EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapeutic framework and treatment method that has been used in Finland since 1996. Originally the method was used for treating post-traumatic stress disorder, but in recent years its scope of use has grown significantly. Today, EMDR therapy is used for many various situations.
EMDR therapy provides several different protocols, i.e. guidelines, on what to do with each separate patient’s situation. The basic protocol of EMDR is treatment guidelines for the adaptation problems caused by post-traumatic stress disorder, whereas its flipped protocol is a treatment guideline for complex trauma. In addition to these, there are special protocols for the treatment of depression, various addictions and fears and phobias. At Mementos, we have developed a special coaching method and treatment guidelines for stress caused by a trial, CopeforCourt.
In Finland and abroad, EMDR treatment has been used for, e.g. the treatment of negative memories and traumas caused by sports injuries and traffic accidents, violent experiences, relationship crises and childhood experiences as well as for the treatment of different performance anxieties, addictions, depression, anxieties and fears and panic disorder. EMDR treatment is also very well suited to be used with children and young people. The method is not bound to making eye movement series and it can also be used with visually impaired people. A successful EMDR treatment of psychological symptoms caused by an isolated traumatic incident usually takes 1 to 3 treatment appointments. Treatment of a more long-term trauma requires more appointments. In addition to the events of the past, the method can also be used for psychological processing of future events that cause anxiety and stress for the client.
EMDR therapy is the recommended treatment for acute and chronic post-traumatic stress disorder as stated by the World Health Organisation (WHO) and the psychiatric association of the United States. In addition to trauma-centred cognitive behavioural therapy, EMDR therapy is the recommended treatment for post-traumatic stress disorder as stated by the Current Care Guidelines compiled by workgroup established by the Finnish Medical Society Duodecim and the Finnish Psychiatric Association. A similar national care guideline has been issued at least in Sweden, Great Britain, the Netherlands, Ireland and France.
Temporal perspective of treatment
When designing a client’s treatment, the focus is on identifying the client’s diagnosis or problem and reviewing whether EMDR therapy provides a protocol, i.e. care guideline for it. The protocol tells the EMDR therapist what to do and at what stage with different kinds of patients. EMDR protocol also shows the therapist where they can find the memories the client needs to process. When the memory has been found, there are different techniques for processing them. Often the stages of the basic protocol are used for processing an unprocessed memory that leads to problems in the present time. If time-related resources do not enable using the basic protocol or if the client is too tired, resource work, i.e. resource reinforcement technique can be used. The decisions concerning work are always based on the client’s current capacity during the appointment. Temporal perspective of treatment is practically always in the past or in the future.
The starting point of a treatment targeted at a person’s past is that the person has a difficult experience and a related memory that disturbs their life in the present and they want to get rid of the anxiety and disruptions it causes. EMDR treatment modifies disturbing images related to certain memories and turns them into regular, neutral memories and images with neutral emotional components. EMDR method is also suitable to be used for neutralising such positive memories and mental images that maintain otherwise harmful habits, which is often the case with various addictions, for example.
The starting point of EMDR treatment and coaching targeted at the future is that the person is about to face a situation perceived as challenging and they wish to be rid of the related stress. EMDR coaching turns these images about the future neutral.
What is EMDR treatment based on?
A traumatic or difficult experience is hard to deconstruct verbally and integrate into the mind, and it leaves a unique memory trace on people. Such experiences are recorded in the human brain as various bodily feelings and sensations, such as images, scents, movements, feelings, sounds and pains. This recording process into implicit (non-verbal) memory is facilitated by stress hormones. True to word, stress remains in the body and the related feelings and pain start to affect the nervous system. Being recorded in the implicit memory makes verbal processing more difficult, but stress often emerges as flashbacks, physiological reactions, hypersensitivity and nightmares. Due to this, a successful treatment of symptoms also requires desensitising of the body.
The effectiveness of EMDR has been explained with the help of Accelerated Information Processing (AIP) model. The starting point of this is a neurobiological change caused by a stress brought on by a traumatic situation, which causes a person to be unable to process the experience they have faces, leaving it in the mind as a disruptive, unprocessed information. According to the AIP model, these harmfully recorded, trauma-related memories form the basis for many various psychological symptoms. For example, being the victim of violence may trigger a fear of being outside. Other methods of psychotherapy focus on the symptom and coping with it are processed by discussing it in different ways and using different methods. In EMDR treatment, the psychological symptoms caused by the trauma are included in the treatment, but they do not have as much focus as the trauma memory.
Unprocessed memories related to the trauma include affective, bodily and cognitive elements as well as elements related to behaviour. They also include the structure of the person’s personality at the time when the traumatic situation occurred. In EMDR treatment, the aim is to discover this unprocessed memory and start its reprocessing at the same time as the person is provided with bilateral stimulant, i.e. a stimulant that activates both hemispheres of brain at the same time. Usually this is series of eye movement but sometimes also hearing or touch stimulants are used. In practise, the client above would be requested to activate their memory and the representative image of being exposed to violence, after which bilateral stimulant is provided. EMDR processing of a trauma memory causes a physiological mechanism, which activates the information process related to the memory. A successful EMDR treatment has both neurobiological and psychological effects. It turns a memory that is seen as distressing and disruptive into an emotionally neutral memory and connects it to a positive belief the person has about themselves.
Currently, plenty of research is carried out about what EMDR treatment is based on. According to the prevailing view, the mechanism of EMDR’s effectiveness is burdening the working memory with bilateral stimuli, i.e. eye movements, claps or hearing stimuli. Studies that utilise PET imaging of brain indicate that EMDR can help repair the activation level of the brain. This promotes the realisation of the memory related to the person’s trauma situation and experience of oneself in relation to this memory. Working with the EMDR method can be combined with any psychotherapeutic working method. In particular, it has been often used and researched in connection to cognitive behavioural therapy.
The stages of EMDR treatment
The EMDR treatment features different working stages. In the treatment, the mechanisms of a person’s information processing are stimulated by focusing, on one part, one the upsetting memory of the traumatic event and, on the other, by paying attention to a competitive, external bilateral stimulant, usually a series of eye movements which has a calming effect on the memory. It the basic protocol, EMDR treatment progresses in the following stages:
- The event and the related memory and mental image that will be processed through the treatment will be selected (i.e. an accident, mistreatment or similar experience).
- The client selects a mental image of the event representing the worst part of the experience (what was the most disturbing part, e.g. fear of death during the accident, feeling of worthlessness after mistreatment).
- The client will select a so-called negative cognition appropriate to the mental image, which expresses a negative belief about themselves (for example, ‘I’m in danger’, ‘I’m a bad person’).
- The client will select a positive cognition appropriate to the mental image, which is a more positive and realistic experience of themselves in the occurred situation (for example ‘I survived it’, ‘I am good enough’).
- The client will evaluate the truthfulness of the positive cognition in relation to the image selected at stage 2, using a scale from 1 to 7, where 1 = not true at all and 7 = completely true.
- The client will evaluate the disruptive strength of the memory related to the event and the mental image representing it on a scale from 0 to 10, where 10 = the largest possible disruption and 0 = emotionally neutral. Additionally, the client will always tell at which part of their body they can sense the disruption when thinking about the mental image (e.g. ‘there is a weight on my chest’).
- When the client simultaneously holds on to the worst image of the event, the negative cognition and bodily sensations, the information processing system will be activated and the desensitising of the disruptiveness of the mental image is started through eye movement series (or hearing or sensation stimuli) carried out by the therapist until the disruptiveness of the mental image is 0 or 1 on the scale from 0 to 10.
- The client’s positive cognition is instilled as a part of the image representing the event with the help of series of eye movements until the client feels that it is completely true in relation to the event.
- The client’s bodily sensations will be gone through in order to ensure that there are no disruptive feelings left. If necessary, these disruptions are removed using bilateral stimulants.
In connection to basic protocol, also other techniques are used, such as the safe place exercise and instillation and reviewing of resources. The individual needs of each patient determined the methods to be used.