EMDR

EMDR was initially developed as an individual treatment for people with post-traumatic stress disorder (PTSD), but it has since been applied in the treatment of many other conditions. For example, it is used by some therapists to treat anxiety disorders, including panic and phobias, depression, dissociative disorders, eating disorders, obsessive-compulsive disorders, and some personality disorders.

To be a candidate for EMDR therapy, patients must be able to tolerate some emotional discomfort and not shut down emotionally or become too easily overwhelmed by feelings. Patients must be able to call on cognitive and emotional resources to reprocess their memories successfully.

Expect a course of treatment that consists of six to 12 sessions, typically delivered one or two times a week, although some people may need fewer sessions. Studies suggest that a single distressing memory can be processed within three sessions.

After taking the patient’s history and explaining the procedure, the therapist helps the patient decide which past experiences will be the subject of treatment. The therapist then activates a disturbing memory by asking the patient to visualize or experience thoughts, feelings, or body sensations related to the event. Once a memory is activated, standard protocol calls for the therapist to assess the level of negative feelings and thoughts regarding the event as well as positive beliefs about oneself the patient wishes to bolster, and then to administer the bilateral visual stimulation.

Patients can expect to experience some level of emotional and physical discomfort while recalling distressing memories. Throughout the procedure, as new feelings and thoughts emerge and are discussed, the therapist samples the level and nature of emotional and cognitive distress and any somatic distress. Sessions end when the patient feels manageably calm, with instructions on how to handle disturbing thoughts and feelings between sessions. Subsequent sessions always begin with an assessment of memories that may have emerged since the previous treatment.

EMDR is based on the so-called Adaptive Information Processing (AIP) model and is said to directly target the way a distressing memory is stored in the brain. The assumption is that past disturbing experiences continue to cause distress because they were not adequately processed, and when such memories are triggered in the present, they contain all the same emotions, thoughts, and physical sensations as the initial experience.

Despite evidence that the technique works, there is no definitive explanation for how it does so. Several theories exist. It may be that by asking patients to recall the distressing memory and engage in eye movements at the same time, the dual tasks tax working memory so that when the memory is reconsolidated, it is done so in a weakened form. Or the reconsolidated memory may become weakened by recall of the traumatic memory under less-threatening conditions.

Another theory proposes that the lateral eye movements mimic the eye movements that naturally occur during REM sleep, with reduced activation of the amygdala, allowing the brain to reintegrate the memory with less emotional charge as it reconsolidates it. Still another theory suggests that the eye movements of EMDR activate the autonomic nervous system (ANS) and induce relaxation, signaling the brain that the recalled memory is no longer dangerous.

It's also been suggested that the lateral eye movements mimic optic flow, the sense of forward movement as in walking, and that signals safety to the brain, deactivating the amygdala and uncoupling the emotional charge of the memory as it is reconsolidated in the brain.

As with any form of therapy, it is important to seek a therapist with whom it is possible to establish clarity of communication and a sense of good fit. In addition, experience counts, so it is advisable to seek a therapist who has had extensive training and experience using EMDR to treat patients presenting with mental health concerns such as yours.

You might ask a prospective therapist such questions as:

• How often have you dealt with problems such as mine before?
• How do you know whether a patient is a good candidate for EMDR?
• How does EMDR work?
• What is a typical plan of treatment, and how long is a typical course of therapy?
• How do you measure progress?

Good as EMDR may be, it is just one tool. Any good therapist has more than one tool available. It is advisable to seek a therapist who is skilled as well in other therapy techniques, such as cognitive and behavioral therapy, exposure therapy, and more.