EMDR: An Evidence-Based Trauma Therapy
During the covid pandemic, and subsequent lockdown, I accepted the advice of a colleague who suggested that we use our lockdown time for professional development. With limited knowledge of Eye Movement Desensitization and Reprocessing (EMDR) therapy I decided to proceed with this year-long training program, albeit with a healthy dose of skepticism.
I recall a comment from one of my master’s degree professors, citing doubt in the EMDR model when he suggested, “if resolving trauma was that easy why wouldn’t we all just go driving in the rain?” His critique pokes fun at a core component of EMDR therapy that practitioners call bi-lateral stimulation (BLS). The most common form of BLS involves the therapist waving their hand in front of the client’s visual field, back-and-forth, to activate one side of the brain and then other. EMDR theory suggests that BLS mimics Rapid Eye Movement (REM) sleep; the sleep cycle when we dream. EMDR posits that this natural physiological mechanism can be used during therapy in order to process traumatic material that became stuck at the time of a traumatic event. As my professor shrewdly noted, how does this differ from watching your windshield wipers? If metabolizing traumatic disturbance was this simple then watching windshield wipers move back-and-forth should result in similar outcomes while saving the client a significant amount of time and money, right? Since I am a skeptic by nature I shared this belief and avoided this model of therapy for years. Then I took the training.
The founder of the EMDR model, Francine Shapiro, seemed to understand the need for extensive evidence to support her approach to address fears that her approach may be moving into the realm of pseudo-psychology. After all, alternative therapies with little to no scientific evidence still attract public support and can mystify the practice of psychology and undermine our profession. Consequently, Francine began her scientific examination of the EMDR model in the late 80s and there are currently 24 randomized-controlled trials that substantiate EMDR effectiveness. After reading the research methodology, outcomes, and taking the training my skepticism started to fade and I concluded there is much more at play here than a simple windshield wiper could manage. Today, EMDR therapy is recognized as an effective treatment and is endorsed by the World Health Organization as the gold standard of treatment for trauma therapy.
EMDR is an 8-stage protocol-based therapy. The initial stages of treatment include taking a client history and resourcing to help the client manage any distressing emotions that might arise when targeting the specified trauma. For some individuals the treatment target is a traumatic memory or group of memories. For others, the target may be vague. An EMDR therapist will work with a client to determine comfortable targets to be addressed during the core part of therapy. For instance, an individual may have a clear target in mind like a car accident, or an assault. For others they may have a cluster of memories of mistreatment, neglect or abuse which can make it more difficult for a person to know where to begin. Your therapist will work with you to determine a starting point that feels manageable.
Next, the therapist assesses the worst part of the target and begins the eye movement desensitization and reprocessing phase. This phase involves sets of eye movements which replicate the REM system noted earlier. Between each set of eye movements the therapist may prompt the client with a statement, ask questions or just continue with the next set. When a therapist refers to “processing a traumatic event” it is important to describe what they mean. Trauma is stored in one’s body in state-specific form. This means that stimuli present at the time of the trauma were too overwhelming to be filtered out or effectively moved into long term memory. These stimuli include the internal and external cues associated with the trauma, sights, sounds, smells, feelings, physical sensations or thoughts about oneself and others. These stimuli represent the disturbance that a client may carry with them years after a trauma occurred. For many clients the disturbance is extreme, and can interfere with relationships, future goals, and other areas of life functioning. Processing means that stuck material begins moving again. By engaging the bi-lateral system and targeting the disturbance with therapeutic support, clients frequently report a reduction in overall distress. It is common for images to become blurry or change color, for one’s position in the trauma to change, for new thoughts about self to emerge, for expected feelings to emerge, for physiological distress to fade or memory of events that followed a trauma to become clearer. Many times a client will report that the disturbance they felt about the trauma is absent or neutral which can be liberating.
Your therapist will help you determine your readiness to proceed with EMDR work. The goal is to begin as soon as the client is fully informed, has developed resources to manage distress emotions (or to shift emotional states) and there is a clear target in mind. Since distress may initially increase once an individual begins treatment on a traumatic target it is common for EMDR therapists to schedule 90-minute sessions to ensure that a client has enough time to feel grounded prior to leaving the office.
If you hope to begin EMDR therapy you can contact a psychologist who has been formally trained. If you would like to learn more about EMDR therapy please watch the introductory videos listed below or you can go to https://emdrcanada.org/.
David Small (He/Him), MA, R. Psych.
Unit 10A, 109 Stockton Point
STN Main P.O. Box 1076
Okotoks, AB T1S 1B3