EMDR: A Path to Healing using Eye Movement Desensitization and Reprocessing

Welcome to my blog! As a passionate psychiatrist trained in EMDR and IFS, I understand the challenges of trauma and seeking effective therapy. This post aims to guide you towards healing and understanding the concepts behind EMDR.

🧠 TL;DR

Download these 25 core concepts of EMDR in a handy pdf. Click here!

🧠 EMDR core concepts

Eye Movement Desensitization and Reprocessing (EMDR):

An integrative psychotherapeutic approach guided by the Adaptive Information Processing (AIP) model. It is an eight-phase, three-pronged process.

Adaptive Information Processing (AIP) Model:

The theoretical framework and principles underlying EMDR therapy, explaining the basis of pathology and personality development. It suggests that disturbing memories are unprocessed and EMDR facilitates their adaptive resolution.

Bilateral Stimulation (BLS):

Stimuli such as directed eye movements, tones, or tactile sensations used to activate the client’s information processing system during EMDR.

The Eight Phases of EMDR Therapy:

The standard protocol involving history-taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation.

Three-Pronged Approach:

The EMDR therapy strategy that targets past events, present triggers, and future templates to achieve comprehensive adaptive resolution.

Target Memory:

The agreed-upon incident the client focuses on during the reprocessing phases of EMDR therapy.

Touchstone Memory:

A past memory that lays the foundation for a client’s current presenting issue or problem.

Present Triggers:

Current stimuli that evoke distress and are related to past unresolved experiences.

Future Template:

Imagined scenarios of desired responses in future situations related to the targeted issues.

Assessment Phase (Phase 3):

The phase in which the components of the target memory (image, negative cognition, positive cognition, emotion, body sensation, Validity of Cognition [VoC], and Subjective Units of Disturbance [SUD]) are identified and measured.

Negative Cognition (NC):

A negative belief associated with the target memory that the client currently holds about themselves.

Positive Cognition (PC):

A positive belief that the client would prefer to have about themselves in relation to the target memory.

Validity of Cognition (VoC) Scale:

A scale used to measure the degree to which the client believes the positive cognition.

Subjective Units of Disturbance (SUD) Scale:

A scale used to measure the client’s current level of emotional distress associated with the target memory.

Desensitization Phase (Phase 4):

The phase where the client processes the target memory using BLS while focusing on the different components of the memory. The goal is to reduce the disturbance associated with the memory.

Installation Phase (Phase 5):

The phase focused on strengthening and integrating the positive cognition with the reprocessed memory using BLS.

Body Scan (Phase 6):

The phase where the client focuses on any remaining physical sensations in their body related to the target memory while engaging in BLS.

Closure Phase (Phase 7):

The phase where the therapist ensures the client is stable at the end of the session, regardless of the level of processing achieved. This may involve using grounding techniques or the safe/calm place exercise.

Reevaluation Phase (Phase 8):

The phase at the beginning of subsequent sessions where the therapist assesses the client's progress and determines if further processing of the initial target or other related memories is needed.

Safe/Calm Place:

A resource development exercise used in the Preparation Phase to provide the client with a sense of safety and calm that can be accessed during or between sessions.

Resource Development and Installation (RDI):

Strategies used in the Preparation Phase to enhance a client’s ability to access positive feelings, cognitions, and behaviors, especially for clients with complex trauma.

Cognitive Interweaves:

Therapist interventions used during the Desensitization Phase to address blocked processing or maladaptive beliefs that emerge.

Abreaction:

An intense emotional release that may occur during the Desensitization Phase.

Blocked Processing:

When the client’s reprocessing of a target memory stalls or no new associations emerge.

Memory Network:

The way the brain stores related memories, thoughts, images, emotions, and sensations that are linked to one another. The goal of EMDR is to facilitate adaptive resolution within these networks.

🧠 What is EMDR. Theory and practice beyond the core concepts

EMDR therapy, short for Eye Movement Desensitization and Reprocessing, is a well-researched and evidence-based psychotherapy approach specifically designed to alleviate the distress associated with traumatic memories and other adverse life experiences. As an integrative psychotherapeutic modality, EMDR therapy goes beyond simple symptom management; it aims to facilitate the brain's natural healing processes to reprocess disturbing experiences and reduce their lingering emotional impact. Rooted in the Adaptive Information Processing (AIP) model, EMDR therapy posits that psychological difficulties arise when traumatic or stressful experiences are not fully processed by the brain and become "stuck" in maladaptive neural networks. These unprocessed memories can continue to trigger negative emotions, beliefs, and physical sensations in the present, impacting daily functioning and overall well-being. EMDR therapy provides a structured and safe way to access and reprocess these memories, leading to adaptive resolution and a reduction in distress. Its effectiveness in treating PTSD, anxiety, phobias, and other stress-related conditions has been supported by numerous research studies and recognized by leading international health organizations. The core of EMDR therapy lies in its eight phases and its three-pronged approach, working to address the past, present, and future impact of distressing experiences.

🧠 The Adaptive Information Processing (AIP) Model in EMDR as developed by Francine Shapiro

The Adaptive Information Processing (AIP) model serves as the theoretical backbone of EMDR therapy, providing a comprehensive framework for understanding how psychological dysfunction develops and how EMDR facilitates therapeutic change. According to the AIP model, the human brain has an innate capacity to process information in a way that leads towards psychological health and well-being. When we experience disturbing or traumatic events, this natural processing system can become overwhelmed, causing the memories of these events to be stored in a state that is isolated and unprocessed. These unprocessed memories retain the original sensory information, emotions, and cognitions associated with the event, making them easily triggered by similar experiences in the present, leading to the symptoms of trauma and other psychological distress. The AIP model suggests that psychopathology arises not from the traumatic events themselves, but from the brain's failure to adequately process and integrate these experiences into the broader network of adaptive memories.

EMDR therapy facilitates the accessing of the brain's natural adaptive information processing system, allowing for the reprocessing and integration of these unprocessed memories. The use of bilateral stimulation (BLS), such as eye movements, is believed to play a crucial role in facilitating this process. This differentiates using EMDR therapy from other forms of trauma treatment like exposure therapy and cognitive behavioral therapy. While the exact neurobiological mechanisms are still being explored, the AIP model proposes that BLS helps to enhance communication between the brain hemispheres and activate neural pathways involved in memory consolidation and retrieval. This enhanced processing allows the traumatic memories to become linked with more adaptive information, including positive beliefs, healthier emotions, and a more integrated understanding of the event. As a result of this reprocessing, the traumatic memories lose their intense emotional charge and their power to trigger distress in the present. The individual can then access the memory without the overwhelming emotional reaction, gaining new perspectives and a sense of resolution. A thorough understanding of the AIP model is essential for clinicians utilizing EMDR therapy, as it guides treatment planning and the application of the eight phases of the therapy to facilitate healing from trauma.

🧠 The Crucial Role of Bilateral Stimulation (BLS) in EMDR

Bilateral stimulation (BLS) is a fundamental and distinctive element of EMDR therapy, involving the rhythmic and alternating activation of the left and right hemispheres of the brain. The most common form of BLS used in EMDR is directed eye movements, where the client follows the therapist's finger or a light moving from side to side across their visual field. However, BLS can also be delivered through tactile stimulation, such as alternating taps on the hands or knees, or through auditory stimulation, such as alternating tones heard through headphones. The primary purpose of bilateral stimulation during the desensitization phase (Phase 4) of EMDR therapy is to facilitate the client's information processing system as they focus on the target memory.

While the precise neurobiological mechanisms by which BLS enhances reprocessing are still under investigation, several theories have been proposed. One prominent hypothesis suggests that bilateral stimulation promotes increased communication and integration between the left and right brain hemispheres. This enhanced interhemispheric interaction may facilitate the activation of neural pathways involved in memory processing and consolidation, allowing for the adaptive integration of traumatic memories that have become maladaptively stored. Another theory posits that BLS may help to create a state of "dual awareness," where the client is simultaneously attending to the traumatic memory and to the present, safe environment. This dual focus may help to diminish the overwhelming emotional intensity typically associated with the traumatic memory, making it more accessible for reprocessing. Furthermore, research has explored potential parallels between the effects of bilateral stimulation in EMDR and the neurological activity observed during REM (rapid eye movement) sleep, a stage known for its role in memory consolidation and emotional regulation. It is theorized that BLS might activate similar neural mechanisms, thereby facilitating the brain's natural capacity to process and integrate distressing experiences. While eye movements remain the most extensively studied and widely used form of BLS in EMDR therapy, research supports the efficacy of other forms of bilateral stimulation as well. The choice of BLS method can be tailored to the client's preferences and comfort level. It is crucial to remember that bilateral stimulation is just one component of the comprehensive eight-phase EMDR therapy protocol. The synergistic application of all phases, guided by the AIP model, contributes to the robust effectiveness of EMDR in promoting healing from trauma and reducing psychological distress.

🧠 Navigating the Eight Phases of EMDR Therapy

EMDR therapy follows a structured and standardized protocol consisting of eight distinct phases. Adherence to all eight phases is essential for the proper implementation of EMDR therapy and for maximizing its potential benefits in treating PTSD and other conditions related to traumatic memories. These phases provide a clear framework for the therapeutic process, ensuring that traumatic experiences are addressed safely and effectively, leading towards adaptive resolution and lasting relief from distress.

The first phase of EMDR therapy is Client History and Treatment Planning. In this initial stage, the therapist gathers a comprehensive history of the client's life experiences, including any significant traumatic events, current challenges, and treatment goals. This information is crucial for identifying potential target memories for EMDR processing and for developing an individualized treatment plan. The therapist also assesses the client's suitability for EMDR, their coping skills, and the strength of their support systems. Building a strong therapeutic relationship and obtaining informed consent are also key objectives of this phase.

Phase two, known as Preparation, focuses on preparing the client for the EMDR process. The therapist explains the theory behind EMDR therapy, what the process involves, and what the client can expect during reprocessing. This phase also involves teaching the client various self-soothing techniques and establishing a "safe place" or "calm place" that they can access during or between sessions to manage any potential emotional distress. For clients with more complex trauma histories, Resource Development and Installation (RDI) techniques may be used to enhance their access to positive feelings and cognitions.

The third phase is the Assessment Phase, where the therapist helps the client to identify and assess the specific components of the target memory that will be the focus of reprocessing. This includes identifying a vivid visual image representing the worst part of the event, the Negative Cognition (NC) associated with the memory, the desired Positive Cognition (PC), the primary emotion felt, the location of any related body sensation, the current level of distress as measured by the Subjective Units of Disturbance (SUD) scale, and the current belief in the positive cognition as measured by the Validity of Cognition (VoC) scale.

Phase four, the Desensitization Phase, is where the client focuses on the target memory and its components while simultaneously engaging in bilateral stimulation (BLS), typically eye movements. Sets of BLS are administered, followed by brief breaks where the client reports whatever comes to mind. This process continues until the SUD level associated with the target memory is significantly reduced.

Phase five, the Installation Phase, focuses on strengthening and integrating the positive cognition with the reprocessed memory using BLS. The goal is to increase the client's belief in the positive cognition, as reflected by a higher VoC rating.

Phase six is the Body Scan, where the client focuses on any remaining physical sensations in their body related to the target memory while engaging in BLS. Any residual tension or discomfort is addressed through further processing.

Phase seven, Closure, occurs at the end of each EMDR therapy session. The therapist ensures the client is stable and grounded before they leave, regardless of the level of processing achieved.

Finally, phase eight is Reevaluation, which takes place at the beginning of subsequent therapy sessions. The therapist assesses the client's progress, reviews the processing of previous targets, and determines if further processing is needed. The systematic adherence to these eight phases ensures that EMDR therapy is conducted in a safe and effective manner, promoting healing from trauma and reducing psychological distress.

🧠 The Three-Pronged Approach: Targeting Past, Present, and Future

A cornerstone of EMDR therapy is its three-pronged approach, which provides a comprehensive strategy for addressing the full impact of distressing experiences across the client's lifespan. This approach involves systematically targeting past events, present triggers, and future templates to facilitate adaptive resolution and promote lasting well-being.

The first prong focuses on identifying and reprocessing past events that are considered to be the foundational roots of the client's current difficulties. These touchstone memories may be early life experiences, significant traumatic events, or any past incidents that have contributed to the development of negative beliefs, emotional patterns, and maladaptive coping mechanisms. By reprocessing these past traumas, EMDR therapy aims to address the underlying causes of present distress and facilitate a shift in core beliefs.

The second prong targets present triggers, which are current situations, stimuli, or internal experiences that evoke emotional distress and are linked to the unprocessed past memories. These triggers can manifest as anxiety, flashbacks, or other distressing symptoms in response to everyday occurrences that resemble aspects of the traumatic past. By identifying and reprocessing the underlying traumatic memories associated with these present triggers, EMDR therapy works to reduce their power to elicit distress in the client's daily life, promoting a greater sense of safety and control in the present.

The third prong focuses on developing future templates, which involves helping the client to envision and prepare for future situations that might be related to the targeted issues. This may involve mentally rehearsing desired responses, installing positive expectations, and building a sense of confidence and self-efficacy in navigating these future scenarios. By proactively addressing potential future challenges, the three-pronged approach of EMDR therapy aims to generalize the therapeutic gains and equip the client with the resources to maintain well-being and resilience over time. While the standard protocol often suggests processing in a past-present-future order, flexibility is key, and the order can be adjusted based on the client's specific needs and presentation. The three-pronged approach underscores the comprehensive nature of EMDR therapy in addressing the multifaceted impact of distressing experiences.

🧠 Understanding Target Memory and Touchstone Memory in EMDR

In the landscape of EMDR therapy, the concepts of target memory and touchstone memory are fundamental to the process of reprocessing traumatic memories and facilitating healing. The target memory refers to the specific, agreed-upon disturbing incident or experience that the client focuses on during a particular EMDR reprocessing session. This target memory is carefully identified and assessed during Phase 3: Assessment of the eight phases of EMDR therapy. The assessment involves identifying key elements of the memory, including a vivid visual image, the associated Negative Cognition (NC), the desired Positive Cognition (PC), the felt emotion, any related body sensation, the current level of distress (SUD), and the belief in the positive cognition (VoC). The selection of the target memory is guided by the client's presenting issues and the three-pronged approach of addressing past, present, and future aspects of their difficulties. The reprocessing of the target memory in Phase 4: Desensitization involves the client focusing on these identified components while engaging in bilateral stimulation (BLS).

The touchstone memory, on the other hand, refers to a significant past memory that is believed to be a foundational experience underlying the client's current presenting issues or problems. It is often an earlier event that has contributed to the development of core negative beliefs about oneself and the world. Identifying the touchstone memory can be crucial because reprocessing this foundational experience can lead to more comprehensive and lasting therapeutic change. The touchstone memory may not be the most obviously traumatic event but rather a subtle or early experience that has set the stage for later difficulties. For example, early experiences of neglect or criticism can become touchstone memories that contribute to feelings of worthlessness in adulthood. The process of identifying the touchstone memory often involves careful history-taking during the initial phases of EMDR therapy, looking for patterns and connections between past experiences and present symptoms. Once identified, the touchstone memory can then become a primary target memory for EMDR reprocessing, allowing for the resolution of core issues that impact a range of related experiences. By strategically selecting both specific traumatic events as target memories and the underlying touchstone memories, EMDR therapy aims to facilitate deep and transformative healing from trauma and promote enduring psychological well-being.

🧠 Addressing Present Triggers and Envisioning Future Templates in EMDR

The three-pronged approach of EMDR therapy extends beyond the reprocessing of past events to actively address the impact of present triggers and to prepare individuals for future challenges through the development of future templates. This comprehensive strategy ensures a more holistic and lasting resolution of the client's difficulties.

Present triggers are current stimuli, situations, or internal experiences that evoke distress and are linked to unprocessed traumatic memories. These triggers can be external, such as specific sounds, sights, smells, or places that were associated with the traumatic event, or internal, such as particular thoughts, emotions, or body sensations that trigger a sense of reliving the trauma. When a present trigger is encountered, it can activate the traumatic memory network, leading to a resurgence of the original distress, negative cognitions, and physical sensations. In EMDR therapy, identifying and understanding these present triggers is an important part of the treatment process. While the primary focus of EMDR is often on reprocessing the underlying traumatic memories that contribute to the reactivity to these triggers, therapists may also address the triggered responses directly through imaginal exposure and bilateral stimulation (BLS). As the foundational traumatic memories are effectively reprocessed, the intensity and frequency of the client's reactions to present triggers typically diminish significantly.

Future templates represent a proactive aspect of EMDR therapy, focusing on preparing the client for potential future situations that might be related to the targeted issues. This involves guiding the client to imagine themselves effectively navigating these situations, envisioning desired responses, and installing positive expectations for the future. During the development of future templates, bilateral stimulation (BLS) is often used to strengthen these positive mental rehearsals and enhance the client's sense of confidence and self-efficacy. By mentally rehearsing successful coping strategies and desired behaviors in anticipated challenging situations, the client can reduce anticipatory anxiety and feel better equipped to handle future events. The incorporation of future templates into EMDR therapy helps to generalize the therapeutic gains beyond the reprocessing of past traumas and the reduction of reactivity to present triggers, promoting a sense of empowerment and hope for sustained well-being.

🧠 The Assessment Phase (Phase 3) of EMDR Therapy in Detail

The Assessment Phase, or Phase 3, of EMDR therapy is a pivotal stage that lays the groundwork for effective reprocessing of traumatic memories. During this phase, the therapist collaborates with the client to clearly identify and thoroughly assess the key components of the specific target memory that will be the focus of the subsequent Desensitization Phase (Phase 4). This structured assessment ensures that the traumatic experience is well-defined and that the client's subjective experience of the memory is comprehensively understood before reprocessing begins. Especially for clinicians new to EMDR, adhering closely to Dr. Shapiro's established protocol during the Assessment Phase is highly recommended, as the specific wording and sequence have been carefully developed and validated through extensive clinical experience and research.

The essential components of the target memory that are meticulously identified and measured during the Assessment Phase include:

Image: The client is asked to bring to mind a vivid visual image that best represents the worst or most disturbing aspect of the target memory.
Negative Cognition (NC): The client identifies a negative belief or statement about themselves that they currently associate with the target memory and believe to be true (e.g., "I am worthless," "I am unsafe," "It was my fault").
Positive Cognition (PC): The client articulates a positive belief or statement about themselves that they would prefer to believe in relation to the target memory (e.g., "I am worthy," "I am safe now," "I did the best I could").
Emotion: The primary feeling or feelings that the client experiences most strongly when focusing on the target memory and the negative cognition are identified (e.g., fear, sadness, anger, shame).
Body Sensation: The client is asked to pinpoint where in their body they feel the identified emotion most intensely when thinking about the target memory.
Subjective Units of Disturbance (SUD) Scale: The client rates their current level of emotional distress associated with the target memory on a scale typically ranging from 0 (no disturbance) to 10 (highest disturbance).
Validity of Cognition (VoC) Scale: The client rates the degree to which they currently believe the positive cognition on a scale typically ranging from 1 (completely untrue) to 7 (completely true).

The information gathered during the Assessment Phase serves as a crucial baseline against which the progress and effectiveness of the subsequent EMDR reprocessing can be measured. The SUD rating provides an initial measure of the emotional intensity, while the VoC rating indicates the initial level of belief in the desired positive belief. Following the Desensitization (Phase 4) and Installation (Phase 5) phases, these ratings are reassessed to evaluate the extent to which the emotional disturbance has decreased and the positive belief has strengthened. A thorough and accurate Assessment Phase is therefore fundamental for guiding the EMDR therapy process and facilitating the adaptive resolution of traumatic memories and associated distress.

🧠 Understanding Negative Cognition (NC) and Positive Cognition (PC) in EMDR

Within the Assessment Phase (Phase 3) of EMDR therapy, the identification of the Negative Cognition (NC) and the Positive Cognition (PC) associated with the target memory is a critical step that sets the stage for the subsequent reprocessing work. These cognitions represent the client's thoughts and beliefs related to the traumatic experience and play a significant role in their current emotional state and self-perception.

The Negative Cognition (NC) is a negative statement or belief about oneself that the client currently associates with the target memory and holds to be true. This negative belief often encapsulates the core feelings of worthlessness, helplessness, or danger that were experienced during the traumatic event and have persisted since. For instance, if the target memory involves an experience of being betrayed, the negative cognition might be "I am not trustworthy" or "People will always hurt me". Identifying the NC provides a crucial cognitive focal point for the EMDR reprocessing. It helps to articulate the maladaptive belief that the traumatic experience has ingrained in the client's understanding of themselves.

Conversely, the Positive Cognition (PC) is a positive statement or belief about oneself that the client would prefer to believe in relation to the target memory. The PC is collaboratively chosen by the therapist and client and should represent a more adaptive, realistic, and self-affirming belief that directly counters the negative cognition. Continuing the previous example, a potential positive cognition could be "I can choose who I trust" or "I am capable of building healthy relationships". The positive cognition serves as the desired outcome to be strengthened and integrated with the reprocessed memory during the Installation Phase (Phase 5) of EMDR therapy. Through bilateral stimulation (BLS), the aim is to enhance the client's belief in the positive cognition, gradually replacing the hold of the negative cognition and fostering a more positive and resilient self-perception. The careful identification of both the negative cognition and the desired positive cognition is a vital step in guiding the EMDR therapy process towards healing and adaptive resolution.

🧠 Utilizing the Validity of Cognition (VoC) and Subjective Units of Disturbance (SUD) Scales

The Validity of Cognition (VoC) scale and the Subjective Units of Disturbance (SUD) scale are integral assessment tools employed in EMDR therapy to quantify the client's subjective experience in relation to the target memory. These scales provide valuable data points that allow both the therapist and the client to monitor progress and gauge the effectiveness of the reprocessing throughout the different phases of EMDR therapy.

The Subjective Units of Disturbance (SUD) scale is used to measure the client's current level of emotional distress associated with the target memory. Typically, the client is asked to rate their level of disturbance on a scale ranging from 0 to 10, where 0 signifies no disturbance or a neutral feeling, and 10 represents the highest level of distress they can imagine. An initial SUD rating is obtained during the Assessment Phase (Phase 3) after the target memory, negative cognition, associated emotion, and body sensation have been identified. Throughout the Desensitization Phase (Phase 4), the therapist will periodically check in with the client, asking for their current SUD rating after each set of bilateral stimulation (BLS). A successful outcome of the desensitization phase is generally indicated by a significant and sustained reduction in the SUD level, ideally reaching 0 or a very low number. The SUD scale provides a direct and immediate measure of the emotional intensity linked to the traumatic memory, helping to guide the reprocessing and determine when sufficient desensitization has occurred for that particular target.

The Validity of Cognition (VoC) scale is used to measure the degree to which the client currently believes the Positive Cognition (PC) that was identified in the Assessment Phase. The VoC scale typically ranges from 1 to 7, where 1 signifies that the client feels the positive cognition is completely untrue, and 7 signifies that they feel it is completely true. An initial VoC rating is also taken during the Assessment Phase. The Installation Phase (Phase 5) of EMDR therapy specifically focuses on strengthening the client's belief in the positive cognition through sets of BLS while the client concentrates on the target memory and the PC. Following the installation phase, the VoC rating is reassessed. A desired outcome is for the VoC rating to increase to a 6 or 7, indicating a strong and internalized belief in the positive and adaptive cognition related to the reprocessed memory. The VoC scale helps to ensure that the reprocessing not only reduces emotional distress but also facilitates the integration of a more positive and realistic belief system concerning the traumatic experience. Together, the SUD and VoC scales provide essential feedback throughout EMDR therapy, guiding the reprocessing and helping to determine when the therapeutic goals for a specific target memory have been effectively achieved.

🧠 The Process of Desensitization (Phase 4) in EMDR Therapy

The Desensitization Phase, or Phase 4, stands as the core of EMDR therapy, representing the active stage where the reprocessing of the target memory takes place through the application of bilateral stimulation (BLS). Following the thorough assessment of the target memory and the careful preparation of the client in the preceding phases, the therapist initiates sets of BLS, most commonly eye movements, while the client simultaneously focuses on the image, negative cognition, emotion, and body sensation associated with the traumatic memory.

A standard set of BLS typically involves a defined number of back-and-forth eye movements or a specific duration of tactile or auditory bilateral stimulation. Immediately after each set of BLS, the therapist pauses briefly and asks the client an open-ended question such as, "What do you notice now?" or "What's coming up for you?". The client is instructed to simply observe and report whatever thoughts, feelings, images, memories, or bodily sensations spontaneously arise, without attempting to censor, analyze, or direct the flow of their experience. This non-directive approach allows the client's brain to access and process the traumatic memory network in its own natural way, following its inherent associative pathways. The therapist's primary role during the desensitization phase is to facilitate this process by administering the BLS and gently guiding the client back to the target memory if their attention significantly deviates. It is paramount for the therapist to trust the client's innate capacity for healing and to "stay out of the client's way" during the reprocessing, allowing their internal system to lead the way.

As the desensitization unfolds through repeated sets of BLS and brief reports, the client typically experiences a gradual shift in their perception and emotional intensity related to the target memory. The level of emotional distress, as measured by the SUD scale, usually begins to decrease, and the grip of the negative cognition may start to loosen. New insights, associations, and perspectives connected to the traumatic event may emerge as the memory becomes linked with more adaptive information. The bilateral stimulation is continued in sets until the SUD rating associated with the target memory is significantly reduced, ideally reaching a level of 0 or 1, indicating that the memory no longer elicits significant emotional distress. The number of BLS sets required for desensitization can vary considerably depending on the complexity of the trauma and the individual client's unique processing rate. Throughout the desensitization phase, the therapist must remain attentive to any signs of blocked processing, where the reprocessing seems to stall, or the emergence of intense emotional release, known as abreaction. In cases of blocked processing, the therapist may employ strategies such as cognitive interweaves to help facilitate continued processing. When a client experiences an abreaction, the therapist will utilize grounding and containment techniques to help them manage the intensity of their emotions and regain a sense of stability. The overarching goal of the desensitization phase is to effectively reduce the disturbance associated with the traumatic memory to a point where it no longer causes significant emotional distress in the client's life.

🧠 Strengthening Adaptive Beliefs in the Installation Phase (Phase 5)

Following the successful reduction of emotional distress associated with the target memory in the Desensitization Phase (Phase 4), the Installation Phase, or Phase 5, of EMDR therapy focuses on actively strengthening and integrating the identified Positive Cognition (PC) with the reprocessed memory. The PC, which was collaboratively chosen by the therapist and client during the Assessment Phase (Phase 3), represents the more adaptive, realistic, and self-affirming belief that the client desires to internalize in relation to the traumatic event.

During the Installation Phase, the client is instructed to consciously focus on the target memory (which should now feel less disturbing) and the chosen positive cognition simultaneously while the therapist administers sets of bilateral stimulation (BLS), typically eye movements. The purpose of the BLS during this phase is to enhance the neural connections between the reprocessed memory and the positive belief, facilitating a deeper integration of the PC and making it feel more intrinsically true and valid for the client. After each set of BLS, the therapist will typically check in with the client by asking, "How true does that feel now?" referring directly to the positive cognition. The client's response is evaluated using the Validity of Cognition (VoC) scale, which ranges from 1 (completely untrue) to 7 (completely true). The installation phase continues with repeated sets of BLS until the client reports a significant and consistent increase in their VoC rating, ideally reaching a level of 6 or 7, indicating a strong and deeply felt belief in the positive cognition in relation to the reprocessed memory.

The Installation Phase is critical for ensuring that the EMDR therapy not only reduces the negative emotional impact of the traumatic memory but also actively replaces it with a more adaptive and empowering belief system. This integration of the positive cognition helps to foster a greater sense of resolution, self-efficacy, and a more positive and hopeful outlook regarding the traumatic experience. It is important for the therapist to ensure that the positive cognition feels genuinely authentic and integrated for the client, rather than just being an intellectual understanding or a forced positive thought. The successful installation of the positive cognition is a key indicator that the EMDR therapy is progressing towards a stable and adaptive resolution of the traumatic memory and its lasting effects.

🧠 Checking for Residual Distress with the Body Scan (Phase 6)

Following the Installation Phase (Phase 5), where the positive cognition has been strengthened and integrated with the reprocessed memory, the Body Scan, or Phase 6, of EMDR therapy aims to identify and address any remaining physical sensations in the body that may still be associated with the target memory. The underlying principle of the Body Scan is that traumatic experiences can often leave residual physical tension, discomfort, or other somatic imprints in the body, even after the emotional distress and negative cognitions related to the memory have been significantly reduced. These lingering physical sensations can sometimes indicate that the reprocessing of the traumatic memory is not yet fully complete.

During the Body Scan, the therapist instructs the client to bring the target memory and the now strengthened positive cognition to mind and then to mentally scan their body from head to toe, paying close attention to any remaining sensations, such as tension, tightness, heaviness, or discomfort. If the client identifies any such physical sensations, the therapist will then administer brief sets of bilateral stimulation (BLS), typically eye movements, while the client focuses their attention on the identified bodily sensation. The BLS is continued until the physical sensation dissipates, reduces in intensity, or shifts in location. The therapist may ask the client to describe the sensation and to track any changes they notice in it during the sets of BLS.

The Body Scan is an important step in ensuring a comprehensive and holistic reprocessing of the traumatic memory. By addressing any remaining somatic manifestations of the trauma, the Body Scan can contribute to a greater sense of overall integration and well-being for the client. It acknowledges the strong mind-body connection in the experience and healing of trauma. If significant or persistent physical distress is identified during the Body Scan, it may indicate that further reprocessing of related aspects of the traumatic memory or other associated experiences is needed in subsequent therapy sessions. The successful completion of the Body Scan without any significant residual physical disturbance related to the target memory is generally considered a positive sign of progress in EMDR therapy.

🧠 Ensuring Stability with the Closure Phase (Phase 7) at the End of Each Session

The Closure Phase, or Phase 7, of EMDR therapy is a critical and non-negotiable step that occurs at the conclusion of every EMDR session, regardless of the level of processing that has been achieved during that session. The paramount goal of the Closure Phase is to ensure that the client leaves the session feeling stable, grounded, and with a sense of safety and containment. This is particularly important because the reprocessing of traumatic memories can sometimes evoke intense emotions, unresolved material, or new associations that may continue to process even after the bilateral stimulation (BLS) has ceased.

During the Closure Phase, the therapist will always check in with the client to assess their current emotional state and ensure they are feeling regulated and able to function effectively outside of the session. Even if significant progress has been made during the session and the target memory feels substantially less disturbing, the therapist will still implement specific closure procedures. If the reprocessing has been particularly intense or if unresolved material has emerged, the therapist will utilize grounding techniques, such as guiding the client to focus on their present surroundings, their senses, or their breath, to help them return to a more present-focused and stable state. The therapist may also guide the client in accessing their previously established "safe place" or "calm place" as a resource to promote a sense of inner security before the session ends.

Furthermore, the therapist will provide psychoeducation to the client about the possibility of continued processing between sessions. The client may be instructed to keep a brief log or journal of any thoughts, feelings, images, or dreams that may arise outside of therapy sessions. This log can serve as a way for the client to track their ongoing processing and can also provide potential targets for future EMDR sessions. However, it is also crucial to reassure the client that keeping a log is not mandatory and that they should contact the therapist if they experience any significant distress or have concerns between appointments. The Closure Phase reinforces the safety and predictability of the EMDR therapy process. It helps to contain the reprocessing within the therapeutic setting and ensures that the client has the necessary resources and understanding to manage any continued processing that may occur afterwards, ultimately contributing to their well-being and fostering trust in the therapeutic alliance.

🧠 Monitoring Progress in the Reevaluation Phase (Phase 8)

The Reevaluation Phase, or Phase 8, of EMDR therapy is a crucial element that marks the beginning of each subsequent therapy session following the initial Assessment, Preparation, Desensitization, Installation, Body Scan, and Closure phases for a specific target memory. The primary objective of the Reevaluation Phase is for the therapist to systematically assess the client's progress since the previous session, carefully review the reprocessing of previously targeted material, and collaboratively determine if further processing is necessary for the initial target or if new target memories need to be addressed.

During the Reevaluation Phase, the therapist will typically begin by inquiring about any changes the client has noticed in their thoughts, feelings, behaviors, or overall well-being related to the reprocessed memory since the last session. This may involve asking specific questions such as, "What has changed since you did the EMDR reprocessing? What is different?". The therapist will also reassess the client's current level of emotional distress associated with the previously targeted memory by asking for a new rating on the Subjective Units of Disturbance (SUD) scale. Additionally, the therapist will re-evaluate the client's belief in the installed Positive Cognition (PC) by asking for a current rating on the Validity of Cognition (VoC) scale. If the SUD level has remained low (ideally 0 or 1) and the VoC level has remained high (ideally 6 or 7), it generally indicates that the reprocessing of that particular target memory was successful and no further desensitization or installation is needed for that specific target.

However, if the SUD level has increased, or if the client reports new aspects of the traumatic memory or related memories that have emerged since the last session, further desensitization may be required. Similarly, if the VoC level has decreased, it may indicate that the installation of the positive cognition needs to be reinforced through additional bilateral stimulation (BLS). The Reevaluation Phase also provides a crucial opportunity for the client to report any new present triggers or concerns that have arisen since the previous session, which may then become potential targets for future EMDR processing, ensuring that the therapy remains relevant and responsive to the client's evolving needs. The Reevaluation Phase is essential for ensuring that EMDR therapy is a dynamic and client-centered process that is continuously monitored and adjusted based on the client's individual progress and experience. This systematic re-evaluation helps to maximize the effectiveness of the therapy, address any residual issues, and guide the planning of future sessions to facilitate lasting healing from trauma and a significant reduction in psychological distress.

🧠 Frequently asked questions about eye movement desensitization and reprocessing treatment for PTSD

Q: What is EMDR therapy?

A: EMDR therapy, or Eye Movement Desensitization and Reprocessing therapy, is a structured therapy designed to help individuals process and recover from traumatic experiences, particularly effective for treating posttraumatic stress disorder (PTSD). Research on EMDR shows it is at least as effective as CBT with a trauma focus and other forms of trauma therapy.

Q: How does EMDR work for treating PTSD?

A: The processing model posits that EMDR therapy facilitates the reprocessing of trauma memories through bilateral stimulation, such as eye movements. The EMDR protocol is a structured therapy that encourages the brain to reduce the emotional intensity associated with distressing life experiences.

Q: What are the benefits of EMDR therapy?

A: Clients can benefit from EMDR therapy by experiencing a reduction in PTSD symptoms, improved emotional regulation, and a greater sense of safety and well-being as they process and integrate trauma memories.

Q: How many EMDR sessions are typically required for effective treatment?

A: The number of EMDR sessions required varies by individual, but many clients may start to see significant improvement after 3 to 6 sessions, although more complex trauma may require additional treatment. A typical EMDR therapy session lasts 45-90 minutes.

Q: Who can benefit from EMDR therapy?

A: EMDR therapy can benefit individuals of all ages experiencing PTSD, including children, as well as those dealing with other trauma-related issues such as anxiety and depression. EMDR can help with clients suffering from child or adult PTSD, and use of EMDR has also been described in the treatment of panic disorder, anxiety disorders in general, depression, and the aftereffects of traumatic events that unfortunately are part of daily life. Sessions of EMDR may also be used in life and executive coaching.

Q: What kind of therapist provides EMDR treatment?

A: An EMDR therapist is a licensed mental health professional who has received specialized training in EMDR therapy to effectively treat PTSD and other trauma-related conditions.

Q: Is there research supporting the effectiveness of EMDR therapy?

A: Yes, numerous studies and reviews, including those from the American Psychological Association and the World Health Organization, support the efficacy of EMDR as an effective treatment for PTSD.

Q: How does EMDR compare to cognitive-behavioral therapy (CBT) for PTSD?

A: While both EMDR and cognitive-behavioral therapy are effective treatments for PTSD, EMDR focuses on processing traumatic memories through a structured approach, whereas CBT typically centers on changing negative thought patterns and behaviors. The EMDR therapeutic process is unlike talk therapy since successful EMDR therapy does not require the client to talk a lot about their psychological trauma.

Q: Are there any side effects associated with EMDR therapy?

A: Some clients may experience temporary emotional discomfort or distress as they process trauma memories during EMDR sessions, but these effects are generally considered manageable and often decrease as treatment progresses.

Understanding EMDR Therapy: Eye Movement Desensitization and Reprocessing Therapy for PTSD Treatment