EMDR Info






Frequent Questions and Answers (F&Q)


What is EMDR?

The mind can often heal itself naturally, in the same way as the body does. Much of this natural coping mechanism occurs during sleep, particularly during rapid eye movement (REM) sleep. Francine Shapiro developed Eye Movement Desensitization and Reprocessing (EMDR) in 1987, utilising this natural process in order to successfully treat Post-traumatic Stress Disorder (PTSD). Since then, EMDR has been used to effectively treat a wide range of mental health problems.


"EMDR is an acronym for 'Eye Movement Desensitization and Reprocessing"
As a Senior Research Fellow at the Mental Research Institute (in Palo Alto, USA), Dr. Francine Shapiro published the first research data to support the benefits of the therapy in the 1989. Since then a wealth of research has been conducted demonstrating its benefits in treating psychological trauma arising from experiences as diverse as war related experiences, childhood sexual and/or physical abuse or neglect, natural disaster, assault, surgical trauma, road traffic accidents and workplace accidents.

 

Since its original development, EMDR is also increasingly used to help individuals with other issues. EMDR has been found to be of benefit to children as well as adults. EMDR is a complex and powerful therapy. Therapists always have a background in mental health before undertaking training in EMDR. You are strongly recommended to only consult legitimate clinicians who have undergone a bona-fide EMDR training.

 

How Does EMDR Work?
When a person is involved in a distressing event, they may feel overwhelmed and their brain may be unable to process the information like a normal memory. The distressing memory seems to become "frozen" on a neurological level. When a person recalls the distressing memory, the person can re-experience what they saw, heard, smelt, tasted or felt, and this can be quite intense. Sometimes the memories are so distressing that the person tries to avoid thinking about the distressing event to avoid experiencing the distressing feelings. Some find that the distressing memories come to mind when something reminds them of the distressing event, or sometimes the memories just seem to just pop into mind.

 

By alternating left-right stimulation of the brain with eye movements, sounds or taps during EMDR, seems to stimulate the "frozen" or blocked information processing system. In the process the distressing memories seem to lose their intensity, so that the memories are less distressing and seem more like "ordinary" memories. The effect is believed to be similar to that which occurs naturally during REM sleep (Rapid Eye Movement) when your eyes rapidly move from side to side. EMDR helps reduce the distress of all the different kinds of memories, whether it was what you saw, heard, smelt, tasted, felt or thought.

 

What can EMDR be used for?
In addition to its use for the treatment of Post-traumatic Stress Disorder, EMDR has been successfully used to treat:

 

  • depression
  • stress
  • phobias
  • sleep problems
  • complicated grief
  • addictions
  • pain relief, phantom limb pain
  • self-esteem and performance anxiety
  • anxiety and panic attacks
  • The list is infinite


What is an EMDR session like?
EMDR utilizes the natural healing ability of your body. After a thorough assessment, you will be asked specific questions about a particular disturbing memory. Eye movements, similar to those during REM sleep, will be recreated simply by asking you to watch the therapist's finger moving backwards and forwards across your visual field. Sometimes, a bar of moving lights, computer screen with moving lights, tactile or headphones are used instead. The eye movements will last for a short while and then stop.

 

You will then be asked to report back on the experiences you have had during each of these sets of eye movements. Experiences during a session may include changes in thoughts, images and feelings. With repeated sets of eye movements, the memory tends to change in such a way that it loses its painful intensity and simply becomes a neutral memory of an event in the past. Other associated memories may also heal at the same time. This linking of related \ memories can lead to a dramatic and rapid improvement in many aspects of your life.

 

What can I expect from my EMDR therapist?
EMDR is not simply the use of eye movements. Rather it is a comprehensive therapeutic approach with principles, protocols and procedures with the goal of reducing distress in the shortest period of time. When you first meet with your EMDR therapist, your therapist will spend time getting to know your history. If your therapist feels EMDR is suited for your difficulty, he/she will describe the EMDR model to you and explain the theory.

 

You can ask your therapist questions and express any concerns you may have. Your therapist will spend some time doing some relaxation exercises with you, which could include a "safe or pleasant place" exercises, guided visualisation, deep muscle relaxation, breathing retraining etc. Once you and your therapist feel that you are sufficiently prepared, you can then target a distressing memory with the eye movements or other forms of left-right alternating stimulation or bilateral stimulation (visual, sound and tapping). Your therapist will ask you to select an image that represents the distressing event.

 

You will then be asked to think about negative and positive thoughts, your feelings, the amount of distress you feel and where you feel it in your body. Your therapist will then begin the eye movements while you hold the image in mind. After each set of eye movements your therapist will ask you what came to mind or what you noticed during the eye movements. During the eye movements you may experience the distressing event quite intensely to start with, but this distress generally reduces as the memory is processed with EMDR.

 

Your therapist will continue with the eye movements until your distress is reduced as much as possible. Your therapist will then ask you to think about your positive thought and also check whether there is any part of your body where you still feel distress. Before the end of the session, your therapist will give you time to feel calm again, using the safe-pleasant place exercise or relaxation techniques.


Can anyone benefit from EMDR?
EMDR can accelerate therapy by resolving the impact of your past traumas and allowing you to live more fully in the present. It is not, however, appropriate for everyone. The process is rapid and any disturbing experiences, if they occur at all, last for a comparatively short period of time. Nevertheless, you need to be aware of, and willing to experience, the strong feelings and disturbing thoughts, which sometimes occur during sessions.

 

How long does treatment take?
EMDR can be brief focused treatment or part of a longer psychotherapy program. EMDR sessions can be anything from 60 to 90 minutes.

 

Will I remain in control and empowered?
During EMDR treatment, you will remain in control, fully alert and wide-awake. This is not a form of hypnosis and you can stop the process at any time. Throughout the session, the therapist will support and facilitate your own self-healing and intervene as little as possible. Reprocessing is usually experienced as something that happens spontaneously, and new connections and insights are felt to arise quite naturally from within. As a result, most people experience EMDR as being a natural and very empowering therapy.

 

What evidence is there that EMDR is a successful treatment?
EMDR is an innovative clinical treatment which has successfully helped millions of people all over the world. The validity and reliability of EMDR has been established by rigorous research. There are now more than twenty controlled studies into EMDR making it the most thoroughly researched method used in the treatment of trauma, (Details on www.emdr-europe.org and www.emdr.org) and is recommended by the National Institute for Health and Clinical Excellence (NICE) as an effective treatment for PTSD.

 

What happens when you are traumatised?
Without you being aware of it, your body routinely manages new information and experiences. However, when something out of the ordinary occurs and you are traumatised by an overwhelming event (e.g. car accident) or by being repeatedly subjected to distress (e.g. childhood neglect), your natural coping mechanism can become overloaded. This overloading can result in disturbing experiences remaining “frozen” in your brain or being "unprocessed". Such unprocessed memories and feelings are stored in the limbic system of your brain in a "raw” and emotional form, rather than in a verbal "story" mode.

 

This limbic system maintains traumatic memories in an isolated memory network that is associated with emotions and physical sensations, and which is disconnected from the brain's cortex where we use language to store memories. The Limbic system's traumatic memories can be continually triggered when you experience events similar to the difficult experiences you have been trough. Often the memory itself is long forgotten, but the painful feelings such as anxiety, panic, anger or despair are continually triggered in the present. Your ability to live in the present and learn from new experiences can therefore become inhibited. EMDR helps create the connections between your brain's memory networks, enabling your brain to process the traumatic memory in a very natural way.


Will my EMDR therapist use any equipment?
Eye movements can be created manually by your therapist moving his/her fingers back and forth across your visual field. However, the eye movements can also be created using a 'light bar', in which you follow a light that moves back and forth across a metal bar. Some therapist use auditory bilateral stimulation, in which they click their fingers alternating from ear to ear.

 

These clicks can also be created through headphones and you can listen to a range of alternating sounds. Some therapist use music to create the alternating sound which you can also listen to with headphones. Other therapists use tactile bilateral stimulation, in which they tap your hands alternating. To create a similar effect, some therapists use small vibrating items that you can hold in your hands, and this vibrates alternating from one hand to another. More recently therapist use computer generated light movements on a computer screen I projector.


What will I feel like after the session with my therapist?
EMDR treatment generates a certain amount of "momentum" to your thinking and conscious awareness. In other words the treatment does not just stop immediately after your session. During your eye movement session a lot of memories may come to mind and people find that after the session they may think about these memories. If these memories are distressing, then for a day or two you may feel distressed. During this time it is recommended that you take care of yourself and use your relaxation technique to sooth yourself.

 

It is recommended that you do not do anything too stressful straight after your EMDR session, such as write an exam. Some people report that after the session they seem to recall more aspects of the events that they hadn't thought about for a while. Some report that they dream more. Everybody is different so keep a note of your experience after the session and discuss this with your therapist. As the distress decreases with EMDR, people report feelings of relief. At the end of EMDR therapy, many people report feeling no distress at all when recalling a distressing event.


Is EMDR a form of hypnotism?
EMDR is not a form of hypnotism. Even though you are moving your eyes during EMDR you will remain conscious AND in control at all times. EMDR cannot be done against your will. Besides eye movements auditory or tactile bilateral stimulation can also be used to create the same effect. Auditory bilateral stimulation is created by sound alternating from ear to ear. Tactile bilateral stimulation is produced by alternating taps that you can feel.

 

What are the side effects?
As with any form of Psychotherapy, there may be a temporary increase in distress. Distressing and unresolved memories may emerge. Some patients may experience reactions during a treatment session that neither they nor the administering clinician may have anticipated, including a high level of emotion or physical sensations. Subsequent to the treatment session, the processing of incidents/material may continue, and other dreams, memories feelings, etc., may emerge.

 

Will EMDR or the eye movements increase the frequency of seizures?

 

There is no indication that EMDR will increase the frequency of seizures.

 

Will EMDRI eye movements cause seizures?

There is no indication that EMDR will cause seizures. In thousands of cases there venture beyond the ordinary and to explore new and challenging frontiers rather than to stagnate. More about my Work Experience


Treatment Descriptions:

EMDR therapy combines different elements to maximize treatment effects. A full description of the theory, sequence of treatment, and research on protocols and active mechanisms can be found in F. Shapiro (2001) Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd edition) New York: Guilford Press. 


EMDR involves attention to three time periods: the past, present, and future. Focus is given to past disturbing memories and related events. Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions. With EMDR therapy, these items are addressed using an eight-phase treatment approach.


Phase 1: The first phase is a history-taking session(s). The therapist assesses the client's readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.


Initial EMDR processing may be directed to childhood events rather than to adult onset stressors or the identified critical incident if the client had a problematic childhood. Clients generally gain insight on their situations, the emotional distress resolves and they start to change their behaviors. The length of treatment depends upon the number of traumas and the age of PTSD onset. Generally, those with single event adult onset trauma can be successfully treated in less than 5 hours. Multiple trauma victims may require a longer treatment time.


Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR is to produce rapid and effective change while the client maintains equilibrium during and between sessions.


Phases 3-6: In phase three to six, a target is identified and processed using EMDR procedures. These involve the client identifying three things:


  1. The vivid visual image related to the memory
  2. A negative belief about self
  3. Related emotions and body sensations.


In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps or tones. The type and length of these sets is different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneously happens. 


After each set of stimulation, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report, the clinician will choose the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track. 


When the client reports no distress related to the targeted memory(s), he is asked to think of the preferred positive belief that was identified at the beginning of the session. At this time, the client may adjust the positive belief if necessary, and then focus on it during the next set of distressing events. 


Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self- calming activities that were mastered in phase two. 


                      

Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.


Helpful other descriptions:


Treating Traumatic memories and The Container by Mike Davison


Treating Traumatic Memories


The mind is like a factory, and one of its jobs is to process life events so that they can become memories. Most life events are of a size and nature that the factory can cope with:


However, sometime an event occurs, such as a trauma, which is simply too large or difficult to process.


Because it isn't processed, the event is prevented from becoming a memory - this means that it remains a current problem, rather than one that's in the past. Current situations or events that remind us of the original trauma trigger us to have 'flashbacks' which means we re-live and re- experience the emotions and physical sensations that were experienced at the time of the original trauma. At those distressing times, we tend to press the factory's STOP button. We also avoid situations which are likely to trigger these 'flashback' experiences, reinforcing the lack of processing.


Effectively treating the traumatic event so that our 'factory' can process them into memories means exposing ourselves to thinking about and imagining the traumatic event, and/or gradually exposing ourselves to real situations which we normally avoid. This will result in experiencing distress, but will also cause the factory to effectively process the traumatic event, which will greatly reduce the distress in the long-term.

The Container

This technique is useful for clients who have difficulty handling distress between sessions. If using EMDR, this technique will slow down processing, but offers safety between sessions.


Examples of how a “Safe and or Secure Place” can be created:


I want you to bring some sort of secure container to your mind's eye, perhaps in this room, or in another secure place. This container will be strong enough to hold all this disturbing stuff - the memories, images, thoughts, physical sensations, sounds, smells, emotions.


What would this container have to be like in order to securely hold your distress? (E.g. a safe, office drawer, shipping container, crate) Can you describe it to me? What is it? What colour is it? How big is it? What does it look like? What is it made of? What makes it safe and secure?


Now imagine taking the distressing images and putting them inside or sending them to the container then shut the door.

Now take the distressing thoughts...... (then go through sounds, physical sensations, smells, emotions, thoughts).


Anything else that needs to go in there?


Now shut the door securely. How do we make the door more secure? OK, can you do that now? Is it secure now? Is there anything else you need to do to make it more secure?


How does this feel now?

Shall we leave this container in the room here, or is there a different secure place where we can leave this container?


During the week (or until next time), if anything disturbing comes up, just imagine sending it here (there) and putting it all in this container.


Alternatively:

Close the Book
Imagine putting everything on the pages of a book. Now close the book and put it away...


Burn a DVD (especially for distressing video images)

Imagine burning those distressing memories or images onto a blank DVD. OK, have you done that? Now imagine putting the DVD in a case, in a secure place...

References:

www.thetraumacentre.com

www.get.gg

www.emdrassociation.org.uk

http://www.emdr.com/faqs.html (EMDR Institute)