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The popular TV show Grey’s Anatomy recently aired an episode tackling the difficult subject of trauma and its long-lasting impact. What was also introduced to many viewers was a specific kind of trauma therapy called Eye Movement Desensitization and Reprocessing (EMDR) which aims to change the way distressing memories are stored in the brain. This episode has been received with curiosity and a variety of positive responses from the general public. Although Grey’s Anatomy is a television drama, the pain that many people experience on a daily basis due to traumatic experiences is very real and EMDR is an effective treatment that can facilitate emotional healing.

Eye Movement Desensitization and Reprocessing is a form of therapy that helps people heal from trauma or other distressing life experiences. It has been extensively researched and shown effective for treatment of a variety of different diagnoses including anxiety, post-traumatic stress disorder, adjustment disorders, and phobias. The psychology model used to explain how EMDR works considers symptoms including flashbacks, emotional numbing, nightmares, and hyper-arousal to result from disturbing experiences that continue to cause problems because the memory was not adequately processed. These unprocessed memories are understood to contain the emotions, thoughts, beliefs and physical sensations that occurred at the time of the event. Unlike other forms of talk therapy that focus on changing the emotions, thoughts and responses resulting from distressing experiences, EMDR therapy focuses directly on the memory and is intended to change the way that the memory is stored in the brain. Thus reducing and eliminating difficult symptoms.

Together a therapist and client will discuss if EMDR is an appropriate treatment. If they agree that EMDR therapy is a good fit, the client will be asked to focus on a specific difficult memory. Attention will be given to an image, a negative belief, and body sensations related to this event. The client will also identify a positive belief that would indicate the issue was resolved. While the client focuses on the upsetting event, the therapist will use sets of side-to-side eye movements, sounds, or taps. The rhythmic left-right bi-lateral stimulation seem to unlock the memory system and allow the brain to process the experience. This is what may be happening in rapid eye movement sleep cycle when intense dreaming takes place. The eye movements appear to be involved during the processing of unconscious material. The client will be guided to notice what comes to mind after each set. They may experience shifts in insight or changes in images, feelings, or beliefs regarding the event. The client has full control to stop the therapist at any point, if needed. The sets of eye movements, sounds, or taps are repeated until the event becomes less disturbing.

A therapist trained in EMDR therapy follows a set of 8 phases that are important in order to successfully process and resolve difficult memories. The following are the general steps to expect as part of EMDR therapy:

History-taking and Treatment Planning

In addition to getting a full history and conducting appropriate assessment, the therapist and client work together to identify “target” memories for processing. Targets include past memories, current triggers, and future goals.  

Preparation

The therapist offers an explanation of EMDR and introduces the client to the procedures, practicing the eye movement or whichever bi-lateral stimulation (BLS) will be used during processing. The therapist ensures that the client has tools to help when experiencing difficult thoughts and feelings including container and calm place, which are two specific emotion regulation exercises. The client is encouraged to practice use of these exercises during the week in preparation for processing.  

Assessment

The third phase of EMDR identifies the specific memory that is being targeted in the session by assessing each of the memory components: image, thoughts, emotions, and body sensation. The client will be asked to rate different parts of the memory so that the therapist can gauge the distress levels attached to the memory. 

Desensitization

During this phase, the client focuses on the memory, while engaging in eye movements or other BLS. Then the client reports whatever new thoughts have emerged. The therapist will guide the client and help them stay on track throughout processing. One difference between EMDR and traditional talk therapy is that a therapist will encourage less talk as this may distract from the brain processing. This process continues until the client reports that the memory is no longer distressing. It may take several appointments of desensitization for a client to experience a significant decrease in difficult symptoms connected to the memory. 

Installation

The fifth phase of EMDR is installation, which strengthens the preferred positive thoughts, emotions, and body sensations. The therapist will continue to stimulate brain processing using BLS, but at a much slower rate to reinforce the new positive connections in the brain.

Body Scan

The sixth phase of EMDR is the body scan, in which clients are asked to observe their physical response while thinking of the target memory and identify any residual distress. This is done because there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory, indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in body memory. If the client notices any negative body sensations, sets of BLS will be used to desensitize the experience until the memory no longer triggers negative body responses. An important component of this phase is visualization of a future template. Once a client has successfully processed a target memory they are asked to visualize themselves handling a similar situation successfully in the future. With the new memory connections and positive thoughts the client is able to view this situation with a new perspective. If any difficult thoughts or sensations come up during this part of processing, the client will be guided back to desensitization (BLS) to target any lingering negative associations with the memory.

Closure

Closure is used to end the session. If the targeted memory was not fully processed in the session, specific instructions and techniques are used to provide containment and ensure safety until the next session.

Re-evaluation

The next session begins with a check-in regarding symptoms and any changes that occurred since the last session. This allows the therapist to determine whether positive effects have been maintained, and what memories may have emerged since the last session. As with any form of good therapy, the reevaluation phase is vital in order to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment, as it is to complete an entire course of treatment with antibiotics.

EMDR is complete once attention has been brought to past memories that are contributing to the problem, addressing any present situations that are disturbing, and identifying what skills a client may need for the future. It is important to seek treatment from a therapist with training specific to EMDR as positive outcomes are dependent on specialized training and professional consultation. With compassionate guidance from a trained therapist it is possible to experience emotional healing and increased confidence for the future using EMDR therapy.

 

Information collected from the following websites: 

 
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Sonia Combs, MS, LMHC, NCC, CMHS

 
*Information from this blog is not intended to treat, diagnose, or substitute as therapy. If you have concerns regarding your mental health, please seek out treatment from a trained professional.