EMDR
Eye Movement Desensitization
and Reprocessing
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Developed by Dr. Francine Shapiro, Mental Research Center, Palo Alto, California, EMDR has proven to be the best exercise of CBT for PTSD and other disorders. I highly recommend you consult with a licensed therapist in a personal setting because my knowledge on this procedure is limited. All information on EMDR is "copy and paste" references gathered from the websites of National Institute for Health and Care Excellence (NICE) http://www.nice.org.uk/
PTSD: National Center for PTSD http://www.ptsd.va.gov/PTSD
PSYCHOLOGYTOOLS: http://psychology.tools
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Because of my lack of credentials in EMDR, the following research has been 'copy and paste' and is credited to those listed above.
I take NO CREDIT! I don’t want to inadvertently mislead you!
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Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy approach designed for working with distressing or traumatic memories. The theory behind EMDR is that many psychological difficulties are the result of distressing life experiences which have not been stored in memory properly and are said to be unprocessed or blocked. These traumatic memories may need some help to become processed, and EMDR is one way to accomplish this.
What is special about trauma memories? Normal memories are stored by a part of the brain called the hippocampus.
You can think of the hippocampus as a sort of librarian which catalogues (processes) events and stores them in the right place. Normally memories are led away by the hippocampus. However, some traumatic events (such as accidents, abuse, disasters, or violence) are so overwhelming that the hippocampus doesn’t do its job properly. When this happens memories are stored in their raw, unprocessed form. These trauma memories are easily triggered, leading them to replay and cause distress over and again.
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What will I be asked to do in an EMDR session?
There are a number of steps to EMDR treatment, but some of the key stages are:
Preparation phase
• Think of a troubling memory, then identify an image of the worst moment of that memory
• Identify a negative belief about that worst moment (the therapist may ask “what is the worst thing that moment says about you?”)
• Identify emotions and bodily feelings linked to that moment
Processing phase
• Think about the image and believe while at the same time making left-to-right eye movements (or while paying attention to tapping sensations or sounds that are alternately given from left-to-right)
• To allow your mind to ‘go with’ whatever comes up and just notice what happens
• This process will be repeated until the memory causes less distress (this may happen in one session, or may take more than one session)
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Why do I need to make eye movements?
In EMDR you are asked to pay attention from one side to another while thinking about your memory. One way to pay attention from
left to right is to follow the therapist’s finger as they move it from side-to-side in your line of vision. Alternative versions of EMDR ask you to pay attention to sounds or tapping sensations which occur in sequence from left to right.
This side-to-side motion is called bilateral stimulation. It has been found to enhance memory processing and there are a number
of theories explaining how it might do this. The important thing is to be able to find a form of bilateral stimulation that you are comfortable with.
What is EMDR used to treat?
This is very good evidence that EMDR is an effective treatment for post-traumatic stress disorder (PTSD), and is recommended
by the National Institute for Health and Care Excellence (NICE) for PTSD. The evidence for
using EMDR to treat other disorders is less clear. EMDR may be an effective treatment for other conditions,
particularly if they involve trauma memories or other distressing memories, but more research is needed.
How long does treatment take?
EMDR sessions are sometimes slightly longer than typical therapy sessions (up to 90 minutes). The number of
sessions needed will depend on the type and severity of trauma which you experienced. NICE estimates that 8-12 sessions may
be necessary to treat simpler traumas, with more sessions necessary for multiple traumas.
Preliminary instructions
• “I will tune you in to the target image. We will do sets of bilateral stimulation (BLS) to help you process your experiences.”
• “I just want you to notice whatever comes up. You may or may not experience images, memories, emotions, or body sensations.”
• “Whatever happens is ok. There is no ‘right way’ to do EMDR.”
• “I won‘t stop if you say ‘stop’ incase that’s part of what you are experiencing. Give the stop signal if you want to stop. If you do become distressed it is normally better if we carry on processing - I want, you to try to tolerate as much emotion as you can.”
• “After each set of stimulation I will ask you to give a brief report of what you were aware of.”
Desensitization
• “Bring the target image & negative cognition to mind, notice where you are feeling it in your body.”
• Set of BLS as fast a client can tolerate comfortably
• If client becomes distressed: “Just notice it”, “Just observe”, “It’s old stu_”
• After a set: “What do you get now?”, “What are you noticing?”
• If client reports new material: “Go with that”, “Notice that”
Decision tree
• If client is reporting new material continue with sets of BLS.
• If SUDS are greater than 0 or 1 further processing is normally necessary.
• When client reports SUDS of 0 or 1 move to installation of the positive cognition.
• End of a channel: If client reports the same content after two sets of BLS then return to target.
• If client is stuck or looping: Use unblocking or interweaves (overleaf )
• Do not proceed to installation until: You have returned to target, completed another set of stimulation, no new material has emerged, and SUDS are 0 (or 1).
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Installation of positive cognition
• “Do the words [positive cognition] still _t, or would another positive statement be more suitable?”
• Check VoC: “Think about the original incident and the words [positive cognition]. How true do they feel now (1-7)?”
• “Bring the target image & positive cognition together in your mind”. Complete sets of BLS until no change. (Continue installation as long as long as adaptive material is emerging)
• If client reports a VoC of 6 or less continue sets of BLS.
• If client reports a VoC of 6 or 7 continue until no further material emerges then proceed to body scan.
Body scan
• “Close your eyes & concentrate on the incident and the positive cognition. Mentally scan your entire body. Tell me if you feel anything.”
• If positive sensations are reported do a short set of slow BLS, if more positive sensations are reported give more slow sets of BLS.
• If any discomfort reported process (”go with that”) with fast sets of BLS until no further negative sensations reported.
Post-session processing
• “You might _nd that the processing we have done today continues after the session. You might become aware of memories, thoughts, sensations or dreams. Just notice what you experience.”
Closure of an incomplete session
• An incomplete session is where material remains unresolved and no positive cognition installed (i.e. SUDs > 1, or any other distress).
• Explain the need to stop.
• Consider using:
• Safe place exercise to end with a positive felt sense.
• Metaphor / imagery of putting issues in a container until the next session.
• Light stream exercise to reduce any remaining distress
EMDR Protocol
Target issue, memory, event, or symptom
“What issue would you like to begin working on?”
Target image
“What image represents the worst part of this event?”
“Which part of this memory bothers you most?”
Negative cognition
“When you think of that incident, what negative thought or belief
do you have about yourself now?”
“What negative thing does that incident say about you now?”
(”I” statement)
Positive cognition
“When you think of that incident and those negative words
[negative cognition] what would you prefer to believe about
yourself now? “
(”I” statement)
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(Validity of Cognition)
“When you think of that incident how true do those words
[positive cognition] feel to you now on a scale of 1 to 7?”
(Completely false) 1 2 3 4 5 6 7 (Completely true)
Emotions
“When you think of that incident and those words [negative
cognition] what emotions do you feel now?”
SUDs (Subjective Units of Distress)
“How disturbing does it feel to you now, on a scale from 0 to 10?”
(No disturbance) 0 1 2 3 4 5 6 7 8 9 10 (Highest disturbance)
Location of body sensation
“Where do you feel that in your body?”
Bring it all into practice. Use all the previous exercises to a specific stuck point works wonders at any point in time.
Use The Reminder Phrase:“Even though I have these Negative Cognitions, I deeply and completely accept myself”.
Use the ABC, Stuck Point, and ELF Worksheets!
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Use the Relax, FIRE, EFT, and Stress Ball Exercises!