The Steps of EMDR Therapy for Trauma and Other Issues
What is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) is a well-researched, evidence-based therapy for treating PTSD, C-PTSD, anxiety, and other trauma reactions. During EMDR, you select a trauma memory to focus on while doing bilateral stimulation, such as eye movement or holding alternating vibrating buzzers in your hands. Bilateral stimulation can last from 15 seconds to over 30 seconds. During this time, your brain is holding onto the traumatic memory while allowing the brain to associate with other memories and connections.
EMDR is different from other forms in that it depends less on talking through a traumatic memory. Instead, you hold a memory in your mind while doing bilateral stimulation. This helps reduce the vividness of the memory, and the intensity of emotions related to the memory. This process allows you to create new connections in understanding the memory.
What happens in the body during trauma?
EMDR is based on our understanding of how your body’s nervous system responds to a traumatic event. When a traumatic event occurs, your body’s sympathetic nervous system (SNS) kicks into gear. It secretes adrenaline which turns on your body’s fight or flight response. This system gets your heart beating faster, moves blood to your muscles for a quick response, and increases your blood pressure. Your body is aroused and ready to respond to the threat. Sometimes in trauma, our bodies get stuck in this state of arousal, even when the threat has passed.
When this happens, the body may have trouble regulating its arousal. Things unrelated to the trauma may remind the body of the trauma. It could send it into an aroused state—these are triggers. Perceiving being rejected, ignored, or criticized by others can send the body into a stress response as it was during the trauma. We can understand these reactions as the body getting stuck in the stress response. The trauma is stuck in the body. This leads to dysregulation and an aroused nervous system when no threat is present.
How does EMDR therapy work?
EMDR identifies distressing thoughts, emotions, and behaviors related to the trauma. It uses the brain’s natural healing processes to process and desensitize distressing memories or thoughts. Our brains have natural ways of recovering from distressing experiences. The brain uses the amygdala, the hippocampus, and the prefrontal cortex to understand trauma and EMDR creates new neuronal connections in these parts of the brain in order to understand the trauma differently. As we say in psychology, what fires together wires together! When we create new connections, we create new ways of feeling.
EMDR accesses unprocessed traumatic memories to create new connections in our brains from new learning during EMDR processing. During EMDR, we process through intense emotions to resolve the stress response. Instead of being stuck in a stress response, we resolve the trauma that was stuck in the body. This helps your brain and body learn that it is safe and can relax. The brain still remembers the event, but the memory no longer hijacks the stress response system.
What is EMDR used to treat?
EMDR is an evidence-based therapy for treating reactions to trauma. This includes PTSD, C-PTSD, Acute Stress, and anxiety related to the trauma. It is also proven to be effective with a variety of other mental health issues, including grief and loss, anxiety disorders, depression, and relational trauma.
What are the steps of EMDR therapy?
EMDR is client-centered and focused on working on issues identified by the client that are distressing and dysregulating. At the beginning of EMDR therapy, we identify past, present, and future memories and events that create distress for us and the associated thoughts and beliefs that come up when thinking about the memory or event. Then we create a plan for processing, usually from less distressing to most distressing memory or event. Before processing, we spend a lot of time doing Resourcing. This is learning different types of coping and regulation skills. Skills that are used to calm down or contain the emotion that is brought up during processing.
Resourcing includes different types of grounding and breathing exercises, visualization exercises of a peaceful place, or visualizations of building a container for difficult memories so they don’t pop up when we don’t want to think about them. Resourcing is a crucial step for EMDR so that you feel equipped to cope with thoughts and feelings brought up by thinking about the trauma.
You are always in control during EMDR therapy.
After Resourcing, we decide together on an event or memory to process through. You are always in control—you can say stop at any time you feel overwhelmed with emotion or when you need a break. At the beginning of this stage, we access and activate the memory or event that you have selected, identify the associated negative beliefs and emotions, and begin processing through bilateral stimulation. Once we have processed through the event and it feels less distressing, we install the new adaptive belief associated with the memory. This is the way you would like to feel about what happened or about yourself related to the memory. We strengthen your belief in this adaptive thought by tapping and rating how much the belief feels true for you.
Afterward, we do a body scan to check for any residual tension in the body. We also process any sensations left in the body related to the memory or event. Finally, every session ends with Closure, or a time to reflect on the processing of the day. We use self-calming and regulation strategies to regain a sense of equilibrium and containment. The final phase of EMDR is Reevaluation or Integration where we consider moments in the past, present, or future when having these new connections and your new adaptive belief will be helpful. We may prepare for future situations related to the trauma, do a mental rehearsal for a future situation, or process through future events when our adaptive belief will be useful.
What is my approach to EMDR therapy?
I use EMDR to treat many types of mental health issues. These issues include trauma, depression, anxiety, grief and loss, and PTSD. I tend to integrate EMDR with other types of therapy such as attachment-focused therapy, CBT, relational therapy, and mindfulness practices. I also emphasize bottom-up processing techniques, such as movement, paced breathing, and touch.
Can EMDR be done Online?
EMDR has been researched and shown to be effective via telehealth. Throughout the pandemic, I did EMDR with my clients online and saw lots of success, at times doing full courses of therapy completely online. When doing EMDR online, I tend to use eye movement, whereas when doing EMDR in person, I use vibrating buzzers for bilateral stimulation. Both are effective at processing traumatic memories and events.
Want more information? Here are some resources about EMDR.
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy
Waking the Tiger: Healing Trauma
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Other Therapy Services Offered at Flourishment Psychology in Los Angeles
As a part of individual therapy at Flourishment Psychology, I offer treatment for both anxiety and trauma. Additionally, I provide support that is tailored to women and therapists. I also offer family therapy, clinical training, and corporate wellness training. For more about Flourishment Psychology check out our FAQs and Blog!