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EMDR in Treatment: Understanding How It Works

EMDR is an acronym for eye movement desensitization and reprocessing therapy. This is a newer, nontraditional approach to therapy designed to lessen negative feelings and reactions associated with remembering trauma or experiencing a trigger that leads to trauma recall.
Talking through trauma and dealing with emotions by developing new coping mechanisms is the standard course for talk therapy. EMDR differs in that it focuses on the specific emotions and physical reactions associated with the traumatic event, which is remembered in brief intervals. 

What Does the Technique Treat? 

This form of treatment was developed by the late Dr. Francine Shapiro, an American psychologist, in the 1980s. EMDR was designed to treat post-traumatic stress disorder (PTSD). Since the first trials of EMDR, the treatment has been expanded to several other applications, including substance abuse and addiction treatment. 

Many people who struggle with mental illnesses such as PTSD, depression, and anxiety self-medicate with drugs or alcohol. Using EMDR to manage the underlying symptoms is one approach to reducing these harmful behaviors.
The goal of EMDR is to help the client fully process their feelings and memories around a traumatic experience and manage or reduce the emotions attached to that experience. Negative thoughts and feelings are systematically substituted with positive thoughts and feelings, which can improve social interactions and feelings about oneself.

EMDR has been compared to hypnosis. It remains a controversial intervention for PTSD, but medical research has shown that it does work for some people.

How Does EMDR Work?

There are eight foundational phases to EMDR

  1. Client’s personal history and creation of an overall treatment plan
  2. Preparation for the EMDR session, to build trust and explain outline the treatment approach
  3. Assessment of the specific negative thoughts and feelings that the client wishes to change
  4. Desensitization, where the eye movement method is used
  5. Installation, to fortify the replacement with positive thoughts and feelings
  6. Body scan, to determine if the client can think of the trauma without having adverse feelings they do not want or that are not relevant
  7. Closure, which is the completion of every session
  8. Reevaluation, which is the start of every session

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Full treatment requires about 12 sessions. You and your therapist can assess how many you will need.

At your first appointment or first few appointments, you will talk through your traumatic experiences with your therapist. Unlike talk therapy or other forms of cognitive behavioral therapy (CBT), you are not eventually discussing the entire event in detail. 

Instead, your therapist will focus on the negative thoughts and experiences you have related to the trauma and decide which of these you would like to replace with positive or neutral thoughts and feelings. Some of your reactions may still be relevant and should not be changed.

You will then begin to learn techniques to manage disturbing thoughts and feelings, as your therapist guides you through a process called desensitization. This phase of the process will occur over several sessions, as you pick one specific, targeted part of your traumatic memory and focus on it.

The process of desensitization involves bringing to mind one specific part of the traumatic event and keeping it in mind as your eyes follow a small item that is moved in a back-and-forth motion. This item can be your therapist’s finger, pen, or other small item, or a light.

In some cases, you may be asked to tap your fingers on your head, face, arms, or legs. In other cases, you may be asked to perform other movements along with the rhythm of the therapist’s motions.

During the process of holding this thought but focusing on something else in the present, your brain can distance itself from the emotions brought up by the experience, and you can think about those feelings and decide how to change them or release them.

This allows you to fully process these negative feelings.
If you become distressed during the session, your therapist will bring you back to the present and gently close the session.

An interview with a patient on a couch

You may evaluate in your next session if there is a different approach to EMDR that may work better.

Future sessions will help you to reinforce this change, strengthen positive feelings and beliefs about yourself and your experiences, and eventually lead to a point when you can think of the traumatic event and not experience intense, reactionary negative emotions. 

If you are interested in EMDR, there are many therapists, psychologists, and social workers who are trained in this technique. Ask about their education, training, and EMDR certification.

PTSD and EMDR

About 20 percent of people who experience a traumatic event — like assault, natural disaster, war, or serious accident — develop PTSD. This condition includes flashbacks to the event, angry outbursts, hypervigilance, feeling emotionally numb, nightmares, insomnia, panic attacks, and avoiding people, places, or even thoughts associated with the experience. 

People who develop PTSD are at a much higher risk of developing an addiction to drugs or alcohol as a method of self-medicating symptoms.

The techniques that became EMDR were developed as a method of managing the more psychologically and physically intense symptoms of: 

  • PTSD
  • Anxiety disorders
  • Phobias

The procedure can reduce the immediate symptoms of stress, tension, and fear associated with certain memories or triggers. This can also reduce the recurrence or worsening of tension and fear reactions later.
The Department of Veterans Affairs (VA) recognizes the success of EMDR in managing PTSD and anxiety in veterans and strongly recommends it as a course of treatment.
A study involving 22 people reported that 77 percent of the participants found EMDR useful in treating their PTSD symptoms. The treatment greatly reduced hallucinations, anxiety, delusions, and depression associated with the condition. 

While EMDR requires the participant to think of a traumatic event, the study found that this approach to therapy did not exacerbate PTSD symptoms, even for those who did not benefit from EMDR.
A different study reported that EMDR had a similar effect to prolonged exposure therapy, and it found that EMDR was more effective at treating symptoms for phobias or PTSD than exposure therapy. Those participating in the EMDR section of the study were less likely to drop out during the study period. 

However, the study concluded that both EMDR and exposure therapy were useful for reducing symptom severity in anxiety and depression associated with trauma, so if a client does not respond to one approach, the other may work well.
Other small studies have found that EMDR may not reduce symptoms in the short term, but it has greater benefit in reducing symptoms in the long term than some other approaches to treatment. This form of therapy may work well for people who have PTSD or anxiety associated with a traumatic event, especially for those who want to avoid medications or for whom prescription medications have too many side effects.

EMDR and Substance Abuse

When used as part of a larger approach to substance abuse treatment, EMDR can be very effective at relieving negative emotions that can otherwise trigger cravings and relapse.
The first two phases, when part of addiction treatment, are focused on building internal resources and helping the client emotionally stabilize. Then, the remaining phases are about long-term relief from PTSD or stress symptoms.

Those in addiction treatment can benefit from EMDR for

  • Alleviating psychological symptoms from trauma and PTSD
  • Alleviating the physical symptoms of stress from PTSD or trauma
  • Decreasing or eliminating distress from disturbing memories, which may otherwise trigger relapse
  • Improving self-esteem and self-efficacy, which are goals with other behavioral approaches
  • Resolving present triggers and developing positive images to avoid future triggers

EMDR Does Not Work for Everyone

Some psychologists use EMDR to treat the following: 

  • Depression
  • Eating disorders
  • Stress or anxiety associated with chronic illnesses
  • Sexual dysfunction
  • Some symptoms of schizophrenia

EMDR may work well for some people with these conditions, but it is more likely to be one of many approaches to treatment. It works more subjectively for people with the above conditions compared to anxiety-based conditions.

EMDR mustn’t be viewed as a quick fix for trauma. For clients who struggle with substance abuse as a response to traumatic events, or whose trauma is associated with addiction or drug abuse, it is important to take these factors into account and spend more time planning the actual EMDR sessions appropriately. EMDR can be a great part of the larger toolkit for treating addiction, but it is not a substitute for long-term care, which must include detox, rehabilitation, and an aftercare plan with social support.

People who are not prepared to work through traumatic events as part of their substance abuse treatment are not good candidates for EMDR. It is important for people with co-occurring disorders, such as addiction and PTSD, to start with standard care approaches, including cognitive behavioral therapy and mutual support groups. Then, they can determine if they want to add EMDR as part of their larger treatment plan. 

Sources

Eye Movement Desensitization and Reprocessing Therapy. Psychology Today. Retrieved April 2019 from https://www.psychologytoday.com/us/therapy-types/eye-movement-desensitization-and-reprocessing-therapy

(November 15, 2015) What is EMDR and Is It Effective for Addiction Treatment? The Fix. Retrieved April 2019 from https://www.thefix.com/can-emdr-treat-addiction

(December 15, 2017) EMDR Therapy: What You Need to Know. Healthline. Retrieved April 2019 from https://www.healthline.com/health/emdr-therapy

(July 18, 2016) Self-Medicating to Cope with Trauma: How EMDR Therapy Can Help in Substance Abuse Treatment. U.S. News & World Report. Retrieved April 2019 from https://health.usnews.com/health-news/patient-advice/articles/2016-07-18/self-medicating-to-cope-with-trauma-how-emdr-therapy-can-help-in-substance-abuse-treatment

(October 8, 2018) How EMDR Therapy Heals Trauma and Addiction. Psych Central. Retrieved April 2019 from https://psychcentral.com/lib/how-emdr-therapy-heals-trauma-and-addiction/

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