& REPROCESSING (EMDR)
What is EMDR? EMDR is a method of therapy that is highly effective at providing relief to people suffering from a variety of emotional problems. It is a proven technique for working with Post Traumatic Stress Disorder, self-limiting beliefs and hard to break patterns of behavior. EMDR was discovered in May 1987 by Francine Shapiro, Ph.D. While walking through a park one day, she noticed some disturbing, traumatic thoughts. Within a moment they disappeared. Having recovered from a traumatic medical event, Ms. Shapiro was used to the feelings, but not to their immediate disappearance. When she brought them back to mind, she found that they were no longer as upsetting, nor as valid. Ms. Shapiro then brought other disturbing thoughts to mind and observed that her eyes were moving rapidly and spontaneously in an upward diagonal motion. After six months of further observation and experimentation, the first protocol was created. It was first known as Eye Movement Desensitization (EMD).
EMD in time evolved into Eye Movement Desensitization and Reprocessing (EMDR) which is a method that produces high speed information processing. It can be integrated with any theoretical framework and practice paradigm. Initially EMDR was used in the treatment of Post-traumatic Stress Disorders (PTSD). Over the years as refinements were made in the protocol, its application has expanded into the treatment of past physical and sexual abuse, anxiety disorders, obsessive compulsive disorders, certain mood disorders, behavioral disorders, addiction and personality disorders.
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EMDR’s approach is based on the idea that our brains and nervous systems have ways of remembering and handling experiences that are both physical and mental. In other words, some parts of a memory are the physical images, sounds, and feelings stored in our brains and nervous systems, and along with those physical parts, the memories also include the thoughts and emotions connected with them, both what we felt and thought when the experience occurred and what we think and feel about it presently. The eye movements used in EMDR appear to unlock the nervous system which allows the brain to re-integrate positive information. The procedure includes reprocessing of negative, distorted self-thoughts associated with the trauma to positive, true self-beliefs.
Normally, as time goes by our brains and nervous systems are able to “process” these physical sensations, thoughts and feelings so that they become merely memories. The emotional pain and distress fade, so we are able to remember without feeling as strongly upset as we initially did when the event occurred and while it was still very fresh in our minds. This “processing” of experiences appears to have a physical element to it, often involving rapid eye movements such as have when we are dreaming. Many researchers believe that when we dream, we are processing experiences in the way described above.
It seems that painful memories sometimes get “stuck” and don’t finish being processed, so that they stay as fresh and painful as if they had just happened, sometimes for years or even decades. This may happen because the experience is so intense that it overwhelms the processing system’s ability to handle it. It leaves the individual who has had such an experience feeling that he or she can’t get over it. This is sometimes recognized by diagnostic terms as PTSD, and at other times may just be indicated by the client’s continuing to feel emotional pain that does not lessen with time.
EMDR uses guided eye movements or other rhythmic sensory activities such as listening to finger-snaps or feeling taps on a person’s hands or knees or ankles, combined with training in relaxation and stress management and other mental and emotional therapy, to “unstick” the processing mechanism and let the painful experiences shift from being fresh and painful to being memories that no longer cause intense upset. One way to describe it would be to say that on a mental and emotional level, it changes them from unhealed wounds to faded scars. The process is often described as similar to the peeling of an onion; the disturbing memories are peeled off in layers, one at a time. EMDR is a “turbo charged” method in that it rapidly accelerates the information processing system to move toward a more adaptive learning state.
How does EMDR work?
EMDR appears to be capable of turning on the brain’s REM sleep system, leading to the activation of the anterior cortex of the cingulate gyrus, thereby facilitating the accurate integration of memory, emotion and thought processes. Another underlying mechanism of EMDR processing appears to be the vestibular activation of the lateral cerebellum. The contribution of the cerebellum to cognitive and language functions has become apparent in the last several years. The activation of the lateral neo-cerebellum has been shown to lead to the activation of the left prefrontal cortex. It is in this region that semantic thinking, reason, logic and wisdom is generated (Uri Bergmann, LCSW, BCD).
The repetitive eye movements stimulate optical nerve clusters to loosen disturbing thoughts, which are frozen and stored, and process them to resolution. By providing side-to-side, bi-lateral stimulation to a person while discussing traumatic events or feelings of any kind in a specific therapeutic manner, EMDR is an excellent tool in allowing a person to heal. The key seems to be the alternating stimulation of the right and left sides of the brain.
How is EMDR done? The process of EMDR is a multistep method. The therapist begins by collecting life history information from the client and evaluating his or her personality, situation, and problems to see whether this therapeutic tool is a good idea for this individual. If it appears to be a suitable therapy, the therapist explains what is involved in detail, so that the client can decide whether or not to participate in EMDR. If EMDR looks appropriate and the client after learning about it wants to receive the therapy, the therapist prepares him or her by teaching relaxation and stress management methods and having the client practice them, as well as helping the client expand and reinforce his or her emotional support network and resources. Once the client is prepared, typically after devoting at least one entire therapy session and the time between that and the next session to the teaching and support reinforcement mentioned above, the therapist goes on to do a current assessment of the type and degree of distress the client is experiencing. This is based on the client’s descriptions of his or her thoughts and feelings and on detailed self-rating scales. These three steps (history, preparation and assessment) take place before the EMDR-specific treatment techniques are used.
The EMDR treatment begins with desensitization. This is the first time the therapist actually uses the eye movement or other nervous system stimulation techniques. This will trigger an “unsticking” and acceleration of the brain and nervous system’s physical processing of the painful experiences. This typically takes one or two sessions, sometimes more, and results in a significant lessening of distress. One experience or issue addressed at a time, and for each one, desensitization is followed by an installation phase in which a supportive, positive way of thinking and feeling about the experience is reinforced as a replacement for the old painful and negative thoughts and feelings. This takes place during the same session, immediately after completion of desensitization for each experience or issue. Installation is not done until desensitization is complete. If desensitization takes more than one session, the therapist works with the client at the end of each incomplete session to help the client notice the progress made so far, to make sure the client is not in a crisis, and to help them make the maximum use of their support system and resources in between sessions.
Two concluding phases following installation in the processing of each painful memory are the body scan, searching for lingering physical signs that the trauma is not fully processed (if such signs are found, the therapist returns to the desensitization phase and finishes the work on that issue); and the closure phase, in which the therapist continues the support and education process and gets the client’s agreement to use his or her support resources including the therapist as needed between sessions.
At the next session, the therapist conducts the final phase, re-evaluation. In this phase, the client and therapist check for signs that the trauma(s) processed at the previous session have not been fully dealt with. If there are signs that the client is still experiencing effects of unresolved trauma, they return to the desensitization phase to help the client complete processing of that experience or issue.
What EMDR is not: EMDR is not Hypnosis. It is not Neuro-Linguistic Programming, another therapy that combines physical, mental and emotional techniques. EMDR is not a blanket solution for all issues or all individuals, nor is it a simple technique to be used without careful preparation and follow-up.
What EMDR will do: For many individuals, EMDR will do the following:
- Give quick and substantial relief and peace of mind from emotional distress stemming form experiences they “can’t get over”; whether those are very recent or decades in the past. Typically this relief will generalize to the after effects of other, similar experiences.
- Help achieve new understanding and insights about the meanings of experiences, and connections between those experiences and patterns of thought and behavior in their lives.
- Help change patterns of substance abuse in which a person automatically turns to a chemical to achieve a desired feeling or state of mind, reorienting these impulses or cravings toward healthy substitutes.
- Sometimes EMDR helps individuals regain memories in greater detail or fill in gaps in their memories. It is important to note that there is no guarantee that any memory “recovered” in this way is true or accurate; often these memories seem to be more symbolic than literally true.
- Other times, EMDR leads to the forgetting of disturbing details in traumatic memories, although it would be a very rare occurrence for a memory disappearing completely.
- Increase the feeling of having control over one’s own destiny and actions that is sometimes lost as a result of experiencing emotional trauma.
What EMDR won’t do: EMDR will not typically so certain things:
- It will not cause painful memories to completely disappear.
- It will not guarantee that memories will return, or that they will be true and accurate if they do.
- It will not get rid of anxiety or distress that is appropriate and suitable to the present situation; for example, if a person is currently in danger, it will not make them feel safe.
- It will not make memories worse or more painful.
Cautions: The following cautions must be considered in deciding whether to participate in EMDR:
- While a specialized EMDR protocol for substance abuse is useful in treating such issues, individuals with active chemical dependencies, or who are in recovery but do not have strong recovery programs in place and support systems may be prone to relapse during or after EMDR therapy unless they receive proper preparation. Some report that they have no craving to use drugs or drink after treatment, but others have had strong cravings. If you have had a drinking or drug problem in the past but you are now clean and sober, before you receive EMDR therapy, you should make sure you have people available to help you through any cravings that might otherwise influence you to start drinking or using drugs again.
- In particular, individuals who have recently (within 6 months) become clean and sober after long-term use of stimulant drugs such as methamphetamine, other amphetamines, or cocaine, may have extreme and intense reactions that are too much for them to cope with, and may need to be hospitalized. If you have this kind of history, you need to talk to your therapist about this before deciding on EMDR.
- Individuals who are not physically able to tolerate high stress for short periods may not be good candidates for EMDR, as it can be physically very taxing.
- Therapists preparing to use EMDR should not only be trained in this method, they should be prepared by training and experience to help clients through the extreme emotions some individuals experience during EMDR. These may include rage, panic, intense grief, or re-experiencing disturbing physical sensations that were part of the original traumatic experiences. Only a trained therapist should use EMDR, for the safety of the individual receiving the therapy, and it should be done only in a setting where any help and support that might be needed is available.
- Therapists should also be generally qualified to work with the specific types of issues and clients they use EMDR to treat.
- EMDR should be used only in a situation where the client: -feels extremely safe and comfortable with the therapist;-will be totally honest about what he or she is experiencing during and after therapy; and-will follow through on promises to call on the therapist or other supportive people if he or she experiences emotional disturbances after a therapy session.
- EMDR can be used with individuals of any age. Standard procedures are modified for children.
- For clients who have limited coping skills and/or emotional support resources, it is vital to strengthen their abilities and strengths in these areas before proceeding with EMDR treatment. The therapist plays a key role in this strengthening and reinforcing period by teaching them ways to relax and cope with stress and by helping them increase their support network. This support may include family members, close friends, the therapist and organized support groups.
This fact sheet has included a lot of basic information about EMDR. After carefully reading this material, many individuals may have more questions and should feel free to ask their therapist about any other questions that they may have in order to help you in deciding whether or not you feel this treatment is for you. EMDR is a powerful and effective therapy method that has been very helpful to many individuals.
(Excerpts Taken from the Addiction Counselor’s Documentation Sourcebook by
James R. Finley and Brenda S. Lenz with the permission of the publisher John Wiley & Sons, Inc.)
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