EMDR: What is it, who is it for, how does it work and is it effective?
In the world of psychology, there are many options for the type of treatment a patient can receive. The type of treatment is all dependent on the psychological disorder, or learning disability someone may have. My most recent article touched on animal-assisted therapy; other therapies include CBT or come from a psychoanalytic, or psychodynamic approach depending on the treating clinician. As the realm of psychology evolves, so can modes of therapy. EMDR now being part of the cocktail of therapies, introduces a very interesting component that you don’t see in most traditional therapies. Playing devil’s advocate here… is it a revolutionary mode of therapy? Read more to find out and form your own opinion!
What is EMDR?
EMDR (eye movement desensitization and reprocessing) is a non-traditional mode of psychotherapy that has been growing in popularity within the PTSD community. EMDR was founded by Francine Shapiro in 1990. It is an eight-step process that has been deemed as unique due to its unusual and never-before-seen feature of using saccadic eye movements when treating those who are highly symptomatic with trauma-related disorders.
During an EMDR session, the treating clinician will determine which traumatic memory is the cause of the patient’s distress. Then, the clinician will ask his/her patient to focus on that specific thought or memory, while following the therapist’s hand as it sways back and forth across the patient’s field of vision.
Almost sounds like hypnosis doesn’t it? We’ll get to that later in the article.
Who is eligible for EMDR treatment?
EMDR is a trauma therapy, used for those who suffer from post-traumatic stress disorder. PTSD is a disorder that is characterized by the failure to recover after being involved or witnessing a terrifying event. Symptoms of PTSD include flashbacks, nightmares, anxiety, depression, and heightened reactivity to stimuli.
Any person who suffers from PTSD is eligible for this type of treatment, depending if the clinician believes EMDR is the right treatment plan for his/her prospective patient. Depending on the severity of symptoms, a person may have to be referred to a higher level of care.
The 8 step process of EMDR
Below you will read the step by step process of EMDR, and what to expect when starting treatment.
- History and treatment planning: During this stage, assessment of the patient’s readiness, and barriers to treatment are made. This is also accompanied by the assessment of any dysfunctional behaviors, other illness characteristics, and specific symptoms.
- Preparation: In this stage of treatment, the therapeutic alliance is developed. Patient education in regards to trauma, suggestions on coping during treatment and explanation and review of EMDR are given.
- Assessment: This stage involves a very specific assessment of the trauma memory. The patient is asked to tell his/her clinician the distressing images in the memory, associated negative cognitions, alternative positive cognition, asked to rate the validity of positive cognition, attribute emotions associated with the trauma memory, identify trauma-relevant physical sensations and their respective bodily locations. This stage is completed by very carefully interviewing the patient, and is quantified by the use of subjective indicators and measures.
- Desensitization and reprocessing: In this stage, we can start to see where the therapist starts the use of hand motions. The patient is asked to focus on the distressing image/moment in mind, accompanied by any negative cognition, and associated bodily sensations while focusing on the therapists’ fingers across the patient’s field of vision. After exactly 20 seconds, the patient is asked to let go of the distressing memory, take a deep breath, and to take note of the changes in image, thoughts, sensations, or emotions that might have occurred.
- Installation of positive cognition: When the disturbing images have been completely desensitized, the patient is then asked to hold on to the positive thought in mind while focusing on the therapist’s fingers once again. In this stage, patients aren’t asked to report back any changes in feelings, emotions, or thoughts. However, they are asked to report on the changes in the validity of cognition (VoC), a 7-point self-report measure, in which 7 is completely valid, and 1 is not valid at all.
- Body scan: During this stage, it is requested that the patient identify any continuous bodily tensions or discomfort. If any of these are present, the patient will have to attend to them individually, while once again – following the finger movements of the therapist.
- Closure: Here, the patient is given coping skills, such as relaxation techniques and positive visualization, to combat any emergent distressing memories. It is highly suggested that a patient starts journaling in regards to any thoughts, dreams, and feelings as it is needed for use between each session.
- Reevaluation: The therapist evaluates if treatment goals are being achieved. This is done at every session, meanwhile, additional sessions may be tacked on depending on the needs of the patient. These additional sessions are used to target further trauma memories, or to help the patient with skills development.
How long does an EMDR session last?
A typical EMDR session can last anywhere from 60-90 minutes. With that being said, like most psychotherapies, EMDR is not a one-session cure form of treatment. As stated above, additional sessions may be suggested by a therapist if he/she doesn’t feel confident that the treatment goals of the patient are being met.
Is EMDR effective?
This is where feedback from skeptics come into play.
To answer the proposed question: The answer is yes. The treatment is effective. However, it isn’t effective for the reasons its practitioners believe it to be. Shapiro and EMDR’s hardcore believers believe that the eye movements and therapist hand movements are the prime reason for its very desirable treatment outcomes. Research shows that up to 78% of patients show reduced PTSD symptoms (Carlson et al., 1998). If you were to remove stages 4-6 of the 8-step process, EMDR is composed of other forms of therapy, and might actually equate to a form of therapy that already exists: Just plain old psychotherapy.
EMDR has often been compared to prolonged exposure therapies to see if it could prove to be more effective. Fortunately enough, with some well-controlled studies looking to see if EMDR is an efficacious treatment – it is. It actually proves to be just as effective as exposure therapy.
The unique feature of EMDR is what seems to have everybody’s interest, and has clinicians who specialize in PTSD in a frenzy to figure out if the eye moments significantly contribute to the effectiveness of EMDR. In a meta-analysis, Davidson and Parker (2001), examined if the eye-jerking movements were an essential part of the treatment. The authors concluded that the data shows that there isn’t a huge benefit of eye movements or other alternating movements. Other studies that came after this meta-analysis proved that eye movements are what makes EMDR effective. However, there is a lack of studies that really dissect EMDR to prove that the eye movements do not provide any incremental benefits on treatment outcome.
EMDR vs. Hypnotherapy
Hands, eyes, focusing on the therapist’s movements, tapping into one’s thoughts; when first doing a quick once over on EMDR, it almost sounds like a patient is experiencing hypnosis. Hypnosis is actually an aid when used in psychotherapies because when a patient is in a hypnotic state, it allows patients to get in tune with painful thoughts, feelings, and memories. Hypnotherapy is used in suggestion therapy when wanting to influence behavior changes like smoking or overeating or can be used for analysis when trying to dig up traumatic events that are hiding in the subconscious.
Even though EMDR and hypnotherapy seem to be similar, I promise, they are not. There are crucial differences that you should look out for when addressing the two. EMDR is used to help reduce and suppress PTSD symptoms, while hypnotherapy is used to tap into a patients mind to unlock any traumatic events that can later be discussed in future psychotherapy sessions. Also, there is the obvious: The state of mind. During an EMDR session a patient is completely conscious, and in hypnotherapy, a patient has been subdued and placed into a hypnotic state.
The ball is in your court! What do you think about EMDR trauma therapy? Do you think that this is a new breakthrough therapy within psychology? Do you or anyone you know have had EMDR treatment to help with your PTSD symptoms? The bigger question here though is, do you believe the eye movements play a huge role in helping reduce PTSD symptoms? The data is there, but some will argue! Let us know what you think in the comments below!
Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund, N.L, & Muraoka, M.Y. (1998). Eye movement desensitization and reprocessing (EMDR): Treatment for a combat-related post-traumatic stress disorder. Journal of Traumatic Stress, 11, 3-24.
Davidson, P.R., & Parker, K.C.H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.
Emdr.com (n.d). What is EMDR?
Spates, C.R, Koch, E., Cusack, K., Pagoto, S., & Waller, S. (2009). Effective treatments for PTSD: Eye Movement Desensitization and Reprocessing, 279-281, 283, 288-289.