What is EMDR?
EMDR stands for Eye Movement Desensitization and Reprocessing. It is a proven, effective therapy modality that can be used to treat PTSD, acute stress responses, anxiety, phobias, low self-esteem, developmental trauma, impacts of emotional and verbal abuse, bullying, and pretty much any distressing life experience.
Even though EMDR has been around for a few decades now, a lot of people are just now hearing about it (thanks to Grey’s Anatomy and Prince Harry!).
How does EMDR therapy work?
A trained EMDR therapist uses bilateral movements, either eye movements, tones, or tapping, paired with an upsetting memory and a negative belief about the self to get incorrectly stored memories moved to more functional parts of the brain, and to change the negative belief about the self to a positive belief.
When something scary happens to us, our brain can keep that original memory front and center - it’s your brain’s way of trying to keep you on high alert for potential danger. That negative belief is either created during the original scary event or strengthened during later similar, scary events.
Unfortunately, when memories get stored this way, they get stored with all the thoughts, feelings, and body sensations you felt when that memory occurred. This means that when something triggers that memory, it can feel like you are right back in that place and time, because to your brain, you ARE right back there.
By using those bilateral movements in EMDR therapy, as I mentioned before, your brain says “Oh that’s cool, I can remember this memory but not feel scared/angry/hurt anymore. I can respond in a healthier way when I’m feeling this same way in the present.” The previously held negative belief no longer feels true, and this makes room for you to fully believe a new, positive belief. The memory stays, but it’s no longer distressing, and your brain can file it away as healed.
Here’s an example of how EMDR therapy works:
Jane Doe* was in a car accident a couple of months ago on her way home from work. She walked away with soreness and bruising, but her car was totaled. She was pretty shaken up and had some trouble sleeping that night. After taking a few days to rest and recuperate, she felt ready to get back to her normal routine. Jane got in her rental car to go to work, but as soon as she got out of her neighborhood, she started feeling scared - her heart was pounding, her hands were sweating, and she saw danger everywhere. Images of her totaled car clouded her vision. She didn’t understand what was going on - it was a completely different time of day, she was in a different car, the weather was different, and she wasn’t even anywhere near where the wreck happened, and besides, she was physically just fine.
Jane’s brain took all the information from the car wreck, stored the memory incorrectly, and decided to generalize the events to try to keep Jane safe. To Jane’s brain, doing anything related to what she was doing the night of her car accident set off alarm bells, and her body’s response was her brain’s way of saying “Nope, no ma’am, not today, don’t even think about driving this car, that’s a terrible idea.”. Jane decided to call her therapist, who had mentioned EMDR therapy before and schedule a session. Jane’s EMDR therapist used bilateral stimulation to help Jane’s brain delete the distress associated with the memory of the car accident, store the memory in a back folder somewhere where it isn’t taking up all her conscious thought, and even instill hopeful and positive thoughts and images about future driving experiences.
Jane also learned some really great calming techniques to use if she does get nervous driving, or even when she’s riding as a passenger. Now, when Jane gets in the car, she is able to fully believe that she can keep herself safe and that her accident is in the past. Jane still thinks about her accident every now and again, and she knows that she does have to stay alert while driving, but she no longer experiences panic and fear about driving.
(*This vignette is not based on any real client or person.)
If you want even more information about the science and research behind EMDR, check out www.emdria.org.
How do you do virtual EMDR therapy?
EMDR was originally designed to be done in person, this is true. However, when COVID-19 moved therapy practices online in 2020, lots of companies stepped up to make sure that people could still get the benefits of EMDR therapy from home. There are several different ways to do EMDR virtually. Sometimes, an EMDR therapist will help their clients learn to tap on their own, and will use this form of bilateral stimulation. There are even buzzers that clients can buy for themselves to use during EMDR sessions. I use a website that clients access during EMDR therapy sessions, which has a dot on a black screen - my clients follow the dot back and forth, and the bilateral stimulation is provided that way.
Seeing an EMDR Therapist for Trauma
Using EMDR for the treatment of trauma, specifically PTSD, is probably the most widely known use of EMDR. But let’s take a second to talk about trauma, and what it is. If you say the word “trauma”, to yourself or someone else, it’s pretty likely that what gets thought of is PTSD, fighting in the military, sexual or physical abuse, car accidents, or other types of violence. These are definitely types of trauma. But they aren’t the only types. Trauma is also deeply personal - what is traumatic for one person, may not be traumatic for the person standing beside them. The difference is all in how the brain codes or stores that event (i.e., did the brain store the memory correctly or incorrectly?), and what that event meant to that person’s sense of safety and well-being.
Trauma can be triggered by so many different events:
Early childhood trauma: traumatic things that happen from birth to age 5, such as intentional violence, a parent/caregiver being away for an extended time, medical procedures, etc.
Grief from the loss of a pet or loved one
Bullying
Community violence
War
Natural disasters
Adoption, foster care
Receiving a certain medical diagnosis, or a loved one receiving the diagnosis (such as cancer, diabetes, etc.)
Parents divorcing
Receiving corporal punishment (spanking) as a child
Verbal or emotional abuse, at any age
Having a parent, caregiver, or sibling with mental health or substance use disorder
Emotional neglect
Physical neglect
And sooooooo many more!
How EMDR Therapy can help
The process is similar to what I described for Jane Doe’s car accident and resulting fear. When using EMDR therapy to treat responses from a traumatic event, we first learn some awesome calming and coping skills, and then we identify what the trauma was, what the negative belief about yourself/the world is associated with the traumatic memory, what other memories relate to it/feed it, and how it’s causing you trouble currently. EMDR lowers the distress you experience when the traumatic memory or its current manifestation pop up until the distress is tolerable. When this happens, you are able to replace that negative belief with a positive belief.
A common negative belief I come across in my clients is “I am not good enough”. With consistent EMDR work, they are able to think of upsetting memories and they notice that “I am not good enough” simply is not true anymore. Instead, they believe “I am worthy/good enough”, and when they think of that old memory with that positive belief… it’s almost like a breath of fresh air. You are finally able to stop believing hurtful and untrue things about yourself. When negative beliefs are changed to positive beliefs, and old memories aren’t as upsetting, you can do, think and feel differently in the present.
So, You Can Just Have Me Watch Some Dots Go Back and Forth and I’m All Good?
Not exactly! Like any therapeutic modality, EMDR therapy has phases, considerations for eligibility, and it looks a little different for everybody.
There are 8 phases involved in EMDR, and depending on the individual, movement from one phase to the next isn’t always linear! I’m going to give you a brief overview of each phase.
Phase 1: History and Treatment Planning
This phase involves getting a thorough history of what’s troubling you in your current life and what’s happened in the past. The main goal is to identify the big “presenting problem” in your life, what event(s) in the past caused it, and what you want to do, think, and feel differently in regards to this problem. This can take 1-2 sessions and may continue throughout treatment if other problems are identified.
Phase 2: Preparation
This phase can last 1-4 sessions and may be longer for those with complicated trauma histories. During Preparation, I teach my clients about how EMDR works, what to expect during EMDR desensitization sessions, and various calming and relaxation skills that you can use during and in between sessions when distress arises from the memories we’ll be working on.
Phase 3: Assessment
During the Assessment phase, we identify the specific memories, called Targets, that are upsetting and distressing to you. The negative belief about yourself in regards to the memories is identified, as is the positive belief you would like to have instead.
Phase 4: Desensitization
The Desensitization phase is the phase that is most commonly associated with EMDR therapy. During this phase, the memories/targets you identified get reprocessed using the bilateral stimulation (back and forth eye movements, taps, or tones) I discussed a few sections ago.
Phase 5: Installation
After the negative belief, emotions, and body sensations around a particular memory are no longer distressing to you, we use Installation to install the positive belief. We use the same type of bilateral stimulation to get the positive belief strengthened in your mind.
Phase 6: Body Scan
After Desensitization and Installation, you’re asked to hold the positive belief and the upsetting memory in your mind and scan down your body to locate any distress or discomfort that comes up with that pairing of the positive belief and the memory. Sometimes the body has lingering tension or upset about a memory that our conscious brains aren’t aware of. If there is, we target that with the bilateral stimulation until all physical distress is gone. Doing a thorough Body Scan helps ensure that there truly is no longer any discomfort with that memory!
Phase 7: Closure
Closure is done at the end of each session. Sometimes a target memory doesn’t get fully reprocessed during a single session. In the event that this happens, Closure is a time where we engage in calming and relaxation skills to further lower any distress you may be feeling. We also talk about self-care that may be helpful for you in the days until your next EMDR session.
Phase 8: Reevaluation
At the beginning of each EMDR session, we review past work and memories, as well as how you feel you are coping and managing situations outside of the therapy session. This helps us determine the best track for therapy.
After all 8 Phases have been concluded for past memories, we use similar techniques to address present-day stressors/triggers. When your present-day triggers have been reprocessed, we install what is called a Future Template for how you would like to think, feel, and act when similar situations come up in the future. Having a Future Template is like having a guidebook in your mind - when a similar stressful situation comes up your brain says “I know what to do! I’ve practiced this before!”. During Present and Future work, we may also use different types of therapy to help build any skills you may need to address your problem in the present and future situations. For example, someone with a fear of public speaking may neutralize their distress about public speaking, but may still need new skills for organizing their notes, controlling their breathing, projecting their voice, and preparing for the speaking event.
But What If I Haven’t Experienced A “Trauma”? Can An EMDR Therapist Still Help Me?
The short answer to this question is… probably, but it depends. At my Asheville, NC-based therapy practice, I use EMDR therapy for a plethora of presenting problems. These include: low self-esteem, negative body image, fear of flying, fear of driving, trouble setting boundaries with other people, difficulty putting yourself first/engaging in good self-care, fear of confrontation, worry about the future, impacts on the adult self from unhelpful parenting experienced in childhood, childhood bullying, receiving a serious medical diagnosis, increased stress from COVID-19/world events/politics, etc, and so many other issues.
Remember, the brain can “store” almost anything as a traumatic event. It doesn’t have to be something your friend or spouse would agree is traumatic. If your brain has stored an event as a trauma and has assigned a negative belief about yourself to the event, then there is a good chance EMDR can be helpful in lowering the distress you feel.
Start EMDR Therapy in Asheville, NC today!
If you’re curious about EMDR therapy and how it may be able to help you, please reach out to Chandler Nobles Counseling today! Together, we can figure out if we are a good match, determine a treatment plan, and discuss the options of using EMDR therapy to help you heal. Contact me today to schedule an appointment.
Other Services at Chandler Nobles Counseling
Maybe EMDR isn’t right for you, but you have realized that you still have things you want to process and work through. At my Ashville, NC-based counseling practice, we offer support for compassion fatigue, therapy for women, trauma therapy, and more. Consider reading our blog for additional information.