“Changing the memories that form the way we see ourselves also changes the way we view others. Therefore, our relationships, job performance, what we are willing to do or are able to resist, all move in a positive direction.” — Francine Shapiro, creator of EMDR therapy
We are all susceptible to traumatic experiences and the negative effects they can cause. According to the National Council for Behavioral Health, 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. Individuals who have experienced abuse, homelessness, economic hardship, who have intellectual and developmental disabilities, or who have served in the Armed Forces may be especially vulnerable to the long-term effects of trauma.
One of the most common ways to treat post-traumatic stress disorder is with cognitive behavioral therapy, or CBT. This type of therapy focuses on changing patterns of thought, with the goal of replacing maladaptive beliefs with more constructive beliefs. CBT has been proven effective at treating trauma and PTSD, but it can take time to produce significant results for some people. For example, although CBT or “talk therapy” for PTSD can produce results within 6 to 12 weeks according to the National Institute of Mental Health, some people may continue to struggle with symptoms for much longer.
However, there is an alternative type of therapy for PTSD, anxiety, depression and some other disorders that often produces results much sooner. Eye movement desensitization and reprocessing, or EMDR, is a newer form of treatment that also helps people change maladaptive beliefs they may have about a traumatic experience. But unlike CBT and traditional talk therapies, EMDR leverages physiology and neuroscience to facilitate these changes. As a result, many people experience relief from their symptoms much sooner than with CBT—sometimes after only a few sessions.
Here at Cummins, several of our care providers are trained in EMDR therapy, and we’ve begun offerings trainings for others who want to learn. In order to familiarize our consumers with this newer form of treatment, we spoke to Laura Coffey, MSW, LSW, who has experience working with several of her consumers using EMDR. In this post, Laura explains the fundamentals of EMDR, including how it’s different from other therapies, how it affects the brain, what a typical session is like, and how she has seen it help her consumers.
What Is EMDR Therapy?
At its core, EMDR therapy is designed to help the client reframe upsetting thoughts and feelings about past experiences. As Laura explains, “It’s a phased, focused approach for treating traumatic and other symptoms that reconnects clients to the images of their trauma in a safe way. It works with thoughts, emotions and body sensations that are associated with the trauma, and it helps the brain move toward an adaptive resolution for the client.”
The major difference between EMDR and other forms of cognitive therapy lies in how these goals are achieved. As its name suggests, EMDR incorporates controlled eye movement—often referred to as “bilateral stimulation”—into the therapeutic process.
In a typical EMDR session, the therapist asks the client to recall a traumatic experience while moving their eyes from side to side. Traditionally, the therapist might hold up one finger and ask the client to follow it with their eyes, but there are alternative techniques that also work, such as moving lights or moving shapes on a screen. In fact, other forms of bilateral stimulation can also be used, such as a sound that moves from the left ear to the right ear or alternating touches on each side of the body.
Although it may seem unusual at first, this combination of cognitive therapy and bilateral stimulation is very effective at treating post-traumatic stress and anxiety. In fact, EMDR therapy tends to produce positive results much more quickly than other forms of treatment, as Laura explains:
“With traditional cognitive-based therapy or dialectical behavior therapy, you might see a therapist for six months to a year for trauma, and sometimes longer. I’ve had trauma patients who I saw for two to four years, and we still didn’t get to the core of everything with cognitive therapy. Using EMDR, I’ve seen that time cut at least in half, depending on the amount of trauma. For a single trauma, symptoms can sometimes be alleviated within three or four sessions using EMDR.”
How Does EMDR Work?
Why does adding eye movement to cognitive-based therapy improve results for clients? It has to do with the structure of our brains and how they operate.
First, it’s important to understand the difference between short-term memory and long-term memory. Short-term memory is where new memories are formed, and this information is stored near the front of the brain. By contrast, long-term memory stores this information for later retrieval, and it’s believed that this happens near the back of the brain. Traumatic experiences can sometimes make us believe negative things about ourselves—such as that we were responsible for the event or that we are worthless because the event happened to us—and these negative self-beliefs may get stored in long-term memory.
When a client recalls a traumatic experience in therapy, they move it from long-term memory into short-term or “working memory,” where it can then be reprocessed so that it no longer triggers symptoms of post-traumatic stress. Laura explains,
“First the person chooses the experience they want to reprocess, then they choose a negative belief they have about themselves because of that experience, and then they choose a positive belief they would rather believe about themselves. That protocol is then used for the desensitization process and the reprocessing process. The idea is to remove the negative belief that they have about themselves because of that experience, and then to replace it with a positive belief that they want to have about themselves, so that when they recall that event, or anytime they experience something that’s similar, they won’t have the negative belief anymore.”
During EMDR, bilateral stimulation serves to activate both hemispheres, or halves, of the brain at the same time, which affects our cognitive functioning in a few important ways. First, it serves to desensitize the client to the memory of their traumatic experience, which makes it less upsetting to recall during the treatment session. Second, research suggests that bilateral stimulation also makes it easier to reprocess traumatic memories in a more positive light.
“Our brain already has the healing capacity to be able to deal with this trauma and to fix the things that are wrong,” Laura says. “It just needs a little help sometimes to stimulate those healing abilities, and EMDR does that extremely well.”
What Happens in a Typical EMDR Session?
Almost anyone can be a candidate for receiving EMDR therapy, even children ages 7 and older. If you’re considering giving EMDR a try, then it might help to know what you can expect in a typical session. Treatment with EMDR is carefully regimented and separated into eight distinct phases.
Phase 1: History taking and treatment planning
In your very first appointment with a therapist, you’ll mostly discuss why you sought out treatment and what you hope to achieve from it. The therapist will ask about any thoughts or self-beliefs that are bothering you, and they’ll work with you to create a list of items you’d like to address. “It’s a client-based assessment,” Laura says. “They tell me what’s going on, and I’m listening very closely to hear what things are the most traumatic for them, or are causing the greatest anxiety or depression, or whatever it is that they’re experiencing right now.”
Phase 2: Preparation
Once planning is complete, the therapist will explain how treatment works and help prepare you for the kinds of emotions and experiences you can expect during your sessions. One way this is done is by helping the client create a mental “safe space.” Laura explains, “I ask them to think of a real or imagined place where they feel safe. We do some visualization exercises to make sure that everything they see there is safe and nothing there is disturbing to them there. And I have them create a box in their safe place, and that box represents where we will pull the memories from. At the beginning of every session we open the box, at the end of every session we close the box and lock it.”
Phase 3: Assessment
When both you and the therapist are confident that you’re ready to begin treatment, you’ll choose the first memory that you want to work on. This is known as choosing your “target.” “We choose a very specific memory with a very specific feeling, and they will gauge it for me on two different scales,” Laura says. “One is the positive belief they want to have and how much they believe that now. And the other scale is how much this memory bothers them right now. That’s how I assess where they are at the beginning of every session.”
Phases 4–7: Desensitization, Installation, Body Scan, and Closure
During the next four phases, the therapist will begin bilateral stimulation in conjunction with cognitive therapy, with the goal of removing the negative belief associated with the memory and instilling the positive belief instead. This process might take several sessions to complete, and it will likely elicit some amount of emotional distress. “Almost all the time, there are emotional reactions during bilateral stimulation,” Laura says. “Sometimes they’re very difficult, because they’ll reveal past trauma or past experiences that are very hurtful for the client, and they’re reliving the emotion. Clients will often feel tired or sleepy after these sessions, and I will warn them about that, because it’s emotionally draining to go through.”
At the end of each session, the therapist will lead you in a “grounding exercise” to ensure that you leave feeling calm and relaxed. “I help them re-enter a state of relaxation and safety before they ever leave my office or the computer screen. And after the first session, I always call the next day to make sure they’re doing OK,” Laura says.
Phase 8: Re-evaluation
At the beginning of each subsequent session, the therapist will evaluate what progress has been made toward your target and what still remains to be done. If you have not yet achieved, or “cleared,” your target, then treatment will resume at Phase 4. If you have cleared your target, then you and the therapist can discuss other targets that you’d like to work toward next. “After they’ve cleared a target, I revisit that in the next session just to make sure that they have cleared that target and that there’s no residual feelings or emotions as a result of clearing that target,” Laura says.