The client always has the autonomy to stop or pause the session at any time if they feel uncomfortable or overwhelmed. In this way the client in in charge of their own healing process and is simply being guided by the therapist.

How was EMDR developed?

EMDR originated in the late 1980s by a clinical psychologist called Francine Shapiro. She was actually out walking and had some disturbing thoughts at the time. She noticed her eyes moving rapidly from side to side as she was thinking and noticed that her thoughts became less upsetting. She connected this to the action her eyes were making, moving from one side to another. She said: “The thoughts weren’t as bothersome. I wanted to see if it would work if it was deliberate, so I brought up something that bothered me, moved my eyes in the same way and saw the same thing happening.”

Shapiro went on to research the technique with her clients, and found that it was an effective way to help people process traumatic memories and reduce symptoms of PTSD (Post-traumatic stress disorder).

Has EMDR been researched?

After her personal breakthrough in 1987, Shapiro first published an article 2 years later. The first published research on EMDR was “Eye Movement Desensitization: A New Treatment for Post-Traumatic Stress Disorder” by Francine Shapiro, which was published in the Journal of Traumatic Stress in 1989. Shapiro was open about her own discovery of the technique in this paper. She presented the results of a pilot study in which EMDR was used to treat patients with PTSD. Thankfully, this study laid the foundation for further research on EMDR and its effectiveness in treating trauma and other psychological conditions. Since then, EMDR has been extensively researched and has been found to be effective in treating a wide range of issues, including PTSD, phobias, and depression.

Is it a recommended treatment?

The National Institute for Health and Care Excellence (NICE) is a UK government-based organization that provides guidance and advice on the use of the most effective treatments and therapies for various medical conditions. These recommendations are only made if there is clear empirical evidence to support them.  According to NICE, EMDR is recommended for the treatment of adults with post-traumatic stress disorder (PTSD) that has developed after a traumatic event. NICE also recommends EMDR as a treatment option for adults with PTSD, who have not responded to other forms of trauma-focused psychological therapy.

What does the literature say?

In 2019, a literature review was published in the Journal of Traumatic Stress which stated that EMDR is an effective treatment for PTSD and other trauma-related disorders. The review analysed lots of other studies that had been conducted between 1989 and 2018. It found that EMDR was effective in reducing symptoms of PTSD, including re-experiencing symptoms, avoidance, and hyperarousal. The review also found that EMDR was as effective as other forms of trauma-focused therapy, such as cognitive-behavioural therapy (CBT) and prolonged exposure therapy.

Another literature review in 2020 which was published in the Journal of Anxiety Disorders, found that EMDR is effective for the treatment of PTSD, anxiety, and depression in veterans, and for the treatment of PTSD in adult survivors of sexual abuse. The review also found that EMDR has been found to be effective with children and adolescents. In practice, EMDR is commonly used by clinicians to treat a variety of presentations.

Is there any theory behind EMDR?

EMDR is based on the idea that traumatic memories are often stored differently in the brain than non-traumatic memories. When a traumatic event occurs, the brain tends to become overwhelmed as it enters its stress response mode. It is therefore unable to process the experience in a healthy way, like it would for other memories. This can lead to the memory becoming stuck, or “frozen,” in the brain. As a result, the individual may continue to experience distress and other negative symptoms related to the trauma. This is because it has not been fully processed. The brain continues to associate stress with it.

The neurobiological mechanism of EMDR is based on the Adaptive Information Processing (AIP) model. The AIP model proposes that the brain naturally processes and integrates experiences, but it can become overwhelmed in certain circumstances. When this happens, the traumatic memory becomes dysregulated and stored in an isolated network in the brain, instead of being integrated into the general memory network.

How does EMDR work?

EMDR works by activating the right and left hemispheres of the brain through the use of bilateral stimulation. Bilateral stimulation is used in EMDR to simultaneously stimulation both sides of the brain through a variety of methods, such as eye movements, tapping, or sounds. The preference of these will be discussed between the client and therapist. The aim of bilateral stimulation is to activate the neural connections between the two hemispheres of the brain whilst focussing on the unprocessed and ‘stuck’ memories which cause distress.

In this way, bilateral stimulation used in EMDR is thought to activate the brain’s natural information processing system and help integrate the traumatic memory into the general memory network. This is referred to as ‘processing’. The bilateral stimulation helps to release the emotional charge associated with the traumatic memory and allows the brain to process and integrate the memory in a more adaptive way.

Research has found that EMDR can lead to changes in the brain’s neural networks, specifically in the amygdala, which is responsible for emotional processing and memory. Studies have found that EMDR can reduce the activity in the amygdala, leading to a decrease in the emotional distress associated with traumatic memories.

In conclusion, EMDR is a powerful therapeutic technique that can help individuals overcome traumatic experiences and other emotional difficulties. It works by activating the brain’s natural information processing system through bilateral stimulation and helps to integrate traumatic memories into the general memory network, leading to a decrease in the emotional distress associated with the memory. EMDR has been found to be an effective treatment for PTSD and other emotional difficulties and continues to be an important tool for mental health practitioners.

 

About the Author

Dr Gurpreet Kaur is a Chartered Clinical Psychologist based in Epsom, Surrey. She qualified from the Doctorate in Clinical Psychology at University College London in 2011.

Dr Kaur has worked with people experiencing psychological and emotional difficulties since 2001 and has practiced in the National Health Service as well as private practice.

To work with Dr Kaur or one of her associates, please contact her directly via the Surrey Psychology website: https://psychologistinsurrey.com

Blog post originally posted on Surrey Psychology website, and reposted with permission from Dr Gurpreet Kaur.

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