Understanding EMDR Therapy

EMDR (Eye Movement Desensitization and Reprocessing) is a type of trauma therapy that most people have heard of, but not a lot of people have had the opportunity to understand leaving many to wonder, “what is EMDR therapy?” Through research, EMDR therapy has strong empirical support as an effective treatment for trauma, PTSD, and anxiety disorders. Multiple meta-analyses and systematic reviews demonstrate that EMDR significantly reduces PTSD symptoms and compares favorably with other trauma-focused therapies, offering effective and reliable therapeutic benefits. (Driessen, Morsink, Busschbach, Hoogendijk, & Kranenburg, 2024; Shapiro, 2014; Vereecken & Corso, 2024; Yunitri et al., 2020)

Some clients enter therapy with limited understanding but trust the process. Others prefer a clearer explanation to feel confident about their treatment. For those in the latter group, this post will provide a detailed overview and explanation of EMDR, helping you determine if this will be a good fit for you. I will break down EMDR in three parts. 1) the theory of EMDR and how it works in the brain, 2) what the therapist is looking for and how they could be approaching EMDR, and in my next post 3) what to expect during a typical EMDR session.

I hope this article helps you gain a better understanding of EMDR and feel more involved in the process. To assist with any therapeutic terms used, a list of helpful definitions will be provided at the end.

The Theory of EMDR Therapy and How it Works in the Brain:

EMDR is a type of psychotherapy aimed to treat traumatic experiences that get “stuck” in the brain. Here’s a brief overview of the theory behind EMDR, starting with the scientific explanation and followed by a simpler analogy I use with my own clients.

The Scientific Explanation of EMDR Therapy

EMDR started in the 1980s, and was created by an American psychologist named Francine Shapiro. Shapiro was walking through a park and noticed that her disturbing and distressing thoughts seemed to decrease as she moved her eyes back and forth between objects. Intrigued by this observation, she began to investigate through scientific study whether this eye movement had any therapeutic effects. Today, EMDR has been endorsed by numerous organizations, including the American Psychological Association (APA) and the World Health Organization (WHO), for its efficacy in treating trauma and PTSD.

Three Main Reasons EMDR Therapy is Known to Work

After years of study and use in therapeutic offices, EMDR is known to work because of three main reasons.

Memory Reprocessing

EMDR uses the theory that distressing memories are “stuck” in our brain and have not been processed correctly. Our goal is to help reprocess these memories.

Dual Attention

The memories are reprocessed using dual attention stimulus, accomplished by using bilateral stimulation. Bilateral stimulation is a type of stimulation that offers alternating stimuli to both sides of the body. This can be done with audio, visual aid, or tactile means. Dual attention comes from using bilateral stimulation while also focusing on distressing memories. This dual stimulus is believed to help in reducing emotional charge connected to the memories, hence the desensitization in the EMDR name.

Neural Network Integration

Through the steps above, a therapist will help the client identify a negative neural network attached to the distressing memory, and help reintegrate the memory into a more positive neural network. This can help with more adaptive and helpful thinking about the distressing memories.

A Simpler Explanation for How EMDR Therapy Works

When I want my clients to have an understanding of EMDR, but do not want to spend a lot of their session time with the above explanation, here is what I share.

Our bodies know how to heal us pretty well. If we get a cut on our finger and we keep it clean, it will heal. This is the same with the brain, it can heal a lot of our emotional wounds. However, just as there are physical wounds we need to set or help in order to heal correctly, there are some emotional wounds too traumatic for our brain to heal on its own. One of the ways that our brains process trauma on its own is through sleeping, and specifically dreaming. Dreaming is believed to help defuse memories that are traumatic and process these emotional memories. EMDR, specifically the eye movement part, helps mimic this activity while we are awake.

While awake, we have more control over what we are targeting, processing, and how that memory is being reintegrated into the psyche. As an EMDR therapist we have a recipe to help guide a client’s brain to do its own healing. We ask the brain to target “stuck” or maladaptively processed memories, and reprocess them while the client is awake.

Therapist Goals + Seven Phases of EMDR Therapy

Clients may assume that EMDR therapy begins only when bilateral stimulation starts. However, EMDR actually commences as soon as a client enters the therapy room for the first time. The process encompasses seven phases, each of which is crucial to the overall treatment.

History and Treatment Planning

The length of this phase varies based on the issue and therapist’s approach. It resembles standard therapy, where the therapist gathers a detailed history, creates a treatment plan, and identifies specific target memories and their associated neural networks.

Neural Networks

Now let me take a moment to explain what a neural network is and what a therapist is looking for. I use the same analogy to explain neural networks to my clients. I say that our brain is like a computer from a very young age, just typing away every single thing we hear, things people say to us, things people say to each other, things we hear on tv, and more. However, when we are young our brain doesn’t have any filters to organize this information. Our brain can’t label messages as “helpful,” “unhelpful,” “true,” “false,” or otherwise. But our brain likes to organize, so it can begin to organize and categorize based on emotion. Let’s use a very simplified example to illustrate:

Let’s say little Billie is in first grade. Billy is talking too much in class one day and his teacher loses their temper. The teacher calls Billy a “bad kid” and that feels really bad. A few days later Billy gets in trouble at home, but no one calls him a bad kid. However, he feels bad in a similar way to how he felt when his teacher labeled him earlier in the week. If this incident was strong enough in Billy’s mind, his mind could create a folder starting with the memory from school. Over his life, every time Billy experienced something that made him feel similar to how he felt that day in school, his brain would put it into the same file folder.

Now Billy is in his 30’s, and whenever he is the cause of a conflict he feels like a “bad person.” This belief is stubborn and encouraged by years of memories put into this folder that offer his brain “proof” of this feeling. Switching analogies, now when Billy feels bad about himself, it’s like he puts on purple colored sunglasses, which colors all of his thoughts and feelings about the new situation using all of the information from his past. But, he is unaware he is putting these glasses on. The fact that Billy is a “bad person” feels factual and based in reality to him.

When a therapist is history taking, they are looking for trends in the way a client’s brain is processing and categorizing information to find these neural networks. A therapist will likely keep note of, or map out these networks to use in treatment planning. The client and therapist will work to choose a target memory on this neural network to begin with when the desensitization phase begins.

Preparation for EMDR Therapy

This phase may be brief or extend over several months, depending on the client’s needs. It involves educating the client about EMDR, strengthening the therapeutic relationship, assessing for dissociation, and teaching coping strategies for potential distress. Key elements include learning grounding techniques and discussing the client's support system. These techniques are crucial if future sessions become overwhelming. The therapist will also tailor EMDR approaches based on the client’s communicated level of distress.

Desensitization

This is the phase that most people are thinking about when they think about doing EMDR therapy. This phase includes narrowing down a specific memory and neural network to target, identifying the negative belief associated with the memory, identifying a positive belief the client would like to install in a later phase, and recognizing any physical sensations that come with the target memory. The therapist will take baseline measurements, and start the bilateral stimulation with the client.

Bilateral stimulation can be auditory (headphones with bilateral music or tapping noises), tactile (holding items that vibrate back and forth in the client’s hands), or visual (the therapist using a number of different options to help the client’s eyes move back and forth.) The therapist will ask the client to stop every so often and report their experience, which the therapist will track and monitor. This involves observing changes in the client’s emotional and cognitive responses, and using a number of interventions to help them shift their perceptions and beliefs.

Installation

The therapist will work with the client to identify a more helpful positive neural network or core belief, and will connect this belief to the disturbing memory. This helps integrate the processed memory into a more positive self-concept.

Body Scan

The client is asked to focus on any residual physical tension or distress associated with the memory and address it using further bilateral stimulation if necessary.

Closure

The therapist helps the client return to a state of equilibrium, ensuring they feel grounded and stable before leaving the session. They might use relaxation techniques or revisit coping strategies created above in the preparation phase.

Reevaluation

In subsequent sessions, the therapist reviews the progress, assesses the impact of the processed memories on the client’s current functioning, and continues working on any remaining issues or targets.

What to Expect in EMDR Therapy in Utah

To learn about what you’ll experience in the therapy room for EMDR in Utah, tap here to read my next post where I explain what to expect during EMDR therapy sessions plus answer commonly asked questions regarding EMDR therapy.

If you’re interested in learning more about EMDR therapy with a therapist or would like to start EMDR therapy in Utah, the therapists at Wasatch Family Therapy would be honored to support you on your journey. Schedule your initial visit by texting or calling 801.944.4555 or contact us using this form.

Sources:

Driessen, H. P. A., Morsink, S., Busschbach, J. J. V., Hoogendijk, W. J. G., & Kranenburg, L. W. (2024). Eye Movement Desensitization and Reprocessing (EMDR) treatment in the medical setting: a systematic review. European journal of psychotraumatology, 15(1), 2341577. https://doi.org/10.1080/20008066.2024.2341577

Shapiro F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente journal, 18(1), 71–77. https://doi.org/10.7812/TPP/13-098

Vereecken, S., & Corso, G. (2024). Revisiting Eye Movement Desensitization and Reprocessing Therapy for Post-traumatic Stress Disorder: A Systematic Review and Discussion of the American Psychological Association's 2017 Recommendations. Cureus, 16(4), e58767. https://doi.org/10.7759/cureus.58767

Yunitri, N., Kao, C. C., Chu, H., Voss, J., Chiu, H. L., Liu, D., Shen, S. H., Chang, P. C., Kang, X. L., & Chou, K. R. (2020). The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials. Journal of psychiatric research, 123, 102–113. https://doi.org/10.1016/j.jpsychires.2020.01.005

Helpful Definitions for EMDR Therapy

Memory Reprocessing: the therapeutic process of transforming and integrating distressing or traumatic memories into a less disruptive and more adaptive form in EMDR

EMDR: (Eye Movement Desensitization and Reprocessing) is a psychotherapy technique that uses bilateral stimulation to help clients reprocess and integrate distressing memories.

Target Memory: the memory chosen to start the desensitization phase in EMDR

Dual Attention: Dual attention comes from using bilateral stimulation while also focusing on distressing memories

Bilateral Stimulation: Bilateral stimulation is a type of stimulation that offers alternating stimuli to both sides of the body. This can be done with audio, visual aid, or tactile means

Neural Network: A neural network is a complex system of interconnected neurons in the brain that processes and integrates information, forming patterns of activity and associations that influence thoughts, behaviors, and emotions.

Therapeutic Relationship: a professional and supportive bond between a therapist and client, characterized by trust, empathy, and collaboration, which facilitates effective therapy and promotes the client's emotional and psychological growth.