Eye Movement Desensitization & Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a nontraditional form of psychotherapy geared toward healing trauma and relieving psychological stress.

This treatment has primarily been used for people who have post-traumatic stress disorder (PTSD). It is now being applied to other forms of emotional or mental stress, including recovery from substance abuse.

History of EMDR Treatment for Trauma & Addiction

EMDR was first developed in 1987 to treat PTSD in a specific number of sessions. Rather than long-term talk therapy, EMDR uses the adaptive information processing model and desensitization through eye movements.

Sessions are generally held once or twice per week for a total of 6 to 12 sessions. In some cases, a participant benefits from fewer sessions. Sometimes, they benefit from going through this process over several consecutive days.

The adaptive information processing model believes that most PTSD symptoms come from past disturbing experiences that continue to cause distress because the memory has not been processed appropriately. Since the memories have been partially processed, the brain continues to reprocess certain emotions, images, thoughts, or beliefs associated with the traumatic event. When these disturbing partial memories are triggered, the mind and emotions can be flooded with reexperiencing the event.

Previous treatments using cognitive behavioral therapy focus on talking through feelings and memories as a method of reprocessing and managing the trauma. EMDR focuses on the memory directly. It uses outside stimuli to change how the memory is stored in the brain, reducing or eliminating symptoms of trauma or stress that come up.

Rhythmic eye movements and bilateral stimulation are methods of reducing the vividness and emotional pain associated with the memory, forcing the brain to reprocess the physical experience associated with the event.

The Process of EMDR Therapy

There are eight basic stages of EMDR therapy.

  1. History and treatment planning: This occurs in the first session and may recur in subsequent sessions as needed. Your therapist will review your history of trauma and medical treatment, and evaluate where you are in the treatment process.This process includes your personal feedback. You will identify potential traumatic memories to specifically treat.
  2. Client preparation: Once you have discussed the overview of the session or treatment plan, your therapist will work with you on methods of coping with any emotional or psychological stress that comes up. While talking about traumatic memories, you may reexperience some of the trauma.Since this can recur throughout the treatment process, finding ways to manage your feelings and find emotional balance will be important. Methods may include deep breathing and mindfulness. Discuss anything that does not work with your therapist, so you can focus on strategies that do work for you.
  3. Target memory assessment: This phase involves identifying specific memories to target and all the components, which are body sensations, images, cognition, and affect.There are two measures used during EMDR to evaluate emotion and cognition: the Subjective Units of Disturbance (SUD) Scale and the Validity of Cognition (VOC) Scale.
  4. Desensitization via eye movements: During this phase, you will focus on the traumatic memory while engaging in specific eye movements that your therapist will lead you through. You will then report new thoughts that emerge during this process. Your personal report will typically become part of the next round of eye movement or other bilateral stimulation (BLS).Eye movements used in EMDR are saccadic — quick, jerky, back-and-forth eye movements that redirect your line of sight, so you fix your vision on a moving object. Other types of BLS may include light tapping on both sides of the head in an alternating pattern, tapping the fingers, or blinking.This process is repeated until you report that the memory is no longer distressing.
  5. Installation: Once you achieve positive or neutral feelings from the memory, the fifth stage strengthens that preferred positive thought in association with the memory.
  6. Body scan: Once you have completed BLS and memory integration, your therapist will have you do a body scan in which you observe your physical response while thinking about the traumatic memory. Identify any residual somatic distress and report it to your therapist. This may indicate more work with BLS is needed.
  7. Closure: This ends the session in a formalized way, so you can walk out of the space without much residual stress or without associating other parts of your life with traumatic memories. This also further strengthens positive cognition associated with the therapy process.
  8. Reevaluation: As part of closure, you may reevaluate, and you may continue reevaluation at the beginning of your next session. This is a process by which your therapist evaluates your current mental state, determines if there are any lingering effects from previous sessions, and assesses if other associated memories have emerged since the last session.

Because phases 4 through 7 occur in the majority of sessions, they are often lumped together. However, it is important to understand them separately because the order in which they occur is critical to the success of EMDR.

It is possible to experience negative side effects during EMDR treatment. These should be reported to your therapist so they can be managed, and the course of your EMDR treatment can adjust to your new needs. Side effects might include:

  • An increase in distressing memories.
  • Heightened emotions and physical reactions during sessions.
  • Feeling lightheaded.
  • Vivid dreams or sleep disturbances.
  • Surfacing of new traumatic memories.

While these symptoms may resolve as treatment continues, discuss them with your therapist. You can learn new coping strategies and change the focus of your treatment if needed.

Effectiveness for Trauma & Mental Distress

Multiple independent studies have found that EMDR is an effective treatment for trauma, especially PTSD.

A study in 2012 involving 22 people found that EMDR helped 77 percent of the individuals with psychological disorders and PTSD. Hallucinations, delusions, anxiety, and depression all eased significantly after the treatment program. Symptoms were not exacerbated during treatment, although participants were asked to recall traumatic memories.

A 2004 study found that EMDR is effective not just in the short term, but also in long-term management of trauma symptoms. The study evaluated participants after they received standard care (SC) for PTSD and compared them to those participating in EMDR therapy. Researchers found that those who participated in EMDR therapy experienced less psychological stress. In follow-ups at three and six months, researchers found participants maintained these benefits.

EMDR is being expanded for use in other psychiatric treatments. One study involving 32 people undergoing inpatient depression treatment found that 68 percent of the group benefitted, experiencing a reduction in symptoms or full remission after treatment. However, the small sample size suggests larger studies are needed.

How Is It Used in Addiction Treatment?

Addiction treatment is adding EMDR therapy as a method of easing trauma associated with substance abuse. People who struggle with drugs or alcohol may have histories of childhood abuse or physical, emotional, or sexual assault as adults.

These traumatic events may have occurred prior to substance abuse, with addiction stemming from self-medication of stress from the trauma. Traumatic events could have occurred while the person was intoxicated, so the memories are even less processed. Therapists who use EMDR during addiction treatment approach the client’s experience with the trauma-focused lens, allowing the client to address the root causes of their substance abuse.

While using EMDR during addiction treatment is still in the early stages, reported benefits include:

  • Alleviating psychological stress from PTSD or trauma.
  • Easing physical symptoms associated with these conditions.
  • Decreasing or eliminating distress from the disturbed memories.
  • Improving self-efficacy and self-esteem.
  • Resolving present triggers and managing potential future triggers.

People may enter treatment for an addiction with diagnosable PTSD, so many treatment programs are integrating mental health evaluations during the first stages of admitting a new client. Adding EMDR to treat PTSD during the rehabilitation process can improve adherence to other types of therapy, improve retention in the rehabilitation program and to aftercare plans, and reduce the risk of relapse due to decreased physical and emotional discomfort.

Addiction Treatment Benefits From Multiple Counseling Approaches

There are several approaches to managing co-occurring mental illness and substance abuse. Detox and rehabilitation programs involve therapy to help you overcome cravings for substances and understand behaviors that may trigger relapse.

When other treatment approaches, like cognitive behavioral therapy and mindfulness, are added to treatment programs, the added support can help you maintain focus on sobriety and long-term health. EMDR is one option that may work for you, promoting complete recovery on all fronts.

References

Eye Movement Desensitization and Reprocessing (EMDR) Therapy. (July 2017). American Psychological Association (APA).

EMDR Therapy: What You Need to Know. (July 2019). Healthline.

Types of Eye Movements and Their Functions. (2001). Neuroscience, Second Edition.

EMDR Therapy: Everything You Need to Know. (July 2019). Medical News Today.

How EMDR Therapy Heals Trauma and Addiction. (October 2018). Psych Central.

What Is EMDR and Is It Effective for Addiction Treatment? (November 2015). The Fix.

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