Eye Movement Desensitisation and Reprocessing

Eye Movement Desensitisation and Reprocessing (EMDR) Therapy

Development and Theory

EMDR (Eye Movement Desensitization and Reprocessing) is a form of psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Founded in the late 1980s by the late Dr Francine Shapiro (Mental Research Institute California) EMDR was discovered by Dr Shapiro as she experimented with her own distressing memories whilst simultaneously moving her eyes rapidly across the body’s midline.

Initially EMDR stemmed from the theory that learning and information is processed naturally during our Rapid Eye Movement (REM) sleep cycles. Initially however, Dr Shapiro steered away from the REM theory, and explained her findings using the Adaptive Information Processing Model. This posits that all current experience, including cognitions, emotions and bodily sensations are represented as memory networks in the brain. My experience of hunger connects back to the explicit and implicit memories of hunger. My cognitions, emotions and bodily sensations around hunger have all been learned, stemming all the way back to my first memory of hunger as an infant, even though I can’t explicitly recall that (implicit memory).

Researchers have found since then, strong correlations between processing of memories in REM sleep and the eye movements in EMDR for Post Traumatic Stress Disorder (Strickgold 2008). EMDR utilises the natural healing processes of sleep processes, working memory, the orienting response and desensitisation. These processes are considered to be key functions that lead to the treatment benefits of the EMDR protocol.

EMDR Protocol

The eight phases of the EMDR Protocol are 1) history taking and treatment planning, 2) preparation, 3) assessment, 4) desensitization, 5) installation, 6) body scan, 7) closure and 8) re-evaluation.

• Phase 1: The first phase begins with a discussion between the therapist and client regarding what brings the client into therapy, the client’s history is discussed, relevant schemas identified and a treatment plan is discussed with attention to the pacing of therapy and the selection of distressing events that will be part of treatment. In addition, the client’s internal and external resources are assessed.
• Phase 2: In the preparation phase, the therapist explains the EMDR therapy process, terms, and sets expectations. Any client concerns and questions are addressed and a safe therapeutic alliance between therapist and client is established. The therapist and client collaborate to prepare specific techniques to cope with any emotional disturbance that might come up. Some clients need quite a bit of time in phases 1 and 2 in order to feel ready to move on to the following phases.
• Phase 3: In assessment, the event/memory to reprocess (also known as the target event) is identified, along with images, beliefs, feelings, and sensations about the event. Initial baseline measures are set by using the Subjective Units of Disturbance (SUD 1-10) scale and the Validity of Cognition (VOC 1-7) scale.

The next three phases are known as the ‘reprocessing’ phases and all involve dual attention bilateral stimulation (BLS). Dual attention BLS activates the client’s information processing system while keeping the client anchored in the present moment. The client focuses on three aspects of the memory: (5 senses) content of the memory, emotions and bodily experience, at the same time as focusing on the dual attention BLS. Dual attention BLS can be side to side eye movements, sounds, butterfly hug, or taps.

• Phase 4: In the fourth phase, desensitization, the side-to-side eye movements, sounds, or taps are begun while focusing on the traumatic/distressing event, and continue until the client’s SUD reduces to zero (or 1 if appropriate). During this time, new thoughts, sensations, images, and feelings may emerge.
• Phase 5: When desensitization is complete, installation begins. In this phase, the client associates and strengthens a positive belief with the target event until it feels completely true.
• Phase 6: During the body scan, the client is asked to hold in mind the target event and the positive belief while scanning the body from head to toe. Any lingering disturbance from the body is reprocessed.

The last two phases ensure safety for the client both at the end of a current session and at the beginning of the next session.

• Phase 7: Every session of reprocessing ends with the seventh phase, closure, in which the client is assisted to return to a state of calm in the present moment whether the reprocessing is complete or not. Reprocessing of an event is complete when the client feels neutral about it (SUD=0), the positive belief feels completely true (VOC=7), and the body is completely clear of disturbance.
• Phase 8: Re-evaluation, is how each new session begins after reprocessing. The client and therapist discuss recently processed memories to ensure that distress is still low and that the positive cognition is still strong. Future targets and directions for continued treatment are determined.