We all face disturbing events at various times in our lives. Generally we are able to effectively manage our responses to such events. There can be times however, when an experience is so traumatic that our brain is unable to fully process it. Stimuli such as sounds, words or smells, can trigger these unprocessed memories so vividly that we re-experience the trauma. If this occurs, we may need to seek professional help to enable us to deal with the stressor, process our memories of the experience, and continue with our daily lives.
Mental health professionals use a range of therapies for treating trauma. One such therapy is Eye Movement Desensitisation and Reprocessing (EMDR) therapy. This therapy was originally developed by psychologist Dr Francine Shapiro in the 1980s. Dr Shapiro observed that under certain conditions bilateral (side-to-side) eye movements appeared to reduce the intensity of disturbing thoughts. She studied this effect and published research findings about using EMDR to successfully treat victims of trauma (1989). EMDR therapy has since been successfully used in many settings to help people recover from trauma related to a distressing life experience.
This article discusses EMDR, explaining how it can help us to better manage our traumatic memories. It briefly explains what EMDR therapy is and how it works. It then considers evidence regarding the effectiveness of the therapy.
The article is intended to provide information not advice. If you are experiencing traumatic memories, it is important to consult a mental health professional for expert guidance.
What is EMDR therapy?
Eye movement desensitisation and reprocessing (EMDR) therapy premises that the brain routinely processes and stores information and experiences during rapid eye movement (REM) sleep. However some experiences are so traumatic that this natural processing mechanism becomes overloaded and the brain is unable to fully process the memories. If this happens, the unprocessed memories are stored in emotional form in the limbic system of our brain rather than as more neutral language in the pre-frontal cortex. When stored in emotional form, these memories can be continually triggered, causing ongoing negative emotions such as anxiety and panic.
During EMDR therapy, the therapist uses bilateral stimulation to facilitate transfer of these unprocessed memories from the limbic system to the pre-frontal cortex where we can better understand and manage them. Left-right eye movements are the most commonly used bilateral stimulation. They are believed to mimic the eye movements of REM sleep. The therapist guides the client to continually move their eyes from left to right while reflecting on thoughts and feelings they experienced during the traumatic event. This facilitates the processing of the memories. After repeated sets of eye movements, the memories lose their intensity and are stored as more neutral memories.
Thus, rather than focussing on changing the emotions, thoughts, and behaviors resulting from adverse life experiences, EMDR therapy focusses on changing how memories are processed and stored. It does not require talking in detail about the trauma and associated memories.
What is EMDR used for?
While originally developed to help clients overcome the anxiety associated with post traumatic stress disorder (PTSD) and other acute stress disorders, ongoing research into the use of EMDR therapy to manage other mental health problems has returned promising results. Researchers are increasingly exploring the use of the therapy for other mental health conditions such as depression, sexual dysfunction, schizophrenia, eating and anxiety disorders.
How does it work?
Overview
EMDR therapy involves an eight phase treatment approach delivered over multiple sessions. A typical EMDR therapy session lasts from 60-90 minutes and is generally delivered once or twice per week for 6-12 sessions. Some people may benefit from fewer sessions.
The eight phases of the structured therapy are: history taking and treatment planning, preparation, assessment, desensitization, installation, body scan, closure and reevaluation. The client works through these phases to manage the emotional distress and trauma, while learning skills to cope with current and future stresses.
Preparation phases
During the initial preparation and assessment phases, (history taking and treatment planning, preparation, assessment) the therapist works with the client to identify the specific problem and consider how EMDR therapy can best be used. This may include compiling a case history noting when symptoms were experienced, identifying the disturbing event to be reprocessed and developing a treatment plan. The therapist explains what the client can expect from the therapy while client concerns and questions are addressed. Several sessions are generally required for these initial phases.
Processing phases
The next phases (desensitisation, installation, body scan) focus on processing the targeted memory. During these sessions, the client is asked to recall the traumatic event while the therapist guides them through a series of bilateral (side-to-side) eye movements. The client may be asked to recall factors such as disturbing emotions, body sensations and negative self-images. The bilateral stimulation helps the brain to transfer traumatic memories to the pre-frontal cortex where the client can make better sense of what happened. The bi-lateral movements are used until the trauma memory loses its intensity and becomes a more neutral memory of a past event.
Processing of a specific memory is generally completed within one to three sessions. This more neutral memory is then stored in the long-term memory.
Closure and Evaluation phases
The last two phases (closure and re-evaluation) focus on the well-being of the client at the end of a current session and at the beginning of the next session. Closure ends the session with the client and therapist discussing recently processed memories. During this discussion, the therapist evaluates the client’s mental well-being. Closure aims to ensure that the person finishes each session feeling better than they did at the beginning.
Re-evaluation occurs at the beginning of new sessions. It reviews the memories and feelings addressed in the previous session to decide whether the therapy should continue focusing on them or move on to new targets. This phase helps to determine the success of the treatment over time.
Things to consider
EMDR therapy focusses on changing the way memories of traumatic events are stored in the brain rather than working on changing emotions, thoughts, and behaviors. Therefore there is no requirement for the client to talk about distressing events in detail if they do not wish to. EMDR therapy is therefore particularly useful for people who have difficulty talking about their psychological trauma.
However, while there is no requirement for the client to talk in depth about the traumatic experience, the client is recalling emotionally painful memories during the memory processing phases of the therapy. These may initially trigger some emotional or physical sensations such as strong negative emotions, headaches or light headedness.
This highlights that EMDR therapy, if not used appropriately, it can leave people feeling retraumatized. It is therefore essential to review the certification and experience of the EMDR therapist.
What is the evidence?
Shapiro published her initial observations and findings in 1989. These indicated that EMDR therapy was beneficial in helping individuals manage stressful memories (Shapiro, 1989). Her work generated much interest in EMDR therapy. According the Eye Movement Desensitisation Association of Australia (EMDRAA), there are more published treatment outcome studies on EMDR therapy than any other post traumatic stress disorder treatments (2022). Clinical studies have found that in the majority of clients, EMDR therapy can help to decrease or eliminate ptsd symptoms (Beer, 2018, Hoogsteder, 2022).
Research further suggests that eye movement desensitisation and reprocessing therapy is generally a safe and effective treatment. This has resulted in several international health and mental health organisations endorsing EMDR treatment as an effective therapy for PTSD diagnosis. These include the World Health Organisation. The International Society for Traumatic Stress Studies the Clinical Division of the American Psychiatric Association and the American Department of Veterans Affairs. In 2018, Australian Psychological Society (APS) included EMDR as a Level 1 treatment for adults and Level II for children experiencing PTSD. Level 1 is the highest rating that can be applied to a specific therapeutic approach. (APS, 2018).
At the same time, researchers suggest that there are gaps in the evidence base for EMDR early interventions. Further research has been recommended (Shapiro and Maxfield, 2019).
Conclusion
Research indicates that eye movement desensitisation and reprocessing (EMDR) is a useful therapy to consider when memories are causing an individual significant disturbance and/or a negative perception of themselves. However, while considered safe and effective, EMDR deals with traumatic memories. It is therefore important to consult a trained professional therapist to ensure the therapy is used appropriately and the client is not retraumatised.
If you’re seeking the support of a Melbourne Psychologist, talk to our team today.
The information in this article is not a substitute for informed professional advice. For expert advice, it is recommended that appropriate professionals be consulted.
References
Beer, Renée, (2018), Efficacy of EMDR Therapy for Children With PostTraumatic Stress Disorder: A Review of the Literature, Journal of EMDR Practice and Research Vol 12 Issue 4, DOI: 10.1891/1933-3196.12.4.177
MDR Association of Australia (2022), https://emdraa.org/
Hoogsteder, L. M., ten Thije, L., Schippers, E. E., & Stams, G. J. J. M. (2022). A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents. International Journal of Offender Therapy and Comparative Criminology, 66(6–7), 735–757. https://doi.org/10.1177/0306624X211010290
Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223.
Shapiro, E., & Maxfield, L. (2019). The efficacy of EMDR early interventions. Journal of EMDR Practice and Research, 13(4), 291–301. https://doi.org/10.1891/1933-3196.13.4.291
