Fear resulting from psychological trauma can be extremely deep-seated. The distress, feelings of helplessness and constant flashback of traumatic events can turn one’s world upside down, causing major problems with daily activities and quality of life. It may be easy for someone to say, “Well, why can’t you just get over it?” But in reality, we need to recognise that it is much easier said than done. In order to help people move past their traumatic experiences, researchers and psychologists have worked tirelessly, creating various therapeutic methods and tweaking them to achieve the optimal recovery outcome. In regards to the treatment of post-traumatic stress disorder (PTSD), you may be familiar with an approach known as Dialectical Behavioural Therapy. In this article, we’ll be introducing you to an alternative psychotherapy technique, also known as Eye Movement Desensitisation and Reprocessing (EMDR).
Developed by Francine Shapiro in 1987, EMDR therapy is an empirically validated treatment for trauma and other negative life experiences. While it is also increasingly applied for the treatment of other mental health conditions such as depression, anxiety or panic attacks, researchers have not found EMDR to be as effective as with trauma-related conditions. As its name suggests, EMDR isn’t all about talk therapy or medications. In a different vein from cognitive behavioural therapy, EMDR doesn’t focus on altering a client’s thought patterns or behaviours. Instead, it relies on one’s own rapid, rhythmic eye movements, allowing the brain to process memories and resume its natural healing process.
What is the Basis of EMDR Therapy?
EMDR is fundamentally based on the Adaptive Information Processing (AIP) Model. A key tenet of this model is that the symptoms of PTSD are manifested due to memories that are dysfunctionally stored or not fully processed. Memories of disturbing experiences often string along negative emotions, thoughts, beliefs and even physical sensations that were associated with them at the time of occurrence. This can bring about a multitude of unpleasant symptoms that can be exceptionally detrimental to one’s mental health.
When one is exposed to stress or trauma, the body’s automatic response would be to activate its Sympathetic Nervous System (SNS). As an adaptive system, it controls our natural fight, flight or freeze instincts, which is critical in ensuring our survival. When the SNS is activated, the individual will undergo physical alterations such as increased heart and breathing rates, decreased blood flow to the digestive system and constricted blood vessels. In addition, hormone levels including those of adrenaline and cortisol will increase dramatically, causing hypervigilance. However, for someone who is under constant stress from traumatic flashbacks, the over-stimulation of the SNS will be greatly damaging to this person’s physical health. As such, EMDR therapy aims to process memories such that the experience is remembered, but the fight, flight or freeze response is eased.
At this juncture, you may be wondering how clinician-directed eye movements could possibly alleviate trauma-induced stress. EMDR therapy involves guiding the client towards reliving triggering experiences in short phases while the clinician directs his eye movements. During the process, the client will be tasked to focus on trauma-related imagery and the relevant sensations. The clinician will then simultaneously move their finger across the client’s field of view, with each phase lasting approximately 20 to 30 seconds. This will then be repeated a couple of times. At some point, other forms of rhythmic left-right stimulation (for example, listening to tones that go back and forth between the left and right sides of your head) will also be incorporated into the therapeutic process. As distressing as it sounds, the process in fact allows for the vividness and emotional triggers of the memory to be reduced over time. When the client’s attention is diverted as they recall the traumatic event, this makes the exposure to negative thoughts and memories less upsetting, hence limiting a strong psychological response. After attending several EMDR therapy sessions (depending on the individual), the impact of the traumatic event is believed to be significantly reduced.
How is EMDR Structured?
Generally speaking, EMDR takes on an eight-phase approach.
Stage 1: History Taking and Treatment Planning
For a start, the clinician will work hand-in-hand with the client to identify the traumatic experiences which require attention. Should the client have a problematic childhood, the initial stage of EMDR may focus on resolving childhood traumas before moving on to resolve adult onset stressors. Identifying targets for EMDR treatment is also crucial – this means looking further into the client’s past memories, their current emotional triggers, as well as what they hope to achieve by the end of the treatment phase.
Stage 2: Preparation
In this phase, the clinician introduces the client to a few emotion-coping strategies to ensure that the client is well able to manage their emotional distress whenever a trigger is brought up. It is important that the client is able to deal with overwhelming emotions even between EMDR sessions in daily life. The clinician may also familiarise the client with the eye movements or bilateral stimulations.
Stage 3: Assessment
The clinician will then identify and assess the specific traumatic memories that need to be tackled. This also involves analysing the associated emotions and sensations triggered by the memories.
Stages 4 to 7: Treatment Process
These intermediate stages focus on the process of desensitisation, installation, a body scan, and seeking closure. The client is asked to concentrate on the trauma-related imagery and memory while engaged in the directed eye movements or other bilateral stimulation. After each set of stimulation, the client will be asked to clear their mind and report what they feel, think, and the sensations they experience. Depending on the individual, the clinician may have the client refocus on the same memory, or move on to another. This process is repeated until the client reports no distress.
Installation is where the clinician works with the client to increase the strength of positive cognition. This means focusing on the preferred positive beliefs, rather than negative ones. For example, an individual dealing with trauma arising from childhood domestic abuse may start off with a negative belief of “I am weak and powerless”. Installation aims to change that belief into one of “I am now in control.” Of course, EMDR does not force one to believe in something that is inappropriate or unsuitable for the situation. In the example brought up, allowing the client to realise that positive belief could mean encouraging them to take on self-defence training, or other skills that can provide them with a greater sense of security and control.
A body scan is used in order to check for any residual somatic response that is linked to event-related tension or stress. Should any undesirable bodily sensations be present, the clinician will then target them specifically in subsequent sets.
Stage 8: Evaluation
The next EMDR session begins with this phase. This stage is mainly for the re-evaluation of the client’s plight. More importantly, this step is to ensure that the necessary progress is made and to review the client’s psychological state. Further review will be carried out, and the relevant changes will be made to provide the optimal treatment effect.
Although EMDR may be a relatively new technique as compared to other forms of therapy, it is nonetheless an extensively researched method proven to alleviate the stress symptoms of trauma survivors and other individuals who have had distressing life experiences. If you think that EMDR therapy is right for you, do seek help from a mental health professional.
References:
- https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing (Accessed 18/03/2021)
- https://www.emdr.com/what-is-emdr/ (Accessed 18/03/2021)
- https://www.emdria.org/about-emdr-therapy/ (Accessed 19/03/2021)
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467776/ (Accessed 20/03/2021)
- https://anxietyreleaseapp.com/what-is-bilateral-stimulation/ (Accessed 20/03/2021)
- https://hornsveldpsychologenpraktijk.files.wordpress.com/2019/01/full-8-phase-explanation.pdf (Accessed 20/03/2021)