Before pursuing PTSD treatment with EMDR (Eye Movement Desensitization and Reprocessing), you probably have questions. I’m an EMDR therapist, as well as someone who has experienced the therapy myself. I can answer those questions and tell you what you need to know before pursuing trauma and PTSD treatment with EMDR.
What is EMDR?
EMDR is a well-researched psychotherapeutic treatment for PTSD, trauma, and more. The Encyclopedia of Social Work defines it this way:
“Eye movement desensitization and reprocessing (EMDR) is a psychotherapeutic treatment approach for alleviating symptoms resulting from having experienced traumatic events. The most distinctive treatment component of the eight-stage EMDR process involves dual-attention stimulation (also called bilateral stimulation), in which the therapist moves her fingers back and forth (or uses an alternate device) to stimulate rapid back-and-forth eye movements as the client visualizes a distressful memory while keeping in mind a related feeling and cognition. Alternatively, the therapist might rapidly alternate right and left hand taps or sounds in the right and left ears during the visualization.”
You can learn more about how a chance experience sparked EMDR in this 2018 PsychCentral interview with its developer, Francine Shapiro, PhD. (Regrettably, 71 year-old Shapiro died in June of this year after more than a year of health problems.)
Is EMDR an effective treatment for PTSD?
EMDR is the most researched psychotherapeutic treatment for trauma. It has been recognized as an effective therapy for PTSD by the American Psychiatric Association. The Veterans Administration and the Department of Defense also placed EMDR in their top recommended treatments for PTSD. The World Health Organization cited EMDR as one of only two psychotherapies recommended for children, adolescents, and adults with PTSD.
These recommendations largely stem from how well EMDR has been empirically validated in over 30 randomized controlled studies. So yes, EMDR is an effective, research-backed treatment for PTSD.
Why would I do EMDR for my PTSD rather than Prolonged Exposure Therapy or Trauma-Focused Cognitive Behavioral Therapy?
Prolonged Exposure Therapy (PE) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) are other common therapies for PTSD. But unlike PE or TF-CBT therapies, EMDR requires no homework. PE and TF-CBT include hours of daily homework for effectiveness.
Additionally PE is structured around the individual vividly retelling the trauma several times during a session and an additional exposure, usually through a recording, as homework. TF-CBT requires the person to re-tell the traumatic event in detail to identify beliefs to target. Many find these exposures re-traumatizing.
While EMDR requires recalling the event(s) that triggered PTSD, you notice the memory only briefly and in short “doses” with bilateral stimulation. Also, it does not require telling details to the therapist, but relies on the brain’s internal processing of the event to resolve the disturbance.
What can I expect in an EMDR session?
While each client situation is different, EMDR sessions follow an 8-phase protocol:
The first phase is history-taking. This may take one or more sessions. In addition to gathering information from your history, the therapist catalogues distressing events from your past and present. This will include the trauma(s) contributing to your PTSD. From this list, he or she develops targets for EMDR processing and an overall treatment plan. The therapist also assesses your ability to manage emotions and your readiness for EMDR. This phase takes one or more sessions.
In the second phase, preparation, the therapist addresses any deficits in your emotional regulation abilities. This might include teaching you additional ways of managing emotions. Skills for stress reduction for between sessions may also be taught to ensure the maintenance of emotional equilibrium between sessions. This phase can complete in the first session or take multiple sessions.
These four phases (target assessment, desensitization, installation, and body scan) will cycle over the upcoming sessions and guide the processing of targeted memories and experiences. For each target, in turn, the therapist asks you to identify:
1. A vivid visual image related to the memory,
2. A negative belief about yourself that seems connected to the memory, and
3. Related emotions and body sensations coming up for you now in the session as you notice the memory and belief.
You will rate the disturbance or negative charge in your body as you notice all of this. In addition, you will identify and rate a positive thought you would like to believe about yourself as you consider the memory.
After this, the therapist directs you to focus on the image, negative thought, emotions, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation (also called dual stimulation). These sets may include:
• eye movements (usually following the therapist’s fingers as his/her hand passes back and forth in front of you; some therapists have a horizontal light bar that your eyes will follow back and forth),
• taps (from the therapist’s hands or your hands on alternate sides of your body – usually on the knees), and/or
• tones (heard in each ear alternately through a headset).
The type and length of these sets is different for each client, but can be as short as 5 seconds and as long as a minute or more. At this point, you will be instructed to just notice whatever spontaneously happens with thoughts, feelings, and body sensations. There is no need to comment; just notice what comes up during the set of the bilateral stimulation.
After each set of stimulation, the therapist will ask you either (1) to let your mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind or (2) to report the last thing you noticed as the set stopped. Depending on your report, the therapist will direct your next focus of attention. These repeated sets with directed focused attention occur many times throughout the session. It is what processes and desensitizes the memory.
After the targeted memory no longer holds negative charge for you, the therapist will ask you to think of the preferred positive belief that you identified at the beginning of the session. If you need to adjust the positive belief you can. Then the therapist will ask you to focus on the belief during the next sets of bilateral stimulation. These sets continue until the new belief about yourself feels fully true to you. Then the therapist asks you to do a body scan as you recall the targeted memory to ensure that the negative charge has dissipated fully.
In this session closure phase, the therapist prepares you to leave the session. You’ll be told to expect that the brain may continue to process the memory, especially in the first 48 hours after the session. The therapist will encourage you to note disturbing thoughts, dreams, or other experiences and report them at the next session. You will also be reminded about self-care techniques. The therapist will
help you leave the session feeling in control and empowered.
This phase happens at the beginning of the next session. The therapist will check in with you about your experience since the last session. You’ll also be asked to recall the memory targeted in the previous session and rate its current negative charge, if any. If distress about the memory is lingering, the therapist will continue processing the memory with the process outline in Phases 3-6 until the memory has no negative charge, and the positive belief about yourself can be installed.
How many sessions will it take to treat my PTSD?
This varies on a number of things: the complexity of your history, the specific problem, your emotional regulation skills, etc.
If your PTSD stems from a single trauma, studies indicate that it could be as few as 3 sessions to process the event. In my own experience it has been more like 5 sessions including the initial session of history gathering. So if you’ve had a car accident and have panic attacks at the thought of driving, EMDR could fairly quickly get you back in the driver’s seat.
If multiple traumas underlie your PTSD, it will take longer, although it could still be fairly brief treatment. A number of controlled studies all reported that over two-thirds of participants who had experienced multiple traumas no longer had PTSD after 6 to 12 sessions of EMDR. So if you’ve had a number of similar traumas, EMDR may be a good fit to resolve PTSD symptoms. This is good news for veterans, first responders, and others who have had multiple trauma experiences.
If you have a complex trauma history, especially early childhood trauma, EMDR can be an important part of your overall treatment. While every disturbing event need not be processed, EMDR on key traumas can be very helpful in desensitizing painful memories and shifting beliefs.
How does EMDR work?
There are different theories on how EMDR actually works. I like the REM theory and explain it to my clients this way.
Negative things that happen to you during the day are processed by the brain during the Rapid Eye Movement (REM) phase of sleep. If the event is traumatic (that is, the brain doesn’t have an adequate frame of reference to make sense of a threatening event), the processing stops.
To move the memory along, the brain applies a temporary “default” meaning. We know that this meaning is always negative and about the self. It’s as if the brain is establishing the floor for the event with the worst possible meaning. (Sort of like the brain is figuring if you discover another meaning later, it can easily replace this “bottom of the barrel” meaning.
So the memories that get the “default” meaning attached are not truly processed. EMDR artificially stimulates the “firing” in the brain that happens during REM sleep. This “reprocesses” the memory. And because this is a body-based therapy, Once desensitized, the memory is then open for a new life-giving, positive meaning.
Adaptive Information Processing Theory
As Francine Shapiro developed EMDR therapy as a treatment for PTSD, she developed the Adaptive Information Processing model to describe how EMDR works. The EMDR Institute notes “The AIP model hypothesizes that if the information related to a distressing or traumatic experience is not fully processed, the initial perceptions, emotions, and distorted thoughts will be stored as they were experienced at the time of the event… [and] that such unprocessed experiences become the basis of current dysfunctional reactions and are the cause of many mental disorders. [Shapiro proposed] that EMDR therapy successfully alleviates mental disorders by processing the components of the distressing memory. These effects are thought to occur when the targeted memory is linked with other more adaptive information. When this occurs, learning takes place, and the experience is stored with appropriate emotions able to guide the person in the future.”
Do treatment effects last?
Multiple research studies demonstrated maintenance of EMDR effects and outcomes even 5 years after a full course of treatment for PTSD (in these studies 12 sessions of EMDR meant the full course of therapy).
I also have experienced lasting results with my own experience as a receiver of EMDR. I had tried for years to change my seemingly automatic flight response to another’s anger. Talk therapy, self-help, and other efforts to find resolution came up empty. About 6 sessions of EMDR finally changed this automatic flight response. I can now be in the presence of another person’s anger, stay put, and maintain my composure.
Are there side effects?
EMDR is a type of therapy, and as with any form of therapy, you may experience some temporary effects. These could be experiencing:
• disturbing, unresolved memories,
• unanticipated high emotion or strong body sensations during the session, and
• signs of the brain’s continuing processing of memories targeted in the session, such as more vivid dreams, disturbing thoughts or feelings, insights, the emergence of related memories, etc.
Is there any reason I shouldn’t have EMDR therapy for my PTSD?
EMDR is used for PTSD treatment, as well as anxiety, phobia, and many other mental health conditions. Sometimes, though, EMDR should not be used – or it should be used with caution.
Know that this therapy can briefly intensify emotion during the session. So you may want to talk to your doctor first if you have a condition like seizures or another neurological disorder. As with other health treatments, it’s a good idea to check it out first with your doctor if you’re pregnant.
Successful EMDR treatment is built on stability in the client. So if you find yourself feeling suicidal or experiencing psychosis, wait to do EMDR until you again stabilize. (And do tell your therapists about your feelings and experience!)
If you take a psychotropic medication or use non-regulated substances, definitely tell your EMDR therapist. Also if you have an eye condition or wear contacts, tell the therapist.
If you suspect that you dissociate more than just daydreaming, make sure the EMDR therapist you select has received training in treating people with dissociative disorders.
A final caution. EMDR generally resolves symptoms, and it’s particularly effective for single incident shock traumas. So if your trauma generated a legal case, think carefully about doing EMDR therapy before the case resolves. It could impair your testimony or influence the perception of a judge or jury concerning the trauma’s impact on you.
How do I find a good EMDR therapist?
Many EMDR therapists seek certification from the EMDR International Association. The “EMDR Certified” credential signifies certification by EMDRIA. Certification by EMDRIA requires:
• licensure for independent practice in the mental health field by their state, with a minimum of two years experience in the field,
• completion of both levels of an EMDRIA approved EMDR training program,
• conducting at least 50 EMDR sessions,
• receiving 20 hours of case consultation by an EMDRIA approved consultant, and
• completing twelve hours of EMDRIA approved continuing education every two years.
However, not every EMDR trained clinician seeks certification. Many of these clinicians provide excellent EMDR therapy, so consider them, as well, to help you heal your PTSD. Use questions like these to help you determine if an EMDR therapist has the qualifications needed:
• Have they received both levels of an EMDRIA-approved training?
• What issues/disorders do they treat most often with EMDR?
• How many PTSD cases have they treated (or whatever your problem/disorder may be)?
• What is their success rate?
As a trauma specialist, I’ve written frequently on trauma, PTSD, EMDR, and more. These articles may interest you, as well:
My Life Care Wellness colleague, Marty Dennen, LCPC, SEP, also has an excellent article that might interest you:
Ready to Pursue PTSD Treatment with EMDR?
If you’re in the west suburban Chicago area, contact us today to pursue EMDR treatment for your PTSD. If you’re outside the Chicago area, you can find an EMDR therapist near you through the directories of:
Rhonda Kelloway, LCSW, SEP