See below for Frequently asked questions & detailed explanations, per EMDR Institute, Inc., founded by Francine Shapiro, PhD (2020).
What is EMDR therapy?
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR training sessions, clinicians help clients activate their natural healing processes.
More than thirty positive controlled outcome studies have been conducted on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 25 years.
EMDR therapy is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.” Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes. The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution — all without speaking in detail or doing homework used in other therapies.
Is EMDR Therapy a One-Session Cure?
No. When Shapiro (1989a) first introduced EMDR therapy into the professional literature, she included the following caveat: “It must be emphasized that the EMD procedure, as presented here, serves to desensitize the anxiety related to traumatic memories, not to eliminate all PTSD-symptomology and complications, nor to provide coping strategies to victims” (p 221). In this first study, the focus was on one memory, with effects measured by changes in the Subjective Units of Disturbance (SUD) scale. The literature consistently reports similar effects for EMDR with SUD measures of in-session anxiety. Since that time, EMDR therapy has evolved into an integrative approach that addresses the full clinical picture. Two studies (Lee, Gavriel, Drummond, Richards, & Greenwald, 2002; Rothbaum, 1997) have indicated an elimination of diagnosis of posttraumatic stress disorder (PTSD) in 83-90% of civilian participants after four to seven sessions. Other studies using participants with PTSD (e.g. Ironson, Freund, Strauss, & Williams, 2002; Scheck, Schaeffer, & Gillette, 1998; S. A. Wilson, Becker, & Tinker, 1995) have found significant decreases in a wide range of symptoms after three-four sessions. The only randomized study (Carlson, Chemtob, Rusnak, Hedlund, & Muraoka, 1998) of combat veterans to address the multiple traumas of this population reported that 12 sessions of treatment resulted in a 77% elimination of PTSD. Clients with multiple traumas and/or complex histories of childhood abuse, neglect, and poor attachment may require more extensive therapy, including substantial preparatory work in phase two of EMDR (Korn & Leeds, 2002; Maxfield & Hyer, 2002; Shapiro, 2001, 2018).
How Many Sessions With the Therapist BEFORE (S)he Begins EMDR Therapy?
This depends upon the client’s ability to “self-soothe” and use a variety of self-control techniques to decrease potential disturbance. The clinician should teach the client these techniques during the preparation phase. The amount of preparation needed will vary from client to client. In the majority of instances the active processing of memories should begin after one or two sessions.
How Many Sessions Will it Take?
The number of sessions depends upon the specific problem and client history. However, repeated controlled studies have shown that a single trauma can be processed within 3 sessions in 80-90% of the participants. While every disturbing event need not be processed, the amount of therapy will depend upon the complexity of the history. In a controlled study, 80% of multiple civilian trauma victims no longer had PTSD after approximately 6 hours of treatment. A study of combat veterans reported that after 12 sessions 77% no longer had post-traumatic stress disorder.
Are Eye Movements Considered Essential to EMDR Therapy?
Although eye movements are often considered its most distinctive element, EMDR therapy is not a simple procedure dominated by the use of eye movements. It is a complex psychotherapy, containing numerous components that are considered to contribute to treatment effects. Eye movements are used to engage the client’s attention to an external stimulus, while the client is simultaneously focusing on internal distressing material. Shapiro describes eye movements as “dual attention stimuli,” to identify the process in which the client attends to both external and internal stimuli. Therapist directed eye movements are the most commonly used dual attention stimulus but a variety of other stimuli including hand-tapping and auditory stimulation are often used. The use of such alternate stimuli has been an integral part of the EMDR protocol for more than 10 years (Shapiro 1991, 1993).
What Can I Expect With EMDR Therapy, ie., What Should/Could Happen?
Each case is unique, but there is a standard eight phase approach that each clinician should follow. This includes taking a complete history, preparing the client, identifying targets and their components, actively processing the past, present and future aspects, and on-going evaluation. The processing of a target includes the use of dual stimulation (eye movements, taps, tones) while the client concentrates on various aspects. After each set of movements the client briefly describes to the clinician what s/he experienced. At the end of each session, the client should use the techniques s/he has been taught by the clinician in order to leave the session feeling in control and empowered. At the end of EMDR therapy, previously disturbing memories and present situations should no longer be problematic, and new healthy responses should be the norm. A full description of multiple cases is available in the book Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy by Shapiro.
Will I Live the Trauma as Intensely as Before?
Many people are conscious of only a shadow of the experience, while others feel it to a greater degree. Unlike some other therapies, EMDR therapy clients are not asked to relive the trauma intensely and for prolonged periods of time. In EMDR therapy, when there is a high level of intensity it only lasts for a few moments and then decreases rapidly. If it does not decrease rapidly on its own, the clinician has been trained in techniques to assist it to dissipate. The client has also been trained in techniques to immediately relieve the distress.
What Are the Side Effects?
As with any form of psychotherapy, there may be a temporary increase in distress.
- distressing and unresolved memories may emerge
- some clients may experience reactions during a treatment session that neither they nor the administering clinician may have anticipated, including a high level of emotion or physical sensations
- subsequent to the treatment session, the processing of incidents/material may continue, and other dreams, memories feelings, etc., may emerge.
How Do I Know EMDR Therapy Would Work for Me/Work for my Anxiety/Problems, etc.? Am I a Candidate for EMDR Therapy?
EMDR therapy has been extensively researched as effective for problems based on earlier traumas. In addition, reports from clinicians over the past 25 years have indicated that EMDR therapy can be extremely effective when there are experiential contributors that need to be addressed. Read the book Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy by Shapiro and see if any of your problems are covered in the cases.”
What Elements of EMDR Therapy Contribute to its Effectiveness?
EMDR therapy is a complex therapeutic approach that integrates elements of many traditional psychological orientations and combines these in structured protocols. These include psychodynamic (Fensterheim, 1996; Solomon & Neborsky, 2001; Wachtel, 2002), cognitive behavioural (Smyth & Poole, 2002; Wolpe, 1990; Young, Zangwill, & Behary, 2002), experiential (e.g., Bohart & Greenberg, 2002), physiological (Siegel, 2002; van der Kolk, 2002), and interactional therapies (Kaslow, Nurse, &Thompson, 2002). Consequently EMDR contains many effective components, all of which are thought to contribute to treatment outcome.
Marks, Lovell, Noshirvani, Livanou, & Thrasher (1998) propose that emotion can be conceptualised as a “skein of responses,” viewed as “loosely linked reactions of many physiological, behavioural, and cognitive kinds” (p. 324). They suggest that different types of treatment will weaken different strands within the skein of responses and that “some treatments may act on several strands simultaneously” (p. 324). EMDR therapy is a multi-component approach that works with strands of imagery, cognition, affect, somatic sensation, and related memories. This complexity makes it difficult to isolate and measure the contribution of any single component, especially as different clients with the same diagnosis may respond differently to different elements.
Shapiro’s (2001) AIP model conceptualizes EMDR therapy as working directly with cognitive, affective, and somatic components of memory to forge new associative links with more adaptive material. A number of treatment elements are formulated to enhance the processing and assimilation needed for adaptive resolution. These include:
- Linking of memory components. The client’s simultaneous focus on the image of the event, the associated negative belief, and the attendant physical sensations, may serve to forge initial connections among various elements of the traumatic memory, thus initiating information processing.
- Mindfulness. Mindfulness is encouraged by instructing clients to “just notice” and to “let whatever happens, happen.” This cultivation of a stabilized observer stance in EMDR therapy appears similar to processes advocated by Teasdale (1999) as facilitating emotional processing.
- Free association. During processing, clients are asked to report on any new insights, associations, emotions, sensations, images, that emerge into consciousness. This non-directive free association method may create associative links between the original targeted trauma and other related experiences and information, thus contributing to processing of the traumatic material (see Rogers & Silver, 2002).
- Repeated access and dismissal of traumatic imagery. The brief exposures of EMDR therapy provide clients with repeated practice in controlling and dismissing disturbing internal stimuli. This may provide clients with a sense of mastery, contributing to treatment effects by increasing their ability to reduce or manage negative interpretations and ruminations.
- Eye movements and other dual attention stimuli. There are many theories about how and why eye movements may contribute to information processing, and these are discussed in detail below.
EMDR Institute, Inc. (2020). Frequent Questions. https://www.emdr.com/frequent-questions/