Eye Movement Desensitization and Reprocessing (EMDR) is an individual and structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements). This stimulation is associated with a reduction in the vividness and emotion associated with the trauma memories. EMDR therapy was developed in 1987 for the treatment of posttraumatic stress disorder (PTSD) and is typically delivered in a timeframe of one to two times per week for a total of 6-12 sessions.
PTSD is believed to be a result from past disturbing experiences that continue to cause distress on an individual because the memory was not appropriately processed. These unprocessed memories are believed to contain the raw emotions, beliefs, thoughts and physical sensations that occurred at the time of the incident. When the memories are triggered from a precipitating stimulus the stored disturbing emotions rise to the surface and are experienced, thus causing the symptoms of PTSD. EMDR therapy focuses directly on the memory with the intent to alter the way the memory is stored in the brain, thus reducing and eliminating the problematic symptoms.
Processing of a specific memory is generally completed within one to three sessions. EMDR differs from other trauma-focused therapies in that it does not include extended exposure to the distressing memory, detailed descriptions of the trauma, challenging of dysfunctional beliefs or homework assignments.
The Eight Phases of EMDR Treatment
Phase 1: History-taking and Treatment Planning
The therapist and patient start to identify targets for treatment after a through history is obtained. The targets can include past memories, current triggers and overall goals of EMDR treatment.
Phase 2: Client Preparation
The therapist explains EMDR treatment and introduces the client to the procedures such as practicing the eye movements. The therapist ensures that the client has adequate resources for affect management and feels they are in a safe environment in the therapist office.
Phase 3: Assessment of the target memory
In this phase of EMDR the therapist activates the memory that is being targeted in the session by identifying and dissecting various aspects or components of the memory. For example, the therapist will discuss the image, cognition around the memory and affect and body sensation that memory brings forth.
Two measures are used during EMDR therapy sessions to evaluate changes in emotion and cognition. The Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale.
Phase 4: Desensitization
During the desensitization phase, the patient focuses on the memory while engaging in eye movements or other bilateral stimulation such as tapping. The patient reports any new thoughts have emerged. The therapist determines the focus of each set of bilateral stimuli with standardized protocol. Usually the associated material becomes the focus of the next set of brief BLS. This process continues until the client reports that the memory is no longer distressing.
Phase 5: Installation
The fifth phase of EMDR is installation, which strengthens the preferred positive cognition.
Phase 6: Body Scan
The sixth phase of EMDR is the body scan. Here the patient is asked to observe their physical response while thinking of the memory and the positive cognition. They identify any distressing physical symptoms (heart palpitations, sweating, pit in stomach). If the patient reports any disturbance, standardized procedures involving EMDR stimuli are used to process it.
Phase 7: Closure
Closure is always used to end the session. If the targeted memory was not fully processed during the EMDR session the therapist will instruct the patient how to contain memories and emotions until the next session.
Phase 8: Evaluation of treatment results
The last phase is when the therapist evaluates the patients current psychological state. The therapist will determine if the treatment effects have been maintained and if any memories may have emerged since the last appointment. The therapist will help the patient to identify any new targets for the current session.