What is EMDR?

EMDR stands for “Eye Movement Desensitization and Reprocessing”. It is an evidence-based treatment used in psychological therapy to help reduce anxiety and the physical and emotional distress associated with past traumatic experiences.

Many people will experience traumatic events or situations in their lives that are deeply distressing and cause physical, emotional, spiritual, or psychological harm.  This includes situations in which you have felt threatened or been unable to control your circumstances, such as being assaulted, abused, bullied, or experienced a natural disaster, an accident, or the sudden death of someone close, or any situation in which your sense of safety or security was affected.  Even though the traumatic experience may have happened many months or even years ago, it can still have an impact in your daily life. You may experience post-traumatic symptoms such as intrusive memories, emotional flooding or numbing, nightmares, anxiety, low self-esteem, and have difficulty getting on with your life.

EMDR is not a new treatment, as it was developed around 30 years ago, however it has only recently been recognised as the best treatment for post-traumatic stress disorder (PTSD) by the The World Health Organisation (WHO, 2013) and the International Society for Traumatic Stress Studies (ITSS, 2019).  There is now a large body of scientific research supporting its benefits and interest in EMDR is rapidly growing in Australia and across the world in the mental health field.

In addition to the treatment of trauma, EMDR can also be used to help people deal with general anxiety and panic problems, grief issues, reactions to physical illness, and many other conditions when strong feelings are overwhelming.

EMDR will help you to process traumatic memories to reduce the emotional distress or physical symptoms that are triggered when you are reminded of a past distressing experience. The EMDR procedure can help desensitize the images and feelings associated with the trauma, and can help you think differently about yourself in relation to the trauma. The therapy can help shift any unhelpful beliefs that you may be carrying, such as “It was my fault” or “I’m a bad person” or “I have no control” so that you feel more empowered and at ease within yourself. It aims to activate and develop your innate coping skills so that you can feel in control and steady when facing future situations that may remind you of those past traumatic events.

How does EMDR work?

Researchers are still exploring the exact mechanisms to explain how and why EMDR is uniquely effective at rapidly resolving the effects of trauma. The use of eye movements during therapy, and other techniques such as tapping each side of the body, is clearly effective but how this works is yet to be fully understood.

The current theory is that eye movements are believed to:

• have a calming effect on your nervous system
• help you to stay present to the here-and-now to prevent reliving a past memory
• interrupt the traumatic memory networks by taxing the mind with an immediate task to focus on
• activate a neurobiological process to “digest” information and regulate emotion, similar to the rapid eye movements (REM) that occur during dreaming (REM sleep).

After processing traumatic memories with EMDR, people generally report the memories becoming distant and less detailed, with helpful changes to the images, sounds and feelings associated with the memories. Feelings of increased confidence and trust in your ability to cope with day to day stressors, without feeling vulnerable to emotional triggers, is the ultimate goal of the approach.

The EMDR Procedure

EMDR therapy is an eight-phase treatment approach that involves, assessment and preparation phase, a processing and desensitisation phase, and a closure and follow up phase.

Assessment and preparation phase

First, your therapist will take a full history of the problems you’ve been facing, and will construct a description of key traumatic events that includes: an image or picture that represents the target past traumatic event, your current beliefs about yourself in relationship to the event, how you would prefer to think about yourself in relation to the event (positive belief), your emotions associated with the event, and your physical sensations associated with the event. You will also be asked to give numerical ratings to your degree of upset and the credibility of the positive belief so your progress can be monitored during the session.

Processing and desensitisation phase

After this preparation your therapist will begin the processing and sensitization phase of the therapy. An EMDR processing session during this stage typically takes 75 minutes and sometimes up to 90 minutes. Your therapist will sit beside you, but facing you at a comfortable distance to help guide you with the eye movements required during processing (explained below). Your therapist will ask you to bring to mind the picture of the traumatic experience that you agreed to work on, along with the negative self-thought, the emotions, and the physical sensations you normally have with this memory. You will be asked to hold this in mind while using your eyes to follow an object moving back and forth about a metre in front of you, such as a pen or the therapist’s fingers. After a series of about 30+ eye movements, your therapist will ask you to stop, let go of the image (or thought) for a second, take a deep breath and then notice and describe briefly what thoughts, feelings, or images arise for you. This process continues until emotional distress is reduced and the memory is fully processed.

Typically, the images, emotions, and sensations you experience change as you go through this process. Assuming that your thoughts, feelings, images, and physical sensations become less distressing, you will be asked to recall a positive self-statement you would like to have paired with the troubling image. EMDR will then help you to associate this new way of thinking about yourself with the original distressing image.

After one or two sessions of EMDR processing it will be clear whether this is a useful technique for you. Sometimes only one or two processing sessions are required, however more severe or complex problems might take several months to resolve.

Closure and follow up after an EMDR session

At all stages of the therapy, you will be able to stop and pause at any time. Your therapist will be guiding and supporting you through the process and will help you to feel calm and in control of your emotions at the end of every session. However, after a processing sesion your brain will continue to process memories and other stored information, which can continue for up to two days. In this time you may experience other memories, images, dreams, thoughts or emotions in some way related to the memories raised during the session.  This a normal and natural process which is an important part of the therapy. Keeping a diary after a session to write down noticeable experiences to share in your next therapy session will assist with the process of therapy.  Record the date, the event which triggered the experience, and any memory, image, thoughts, or emotions and bring this sheet to your next appointment.

If you experience significant distress or find new traumatic memories arise between sessions it is important to contact your therapist to let them know, so they can help you access more support between sessions.

Immediately after EMDR processing it is common to find your mind wandering a lot, as your brain continues to process information. Due to higher than normal levels of distractibility after processing sessions, you are advised not to drive until at least 30 mins after a session. It can be helpful to go for a walk or wait at reception or at a café until you feel completely present and focussed enough to drive. Ideally, someone could pick you up from the psychology clinic.

It is important that you attend a follow up session after the processing phase to evaluate your progress and discuss any ongoing needs or concerts with your therapist.

Cautions

EMDR processing can be upsetting. There are many safety procedures built into the EMDR process, but it can still be an intense experience for a brief time.  The aim of each EMDR session is to help you feel less distressed at the end of the session, however sometimes multiple sessions are needed to make progress.  Let your therapist know if you feel overwhelmed between sessions and need further support, or if new memories arise that you hadn’t expected and you find them too distressing to manage on your own. New memories can be incorporated into the treatment, so that all associated memories have been processed in some way.

As a final note, when you begin EMDR it is important you are prepared to follow through with a course of treatment. For this reason, it is not recommended that you start EMDR if your life circumstances and financial resources will not allow you to work safely and bring the therapy to a reasonable conclusion.  While the number of sessions required cannot always be predicted at the start of therapy, usually but the first or second processing session it will be easier to gauge the number of sessions required.

Dr Giselle Withers is an experienced Clinical Psychologist, who is a trained EMDR therapist. Giselle also has advanced training at a doctoral level in mental health assessment and psychological therapy, and has over 20 years of experience treating trauma related anxiety, and a range of other mental health problems.  Giselle has a compassionate and non-judgemental counselling style, and will work with you to understand the trauma you have faced, and can help you with EMDR therapy to overcome these effects of trauma in your life.

Your first step

If you have experienced a past trauma or traumatic situations an important first step is to talk to your general practitioner (GP). Your GP can provide an initial assessment to look at your overall health and symptoms, and discuss treatment options with you. If appropriate, your GP can prepare a Mental Health Treatment Plan which will allow you to access a Medicare rebate for your psychology sessions.

Making a booking with Dr Giselle Withers

To make a psychology appointment with Giselle please contact Avoka Health using the link below.  Giselle will assess whether EMDR therapy is right for you, and if suitable will guide you through the EMDR approach.

References

This guide is adapted from EMDR: A Closer Look by Jon G. Allen, Michael W. Keller, and David A. Console.

1. Shapiro, F., (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures(1st edition). New York: Guilford Press
2. Shapiro, F., (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures(2nd edition). New York: Guilford Press
3. Shapiro, F., (2002). Paradigms, Processing, and Personality Development. In F. Shapiro [Ed.]. EMDR as an Integrative Psychotherapy Approach; Experts of Diverse Orientations Explore the Paradigm Prism. Washington, D.C.: American Psychological Association Books.