Eye Movement Desensitization and Reprocessing

EMDR is a comprehensive therapy designed to address a wide range of psychological issues by focusing on how past experiences continue to influence present behavior. Often, these effects may not be apparent until they manifest through overreactions or other symptoms.

The therapy is based on the understanding that the human brain can maladaptively store traumatic or disturbing experiences from as early as preverbal stages or even in utero. These experiences may include direct negative experiences or deficits in care, such as insufficient nurturing or protection from caregivers. Additionally, social challenges during formative years, such as difficulties in school or with peers, can exacerbate these effects.

EMDR facilitates accessing these memories safely to resolve them, significantly reducing their lingering impact. For example, experiences like early childhood illness or caregiver absence might underpin a person’s anxiety, becoming clearer through EMDR therapy.

EMDR therapy has been supported by decades of clinical practice and the success stories of many who have undergone the treatment, illustrating its potential to significantly improve psychological health and well-being. For those interested in the research base of EMDR, extensive resources are available on the professional website of the EMDR International Association.

Like any therapy, EMDR requires proper application by a trained therapist who is knowledgeable about the specific presenting issues. In the early years of EMDR, when it was still experimental, the outcomes were not always successful. This was often due to the novelty of the approach and the therapists’ developing familiarity with the process. Reflecting on these early experiences, it is believed that with greater skill and understanding, those initial clients who saw limited benefits might have had more positive outcomes.

EMDR therapy embodies the promise of change. It requires time and patience—consider the duration it took for the concerns to develop. Therapy may intensify emotional responses temporarily as it addresses deeply rooted issues and experiences that individuals have often blocked or avoided. 

This process can be painful at times but is essentially ‘pain with a purpose.’ It aims to dismantle the negative beliefs many hold about themselves due to adverse experiences—beliefs such as fault, defectiveness, inadequacy, or undue responsibility for others’ actions. Clients sustain these gains, resulting in improving present and future lives 

What EMDR Is Not

EMDR has been misunderstood, maligned and attacked as the body of research grew to validate the model.. It is not simply cognitive therapy accompanied by unnecessary bilateral stimulation, such as eye movements. This misconception has been clearly refuted by early research. A substantial body of research supporting EMDR can be explored on the EMDR International Association’s professional website, which also includes a “Find a Therapist” function. Effective EMDR therapy requires a skilled therapist who is well-versed in addressing specific issues presented by clients.

Furthermore, EMDR is not a form of hypnosis. Although some EMDR clinicians are also trained in hypnosis and utilize both approaches for effective healing, EMDR itself does not involve hypnotic techniques. Concerns sometimes arise, particularly among individuals with strong spiritual or Christian beliefs, regarding the nature of EMDR. However, it is important to clarify that EMDR does not involve hypnosis; rather, it enables individuals to heal through their brain’s natural processes, maintaining control throughout the therapy.

Additionally, EMDR is not necessarily a brief therapy. The duration of EMDR treatment varies depending on the individual’s history of trauma and the presence of protective factors, such as adequate caregiving and a supportive environment that fulfills basic needs. 

Is It Working?

EMDR therapy includes built-in measures for tracking progress. Initially, your therapist will establish baseline measurements for each traumatic memory addressed. This involves rating the believability of a positive belief you wish to hold about the event on a scale from 0 (not believable at all) to 7 (completely believable). For example, you might initially rate the belief “I am good enough regardless” as a 3.

During therapy, this belief is reassessed, and the rating is expected to increase as the disturbance associated with the memory is processed. The therapy aims for a final belief rating of 7, indicating full belief in the positive cognition. For severe trauma, the target belief might be adjusted to something more gradually attainable, like “I can begin to believe that I am good enough regardless.”

Another baseline measure is the level of distress associated with the memory, assessed using the Subjective Units of Disturbance Scale (SUDS) ranging from 0 (no disturbance) to 10 (extreme disturbance). Your therapist uses Bilateral Stimulation to help process the trauma, often checking in to see if the SUDS rating decreases, which is a primary indicator of EMDR’s effectiveness. It’s normal for these ratings to fluctuate, sometimes increasing as more of the memory is processed.

As therapy progresses, the Validity of the Positive Cognition (VoC) is reassessed once the SUDS level has significantly reduced or reached 0. This ensures that any remaining disturbance does not affect the belief in the positive cognition. The final area of assessment is whether the body feels clear or neutral when recalling the memory, as physical responses can be the last to resolve.

These markers, along with client feedback, guide the EMDR process, helping both therapist and client recognize progress and areas needing further attention.

Session Length and Frequency

Standard EMDR sessions typically last between 45 minutes to an hour, conforming to most insurance requirements. Dr. Francine Shapiro notes that effective processing can occur within 20-25 minutes of a session, with time remaining for setup and review. Some clinicians offer “Intensive EMDR” lasting several hours, particularly beneficial for clients who travel long distances or are in inpatient group treatment settings.

When clients must wait a few weeks between EMDR therapy sessions, which is increasingly common due to high demand, therapists play a crucial role in equipping clients with resources and skills to manage their symptoms. Skilled EMDR therapists teach a range of coping mechanisms, from concrete techniques like breath work to imaginative strategies such as envisioning a “Peaceful Place.” These resources are crucial for stabilizing symptoms between sessions. If clients experience significant difficulties during these intervals, it is important they communicate this to their therapist to receive additional support.

Therapists also provide emergency contact information and set clear boundaries for communication between sessions. They help clients understand what situations warrant immediate contact and what issues can wait until the next scheduled session.

Preparation, which is Phase 2 of the 8 phases of EMDR therapy, focuses on stabilization through emotional regulation and symptom management. This early stage of therapy, combined with taking a detailed history, aims to establish a foundation not only for later trauma processing but also for daily coping. 

Processing traumatic memories can be destabilizing, and it is not uncommon for this effect to continue for a few days after a session as the brain works to resolve hyperarousal and integrate new information while maintaining adaptive behaviors. Therapists  inform clients that the processing of traumatic events may continue beyond the session. This ongoing mental processing helps integrate the traumatic memory with current knowledge, like recognizing one’s present safety and that the event was not their fault. However, a necessary sense of caution remains, allowing individuals to be alert without being overwhelmed by past trauma.

EMDR or CBT? 

EMDR, Trauma-focused Cognitive Behavioral Therapy (CF-DBT,) and Cognitive Processing Therapy (CPT, a derivative of CBT, are evidence-based and have been proven successful through extensive research. EMDR has over 40 years of research backing, while CPT, though newer, builds on the longstanding principles of CBT, the predominant therapy model in the U.S.

CBT therapies focus on altering thoughts to change behavior and symptoms, operating under the premise that irrational thoughts cause mental health issues. The EMDR model suggests that thoughts are a symptom rather than the cause of mental health issues. EMDR addresses thoughts, emotions, and bodily sensations, aiming to alter the brain’s storage of traumatic memories.

One notable difference between the approaches is their effectiveness with preverbal childhood experiences. CBT does not typically address non-verbal traumas, which are stored in emotions and bodily sensations, not words. This distinction is critical, as the Adverse Childhood Experiences study of 17,000 individuals highlights the profound impact early life experiences, such as divorce, addictions, and medical interventions, have on future mental, physical, and behavioral health. More details about this study can be found on the Centers for Disease Control (CDC) website.

Recent studies comparing EMDR and CBT have shown that both are effective; however, EMDR often produces results more rapidly, even within six months, whereas CBT may take up to a year. The World Health Organization (WHO) endorses both methods but notes that EMDR may have a lower dropout rate because it does not require homework, including rehearsal of trauma narratives.

Choosing the right therapy depends on individual needs. EMDR is particularly effective for those with adverse childhood experiences that affect their emotions and bodily responses. As highlighted in Dr. Bessel Van der Kolk’s book, “The Body Keeps the Score,” EMDR is a powerful intervention for trauma, which has become increasingly pertinent.

The choice of therapy also hinges on the therapeutic relationship and the therapist’s confidence in their chosen method. Research from the 1980s supports this, underscoring the importance of the connection between therapist and client in achieving successful outcomes.

Bonnie Mikelson, LISW