What is EMDR therapy?
Eye Movement Desensitization and Reprocessing (EMDR) is a structured therapeutic approach that has been used to treat various mental health conditions, traumatic experiences, and distressing memories. The therapy involves several stages and follows a specific protocol. The general EMDR process is as follows:
Preparation: The therapist begins by conducting a comprehensive assessment of the client’s history, trauma, and current symptoms. They establish a therapeutic relationship and ensure the client has adequate coping skills to handle emotional distress. If necessary, the therapist may teach relaxation techniques or other strategies to help the client manage anxiety during the therapy sessions.
Assessment: The therapist and client identify a specific traumatic event or distressing memory that will be the target of the EMDR session. The client is asked to bring to mind an image related to the memory, the associated negative belief about oneself, and the emotions and physical sensations associated with the memory.
Desensitization: The client is asked to hold the traumatic memory in mind while simultaneously engaging in bilateral stimulation. Bilateral stimulation can be achieved through eye movements, where the client follows the therapist’s fingers moving back and forth horizontally, or through other methods such as auditory tones or tapping. The bilateral stimulation is believed to facilitate the processing of the traumatic memory by stimulating both hemispheres of the brain.
Reprocessing: As the client focuses on the traumatic memory and engages in bilateral stimulation, their thoughts and emotions are allowed to flow freely. The therapist does not direct the content of the client’s thoughts but rather encourages them to notice any spontaneous associations, thoughts, images, or insights that arise during the process. The goal is to promote the integration of new information and adaptive beliefs that can replace the negative beliefs associated with the traumatic memory.
Installation: Once the distress related to the targeted memory decreases significantly, the therapist helps the client install positive beliefs or self-statements that are more adaptive and accurate. These positive beliefs serve to counter the negative beliefs that were previously associated with the memory.
Body Scan: The therapist guides the client in checking their body for any residual tension or discomfort related to the memory. If any physical sensations are present, additional desensitization sets may be performed until the distress is fully resolved.
Closure: At the end of each session, the therapist ensures that the client is in a stable emotional state and provides appropriate grounding techniques or coping strategies to help them manage any residual distress that may arise outside of therapy.
Reevaluation: In subsequent sessions, the therapist reassesses the progress made and determines if there are any new targets that need to be addressed. The process of desensitization, reprocessing, and installation is repeated for each target until the client achieves a significant reduction in distress and the traumatic memories become less disruptive.
The specific techniques and approaches may vary depending on the therapist and the client’s needs. EMDR therapy typically requires multiple sessions to address different targets or traumatic memories comprehensively.
Is EMDR therapy evidenced based?
Several peer-reviewed studies highlight the effectiveness of EMDR:
- Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults
This Cochrane review analyzed several randomized controlled trials (RCTs) that compared EMDR with other therapies for PTSD. The review concluded that EMDR was an effective treatment for PTSD, with similar outcomes to cognitive behavioral therapy (CBT) and other established treatments. - A multi-site single blind clinical study to compare the effects of prolonged exposure, eye movement desensitization and reprocessing and waiting list on patients with a current diagnosis of psychosis and co morbid post traumatic stress disorder: study protocol for the randomized controlled trial Treating Trauma in Psychosis
This study focused on individuals with psychosis and comorbid PTSD. It compared the effectiveness of EMDR, prolonged exposure therapy, and a waiting list control group. The results showed that EMDR and prolonged exposure therapy were both effective in reducing PTSD symptoms compared to the waiting list control group. - Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. JAMA Psychiatry
This randomized clinical trial compared EMDR, prolonged exposure therapy, and a waiting list control group in individuals with psychotic disorders and comorbid PTSD. The study found that both EMDR and prolonged exposure therapy were effective in reducing PTSD symptoms compared to the waiting list control group, with no significant differences between the two therapies.
There is a substantial body of research on EMDR, including numerous randomized controlled trials and meta-analyses. These studies represent just a small sample of the available literature supporting the efficacy of EMDR as a therapy for PTSD. Generally, EMDR therapy is covered by most insurance plans.
Can EMDR therapy help PANS and PANDAS?
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are conditions characterized by the onset of neuropsychiatric symptoms in children and adults, often associated with infections or inflammation. Interest is growing in using EMDR therapy as a potential treatment for individuals with PANS/PANDAS.
While there is limited peer-reviewed literature specifically focused on this population, given that PANS/PANDAS is frequently traumatizing in numerous ways, patients and families may want to consider EMDR therapy. The onset of disturbing and intrusive symptoms is difficult not only to the individual experiencing the illness, but frequently to family members as well. Navigating a medical system that is so poorly versed in inflammation and infection-driven neuropsychiatric symptoms can be traumatizing, especially when hospitalizations and invasive medical treatments are required.
Some clinicians have found that EMDR therapy may be helpful in relieving symptoms associated with PANS and PANDAS.
One theory is that the sudden onset of symptoms in PANS/PANDAS is often perceived as traumatic for the child and family, and that EMDR therapy may help process this trauma and reduce symptoms. Additionally, some clinicians believe that EMDR therapy may help calm the nervous system, having a positive impact on the bidirectional relationship between the immune system and the nervous system by addressing underlying stress and anxiety.
While there is limited research on the use of EMDR therapy specifically for PANS/PANDAS, some clinicians and families have reported positive outcomes, such as reductions in anxiety, OCD symptoms, and tics. As with any therapy, it is important to work with a qualified and experienced practitioner who is familiar with PANS/PANDAS and can tailor the treatment to the individual’s unique needs. It is also important to use EMDR therapy in conjunction with medical treatment as part of a comprehensive treatment plan.
For more information on EMDR therapy in PANS/PANDAS:
- Eye movement desensitisation and reprocessing (EMDR) treatment associated with parent management training (PMT) for the acute symptoms in a patient with PANDAS syndrome: a case report.
- Neuroimmune Foundation executive director and founder, Anna Conkey, interviewed the authors of the paper on use of EMDR therapy in PANS/PANDAS.
- Join the Community Room and watch an actual EMDR session in the webinar with therapist Tina Motley: EMDR 101 for Families of Children and Young Adults with PANS/PANDAS/Encephalitis.
