EMDR: Eye Movement Desensitization and Reprocessing

by Peter Nevin

A version of this article first appeared in Irish Medical News, November 23^rd, 2009.

EMDR is a therapy which has been shown to be very effective in working with people who have experienced severe trauma. It was first developed in the U.S. in the late 1980s by Francine Shapiro, a clinical psychologist, and is now recognised as a treatment of choice in working with adults with Post Traumatic Stress Disorder (PTSD). Over the past two decades or so, EMDR has also been used with clients experiencing a range of difficulties including anxiety, depression, childhood physical and sexual abuse and prolonged grief. However, EMDR is not a stand alone therapy and is best used within ongoing counselling or psychotherapy as an additional help for clients with specific processing difficulties and may be modified at times to suit the clients’ needs.

In my practice I have been using EMDR for the past two years as part of my therapeutic approach with clients presenting with a broad range of difficulties. Ann was referred by her G.P. following a violent assault three weeks previously as she was making her way home from a night out with friends. She told me that she had been grabbed from behind by a man and dragged down a lane way where she was violently assaulted and believed she was about to be sexually assaulted also. A passerby came to her help and her attacker ran off. The client told me that she could not remember too much of the actual assault and that for her, the worst part of the whole experience was seeing the reaction of her family when they first saw her in the hospital. We used EMDR in two separate sessions and she was able to process the trauma in a very short period of time. Each session was around ninety minutes long. We arranged to meet for a check-in session six weeks later and she phoned to cancel it as she was feeling back to normal again.

Brian referred himself for counselling describing how his life had changed so dramatically in the previous eighteen months or so. He had been an active sportsman and was pursuing a career in Law. However he had then been diagnosed with Multiple Sclerosis, his relationship had ended, his work was suffering due to fatigue and he was now using a cane for mobility, so sports activity was ended. We met for nine sessions, two of which were EMDR sessions. In those sessions we focused on the ending of his relationship and on his fears for the future, specifically his fear that he would eventually have to use a wheelchair. His fears around a wheelchair seemed connected to his anxieties around dependency, yet as we processed this, he was able to see possibilities of developing a career in computing, his hobby at present, and which could be pursued even if he became wheelchair dependent.

What happens in an EMDR session?

In an EMDR session, the client is asked to focus on a particularly distressing picture or memory of the event, the associated emotions of the event and the location of the associated disturbance in their body. The client is also asked to describe both positive and negative beliefs about themselves arising from the disturbing event. At this point, the therapist adds alternating eye movements or other form of bilateral stimulation (BLS), e.g., headphones, hand tapping, etc, for the client. This stimulates adaptive information- processing, a ‘rapid free association of information between memory networks that enables clients to draw on information where they find insight and understanding’ (Parnell, 2007).

Some clients process the material very quickly while others become stuck at certain points. In these situations, the therapist can make interventions such as ‘what could your Adult Self do to help you now?’; or ‘do you remember another time when you felt like this?’. These interweaves help the client to move through the material towards insight and understanding. I often use the image of being a passenger on a train moving through the countryside, inviting the client to simply notice what is passing, just observing the images, feelings, sounds and so on. At the end of each set of BLS the client is asked ‘what did you get there?’ or ‘what did you notice?’ When the client describes, briefly, what they noticed, the therapist says ‘go with that’ for the next set of BLS. The session continues with sets of BLS during which the client continues to process disturbing information leading to a more balanced state where integration takes place.

EMDR transforms memories that are emotionally charged and ‘present’, into memories that are more objective and ‘remembered’ as events. One client said he remembers how he used to feel about a particularly distressing experience in his late teens, yet was able, after an EMDR session, to talk openly and calmly about the experience to his partner for the first time ever. Another client said ‘it’s like reading about it in the newspapers’, while talking about her difficult childhood experiences.

How does EMDR work?

The model for understanding EMDR contains a theory of information processing and a number of key concepts although no one is yet completely sure how EMDR actually works. Interpreting and making sense of experiences in a flexible way are signs of good mental health. Conversely, the reduced ability ‘to choose one’s attitude’ (Shapiro, 2002) in any particular situation is found in those people who present for therapy. A central concept in EMDR therapy is that we all have a physiological information-processing system that maintains an associated memory network and that it our ability to make appropriate connections across these networks that ensures our mental well-being.

In theory, the body-mind can process and integrate information in a helpful way but traumatic events interrupt this processing and leave the events in their ‘raw’, unprocessed state. This is perhaps why traumatised people seem to live in the traumatic experience in the present, while nightmares, for example, may be the mind’s attempt to process these experiences.

Traumatic experiences cause us to develop mistaken beliefs about ourselves and the world around us, leading us to behave in ways that are unhelpful. Over time, these experiences become fixed in the body-mind as irrational emotions, blocked energy and physical symptoms, complete with images, physical sensations, smells and sounds, and beliefs. According to Shapiro (2002), ‘…the individual reacts dysfunctionally to current situations because of automatic responses that were first elicited by past events and have become physiologically encoded.’ The purpose of EMDR, like all psychological therapies I believe, is to build or restore the client’s freedom to choose their response in any given circumstance.

Often clients who have been traumatised say that it’s too upsetting to even think about the event; eye movements and other BLS may help by distracting the client sufficiently to enable the experience to be brought to mind so that processing can be completed. This ‘dual attention’, the client focusing simultaneously on their internal world and on the BLS, allows the mind to process whatever it is noticing. Another theory suggests that it is the rhythm of BLS that effects change. In different cultures and in different times, drumming and dancing are used to help process individual and group experiences. Our nervous systems are perhaps hardwired to the sound of a calming rhythm, a legacy of our time in the womb (Perry, 2002).

EMDR has more published case reports and research to support it than any other method used in the treatment of trauma (Parnell, 2007).  In the U.S., the Departments of Veterans Affairs and of Defense recommend EMDR as one of four therapies for the treatment of PTSD. In Australia, the National Health and Medical Research Council recommends EMDR while in the U.K., the Department of Health recommends EMDR for the treatment of adults with PTSD (NICE guidelines). The Cochrane review also recommends EMDR for the treatment of PTSD.

A listing of EMDR practitioners in Ireland can be found on www.emdrassociation.org with therapists located throughout the country.

Peter Nevin, IAHIP can be contacted at Watergate House, Charlotte Quay, Limerick. (061) 405028, www.talktherapylimerick.ie

References

Parnell, L. (2007), A therapist’s guide to EMDR. New York, Norton and Co.

Perry, B. (2002) Trauma memory and neurodevelopment: A proposed mechanism of action for EMDR. Plenary session of the conference of the EMDR International Association.

Shapiro, F. (2002). ‘Introduction: Paradigms, Processing, and Personality Development’ in F. Shapiro (ed) EMDR as an Integrative Psychotherapy Approach, Washington, American Psychological Association.

Gunter, R. (2008), BBC Radio 4 documentary, All in the Mind. November 2008. Hear this programme at –

http://www.bbc.co.uk/radio4/science/allinthemind_20081118.shtml

For a brief U.S. TV video report on EMDR see

http://www.youtube.com/watch?v=zBtqWrs2-K0

Other websites for further information –

www.emdria.com

www.emdrassociation.org.uk

www.nhs.uk/Conditions/Post-traumatic-stress-disorder/Pages/Treatment.aspx

www.cochrane.org/reviews/en/ab003388.html