There are dozens of different types of psychological therapy, also called psychotherapy. As a result, choosing the best treatment option can be challenging, especially if you’re not familiar with the many different forms of psychotherapy. EMDR therapy is quickly becoming a popular option for clients with PTSD and anxiety, but what is it? And how does it work?
Eye movement desensitization and reprocessing (EMDR) therapy is a form of Psychotherapy and is often used to treat PTSD and anxiety disorders. It utilizes guided eye movements and discussion to address negative emotions associated with traumatic events, helping clients overcome feelings of panic associated with specific memories.
This article will explain what EMDR therapy is, how it works, and why it might benefit some clients. Additionally, we’ll examine the eight primary phases of EMDR therapy to help you become more familiar with this treatment and know what to expect during each session.
What Is EMDR Therapy?
Eye movement desensitization and reprocessing (EMDR) therapy is a form of psychotherapy often used to help individuals diagnosed with conditions like post-traumatic stress disorder (PTSD), anxiety, and depression.
This form of therapy utilizes guided discussion and eye movement exercises to help alleviate emotional distress associated with specific memories or traumas. Unlike other forms of psychotherapy, most notably cognitive behavioral therapy (CBT), EMDR therapy doesn’t require clients to go into detail about past traumatic events.
Instead, the therapist may help the client select a particular moment that produces negative thoughts and emotions and gently discuss those emotions. Consequently, EMDR therapy may be an excellent treatment solution for those who find themselves deeply triggered by recounting past traumas or repressed memories.
How Does EMDR Therapy Work?
Understanding how EMDR therapy works can be challenging, especially since medical professionals still cannot fully agree on the mechanisms behind this therapy’s success.
For example, EMDR therapy incorporates three primary focal points, which include:
- External stimuli
- Guided processing
- Positive affirmations
The combination of these three focal points is what makes EMDR therapy so unique. Still, there’s little understanding of how these three aspects can help clients relieve their stress and overcome past trauma.
That said, we can explore the three essential focal points of EMDR therapy to discover more about how they influence the way we process trauma. In this way, we can begin to piece together information and form a more comprehensive understanding of how EMDR therapy affects our behavior and perception.
Many forms of psychotherapy rely heavily on discussion, but few offer external stimuli. More specifically, few other forms of therapy rely heavily on eye movement to elicit a positive emotional response or effect.
But EMDR therapy combines therapeutic conversation with guided eye movements. Typically, the therapist administering EMDR therapy will ask the client to follow their hands or fingers during particular stages.
In some ways, this guided movement helps the client’s eyes achieve a near-REM speed and motion. This is a vital aspect of EMDR therapy and may help us understand more about how it works.
REM (Rapid Eye Movement) and EMDR Therapy
Rapid eye movement (REM) is a sleep stage that often occurs while we’re dreaming. Triggering it during waking hours may affect our sense of perception by activating the brain to enter a dreamlike state.
Notably, scientists and medical professionals aren’t entirely sure why we dream, though there are several worthwhile theories. One of the most popular and supported theories that explain dreaming and REM sleep purports that dreaming is necessary for our brains.
When we dream, our subconscious selves can communicate with our conscious aspect, often helping improve our ability to remember past and future events. Individuals that fail to enter REM sleep may have cognitive difficulties, including memory recollection and formation.
Consequently, EMDR therapy may trigger the areas of our brains responsible for forming and recalling memories. Because the client is awake during this process, they may allow their subconscious feelings to communicate with their conscious mind, helping to address deep emotions more effectively.
Additionally, recalling specific memories changes the way our brains store and handle that information. Guided conversations between eye movement sessions may change how you perceive a past trauma by altering how your brain processes that memory and its associated emotions.
Although EMDR therapy doesn’t require clients to detail their traumatic experiences, it does offer guided conversation to help address trauma. However, unlike other forms of psychotherapy, this type of discussion-based therapy is distinctly single-minded.
While a cognitive behavioral therapist might ask a litany of questions about your childhood, family, or career, an EMDR therapist is far more likely only to address a singular trauma during sessions. This type of guided processing helps keep clients calm and relaxed, even when recalling painful emotions.
For some, recalling several traumatic memories at a single time can trigger severe panic attacks. This is especially true of those suffering from PTSD or anxiety disorders. But EMDR therapy lessens the potential for this negative side effect by focusing on singular memories and events and avoiding detailed discussion of those traumatic moments.
This guided processing focuses on the emotions that the client associates with past trauma rather than the trauma itself. That’s because the primary focus of EMDR therapy is to help individuals replace unwelcome, unhelpful, and destructive emotions with more positive ones. This often means ‘rewriting’ the traumatic memories that are triggering stress responses.
Trauma and the Human Stress Response
Traumatic events are often life-changing, but they can also change your biology. When individuals are forced to survive a traumatic event, their brains trigger the body to enter into a survival state. This change is called the human stress response or the fight-or-flight response.
When you encounter a stressor, your brain recognizes the threat and triggers your body to release a flood of hormones. Adrenaline, norepinephrine, and cortisol are the three chemicals most associated with the stress response.
These beneficial compounds can help your heart beat faster, your blood vessels dilate, and reduce your ability to perceive pain. All of these interactions are designed to help you survive a sudden threat. However, they can become destructive when released regularly. Consistent or constant stress can overwork the body and can change the brain’s chemistry.
Instead of your brain triggering the stress response in life-or-death situations, it might start going off from minor stressors. Your mind may recognize a multitude of everyday situations as threats, causing your body to enter fight-or-flight mode often. Unfortunately, long-term exposure to the stress response chemicals and hormones can have severe, adverse effects.
By addressing past traumas, therapists may help clients reduce their body’s natural tendency to misidentify threats. This allows individuals with PTSD and anxiety to reduce their triggers and learn how to cope with stressful events. Additionally, the introduction of positive affirmations helps replace the painful emotions with practical, healing thoughts and feelings.
EMDR therapy consists of several stages. During the installation phase, the therapist will attempt to replace the client’s negative emotions and connotations with positive or neutral ones.
When combined with eye movements and focused processing, these affirmations, and beneficial suggestions may help the client let go of their painful thoughts and feelings. In their stead, the client may experience a positive change in perception.
For example, let’s say that a client seeking EMDR therapy is experiencing painful emotions relating to a traumatic memory of learning how to swim. They may experience anxiety every time they see a swimming pool, lake, or ocean.
To help them overcome this trauma and its associated emotions, an EMDR therapist will use guided eye movement exercises and guided processing. During the installation phase, the therapist may discuss the positive aspects of swimming.
In this example, the therapist might discuss how learning how to swim saves the lives of children every year. They might also discuss the fact that babies have a natural swimming reflex, allowing them to dive beneath the water for short periods. These statements are designed to help the client disassociate their trauma from the trigger.
Though the client may not agree with these statements, they’re still helpful in providing a logical, positive juxtaposition to their natural state of fear, anger, and sadness. Over time, these ‘installed’ ideas may change how the client perceives the trauma, helping them overcome and change the negative associations of the memory.
What Are the Benefits of EMDR Therapy?
EMDR therapy presents several potential benefits. Naturally, EMDR therapy’s effectiveness will vary from individual to individual.
That said, some of the most commonly reported benefits of EMDR therapy include:
- Decreased anxiety
- Lessened symptoms of depression
- Fewer panic attacks
- Improved coping skills
In addition to treating PTSD and anxiety, EMDR therapy is sometimes used to help individuals overcome addictions, break-ups, unwelcome physical habits, and symptoms relating to ADHD. That’s because EMDR therapy focuses on shedding negative emotions and the beliefs that cause them.
After completing an entire EMDR therapy session (all eight phases), clients may be better able to cope with future traumatic episodes or panic attacks. Common coping mechanisms addressed during EMDR therapy include breathing techniques, improved body awareness, and heightened control over intrusive, upsetting thoughts.
Consequently, EMDR therapy could help you heal from emotional trauma while preparing you to handle potential challenges. However, the first few sessions can be intense, particularly for clients that struggle with intense emotions.
Although EMDR therapy can be beneficial, it’s not completely void of risks.
Are There Any Drawbacks to EMDR Therapy?
Even though EMDR therapy is a gentler form of cognitive therapy, that doesn’t mean it isn’t without potential side effects and drawbacks. Clients who undergo EMDR therapy may experience heightened emotions, increased negative thoughts or feelings, emotional distress, and an increase in vivid dreams.
These symptoms tend to lessen as sessions continue, but they may be particularly intense after the first few meetings with your therapist. Getting to know the eight primary phases of EMDR therapy may help you prevent and prepare for such reactions.
What To Expect When Undergoing EMDR Therapy
In many cases, the only thing stopping clients from trying EMDR therapy is fear of the unknown. After all, EMDR therapy is designed to help treat individuals with anxiety. New or unfamiliar things can induce a sense of panic in those naturally susceptible to such emotions.
Becoming more familiar with the process of EMDR therapy might be the best way to overcome this fear. EMDR therapy consists of eight major phases, and each session may include one or more of these stages.
Here’s what you should expect if you and your therapist agree to EMDR therapy:
Stage 1: Client History and Planning
As with most (if not all) psychotherapies, the very first step is gathering and submitting information on your medical history. You may want to have medical documentation or references ready for this initial step. Still, if you cannot find any documentation, there’s no cause for alarm.
While scheduling your primary therapy session, you’ll likely be required to submit a series of documents. One (or several) of these documents will cover your medical history and current allergies. Be sure to answer honestly and seek help from a spouse, family member, or medical professional when necessary.
Once your therapist has received your paperwork, they’ll take some time to review your information and determine the best course of action. In some cases, your therapist may recommend an alternate form of psychotherapy.
However, if the therapist feels that you might benefit from EMDR therapy, they’ll go ahead and schedule a preparation session with you. In the wake of 2020, many preparation sessions are performed online, virtually. Depending on your location and preferences, you may also be able to experience full EMDR therapy sessions from the comfort of home.
Still, if possible, it’s crucial to attend in-person sessions, particularly during your first few treatments. Following your therapist’s movement and directions can be challenging if your internet connection is slow, the device you’re using is outdated, or you’re easily distracted. In-person sessions can be more effective for individuals with ADHD or inconsistent WiFi.
Stage 2: Preparation
You’ve likely guessed that the preparation phase is all about preparing you for EMDR therapy. However, this second stage is also crucial in helping a therapist and client connect and build a sense of trust. Psychotherapy treatments are often relatively ineffective if a client feels that their therapist is untrustworthy.
As such, the preparation stage is crucial to the overall effectiveness of EMDR therapy. It gives both parties a chance to sit down with each other, discuss your medical history, and address any concerns or questions they may have about EMDR therapy. It’s also a prime opportunity for therapists to detail the nature of the upcoming sessions.
Not only does the preparation phase ensure that you know what to expect, but it can also help lessen pre-treatment anxiety. Additionally, the preparation phase is the point at which you and a therapist discuss your treatment goals. When you have a dream that you’re hoping to achieve, you’re more likely to feel inspired and confident.
Basic self-coping techniques, such as deep breathing, are also addressed during the preparation phase. Stop signals are commonly discussed during the preparation phase too. These allow you to communicate quickly and effectively with the therapist during moments of intense emotion or discomfort.
The preparation stage is crucial to ensuring you have all the information and tools necessary to enjoy a satisfactory and effective therapy session. If you attend this initial meeting but think of additional questions or concerns after the session has ended, you may be able to send your therapist a quick message or email. In most cases, they’ll be more than happy to offer you answers and reassurances, especially as you enter the assessment phase.
Stage 3: Assessment
The primary focal points of the assessment phase are: Setting a target and determining a base level of comfort. For many clients, the assessment phase can bring up intense emotional responses. However, the therapist will likely do everything they can to mitigate, prevent, or lessen these responses.
Still, the assessment phase requires you to identify a particular trauma or upsetting memory. This process can be emotionally painful, but the therapist won’t ask you to recount any stories or share details of the past trauma. Instead, they’ll simply ask you to pick a singular upsetting memory. If you struggle to choose a target, the therapist will help guide you to select one.
Once you’ve chosen a trauma, the therapist explains that the selected trauma will be the target. And once a target has been chosen, the therapist will begin to ask you questions about the said target. They may ask you to focus on the imagery and emotion associated with it. This information is then used as a baseline, which the therapist can utilize to gauge your progress and emotional changes.
This is the first EMDR therapy stage that includes guided eye movements. These movements are typically relatively slow and infrequent during the assessment stage. In many cases, the therapist will ask you to follow the direction of their finger while remaining still.
While initiating these movements, or directly afterward, the therapist may begin to address the images and emotions associated with the trigger, gently countering your irrational beliefs and transitioning into the sensitization phase.
Stage 4: Desensitization
The fourth stage of EMDR therapy is called desensitization. During this treatment phase, the therapist will continue to engage you in rapid eye movement exercises. These guided motions may become faster and more regular during this stage.
The primary focus of the sensitization phase is to ease you away from your painful emotions and negative thoughts. The therapist may offer positive affirmations and statements that conflict with your personal beliefs but are logically valid.
This stage often takes up the bulk of each session, as the therapist may guide your eye movements and begin installing new ideas before suddenly stopping their hands and asking you to close your eyes and focus on your breathing. This on-and-off technique is designed to help distance your negative emotions from the chosen target trauma.
Stage 5: Installation
After desensitizing you to the traumatic target experience, the therapist will start the installation phase. In some ways, this stage of EMDR therapy is an extension of the previous step, focusing on lessening your emotional burden. However, the installation phase takes things a little bit further than the desensitization stage.
Your therapist might repeat some of the positive affirmations and thoughts supplied during the previous stage, but they’ll also add some powerful messages to this series. In fact, the installation phase revolves around the repetitions of the most positive and practical thoughts and feelings.
This stage also incorporates guided movements designed to trigger rapid eye movement. The installation phase is the final stage in which these movements are used, though their frequency and speed may increase while the therapist installs new emotions and ideas. In many ways, installation is the heart of EMDR therapy.
And because this phase focuses on positivity and pulls away from any focus on negative emotions, it can also be one of the most enjoyable parts of EMDR therapy for both therapists and clients. Typically, the installation phase begins with regular eye movement exercises, increasing for a short time before decreasing to an infrequent application.
This process helps the therapist transition you into the next stage, the body scan. Overall, you may expect to spend most of your EMDR sessions completing the desensitization and installation phases. However, each session will end with a body scan and closure stage.
Stage 6: Body Scan
The body scan phase is all about self-awareness and physical control. During this stage of EMDR therapy, the therapist uses vocalized commands and suggestions to help you become more self-aware of your physical self.
During this stage, your therapist might ask you to notice areas of your body where your muscles are tense. They then might instruct you to release the tension from these areas, focusing on taking deep breaths while also clearing your mind of intrusive thoughts or worries.
They’ll then ask you to vocalize your current physical feelings and sensations. They may also take a moment to help you remember the strong effect our minds have on our physical selves. This stage often emphasizes recognizing that a calm and positive mind can lead to a relaxed, healthy body.
By having you focus on your breathing, heart rate, and physical sensations, the therapist can help you remove the focus on the trigger event. The body scan stage is crucial in helping you reach a sense of calm. It also functions as an excellent transition phase between installation and closure.
Stage 7: Closure
The penultimate stage of EMDR therapy is called closure. As you might imagine, this phase is devoted to closing out the session. To do this, therapists may help guide you back into a ‘normal’ mental and emotional state. This is typically achieved in tandem with the body scan, ensuring that physical self-awareness overrides emotional response.
The closure stage also typically features several self-coping techniques and mechanisms, such as deep breathing. The therapist may also ask you to stand up, move around the room, and stretch. The small act of changing your physicality is often enough to shift your mental focus and return to a base state.
Once the therapist is satisfied that you’ve reached your normal state of being, they may ask simple, unintrusive questions to help you feel more comfortable. After this, it’s time for the therapist to reevaluate you and determine the effectiveness of the EMDR therapy session.
Stage 7: Reevaluation
The final stage of EMDR therapy is reevaluation. During this phase, the therapist may ask you the same diagnostic questions from the assessment phase. This allows the therapist to gauge the effectiveness of the treatment.
Reevaluation also helps therapists create a tailored treatment plan to meet your unique needs. As with the other stages of EMDR therapy, it’s crucial to remain honest during this final phase.
Don’t feel pressured to give your therapist a positive evaluation or report, especially if you’re still struggling with negative emotions. It’s perfectly normal to require multiple rounds of EMDR therapy when attempting to overcome powerful trauma.
The most critical aspect of reevaluation is discovering the best path forward for both the therapist and the client. Transparency can help you achieve your therapy goals, so always be honest with yourself and your therapist when discussing further treatments, thoughts, and feelings.
EMDR therapy is a form of psychotherapy that may be beneficial for treating conditions like PTSD, anxiety, or depression. EMDR therapy is designed to ease clients into a healing state by addressing the emotions associated with trauma instead of the trauma itself.
Though medical professionals are still studying the precise mechanisms that allow EMDR therapy to work, there’s plenty of evidence to prove this treatment’s effectiveness. Many clients who undergo EMDR therapy report decreased feelings of anxiety, depression, and panic. Familiarizing yourself with the eight phases of EMDR therapy can help you know what to expect.