Helping individuals overcome trauma and PTSD
What is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) is a therapy which was developed by Francine Shapiro in 1987, to help people who have suffered from trauma and PTSD. It has also been found to be effective with a number of other mental health problems, including anxiety, phobias, panic disorder and depression.
A core element of EMDR is to use eye movements from left to right to process traumatic memories which may have become stuck in our memory system. Sometimes instead of eye movements taps back and forth are used. These movements are known as Bilateral Stimulation (BLS).
EMDR is recommended for 8 – 12 sessions for PTSD. Individuals who have more trauma experiences, or have suffered from chronic trauma, may require more sessions.
Francine Shapiro states that EMDR originates from her walking in a park looking left and right at the view and noticing that some disturbing thoughts she was having disappeared. Although, she had spent many years studying the connection between mind and body reactions before!
EMDR has eight phases:
- Phase One: History taking. This involves assessment of an individual’s trauma experiences and symptoms. In this phase you will also develop a treatment plan of memories to focus on.
- Phase Two: Preparation. In this phase the EMDR model and what will happen in therapy will be explained. Because many people who access EMDR will have ongoing symptoms of trauma – including anxiety, nightmares and emotional difficulties – this phase focuses on developing strategies to manage these before starting the main processing.
- Phase Three: Assessment. For every memory that is processed, the first step is for the individual to identify an image of this and connect with the negative belief about themselves that they hold when remembering the trauma, and the feelings they associate with it. they will then be asked to think about a positive cognition, which is what they would prefer to believe about themselves when they think of the memory.
- Phase Four: Desensitisation. In this phase, the person will use Bilateral Stimulation to process the memory.
- Phase Five: Installation. In this phase, once the memory has been processed, the positive cognition that the person identified earlier is installed, using eye movements.
- Phase Six: Bodyscan: Processing is completed by asking the individaul to check for any outstanding body sensations associated with the trauma memory, and process these using eye movements.
- Phase Seven: Closure. When the memory has been processed, the individual will be supported to manage any experiences they may have outside of the session. Sometimes, processing can continue outside of the session, in the form of dreams, thoughts and remembering other related memories.
- Phase Eight: Re-evaluation. This occurs at the start of the next session, where any experiences in between sessions are discussed and evaluated, and the person is given the opportunity to discuss any changes that they have noticed. It is also the time to discuss any new associations, and re-evaluate the memory they have been working on.
EMDR has three stages of treatment, and it is usual to focus on past memories before moving on to present triggers and situations and processing these. Lastly, therapy will focus on helping to identify future situations where the persons wants their response to be different and developing alternative patterns to cope.
What is a trauma?
Trauma is defined as a deeply distressing or disturbing experience. The word originates from Greek, where trauma means ‘wound’. Traumatic experiences are defined as those that put a person or someone close to them at risk of serious harm or death.
It can be helpful to break down types of trauma into the following three categories:
- Acute trauma: this results from a single one off stressful or distressing event. This could include a car accident, being involved in a natural disaster or being the victim of a serious attack.
- Chronic trauma: this trauma is created from repeated or prolonged exposure to highly stressful events. It can include bullying, domestic violence or childhood abuse.
- Complex trauma: This results from an individual being exposed to multiple different traumatic events.
Post Traumatic Stress Disorder (PTSD) is the medical condition that can be diagnosed if someone has symptoms such as nightmares, flashbacks, hyper-vigilance or avoidance. Please see here for more details on PTSD.
Trauma and Processing
When an individual experiences a non traumatic event in their life, their brain has time to process this and store it in their memory network with other similar memories.
However, when a traumatic event occurs, the memory system does not work so well, as it is in a state of high arousal. On these occasions, the memory is locked in the brain with the original picture, sounds, thoughts, feelings and body sensations. Instead of being ‘filed’ with similar memories, it is stored in the wrong place. Because we do not process these areas linked to the memory, they can start to effect situations in the present which may have some similarities but are not threatening.
- Someone may have suffered a car accident when a certain song was playing on the radio. Now, every time they hear that song they start to panic and think that they are in danger when they are not.
- Someone who has suffered domestic abuse may have panic triggered when they smell a certain aftershave, because it reminds them of the perpetrator.
- Someone who has feared for their life after having a heart attack may start to feel panic if they become out of breath, or feel their heart beating stronger due to physical exercise.
Other symptoms which suggest a traumatic memory has not been processed and is impacting on current life include having nightmares (which may not be about the traumatic event), getting flashbacks and feeling overly emotional. This may involve getting frustrated very quickly, or thinking so much it impacts on sleep.
A normal reaction to trauma, and having these symptoms, is to develop ways to avoid triggering such feelings or sensations. However, when someone uses avoidance, it actually heightens the minds belief that there is a real threat when there is not one. This can make the above reactions even worse when a person has to face the situation that they are trying to avoid.
How does EMDR work?
It is believed that the left to right movement, known as ‘Bilateral Stimulation’ works on the information processing part of the brain. By focusing on both the traumatic memory, and an external stimulus such as eye movements, it allows an individual to access unprocessed memories and help them to be digest these in a way that removes the negative emotional states that are attached to them. It helps the person to file the memory in the right place, and for their brain to dismiss untrue associations with the present which may have been made.
It is likely that EMDR works in a similar way to Rapid Eye Movement (REM) sleep, which is believed to be the point in sleep where we process events. Treatment for trauma is advised to be taken after a minimum of a month has passed from the traumatic event; this is because for many people their mind is able to process the event without the need for longer term therapies.
EMDR can be used for people who have all the types of trauma above. If someone has a one-off trauma, they are likely to need less sessions than someone who has a number of traumatic experiences.
When a person has experienced a number of traumas, or chronic trauma of the same experience (such as domestic abuse) EMDR works by clustering symptoms or experiences and starting processing with the earliest memory of this. It has been found that by starting with the earliest memory this often helps to reduce current symptomology without having to process every event that occurred.
What can I expect from EMDR?
EMDR is a bit different from other therapies, as the aim is to process the memory rather than talk in depth about your experience of trauma or analyse your behavioural reactions in detail.
As such, when you are processing with eye movements there is no right or wrong response, you just go with whatever comes up for you regardless of whether it seems to make sense of not. You will never be challenged directly about your experience, instead therapists are there to help you to experience and connect with emotions, physical sensations, and the memory. When we experience trauma, it is like it gets stored in a muddled, disorganised way, so sometimes the processing can feel like this as well.
Due to the way that EMDR works, it is not necessary that you have a good memory of your trauma, it can help people even if they have very limited memory of what occurred.
How is it different to Trauma Focused CBT?
- In EMDR, the focus is not on talking through the incident, it is about targeting an image from this and processing all aspects of the memory – including feelings, thoughts and physical sensations.
- Trauma Focused CBT (TF-CBT) has more of a focus on helping an individual to challenge the dysfunctional beliefs that have arisen from the traumatic event.
- TF-CBT involves behavioural techniques to manage avoidance. This includes ‘in vivo’ exposure, whereby the person directly faces the feared situation in real life. It also uses ‘imaginal’ exposure, where the person is asked to imagine the traumatic experience repeatedly, to reduce the fear response to this.
I am a level 3 trained EMDR therapist and I am able to offer therapy face to face and online. Please contact me for more details. Got questions about the therapy process? Please see my Frequently Asked Questions.
If you would like further information, please see the links below.