For PTSD treatment, EMDR could mean less pain, faster gain

EMDR, which stands for Eye Movement Desensitization and Reprocessing, is a treatment approach that, according to the EMDR Institute’s website, “has been empirically validated in over 24 randomized studies of trauma victims.” In many cases, EMDR is effective in treating PTSD and related problems that arise from experiences and resulting memories so traumatic, life-threatening, or horrifying that they “get stuck,” defying the brain’s normal memory-processing functions and wreaking emotional havoc in the lives of PTSD victims.  

“Every experience we’re having is changing the brain in some way. The past remains for the person,” explains Francine Shapiro, PhD, the psychologist who developed EMDR and today serves as executive director of the EMDR Institute (Watsonville, CA). While remembering the past is good when it comes to positive memories—happy events, education and work experiences, life milestones—it can be a negative for traumatic memories.  Sometimes, the memory of traumatic events overwhelms the brain’s routine process of memory consolidation and storage causing the memory—and all of its frightening, horrible, and sensitive emotional triggers—to get “stuck” in the brain.   

Shapiro says that people who suffer PTSD or related problems typically struggle to “get past” one of three different types of “stuck” memories. She summarizes the dominant themes of these memories as:

·        “I’m not good enough.”

·        “I’m not safe.”

·        “I’m not in control.”

One common example includes situations like the ongoing recession, when people lose jobs and may experience all of these feelings.  Another all-too-common example involves members of the military who face the constant threat of near-instant death or serious injury.

When a client has a stuck memory, PTSD is often the result. That’s where EMDR comes in.  The treatment helps to process bad or traumatic memories in a more normal way.

EMDR: an eight-phase process

According to the EMDR Institute, “EMDR psychotherapy is an information processing therapy and uses an eight-phase approach to address the experiential contributors of a wide range of pathologies.” The process identifies the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experiences or beliefs that are needed to enhance future adaptive behaviors and mental health. 

Phase 1: History and Treatment planning. The first phase of treatment is a history taking session in which the therapist develops the treatment plan based on the recent distressing events, current situations that trigger emotional disturbance, and the skills that will be needed to overcome these memories and emotions. 

Phase 2: Preparation.The second phase is a preparation stage, in which the therapist teaches a variety of self-control techniques to the client so they can start feeling in control and start dealing with current situations. “It’s important that they build these skills so when you start the memory processing they can feel in control so if things get a little bit heavy, they can stop, return to neutral and then start again,” Shaprio explained.  “Teaching the client that they are in control takes away a huge amount of fear, eliminates the need to drop out.” 

Phases 3-6.  Memory targeting and processing.  Before a memory can be processed, the clinician and client must identify a painful target memory, a related negative belief, and related emotions or sensations.  In the phases of processing, the clinician supports and instructs the client in the use of physical actions (eye movement, taps, or tones, for example) that replicate the brain’s normal memory-processing functions.  With the help of EMDR, then, the client’s memory is often processed more appropriately and positively. The client realizes new insights and understanding about the experience and finds that its power to trigger negative emotions or sensations is reduced. 

Phase 7: Closure.The therapist closes the EMDR session by asking the client to document any related issues that occur during the week and to utilize tools learned in Phase 2. 

Phase 8: Re-evaluation.  This phase launches the next treatment session by evaluating the impact of the previous session and the client’s recent progress. 

In summary, Shapiro says that the eye movements used in EMDR “link into the same processes that occur during REM (rapid eye movement) sleep. EMDR shifts the memory from episodic memory where it holds the emotions and the physical sensations that occurred at time of the event, into semantic memory where the person understands what happened but they’re not troubled by it.”

A way to make PTSD therapy more tolerable

Shapiro refers to EMDR as “very focused work” and says that one of its major benefits is that it takes place internally—it does not require a lot of detailed discussion or depend on a client’s verbal abilities. “What we’re looking at is stimulating the brain’s processing system so the connections are made,” she said. 

Referring to eye-movement studies, Shapiro says that one consistent finding about EMDR is that “once the client starts the eye movement, there’s an immediate decrease in the emotion and vividness of the picture.”  This, she asserts, can “rapidly reduce profound suffering,” make therapy more tolerable, and thus the rate of clients who complete it.   

She adds that the process doesn’t take long, either. Clients are often able to have EMDR therapy on consecutive days and may complete a full course of treatment in two weeks or less.  “With EMDR, there’s no homework. Everything is done during the process. So, you don’t have to worry about client compliance in order to be able to get the positive treatment effects.”

Shapiro notes that some 60-70,000 clinicians have been trained in EMDR worldwide.  The training is straightforward, built around standardized procedures and protocols, and open to any licensed mental health professionals or graduate students under supervision. 

The developer of EMDR therapy, Francine Shapiro PhD, is the executive director of the EMDR Institute (Watsonville, Calif.), the author of Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy, and the founder and President Emeritus of the EMDR Humanitarian Assistance Programs (Hamden, Conn.), a non-profit that offers low-cost EMDR training for clinicians who serve disaster and trauma victims.