Eye Movement Desensitization and Reprocessing: Treatment

Eye movement desensitization and reprocessing (EMDR) is a treatment procedure that addresses the unwanted effects of traumatic stress. EMDR was developed by psychologist Francine Shapiro following a personal discovery that focusing on distressing material while her eyes were moving from side to side resulted in a reduction in distress. She tested and experimented with this effect and developed a treatment protocol that is delivered in eight stages. The first two stages involve reviewing the client's history and assessing their preparedness for EMDR. This includes assessing the nature of any current and past traumas and the client's ability to be able to engage in the process. A critical part of this assessment phase is to determine whether the person has the emotional resources to tolerate the therapy and to ensure that satisfactory rapport can be established. The therapist also ensures that the client's more basic needs, such as physical safety, are taken care of before treating the distressing memories.

In the third phase, the therapist assists the client in identifying positive memories associated with feelings of safety and calm. These are used if the treatment triggers too much distress once the reprocessing of the memory begins. The therapist also focuses the attention of the client on the crucial aspects of the traumatic memory. This includes a detailed description of images associated with the event, the meaning the client attaches to the memory, and the associated emotions. Once the negative meaning of the event has been determined, the therapist assists the client to think of an alternative positive idea that the client might be able to believe once they are no longer bothered by this experience.

In Stage 4, the client is then asked to focus on the key aspects of the targeted traumatic memory and simultaneously engage in an attention task; typically, this is tracking the therapist's finger as it moves across the person's horizontal field of vision. Sometimes the therapist may also use other tasks that involve sensory experiences in a bilateral manner such as auditory tones delivered to each ear or tapping with alternate hands. This bilateral stimulation is repeated for approximately 25 seconds, then the therapist asks for a report on what the client has experienced. The stimulations are then continued using standardized procedures until the client reports no emotional distress. In this phase of the treatment, each session typically lasts for 1.5 hours.

In Stage 5, the client is asked to think of a positive belief regarding the incident and to focus on this idea while continuing the bilateral stimulation. This is continued as long as the client reports an increasing sense of this idea being true.

Stages 6 and 7 involve an assessment that the desensitization and reprocessing has stabilized and any residual distress is targeted. In the final stage, the client imagines possible future scenarios that they feel may cause distress. The therapist focuses on these events and uses the bilateral stimulation to reduce any anticipated anxiety and enhance the client's positive self-belief with regard to this future experience.