What did you notice? Decoding EMDR Therapy

I recently completed training in Eye Movement Desensitization and Reprocessing (EMDR) therapy, and it has already been a game-changer for my clients and many others struggling with trauma, anxiety, depression, and more. However, EMDR is a therapy that often seems mysterious or even confusing. Even as a psychologist, before I received specific training, I had very little understanding of what EMDR was, how it worked, and what it was like to experience it . This post will shed light on what EMDR is all about and how it could help you or someone you know work through trauma, depression, anxiety, and many other struggles. I also provide some resources to find your own EMDR therapist. 
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How emdr came to be

One fine spring day in the late 1980s, Dr. Francine Shapiro was walking on a sidewalk and thinking intensely about something that was really bothering her. Her mind kept perseverating on it, and she felt strong negative feelings as she focused on it. Oddly, a few moments of walking later, she suddenly realized her negative feelings had vanished and her thoughts had shifted, without any conscious effort on her part. Bewildered, she paused and considered what she had been doing while she was focusing on the distressing situation. In addition to walking, she had also been moving her eyes side to side while focusing on her distress. She became immediately curious about how the side-to-side movement of her eyes (as well as her feet) may have impacted her emotional and cognitive process.

Shapiro's discovery led to series of first informal and then formal clinical trials evaluating the effects of bilateral stimulation (BLS), which is the intentional, repetitive, back-and-forth stimulation of the left and right hemispheres of the brain, on distress. More and more studies,  which originally focused primarily on the veteran population with Post-Traumatic Stress Disorder (PTSD), began to suggest a powerful effect of eye movement BLS on the reduction of PTSD symptoms. From those findings, EMDR was born. Since those early years, EMDR has been found to be effective for a vast range of presenting issues, including:

• Trauma and PTSD
• Anxiety, phobias, panic attacks
• Depression and bipolar disorders
• Grief and loss
• Pain and chronic illness
• Eating disorders
• Personality disorders
• Addiction

What it's like to experience emdr

EMDR treatment includes a series of stages, and despite being a fairly structured treatment, there are many ways it can vary client-to-client, so this is a very general overview. Before beginning, your clinician should explain EMDR to you in detail, answer any questions you have, and obtain your consent to move forward. Then, the first stage focuses on treatment planning. During this process, your clinician will explore with you what you hope to achieve by completing EMDR. I think of the planning like a funnel - starting with broad areas of concern, and then honing in on a more specific problem along with the core belief you hold about yourself related to the issues at hand. When we start to explore what negative beliefs (e.g., "I am incompetent") underpin the more surface-level symptoms (e.g., performance anxiety), the target for EMDR becomes evident. Once the negative belief is identified, your clinician will help you determine what positive belief you'd like to strive towards that counteracts the negative belief (e.g., "I am competent, regardless"). The last step of the planning process is to then identify specific incidents in the past, more recent present, and/or future, where the negative belief felt especially true to you. This creates an incident map of your negative belief, which will guide the EMDR focus. You typically then select a single incident from the map to focus on first during EMDR processing.

The second stage of EMDR is focused on resourcing. During this stage, your clinician works with you to build up your abilities to cope with and handle strong emotions or triggering memories. EMDR does have the potential to evoke intense emotions, so it is important that you have grounding and soothing skills to help you regulate your emotions if needed. These skills are also valuable outside of the context of EMDR, and can be used during any stressful moment. One of my personal favorites is helping clients develop a peaceful inner place. We use visualization and slow BLS to develop a vivid scene of a place, real or imagined, that produces a sense of tranquility. 

The third stage of EMDR is focused on desensitization and reprocessing. Once the plan and resourcing techniques are set, it is time to begin the application of BLS to work on the incidents and negative beliefs that have been identified. The clinician first takes you through a structured set of questions designed to activate the chosen incident (i.e., turn on your emotional response). Then, the clinician will instruct you to focus on the incident, belief, and associated feelings and sensations, and will apply a set of BLS for typically 20-45 seconds. There are many options for how the BLS can be applied - your clinician will review options with you and together determine the right choice:

1. Eye movement: this is the original BLS mechanism and involves following the clinician's hand as it moves left and right in front of your eyes. Some clinicians also may use a light bar, where the client visually tracks the light back and forth. For virtual meetings, a clinician may use a website or app to create the lateral motion, or they may use their hand on the screen if the client has a wide enough monitor.
2. Tactile: BLS can also be experienced through touch. Clients can self-tap their shoulders or biceps with crossed arms, or tap on their thighs. Some clinicians may also apply tapping on the backs of client hands or knees. Another popular option are "tappers," which are small vibrating electronic paddles that the client holds in either hand. The clinician can alter the speed and intensity of the tappers based on client comfort and need. BLS can even be achieved through movement, such as left-right punching, squeezing stress balls in each hand, walking/jogging, or even stepping the feet while stationary. Tactile BLS is another great option for virtual sessions.
3. Auditory: this option requires the use of headphones. BLS can be applied through auditory tones moving between each ear. 

The clinician will take you through 20-45 second sets of BLS. Between each set, they will check in with you, often asking, "what did you notice?". There are no "shoulds" or "supposed to's" with what you experience. The goal is to allow your brain, body, and mind to go where it needs to go during the set. The metaphor I tend to use is thinking about EMDR as driving down a highway, except you get off at each exit to check in before resuming your drive. Depending on the scope of the EMDR you agreed on with your clinician, as well as the emotionality and complexity of the focus, this stage may take a single session up to weeks or months to fully process through.

Your clinician will be actively tracking what you notice between sets to gain a picture of the healing process. It is common for clients to first feel their distress more acutely in the earlier sets, as their brains take them into the unhealed memory. However, as the sets progress, clients very often start to notice subtle changes indicating that healing is taking place. This is where your clinician's training and clinician intuition will come into place to guide the process. After it seems the unhealed trauma, negative believe, or incident has been fully addressed, the clinician will then instruct you on installing the new positive belief you had come up with together. Focusing on the positive belief along with BLS helps to deeply instill a new framework for seeing yourself in a more compassionate light.  Once the positive belief is installed, either EMDR is complete, or it is time to move to another incident or negative belief system and start again. 

After sessions, it is common to experience some residual effects of doing EMDR. These effects can vary greatly and may depend on what was addressed in the session, how activating it was, and whether it was resolved. Some clients report feeling more relaxed and present, better OR worse sleep, changes in dreams, body sensations, or in behavior (e.g., suddenly acting more assertive with others). Your clinician will check in with you about anything you may have  experienced between sessions. Once an area of concern is fully processed with EMDR, you should feel a notable shift in your emotional reaction to the incident that was addressed, in that you still remember it, but you don't feel distressing feelings or hold the same negative beliefs related to it. 
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Why we think​ emdr works

I say think for a reason. Like most forms of therapy, we aren't exactly sure of the specific mechanism of why it helps people feel better. EMDR certainly stands out this way, because it can sometimes feel like magic when a client's strong negative feelings seem to evaporate into thin air. However, there are several compelling theories about why we believe it has such efficacy, and I'll share two of them here: 

1. The REM Theory: I find this theory to be the most fascinating. Brain and sleep research have indicated that Rapid Eye Movement (REM) sleep is integral for memory consolidation. During REM, our bodies and brains are most active, where it is common for eyes to dart around behind their lids and brains to be busy with dreams and memories. There may be an essential link between the back-and-forth eye movement of REM with the processing and storage of memories. However, when we experience something traumatic or even moderately distressing, our brains are not functioning at full human capacity. During times of fight or flight (e.g., in an active warzone), the most human part of the brain, the prefrontal cortex, is largely off-line, while the more mammalian and reptilian parts of our brain take over. In essence, we are governed more by instinct to self-preserve than conscious, rational thought. Perhaps what also takes place is that our memories of those experiences are then not processed, consolidated, and stored due to the shift in our brain functioning in this threatening context. Instead, the memories sit in our brain, wired into our neurons, affecting how we respond to familiar-feeling situations moving forward (e.g., hearing fireworks). BLS may, in effect, be a consciously induced REM stage to help create a processing, healing, and storage function for those memories that have stayed unhealed. 
2. The Distracting Stimuli Theory: A second possible theory for why EMDR works considers the use of distraction through BLS. Rather than enacting a memory processing change, BLS may instead be pairing a neutral distracting stimuli while the client intentionally focuses on a difficult memory. Perhaps the association of the distracting stimuli with the memory aids in soothing or shifting the previous negative emotional association of the event. 

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Finding an emdr provider 

If you are wanting to try EMDR for yourself, there are a few places to look to find yourself a trained provider. Because EMDR is a specific form of treatment and often used for traumatic memories, it is important to ensure that your clinician is properly trained in the approach. Here are a few places to begin your search:

1. Directories
   1. Psychology Today: you can filter the search to include EMDR as a specific modality of therapy. https://www.psychologytoday.com/us
   2. EMDR International Association: https://www.emdria.org/find-an-emdr-therapist/
   3. EMDR Institute: https://www.emdr.com/SEARCH/index.php
2. Google search, "EMDR therapist near me"  
3. Word of mouth - consult with your other healthcare providers to inquire
4. Insurance company - check their website or call to get provider referrals

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References for more information

• Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. New York: Guilford Press
• EMDR International Association: https://www.emdria.org/
• Recent research on EMDR: https://www.emdria.org/about-emdr-therapy/recent-research-about-emdr/

I hope this post was helpful in demystifying what EMDR therapy is all about. Feel free to submit any questions or comments below, or contact me directly if you'd like to learn more.