Common Questions about EMDR (Eye Movement Desensitization and Reprocessing)
How was EMDR developed?
In 1987, a psychologist, Dr. Francine Shapiro made a chance observation that
under certain circumstances, eye movements can reduce the discomfort of
disturbing thoughts. In 1989, through the Journal of Traumatic Stress, she
reported her success using EMDR in the treatment of trauma victims. Since then,
EMDR has developed and been refined through contributions of therapists and
researchers throughout the world.
Trauma: Small t trauma and Big T trauma
All of our experiences as human beings affect our inner lives. Of particular
concern are those experiences defined as traumatic. Dr. Shapiro distinguishes
two types of trauma. One, she refers to as "big T trauma," (the trauma primarily
associated with Post-traumatic stress disorder or PTSD) and the other as "little
t trauma."
Big T trauma often has its origin in life threatening events such as combat,
crimes such as rape, kidnapping or assault, and natural disasters such as
tornadoes, earthquakes or floods. Children may experience big T trauma as a
result of repeated exposure to the disruptions of family dysfunction, which
threaten their sense of survival or security. Children may also be affected when
exposed to experiences such as sexual abuse, physical or emotional abuse or
abandonment. These events may lead to intense fear, extreme feelings of
helplessness, loss of control and an inability to cope with normal life
expectations.
The symptoms of PTSD take forms of behavior that seem quite inconsistent such as
attraction and avoidance. The individual relives experiences through flashbacks,
nightmares, panic attacks or obsessive thoughts, while on the other hand
avoiding the experiences through social isolation, emotional numbing or
substance abuse. Frequently the symptoms involve denial to minimize the impact
of the experience on day to day functioning. Those experiencing trauma
frequently have physiological reactions such as insomnia, hypervigilance
(fearful alert, watching, waiting) and a tendency to startle reactions resulting
from reminders in the form of sound, smell, touch or some visual experience such
as watching a movie.
Small t trauma occurs with the upsetting though less innocuous experiences of
everyday life. Even these experiences may produce reactions similar to big T
trauma, with similar consequences. Small t trauma may be an emotional shock with
enduring psychological impact. These experiences will be felt as distressing,
and when in conscious awareness, bring about feelings of anxiety, depression and
a negative self-reference such as, "I'm so stupid!" The other extreme is to
place blame and responsibility on the other for how their actions and behaviors
impact those around them. Someone else is always to blame or at fault and needs
to change.
How does EMDR work?
No one knows precisely how EMDR works. We do know that when a person is very
upset, their brain cannot process information as it ordinarily does. This is
obvious to most of us who have experienced moments of confusion. One traumatic
moment becomes frozen in time and, remembering a trauma often produces feeling
as disorienting as the original experience. Images, sound, smells and feeling
have not changed. Such memories have a lasting affect on the way a person sees
the world, and relates to people perceived to be interfering with their life.
EMDR seems to have a direct effect on the way the brain functions. Normal
information processing begins to resume when the original traumatic event is
brought to mind. Following a successful EMDR session, the images, sounds and
feelings are no longer relived with the same negative intensity, as when the
event occurred. What happened is remembered without the emotional upset. While
many types of therapy have a similar goal, EMDR is unique in that sets of eye
movements or alternating left-right attention, accelerates the process so that a
successful resolution is attained much more rapidly. What happens during EMDR
appears similar to what occurs naturally when dreaming or during REM (rapid eye
movement) sleep. EMDR may be thought of as a physiologically based therapy that
enables a person to re-experience disturbing material in new and less disturbing
ways.
Does EMDR really work?
A number of research studies have shown EMDR to be effective. For example, the
Journal of Consulting and Clinical Psychology, published an article by Wilson,
Becker and Tinker in December, 1995; a study of 80 subjects with postraumatic
stress, demonstrated that client improved significantly with EMDR treatment. A
follow up study showed that improvement was maintained for at least fifteen
months. The findings from this and other studies clearly indicate that EMDR is
effective and that results are lasting. Further references pertaining to
research on EMDR many be found on their internet site.
What Is an actual EMDR session like?
In EMDR treatment, the therapist works with the client to identify a specific
problem to be the focus for a treatment session. The client recalls to mind a
disturbing issue or event, what was seen, felt, heard or thought, and indicates
what thoughts or beliefs are currently held about that event. The therapist
performs sets of movements, moving a hand back and forth (a set) while the
client focuses on the disturbing material and simultaneously watches as the
therapist move their hand from left to right (a set). The client just notices
whatever comes to mind without making any effort to control direction or
content.
Each
person's information processing will be unique, based upon that persons values
and experiences. It is essential to understand that there is no way for the
client to do EMDR processing incorrectly. Successive sets of eye movements are
continued until the memory becomes less and less disturbing and becomes more
associated with positive thoughts and beliefs about oneself. For example, the
client may spontaneously exclaim, "I did the best I could".
During the initial stage of an EMDR session the client may experience intense
emotions; by the end of the session most people report a marked reduction in
their level of disturbance. Following each session clients are asked to keep a
log or journal of memories, feelings and experiences related to their experience
of that session. This information may then be used in future sessions as a focus
for unresolved memories or simply remain as information and be utilized as a
mark of progress. The information may also serve as a reference point to where
the process began and where their work has taken them.
How long does EMDR take?
One or more sessions are required for the therapist to understand the nature of
the problem and to decide whether EMDR is the appropriate treatment. The
therapist will often ask the new client to complete a Psychological Inventory to
assist in understanding potential characteristics that might either forestall or
help to foster change. The therapist will also discuss the EMDR program and
provide an opportunity to ask questions about the method. Once the therapist and
client have agreed that EMDR is appropriate to the specified problem, the EMDR
therapy can begin.
A typical first session lasts approximately ninety minutes. Subsequent sessions
range in length from forty-five to ninety minutes. The nature of the problem,
life circumstances, and experience of previous trauma will determine the number
of treatment sessions required. In some cases a single EMDR session is
sufficient. More typically the course of treatment is three to ten sessions,
scheduled weekly or for alternate weeks. While EMDR may be used as the therapy
of choice, it may also be used along with other forms of therapy, such as "talk
therapy." The process could involve the same therapistusing the various forms of
therapy, or different therapists for each form of therapy being utilized.
Is EMDR appropriate with children?
EMDR has been used successfully with children and adolescents. With all clients
the establishing of trust and rapport is essential. EMDR may be used in
combination with Play Therapy or other forms of self-expression. EMDR with
children can often quickly reduce trauma which typically affects other aspects
of their lives, e.g. school, friends or home life. In many cases EMDR can help
children with the emotional and social impact resulting from having a learning
disorder. While reducing the emotional impact of the disorder, the treatment may
or may not have an impact on the learning disorder itself. Children with
learning disabilities have typically experienced repeated academic failure,
leading to frustration and self-loathing. As an outlet, such children will often
turn to a peer group with similar developmental difficulties. This, in turn,
leads to conflict among families, peer group, and school. As this conflict
escalates the child's self esteem is increasingly wounded. The child may begin
acting out, creating even more stress for both the child and the family.
Symptoms may include forms of sleep disorder, difficulty falling asleep or
difficulty awakening, decrease in appetite or turning to drugs or alcohol to
alleviate feelings of anger, anxiety or dispair. It is these types of trauma and
symptoms that are being successfully treated with EMDR.
What kinds of problems can EMDR treat?
Research evidence has supported EMDR as an effective treatment for
Post-traumatic stress. Various clinicians have reported success-utilizing EMDR
in the treatment of each of the following conditions:
Post-traumatic stress
Phobias
Panic attacks
Performance Anxiety
Dissociative Disorders
Stress Reduction
Sexual and/or Physical Abuse
Disturbing Memories
Complicated Grief
Anxiety Disorders
Addictions
The anxiety and social impact of having a learning disability
Traumas experienced by children following a loss
Night terrors
Fear of abandonment
Patrick
B. McGinnis, PhD, LMHC
