EMDR Therapy: History, Phases & Process, Qualifications to Perform EMDR & EMDR for Addiction and PTSD
EMDR Therapy History
Eye Movement Desensitization and Reprocessing (EMDR therapy) originated in the late 1980s as a result of the observations and experiences of psychotherapist Francine Shapiro.
Shapiro had noticed that lateral movements of the eyes were associated with reduced emotional responses to particular types of unsettling or disturbing thoughts or memories. She began to experiment with individuals who had experienced some particularly devastating trauma in their lives, and who had adjustment issues or were diagnosed with a formal post-traumatic stress disorder (PTSD diagnosis). She began to refine the technique of using lateral eye movements to help individuals process the effects of trauma.
Eye Movement Desensitization and Reprocessing (EMDR Therapy) Procedure
During the EMDR therapy procedure, the therapist has the client reflect on particular aspects of traumatic experiences that are associated with the most stress/emotional reaction while the client follows the hand motions of the therapist with their eyes. The therapist typically moves their fingers back and forth in front of the visual field of the client during this procedure, and the client, using only their eyes, follows this movement.
The eye movements are broken down into saccadic eye movements, which are quick, jerky movements of the eye that redirect a person’s line of sight in order to fix their vision on a moving object. Proponents of EMDR therapy, such as Shapiro and her followers, claim that inducing these movements while reflecting on past traumatic experiences helps individuals to reprocess the experience and curbs the emotional response even if it is severe. However, EMDR also incorporates a number of other principles from behavioral therapy and Cognitive Behavioral Therapy.
EMDR Therapy Phases & Process
During the overall EMDR therapy procedure, the therapist focuses on the individual’s current situation and attempts to understand the history of the individual; however, the focus is not on the past as much as a focus of the treatment concerns itself with how the individual is reacting currently in the world. The actual delivery of EMDR therapy can vary from treatment provider to treatment provider; however, in its classic presentation, the delivery of EMDR is accomplished over eight major steps or phases. These phases will be very briefly explained here. The eight phases are:
- Phase I – History and background of the client and the preparation of an individualized treatment plan: Most often this phase will occur over the first two sessions, but most therapists continue to gather information regarding the history and background the client throughout the entire process. In this phase of treatment, the therapist and client will define the specific “targets” to be addressed in therapy. These can include traumatic events or other presenting problems.
- Phase II – Treatment preparation: During this phase, the treatment alliance is developed, and the therapist explains EMDR to the client. The therapist will instruct the client in some specific techniques that can help them to deal with the effects of trauma. These techniques are typically breathing, relaxation, and other practices that can help to deal with stress.
- Phase III – Assessment phase: This phase can be quite lengthy and involves quite a bit of interaction between the client and therapist. Typically, various targets are identified, and their emotional effects on the client are evaluated. The client and therapist work together to develop more functional approaches to existing emotional reactions. Then, the client and therapist work together to develop methods of rating current feelings of stress and alternative desired approaches to dealing with stress.
- Phase IV – Desensitization stage: During this stage, the actual work of using the eye movement desensitization technique is paired with reevaluating both the traumatic events and their emotional experiences. In addition, positive emotions are inserted with recollections of past experience that resulted in distress (during phases III-VI, most of the exposure and cognitive restructuring occur).
- Phase V – The installation phase: During this phase, more reprocessing is done to instill positive feelings regarding the client’s perception of past events as well as the client’s own efficacy in dealing with everyday experiences.
- Phase VI – Body scan: During this phase, the therapist and client go back and try to evaluate any remaining tension related to stress that is associated with the targets identified in the early sessions and reprocessed over the course of treatment. Any remaining tension is dealt with.
- Phase VII – Closure: During this phase, the client’s reactions are reassessed to make sure they have responded to the treatment, and the client feels better as a result of the treatment.
- Phase VIII – Reevaluation: During the final phase, the therapist and client reevaluate the entire process to make sure that the goals of treatment have been reached and that the techniques for coping are working well. If any issues need to be addressed, the therapy returns to the appropriate stage and works through them. If the goals of the therapy have been met, the treatment is terminated.
EMDR Therapy Borrows Principles from Established Paradigms
EMDR therapy was originally designed to treat the experience of trauma that results in difficulties with emotional adjustment in individuals. The American Psychiatric Association lists a number of disorders under the overall heading of Trauma and Stressor Related Disorders in the DSM–5, the latest version of the diagnostic manual.
EMDR therapy was intended originally to help in the treatment of PTSD, adjustment disorders, and acute stress disorder, which are still listed in the diagnostic manual. The proponents of EMDR therapy have also gone on to claim that it is useful in treating a number of other different psychological problems/disorders that have components of anxiety, depression, and maladjustment.
Although the EM in EMDR therapy represents the notion of eye movements, not every therapist using the EMDR technique incorporates the eye movement component. Sometimes, the therapist simply tabs their finger, uses sound, or uses some other technique instead of the eye movement component in conjunction with the overall EMDR therapy treatment package. As will be revealed later on, this is a problem for the theoretical foundations of this particular technique.
EMDR therapy does include the following components in its overall treatment package that have empirical validation for their usage:
Session assignments and homework
The majority of cognitive and behavioral therapies require that clients in therapy complete certain practice assignments during the therapy sessions and that they complete assigned homework given to them by the therapist. The principle of giving homework for clients to practice newly developed skills in an effort to deal with some type of emotional issue has a long history in psychotherapy.
The notion of developing a strong therapeutic alliance
EMDR therapy practitioners attempt to develop a strong working alliance between the client and the therapist as the main contributor to the success of the treatment. This is a longstanding aspect of successful therapy that dates far back in the history of psychotherapy.
The notion of exposure treatment
As part of the reprocessing component of EMDR, individuals are required to reflect on aspects of their traumatic experience that are particularly distressing for them. The process of this type of reflection, especially when individuals are instructed to visualize, try and hear aspects of the experience, and involve all the senses, is borrowed from a behavioral psychology therapeutic technique is known as exposure therapy.
Exposure therapy has a long history of use, with behavioral therapy and Cognitive Behavioral Therapy, to assist individuals who have experienced traumatic events to desensitize themselves emotionally to those events. The basic premise behind exposure therapy is that when people feel anxious, fearful, etc. as a result of some particular stimulus, having them re-experience the stimulus/event or remain in the presence of the stimulus eventually results in their anxiety peeking and then leveling off.
Repeating this process of exposing a person either directly or through mental imagery results in the individual’s anxiety levels steadily decreasing to the point where recalling the experience no longer produces any significant distress. Individuals can also be taught breathing and relaxation during exposure to facilitate the process. A major component of EMDR therapy is to have the person recollect important aspects of the traumatic event while undergoing the eye movement component of the treatment.
The notion of cognitive restructuring
Cognitive restructuring is a technique that is borrowed from Cognitive Behavioral Therapy (CBT), one of the most popular therapeutic paradigms used by therapists today. Cognitive restructuring involves re-conceptualizing one’s attitudes, thoughts, belief systems, etc. in a manner that is more functional and realistic.
CBT works on the notion that many dysfunctional behaviors, such as substance abuse or psychological disorders like depression, are fueled by an irrational and dysfunctional belief system. CBT identifies these core irrational beliefs and, through a therapeutic process, helps the individual restructure them so they are more in line with reality.
Part of the process of EMDR is for the therapist to help the client develop a different attitude and value system regarding aspects of their traumatic experience. This is done in conjunction with the exposure technique and eye movement component.
Who is Qualified to Perform EMDR?
Because the formal process of EMDR treatment is rather lengthy and complicated, only therapists who are specifically trained in the technique and certified to perform it should be using EMDR therapy.
Thus, there are two major qualifications:
- The individual should be licensed by the state to perform therapy.
- The individual should have specific training and certification in EMDR therapy.
Treating Addiction and PTSD with EMDR Therapy
The research on the effectiveness of using EMDR to treat PTSD and addiction is limited. In a 1994 article published in the Journal of Psychoactive Drugs, researchers argued EMDR could resolve problematic memories contributing to substance abuse and reduce the effects of relapse triggers.
A 2014 study of 12 patients with co-occurring PTSD and drug or alcohol addiction found that EMDR therapy in combination with “treatment as usual” effectively reduced symptoms of PTSD but did not treat addiction. However, the study was significant in finding it could treat PTSD in patients with substance abuse issues.
The findings indicate that EMDR can be an effective complement to a comprehensive substance abuse treatment plan for patients affected by trauma and addiction, but it should not be the sole treatment for addiction.
Dangers and Downsides of EMDR Therapy
Numerous studies have found that EMDR is a safe and effective therapy. However, some patients may experience distressing side effects.
For example, a 2016 study exploring the effectiveness of EMDR among people with PTSD found that two participants panicked and experienced intense emotions and increased emotional instability. The study authors said these reactions could have been caused by the combination of EMDR and a technique the researchers used to measure the patients’ responsiveness to the traumatic memory.
Research published in the Encyclopedia of Social Work stated that the intense levels of emotion associated with the technique could be harmful to some patients, including certain people with substance abuse issues and those with dissociative disorders. The author explained that the severity of medical conditions such as seizures and neurological disorders may be worsened by EMDR.
In addition, some scientists have criticized the effectiveness of EMDR. Several experts in the field of psychology have said that reprocessing clinicians rely on anecdotal reports of its effectiveness rather than on scientific evidence. Other experts have questioned the usefulness of eye movements in alleviating traumatic thoughts.
While research has shown that EMDR can be an effective treatment for PTSD, a meta-analysis of EMDR research found overwhelming evidence suggesting that eye movements are not a necessary or useful element of trauma therapy. And traumatic feelings, some critics contend, could persist after completing a therapy session.
In the 1990s, several studies examined EMDR’s effectiveness in treating combat veterans experiencing trauma and reported mixed or negligible results. However, the Department of Veterans Affairs and the International Society of Traumatic Stress Studies criticized these studies for providing an insufficient amount of treatment for this demographic.
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 Herbert JD, Lilienfeld SO, Lohr JM, Montgomery RW, O’Donohue WT, Rosen GM, Tolin DF. Science and pseudoscience in the development of eye movement desensitization and reprocessing: implications for clinical psychology. Clin Psychol Rev. 2000 Nov;20(8):945-71.
 National Center for PTSD – (www.ptsd.va.gov)
 PTSD Causes, Symptoms & Treatment We Level Up Treatment Center – ‘PTSD Treatment’ –