EMDR in Sussex

EMDR is a highly effective psychotherapy, in Britain recommended by the NICE guidelines within the NHS and worldwide endorsed by the World Health Organisation. The letters stand for Eye Movement Desensitisation and Reprocessing and, although the name is a bit of a mouthful, its effectiveness makes it worthwhile to find out more about.

EMDR is over 25 years old and has good evidence base. It was invented by Francine Shapiro, an American psychologist, and was originally used to treat Post Traumatic Stress Disorder (PTSD) in Vietnam veterans.

After its success with PTSD -previously a notoriously difficult condition to treat- research has also shown its effectiveness with more common conditions, such as various anxiety problems (general anxiety, phobias, panic disorder, social and health anxiety), low mood, depression, addictions and low self-esteem.

EMDR works by helping the brain resolve past issues (such as losses, tragedies, difficult relationships and other adverse life events) so that we can stop being effected by them in the present, begin to live well and are able to face new challenges. And so EMDR is a three-pronged approach, encompassing the past, present and the future.

As human beings, we’ve been designed to make sense of the world and this is our brain’s job. And so every event, every interaction, every experience will carry a meaning for us. We interpret an event and work out what that event says about us, sometimes not consciously. Often we carry that meaning forward into our life in general and it can provide basis for our self-image.

For example, a child whose parents have violent arguments will experience intensely frightening emotions. If the experience is repeated or very significant, the sense of lack of safety might be a general belief the child adopts about themselves. Over time, this can become as a general outlook on life (“I’m not safe”) and manifest itself as various forms of anxiety in adult life.

Similarly, if significant people in our life were not sufficiently present and responsive to our needs as children, we will often assume this to mean we are not really important enough to be worth the effort. Most clients with low self-esteem or depression will have had these sorts of early experiences.

EMDR can help the brain to examine the “evidence” (i.e. our memories) from a new, current perspective, to see if the conclusions we had drawn earlier (our negative self-beliefs) really hold true.

Unlike other psychological therapies, talking about the problem alone is not the central part of the change and recovery process. What is different about EMDR is the idea of reprocessing (or coming to terms with) an event, or a series of events, which negatively affected us.

Reprocessing involves bilateral stimulation of the brain (that is sending alternating signals to both the right and the left hemispheres) while recalling an emotionally charged event from our life, which we know still affects us.

Bilateral stimulation is achieved by very simple means. The therapist might ask the client to follow the therapist’s hand while they move it, right to left, across the client’s field of vision (that’s is the eye movement element of therapy). Other methods involve listening to alternating sounds through a set of headphones or holding gently vibrating pulsars.

In the process, the originally disturbing event loses its emotional charge and no longer upsets, scares or angers us. We can think about the event with our body remaining calm. This is the desensitising element of the therapy.

Additionally, we are able to draw different conclusions from that event to the ones we originally had come to. Usually, we end up having a more balanced view on the event and our role in it. Our self-beliefs get updated to accommodate our new understanding. This is the reprocessing element of the therapy.

The central concept in EMDR is the Adaptive Information Processing (AIP), which describes how our brain works to help us survive. Generally speaking, our brain’s job is to process incoming information, make sense of it and draw appropriate conclusions to enable us to go on.

Most of the time our brain processes information very efficiently, making sense of events which happen to us. Even emotionally charged events, such as a row with a person we love, can usually be processed well. After the initial upset, we are able to think about the memory of it more calmly and we have learnt something useful from the initially painful experience.

Some events, however, are so emotionally overwhelming for us that the brain cannot come to terms with them. It needs additional help to kick-start the natural processing and this is where EMDR comes in. It gives the brain another chance to come to terms with unprocessed material.

Any overwhelmingly adverse event or set of enduring circumstances can lead to later difficulties. For example the brain can struggle with processing experiences where we felt intensely frightened. This could be because what happened defied our expectations (for example being involved in a terrorist attack) or because we felt vulnerable (for example when we are seriously injured) or because it happened when our brains were not fully developed yet (for example in childhood).

The difficult events could be traumas in the classic sense, where there is direct danger to life, such as being involved in armed combat or being a victim of natural disaster. However, other events could also affect us negatively, even if there was no direct threat to life.

These events include such experiences as early separations, illness, difficult relationships with a parent, losses of various kinds, bullying or being humiliated. Francine Shapiro called them “small-T” traumas, to distinguish them from the “big-T” traumas, which most of us recognise.

There are several theories to explain why a simple eye movement might help us gain a different perspective on the issues that trouble us.

Some experts believe it mimics the naturally occurring Rapid Eye Movement (REM) phase of sleep, where we know the brain processes recent experiences. In the REM phase our eyes spontaneously move from left to right and dreaming occurs, which is the brain’s way of digesting the events of the day. When we suffer from psychological difficulties, our sleep can be disturbed and so many people may never experience the deep sleep of the REM phase.

Another theory is that paying attention to two things at once (e.g. following the therapist fingers while recalling a disturbing memory) makes the reprocessing of information easier and quicker. It is a bit like going for a romantic dinner: if you are in a stuffy posh restaurant, with nobody there and an overly attentive waiter always hovering over the table, chances are it will be difficult to talk. If you are in a busy Tapas bar, with plenty of people, hubbub and commotion, chances are the conversation will flow. Reprocessing is a bit like having a good conversation with your brain- somehow it’s easier to talk when there is plenty going on around us.

Neuro-images of the brain taken before and after EMDR reprocessing throws additional understanding on it. Studies have shown that EMDR helps deactivate the areas of the brain responsible for danger response. In traumatised or highly anxious people these areas never “switch off”, even when there is no danger present. This allows the brain to react appropriately, rather than keep “jumping the gun” with excessive emotional response.

Most people can. Recent research has shown that EMDR can be used successfully not just for PTSD but also for other conditions where the present difficulty can be traced back to events or relationships from the past.

Studies have demonstrated excellent results of using EMDR with such conditions as depression and anxiety. Within anxiety disorders, this includes phobias, panic disorders, health anxiety, social anxiety and obsessive-compulsive disorder, as well as general anxiety disorder. EMDR has been helpful in treating complex bereavement and self-esteem issues.

Although this is highly individual, EMDR tends to be the fastest working therapy available. This is because it goes to the very heart of the problem and helps the brain resolve the issue at source.

By comparison, other taking therapies tend to help people become more aware of the origins of the problem and become adept at living with the difficulty by developing various coping strategies. EMDR helps the person resolve the original difficulty so that they no longer get triggered in the present.

The length of therapy depends on the amount of material to reprocess. If the client suffered only a few adverse events in life and had a background of good, safe and supportive early life, the reprocessing part of EMDR can take just a few sessions. Understandably, if there is more to process, the length of therapy will need to reflect this.

In my clinical experience, most highly functioning people (people who can hold a job, form good relationships, be independent) can usually resolve their difficulties within a few months of weekly sessions.

Thankfully, no. Your brain has done an amazing job of coming to terms with most of them already. The memories that still cause you disturbance are the only ones where the brain needs a little help in kick-starting the process.

The memories we work with leave us feeling bad about ourselves and they can be divided into themes. For example, we can end up believing that we are not safe or that we have no control, or that we are no good, or perhaps that we are guilty and responsible for what had happened when that’s not true. It’s been found that it is often enough to reprocess just the key memories in the theme for the other memories to become less disturbing or not disturbing at all. This is the generalising effect of EMDR which makes the therapy quicker that other treatments.

People also notice that their brain carry on quietly working outside of the reprocessing sessions while they go about their life, a little bit like a computer getting a programme update. And so often where people pick up in the next session is much further ahead from where they left it off, with no conscious effort involved. Naturally, this also speeds up the process, making EMDR very efficient.

EMDR is a fully developed form of psychotherapy, not a technique. Like with other forms of .therapy, general rules of it, such as good initial assessment, including history taking will of course apply. This can take a few sessions.

The reprocessing part of EMDR often involves experiencing strong emotions (that’s the key to its success) and so the therapist will teach the client all about feelings. Clients will find out what type of emotions there are, why we have them and how our body and brain behaves with different intensity of feeling.

Clients will learn how to cope with and regulate their emotional responses in preparation for reprocessing. To achieve that, the therapist will teach the client a variety of self-calming exercises for when we get overstimulated as well as techniques to activate ourselves when we feel numb and detached. Learning to do that is essential and takes different amounts of time with different clients.

Clients who were lucky enough to be brought up in circumstances where they were helped to manage their emotions (for example their caregivers generally responded when they were frightened or upset) can learn these techniques quickly, even within a session or two.

On the other end of the spectrum, clients who experiences prolonged neglect or abuse will naturally need a longer time to learn what they had never had a chance to achieve in childhood and adolescence.

Once we have a good understanding of what contributed to the client’s current difficulties (thorough assessment and history taking) and are confident that the client can manage their emotions well, we can start reprocessing the relevant memories.

Reprocessing involves holding the disturbing memory in mind while experiencing a form of bilateral stimulation (for example eye movements). The brain spontaneously makes new connections, it experiences and resolves past emotions and, in the end, we feel differently about the memory. We can think about it without being disturbed and we feel differently about ourselves too.

Once the past is resolved, we also attend to any present difficulties still remaining and future challenges lying ahead. This again is done using bilateral stimulation.

Currently EMDR is only offered within the NHS for Post-Traumatic Stress Disorder. The other treatment offered for PTSD is Cognitive Behavioural Therapy so you may be offered either. PTSD effects about 8% of the general population.

By contrast, depression and anxiety effect 75% of the population over the course of a lifetime. There is as yet no provision of EMDR for these more common conditions.