EMDR - Eye Movement Desensitisation and Reprocessing

Having a traumatic experience can mean different things to different people. In general, however, if the experience involves horrifying situations involving death, serious injury or sexual assault some individuals may find themselves unable to recover in the way the body and brain are programmed to do. In addition to first hand horrible personal experiences, traumatic responses can be brought about by witnessing them happening to others or the aftereffect of them and also sometimes just hearing about others’ experiences, especially if they are close.

Examples of traumatic experiences will include being under fire in an armed conflict, sexual assault or another extreme physical attack, a car or motorbike crash, witnessing sudden death, exposure to a major disaster, fearing for your own life and physical safety and of course childhood sexual abuse. In studies, it has been found that up to 69% of people suffer a traumatic event at least once in their lives and over 5% of the population are suffering from PTSD at any given moment. 12% of people suffer from PTSD at some stage in their lives. The good news is that most people can recover with the right help.

Secondary trauma has only recently been included in the official clinical definition of PTSD although the former has been known in clinical settings for a long time. Many people who work in emergency services, social services or legal teams have often been exposed to the aftermath of original traumatic experiences such as body recovery, looking at computer images of abuse, reading detailed shocking reports and so on. The symptoms experienced after continued exposure to such extreme situations can lead to anxiety, negative thinking and low mood, and may even trigger personal unresolved memories in a person’s own past, causing flashbacks, hyperarousal or avoidance behaviours in relation to events long before the current traumatic experience.

When individuals begin to realise that they are struggling there is no shame in seeking help to process these experiences so that the body and brain can function again properly. The feelings and the struggle are simply normal reactions to an abnormal event or events. Sometimes traumatic experiences are just too much for someone to recover from easily especially if they are several and cumulative over a period of time, or, have some connection with unresolved childhood experiences. Some symptoms can remain long after the event (more than a month) and in a few cases, full-blown post-traumatic stress symptoms (PTSD) may occur. These symptoms include increased vigilance or alertness to other potential dangers, anxiety and panic attacks, sometimes a tendency to avoid potentially similar dangerous situations and sometimes intrusive flashbacks to the event in the form of images, thoughts and dreams. Negative self-talk and beliefs, a sense of detachment from reality, constant rumination and low mood may also be present.

Although other approaches may well be helpful, there are two main therapeutic approaches that have been found to be particularly helpful for people suffering from the effects of trauma, secondary trauma or post-traumatic stress. These are called “trauma-focussed cognitive behaviour therapy” (TF-CBT) and “eye movement desensitisation and reprocessing” (EMDR).

EMDR is a most powerful and almost, on occasions, a seemingly “miraculous” approach to expunge the ill-effect of the types of events, mentioned above, from a person’s system. A cutting-edge therapy, it has grown slowly but surely since 1990 when it was devised by the American psychologist called Dr Francine Shapiro. She found it to be as helpful for either a single incident trauma such as a terrible car crash or multiple incident traumas such as those suffered by service personnel with combat stress returning from war zones.

As time went on Dr Shapiro found that EMDR could be used to reprocess and reframe people’s other painful life experiences too. Although its effectiveness in other areas has not been so well researched there is, however, plenty of empirical and clinical evidence to demonstrate its power to heal and change the lives of people who are struggling emotionally and mentally. These other issues include more general anxiety, phobias, depression, abuse, relationship problems, anger issues, addictions and so on.

The ultimate goal of the EMDR process is to be able to recall difficult memories of events without experiencing the physical and emotional disturbance anymore and gain improved self-esteem and a greater sense of self-efficacy.

In practice, there is an 8-stage, 3-pronged overall protocol that a therapist will follow but this may not be obvious to the client. The protocol first ensures that the client feels safe and stable enough to re-process their distressing and traumatic memories and this sense of safety needs to be underpinned by a good working relationship between the therapist and the client. It can take place over just 6 x 1.5-hour sessions if working on a single issue (although this may vary according to individual needs) but, if very deep-rooted the processing will take place over months or years. If several different issues are discovered as being problematic, whether troubling feelings or specific memories, then the protocol may be used many times over to cover each issue or unpleasant memory or cluster of memories.

Very briefly, these stages involve the following

• A thorough background history taking,
  
• Inner resource building, also known as the preparation and stabilisation phase, to help strengthen the client so as to deal with the core of the work
• Target assessment – this means determining the images, unhelpful negative beliefs, positive beliefs desired, emotions and body sensations experienced when thinking of the traumatic event
• Desensitisation or processing of the issue stored in the person’s memory, as outlined above, using bi-lateral stimulation of the brain (which I explain more about in the paragraph below). If, at this stage, a client finds the processing too difficult sometimes the therapist will interweave suitable questions or techniques to help ease the process or unblock the processing
• Positive belief installation which involves checking that the client can genuinely think better of themselves, when imagining they are back in the memory, without any remaining inner disturbance
• Body scan to check for residual storage of the difficult event in the body with a view to processing it further and eradicating it completely
• Closure at the end of each session to ensure a client can safely leave the room
• Re-evaluation is carried out in the next session by testing the effectiveness of the work done in previous sessions and determining what images and memories remain which need to be desensitised next.

The Eye Movement element of the therapy name is unfortunately misleading. Although it started out in this way it was discovered that any form of bi-lateral stimulation of the brain such as alternating pulsations in the palm of the hand or alternating sounds in the ears, for example, was, in certain circumstances, just as effective as eye movements in healing the disturbing memory. Sometimes the therapist will use special equipment to stimulate an improved left-right brain connection and sometimes will use hand movements in front of the client’s eyes or tap their knees alternately. This process is coupled with the client recalling certain elements of the trauma which has been discussed in the target assessment phase (see above).

EMDR is not suitable for everyone of course. Sometimes it is more helpful to integrate it into general psychotherapy if a disturbing or traumatic memory has been activated and needs clearing from long ago. But often EMDR stands alone as a complete therapy in its own right. Note that, even if it is used and contained within a broader, open-ended psychotherapeutic process, the 8-stage process should be completed.

As a great deal of research has been done to demonstrate its clinical efficacy for post-traumatic stress and trauma, it is recommended by WHO (World Health Organisation) and is a treatment of choice quoted in the UK NHS NICE guidelines in addition to Trauma Focussed CBT.

Appropriate EMDR practitioners are fully qualified mental health professionals who have undertaken further training in EMDR. The standard of training in this therapy is upheld in the UK by the professional body called EMDR Association UK which is part of EMDR Europe.