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Since the days of Freud, we’ve come to expect that processing our trauma is a lifelong journey. Not for the faint of heart. Excavating and sorting out traumatic experiences, as with physical excavations, is hard work.
That might be changing. Evidence suggests alternate ways to process trauma may be as effective.
EMDR therapy is a relatively new, clinically-supported psychotherapy treatment for releasing trauma, especially for experiences that are difficult to talk about.
If you’ve watched the docuseries “The Me You Can’t See,” Prince Harry, the Duke of Sussex shares his experiences in EMDR therapy. In one episode, BetterUp's Chief Impact Officer takes viewers into one of his private sessions. But you might be wondering, what is EMDR therapy, and how does it work? Let's take a look.
What is EMDR therapy?
Eye movement desensitization and reprocessing, or EMDR therapy, is a psychotherapeutic treatment for stress, PTSD, depression, and anxiety disorders. It is fairly unique. Unlike many others forms of therapy, EMDR doesn’t require talking about the traumatic event or challenging specific thoughts.
Instead, clinicians work with their patients to relive traumatic memories in brief doses, helping them process the trauma in a safe and guided setting.
How does EMDR therapy affect the brain?
Our memories, learnings, and experiences are coded into the neural networks of our brain. These neural pathways are intrinsic to how the brain processes and retains information. Under normal circumstances, new ideas and experiences are connected to other pathways, allowing us to consider information from various angles and expand what we know.
With traumatic experiences, these pathways get impaired. Because the neural pathways are connected to emotions, feelings, and reactions, we get “stuck” feeling like we’re back in the experience. We have difficulty connecting it to new life experiences. Dr. Arielle Schwartz compares the experience to a CD skipping on the same part, over and over.
What EMDR does is revisit the unprocessed trauma, using new sensory experiences to “manually” create those new connections. With assistance, the original cognitive response begins to lose its potency. The brain, so to speak, now has somewhere else to go.
Eye movements are used as the basis for the therapy because they simulate REM (rapid eye movement), which the brain already uses during sleep to process life experiences. The goal is to create adaptive resolution — a state in which the targeted memory no longer triggers a palpable stress response.
Who can benefit from EMDR therapy?
Because it’s non-invasive and doesn’t involve talking about the traumatic event in detail, EMDR is effective for children and adults, anyone that has difficulty talking about their experiences. It’s a scientifically validated treatment that is proven to be effective in treating trauma.
Eye movement desensitization and reprocessing therapy can be used to treat:
- Anxiety, phobias, and panic attacks
- Bipolar disorder
- Eating disorders
- Grief and loss
- Post-traumatic stress disorder (PTSD)
- Sleep disturbances
- Pain and chronic illness
- Physical and sexual assault
- Substance abuse and addiction
- Low self-esteem
- Performance anxiety
- Dissociative and personality disorders
How does EMDR therapy work?
The EMDR therapy process occurs over eight stages, or phases. Here’s a breakdown of how EMDR works and a typical EMDR treatment plan:
Phase 1: History-taking session
In the first session, the therapist assesses the client, taking a history of any trauma and answering questions about EMDR. Once the therapist and the client have agreed that EMDR is an appropriate treatment option, the therapist can put together a plan. This normally consists of the specific traumas that the patient wants to overcome and any other stressful experiences.
Phase 2: Imagery and stress reduction techniques
The EMDR therapist prepares the patient for the next phase of treatment by prepping them to relive the disturbing event. The therapist goes over the basic principles and process of EMDR, and the client learns emotional regulation and self-calming techniques. In this stage, the therapist and patient learn to work together and build rapport.
Phase 2 takes anywhere from one to four sessions, and provides a solid foundation for the next phase of treatment.
Phase 3: Assessment
Together with their therapist, the patient chooses an image that represents the distressing event, and a statement that expresses their belief about it. The therapist also takes a measurement of the patient’s subjective discomfort with the experience (SUD, or Subjective Units of Disturbance).
The goal of EMDR is to reduce subjective discomfort (SUD) while improving VOC. VOC, or Validity of Cognition, is how true the new, positive thought feels in place of the old, negative belief.
Phase 4: Desensitization
The therapist guides the patient through a series of eye movements as they recall the traumatic experience. While the patient is in recall, the therapist continues to direct their attention to the eye movement until their SUD level begins to come down. The most common intervention is bilateral stimulation — that is, focused, rapid eye movements on both sides. In addition to eye movements, though, the therapist might also use tapping or other sounds to guide the experience.
Phase 5: Installation
In Phase 5, the therapist works to strengthen the positive belief that will replace the negative thought. The goal is that the patient will be able to fully believe that the thought is true (indicated by a rating of 7 on the VOC scale).
For example, the therapist and patient (let’s call them Jesse) decide to work on a memory the patient has of being attacked. When they think of it, Jesse remembers feeling helpless and the sight of the attacker coming at them. In sessions, the therapist guides Jesse through a series of eye movements as they recall the attacker. They work together to reinforce the belief that Jesse is no longer helpless and strong enough to defend themselves.
Phase 6: Body scan
The patient revisits the memory to see if it still triggers a somatic (bodily) stress response. If they're still experiencing uncomfortable physical sensations, the therapist repeats the eye movement desensitization as needed. This may happen over several EMDR therapy sessions.
Phase 7: Closure
The patient begins keeping a log of any emotional disturbances or triggers that may come up between sessions. They practice the self-calming techniques learned in phase 2 and work on mastering their response to emotional triggers. The therapist will often conduct a follow-up appointment to see if the patient feels comfortable managing body sensations and emotions on their own between session.
Phase 8: Re-evaluation
The EMDR therapist and patient evaluate the progress that has been made so far. If they’re working on multiple traumas, they might select a new target trauma and begin the process all over again.
How effective is EMDR therapy?
EMDR is an effective, non-invasive therapy for trauma and mood disorders. It’s proven to be as effective as cognitive-behavioral therapy (CBT) and at least as effective as medication, without the potential side effects of the latter.
However, some professionals in the field find EMDR therapy problematic, and many doubt its effectiveness. Some of their concern comes from the fact that the studies conducted on EMDR frequently involve small sample groups, and in some ways, it sounds too good to be true. After all, traditional talk therapy takes some time, whereas EMDR can begin to show results in as few as three sessions. There are also some important caveats for anyone looking to EMDR as a treatment for their mental health.
If you think EMDR therapy might be a good fit for you, reach out to a clinically-trained professional who specializes in EMDR. Don’t attempt to do this type of therapy on your own. Reliving your traumas can be triggering and difficult work.
Guidance from a qualified professional is important. If you’re taking medications, don’t stop taking them without consulting a doctor.
The bottom line
EMDR therapy is an effective complement (or alternative) to traditional treatments for depression, anxiety, PTSD, and other traumas. If you’ve tried other treatments or you’re wary of taking medication, it’s worth looking into what EMDR therapy is and whether it would be an effective treatment for you.
BetterUp Staff Writer