Eye Movement Desensitisation Reprocessing (EMDR)

What is EMDR?

EMDR is an acronym for ‘Eye Movement Desensitisation and Reprocessing’.

EMDR is a powerful psychological treatment method that was developed by an American clinical psychologist, Dr Francine Shapiro, in the 1980’s. As a Senior Research Fellow as the Mental Research Institute (in Palo Alto, USA), she published the first research data to support the benefits of the therapy in 1989.

Since then a wealth of research has been conducted demonstrating its benefits in treating psychological trauma arising from experiences as diverse as war related experiences, childhood sexual and / or physical abuse or neglect, natural disaster, assault, surgical trauma, road traffic accidents and workplace accidents.  Since its original development, EMDR is also increasingly used to help individuals with other issues and performance anxiety.  EMDR has been found to be of benefit to children as well as adults.

EMDR is a complex and powerful therapy.  Therapists always have a background in mental health before undertaking training in EMDR.  You are strongly recommended to only consult legitimate clinicians who have undergone bona-fide EMDR training.

What kind of difficulties does EMDR work for?

A wealth of research has been conducted demonstrating its benefits in treating a range of distressing experiences such as:

• Childhood sexual and/or physical abuse
• Childhood neglect
• Bullying
• Natural disasters
• Assault
• Surgical trauma
• Road traffic accidents
• Workplace accidents
• Bereavement 
• Pain disorders
• Panic attacks
• Phobias
• Dissociative disorders
• War related experiences
• Body image disorders
• Performance anxiety

How does EMDR work?

When a person is involved in a distressing event, they may feel overwhelmed and their brain may be unable to process the information like normal memory.  The distressing memory seems to become frozen on a neurological level.  When a person recalls the distressing memory, they re-experience what they saw, heard, smelt, tasted or felt and this can be quite intense.  Sometimes the memories are so distressing that the person tries to avoid thinking about the distressing event to avoid experiencing the distressing feelings.  Some find that the distressing memories come to mind when something reminds them of the distressing event, or sometimes the memories just seem to pop into mind.

EMDR works because the alternating left-right stimulation of the brain with eye movements, sounds or taps seems to stimulate the frozen or blocked information processing system.  In the process the distressing memories seem to lose their intensity, so that the memories are less distressing and seem more like ‘ordinary’ memories.  The effect is believed to be similar to that which occurs naturally during REM (Rapid Eye Movement) sleep, when your eyes rapidly move from side to side.  EMDR helps reduce the distress of all the different kinds of memories, whether it is what you saw, heard, smelt, tasted, felt or thought.

What can I expect from my EMDR therapist?

EMDR is not simply the use of eye movements.  Rather it is a comprehensive therapeutic approach with principles, protocols and procedures with the goal of reducing distress in the shortest period of time.

When you first meet with your EMDR therapist, your therapist will spend time getting to know your history.  This generally includes the kind of distress you are experiencing, the kind of difficulties you have experienced, if you have physical problems, if you are taking medication and explore the support you already have.   If your therapist feels EMDR is suitable for your difficulties then they will describe the EMDR model and explain the theory to you.  You can ask your therapist questions and express any concerns you may have.  Your therapist will spend some time doing some relaxation exercises with you, which could include ‘safe or pleasant place’ exercised, guided visualisation, deep muscle relaxation, breathing retraining etc.  Once you and your therapist feel that you are sufficiently prepared, you can then target a distressing memory with the eye movements or other forms of left-right alternating stimulation, such as sounds or taps.

Your therapist will ask you to select an image that represents the distressing event.  You will then be asked to think about negative and positive thoughts, your feelings, the amount of distress you feel and where you feel it in your body.  Your therapist will then begin the eye movements while you hold the image in mind.  After each set of eye movements your therapist will ask you what came to mind or what you noticed during the eye movements.  

During the eye movements you may experience the distressing event quite intensely to start with, but this distress generally reduces as the memory is processed with EMDR.  Your therapist will continue with the eye movements until your distress is reduced as much as possible.  Your therapist will then ask you to think about your positive thought and also check whether there is any part of your body where you still feel distress.  Before the end of the session your therapist will give you time to feel calm again, using the safe-pleasant place exercise or relaxation techniques.

Will my EMDR therapist use any equipment?

Eye movements can by created manually by your therapist moving their finger back and forth across your visual field.  However, the eye movements can also be created using a ‘light bar’, in which you follow a light that moves back and forth across a metal bar.  

Some therapists use auditory bilateral stimulation, in which they click their fingers alternating from ear to ear.  These clicks can also be created through headphones and you can listen to a range of alternating sounds.  Some therapists use music to create the alternating sound which you can also listen to with headphones.  Other therapists use tactile bilateral stimulation, in which they tap your hands in an alternating pattern.  To create a similar effect, some therapists use small vibrating items that you can hold in your hands, and this vibrates also in an alternating pattern from one hand to another.

NICE Guidelines

Nice is the National Institute of Clinical Excellence.  The clinical guidelines written by NICE are recommendations for good clinical practice.  NICE recommends EMDR in the treatment of Post Traumatic Stress Disorder (2005).  The guidelines are based on a number of high quality randomised control trials (RTC) that have provided an evidence base for the effectiveness of EMDR in the treatment of traumatic memories.