EMDR offers new hope for many people who have experienced trauma
A recent development in the Cognitive Behavioural treatment of trauma means that people who have suffered for years from distressing memories, nightmares, abuse or other traumatic events can often gain relief from this rapid information processing intervention discovered 16 years ago.
EMDR represents a valuable addition to the Cognitive Therapist's armamentarium of techniques, helping people with a wide range of emotional disorders. Research shows that it is fast, safe and effective and does not involve the use of drugs, or hypnosis. When used as an adjunct to Cognitive Therapy EMDR processing can often be helpful in changing the meaning of early, painful memories, which have resulted in negative core beliefs and Early Maladaptive Schemas - events in our lives which when recalled trigger negative emotions, sensations and beliefs. These memories can be referred to in Cognitive terms as ‘hot spots’ or in Gestalt terms ‘unfinished business’.
What is EMDR?
It is an acronym for Eye Movement Desensitisation and Reprocessing. An innovative clinical treatment that has successfully helped over a million individuals who have survived trauma, including sexual abuse, domestic violence, combat, crime, and those suffering from a number of other complaints.
This processing technique can bring quick and lasting relief for many types of emotional distress. EMDR uses a natural function of the body, Rapid Eye Movement (REM), as its basis. The human mind uses REM during sleep time to help it process daily emotional experiences. There is some evidence that the eye movements perform a similar function to those that occur during REM sleep (when we dream), which we already know to have a vital information processing function. The human mind uses REM during sleep time to help it process daily emotional experiences. When trauma is extreme, this process breaks down and REM sleep doesn't bring the usual relief from distress. EMDR comes is thought to be an an advanced stage of the REM processing. As the brain via the eye-movement processes troubling images and feelings, resolution of the issue can be achieved.
How does EMDR work?
Normally, the individual processes disturbing experiences naturally. However, when a person is severely traumatised, either by an overwhelming event or by being repeatedly subjected to distress, this healing process may become overloaded, leaving the original disturbing experiences unprocessed. These unprocessed memories can be stored in the brain in a "raw" form where they can be continually re-evoked when experiencing events that are similar to the original experience. They are stored in the brain with all the sights, sounds, thoughts and feelings that accompany it. Therefore, the negative thoughts and feelings of the traumatic event are trapped in the nervous system. Since the brain cannot process these emotions, the experience and/or its accompanying feelings are often suppressed from consciousness. However, the distress lives on in the nervous system where it causes disturbances in the emotional functioning of the person. Similarly to the way rapid eye movement (REM) or dream sleep works, the eye movements during the EMDR session does two very important things:
First, it "unlocks" the negative memories and emotions stored in the nervous system, and secondly, it helps the brain to successfully process the experience. The therapist works gently with the client, guiding him or her to revisit the traumatic incident. When the memory is brought to mind, the feelings are re-experienced in a new way. EMDR makes it possible to gain the self-knowledge and perspective that will enable the client to choose their actions, rather than feeling powerless over their re-actions. This process can be complex if there are many experiences connected to the negative feelings. The EMDR sessions continue until the traumatic memories and emotions are relieved.
Cognitive Research into Trauma
The EMDR processing of traumatic events is supported by the latest Cognitive Neuroscience Model of PTSD. According to Dual Representation Theory (DRT), proposed by Professor Chris Brewin, (University College London), the situationally accessible memory system (SAM), which is located in the emotional part of the brain called the amygdala, interferes with hippocampal function, disrupting encoding in Verbally Accessible Memory (VAM). It is this impairment in VAM that accounts for increased intrusions. EMDR plays a critical role in transferring information from the non-hippocampally (amygdala) dependent SAM memory store to the hippocampally-based VAM and completing the processing of the trauma.
In terms of DRT, dissociation can be thought of as impairing the formation of a normal autobiographical narrative. This phenomenon can be witnessed in minor traumas such as panic attacks, whereby, the client misinterprets the physical sensations of panic in a catastrophic fashion, without checking out checking out the negative interpretation, which maintains the panic. EMDR can often be used to process early negative memories, and help weaken early maladaptive beliefs which appear resistant to change. (see Schema Therapy and Early Maladaptive Schemas)
EMDR shares a number of treatment elements with the well established Cognitive Processing Therapy. For example, clients are asked to recall the events of their trauma, monitor physiological responses to the memory. The treatment also prompts the client to engage in repeated sets of lateral eye movements while focusing on initial reactions and the therapeutic alternative cognition.
What are the advantages of EMDR?
Research studies show that it is very effective in helping people process painful and traumatic experiences. The processing can help move the client quickly from emotional distress to peaceful resolution of the issues or events involved. The positive, long-term results of EMDR processing, can affect all levels of the client's well being - mental, emotional and physical, so that their responses return to normalcy and health. Studies consistently show that this information processing can result in elimination of the targeted emotion. The memory remains but the negative response is neutralised.
Who can be helped by EMDR?
When used as an adjunct to Cognitive Therapy, it has direct application to many human situations, including phobias, many anxiety-based disorders and emotional problems that have their basis in emotional trauma, from earlier experiences. It has been used to help reduce many types of emotional blocks or fears, including PTSD, sexual abuse, grief, performance anxiety, social anxiety and pain.
Are there studies that show that EMDR is effective?
Fourteen controlled studies support its efficacy in treatment of trauma.
The National Centre for Clinical Excellence (NICE) is responsible for providing national guidance on treatments for providing national guidance on treatments and care for those using the NHS in England and Wales. NICE reviews all available treatments for a disorder (both psychological therapies and medication) to establish which are most effective. The only psychological treatments for Post Traumatic Stress Disorder recommended by NICE are Cognitive Therapy and EMDR.
How EMDR is used in clinical practice
Following in–depth assessment of the client’s presenting problems and other relevant issues in their personal history, time will be taken to explain the process and demonstrate the eye movements so that the client is fully prepared foe what the procedure involves. The aim is to enable the client to end each session felling reasonable relaxed, comfortable and free from distress regardless of the material which may be addressed during the treatment sessions.
EMDR requires clients to focus on three main aspects of the trauma. Firstly, a visual image which is usually that of the most disturbing part of the trauma. Secondly, the negative thought that they have about themselves in relation to the trauma. Thirdly, the location of the disturbance in their body.
Focusing on these aspects, the client then tracks the therapist’s finger across the visual field in rapid saccadic eye movements and after each set of such movements, the client is simply asked to report on what they are experiencing. During the course of this procedure, a decrease in the emotional impact of the traumatic memory usually occurs. The decrease may be gradual but in some cases may be sudden. In addition, the client’s perception of their own part in the trauma can change, often dramatically. Abreaction may occur, which is where disturbing memories that have been forgotten or repressed suddenly come to the surface, often accompanied by the release of painful emotions.
How do I know if EMDR is right for me?
There are a number of factors to consider when evaluating its appropriateness for a client's particular situation and history. During your initial consultation an in-depth assessment of your presenting problems and all other relevant factors will be discussed in full. After this in-depth assessment a decision can be made as to whether this would be an appropriate intervention. In general you are an excellent candidate for EMDR if you have traumatic memories that are clearly identifiable and vivid.
How often would I need EMDR?
Typically, a session lasts from 60 to 90 minutes. The length of the session depends upon a number of factors, including the nature and history of the problem, the degree of trauma the specific circumstances on that particular day, etc. The history and formulation are usually done in the few sessions. The therapist and client collaborate to agree on the current problem, establish how and when it arose, identify any maintaining factors and agree on goals for change.
Treatment can be very rapid, however, the number of sessions will vary, according to the complexity of the issues being dealt with. In general, the more isolated the traumatic memory being treated, the shorter the treatment tends to be. For individuals with a history of multiple painful experiences and years of feeling bad about them, a number of EMDR sessions in conjunction with cognitive therapy or schema focused cognitive therapy may be needed.
What happens between EMDR sessions?
Between sessions, it is a good idea for client’s to keep a daily thought log of any unusual or noteworthy thoughts or feelings. He or she can then bring their notes to the next session. This thought record will help the therapist to know if any adjustments in therapy are warranted. After an EMDR session, there may be a strong sense of relief, a feeling of openness or even euphoria.
Is EMDR Hypnosis?
Absolutely not, the client is awake, alert and in control at all times. No trance state is induced, no suggestions are made, and the changes that occur are the result of the client's own innate processes.
How do I know that my therapist is qualified to use EMDR?
Only practicing, registered psychotherapists, psychiatrists, psychologists and counsellors may receive this specialised training. To-date, over 300 British clinicians have been officially trained by the EMDR Association (UK and Ireland).
Eye Movement Desensitisation and Reprocessing is a highly specialised method that requires supervised training for therapeutic effectiveness and client safety. In the words of the Behaviour Therapist Journal, "Clients are at risk if untrained clinicians attempt to use EMDR".