Imagine you had a bike accident…

Imagine you had lived a not too crazy life and you loved riding your bike each day which was good because you also needed your bike to get to work. One day you had a painful bike accident and in the following weeks you found yourself afraid to get back on your bike. This was making it difficult to get to work and causing significant stress in your life.

Then you heard about EMDR…

Then you heard about an approach called EMDR (Eye Movement Desensitization and Reprocessing) which might help. So you went to see a therapist trained in EMDR. The therapist turned out to be friendly and very skilled and knowledgeable. After some sessions getting to know you and assessing whether EMDR was a good fit for you, you both agreed to proceed with the standard EMDR therapy protocol.

First you learned resourcing…

The therapist began by teaching you a number of resourcing interventions including:

Making sure your support network was adequate.
Visualizing and connecting to a positive scene that feels safe and peaceful.
Learning to get fully present in the room by noticing the colors, sounds, textures, smells around you.
Thinking of people you know who are protective, nurturing, and wise.
The therapist also included some calming techniques from models such as Cognitive Behavioral Therapy and mindfulness.

Then you process the memory…

Having no problems with the resourcing, or complicating concerns from your history, the therapist and you decide to proceed in the next session with the EMDR processing work. The therapist explains that EMDR is a model that is based on applying bi-lateral (side to side) eye movements while thinking about a target memory. Sometimes the processing happens quickly, other times it may take some time to resolve. Emotions may fluctuate strongly but as processing occurs, the memory will gradually begin to feel more calm, organized, and ‘in the past.’

The next session you begin with some resourcing as previously practiced and then proceed with processing the bike accident memory. The therapist stays tuned in to you and helps keep you grounded as you process through the memory. They coach you to simply follow their hand motion with your eyes from side to side as you think about the experience. You are surprised by how each short set of bi-lateral eye movements brings forth a range of emotions and thoughts. The therapist pauses between each brief set of eye movements to check in on how you are doing. To your surprise by the end of the session, you can think about the bike accident memory and it no longer creates tension, anxiety, or stress. It simply feels like another past memory. You no longer have the belief that “riding my bike is extremely dangerous”, but now feel a new belief along the lines of “I need to be careful but I can ride and be ok.”

To your pleasant surprise…

The next day you decide to try riding your bike. At first you are a little bit nervous but not panicky like before. You start easy with a short ride around the block. Pretty soon you are feeling quite comfortable and are ready to head to work. You ride to work, somewhat more cautiously than before and with new knowledge and accurate awareness of how risky the road can be but not with panic or dread.

There you have it.

This is an example of a successful round of EMDR therapy for resolving a particular single incident trauma. I and many therapists have seen a lot of sessions like this where traumatic experiences were resolved using EMDR. As you will learn, there are many cases where things are more complicated and require more time and care, however, EMDR can be an amazingly effective treatment.

What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) is one of the most well researched and effective treatments for processing both large and small traumatic memories. It was developed in the late 1980’s by Francine Shapiro. Since then EMDR has become one of the most heavily researched therapy models in teh world and has been shown in many clinical studies to resolve symptoms of Post Traumatic Stress Disorder and to be effective for treating a range of other issues.

Common uses of EMDR include:

Trauma-Related Disorders:
Anxiety Disorders
Mood Disorders
Eating Disorders:
Addictions and Substance Use Disorders:
Stress and Pain

Further research: If you are interested in a deeper look into the extensive research around EMDR, the Mental Health Academy website and the EMDR Institute website provide additional explanation.

More Uses of EMDR:

Since it’s development in the late 1980’s a lot of trained clinicians have experimented with additional uses for EMDR and various ways to modify the standard protocol to meet the needs of particular groups. Some of these pioneers have developed ways of using EMDR that go beyond the typical treatment uses including:

Addressing early life attachment losses
Working with Complex PTSD and dissociation
Performance enhancement
Stress reduction
Group models of EMDR processing
Super brief EMDR type modalities such as the Flash Technique

Examples of EMDR “cousins”:

There are now also models that have roots in EMDR but are different enough that they are not technically considered part of the umbrella of EMDR therapy. These would include models like

Accelerated Resolution Therapy (ART)
Brain Spotting

Understanding the Standard EMDR Protocol

The standard protocol for EMDR was developed by a woman named Francine Shapiro during her doctoral research in the late 1980’s. The full history of it’s development is traced on the official EMDRIA website here: https://www.emdr.com/history-of-emdr

The standard EMDR protocol involves some preparation work to develop some basic containment and grounding skills, establish a therapeutic alliance. It also includes a history taking phase to understand what processing work will need to be done and to establish an initial plan. It also involves assessing for potential concerns that might require a modified version of EMDR. Once everything is checked and ready the processing work can begin. This is where the eye movements come in.

EMDR relies on what founder Francine Shapiro calls bi-lateral stimulation. In other words, shifting input from one side of the body to the other. This is typically done by moving the eyes side to side while looking straight ahead. Other ways of applying bi lateral stimulation include holding hand held buzzers that buzz first on one side and then on the other back and forth. EMDR combines thinking about a particular target and then applying bi-lateral stimulation (BLS). Typically the BLS has a calming effect and seems to expand associations to positive memory networks. In the preparation phases the therapist applies BLS to positive memories or thoughts which typically strengthens the client’s connection to the positive aspects of what they are focusing on. Once the preparation phase is complete clients are free to move forward with processing material.

Why is EMDR Effective?

The fact that EMDR can be and is effective for resolving a wide range of problematic symptoms is not in question, but has been proven by hundreds of research studies. The questions are more: 1) Why is it effective? And 2) Whether it is the best fit in your particular case.

Researcher and psychologist Dr Bruce Ecker argues in his seminal book Unlocking the Emotional Brain that EMDR like other effective psychotherapy models seems to promote a key process in the brain known as memory reconsolidation. In short memory reconsolidation is the process wherein the brain activates, unlocks, and updates an unresolved memory such that the old learnings/feelings/associations are updated in an adaptive way. For a more full explanation on what it is and how it works, please see my post on memory reconsolidation.

EMDR’s wide ranging effectiveness is likely due to the fact that a significant range of symptoms like anxiety, depression, addiction, etc. can be traced back to the unresolved beliefs, emotions, somatic feelings, and assumptions lingering in unprocessed memories. When used appropriately and skillfully EMDR can be very effective for processing and resolving these problematic beliefs, emotions, sensations, and assumptions. Effectively updating these memories can then in turn really help resolve the associated symptoms.

Is EMDR appropriate for me?

After taking multiple advanced EMDR trainings from recognized EMDR experts and having used EMDR both personally and professionally a lot since 2016 it is clear to me that the standard out of the box EMDR protocol is great for a large percentage of people but there are also many people for whom EMDR either needs to be modified, combined with other models, or held in reserve until certain key objectives are met. Let me try to explain some simple guidelines to give you a general sense of whether standard EMDR may or may not be a good fit for you. Note that this list is not exhaustive and you should always get specific recommendations from a highly qualified mental health professional who is both familiar with EMDR and with your situation.

Standard EMDR therapy may be a good fit for:

People with a fairly stable childhood dealing with isolated traumatic events such as a car accident, etc.
People with low levels of internal defenses

Standard EMDR may not be a good fit for:

People who needed to “forget” a lot of stuff in their childhood in order to cope with chronic problems.
People who have a lot of internal compartmentalization to the point that significant parts of their memory seem to be inaccessible and disconnected from other parts. The technical term for this is dissociation. It is a brilliant survival strategy but needs to be worked with carefully, especially when it comes to using EMDR.
People who can’t remember much of their childhood should probably be slow to jump into EMDR.
People who have significant difficulty connecting to their own body.
People who tend to panic when they start to relax may need adjustments or other interventions prior to using EMDR.

What is the Problem With the Standard Protocol.

According to trainings I have taken from EMDR expert Dr Sandra Paulsen, here is the big danger with using EMDR: EMDR is associational. In other words, it works largely by making connections in the brain (and body) that speed the processing of material. The speed with which EMDR can promote associations is great when it speeds the integration and processing of an unprocessed memory. However, it is dangerous when there is a big pile of unprocessed material behind a dissociative wall. In these cases sometimes EMDR can essentially punch a hole in the wall and start associating into a big pile of unresolved material that the person is not in a good position to fully deal with. Once this hole has been punched, it is difficult or impossible to fully close it back up again. This can lead in some instances to a lot of intense emotional processing work that a person may not have the internal and external resources and time to adequately address. In short, the danger of EMDR if there is a large pile of dissociated material is that it will cause this material to come out in ways that feel flooding or overwhelming.

Over the years I have taken advanced training in EMDR including multiple advanced courses in how to apply EMDR to complex situations like dissociation, attachment issues, and somatic work.

What to Expect:

Preparation and Resourcing

Forms of BLS

Side to side eye movements
Side to side sound with headphones
Hand held tappers that vibrate one then the other.
Tapping ones own knees or shoulders such as the butterfly technique.

Processing Memories and Material

The processing phase of EMDR typically involves calling to mind the memory that has been chosen as the target for that session. The client identifies the image that represents the scene, as well as associated negative beliefs and feelings, and the level of distress. They also identify a positive belief that they would prefer to believe instead of the old negative belief. Typically at the beginning the negative belief feels very true and the positive belief feels distant.

Next the client thinks about the negative memory while applying short sets of either eye movements, hand held tappers, or tapping side to side themselves. After each short set the client checks in with the therapist about what is coming into their awareness. They don’t have to share everything, just a simple check in about whatever they want to share. Whatever is coming up, the therapist typically says simply, “go with that” or “notice that” and then moves forward with another set of BLS. This pattern continues until over time, the negative aspects of the experience shift and resolve and new positive and adaptive changes take place. Sometimes strong emotions or feelings will arise along the way as material emerges that needs processing but over time these typically resolve. Towards the the end of successful processing the distress level will be down to 0 or 1 out of 10, the negative belief will no longer feel true. Once this has occurred the client focuses on what they would prefer to believe instead. This positive belief now becomes the focus during sets of BLS until the positive belief feels very strong. The therapist will then scan the body for any tension which will be processed using BLS. Clients then have the option to create what is called a future template by imagining how they would like to handle this situation in the future. Sets of BLS are applied until they feel confident about their ability to handle the situation going forward.

Dealing With Blocks

Even in the standard EMDR process there can be times when blocks come up and the processing seems to stall. EMDR has a range of tools for working with this that are beyond the scope of this article but which a trained practitioner will know how to do. I also integrate models such as Laurel Parnell’s resourcing interventions or Internal Family Systems related interventions to work with blocks.

Complex Situations:

As noted above there are also times when standard EMDR is not a good starting point for people because there is too much of a risk of causing emotional flooding for the person. In these cases it is very important to move slowly and carefully and to have a clinician skilled in working with complex PTSD, dissociation, and trauma informed interventions. These concerns are very resolvable but need some dedicated support, expertise and patience.

Closing Thoughts: Is EMDR Really New?

When we step back and think about it, applying bi-lateral eye movements or stimulation while thinking about a concern or problem is not anything new. Humans have been doing this for as long as we have walked. In fact, this is how Francine Shapiro discovered EMDR. She was walking in a rose garden and thinking about something upsetting. Suddenly she realized the concern no longer bothered her. She went back and thought through what she had been doing just previously and realized that she had been moving her eyes quickly from side to side. She tried thinking about another problem and moving her eyes back and forth in the same way and found it also resolved. She then began experimenting with eye movements on friends and research participants which were also effective. This gradually developed the protocol which became the standard EMDR protocol. If we think about it, humans have always walked everywhere and as we walk we naturally move our eyes from side to side. Neuroscientist Andrew Huberman explains that this typically has a calming effect on the brain. Footsteps, drumming, and other forms of bi-lateral stimulation are also a longstanding part of human behavior. No doubt humans have instinctively known for much of history the healing and calming effects of bi-lateral input. Interestingly in the modern world many people are perhaps deprived of these key ingredients. Many of us walk very little, drum very little, and rarely allow ourselves un-distracted freedom to muse and think about things while walking, drumming or dancing.