EMDR Therapy

[Siúil a Rúin]

This is online info about EMDR (Eye Movement Desensitization and Reprocessing)
It's purpose is to enable to mind to process traumas that have been suppressed. It treats PTSD on all levels from war trauma to car accidents. The process connects the frontal cortex with the deep limbic system and amygdala. In that way the deep fears can be connected to the judgment processing center of the brain and reset with peaceful and positive sensations. It does this by triggering the deep brain through the external cues of REM sleep. This is done by alternating sensations between the hemispheres of the brain through eye movement back and forth, a sound cue alternating between the ears via headphones, or tapping alternately on the knees.

http://www.emdr.com

http://www.emdria.org

http://www.emdrnetwork.org/description.html

There has been research done on this to demonstrate its process through brain scans and to determine its long-term effectiveness. It is a real "meat-and-potatoes" kind of therapy. It is like the psychological equivalent of physical therapy in that it can be painful and very direct, and yet resets the damage in the system.

This thread can be set up as a discussion of pros and cons to this therapy if anyone knows enough background on it. It can also be a place to discuss experiences with it to whatever extent people feel comfortable.

 

[Comeback Girl]

I've heard a therapist tell about working with this. She said 'nobody knows how it works, but it works' and that it's highly effective within just a few sessions, way better than CBT. However, she still preferred using CBT, because it would keep her clients coming back longer, making sure she'd earn enough cash.

 

[Aquarelle]

I've done a bit of this combined with tapping therapy, and it did seem to help for my anxiety.

 

[Siúil a Rúin]

I've heard a therapist tell about working with this. She said 'nobody knows how it works, but it works' and that it's highly effective within just a few sessions, way better than CBT. However, she still preferred using CBT, because it would keep her clients coming back longer, making sure she'd earn enough cash.

It may be that they have done more research on it since you spoke with her. There may also be aspects of it that are not understood. I hope we can explore more of the research in this thread.

I've done a bit of this combined with tapping therapy, and it did seem to help for my anxiety.

That is good to hear. I know quite a few people with anxiety and PTSD issues, so I've started the process partly to be a guinea pig in hopes of it helping them after they see me do it. The problem with traumatized people is that something like this can be a bit scary.

I've had three sessions, including one long session. I feel like it is the first therapy I've had that really digs in and has the potential to help with what I need. I've done talk therapy and it was useful, sometimes pragmatic in its help for big life decisions and issues. I felt like most talk therapy helped to maintain my needs in the current situation, but there wasn't a long-term effect of correcting the problems in my mind. I'm hopeful for this process.

I use the alternate knee tapping by the therapist because I tend to intellectualize sight and sound. Feel is more visceral for me. I'm keeping a scrapbook of sorts with the images that come to my mind during the process. After the session, I look up images on google and print them off. I find this helps me see the progression of symbols/memories. I find this therapy to be an excellent match for deep traumas that are not remembered clearly. The danger of trying to identify the memories through hypnosis is that the imagination can twist these. This process does not claim to extract repressed memories, but focuses on the "felt-sense" that the past trauma caused. The images that come to my mind are like a dream in which some are clearly imaginary, some are more concrete like a memory, and most are somewhere inbetween. It is fascinating to me to be in this conscious dream state and able to report each image as it passes through my mind. I'm also a little intimidated by it because it has rather powerful effects on my mind. That is part of my motivation to start this thread. It's a way to learn more and share it with other people who have/will benefit from it.

 

[Stanton Moore]

I've had EMDR therapy. I've also had 'energy' therapy (which included tapping on meridians). I found both to be very beneficial. I can't tell you how they work, but they do for me.

 

[Comeback Girl]

It may be that they have done more research on it since you spoke with her. There may also be aspects of it that are not understood. I hope we can explore more of the research in this thread.

It was a year ago. But that therapist was a rather uneducated one. She graduated back when psychologists didn't need as much degrees to work independently as they do now and she kept working at the same level, never getting any more education. If I had the same degrees as she does, nobody would even consider hiring me.

 

[Ivy]

I had EMDR about 9 years ago. It was for a very specific purpose (my first birth experience was traumatic, so when I was expecting my second child I feared giving birth again). It worked well for me- I was able to go into my second child's birth with no fear and had a healing, positive experience that time.

I was very skeptical before undergoing the therapy. It sounded really pseudoscientific to me. But I was desperate and willing to try it since I figured it couldn't harm me. I was already reliving those traumatic experiences involuntarily every time I thought about birth again, so being asked to relive them under guidance was no more anxiety-provoking than what I was already going through. It helped that I trust my therapist implicitly and was able to reach a deeply relaxed state with her guidance.

 

[Siúil a Rúin]

EMDR definitely produces an altered state that has been researched. The degree of this altered state is a bit intense - enough so that I can feel a bit intimidated. I've done four sessions so far and they produce rather striking images. Perhaps it works better for some minds than others?

 

[Siúil a Rúin]

The Wikipedia sections I linked to contain a plethora of citations to actual published literature. That literature suggests that EMDR only works to the extent that it mimics exposure therapy. There is no evidence that any of the rest of the claims are true.

So how do you use exposure therapy with sexual trauma? serious question.

 

[Siúil a Rúin]

This looks like one method: http://en.wikipedia.org/wiki/Cognitive_processing_therapy

How about repressed trauma which has been suppressed into the body as chronic pain.

The problem for me is that my beliefs about my own traumatic event are perfectly profound - forgiving even. That doesn't stop my chronic pain or felt-sense about it.

Not all traumas are created equal and 12 session is not typically enough for dealing with repressed and repeated trauma events. I do appreciate the info, and the only personal investment I have in EMDR consists of four session which provided some interesting information I don't have access to through other methods. It is a wakeful dream state filled with pronounced metaphorical images and possible memories. So far it helped me realize how much anger I also have in my subconscious which wasn't available to me. It is entirely possible that it won't help me, and that it is as bogus as MBTI I suspect I'll try CPT as well if it seems more helpful. The only thing I know I don't want is to try to retrieve repressed memories as facts.

Edit: I"m curious why you are so against EMDR? Is it the wiki link alone or are you in the mental health professions? negative experience with it?

 

[Siúil a Rúin]

The reason is that it has very obvious problems with regards to the scientific method. This implies that every professional that developed it and utilizes it has a lack of understanding of the scientific method. That does not create a safe space for trying to heal a mind.

That's an interesting perspective and I get it to a large extent, but because perception plays such a strong role in the mind, that means one most look at the level of the individual and not just the statistical level for determining cures.

The meta-analyses in the wiki link you provided are primarily what suggested that EMDR was only as effective as immersion therapy to the degree it imitated it. If these meta-studes did not distinguish between different sorts of trauma, then this could be a problem for delineating what is the most effective treatment for a specific issue.

Totally agree, don't do that! I recommend practicing self-control as a way to slowly rewire your brain back to the way it used to be before it responded to the trauma.

That makes perfect sense for adults who experience trauma, but when it happens to children, then you are dealing with a different process. There may not be a time before the mind responded to trauma, or if there was a time, it was a mind that had different hardware, perceptions, and processes from an adult. I was age two. These developmental traumas would reasonably require a different approach than adult traumas, especially single event, depersonalized traumas.

What you are saying makes a lot of sense for trauma from a car accident or something similar. I personally overcame debilitating driving anxiety through exposure therapy with some guidance from a counselor, but mostly it was just me making myself do it. It was so clear, linear, direct, that it was possible to draw a line from A-->B and figure out how to fix it and it did fix it to about 90%. From a functional standpoint it was a success. Even though the driving anxiety could have been linked to something earlier on, there were other factors during adolescence and adulthood that could reasonably have exacerbated it, so it was a much different case.

http://neuro.psychiatryonline.org/article.aspx?articleID=102021

 

[drpattijane]

Beware wikipedia! All the info is not correct, and I know for certain that the info on EMDR is not completely reliable. As for the scientific method, EMDR is a psychotherapy which has been empirically validated in over 24 randomized studies of trauma victims. It is considered one of the three treatments of choice for trauma (along with CBT and PE) by organizations such as ISTSS (International Society for Traumatic Stress Studies), American Psychiatric Association, American Psychological Association, Department of Veteran Affairs, Department of Defense, Departments of Health in Northern Ireland, UK, Israel, the Netherlands, France, and other countries and organizations.
See Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press. EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR “A” rating for adult PTSD.

And as noted in the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR “traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them.” Given the reluctance of many combat veterans to divulge the details of their experience, as well as other trauma survivors, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains.

As for the eye movements, a number of International Practice Guideline committees have reported that the clinical component analyses reviewed by Davidson & Parker (2001) are not well designed (International Society for Traumatic Stress Studies/ISTSS; DoD/DVA). Davidson & Parker note that there is a trend toward significance for eye movements when the studies conducted with clinical populations are examined separately. Unfortunately even these studies are flawed. As noted in the ISTSS guidelines (Chemtob et al., 2000), since these clinical populations received insufficient treatment doses to obtain substantial main effects, they are inappropriate for component analyses. However, as noted in the DoD/DVA guidelines, the eye movements used in EMDR have been separately evaluated by numerous memory researchers. These studies have found a direct effect on emotional arousal, imagery vividness, attentional flexibility, and memory association.

The World Health Organization now has "Guidelines for the management of conditions that are specifically related to stress. (Geneva, WHO, 2013)
Trauma-focused CBT and EMDR are the only therapies recommended for children, adolescents and adults with PTSD. Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework."

 

[baccheion]

Have you tried brainwave entrainment with affirmations? How well does it work compared to EMDR?

 

[Siúil a Rúin]

Beware wikipedia! All the info is not correct, and I know for certain that the info on EMDR is not completely reliable. As for the scientific method, EMDR is a psychotherapy which has been empirically validated in over 24 randomized studies of trauma victims. It is considered one of the three treatments of choice for trauma (along with CBT and PE) by organizations such as ISTSS (International Society for Traumatic Stress Studies), American Psychiatric Association, American Psychological Association, Department of Veteran Affairs, Department of Defense, Departments of Health in Northern Ireland, UK, Israel, the Netherlands, France, and other countries and organizations.
See Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press. EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR “A” rating for adult PTSD.

And as noted in the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR “traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them.” Given the reluctance of many combat veterans to divulge the details of their experience, as well as other trauma survivors, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains.

As for the eye movements, a number of International Practice Guideline committees have reported that the clinical component analyses reviewed by Davidson & Parker (2001) are not well designed (International Society for Traumatic Stress Studies/ISTSS; DoD/DVA). Davidson & Parker note that there is a trend toward significance for eye movements when the studies conducted with clinical populations are examined separately. Unfortunately even these studies are flawed. As noted in the ISTSS guidelines (Chemtob et al., 2000), since these clinical populations received insufficient treatment doses to obtain substantial main effects, they are inappropriate for component analyses. However, as noted in the DoD/DVA guidelines, the eye movements used in EMDR have been separately evaluated by numerous memory researchers. These studies have found a direct effect on emotional arousal, imagery vividness, attentional flexibility, and memory association.

The World Health Organization now has "Guidelines for the management of conditions that are specifically related to stress. (Geneva, WHO, 2013)
Trauma-focused CBT and EMDR are the only therapies recommended for children, adolescents and adults with PTSD. Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework."

Thank you for all this information! I'm pretty new to the concept, but I am working with a therapist that I am comfortable with and trust.

It feels like this is the first time I'm able to get at some of this information in a manner that matches the type of issue that it is. It's helpful to not feel like I have to draw out any repressed memories, but can just describe a lucid dream-state. I get a lot of clear images and metaphors during the process. My positive image that came to me was a little girl and teddy bear which I now use as a screen saver.

 

[drpattijane]

Thank you for all this information! I'm pretty new to the concept, but I am working with a therapist that I am comfortable with and trust.

It feels like this is the first time I'm able to get at some of this information in a manner that matches the type of issue that it is. It's helpful to not feel like I have to draw out any repressed memories, but can just describe a lucid dream-state. I get a lot of clear images and metaphors during the process. My positive image that came to me was a little girl and teddy bear which I now use as a screen saver.

Fia, working with a therapist with whom you're comfortable and trust is essential! So you're already a "step ahead" in your process. I'm a psychologist who uses EMDR as my primary treatment psychotherapy and I've also personally had EMDR therapy for anxiety, panic, grief, and “small t” trauma. As a client, EMDR worked extremely well and also really fast. As an EMDR therapist, and in my role as a facilitator who trains other therapists in EMDR (certified by the EMDR International Assoc. and trained by the EMDR Inst) I have used EMDR successfully with panic disorders, childhood sexual/physical/emotional abuse and neglect, single incident trauma and complex/chronic PTSD, anxiety, depression, grief, body image, phobias, distressing memories, bad dreams and more...

I wanted to say more on this blog about the actual experience of EMDR. So Fia, you probably already know most or all of what I'm writing. It's really crucial that the therapist spends enough time in one of the initial phases (Phase 2) in EMDR that involves preparing for memory processing or desensitization (memory processing or desensitization - phases 3-6 - is often referred to as "EMDR" which is actually an 8-phase psychotherapy). In this phase resources are "front-loaded" so that you have a "floor" or "container" to help with processing the really hard stuff. In Phase 2 you learn a lot of great coping strategies and self-soothing techniques which you can use during EMDR processing or anytime you feel the need. You learn how to access a “Safe or Calm Place” which you can use at ANY TIME during EMDR processing (or on your own) if it feels scary, or too emotional, too intense (like the image of yourself as a little girl with a teddy bear). So if you start feeling overwhelmed or that it's too intense, you can ground yourself (with your therapist's help in session, and on your own between sessions) and feel safe enough to continue the work. In my practice, after the Phase 2 work lets us know that my patient is safe enough and able to cope with any emotion and/or physical sensation both during and between EMDR processing sessions, I often suggest we try a much less intense memory first if there is one that happened BEFORE the trauma(s). If there isn't one, then I suggest we start developmentally with the least disturbing memory and work our way "up" to the most disturbing event(s).

Grounding exercises are indispensable in everyday life, and really essential in stressful times. Anyone can use some of the techniques in Dr. Shapiro's new book "Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR." Dr. Shapiro is the founder/creator of EMDR but all the proceeds from the book go to two charities: the EMDR Humanitarian Assistance Program and the EMDR Research Foundation). Anyway, the book is terrific. It's an easy read, helps you understand what's "pushing" your feelings and behavior, helps you connect the dots from past experiences to current life. Also teaches readers lots of helpful techniques that can be used immediately and that are also used during EMDR therapy to calm disturbing thoughts and feelings.

One of the key assets of EMDR is that YOU, the client, are in control NOW, even though you likely were not during past events. You NEVER need re-live an experience or go into great detail, ever! You NEVER need to go through the entire memory. YOU can decide to keep the lights (or the alternating sounds and/or tactile pulsars, or the waving hand, or hand/knee tapping - all forms of bilateral stimulation that should be decided by the client for the client's comfort) going, or stop them, whichever helps titrate – measure and adjust the balance or “dose“ of the processing. During EMDR processing there are regular “breaks” and you can control when and how many but the therapist should be stopping the bilateral stimulation every 25-50 or so passes of the lights to ask you to take a deep breath and to say just a bit of what you’re noticing. The breaks help keep a “foot in the present” while you’re processing the past. Again, and I can’t say this enough, YOU ARE IN CHARGE so YOU can make the process tolerable. And having a therapist who is experienced in the EMDR techniques helps make it the gentlest and safest way to neutralize bad life experiences and build resources.

Pacing and dosing are critically important. So if you ever feel that EMDR processing is too intense then it might be time to go back over all the resources that should be used both IN session and BETWEEN sessions. Your therapist can use a variety of techniques to make painful processing less painful, like suggesting you turn the scene in your mind to black and white, lower the volume, or, erect a bullet-proof glass wall between you and the painful scene, or, imagine the abuser speaking in a Donald Duck voice... and so forth. There are a lot of these kinds of "interventions" that ease the processing. They are called "cognitive interweaves" that your therapist can use, and that also can help bring your adult self's perspective into the work (or even an imaginary Adult Perspective). Such interweaves are based around issues of Safety, Responsibility, and Choice. So therapist questions like "are you safe now?" or "who was responsible? and "do you have more choices now?" are all very helpful in moving the processing along.

In addition to my therapy practice, I roam the web looking for EMDR discussions, try to answer questions about it posted by clients/patients, and respond to the critics out there. It's not a cure-all therapy. However, it really is an extraordinary psychotherapy and its results last. In the hands of a really experienced EMDR therapist, it's the most gentle way of working through disturbing experiences.

 

[Siúil a Rúin]

[MENTION=19605]mingularity[/MENTION], I still don't quite get why you are so passionate against EMDR. I don't think the meta-studies are a definitive dismissal for a couple of reasons. Firstly it says that EMDR is a source of help, but suggests that immersion therapy and cognitive behavioral therapy are moreso, that EMDR is helpful to the extent it mimics these others therapies. It is not saying that it is definitively ineffective. It says that it mimics effective forms of therapy, so a most negative interpretation would be that it is less effective, but has still measured as having a level of effectiveness.

My husband doesn't post here anymore, but he is an extremely high level complexity scientist, and so I asked him a bit about this question. (I realize that is some appeal to authority, but without equal knowledge and experience, it is unlikely to understand a subject on the same level, so authority means something in a rational context). He does meta-studies and explained to me the difficulties of getting accurate and meaningful results from meta-studies because each study uses a different metric and attempts to prove somewhat different results. To equalize those metrics and results is no small challenge and even studies published in high level journals are not always demonstrating an accurate result.

Finding a trusted client-therapist relationship is not easy. That is actually the most important step in the process (assuming that the therapist is at least proficient). If your trusted therapist is expert in cognitive-behavioral, then it makes sense to use that approach. If their expertise is in EMDR, then it makes sense to use that approach.

I don't think you effectively dismissed drpattijane's presentation of EMDR. You have not demonstrated an expertise in these different approaches, which is why your passionate dismissal seems a bit confusing to read.

I find the meta-studies on therapies for trauma to be especially problematic just because I know for a fact that different sorts of trauma require different approaches. I can see that there could be a completely reasoned argument that EMDR is not most effective for some type of trauma, but I am not seeing evidence that it is ineffective for all types of trauma. The more I read, the more I see it is a perfect match for my particular sort of trauma because it is especially intangible and yet effects me every moment of every day. The therapist isn't really doing anything "to me". The alternating hemisphere sensation does help to open up an altered state, but it is one I am in control of, and it is all just me gaining information about my mind. I have worked with five therapists over the years and this is the first time I feel like I'm actually getting access to information and a felt-sense of what underlies my generalized anxiety disorder and chronic pain.

In each session I get tons of images, probably because I'm rather imaginative as an artist. At the end of the session, my therapist reads over all the notes she has taken and I record that. Then when I come home I look for comparable images online, print them off, and make a scrap book. It is like a process of dream images, and some are metaphors like in a dream, some are accompanied by strong feelings, and there are moments of heightened concrete details that could plausibly be actual memories, but in this context I don't feel responsible to establish memories, so I just leave the images in a subjective interpretation. This is exactly what deeply repressed trauma needs to do. It is intangible, indistinct, subjective, and so the process and interpretation needs to match the nature of the issue. There is no immersion therapy that can emulate someone sexually and physically harming a toddler. You can't recreate that scenario, and I can't even talk about it because it is only surrounded by facts that strongly insinuate this, evidence of psychological harm in me, but a complete inability within myself to concretely connect all of this.

I've used intense will power my entire life and it isn't enough. I have more will power than most people probably, but the nature of my trauma increases pain, fatigue, and creates decision fatigue. The nature of the problem breaks down the will to fight it, so it needs additional support. It cannot be fixed with mental force. At least in my case I can swear that is an accurate evaluation.