Program Goals/Program Theory
Eye Movement Desensitization and Reprocessing (EMDR) is a therapeutic approach designed to treat individuals who are dealing with the aftermath of a traumatic life event, including children exposed to violence. The approach is guided by the adaptive information processing model. As the brain slowly processes memories of everyday life experiences, these memories are transferred to the left cerebral cortex, where they are filed away with other neutral memories, becoming part of an individual’s life story. Traumatic experiences, however, are often highly emotionally charged and can overwhelm the brain’s capacity to process information. Instead of being properly connected and stored with other memories, episodic memory of traumatic experiences may be indefinitely stored in the limbic system. Dysfunctionally stored traumatic memories can in turn lead to maladaptive coping strategies and cause intense anxiety and other symptoms of posttraumatic stress disorder (PTSD).
The goal of EMDR treatment is therefore to help individuals who have experienced traumatic stress to reprocess and adaptively store dysfunctionally stored traumatic memories. Treatment sessions focus on the past experiences that may have caused PTSD or other psychological disorders; the current circumstances that trigger dysfunctional emotions, beliefs, and sensations; and the positive experiences that can improve future adaptive behaviors and mental health.
EMDR treatment involves an eight-phase protocol that addresses an individual’s past, present, and future experience and behavior. During phase 1, treatment focuses on obtaining the individual’s history and determining if the individual is a good candidate for EMDR. If treatment is appropriate, the therapist creates a treatment plan and works with the individual to identify traumatic experiences that can be targeted for EMDR processing. During phase 2 (the preparation phase), a therapeutic alliance is established between the individual and the therapist, and the process of EMDR is fully explained. Individuals in treatment are taught about strategies to manage intense feelings of distress and to reduce stress that may occur during or between sessions. Ideally, individuals will not need to use these strategies once therapy is complete.
Phase 3 (assessment phase), involves identifying and accessing the target memory that will be processed. Therapists ask the individuals to focus on a vivid, disturbing image that represents the traumatic event and to identify negative beliefs about the self that are rooted in that experience. Individuals must create a positive cognition or belief that could replace the negative belief. The individual is also asked to notice the feelings and body sensations that may be associated with the disturbing memory. Baseline measurements of reactivity are assessed during the exercise.
During phase 4 (desensitization), the traumatic event and present stimuli that trigger the past experience are processed. Individuals are told to hold the disturbing images of the traumatic event in their mind along with the associated negative belief, feelings, and sensations in their body while focusing on external stimulus. The external stimulus is the therapists’ fingers or hands that are moved back and forth in front of the individuals’ eyesight for about 20 to 50 seconds. After each set of bilateral stimulation, individuals are asked about any changes or thoughts they experience. Through each treatment session, rating scales are used to keep track of any changes in the intensity of feelings and body sensations. As individuals focus on the traumatic experiences, the episodic memory is processed and individuals should experience noticeable shifts in cognitions, emotions, and sensations. The memory of the traumatic event can then be integrated and consolidated as a narrative memory. As a result, individuals are brought to an adaptive resolution through adaptive information processing.
In phase 5 (installation), individuals indentify the most positive belief about themselves (either the initial positive cognition from phase 3 or another one that may emerge during treatment sessions). Using bilateral stimulation, therapists help individuals increase the connection of the new positive cognition with existing positive cognitive networks. The effects can then be generalized within associated neural networks.
During phase 6 (body scan), therapists assist individuals in identifying and processing residual body sensations. In phase 7 (closure), therapists ensure individuals’ stability, and individuals are told about what they might experience between treatment sessions. The final phase (reevaluation) is the assessment that occurs at the beginning of each subsequent session. In each new session, the individual’s psychological state guides the next step of treatment.