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Therapy

5 Things to Know About EMDR

It's not magic, but some feel it's magical.

Key points

  • Eye Movement Desensitization Therapy, or EMDR is a type of psychotherapy used for PTSD and other challenges.
  • While the exact mechanism of change is unknown, some believe EMDR can induce a state similar to REM sleep.
  • EMDR involves components that approach past, present and future circumstances.

Eye Movement Desensitization Therapy, or EMDR, is a type of psychotherapy best known for its effectiveness in helping people process trauma. It utilizes a mix of strategies, including bi-lateral stimulation (such as eye movements or tapping) to assist in healing trauma. While the exact mechanism by which EMDR works is largely unknown, one hypothesis is that the bilateral stimulation induces a state similar to rapid eye movement sleep, wherein a person can more effectively work through memories (Stickgold, 2008). In addition to PTSD, adaptations have been made to EMDR to assist with a variety of mental health diagnoses, such as phobias and other anxiety disorders.

When I first learned about EMDR, a respected friend described it as magical. I did not believe them. Talk therapies like cognitive behavioral therapy, with their long-standing bases of evidence, seemed less mysterious (and honestly, more legitimate) to me. I have seen healing in sharing a story and working through the tangles within through talking or writing. I thought that was enough.

In time, I met a subgroup of people who seemed to hit the same wall repeatedly in talk-based therapy. They could tell their story and understand how their situation caused them to take on beliefs that weren't quite reasonable. In session, we could change those thoughts and discuss new behaviors. Yet, the post-traumatic stress symptoms would persist. Words were not enough. I wished for other tools.

I looked into the research on EMDR with interest. Many of my colleagues spoke highly of the approach. So, in 2019, I completed training in EMDR and added it to my toolbox. These are 5 Things to Know About EMDR

1. It's Not Snake Oil

Part of my initial cynicism regarding EMDR rested in not understanding how it worked. Waving my hands in front of someone as we talked sounded like...well...quackery. At face value, at least. Still, more than 30 randomized controlled studies have demonstrated the effectiveness of EMDR (de Jongh et al., 2019). Meta-analysis has also shown it to be as effective as trauma-focused cognitive behavioral therapy, a long-standing treatment for PTSD (Seidler and Wagner, 2006).

2. EMDR Goes Deep

EMDR opens a window for a person to reach back to find when a core negative belief (such as "I am a bad person") got formed and in processing through all the memories that piled onto that belief and resolving that trauma. Sometimes, this process brings up a surprising level of emotion. What might have felt like a low-impact event, such as a neighbor cursing you as a child, can reach back to a whole tree of emotions and beliefs, including shame. In terms of healing, this is meaningful. It can also make EMDR an intense and sometimes unpredictable process. Some sessions may leave you feeling strong, while others can give you a sense of fatigue. I encourage clients participating in EMDR to meet on days when they can rest after the session.

3. EMDR Is More Than Processing

The first phases of EMDR focus on building a therapeutic relationship and resources to prepare you for treatment. How long this preparation will take depends on many factors, like the complexity of your PTSD, whether you have dissociative symptoms, and your ability to build trust with the therapist. There are traditional exercises to build up a person's resources, such as the use of mental imagery and ones crafted for individual circumstances. Some therapists also integrate EMDR with other therapies, such as internal family systems, somatic approaches, and mindfulness-based approaches to assist. In any course of EMDR, aspects from the past, present, and future are typically explored.

4. In EMDR, You Are in Control

In EMDR, you are always in the driver's seat. If at any point you wish to stop, you can. You can also choose how far you wish to walk in any given session. An EMDR therapist will review this with you and will help create a plan for indicating if you need a break at any point.

5. “Go With That” Is the Phrase of EMDR, but There’s More to It Than That

In processing, your therapist will likely lead you through several sets of eye movements or other bilateral stimulation (like tapping) followed by words. The most common words are "go with that." This is because, in EMDR, the hope is to stay out of the way of the person's natural processing. Your therapist may also integrate a range of questions to introduce creative imagery (for example, an image of holding a sword in a situation where you felt powerless). No two EMDR sessions are the same

In Closing

While EMDR might not be straight-up magic, it offers an evidence-based, if still somewhat mysterious, means of working through trauma using something other than traditional talk therapy. Many find it healing. Maybe even magical.

To find a therapist near you, visit the Psychology Today Therapy Directory.

References

de Jongh, A., Amann, B. L., Hofmann, A., Farrell, D., & Lee, C. W. (2019). The status of EMDR therapy in the treatment of posttraumatic stress disorder 30 years after its introduction. Journal of EMDR Practice and Research, 13(4), 261-269.

Seidler, G. H., & Wagner, F. E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychological medicine, 36(11), 1515-1522.

Stickgold, R. (2008). Sleep-dependent memory processing and EMDR action. Journal of EMDR practice and research, 2(4), 289-299.

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