Eye Movement Desensitization and Reprocessing – known as EMDR – is an evidence-based therapeutic technique that helps people with a history of trauma work through past events in order to resolve current mental health symptoms that cause significant emotional distress and disruption.
Created by Dr. Francine Shapiro in the late 1980s, EMDR leverages a model of brain function called Adaptive Information Processing. EMDR allows me to work with patients to access memories and difficult life experiences connected to trauma, and – following a specific, 8-step process – help process those memories in healthy and productive manner.
The Eye Movement Desensitization and Reprocessing International Association defines EMDR as follows:
Who Can EMDR Help?
Evidence shows EMDR is most effective in treating trauma-related and stressor-related disorders, including:
- Posttraumatic stress disorder (PTSD)
- Acute stress disorder (ASD)
Research also indicates EMDR is also effective for patients diagnosed with:
- Anxiety
- Depression
- Obsessive-compulsive disorder (OCD)
- Personality disorders
- Eating disorders
- Dissociative disorders
While diagnoses like depression and anxiety are not classified by The Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5) as Trauma- and Stressor-Related Disorders, at Crownview we understand that trauma – especially early life trauma – can increase risk of developing various mental health diagnoses.
The American Psychological Association (APA) offers this definition of trauma:
The APA elaborates, explaining that traumatic events can be caused by others, in the form abuse, violence, or prejudice, and by nature, in the form of natural disasters. Trauma often upsets and upends an individual’s view of the world. Our experience teaches us that a traumatic event can disrupt a person’s ability to trust. That’s a big deal: people with a history of trauma may lose trust in faith in people, institutions, and the world in general – including belief and hope they can heal.
That’s why techniques like EMDR are important. A person who loses the ability to trust as a result of trauma may experience a range of mental health symptoms including hopelessness, despair, anger/irritability, withdrawal from friends and family, disruptions in work, school, and relationships, as well as problems with sleep, memory, concentration, and decision-making.
With EMDR, we help patients resolve unprocessed trauma that causes these symptoms. One reason EMDR is effective is because it aligns with the principles of trauma-informed care.
Principles of Trauma Informed Care
The Substance Abuse and Mental Health Services Administration (SAMHSA) define three guidelines for trauma-informed care:
- Providers must fully realize and understand the significant effect of trauma on mental health.
- Providers should be trained to recognize the signs and symptoms of trauma.
- Providers must avoid re-traumatization during the treatment process.
These three guidelines inform the six principles of trauma informed care:
- Safety
- Trust/Transparency
- Peer Support
- Collaboration
- Empowerment
- Culture History, and Gender Awareness
For a detailed examination of the guidelines and principles of trauma-informed care, please read our article:
What is Trauma-Informed Care for Mental Health Disorders?
EMDR: How it Works
Treatment with EMDR is slightly different for every therapist-patient relationship. However, EMDR itself follows a tightly designed, predetermined structure: what varies is the character of the relationship, not the EMDR itself.
At Crownview, we create a low-stress, nurturing environment, based on mutual respect and trust. Within that relationship – designed for optimal healing and growth – the EMDR process occurs in eight distinct phases.
EMDR: The Eight Phases of Treatment
Phase 1: Patient History /Treatment Planning
During this phase, the therapist learns as much as possible about the patient. Together, patient and therapist identify past traumatic events to reprocess with EMDR. In addition, the therapist evaluates internal and external resources available to the patient that promote recovery.
Phase 2: Preparation/Education
During this phase, the therapist prepares the patient for the EMDR process. They explain how EMDR may involve revisiting difficult and painful memories, and provide effective techniques to manage emotions and thoughts associated with those memories. When the therapist thinks the patient is ready, it’s time for the next phase.
Phase 3: Assessment
During this phase, the therapist and patient collaborate to identify targets for treatment. They identify which negative memories, emotions, and thoughts to process, and decide which positive thoughts, feelings, or emotions to replace them with. For example, a patient might target a recurring pattern like “Nothing good ever happens to me and my life is miserable,” and decide to replace it with “When good things happen, I can see them, appreciate them, and understand how they improve my life.”
Phase 4: Desensitization
During this phase, the therapist asks the patient to identify/think about one of the negative images, thoughts, feelings, or emotions they want to resolve. While they hold the memory or event in their mind, the therapist guides your eyes through a sequence of movements – or they may use a tactile technique, such as tapping – in order to decouple the memory from the trauma. During this reprocessing stage, the therapist asks the patient to notice and remember any new thoughts or feelings associated with the target memory, so they can work on processing them appropriately later.
Phase 5: Installation
During this phase, therapist and patient consolidate the work they did to decouple the target memory from traumatic or disturbing emotions. Then, during this phase, the therapist and patient work to reinforce the desired positive emotions and thoughts defined previously. The reinforced thoughts or emotions might be those identified earlier, or new thoughts or emotions that arose in Phase 4. In either case, Phase 5 is about making those positive, desired thoughts become permanent, default thoughts.
Phase 6: Body Scan
During this phase, therapist and patient revisit the processed/reprocessed memory/memories and thoughts. However, this phase involves identifying any uncomfortable or painful physiologic sensations connected to the processed/reprocessed memory/memories. If distress, pain, or discomfort are present, the therapist and patient repeat the EMDR steps – the same as with negative thoughts/memories – to process that distress. When those memories stop causing negative physiological reactions, then they’re considered successfully reprocessed.
Phase 7: Closure/Stabilization
Formalized closure occurs before ending every treatment session, and at the end of the entire treatment process. During this phase, the therapist works with the patient to establish effective strategies to consolidate gains and cope with disturbing memories or emotions that appear between therapy sessions. This phase helps resolve anything lingering from the session that just occurred, in order to create a fresh slate for the next session. In the treatment plan writ large, this phase helps resolve any remaining issues, and prepares the patient for independent living.
Phase 8: Reevaluation
Reevaluation is the final phase of EMDR. During this phase, the therapist and patient evaluate progress, review treatment goals, and decide if the patient is ready for full independence, or needs to continue treatment. For some patients, the EMDR process may reveal hidden trauma that needs processing/reprocessing. For other patients, formal treatment ends here. During a reevaluation session, the therapist and patient discuss techniques to address difficult memories that may arise in the months or years to come, using EMDR processing skills and tools.
The Benefits of Eye Movement Desensitization and Reprocessing (EMDR)
EMDR helps people resolve trauma in ways that other techniques do not. Patients with a history of trauma who’ve tried therapy without success can lose hope that they’ll ever heal. As we mention above, unresolved trauma can lead to serious mental health difficulties, increase risk of developing clinical mental health disorders, alcohol and substance use problems, and cause significant disruption in almost all phases of life.
EMDR can change that.
If you have a history of trauma – whether simple or complex – EMDR can help you address, resolve, and move past those traumatic events and lead the life you want and deserve: a full and fulfilling life dictated not by the symptoms of a mental health diagnosis, but rather, by your vision of happiness and success.
Learn More Today
If you or a loved one has a trauma-related mental health disorder, eye movement desensitization and reprocessing may be exactly the treatment modality required to help achieve long-term treatment and recovery goals.
Gianna Melendez
Jodie Dahl, CpHT