EMDR at a Glance

Man with grief therapist

What is trauma? Robert Scaer, MD, says trauma is a deeply distressing or disturbing experience. “Any negative life event that occurs in relative helplessness.

As a trauma expert and clinical psychologist who has sat with people who are suffering for over 20 years, I can tell you that trauma is a real thing. Gratefully, I found a method of therapy called EMDR that can take someone’s pain and distress away like no other method I have discovered. If you are looking for relief from your emotional suffering, let me introduce you to EMDR, or (Eye Movement Desensitization and Reprocessing).

It is a fantastic, evidence-based, proven, effective therapy for treating small (t) and big (T) traumas. Small T traumas are essentially single-incident traumas. These for people are rather rare; someone in a lifetime would have just one bad experience. Truth be told, Big T trauma, often referred to as (complex trauma) involves relationship injury and is more chronic and repetitive.

It usually occurs in early childhood via attachment injuries caused by abuse, neglect, or family dysfunction. The outcomes of complex trauma on the developing brain, nervous system and memory result in many lifelong symptoms such as anxiety, depression, low self-esteem, fear, lack of motivation and many more. EMDR can assist with alleviating these symptoms.

Complex trauma is more common than single-incident trauma, as the ACE study showed. The Adverse Childhood Events study evidenced that 68 % of middle-class Americans have had Big T traumas. The ACE study correlated complete trauma experiences to longevity and health. See the link to this TED talk about this study and take the ACE test after reading this post to check your ace score. 

If you feel trauma therapy may be for you, let’s take a glance at what EMDR is and how it works. The E stands for eyes, which refers to the mode of bilateral movement. The M refers to the movement of the eyes bi-laterally, meaning the eyes track left and right, back and forth. This is done through the therapist guiding the client’s eyes with their hand waving back and forth in front of the client’s eyes. Essentially, with EMDR, you activate the negative memory networks of the brain that have not been brought forward in time, and integrate with more adaptive information, that is, positive memories. The neurons rewind themselves. It is all natural and is a built-in process we hold within us. This is referred to as the Adaptive Information Processing Model or AIP model, and it is the foundation on which the method of EMDR is based. I always say EMDR sounds weird, but it works.

Is EMDR Effective? Research & Evidence Base.

This is a great question. Some may ask, is EMDR research and evidence-based? Yes, there has been exhaustive research done on EMDR and continues to be. 

EMDR is widely recognized as an acceptable and appropriate treatment methodology for trauma, endorsed by the World Health Organization and many doctors and neuroscientists. The research comprises meta-analyses, random clinical trials, non-randomized studies, and other supporting studies.

A comprehensive list of research can be found at EMDRIA EMDR International Association and in the Francine Shapiro Library.

EMDR involves eight structured phases of treatment, which are outlined below. Let’s review how this method works so that you can decide if it is right for you.

Phase 1: History Taking and Treatment Planning

In this phase, the goal is to collect routine background history about the client to create a case conceptualization and then a treatment plan. Clinicians use their typical history and intake process using psychosocial assessments and receive informed consent. The therapist also begins to understand what memory networks need to be processed. Therefore, part of the history-taking process is understanding the client’s implicit and explicit memories and developing a case conceptualization for the treatment plan.

Phase 2: Preparation

This phase ensures the brain has enough adaptive information to relink the negative memory networks. For example, in phase 2, the assessment is whether the person can shift emotional states and tolerate the feelings they feel. The clinician must determine the client’s ability to engage in the EMDR process and prepare them so that the trauma therapy is never traumatizing. Addressing trauma phobia and defending parts of the person’s personality is essential in this phase as well if indicated. Another task to accomplish in the preparation phase of EMDR is establishing a therapeutic relationship of trust between the client and the therapist. Teaching the client various relaxation techniques for self-soothing in preparation so that in the event that they face any emotional disturbance that may arise during or after a session, they can manage these symptoms.

This is referred to as resource development. Resources created can vary but often include a calm place, a container, a nurturing figure, a safety resource, a wisdom resource, a helper, campaign guides, superpowers, maternal and paternal figures, animal nature, and so much more.

Phase 3: Assessment

When the client is ready, the therapist works with the client to identify the first (target) or memory to be processed. This can be a memory, feeling, or body sensation. You do not need to have explicit memory, i.e., picture memory, to do EMDR. The goal of EMDR in phase 3 is to set a baseline of the experience of this target before reprocessing it and activating the memory network. Your therapist will ask you these questions that meet these goals:

  • Image: What picture represents the worst part of the incident?
  • NC: What words go best with the picture and express your negative belief about yourself now? NC: _
  • PC: When you bring up that picture (incident), what would you like to believe about yourself now?
  • VoC: When you think of the picture or incident, how true do those words__ (PC)__feel to you now on a scale of 1-7 where one is completely false and seven is completely accurate (VoC on Positive Cognition:
  • Emotions: When you bring up that picture or incident and those words__ NC__, what emotions do you feel now? Emotions:
  • SUDS on Target On a scale of 0-10, where 0 is not disturbance or neutral, and 10 is the highest disturbance, you can imagine how disturbing it feels to you now. SUDS on Target
  • Body: where do you feel it in your body?

Phase 4: Desensitization

Then, in phase 4, the BLS starts, which allows the brain to process the memory. BLS, which stands for bilateral movement or is sometimes called dual attention stimulus, is used to process memories. As BLS is applied, the clients may see memories, feel things in the body and have emotions or a somatic sense. The memories will start negative, but adaptive positive information and insights are experienced as BLS is applied. The modes of BLS vary from eye movement; these have been researched to be the most effective, taping, such as butterfly hug, where you cross your thumbs and form your hand into a butterfly shape, then tap left, right, left, right on your chest. Light bars that guide the eyes, tappers that you hold in your hands or audio BLS are offered. 

When you return to the original experience, what do you get now? After BLS is applied, the therapist will ask when you bring up the original experience, where 0 is not disturbance or neutral, and 10 is the highest disturbance. You can imagine how disturbing it feels. Again, this is called the SUDS on Target. BLS is used until the memory is no longer disturbing. Once the memory is desensitized, the next phase, 5, reprocesses the memory. 

Phase 5: Installation of the Positive Cognition

This phase aims to reprocess the memory after it has been desensitized by connecting positive adaptive information via new positive core beliefs to the memory network. The therapist will ask you if the positive belief you picked in the beginning still fits or if there is another positive statement you feel would be more suitable. Then, you are asked to think of the original incident and positive words and decide how true they feel on a scale of 1-7, with seven being totally true and one not true at all. How true does the positive cognitive feel? This is called the VoC (Validity of cognition). Think of them together. More BLS is done, and the client is asked to notice what you get. Eventually, the positive cognitive feels very true, and the client moves to phase 6.

Phase 6: Body Scan

In this phase, the goal is to clear the body of any leftover somatic memories. BLS is used to process any physical sensations left in the body. Your therapist will ask you to close your eyes, concentrate on the original incident and the positive cognition chosen, and mentally scan your entire body. The client is asked to look for any residual body discomfort, even if it is mild.  If there is residual somatic discomfort, BLS is repeated until this is clear.

Phase 7: Closure

The goal of this session is to ensure the session is closed and the person is calm and settled before they go home. The clinician debriefs with the client and advises that reprocessing and side effects may continue after the session. 

It is determined if the client needs containment or relaxation exercises to tie loose ends. Evaluation of whether the session is complete or incomplete is done. The therapist will tell the client they are out of time: how comfortable are you with stopping? They brief the client on what to expect: The processing you have done today may continue after the session. You may or may not notice new insights, body sensations, or dreams. Just see and keep a log (log sheet given to the client). 

The client is invited to do Containment if needed.

The Therapist will say something to the effect of, let’s do a containment exercise, Calm place, etc.…… What percentage of what you experienced today is in the container? 

The client is reminded of side effects and how to cope with them, and a plan is created for dealing with them. As discussed, following EMDR, processing will continue as your brain assimilates and integrates information. This is a positive sign that material is being processed, and change is occurring. Having said that, the side effects can be off-putting if you do not expect them, so let’s review what can happen. You may feel tired or energized for the rest of the day.  Experience physical reactions (e.g., a headache) are common. Some people report a “cotton wool” feeling in their heads. You may think that “a weight has been lifted, getting a sense that something has changed, but you are unsure what. You may experience a short-term lack of concentration. “Your brain feels like it has gone into slow motion. Or “echoes” of the memory you were working on, such as faint reminders of parts of the incident. The most common side effects are vivid dreams and feelings. Other related or unrelated memories may surface. As processing continues after the session, you may gain insights. The side effects are manageable for people using the skills developed in Phase 2 and typically last about two days.

Phase 8: Reevaluation

The final phase of EMDR is Phase 8. Once reprocessing of the original memory target is complete, the client returns to the next session, and the re-processed memory is again assessed.

The therapist assesses the current level of disturbance, and if the client remains at a SUDS of 0 or low enough to be ecologically sound, then the memory is completed, and another memory is chosen to work on. If, however, the client shows some level of disturbance when the original target is brought up, reprocessing continues. Although EMDR is a very linear method, it is practiced circularly, and the phases are moved through as appropriate for the changes in the client’s life.

So, that is EMDR at a glance. Suppose you feel you may be interested in pursuing this method. In that case, contact us at Can’t We Get Along counselling if you live in Calgary or Alberta. We would happily assist you in person or virtually with the method.