What is EMDR ?
EMDR (Eye Movement Desensitisation and Reprocessing) is a relatively new form of psychotherapy which has been demonstrated by extensive research to be particularly effective for the relief of post traumatic stress. It is recommended by NICE (National Institute for Clinical Excellence) as one of the treatments of choice for PTSD (Post traumatic stress disorder). It is also recognised to be effective in treating more chronic problems such as anxiety, phobias and poor self confidence.
EMDR works with eye movements but a variety of other ways of providing right/left alternating stimulation have also been found to be effective. Common alternatives to eye movements are earphones with right/left sound or small pads held in the hands which vibrate alternately right and left.
A Chance Discovery
In 1987 a psychologist called Francine Shapiro was walking in a park while thinking of something that troubled her. She noticed that her eyes were darting left and right and at the same time she came to a resolution on the matter that was troubling her. She experimented further with herself and discovered that the way she felt about disturbing memories changed if she deliberately moved her eyes in this way while in touch with the memory. Further testing followed with Vietnam war veterans. Many of these men had been in traditional therapy for 15 – 20 years but still continued to have nightmares and flashbacks. When they were treated with eye movements many of them were completely relieved of PTSD symptoms in a small number of sessions. From this initial research Francine Shapiro and her colleagues developed a working method to maximise the positive effects of this chance discovery. This method is now known as EMDR.
What is an EMDR Session Like?
The therapist works with you to identify a specific problem or event as the focus of the treatment session. You call to mind the disturbing event, recalling what was seen, felt and thought at the time as well as the feelings and sensations that are currently felt on recalling the event. The therapist then facilitates the directional movement of the eyes or other dual attention stimulation of the brain while you focus on the disturbing material. You are told to “just notice” what comes to mind without making any effort to control direction or content. Each person will process information in their own unique way – sometimes focused on the detail of what happened and sometimes more focused on body sensations or symbolic associations. Sets of eye movements are continued until the memory becomes less disturbing and is associated with more positive thoughts and beliefs such as “I did the best I could”. During EMDR you may experience intense emotions and powerful physical sensations, but by the end of the session most people report a great reduction in the level of disturbance.
How Long does EMDR take?
One or more sessions are required for the therapist to understand the nature of the problem and decide whether EMDR is an appropriate treatment. Time is also needed to ensure that the therapy can be contained and conducted safely. In the case of people who have lived for many years with the effects of early trauma the preparation phase of the therapy is likely to be extended over a considerable period. Once you and the therapist have agreed that EMDR is the appropriate treatment and you are ready to begin work on the disturbing memory or memories, the re-processing stage of the treatment can begin.
A typical EMDR session lasts from 60-90 minutes. The type of problem, current life circumstances and your early history will all affect the number of sessions that will be needed. EMDR may be used within a standard “talking therapy”, or as an adjunctive therapy with a separate therapist or as a treatment by itself.
Examples from practice
These are composite accounts based on experience but with names and details changed to protect the identity of the clients.
Michael had discovered his son's body hanging in the garage. He was so shocked and distressed that he believed himself to be "beyond forgiveness" and he was too numb to feel his sorrow. Using EMDR he was able to shift over a couple of extended sessions to recognise that he had done "no worse than the next man" as a parent and was then able to be in touch with his deep sorrow and begin to grieve for the loss of his son.
Christopher had been having frequent flashbacks and nightmares after a car accident in which his car had repeatedly rolled over. During EMDR he worked through the whole event and appeared to re-orientate himself in time and space. The flashbacks stopped and his comment on the capacity of his brain to heal itself was "What an amazing bit of kit!"
Ellen had experienced a traumatic assault as a twelve year old and had been unable to speak about this for over 30 years. It took 14 months of very tough work with EMDR, which first addressed the trauma itself and then moved on to the consequences for her life of this event, before Ellen began to experience herself in a much more positive and hopeful way and was able to make new choices in her present life.
How does EMDR work?
If you are involved in a distressing event, you may feel overwhelmed and your brain may be unable to process what has happened. The distressing memory seems to become frozen on a neurological level. When you recall that memory, you can re-experience what you saw, heard, smelt, tasted or felt, and this can be quite intense. Sometimes the memories are so distressing, that the person affected tries to avoid thinking about the event to avoid experiencing the disturbing feelings.
The alternating left-right stimulation of the brain with eye movements, sounds or taps during EMDR, seems to stimulate the brain's frozen or blocked information processing system. This may be by helping to connect the cognitive/thinking areas of the brain with the more primitive emotional/feeling areas. As this processing takes place, the distressing memories seem to lose their intensity, so that they are less disturbing 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.
For further information on EMDR see EMDR Association website