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EMDR

Is EMDR a Fad?  Hocus Pocus?

EMDR stands for Eye Movement Desensitization and Reprocessing. It is a scientifically validated method of psychotherapy, accepted by the Canadian Justice System, World Health Organization, Therapyadvisor.com, many Employee Assistance Programs, and some medical doctors are either practising it or referring their patients for it. It has been recommended by the American Psychiatric Association, the UK Dept. of Health, Harvard & Boston U, and the International Society for Traumatic Stress.
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EMDR was developed around 1988 by Dr. Francine Shapiro in California and has been used worldwide. Dr Bessel Van Der Kolk (a psychiatrist, Medical Director of the Trauma Center in MA, professor at Boston U. and Harvard, & researcher/author on trauma) found specific positive changes in the brain due to EMDR and recommends it highly as a treatment for PTSD.  More than 20 randomized studies have reported that EMDR is effective, that the eye movements are producing positive effects, and when used to treat PTSD, the improvement in trauma symptoms is maintained & even continues to improve after cessation of treatment.
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EMDR has been recommended by many neuroscientists, psychiatrists, psychologists, & trauma experts around the world. You may have heard of some of these American experts:

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excellenceDaniel Siegel, MD
Bessel Van Der Kolk, MD
Pat Ogden, PhD
Laurel Parnell, PhD
Norman Doidge, MD
Antonio Damasio, MD
Daniel Amen, MD
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Over 100,000 clinicians in over 20 countries use EMDR. The EMDR Institute offers training in US, Canada, Australia, New Zealand, Taiwan, & Singapore.  EMDRIA is a professional association that holds an annual international conference, and lists training opportunities and published research on the therapy.
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Who uses EMDR as Therapy?

Psychologists, psychiatrists, counsellors/psychotherapists.  If a professional has graduated from a recognized program, they are allowed to attend Level I and II training. If they have completed that training, they can then practise EMDR on their patients. A clinical background is necessary for the effective application of EMDR therapy. Attendance at the workshop is limited to all levels of social workers and mental health professionals who have a master’s degree or higher in the mental health field; and if in US, are licensed or certified through a state or national board which authorizes independent practice. Canadian requirements include a minimum of a master’s degree in clinical or counseling psychology or social work, membership in a professional association that has a written code of ethics or standards of conduct, & professional liability insurance.
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What is EMDR?

Dr. Shapiro, the creator of EMDR,  describes it as “a simultaneous desensitization and cognitive restructuring of memories and personal attributions, all of which appeared to be byproducts of the adaptive processing of the disturbing memories.”  This therapy is a set of standard protocols that incorporate elements from many other treatment approaches, such as mindfulness, CBT, somatic experiencing, experiential, psychodynamic, & family systems theory. Bilateral stimulation is added to this, usually by the therapist guiding the clients’ eye movements left to right, as our eyes do naturally in REM sleep. Some therapists use bilateral tapping on the client’s knees instead of eye movements.  There is much less talking in EMDR sessions, so that you can go inwards and process (like mindfulness with a jet pack and a laser targeting specific beliefs). You choose which beliefs you want to work on.
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How Does it Work?

Traumatic memories stay “stuck” in the brain’s nether regions– the nonverbal, nonconscious, subcortical regions (amygdala, thalamus, hippocampus, hypothalamus, and brain stem), where they’re not accessible to the frontal lobes– the logical, reasoning parts of the brain. They are recorded as sensory memory traces (including body sensations) and are inaccessible to conscious examination (Damasio, 2006). This therapy activates all these parts simultaneously and because neurons that fire together, wire together = triggers are desensitized and new neural pathways are formed that are more adaptive.  The insights clients gain in EMDR result not from clinician interpretation, but from the clients’ own accelerated intellectual and emotional processing. Once the trauma is resolved, spontaneous improvement in other psychological domains occurs. See Shapiro’s AIP model for more explanation.
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What To Expect During EMDR Sessions:

When you have done all the prep and have chosen the first memory and belief to work on, your therapist will sit opposite you but to one side. They need to move closer temporarily when using eye movement so their fingers are at a distance that is comfortable for your eyes to focus on and follow. The therapist will ask you to focus inward on the traumatic memory, your emotions, thoughts, bodily sensations, visual images and follow their fingers with your eyes: left-right. No, it is not at all like hypnosis, where you are in a calm, relaxed state. You will experience strong emotions, as that is what helps activate the parts of the brain where the trauma/disturbing event is stored. This is necessary to produce change.  I used to use therapies that only dealt with the conscious mind and found little improvement that didn’t last.  With EMDR, more parts of the brain are activated, in an intense way. I found significant progress in my clients in much less time and with lasting results.
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 If you cannot do the eye movements, some therapists offer other forms of bilateral stimulation (BLS): hand taps, auditory tones, hand–held buzzing mechanisms.  They are all alternating activation of the right hemisphere and then the left hemisphere of the brain (BLS) which  facilitates processing of psychological difficulties. You will be pausing briefly & reflecting on what you were noticing during the BLS. If needed, your therapist may ask you questions occasionally to help you move to a neutral or positive interpretation of what the event meant about you e.g., “I did the best I could.”  A crucial step is pairing the original disturbing event with the new positive cognition.  By the end of each session, clients report significant reduction in level of disturbance and report feeling relief, peace, & calmness.
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Unlike some other therapies, EMDR clients are not asked to relive the trauma intensely for prolonged periods of time. In EMDR when there is a high level of intensity, it will only last for a few moments and then decrease rapidly. If it does not subside quickly on its own, let your therapist know because they can then use techniques to help your distress quickly dissipate. This is important so you can function comfortably outside of the sessions. You may be tired after EMDR sessions, so plan to have some down time after each treatment.
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Past, present, and future aspects of events are addressed and evaluation is included briefly in each session to assess progress and choose next events/beliefs to work on.
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What Prep is Done & Why? 

Prep includes taking your history, clarifying the problem to work on, assessing your coping ability, setting goals, explaining EMDR, & getting your informed consent. You usually do 1–2 sessions of preparation before starting EMDR.  You will decide which hindering beliefs you want to replace with more positive ones, with the guidance of your therapist. The therapist will also teach you techniques that you can use at end of each session so that you leave feeling empowered, calm, and in control. This prep is part of the standard protocol that includes 8 phases.
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How Long Will it Take?

A typical EMDR session lasts 90 minutes. Occasionally a session can be 60 minutes. It’s difficult to predict the number of sessions you will need.  For single incident trauma, with no hidden connections to other events or beliefs, it could take 3 sessions, after the 1–2 prep sessions. For more repeated trauma, it could take 12 sessions or longer, depending on your life circumstances, the type of trauma, & the pace you can handle. For the results to be maintained over time, it is important that all the significant traumatic memories be treated.
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What Will I be Like After Treatment is Complete?

You will still be the same person and be able to remember accurately what happened, but it will be less upsetting or not disturbing at all. It will not mean anything negative about you. You’ll have learned all you need to learn from it. If you’ve had PTSD, you will no longer suffer from nightmares, intrusive memories, emotional flooding, anxiety, numbing, low self–esteem. Even small–t trauma (life events) or hindering beliefs from any overwhelming event can be treated effectively with EMDR. I’ve had clients become more confident, calm, stable, hopeful, adaptive, able to focus, learn, recover from a breakup, have healthier relationships.  They have also become able to set healthy boundaries, be more assertive, build more friendships, change careers, take on developmental tasks they had been avoiding, & become competent leaders.
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What is EMDR Effective for?

EMDR can be used to enhance performance (interviews, public speaking, dating, using anti–bully skills, etc.) as well as to treat trauma or PTSD from a natural disaster, assault, abuse, an accident, a medical or dental procedure.  It is also effective for anxiety, depression, survivor guilt, recovery from being bullied or mobbed, low self–esteem.  One study found EMDR was twice as effective in half the time when compared to the standard type of treatment.  Research showed that EMDR for dental treatment phobia was effective in just 3 sessions and effects were maintained at 1 year followup.
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“I Had EMDR and it Didn’t Work”

 
I notice that in rare cases, if an individual cannot feel their emotions, EMDR (and many other therapies) will not be effective.  Please be genuine with your therapist about what you are feeling, or not feeling, and try to let yourself fully experience all your feelings during the EMDR. Your understanding of the phases, your own role, your therapist’s role, & how to work together all affect the efficacy of EMDR.  Feel free to ask questions at any time to help understand the process.  Also, if the positive cognition is not installed (Phase 5: “Hold the original memory and the new positive belief in your mind at same time,”) then the treatment will not cause a lasting benefit.  The therapeutic alliance (rapport/attachment) is important and the attunement of the therapist as they perform EMDR is a significant factor in the success of this approach.   Dr. Van der Kolk believes that what patients really need is the “therapist’s attuned attention to the moods, physical sensations, and physical impulses within.”  I found my success with using EMDR improved dramatically after implementing Dr. Laura Parnell’s methods of adapting the therapy appropriately to the client while still adhering to the 8 phase protocol, using attachment. So please let your therapist know what you are experiencing and what you may need. Find a therapist that is naturally good at attunement and is patient; it can take 12 sessions or more to clear many years of past abuse, trauma, or neglect. Some events may need to be redone if more hidden negative beliefs remain but are not replaced.  EMDR is like antibiotics– you may feel better early on; however you need to take a full course of treatment for it to work.
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Neurobiology Research Findings: 

Rauch, Van der Kolk, and colleagues (1996): PTSD symptoms are reflected in actual changes in brain activity (heightened activity only in the right hemisphere area, involved in emotional arousal and in the right visual cortex).  Broca’s area – the part of the left hemisphere responsible for translating personal experiences into communicable language – was “turned off”.

Case study research by Levin, Van der Kolk and colleagues (1999): SPECT scans were administered pre- and post-EMDR for 6 PTSD subjects who each received 3 EMDR sessions. Findings indicated metabolic changes after EMDR in two specific brain regions. There was an increase in bilateral activity of the anterior cingulate. This area facilitates the experience of real versus perceived threat, indicating that after EMDR, PTSD sufferers may no longer be hypervigilant. There also appeared to be an increase in pre-frontal lobe metabolism, which may indicate improvement in the ability to sort incoming sensory stimulation. The authors concluded that EMDR appeared to facilitate information processing.

Lansing, K., Amen, D.G., Hanks, C. & Rudy, L. (2005) reported that pre-post treatment SPECT scans indicated a decrease in anterior cingulate, basal ganglia, and deep limbic activity.

All psychophysiological studies indicated significant de-arousal. Neurobiological studies have indicated significant changes in cortical and limbic activation patterns, and an increase in hippocampal volume.

 

How EMDR is Similar to REM Sleep

 
Robert Stickgold (2000) has pointed out the similarity between the associative process produced by EMDR and what seems to occur in REM sleep.  He points out how REM sleep activates cholinergic activity in the brain. He has proposed that cholinergic activity during REM sleep promotes the loose association between various elements of experience. It is these loose associations that give dreams their irrational quality, but also promote the sprouting of associative networks that open up the possibility of multiple, flexible associations.  Unlike in traumatic memories, where one sensation precipitates very specific associated memories, in REM sleep & in EMDR – associative networks are highly flexible.   EMDR seems to enable trauma related sensations to be integrated into new associations that are not necessarily connected with the traumatic past.
 
For further information and a bibliography of research, please check emdr.com/faqs, emdrnetwork.org, and the EMDR International Association’s website emdria.org.

If you are interested in booking an appointment for EMDR treatment provided by Pamela Catapia, please click HERE