EMDR: Treatment for Trauma and Beyond

As a psychotherapist treating clients with a variety of anxiety concerns in Chicago, having a well-rounded approach to treatment is key. Once thought of as a fairly specialized form of intervention, more and more people these days are looking into EMDR therapy. Although I’ve been practicing the method since I was trained in it in 2006, I’ve definitely been noticing an increase in clients requesting EMDR as a part of their therapy in the last couple years.

The EMDR method is getting more popular, and for good reason. I’ve personally witnessed great results using EMDR with clients as part of an integrated anxiety management plan. I’ve always gravitated towards EMDR because it targets the many parts of our experience that anxiety affects in an integrated way: our emotions, thought patterns, beliefs, memories, self-talk, relationships, self-image, and somatic/body sensations.

But what IS EMDR? EMDR stands for “Eye Movement Desensitization and Reprocessing.” Quite a mouthful! Francine Shapiro, the psychologist who developed the method, originally formed a clinical protocol that called for back-and-forth eye movements used in conjunction with therapist interventions. Nowadays however EMDR is a bit of a misnomer, because clinicians can use any form of bilateral stimulation and achieve the same results. In my practice for instance, I tend to use a device that plays tones back-and-forth through headphones, or paddles that are held in each hand and produce a bilateral pulsing sensation.

For more information on this treatment approach, the EMDR Institute’s website offers a summary of relevant research here as well as an explanation of the methodology here. As a therapist, I have been amazed and inspired by the healing that my clients have made when combining EMDR with other therapy methods in my practice.

EMDR: Effective Therapy for Anxiety
For folks who have heard of it, they may (mistakenly) think of EMDR as a type of therapy that’s most appropriate for trauma or PTSD. That may be because the research data available on the efficacy of this form of therapy appears to have been focused on its’ positive benefit for survivors of traumatic incidents. For example, a glance at the abstracts available on PubMed seem to focus on EMDR in the treatment of PTSD. But EMDR has continued to be applied by clinicians to treat a host of client problems, including a broad range of anxiety issues beyond traditional PTSD.

EMDR has a lot of applications. We now have a lot of research around its’ efficacy around traumatic events, but I’ve also used it to help clients with other forms of anxiety. Examples include helping clients desensitize long-standing phobias, reduce social anxiety, repair low self-esteem, and improve relationships. There have also been times when I’ve been working with a client in talk therapy, and my client has brought in a terrible incident that happened to them between therapy sessions to discuss. By applying EMDR immediately to help resolve the stress response from this recent memory, I’ve witnessed the method spontaneously resolve any negative impact the stressful experience might otherwise have had. My clients have reported to me that their sleep returned to normal and hypervigilance went away after our EMDR session. This may be thought of as a preventive application of EMDR.

As a clinician, and not a researcher, I wonder if part of the problem may lie in how we define trauma. When many of us think of the term “trauma,” we might think of single-incident episodes such as a traumatic injury or illness, a significant fire, discovering a betrayal from a trusted partner, sexual assault, memories of childhood abuse, a fight that erupts into domestic violence, a terrible accident, or witnessing someone close to us get hurt or die. And sometimes traumas do occur in our lives just like that: a single, profound, and deeply wounding experience that changes the landscape of our minds. Researchers may need to strictly define terms such as trauma or diagnoses such as PTSD when comparing EMDR to other available treatments such as medication or cognitive-behavioral therapy.

But sometimes seemingly smaller incidents from growing up well into adulthood can contribute to the development of anxiety. The mainstream media has been opening up a dialogue within our communities on the traumatic effect of schoolyard and cyber bullying. Some children and teens may even attempt suicide after these bullying experiences. Trauma can be defined as larger than single-episode events like a mass school shooting. Other, more invisible forms of trauma can include absent parenting, and the way in which neglect negatively impacts emotional development. Verbal and emotional abuse can likewise cause significant damage. Verbal abuse can continue well into adult life. Sometimes these comments can be so subtle that it can be difficult to identify- the unsupportive spouse, competitive co-worker or boss, chronically disapproving parent, or passive-aggressive “best friend.” The cumulative effect of these mini verbal assaults build up gradually over time. These experiences tear down our sense of self.

Sometimes a seemingly benign event may contribute to the formation of phobias, or avoidance of certain activities or people. Profound losses- everything from a miscarriage to a nasty break-up to the death of a pet- can become unbearably painful parts of our personal narrative. These moments may not be thought of as traumatic incidents in the traditional sense, but can play a significant role in the formation of all kinds of anxiety.

When we go through extreme difficulty, several things can begin to take shape. Often these experiences are characterized by a heightened “fight-or-flight” response in our brains. When we go into “fight-or-flight,” our brains are flooded with neurochemicals that can lead to memories that pack more of a punch than ordinary memories. Examples of this can be distinct picture or sound, such as a particularly nasty piece of criticism or remembering getting bad news by phone. These memories can get played over and over again in one’s mind. Sometimes our belief systems take a negative shape, such as “I’m not going to be safe is this situation- it reminds me of the past,” or “I must deserve it if this bad thing happened to me,” etc. Our self-talk or belief systems become affected. Painful memories also get attached to the physiological cues associated with the original trauma or loss.

EMDR works because the bi-lateral stimulation, used in combination with a trained therapist’s interventions, helps us connect the dots. Difficult memories also often elicit a hyper-arousal, meaning that the memory is attached to the bodily sensations of a quickened heartrate, stomach upset, and tense muscles. Just thinking about our past event can upset us! Often re-playing these memories, which is perfectly natural and common, will unintentionally serve to strengthen the traumatized response. It’s like you’re re-experiencing the your past, without being offered tools to cope more effectively with the memory. In addition, our memories get stored in different locations in our brain. The visual memory, thoughts, the meaning we assign to things, bodily sensations, and emotions all get stored in different parts. When a memory attaches to certain destructive thought patterns and difficult emotions, it’s like a piece of undigested food. It remains “stuck.” Have you ever thought of an especially embarrassing memory, and you can feel your face flush? Maybe you’re too embarrassed to even talk about it, even if it happened in 3rd grade! It’s like that. Processing an old memory alongside bilateral stimulation helps us build new connections and a better integrated sense of our self. We can finally bring closure to help us find peace around our past.

EMDR in Action
EMDR therapy is divided into different “phases” of treatment, including assessment, stabilization, active EMDR processing, and resolution/closure. Even if you approach a new therapist knowing that you would like to try EMDR as part of your healing journey, you should expect that the first phase of treatment will involve having your clinician get to know you. This assessment will help you and your therapist develop a focused plan and problem list to apply the method to. Sometimes a combination of EMDR and talk therapy is recommended.

Please keep in mind: EMDR may not always be the best fit for you. Assessment can take several sessions at minimum. A responsible clinician will want to understand not just what you want help resolving, but how you currently cope with stress. You won’t be starting the active phase of EMDR from the first session in your new therapist’s office. Sometimes doing a period of talk therapy or applying CBT methods might help you improve your self-care and allow you to stabilize your daily coping strategies first, before digging into old or traumatizing memories. A good anxiety therapist will help you evaluate how therapy might help. Effective therapy improves the quality of your relationships, your sleep patterns, self-medicating behaviors, concentration, productivity, frequency of panic attacks, etc. It’s important to be gentle with yourself while you heal. Your anxiety treatment plan should be customized to you.

Once you are ready, your therapist will move you into the “active” phase of EMDR therapy. During active EMDR processing your therapist will help you identify a target, which includes a visceral (often visual) memory associated with a negative belief system. During bi-lateral stimulation, your therapist will help you process the limiting self-concept, pictorial/auditory memories, and body sensations (and related emotional states) associated with the issue that you would like help with. Desensitization can take place over multiple sessions. One of the things that I like best about the method is its’ ability to help clients not only tell the story of their anxiety, but make profound connections between these stories and all the other parts of our experience. Bodily sensations, self-image, negative beliefs and memories all become part of what is targeted and desensitized.

Clients can sometimes be surprised that the “charge” connected with once-unpleasant memory fades after EMDR. Although you should still be able to remember what has happened to you, you may no longer be as upset by it. This may take some getting used to, if you have been used to seeing yourself or others in a fixed way. Don’t worry, this is a sign that you are well on your way to healing!

The EMDR method helps guide you to a new closure around past losses and negative beliefs first through desensitization, and second through reprocessing. Once your therapist identifies that full desensitization has been completed, you and your therapist will move to the re-processing phase. This phase will help you define and instill a more positive meaning around difficult life experiences. This is a growth mindset in action. Examples might sound like “I’m a strong person who makes good decisions,” or “I can choose healthy relationships that benefit my life.” This re-processing phase of active treatment encourages you to replace old, destructive belief systems with new healthy ones. EMDR often reinforces developing better coping strategies moving forward and provides the language for improved self-talk. In this way, EMDR helps you not only resolve issues with your past, but helps move you to a better future.

I’m Interested in EMDR: Where Do I Start?
If you are interested in finding an EMDR clinician near you, there are a lot of good places to start. The EMDR Institute and the EMDR International Association (EMDRIA) keep an online database of EMDR-trained clinicians. Many therapist search engines also now list EMDR as a category of training you can search for specifically. Wishing you the very best in your journey of healing!