Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychotherapy developed by Francine Shapiro for treating trauma and post-traumatic stress disorder (PTSD). EMDR helps people heal from the symptoms and emotional distress resulting from disturbing life experiences.

EMDR therapy is based on the Adaptive Information Processing (AIP) model, which proposes that traumatic memories are not properly processed and stored, leading to ongoing psychological distress. Through bilateral stimulation (typically eye movements), EMDR facilitates the reprocessing of these memories, allowing them to be integrated adaptively.

EMDR therapy follows a structured eight-phase protocol that ensures comprehensive treatment and client safety:

• Phase 1: History Taking and Treatment Planning
  Gathering comprehensive client background information and identifying target memories for treatment. The therapist assesses the client's readiness for EMDR, identifies traumatic memories and current triggers, and develops a treatment plan. This phase includes evaluating the client's resources, support systems, and ability to tolerate emotional distress. The therapist and client collaboratively identify specific memories to target, prioritizing based on clinical judgment and client needs.
• Phase 2: Preparation
  Establishing client safety, building therapeutic relationship, and teaching coping mechanisms. The therapist explains the EMDR process, sets expectations, and ensures the client feels safe and prepared. This phase includes teaching stress reduction techniques (such as the "safe place" or "container" exercises) that clients can use between sessions. The therapist also introduces bilateral stimulation in a non-threatening way and ensures the client has adequate resources to manage emotional distress.
• Phase 3: Assessment
  Identifying specific target memories and establishing baseline measurements. For each target memory, the therapist helps the client identify: the image that represents the worst part of the memory, a negative cognition (negative belief about self), a positive cognition (desired belief), emotions and their intensity (using the Subjective Units of Disturbance scale, 0-10), and body sensations. The Validity of Cognition (VOC) scale (1-7) measures how true the positive cognition feels. This detailed assessment provides a baseline for measuring progress.
• Phase 4: Desensitization
  Processing traumatic memories through bilateral stimulation to reduce emotional intensity. The client focuses on the target memory (image, negative cognition, emotions, and body sensations) while engaging in bilateral stimulation (typically 25-30 seconds of eye movements). After each set, the client reports what they notice, and the therapist guides them to continue processing. This phase continues until the memory's disturbance level (SUD) reaches 0 or 1. The therapist allows the client's natural healing mechanisms to emerge, following the client's associations without directing the content.
• Phase 5: Installation
  Strengthening positive beliefs and replacing negative cognitions with adaptive, positive thoughts. Once the memory is desensitized (SUD = 0-1), the therapist helps the client install the positive cognition. The client focuses on the original memory while holding the positive cognition and engaging in bilateral stimulation. The goal is to strengthen the positive belief until it feels completely true (VOC = 7). This phase reinforces emotional resilience and adaptive self-beliefs.
• Phase 6: Body Scan
  Identifying and releasing residual physical tension related to the memory. The client mentally scans their body from head to toe while thinking about the target memory and positive cognition, checking for any remaining physical discomfort or tension. Any residual body sensations are targeted with additional bilateral stimulation until the body scan is clear. This ensures complete emotional processing and addresses the somatic component of trauma.
• Phase 7: Closure
  Stabilizing the client at the end of each session and ensuring emotional regulation. The therapist helps the client return to a state of equilibrium, using relaxation techniques if needed. Clients are informed that processing may continue between sessions and are instructed to keep a log of any new memories, dreams, or situations that arise. The therapist ensures the client feels safe and grounded before leaving the session. Self-care strategies are reviewed and reinforced.
• Phase 8: Reevaluation
  Reviewing treatment progress and assessing effectiveness of previous sessions. At the beginning of each new session, the therapist checks the previously processed memories to ensure they remain resolved (SUD = 0-1, VOC = 7). Any new aspects or related memories that have emerged are identified and targeted. The therapist assesses whether treatment goals are being met and adjusts the treatment plan as needed. This phase ensures comprehensive treatment and identifies any remaining therapeutic needs.

Bilateral stimulation is a key component of EMDR therapy. It involves alternating left-right stimulation that activates both hemispheres of the brain, facilitating the processing of traumatic memories.

• Visual Bilateral Stimulation (Eye Movements)
  The most traditional and commonly used method. The therapist guides the client to watch their finger, hand, or a light bar moving back and forth in a rhythmic pattern. The client follows the movement with their eyes while simultaneously focusing on the traumatic memory. Typically involves 25-30 back-and-forth movements per set. The speed and direction can be adjusted based on client comfort and effectiveness.
• Tactile Bilateral Stimulation (Tapping)
  Alternating physical touch or tapping on the client's hands, knees, or shoulders. Can be administered by the therapist or through electronic devices with handheld paddles that vibrate alternately. The "Butterfly Hug" is a self-administered technique where clients cross their arms and alternately tap their shoulders. This method is useful for clients who have difficulty with eye movements or prefer tactile stimulation.
• Auditory Bilateral Stimulation
  Using alternating auditory tones delivered through headphones, with sounds moving from left ear to right ear in a rhythmic pattern. This method is particularly useful for remote/telehealth sessions or when visual or tactile methods are not feasible. The tones can be adjusted for volume, speed, and pitch based on client preference.
• Combined Methods
  Some therapists use multiple forms of bilateral stimulation simultaneously (e.g., eye movements with tapping) or alternate between methods based on what works best for each client and situation. The key is maintaining the alternating left-right pattern while the client processes the traumatic material.

In EMDR therapy, cognitions are beliefs about oneself related to the traumatic memory. Negative cognitions represent the maladaptive beliefs formed during trauma, while positive cognitions represent the desired adaptive beliefs.