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Eye Movement Desensitization and Reprocessing

What is EMDR?

EMDR was developed in the 80s by psychologist Francine Shapiro. She discovered that her eye movements naturally followed a side-to-side pattern when she was walking and thinking about a problem. When she focused on these movements while thinking about an issue, her negative thoughts and feelings about the problem seemed to disappear.

Shapiro used herself as a test subject and eventually reached out to others, who she found also experienced a reduction in anxiety. Over time, she realized that EMDR could help with reprocessing old memories.

“I basically gathered every individual I knew and asked them “Bring up something that bothers you” and then I tried to duplicate with them what I had done with myself. I asked them to move their eyes in the same way. I showed them how mine had moved and discovered that most people did not have that type of muscle control and I had to use my hand in order to guide them. The feeling that I had at the time was that I had stumbled on a natural physiological process that we all had, something that I had noticed and was now using deliberately. The feeling was that if it worked for me, then reasonably it should work for everyone else.”

When working with a small group of people she was close to, she observed an almost immediate reduction in anxiety when using Shapiro’s eye movement technique while discussing a distressing memory. Which, at first, led Shapiro to believe that the eye movement technique was simply a tool for immediate anxiety reduction. In other words, the element of “reprocessing” hadn’t entered her mind. However, she discovered the reprocessing benefits as she continued her work. 

“I’d realized that old memories were the easiest to work with. If you look through the DSM, the folks most troubled by old memories seemed to be trauma victims, rape victims, et cetera. Not knowing if it would work with a diagnosed population, I approached a veterans outreach center and asked them if I could work with some people there. They allowed me to first demonstrate it with a counselor—a Vietnam vet—who was still greatly troubled because of an incident from the war. After a few moments, the memory was fading and changing and was quickly resolved. Since it clearly worked, I launched into a controlled study with a group up in northern California made up primarily of sexual assault victims, and that study was published in the Journal of Traumatic Stress.”

In 1989, she published the results of her initial research, and EMDR has since gained widespread recognition as an effective treatment for various mental health conditions, like PTSD, anxiety, and phobias. It's been endorsed by organizations like the American Psychological Association and the International Society for Traumatic Stress Studies as an evidence-based treatment for PTSD.

I’ll admit it. When I first learned about EMDR through my therapist, it sounded like pseudoscience. As a mostly rational and pragmatic person, I was reluctant to believe that moving my eyes around would somehow allow me to process old traumatic experiences. After a single session, I realized how wrong I was.

What is the purpose of EMDR?

EMDR is based on the idea that certain memories and experiences, particularly those that are traumatic or distressing, can get stuck in the brain and cause ongoing emotional and behavioral problems. 

My experience with EMDR was consistent with this hypothesis. What EMDR sessions allowed me to do is revisit traumatic memories, re-experience them in a way that allowed me to shift my perspective of the traumatic experience, and then significantly lower the negative emotional response I had attached to those memories. 

For example, during my first EMDR session, I revisited my memory of seeing my mom in the hospital when she attempted suicide. That memory was deeply disturbing to me. For years, any mention of the word “mom” or “suicide” would trigger my trauma, sending me into a panic attack. After processing that memory through EMDR, I am no longer triggered by that memory or any of its associations. I can now speak comfortably about the memory.

What is the general process for an EMDR session?

Okay, let's break down what happens during an EMDR session:

  1. History taking - Your therapist will start by asking you about your background, making sure you're ready for EMDR, determine what symptoms you want relief from, and then figure out a treatment plan. They'll want to know things like what you've been diagnosed with, any other problems you're facing, your support system, and how you're handling stress. This information helps them identify what to focus on during the session.
  2. Preparing you - Next, your therapist will work on building a relationship with you, explaining what to expect from EMDR, and making sure you're feeling stable. If you have a history of trauma or anxiety, they'll help you work through that before diving into the more intense part of the session. Also, in this phase the therapist will develop and "install" imaginary self-soothing resources for you to use during and in-between sessions to reduce the distress that may come up. For example, in my case I had a "safe place" memory I could return to whenever I needed in order to sooth myself.
  3. Assessing the memory - Together, you and your therapist will pick a specific memory to work on and identify the thoughts, feelings, and physical sensations that go along with it. Your therapist will take some baseline measurements so they can see how much you improve during the session.
  4. Desensitizing - This is the main part of the session where you'll focus on the memory while your therapist leads you through some eye movements or other stimulation. You'll talk through what comes up, and the therapist will guide you to the next step. This cycle will be repeated a few times until you start feeling better.
  5. Installing new beliefs - As the negative aspects of the memory become less intense, positive thoughts and beliefs will take their place. Your therapist will help you solidify this shift.
  6. Body scan - Your therapist will ask you to notice if there's any tension in your body related to the memory. If there is, you'll work through that with more eye movements.
  7. Closure - At the end of the session, your therapist will check in to make sure everything was processed enough. They might ask you to keep a journal to track any lingering feelings or memories that come up later.
  8. Reevaluation - At the start of every session after the first, your therapist will check in with you to see how you're doing and what you want to focus on next. They'll review your journal and see if there's anything that needs more attention.

Who is EMDR ideal for?

The consensus is that EMDR is a good option for people with PTSD, C-PTSD (Complex PTSD), and anyone with single-incident trauma (like a car crash or a rape), anxiety disorders, and phobias. There are also individual characteristics that make someone a good candidate, such as:

  1. Willingness: EMDR requires active participation and engagement from the client.
  2. Focus: EMDR involves focusing on specific memories and experiences, so individuals who can maintain focus and concentration during the therapy sessions may be more likely to benefit from the therapy.
  3. Ability to cope with strong emotions: EMDR may bring up strong emotions and memories for some people, so clients need to be able to cope with these emotions in a healthy way. This is why therapists will teach different coping skills to the client in advance of the session starting.
  4. No contraindications: people need to be free from medical conditions or other circumstances that may make EMDR an inappropriate treatment option. 

Ultimately, you’ll want to defer to your doctor to determine if EMDR is right for you.

When not to use EMDR?

Some people may not be suitable candidates for EMDR if they:

  1. Are experiencing severe psychosis, or are in a severe state of dissociation
  2. Anyone prone to seizures since the eye movements used in EMDR may trigger a seizure in these individuals.
  3. Are under the influence of drugs or alcohol. This one is straightforward. You can’t be drunk or high when doing trauma therapy.
  4. EMDR may not be appropriate for individuals experiencing severe suicidal ideation, as the therapy may trigger strong emotions that could increase the risk of self-harm.

Does EMDR work long-term or short-term?

The long-term effectiveness of EMDR therapy is less well-studied, but some research suggests that the benefits of EMDR may be long-lasting. 

One study found that EMDR was effective in reducing symptoms of PTSD in a group of military personnel with chronic PTSD. The study found that EMDR was associated with significant reductions in PTSD symptoms, depression, anxiety, and overall distress at the end of treatment and at follow-up assessments up to 3 years later.

Another study found that EMDR was effective in reducing symptoms of PTSD in a sample of adults who had experienced a range of traumatic events. The study found that EMDR was associated with significant reductions in PTSD symptoms and overall psychological distress at the end of treatment and at a 6-month follow-up assessment.

Here are a few specific studies that have looked at the long-term effectiveness of eye movement desensitization and reprocessing (EMDR):

  1. "Long-term follow-up of eye movement desensitization and reprocessing (EMDR) treatment for PTSD." This study followed a group of military personnel with chronic PTSD who received EMDR treatment. The study found that EMDR was associated with significant reductions in PTSD symptoms, depression, anxiety, and overall distress at the end of treatment and follow-up assessments up to 3 years later.
  2. "EMDR for PTSD: A randomized controlled trial." This study compared EMDR to a waitlist control condition in a sample of adults who had experienced a range of traumatic events. The study found that EMDR was associated with significant reductions in PTSD symptoms and overall psychological distress at the end of treatment and at a 6-month follow-up assessment.
  3. "The long-term effects of EMDR on depression, PTSD, and dissociation in survivors of torture: A randomized controlled trial." This study compared EMDR to a waitlist control condition in a sample of refugees who had experienced torture. The study found that EMDR was associated with significant reductions in depression, PTSD, and dissociation at the end of treatment and at a 6-month follow-up assessment.

From my personal experience, I can say that EMDR is both fast-acting and long-lasting. It quickly and sustainably reduced my trauma triggers, and the benefits have been sustained over time.

How effective is EMDR?

Research studies have consistently found that EMDR is an effective trauma treatment. Many studies demonstrate significant reductions in symptoms such as posttraumatic stress disorder (PTSD) and anxiety in individuals who have undergone EMDR therapy.

The success rate of Eye Movement Desensitization and Reprocessing (EMDR) therapy varies depending on the person and the specific condition being treated.

For example, a meta-analysis of 15 studies found that EMDR was more effective than no treatment or a waiting-list control condition in reducing symptoms of PTSD in adults. A meta-analysis of 25 studies found that EMDR was more effective than other forms of treatment, such as cognitive behavioral therapy (CBT), in reducing symptoms of PTSD in adults. This is also consistent with my personal experience. I found very little benefit from CBT in reducing my trauma responses. It wasn’t until I began EMDR that I noticed an immediate reduction in anxiety and trauma reactions. 

There is also evidence that EMDR may effectively treat other mental health conditions, such as depression and anxiety. Some studies have found that EMDR may be as effective as other forms of therapy, such as cognitive-behavioral therapy (CBT), in treating these conditions.

As stated in the Encyclopedia of Psychotherapy:

“Currently, EMDR has been found efficacious in the treatment of PTSD. Civilian participants have shown a 70 to 90% decrease in PTSD diagnosis and a substantial improvement in reported symptoms after three or four sessions. The only combat veteran study that provided a full course of treatment also revealed EMDR to be efficacious with a 78% decrease in PTSD diagnosis after 12 sessions. In all but one controlled study, EMDR appeared to be equivalent in treatment outcome to CBT comparison conditions and was reported to require fewer direct treatment and/or homework hours. Although there are numerous anecdotal and case study reports documenting EMDR’s effectiveness in the treatment of other disorders, controlled studies are lacking or inconclusive, and future research is required to establish the parameters of EMDR’s usefulness with these populations.”

How do I know if EMDR therapy worked?

There are several ways in which you can assess if EMDR is “working” for you. Most of them involve tracking your progress or changes in mood and behavior over time. There are other indicators, such as:

  1. Reduction in symptoms: You may notice a decrease in the intensity or frequency of your symptoms, such as fewer flashbacks, less anxiety, or less depression.
  2. Improved functioning: You may notice an improvement in your overall functioning, such as being able to participate in activities that were previously difficult or being able to cope with stress more effectively. 
  3. Increased self-awareness: You may become more aware of your thoughts, feelings, and behaviors and better understand their origins and how they may impact your life.
  4. Improved relationships: You may notice an improvement in your relationships with others, such as being more able to communicate effectively or resolve conflicts.

I found that my social anxiety reduced after EMDR, allowing me to be more comfortable in large crowds. That was in addition to a significant reduction in anxiety and panic when exposed to a certain set of triggers. 

What side effects might I expect?

Like any therapy, EMDR can sometimes have side effects, although they are usually temporary and resolve independently. They include:

  1. Emotional distress: During EMDR therapy, individuals may be asked to focus on distressing memories or emotions, which can sometimes be emotionally challenging. Some individuals may experience temporary increases in distress or discomfort during the EMDR process.
  2. Physical discomfort: Some individuals may experience physical discomfort or sensations during EMDR therapy, such as dizziness, nausea, or headache. 
  3. Flashbacks: Some individuals may experience flashbacks, or vivid memories of a traumatic event, during or after EMDR therapy.
  4. Other symptoms: Some individuals may experience other symptoms, such as difficulty sleeping or changes in appetite, during or after EMDR therapy.

These symptoms are usually temporary and resolve on their own. In my case, I experienced a temporary increase in emotional distress during the sessions, followed by a drain in energy after the session from releasing a lot of emotional pain. Otherwise, I didn’t experience any negative side effects that would prevent me from pursuing additional EMDR therapy, if necessary.

Is EMDR effective for addiction?

Scientific studies have consistently found that EMDR is an effective addiction treatment. Many studies demonstrate significant reductions in addiction-related symptoms and improved overall functioning in individuals undergoing EMDR therapy.

EMDR is believed to be effective in treating addiction because it helps individuals process and resolves the underlying trauma, stress, and other distressing emotions that may be driving their addictive behaviors. By resolving the underlying issues, people may be better able to break free from their addiction and adopt more adaptive coping strategies.

Podcasts and Interviews on EMDR

I spent an hour chatting with Annie Wright, LMFT to learn about her experience as an EMDR practitioner. She is a licensed trauma clinician, therapy center founder, writer, and mental health entrepreneur. Every bit of her work in the world centers on helping individuals recover from relational trauma backgrounds.

In addition to that, check out this interview with Francine Shapiro, the creator of EMDR.

Lastly, there's a series of client testimonials on Youtube from people that have undergone EMDR therapy. I personally enjoyed the openness and honesty from this gentleman.