The Power of EMDR Therapy

Have you ever experienced an event that caused you to feel frightened, anxious, overwhelmed, angry or deeply sad? Maybe your heart rate increased, your stomach started to twist and turn, your mind went blank, and you wanted to run away, hide, or fight.

The answer is probably, yes. These emotional and physical sensations are our body’s natural, biological responses to stressful situations and events. Typically, our brains are able to process and consolidate stressful or emotional events so that these experiences become a part of our explicit memory. This means that when we are recalling and thinking about past stressful events, they are just that: past memories that no longer cause us to feel anxious, overwhelmed, or upset.

Let’s look at an example: You completely freeze and your mind goes blank when giving a presentation. You feel your heart racing, your palms are sweaty, and you stutter as you try to present the material you prepared. You feel humiliated and embarrassed and think to yourself: “everyone is judging me.”

However, following the presentation, you receive ample support from your coworkers and think to yourself: “that was scary but I got through it. I’m a good presenter and I’ll do better next time.” Then when you think back on this event, you’re able to tell others about it without much discomfort or anxiety. And the next time you give a presentation, you may feel slightly nervous, but you know you are prepared and capable.

But what happens when the events we are experiencing are so stressful and overwhelming that our brains simply do not have the capacity to process them? When this happens, the feelings, body sensations, thoughts, and images associated with that memory are unable to move to explicit memory. Instead, the parts of the memory become fragmented and are stored as implicit memory. When we think back on that memory or are triggered by something that reminds us of the memory, we experience the thoughts, feelings, and body sensations as if we are reliving that experience.

Let’s go back to our first example: Instead of receiving support from coworkers, you quickly run out of the room, book it to your car, and drive home. You feel devastated by your presentation and believe everyone thinks you are a failure. Even though you know rationally that it’s probably not true, it feels true based on the emotions and physical sensations you are experiencing.

A week later, you’re at work and are assigned another presentation. You feel frozen just at the thought of this. Your throat begins to close up, your stomach twists and turns, and you feel an overwhelming sense of dread.

In this version of the example, the memory of giving a presentation deemed disastrous remained stuck in implicit memory. So, how do we move these stressful memories from implicit to explicit memory? With the power of EMDR therapy.

What is EMDR therapy?

EMDR stands for eye movement desensitization and reprocessing.This type of therapy is different from traditional talk therapy, in that it uses bilateral stimulation to help move events that are stuck in implicit memory to explicit memory, which helps lower the intense feelings of overwhelm and distress associated with the memory. Bilateral stimulation is the process of alternating stimulation on the right and left sides of the brain. This can be done through our many different sensory systems:

• Visual: moving your eyes back and forth
• Tactile: alternating vibrations between your left and rights hands
• Auditory: alternating beeping sounds in your ears

EMDR is an evidence based treatment that is effective in treating PTSD, complex trauma, anxiety, depression, and phobias. When one is being treated with EMDR, there are 8 phases that they must go through. Let’s look at those 8 phases and how they are used in the therapy room (or some kind of transitional wording).

8 Phases of EMDR

1. Client history, rapport, informed consent: This phase involves gathering background information about presenting concerns and explaining why EMDR may be helpful regarding the goals you want to achieve. This phase typically takes one session.

For example: John expresses concerns about presentations and desires to work on his anxiety around them.

1. Client preparation: During this phase, the therapist is equipping the client with grounding techniques, breathing exercises, and relaxation techniques. These techniques are called affect management skills. Before processing painful memories, it’s important that clients have skills to use at the end of and between sessions as processing distressing memories can feel emotionally overwhelming.

For example: John practices deep breathing, calming visual imagery exercises, and grounding techniques such as four square breathing, and guided meditations. Phase 2 typically takes between one to three sessions and is dependent on how well the client can regulate their emotions.The therapist will ensure the client has enough skills to regulate before processing distressing memories.

1. Assessment: The third phase of EMDR, assessment, involves choosing a memory or event to process. The client will identify the negative thoughts, emotions, and body sensations they feel when thinking about their target memory. This phase takes about 10 to 15 minutes at the beginning of a therapy session to choose the target memory before beginning phase 4.

For example: John targets the presentation he deemed a disaster. He identifies the worst moment as being his mind going blank and seeing his coworkers staring back at him. This image is paired with the thought: “I’m a failure.” He feels anxious, scared, and embarrassed and feels a tightness in his chest, sweaty palms, and slight dizziness.

1. Desensitization: This is the phase where the distressing memory and associated negative thoughts, feelings, and body sensations will be processed using bilateral stimulation. During this phase of EMDR, the client’s job is to notice and feel what is arising for them. Every client processes differently. Some clients notice thoughts, images, body sensations, and/or strong emotions. The client is simply asked to allow their mind to go wherever it wants to go. This allows “stuck” thoughts, feelings, body sensations, and memories to move from implicit to explicit memory. Phase 4 can take up to anywhere between one session and several sessions depending on the intensity of the memory being processed. Single isolated events typically take less time to process whereas memories that are linked to a myriad of negative past experiences will take longer to process.

For example: John feels anxious and sweaty. He sees the faces of his coworkers staring back at him. Then his mind travels to a time in childhood where his mind went blank during a class presentation. He felt awful about his performance and recalls being laughed at. He remembers other times where he has felt like a failure. John moves through the feelings, thoughts, memories, and body sensations with support from the therapist. The therapist stops the bilateral stimulation every few minutes to check in about what John is noticing about the process.

1. Installation: This phase begins once processing of the distressing memory is complete. That is, the client can think about the distressing memory without feeling dysregulated and overwhelmed. The client will instead think about what they want to believe about themselves when they think back on the target memory (i.e., I am safe, I am valued, It wasn’t my fault). After phase 4 is complete, this phase can take up to 10 to 30 minutes of a session.

For example: John starts to notice a decrease in anxiety, his chest feels less tight, and he has the thought: “this one presentation does not define me.” At  this point, the therapist will ask John to pair the chosen memory with a positive thought. John chooses the thought: “I am capable.” Bilateral stimulation is used to strengthen the client’s belief in this thought. John truly feels more calm and more capable of his abilities.

1. Body Scan: Once the client strongly believes in the positive thought, they will be asked to do a body scan, that is turning their attention to different parts of their body to assess for any tension or discomfort still lingering. With any tension identified, the therapist will run the bilateral stimulation to clear away any feelings of tension. This phase can take up to a few minutes after phase 5 is complete.

For example: John strongly believes “I am capable” when he thinks back on his presentation at work. He still feels slight tension in his chest. The therapist runs the bilateral stimulation as the client focuses on his chest and he begins to feel the tension release.

1. Closure: The therapist will ensure the client is feeling relaxed and calm at the end of the session. The therapist will also alert the client that it is normal for them to have some thoughts, emotions, memories, or vivid dreams after the session because the brain continues to process memories even without the assistance of bilateral stimulation. The therapist will allow about 5 to 10 minutes at the end of the session to debrief with clients about their experience.

For example: John feels calm and relaxed at the end of session, is aware he may have some vivid dreams or other insights about the memory, and schedules a follow-up appointment for next week. When he thinks back to the target memory of giving that presentation at work, he doesn’t feel any distress.

1. Reevaluation: Phase 8, the last and final phase of EMDR, occurs during the next session. The therapist will ask the client if they are experiencing any distress related to the memory processed during the previous session. There may be more processing that needs to be done on that memory, or the therapist and client will choose the next memory to target!

For example: John presents for the following session and is not experiencing any distress related to the memory of giving the presentation at work. However, he has noticed anxiety and fear related to an upcoming performance evaluation and is worried about falling short of his manager’s expectations for him. John and his therapist decide this will be the next event to target using EMDR.

Are you tired of telling yourself the same old story about yourself that you know is not true but feels true? Simply talking about these issues is not enough to shift deep-seated beliefs. Whether these beliefs stem from past trauma, anxiety, depression, or early childhood experiences, the power of EMDR will untether you from the past and help you start living the life you want to live. If you are interested in learning more about EMDR, please visit our website to start the process today!