Frequently Asked Questions
EMDR stands for Eye Movement Desensitization and Reprocessing therapy. It is an “evidence-based, clinician led psychotherapy” (EMDRIA) that has since been the golden standard in the treatment of Post-Traumatic Stress Disorder (PTSD). Since its inception, EMDR has proven to be successful with a wide range of somatic issues, mental health problems, and psychiatric disorders.
It is an 8 phase, three-pronged approach that is based off of Francine Shapiro’s Adaptive Information Processing (AIP) model.
The AIP model is the theoretical foundation of EMDR. It posits that the past is in the present.
The three-pronged approach refers to the order in which the EMDR protocol is administered in order for successful treatment to occur.
The standard protocol for EMDR is 8 phases long, with phases 1-2 taking up multiple sessions, 3-7 typically taking up one session, and 8 taking up another one.
“EMDR moves information from dysfunctional to functional. The end result of successful EMDR is adaptive resolution of the trauma. This means that the emotional charge is reduced or eliminated, and there is an objective view or understanding of the incident. Just like the river flows to the sea and the body heals the wound, EMDR clears the trauma and brings integration and wholeness. (…)
EMDR removes blockages caused by negative images, beliefs, and body sensations, allowing one’s natural state of well-being and emotional balance to come through. EMDR unlocks what is natural within each of us. It is our innate healing process that has been blocked and can be unblocked with EMDR. There is an inherent wisdom within each person that is already whole, it is just obscured by the traumas.” (Parnell, 2007)
The 8 phases of EMDR are the procedural steps used to access and process information.
These well-defined treatment procedures and protocols facilitate information reprocessing. EMDR utilizes an 8-phase, 3-pronged, approach to treatment that optimizes sufficient client stabilization before, during, and after the reprocessing of distressing and traumatic memories and associated stimuli.(EMDRIA)
Phase 1 - History & Treatment Planning Typically between 1 and 2 60-90 minute sessions
The first phase involves taking a thorough client history - an essential step for successful EMDR treatment. This might include developmental history, starting from birth, medical history, mental health history, and any contraindications for EMDR therapy, among other things. During this phase, the suitability of EMDR treatment for the client is determined.
This phase allows for the therapeutic relationship to develop and/or strengthen - a crucial component to EMDR therapy. It also enables to clinician to better understand the client and to help the client select the best targets for processing.
Phase 2 - Preparation This can last anywhere between 1 and 10+ sessions, depending on resourcing needs.
In the preparation phase, the clinician gives the client psychoeducation on EMDR processing and trauma, what to expect, and what processing will look like. Informed consent is obtained. The therapeutic relationship continues to strengthen. Here, a stop signal is established, and resourcing takes place.
Resourcing refers to the identification and mastery of appropriate self-soothing and affect regulation techniques. These are chosen and done together, and can be anything from breathing techniques and exercises, meditations and guided visualizations. It is absolutely vital to go through this phase as thoroughly as possible prior to processing disturbing memories. Resourcing enhances the ability of the client to experience positive emotions through promoting the development and expansion of positive and adaptive memory networks, thus expanding the window of affect tolerance, and stimulating the development of the capacity for therapeutic relationship.
Phase 3 - Assessment
Phases 3 through 7 may require between 1-3 90 minute sessions per target.
Together, the clinician and the client identify the components the components of the target/issue. Once the memory or issue has been identified, the clinician asks the client to select the image or other sensory experience that best represents it. The clinician then asks for a negative belief that expresses the client’s currently held maladaptive self-assessment that is related to the experience, a positive belief to begin to stimulate a connection between the experience as it is currently held with the adaptive memory network(s) and the validity of the positive belief, utilizing the 7 point Validity of Cognition (VOC) scale.
Finally, the clinician asks the client to name the emotions evoked when pairing the image or other sensory experience and the negative belief, to rate the level of disturbance utilizing the 0 to 10 Subjective Units of Disturbance (SUD) scale and to identify the location of the physical sensations in the body that are stimulated when concentrating on the experience.
Phase 4 - Desensitization and Reprocessing
In this phase, the reprocessing begins. The selected target is activated and reprocessed through bilateral stimulation (BLS). The client is asked to bring up the disturbing images, body sensations, negative cognitions and emotions before adding BLS to the equation.
Phase 5 - Installation
Once processing has been completed, and the level of disturbance is at a 1 or a 0, the therapist asks the client to check for a potential new positive belief related to the target memory.
The client selects a new belief or sticks with the previously established positive cognition. The clinician asks the client to hold this in mind, along with the target memory, and to rate the selected positive belief on the VOC scale of 1 to 7. The therapist then continues alternating bilateral stimulation until the client’s rating of the positive belief reaches the level of 6 or 7 on the VOC Scale.
If the VoC is less than a 6, the clinician should check for the appropriateness of the positive cognition, blocking beliefs, or if further processing needs to occur, in which case the client will be redirected back to Phase 4.
Phase 6 - Body Scan
The body scan is done after the desensitization, reprocessing and installation are complete. The client will be asked to scan their entire body, and to report back any sensations. If positive sensations are reported back, a set of BLS is done to strengthen that. If negative sensations are reported back, the clinician should guide the client back to reprocessing until the feelings are cleared.
Phase 7 - Closure
The closure phase occurs at the end of any session in which unprocessed, disturbing material has been activated whether the target has been fully reprocessed or not. If the target has been fully reprocessed, discussion of the client’s experience may occur. If the target has not been fully reprocessed, the therapist may used a variety of techniques to re-orient and ground the client fully to the present.
The client is reminded that processing continues between sessions, and is asked to observe and log new observations, symptoms, dreams and/or insights.
Phase 8 - Re-evaluation
1 60-90 minute session
In the final phase, the clinician, utilizing the EMDR standard three-pronged protocol, assesses the effects of previous reprocessing of targets looking for and targeting residual disturbance, new material which may have emerged, current triggers, anticipated future challenges, and systemic issues. If any residual or new targets are present, these are targeted and Phases 3-8 are repeated.
The three-pronged approach refers to how clinicians organize the information gathered in the first two phases of EMDR treatment (history taking & treatment planning and assessment).
It informs the order in which we will go about reprocessing a single target in order to achieve full resolution:
The past Identifying and addressing past events, typically “first or worst”
The present Identifying and “cleaning out” present circumstances or stressors, internal/external triggers, etc.
The future
Prepare you for future situations where you might encounter similar circumstances and/or reactions. This is where the development of more adaptive, alternative patterns of response are learned.
Through the three-pronged approach, we are “clearing out” old learning and making room for new learning to occur.
The AIP model posits two very important concepts:
The past is in the present.
Our brain, much like our body, has an innate ability to heal itself.
The past is in the present refers to how our mind and body stores traumatic memories. The idea is that “when a person experiences a trauma, it becomes locked into its own memory network as it was experienced - the images, physical sensations, tastes and smells, sounds, and beliefs - as if frozen in time in the body and in the mind. (…) Ordinary daily events seem to pass through us without leaving a mark. Traumatic events, however, often get trapped and form a perpetual blockage. Like a broken record, they repeat themselves in our body-mind over and over again.” Parnell, 2007
The idea is that we are almost “stuck” in the past, and the past informs how we perceive ourselves, others and the world. The things our brain did to (very wisely) adapt to traumatic situations and circumstances are still occurring, even though the threat is no longer present, and are now considered “maladaptive” and harmful to the self.
We have an innate ability to heal.
The second part of the AIP model is our brains have a beautiful capacity to heal itself. Just like our bodies do: when we cut ourselves, our body knows how to heal the wound. Similarly, though, if debris is stuck in the wound, the body will not be able to heal itself. We have to facilitate healing by cleaning out the debris - or by unblocking a traumatic memory. EMDR facilitates the natural healing process by unblocking.
It’s important to note that EMDR will not remove anything that is useful or necessary. It will only clear what is dysfunctional, but it will not remove anything you might need for functioning. It will also not clear emotions that are deemed suitable for a given individual, time and situation. It also cannot clear anything that is true.
EMDR is currently the most extensively researched and supported method used in the treatment of trauma.
The EMDR Institute reports:
Multiple studies show that 84%-90% of single-incident trauma survivors became free of symptoms after only three 90-minute sessions.
For combat veterans with PTSD, one study showed 77% became symptom-free after 12 EMDR sessions.
In another study of people with phobias about going to the dentist, over 83% were making regular dentist visits one year later after three sessions of EMDR therapy.
Many theories about how EMDR works are primarily based on observed clinical effets.
EMDR practitioners integrate patterned eye movements or other BLS with talk therapy techniques to clear emotional, cognitive, and physical blockages. In theory, traumas leave unprocessed memories, feelings and thoughts that can be reprocessed or “metabolized” with BLS. Similar to the way rapid eye movement (REM) or dream sleep works, the eye movements help to process this blocked information, allowing the body-mind to release it.
Dreams each night cleanse the body-mind of the day’s residues. It seems that some particularly strong dreams that are related to past events are the body-mind’s attempt to heal. The problem is that during disturbing dreams, the eye movements are often disrupted, and one wakes up, thus not allowing the REM sleep to complete its job. With EMDR, which is different from dreams, the therapist keeps the eyes moving back-and-forth and guides the client into focusing on the traumatic event. This allows the event to be fully experienced and reintegrated.
EMDR clinicians have found that hand tapping and bilateral sounds are also effective in stimulating the reprocessing of material. Perhaps the stimulation of the two hemispheres of the brain causes the reprocessing effect.
There is also a theory that the eye movements are linked with the hippocampus, which is linked to the consolidation of memory.
Another theory is that the dual attention the client maintains with EMDR, focusing simultaneously on the inner feelings and the eye movements, allows the alerted brain to metabolize whatever it is witnessing.
Bilateral stimulation (BLS) is one of the key components to EMDR therapy. It refers to the use of a stimulus (something you can see, hear or feel) that crosses the body in a rhythmic pattern. An everyday example of this would be pedaling a bicycle. In EMDR therapy, we achieve BLS through left-right eye movements, shoulder or thigh tapping, auditory sounds or tactile buzzers.
BLS is an essential part of EMDR that facilitates unlocking the part of the brain that is storing the traumatic memory, as well as the emotions, thoughts and feelings that accompany the memory.
BLS is used during the resourcing phase at a very slow pace, and at a quicker pace during the reprocessing, desensitization and installing phase.
This is the most common misconception about EMDR therapy. When EMDR was first gaining momentum as a new form of psychotherapy, research was necessary in order to validate its efficacy in reducing symptoms and creating quantifiable change. As a result, numerous randomized controlled studies have shown EMDR to be one of the most effective therapies for treating traumatic memories and the symptoms Post-traumatic Stress Disorder (PTSD).
However, EMDR therapy has since evolved to best meet the needs of most clients, and therapists have seen the efficacy of EMDR in their clinical work with common issues such as anxiety, stress, depression, eating disorders, performance enhancement, grief…
Trauma can be separated into two categories: big “T” traumas and little “t” traumas, or as shock trauma and developmental trauma.
Shock trauma Typically involves a sudden threat that is perceived by the central nervous system as overwhelming and/or life threatening. Typically a single-episode event. Has a lasting negative effect on one’s sense of safety in the world.
Shock trauma, or big “T” traumas include, but are not limited to:
Man-made disasters, such as explosions, wars, fires, acts of terrorism.
War and combat related incidents.
Natural disasters, such as earthquakes, hurricanes, forest fires, floods.
Physical assaults.
Sexual assaults.
Serious accidents such as car or bike accidents, plane crashes, serious falls.
Major life changes, such as serious illnesses and loss of a loved one.
Major surgeries, such as heart bypasses.
Life threatening illnesses, such as cancer.
Ongoing life events, such as sexual abuse or domestic violence.
Developmental trauma
Small “t” traumas refer to events that occur over time and gradually affect and alter the neurological system to the point that it remains in a traumatic state. This type of trauma can cause interruptions in a child’s natural psychological growth. It can have a lasting negative effect on one’s sense of self (self-confidence, self-esteem, self-definition), sense of others, as well as one’s sense of safety in the world.
Examples of developmental trauma, or small “t” traumas, include, but are not limited to:
Moving multiple times during childhood.
Excessive teasing or bullying.
Growing up in an unsafe or unstable environment.
Constant criticism.
Abandonment or long-term separation from a parent.
Betrayals.
Rejections.
Losing jobs.
Physical neglect.
Emotional neglect.
Chronic harassment.
Divorce.
Witnessing parental conflict.
Persistent physical illnesses.
Death of pets.
Unmet developmental needs.
Public shaming, humiliation, or failure.
Disparaging remarks.
Traumatic memories are stored differently than other memories. Traumatic memories are stored in the right hemisphere in fragmented, unintegrated form.
In our first few years of life, our memories are stored as implicit memories. Those memories, like traumatic memories, are stored in the right hemisphere as emotional, behavioral, somatic, perceptual and nonverbal.
Psychological trauma causes dissassociation of hemispheric processing. The left hemisphere - which is responsible for verbal and motor control, the manipulation of words and symbols, and the sequential processing of information - is locked out, and memory is encoded only as implicit memory in the right hemisphere. Memory remains in fragmented form as somatic sensations and intense affect states and is not collated and transcribed into personal narratives (explicit memories).
It appears that terror blocks the hippocampus so that information will not go to explicit memory. If a person is triggered by something in their life that activates their implicit memory, it feels “timeless” - like it is happening now.
Trauma interferes with the evaluation, classification, and contextualization of experiences. Memory remains as implicit memory stored in the limbic system, which is responsible for fleeing, fighting, feeding, and reproduction. In the limbic system, the amygdala attaches emotional meaning to incoming information. It passes the information on to the hippocampus, which is the brain’s early warning system, telling it whether the information is dangerous or not. The hippocampus filters out irrelevant information, evaluates what goes on, and files it.
For traumatized people, because the amygdala-to-hippocampus connection is disrupted, the information is not integrated and filed. Information is left in fragmented form.
When a person experiences a trauma, the left anterior frontal lobe known as Broca’s area - the language part of the brain - is deactivated. This deactivation of Broca’s area causes “speechless terror” for many traumatized people and they can’t talk about or understand their experience with words. They feel intense emotions without being able to put a label on what they are experiencing.
Parnell, 2007
An EMDR session is not the same as Hypnosis. During an EMDR session you are entirely present and in control during the whole process. Here are a few differences between EMDR therapy and Hypnosis:
EMDR therapy is an integrative psychotherapy model.
Bilateral stimulation is utilized.
During the desensitization phase of EMDR, the client may be in a state of heightened emotional arousal, whereas in hypnotherapy the client is usually in a deep hypnotic state.
EMDR clinicians follow a set procedure and lacks clinician suggestibility, whereas hypnosis does the opposite.
Memory retrieval is not the primary focus with EMDR, as it is with hypnosis.
Eyes are usually open in EMDR therapy. They are closed during hypnosis.
EMDR does not induce a trance state.
Images of memories generally become more distant and less vivid.
Dual focus of attention is deliberately maintained at all times.
Please refrain from using EMDR therapy by yourself. In fact, even us clinicians, who are extensively trained in this approach, are discouraged from using EMDR therapy on ourselves.
EMDR is a complex and intensive therapy. Just like you would go to a doctor to get a wound stitched up, it is recommended that you consult an EMDR trained clinician for reprocessing.
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