Eye Movement Desensitisation and Reprocessing

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EMDR is an evidence-based integrative psychotherapy for Post-traumatic Stress Disorder (PTSD) and of other psychiatric disorders, mental health problems, and somatic symptoms. The model on which EMDR is based, the Adaptive Information Processing (AIP), posits that much of psychopathology is due to the maladaptive encoding of and/or incomplete processing of traumatic or disturbing adverse life experiences. This impairs the client’s ability to integrate these experiences in an adaptive manner.

EMDR therapy enables the resumption of normal information processing and integration. Specifically, EMDR addresses issues involving the past, present and future by targeting past experiences, current triggers, and future potential challenges, results in the alleviation of presenting symptoms, a decrease or elimination of distress from the disturbing memory, improved view of the self, relief from bodily disturbance, and resolution of present and future anticipated triggers.

Francine Shapiro’s (2001) Adaptive Information Processing model, guides clinical practice, explains EMDR’s effects, and provides a common platform for theoretical discussion. The AIP model provides the framework through which the eight phases and three prongs (past, present, and future) of EMDR are understood and implemented. The evolution and explanation of both mechanisms and models are ongoing through research and theory development.
EMDR accomplishes the resolution of traumatic and disturbing adverse life experiences through a standardised set of procedures and clinical protocols which incorporates dual focus of attention and alternating bilateral visual, auditory and/or tactile stimulation. This process activates the components of the memory of disturbing life events and facilitates the resumption of adaptive information processing and integration.

Traumatic events and/or disturbing adverse life experiences can be encoded maladaptively in memory resulting in inadequate or impaired linkage with memory networks containing more adaptive information. Pathology is thought to result when adaptive information processing is impaired by these experiences which are inadequately processed. Information is maladaptively encoded and linked dysfunctionally within emotional, cognitive, somatosensory, and temporal systems. Memories thereby become susceptible to dysfunctional recall with respect to time, place, and context and may be experienced in fragmented form. Accordingly, new information, positive experiences and affects are unable to functionally connect with the disturbing memory. This impairment in linkage and the resultant inadequate integration contribute to a continuation of symptoms.

In EMDR, specific and well-defined treatment procedures facilitate information reprocessing by utilising an approach to treatment that optimises client stabilisation before, during, and after the reprocessing of distressing and traumatic memories and associated stimuli. The EMDR approach to psychotherapy is to facilitate the client’s innate ability to heal. Therefore, during memory reprocessing, therapist intervention is kept to the minimum necessary for the continuity of information reprocessing.

The eight phases of EMDR therapy begin with history taking, in which the presenting problems and early clinically significant life events causing them are identified, and fulfilling future goals are set.
The second phase involves preparing the client for memory processing, as well as teaching self-control techniques. A preparation technique will allow the person to feel in control during memory processing.

Assessment is the third phase, during which a memory and its different components are identified: a memory that has been causing the symptoms and its related aspects—the image, the negative thoughts associated with it, where it is located in the body, what the emotion is, etc. Processing involves stimulating the brain’s own information processing system that allows the different connections to be made.

Phase 4 involves desensitisation which allows insights and connections to be made. In this phase, the client is directed to attend briefly to the identified aspects of the memory while the information processing system is simultaneously stimulated. During this phase, the client engages in periodic sets of eye movements (sometimes taps or tones) for approximately 30 seconds each. It is during this time that the process of transforming the “stuck memory” into a learning experience and an adaptive resolution is observed. New and adaptive emotions, thoughts and memories emerge, and old and counterproductive ones are resolved. Processing disturbing memories will help not getting triggered by them any longer. For example, the feelings of shame and fear voiced by a rape victim at the beginning of an EMDR session may be replaced by the feeling that she is a strong and resilient woman.

Phase 5 involves installing new adaptive information by concentrating concentrate on a desired positive belief the client wants: therapist’s aim is to strengthen this belief so that it feels completely true to the client.

Then follows the Body Scan phase, where client thinks of that memory, the positive belief, and scans to see if there’s any disturbance in the body. If there is, it will be processed. The memory is processed, evaluated, re-evaluated, reassessed, until all of the issues have been addressed and the client is feeling empowered.

The Closure phase brings the clients back to the full state of equilibrium. Client is reminded about their self-control techniques and the in-between-session processing they can continue to do. If a disturbance comes up, in between sessions, client can write down what happened.
The eighth phase at the next session is Re-evaluation, where client is asked to bring back the memory and see how it feels and if there’s anything else that needs to be addressed.