EMDR stands for Eye Movement Desensitization Reprocessing and this is a type of psychotherapy that I’ve become more aware of in recent months. Since a close friend of mine mentioned they had EMDR and a good podcast I listened to mentioned that she went for EMDR too. And before this podcast episode, I knew it was an effective psychotherapy but I had no idea what it actually involved and I knew there was a sort of stigma around it within the psychology community. Therefore, in this clinical psychology podcast episode, you’ll learn what is EMDR, how does EMDR work and much more. If you enjoy learning about mental health, clinical psychology and psychotherapy then you will love today’s episode.
This episode has been sponsored by Biological Psychology. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also, you can buy the eBook directly from me at https://www.payhip.com/connorwhiteley
What Is EMDR?
EMDR isn’t really a psychotherapy in and of itself, it is more of a psychotherapy technique that is designed to relieve the psychological distress associated with a client’s disturbing memories. As well as it involves a client recalling a specific negative experience while following a side-to-side visual stimulus delivered by the therapist. A client needs to do this in EMDR because the lateral eye movements that following this stimulus causes that are thought to help reduce the emotional impact of this memory. This helps the negative experience to become easier to discuss with the therapist as the memory is effectively stripped of its power to trigger avoidance behaviours and anxiety within a client.
In addition, there have been a lot of empirical studies that show that EMDR works for some clients, but it is very, very controversial. There are a lot of reasons for this but one of the main reasons is that we just don’t know how it works. There are a lot of theories that try to explain how EMDR works but there isn’t a universally accepted theory. Another reason why EMDR is controversial is because there isn’t much clear evidence that EMDR is better than other forms of exposure therapy. Since EMDR and other exposure therapies are basically the same in terms of you have a client recalling a traumatic memory in the safe environment provided by a therapist. As well as the client repeatedly talks about the event in this safe context and this leads to a decrease in avoidance and fear responses.
Personally, when I first learnt those two reasons I wasn’t very surprised, because I completely understand that EMDR is basically the same as other exposure therapies. They all follow the same principles and whilst it is good that we know EMDR works for some clients. Clinical psychology is a science after all, and we need to understand how and why EMDR works. Not just as a whole but why does it work for some clients and not others, and once we understand what are the important elements or components of EMDR then we might be able to distil EMDR and combine it with other treatment models. There is a lot of work to do in EMDR research as you’ll see later on.
How Does EMDR Work?
Whilst as I mentioned a moment ago, there are no widely accepted theories that explain EMDR, but I’m going to tell you about some of the theories. None of these are conclusive and these are all just theories, but I think having at least a basic understanding of how EMDR might work is more important here.
Therefore, EMDR is meant to be based on the so-called Adaptive Information Model and this is meant to target the way a distressing memory is stored in the brain. The idea behind this is that the experience is distressing because of how it’s stored in the brain so if you can change how the memory is stored then you can change how distressing it is to a client. As well as when these memories are triggered in the present they contain all the same emotions, physical feelings and thoughts as the experience did in the past. All because the experience wasn’t processed properly in the first place.
I’m just going to say upright that I find this theory very suspect already, but let’s continue.
Interestingly, there have been studies that have called into question whether the eye movement part of EMDR is even needed. Due to these studies suggest that EMDR actually works because the desensitisation involves recalling, confronting as well as reprocessing the aversive memories under the careful supervision of a therapist.
And you know what that’s called. It’s called exposure therapy.
On the other hand, there have been some new theories suggested in recent years to explain how EMDR works. For example, Andrew Huberman of Standford University supports the eye movements as an important part of EMDR because he proposes that the movements seen in EMDR copy optic flow and this decreases a person’s fear system as well as temporarily decreases the sense of threat that the traumatic memory holds.
Additionally, the eyes are a part of the central nervous system and research Huberman conducted shows when the eyes are relaxed, a client adjusts their inner state to match. This is supported by additional research, including a study done by Dutch researchers and published in the Journal Of Neuroscience.
Also, I want to add in this quote from Huberman that further supports his theory: “It makes sense from an evolutionary perspective. We’ve always been confronted with threats—animal threats, interpersonal threats. Forward movement is the way you suppress the fear response.” Then when it comes to the visual system, he says, “is a steering wheel and brake of the nervous system. The brain will follow the visual system in many ways.”
Overall, I think this theory makes a lot of sense because it helps to explain how EMDR works, the biological mechanisms behind it and how this has a knock-on effect for our mental processes. However, there are still other questions that have yet to be answered about EMDR’s workings. For example, the interpatient factors that explain the variance in why it works for some and not others, and this almost sounds a little reductionist in a sense. Since this theory only focuses on the biological aspects of the eye movements. It fails to explain how the social factors, like being in a safe environment of the therapist’s office, helps to explain how works.
When Is EMDR Used?
Whilst originally this therapy technique was developed to treat PTSD, it’s now used for a wide range of conditions. For instance, anxiety disorders, depression, eating disorders, some personality disorders, obsessive-compulsive disorders and a few others.
However, it’s important to note that for a client to be a good fit for EMDR, they need to be comfortable with some emotional discomfort. Also, they shouldn’t be too easily overwhelmed by their feelings and not shut down emotionally when they face discomfort. As well as clients should be able to use their emotional and cognitive resources to help them reprocess their memories.
I will just add there that I don’t think a single one of those points is actually unique to EMDR. I think they are basic assumptions of all clients going in psychotherapy because you can’t do therapy successfully if you aren’t willing to confront and process the past and you need to have a capacity for change too.
What Should Someone Expect In EMDR?
Whilst some clients might need fewer sessions, a typical course of EMDR lasts between 6 and 12 sessions that are delivered once or twice a week. With some studies showing that reprocessing a single distressing memory can be processed within three sessions.
Then after the client and therapist talk about the client’s history and the therapist explains the procedure, the two work together to decide on which past experiences will be the subject of the treatment. Afterwards, the therapist activates the distressing memory by asking the patient to visualise and/ or experience their thoughts.
I find that term “activate” quite funny because it makes it sound like the therapist has a switch into a client’s head.
Anyway, once the memory is activated, the therapist assesses the level of negative thoughts and feelings within the client about the event, and the positive beliefs the client wants to increase about themselves. Next, the therapist administers the bilateral visual stimulation.
In addition, the client can almost always expect to experience some physical and emotional discomfort here because they’ll be recalling the distressing memories. Then as the procedure continues, new thoughts and feelings will emerge and these are discussed. Also, the therapist samples the nature and level of the client’s emotional and cognitive distress as well as any physical distress.
Finally, the session ends when the client feels manageably calm and the therapist gives them instructions about how to handle any disturbing thoughts and feelings in-between their sessions. As well as in the following sessions, these begin with an assessment of the memories that might have emerged since the last treatment.
Clinical Psychology Conclusion
I have to admit that this has been a rather fun podcast episode for me because we’ve looked at how EMDR works, what EMDR is, what to expect in EMDR and more. And whilst I have made fun of EMDR in at least two sections of this episode, I think this therapy does have a place in clinical psychology. Of course, more research has to be done so we can actually understand how it works because psychology is a science and we have to use empirical tools in therapy. Also, there needs to be more research into how EMDR is different to other forms of exposure therapy because I am personally not convinced it’s as different as it claims to be.
However, at the end of the day, there will be clients that need EMDR to improve their lives, decrease their psychological distress and function clinically normally. My friend’s proof of that and so is the podcast host that I listen to from time to time. I think as long as we admit the limitations, we try to fix the limitations and we don’t overstate how effective or great EMDR is compared to other therapies. Then this is a good compromise because EMDR is good for some people, but it isn’t for others. And even for the people who it works for, we just don’t know why.
And that little bit of controversy is why psychotherapy can be important, fascinating and seriously fun to think about.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Biological Psychology. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also, you can buy the eBook directly from me at https://www.payhip.com/connorwhiteley
Have a great day.
Clinical Psychology References
Balban, Melis, Erin Cafaro, Lauren Fletcher, Marlon Washington, Maryam Bijanzadeh, A. Lee, Edward Chang, and Andrew Huberman. “Human Responses to Visually Evoked Threat.” Current Biology, 31, no. 3 (November 25, 2020): 601-12. https://doi.org/10.1016/j.cub.2020.11.035
Davidson, P. R., & Parker, K. C. (2001). Eye movement desensitization and reprocessing (EMDR): a meta-analysis. Journal of consulting and clinical psychology, 69(2), 305.
Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Clinical Practice Guidelines for the Treatment of Post-Traumatic Stress Disorder, American Psychological Association, https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing
Ironson, G., Freund, B., Strauss, J. L., & Williams, J. (2002). Comparison of two treatments for traumatic stress: A community‐based study of EMDR and prolonged exposure. Journal of clinical psychology, 58(1), 113-128.
Lycia D. de Voogd, Jonathan W. Kanen, David A. Neville, Karin Roelofs, Guillén Fernández and
Erno J. Hermans. “Eye-Movement Intervention Enhances Extinction via Amygdala Deactivation.” Journal of Neuroscience 3 October 2018, 38 (40) 8694-8706. https://www.jneurosci.org/content/38/40/8694
Oren, E. M. D. R., & Solomon, R. (2012). EMDR therapy: An overview of its development and mechanisms of action. European Review of Applied Psychology, 62(4), 197-203.
Rodenburg, R., Benjamin, A., de Roos, C., Meijer, A. M., & Stams, G. J. (2009). Efficacy of EMDR in children: A meta-analysis. Clinical psychology review, 29(7), 599-606.
Seidler, G. H., & Wagner, F. E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychological medicine, 36(11), 1515-1522.
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