Eye Movement Desensitization Reprocessing (EMDR)
What is EMDR and How Does it Work?
EMDR is short for Eye Movement Desensitizing and Reprocessing. It was developed by Francis Shapiro and originally called EMD. Shapiro later modified her work to go beyond decreasing emotional reactivity to tap into the memory aspect of healthy processing (the “R” in EMDR) and the name is what it is today.
EMDR helps release painful emotional experiences that are trapped in the nervous system.
EMDR and REM Sleep
Though we might think that the only thing that happens while we sleep is rest and dreams, as essential as those things are, we also invoke a kind of night therapy evaluating the troubling parts of our day in an attempt to draw meaning and integrate them into our being.
Fast forward for more information on about how to prepare for an EMDR session and about EMDR costs.
This is what we often refer to as “processing” when we take time out while we are awake to “figure things out.” Well, we also do this while we sleep which probably explains the sage advice that it is a good idea to sleep on problems to get a better perspective in the morning.
For the most part, this naturally occurring ability allows us to draw meaning from our troubling life experiences. Our body incorporates the events of the day into our overall experience. It all gets “updated” against this prior experience to form a current and useful perspective on things to inform our actions in the future. At least, this the ideal outcome. All of this meaningful integration is supposed to happen during REM sleep.
We apparently go in and out of this REM (Rapid Eye Movement] period of sleep throughout the night as we alternate between regular sleep and REM sleep. Interestingly, during REM sleep, there’s another unique occurrence. Our brain halts release of the stress-related chemical, noradrenaline. In the body, this chemical is known simply as adrenaline. Perhaps this is why we don’t feel so rested when we lack time in this sleep state. There’s a little more to it than this, of course, but this is the gist of it for a good intro.
What has this to do with EMDR? EMDR mimics this rapid eye movement through hand gestures, devices or apps (now that so much counseling is in a virtual environment). In a way, it seeks to trigger this internal and organic way we have of integrating disturbing experience. As we know, not all disturbing experience is integrated. It comes back on us in the form of a “trigger.” When distressing events are “processed,” they fade with time. Painful events that are triggered feel as though they are happening right now. All over again.
Adaptive Information Processing Theory (AIP)
According to the theoretical approach upon which EMDR is based, AIP, some experiences are thought to be so overwhelming that they get “stuck” which interrupts our ability to store or retrieve the memory properly. Following this, whenever our body sees cues in our environment that evokes i.e., “triggers” the traumatic memory whether its an image, thought, smell, sound, or another aspect of that memory, it is recalled in the present in its incomplete state. This results in our feeling, seeing or experiencing this aspect with the same intensity of its original form. We lose sense of time with this “stuck” state, so our distress in the past is felt in our present.
Not Just Trauma and More Than Protocol
There’s so much interest in EMDR because its applications extend beyond trauma. There has been extensive research conducted with respect to the benefits of EMDR. It has resulted in successful treatment outcomes for many mental health conditions, including anxiety, depressive symptoms and panic disorder.
EMDR is actual therapy. It’s not just a protocol. Indeed, the World Health Organization (WHO) has identified EMDR therapy and trauma-focused cognitive behavioral therapy (CBT) as the only psychotherapies recommended for PTSD.
While commonly known as a treatment for PTSD and trauma, EMDR is also successfully used to treat a number of ailments and issues:
- Trauma or PTSD
- Chronic stress
- Eating disorders
- Chronic pain
We are currently accepting new clients for EMDR.
EMDR is an effective treatment for many Ailments and Disorders
Readiness for EMDR
How do You Prepare?
Assessment for Readiness
There’s a lot you can do on your own and with your therapist to prepare for EMDR sessions. In addition to the motivation and willingness that is helpful in most mental health treatment, EMDR requires ability to tolerate distressing material. Yes, it’s likely you are interested in EMDR therapy to manage high levels of emotion, but not being able to do so can not only jeopardize a successful outcome, but re-expose a client to traumatic memory unnecessarily.
To address this, an experienced therapist will take time to evaluate your tolerance.
Your preparation for EMDR includes support and guidance to develop strategies that help you downregulate on your own independent of your therapist.
Generally speaking, a client needs to be able to recall a distressing material without free falling into related sensations or emotions and while being able to be sufficiently present in the now to hear any therapist prompts.
These strategies include “internal” work to build up interoception i.e. your ability to perceive your inner and sensory experience . (EMDR therapists refer to this as imaginal resource development).
How EMDR is Unique
Some key things to note about EMDR which may help in your preparation:
- EMDR should not be overwhelming or retraumatize.
- You need to be able to process thoughts and emotions.
- Generally, you need at least 10-12 sessions to see the effects of EMDR.
- If therapy hasn’t worked for you, EMDR may work.
EMDR involves less verbal processing compared to other conventional treatments. (That is, you don’t have to talk about painful events in too much detail).
- Some studies show that 84%-90% of single-trauma victims no longer have PTSD after only a few sessions.
- EMDR slows down your overstimulated brain!
Ask your therapist about EMDR intensives. For some, particularly those with single event trauma, it is possible to learn skills to manage nervous system dysregulation quite quickly and complete multiple EMDR sessions over a week or less.
The EMDR Session in a Nutshell:
- Individual sessions are about 90 minutes each.
- Sessions can be on consecutive days.
- At the start, you are asked to recall and activate a negative experience that was previously discussed as a suitable target.
The therapist initiates sets of rapid eye movements (or some other form of bilateral stimulation).
You free associate so that “whatever happens, happens.” You simply let your mind go where it wants to go.
- The therapist repeats eye movements and alternates these with prompts to which you can briefly report on whatever you are experiencing.
- EMDR continues until the target memory fades into your past.
- Sessions are repeated so that there is an opportunity to check that the memory is still distant and to complete all of your target memories.
Preparation Prior to Your Session-Key Reminders:
- Review your safety plan with your provider prior to your EMDR session and have a support lined up in case you feel unusually distressed during or after your session.
- Dress comfortably.
- Have headphones on hand that you have tested prior to your session in case any visual BLS does not work for any reason.
- Make sure you have high internet speed. (If you can stream movies, you are probably ok).
- Only keep applications open on your device that you will need for the session.
“Try not to let overthinking get in the way of your EMDR. Let the brain do what it knows how to do naturally. You can’t *force* the right outcome. Over-analyzing brain isn’t helpful. You’ll get your best results from EMDR if you stay grounded, present and in a state of acceptance letting whatever happens, happen.”
What to Expect After EMDR Reprocessing
The Train of Life Experience Moving Forward
To fully appreciate the impact of EMDR and to prepare for any subsequent sessions, it’s worth revisiting the AIP theory of information processing described above. Remember, trauma “freezes” time so that some memories stay stuck in the past. When they are “triggered” they do not fully integrate subsequent experience.
So, for instance, you might find yourself fully capable in certain settings and around certain people, but a particular person or situation renders you immobile as though you were six, or shaking with tears as your body relives the embarrassment or frustration of a past event. It’s a familiar feeling from the past, but reexperienced in the present in a way that is out of touch with current reality.
Outside of traumatic episodes, we are integrating all of our experience all the time. We might not be aware until our focus is called to attention. For example, how you position your cutlery on the table at breakfast. The order in which you sample foods and drink your tea. You know what to do without thinking. This is integrated experience. You eat breakfast every day, but it’s not exactly the same process. It’s more or less the same. Today you’re out of sugar. The forks are dirty and you only have a spoon. You make small adjustments every day, yet, there’s a consistency to things so you don’t really belabor eating breakfast. This is because your body rapidly fetches and scans prior experience to calculate what you do right now so you conserve energy automating activities that don’t eat up brainpower you might need for that not-so-typical morning Board meeting. Think of EMDR as a software update that corrects any glitches in this process of automation and seamless updating.
What Integration Might Look Like
Because everyone’s trauma and vast experiences differ together with their insight into those experiences, it’s hard to determine how “integrated” experience might show up for you after an EMDR session.
Of course, the most anticipated and hoped for sign of integration is the diminishment of intense feelings around the target memory. Clients who have completed EMDR, even after a single session, typically describe feeling considerably less reactive to a target memory that was previously distressing.
After your EMDR session as the train of life experiences moves forward, you might discover:
- New insights into past events
- Recall new details about matters related or not related to the targeted memory
- New memories
- Random thoughts that feel important to you
- Disturbing or pleasant dreams
- Uncomfortable body sensations
- Shuddering or shaking
It’s hard to say what, but it’s not uncommon for people to notice something different. Clients undergoing EMDR are encouraged to note these events, triggers, whatever they are thinking or feeling, for discussion with their therapist. Many of these after session manifestations, such as shaking, are naturally occurring and part of the release of long stored energy that needs to dissipate and run its course.
Your EMDR reprocessing is not considered “complete” until these events have been evaluated with your therapist. This will occur in a follow-up session usually within a week of your EMDR reprocessing. Your therapist can guide you regarding common results and those requiring additional intervention.
“The most anticipated and hoped for sign of integration after EMDR is the diminishment of intense feelings around the target memory. Clients who have completed EMDR, even after a single session, typically describe feeling considerably less reactive to a target memory. Studies show as much as 77% success rate. Randomized studies show rapid decreases in negative emotions and/or vividness of disturbing images.”
THE COST OF EMDR -LET'S TALK MONEY
One can expect therapists trained in EMDR to charge anywhere from $100 to $300 per EMDR session. Note that some therapists charge for a single hour EMDR session.
While this might seem like a lot of money compared to a regular 50 minute talk therapy session, it actually works out to be less given the average number of sessions of talk therapy to gain traction. An intensive course of EMDR over a couple of weeks might total $1500 compared to a year of talk therapy at around $5000. In fact, EMDR is considered one of the more cost effective treatments for PTSD. Indeed, a recent 2020 study on the cost-effectiveness of psychological treatments for PTSD determined that EMDR “is the most cost-effective intervention for adults with PTSD.” In the study, EMDR was compared to somatic and cognitive therapies, self-help with and without support, psychoeducation, selective serotonin reuptake inhibitors (SSRIs), trauma-focused cognitive behavioral therapy (TF-CBT) and combined TF-CBT/SSRIs.
Options for Those With Limited Income
It makes little sense when evaluating mental well-being to discuss cost out of the context of how we might determine the cost of prolonged trauma and how we might measure treatment outcomes. Some clients look for the most affordable “right now” option and spend years in treatment with questionable outcomes. Clinician training, expertise, experience and credentials, as well as client motivation and commitment to therapy, their clinical needs and abilities also factor into what makes sense.
There are a number of ways in which we can make EMDR accessible for those for whom it might otherwise be out of reach. Here are some of the things you might discuss with your therapist based on some of the ways in which we work with individuals of varying means so they get the most out of their sessions:
- Consider appointments that are at “low traffic” hours and same day. This are often mid morning or early afternoon.
- Ask about small group work in which you join with other clients for stabilization work in preparation for EMDR.
- Utilize our in-between sessions support and stay active in your treatment.
- Consider including your family member or loved ones as support in your sessions to keep your motivation and practice level high.
- Keep cancellations to a minimum.
- Come to sessions prepared and review your treatment plan objectives/goals to help you stay focused.
- Ask about our EMDR intensives which can be done over a much shorter time than regular talk therapy. (1-4 weeks). If discussed ahead of time, a bulk discount might be an option.
- Reach out, prior to scheduling, regarding other options that might increase your access to EMDR and/or trauma therapy. Above all, consider your availability to invest emotionally and otherwise in therapy particularly in between sessions.
It takes thousands of dollars and many hours of training to be an accomplished trauma therapist. If your therapist has EMDRIA training, that signals their investment in quality training. (EMDRIA is a professional association for EMDR practitioners and researchers). Keep an open mind and remain flexible. You’re worth quality care.
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