Polaris Counseling, LLC

Bryce Carithers, MA, LPCC

EMDR

Eye Movement Desensitization and Reprocessing
Applications and Support for EMDR 

EMDR is recognized as an effective treatment for Posttraumatic Stress Disorder (PTSD) by several organizations including The World Health Organization and The American Psychiatric Association (1; 8). Numerous research reports support its use to treat PTSD and similar symptoms (5), and document its effectiveness when compared to psychopharmaceuticals (7; 8) and other forms of psychotherapy (2; 3).
     EMDR has been found to be useful for many other problems, including:

  • Panic attacks and Anxiety
  • Dissociative disorders
  • Certain forms of Depression
  • Phobias
  • Pain disorders
  • Performance anxiety
  • Stress reduction
  • Sexual and/or Physical abuse
  • Personality Disorders


The Eight Phases of EMDR
Phase 1: History Taking and Treatment Planning
History taking and treatment planning typically consist of the first handful of sessions and continue throughout the duration of therapy as new insights and problems are revealed.  We will discuss specific problems bringing you to therapy and identify troublesome behaviors or symptoms resulting from these problems.  Then we will explore your past and current experiences, looking for those that are connected to current problems, and will collaboratively create a treatment plan.  Some of these experiences will be identified as “targets” to be reworked through EMDR, including: a) the event(s) from the past that created or reinforced the problem, b) the current situations or problems that cause distress, and c) new skills or resources needed for future well-being.
Phase 2: Preparation
During this phase, I will explain the theory behind EMDR and what to expect during and after sessions. We will use this time to identify skills for relaxation and stress management, as well as for coping with disturbing thoughts, feelings, and memories that may arise.  You are always in control in therapy, and are free to stop, reassess, or ask questions at any time.
Phase 3: Assessment
Once you are feeling comfortable in therapy and using new skills, EMDR moves into reprocessing. Sometimes, phases 3, 4, and 5 will happen progressively in a single session, or may span two or more sessions depending on the specific target being addressed. 
The Assessment phase begins by allowing you to get in touch with a memory by selecting a certain picture or image that best represents the event.  Next, you will pick a statement that expresses a negative belief that you have about yourself when you think of that experience, some examples being “I am worthless”, “I am not safe”, “I am incompetent”.  Once this negative statement is identified, you will be asked to think about how you would ideally like to think of yourself instead.  A positive self-statement will then be chosen, such as “I am worthy”, “I am safe now”, “I can succeed”, and you will rate how true this positive statement feels.  Then you will be asked to identify the emotions, level of distress, and physical sensations that come with the memory.
Phase 4: Desensitization
With the content, feelings, and distress of a memory accessed, the process moves into the Desensitization phase.  During this stage, bilateral stimulation (BLS) in the form of eye-movements, tactile taps, or audio tones is used to facilitate reprocessing.  You will be asked to notice any thoughts, feelings, images, or sensations that arise as I lead you through sets of BLS, and this process continues as your brain reprocesses the disturbing elements of the memory.  At certain points, you will be prompted to reassess the level of distress experienced with the memory, or I may alter the BLS by changing the speed, direction, or modality.  This will continue until the level of distress is lowered.
Desensitization allows your brain to work through all of your different responses to a certain memory until the disturbing elements have been reworked and it feels less distressing.  It also provides the opportunity to identify and reprocess experiences that are related or similar to the original event.  It is this particular part of the process that makes EMDR different than other therapy approaches, as it allows clients to work through unanticipated material and achieve healing beyond original expectations. This process is also what makes EMDR preferable for many clients, as it is not necessary to discuss an experience in depth or remember every detail to successfully rework the unresolved parts.
While the level of distressed around a difficult memory is lowered during Desensitization, the goal is not necessarily to feel happy or positive about it, but rather to have a level of emotional acceptance.  A typical comment heard at the end of this phase is, “It’s sad that my child-self went through that, but it doesn’t feel awful anymore.  It just feels like a part of my past now”. 

Phase 5: Installation
In the Installation phase, the goal is to strengthen and confirm your belief in the previously selected positive self-statement.  With the emotional weight of the memory now lowered, it may already be easier to believe something more positive.  I will ask you to be aware of the memory and the positive statement while leading you through sets of BLS, and you will be asked to measure how true the positive statement feels to you throughout this process.  Clients typically find themselves believing more in the positive statement as sets continue, and this can be accompanied by wonderfully positive feelings.  I will continue to lead you through sets for as long as these positive beliefs and feelings increase.  
Phase 6: Body Scan
Lingering physical or bodily sensations that are still associated with the target memory are addressed in the Body Scan.  After a trauma, the memory of the experience is stored improperly in motoric or implicit memory instead of narrative or declarative memory (5), meaning that body sensations associated with the memory need to be addressed in addition to the emotional and cognitive elements.  Therefore, a memory is not considered fully reprocessed until the body sensations that it evokes are all neutral or positive.  I will ask you to notice the memory and look for any tension, tightness, or unusual sensations in your body.  If any are found, they are targeted for reprocessing until they are reduced to neutral or positive sensations.  
Phase 7: Closure
Every session will include time for Closure to ensure that you are leaving the session with a sense of emotional control and stability.  Even if a memory is fully reprocessed in one session, time is needed for conversation and calming techniques before you leave the therapy room.  We will talk about what to expect between sessions and how to log this information, as well as ways to handle any difficult feelings, thoughts, or memories that might arise.  As always, it is important to remember that you are in control of your therapy process, and this feeling should remain with you between sessions.
Phase 8: Reevaluation
At the start of sessions, I will check to make sure that the positive reprocessing results from the previous session have been maintained.  Then we will check for any new memories that need attention, and continue reprocessing memories that have been identified through the course of therapy.  This phase is helpful for maintaining an effective and current treatment plan and for gauging progress over time.  Since processing can continue between sessions, Reevaluation is also helpful for ensuring that EMDR is successful as an overall process of long-term change, as well as for achieving immediate relief following individual sessions.  

More information regarding EMDR

History
In 1987, psychologist Dr. Francine Shapiro made a chance discovery by noticing that her distress connected to certain memories was greatly reduced when she engaged in back and forth eye-movements in certain situations.  Dr. Shapiro began utilizing clinical and research experience to enhance these findings, and EMDR has since evolved into a step-by-step protocol that allows for tracking changes and progress over time, while still allowing room for creativity and flexibility (5).
Theory and Components of EMDR
Memory Networks: EMDR believes that our experiences create and reinforce neurological “memory networks” in our brains.  It states that most problems are a result of difficult experiences that set in motion a pattern of behaviors, feelings, thoughts, and identity.  These traumatic memories are stored in an inappropriate part of memory, and the resulting thoughts, feelings, and self-image can be reinforced by future experiences, further increasing problems (5). 

Adaptive Information Processing (AIP) Model: According to the AIP model, a traumatic memory is formed when the brain is unable to process a traumatic experience due to the nervous system becoming overwhelmed during or after the event.  Fortunately, our bodies and brains have natural healing abilities. This model states that given the proper circumstances, the brain can access this innate ability and successfully reprocess the memory of a traumatic experience, storing it in a more adaptive place in memory and reducing its negative impact (5).
Bilateral Stimulation (BLS)/ Dual Attention:  To access the brain’s natural ability to process information and heal, EMDR utilizes bilateral stimulation (BLS) in the form of eye-movements, audio tones, or tactile taps.  A balancing act of “dual-attention” is achieved by noticing the traumatic memory while also being grounded in the therapy room by the physical stimuli, allowing for the spontaneous processing of information and healing to take place (5).
EMDR with Children and Teens
In 2013, The World Health Organization released guidelines naming EMDR as an effective treatment for PTSD in children and adolescents (8).  EMDR can successfully help young clients overcome complex trauma and improve emotional functioning (6), and a meta-analysis of existing research on EMDR with children and adolescents found it to be effective, especially when accompanied by Trauma-Focused Cognitive Behavioral Therapy (CBT; 4).  
When using EMDR with young clients, creative approaches including art, play, toys, and props can be used to keep the process engaging and age-appropriate.  With both kids and teens, books are helpful for introducing the idea of therapy in a way that’s enjoyable and encouraging, as well as for explaining concepts that are central to EMDR.  Depending on the age of the client, certain parts of EMDR are adapted, such as when choosing a negative and positive self-belief.  Charts that list or visually display different emotions can help young clients identify feelings that accompany memories, and tangible props and toys can help with the abstract idea of scaling, engaging in eye-movements, and identifying body sensations.
Past, Present and Future
Although EMDR tends to be a faster process than other forms of therapy, the length and details will be different for every individual and the process isn’t always linear.  Some people reprocess the traumatic events chosen at the start of therapy without identifying additional memories along the way, while others find during the process that they have other memories to address.  In all cases, the overarching goal of EMDR is to reprocess difficult past experiences, address current triggers, and prepare you to meet future goals by developing helpful skills and a more positive identity and sense of self.  
References 
1.  American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines.
2.  Bisson J., Andrew M. (2007). Psychological treatment of post–traumatic stress disorder (PTSD). Cochrane Database Syst. Rev. 3:CD003388 10.1002/14651858.CD003388.pub3
3.  Nijdam M. J., Gersons B. P., Reitsma J. B., de Jongh A., Olff M. (2012). Brief eclectic psychotherapy v. eye movement desensitisation and reprocessing therapy for posttraumatic stress disorder: randomised controlled trial. British Journal of Psychiatry, 2003, 224–231.
4.  Rodenburg R., Benjamin A., de Roos C., Meijer A. M., Stams G. J. (2009). Efficacy of EMDR in children: a meta–analysis. Clinical Psychology Review, 29, 599–606.
5.  Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing, 2nd edition, N.Y.: The Guilford Press.​
6.  Trentini, C., Pagani, M., Fania, P., Speranza, A. M., Nicolais, G., Sibilia, A., … Ammaniti, M. (2015). Neural processing of emotions in traumatized children treated with Eye Movement Desensitization and Reprocessing therapy: a hdEEG study. Frontiers in Psychology, 6, 1662.  http://doi.org/10.3389/fpsyg.2015.01662​
7.  van der Kolk B. A. (2007). The developmental impact of childhood trauma. In L.J. Kirmayer, R. Lemelson, & M. Barad (Eds.), Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives (224-241). New York, NY: Cambridge University Press.
8.  World Health Organization. (2013).  Guidelines for the management of conditions specifically related to stress. Geneva: WHO.