How EMDR Works: 8 Phases of Treatment
What is EMDR? EMDR is an 8 phase, research-based, treatment approach proven to reduce the symptoms of PTSD. Through treatment, you reduce the dissonance, or disagreement, between your logical and emotional perceptions of both the past and current events. When you have finished EMDR you will be able to recall the traumatic event with an awareness that it was traumatizing, but no longer experiencing the emotional or physical reactions along with that awareness.
What to Expect with EMDR Treatment
Phase 1: Resourcing for Resilience During this phase, you will learn more about EMDR and what to expect throughout the treatment process. Additionally, you will develop resources to increase your confidence and sense of calm. These resources can be utilized both in and out of sessions to reduce distress in overwhelming situations and increase your ability to regulate emotions effectively. Finally in this phase you will learn visualizations and physical techniques to utilize between sessions to reduce distress and contain the upsetting memories. The resourcing phase typically takes place during both the assessment appointment and one to two, 55-minute appointments, but can take longer for individuals working to increase their emotional stability prior to beginning EMDR.
Phase 2: Target Planning This phase will involve building on the information already gathered during your initial evaluation appointment. Your therapist will collect an extensive history, looking for significant life events and drawing connections between the events from your past and the symptoms that brought you to treatment today. A treatment plan is then developed, with your EMDR therapist, to identify (1) the current situation(s) causing you distress, (2) the memories from the past that created the current distress, and (3) the skills and beliefs needed to be successful in future situations. These will be the targets you will work to process throughout your treatment. The process of target planning typically takes place in two to three, 55-minute appointments and is revisited throughout treatment as new information arises, and additional target planning is warranted.
Phase 3: Target Activation In this phase you will access the target incident. You will start this process by recalling specific or symbolic images of the selected incident. You will then work with your therapist to identify the negative belief about yourself, as you recall the incident. Often people find that they logically know the negative belief is untrue, but they experience an emotional reaction to the belief, indicating unresolved feelings. After identifying the negative belief, you will notice the emotions and physical sensations that arise when thinking of this memory and belief. You will rate the intensity of these reactions on a scale of 0-10. You then chose a positive belief that you would like to replace the negative one. It is important that the positive belief be a realistic reflection of present day circumstances. For example, the negative belief may be “I'm not safe” while the positive belief could be “I am safe now.” Once identified, you will rate the positive belief on a scale from completely false to completely true. The assessment phase typically takes 10-30 minutes and will be revisited for any additional memories that need to be targeted.
*The goal of your EMDR treatment is to reduce the negative emotional and physical response to 0 and increase strength of the positive belief to completely true.
Phase 4: Desensitization Desensitization is the work of your brain reducing the distress and increasing the positive belief for the identified trauma. This shift is done through the use of bilateral stimulation (BLS). BLS can be done by having you follow back and forth with your eyes, holding tapers that buzz back and forth in your hands, or even wearing headphones that beep on alternating sides. This stimulation of the brain allows you to make significant changes in the way you think and feel about your trauma, in a very short amount of time. These changes are similar to the changes that you might have the morning after an argument. There are likely times you have woken up and noticed a sense of calm or understanding that you did not have the night before. Logically however, this change does not make sense. You didn't get new information or have a conversation with the person who upset you; nothing changed. But while you slept your brain took the information that you already had, and used it to create new perceptions of the already completed situation. This allowed you to develop new insights and reduce the negative emotions attached to it. Through EMDR you will attain similar results; shifting your perceptions and reducing your distress.
Clients coming to treatment with a single-event trauma often are able to complete phases 4-8 in 4 to 6, 55-minute sessions.
Phase 5: Installation Once your distress about the past trauma has been eliminated you will work with your therapist to increase the strength the positive belief. BLS is continued in this phase while focusing on the memory and the new positive belief.
Phase 6: Body Scan Once you have completely installed the new positive belief you will scan your body for any physical reactions or distress. Even when we logically have moved past a trauma and believe the positive belief, it is not until the physical reactions are resolved that we are truly able to move past the traumatic event.
Phase 7: Closure At the conclusion of each session, time is dedicated to returning to a state of calm in your thoughts and body so that you can return to your day. The closure process will take 5-10 minutes at the end of each session.
Phase 8: Reevaluation At the beginning of subsequent sessions your therapist will begin by reassessing your treatment goals, noting any insights or effects following your previous session and revisiting your target memory assessing for any changes since the last session.
Future Templates Following the completion of a target memory you will use the newly strengthened positive belief(s) to build your skills and confidence in difficult future situations. Often 3-5 future templates can be completed in a single session. The 3-prong approach of EMDR includes the Resolution of distress around the memory from the past; resolving the symptoms currently experienced; and increasing your sense of capability in future situations with future templates. Addressing all three areas allows you to move forward without the negative impact of the events from your past dictating your emotional experience or decision making.
What to Expect with EMDR Treatment
Phase 1: Resourcing for Resilience During this phase, you will learn more about EMDR and what to expect throughout the treatment process. Additionally, you will develop resources to increase your confidence and sense of calm. These resources can be utilized both in and out of sessions to reduce distress in overwhelming situations and increase your ability to regulate emotions effectively. Finally in this phase you will learn visualizations and physical techniques to utilize between sessions to reduce distress and contain the upsetting memories. The resourcing phase typically takes place during both the assessment appointment and one to two, 55-minute appointments, but can take longer for individuals working to increase their emotional stability prior to beginning EMDR.
Phase 2: Target Planning This phase will involve building on the information already gathered during your initial evaluation appointment. Your therapist will collect an extensive history, looking for significant life events and drawing connections between the events from your past and the symptoms that brought you to treatment today. A treatment plan is then developed, with your EMDR therapist, to identify (1) the current situation(s) causing you distress, (2) the memories from the past that created the current distress, and (3) the skills and beliefs needed to be successful in future situations. These will be the targets you will work to process throughout your treatment. The process of target planning typically takes place in two to three, 55-minute appointments and is revisited throughout treatment as new information arises, and additional target planning is warranted.
Phase 3: Target Activation In this phase you will access the target incident. You will start this process by recalling specific or symbolic images of the selected incident. You will then work with your therapist to identify the negative belief about yourself, as you recall the incident. Often people find that they logically know the negative belief is untrue, but they experience an emotional reaction to the belief, indicating unresolved feelings. After identifying the negative belief, you will notice the emotions and physical sensations that arise when thinking of this memory and belief. You will rate the intensity of these reactions on a scale of 0-10. You then chose a positive belief that you would like to replace the negative one. It is important that the positive belief be a realistic reflection of present day circumstances. For example, the negative belief may be “I'm not safe” while the positive belief could be “I am safe now.” Once identified, you will rate the positive belief on a scale from completely false to completely true. The assessment phase typically takes 10-30 minutes and will be revisited for any additional memories that need to be targeted.
*The goal of your EMDR treatment is to reduce the negative emotional and physical response to 0 and increase strength of the positive belief to completely true.
Phase 4: Desensitization Desensitization is the work of your brain reducing the distress and increasing the positive belief for the identified trauma. This shift is done through the use of bilateral stimulation (BLS). BLS can be done by having you follow back and forth with your eyes, holding tapers that buzz back and forth in your hands, or even wearing headphones that beep on alternating sides. This stimulation of the brain allows you to make significant changes in the way you think and feel about your trauma, in a very short amount of time. These changes are similar to the changes that you might have the morning after an argument. There are likely times you have woken up and noticed a sense of calm or understanding that you did not have the night before. Logically however, this change does not make sense. You didn't get new information or have a conversation with the person who upset you; nothing changed. But while you slept your brain took the information that you already had, and used it to create new perceptions of the already completed situation. This allowed you to develop new insights and reduce the negative emotions attached to it. Through EMDR you will attain similar results; shifting your perceptions and reducing your distress.
Clients coming to treatment with a single-event trauma often are able to complete phases 4-8 in 4 to 6, 55-minute sessions.
Phase 5: Installation Once your distress about the past trauma has been eliminated you will work with your therapist to increase the strength the positive belief. BLS is continued in this phase while focusing on the memory and the new positive belief.
Phase 6: Body Scan Once you have completely installed the new positive belief you will scan your body for any physical reactions or distress. Even when we logically have moved past a trauma and believe the positive belief, it is not until the physical reactions are resolved that we are truly able to move past the traumatic event.
Phase 7: Closure At the conclusion of each session, time is dedicated to returning to a state of calm in your thoughts and body so that you can return to your day. The closure process will take 5-10 minutes at the end of each session.
Phase 8: Reevaluation At the beginning of subsequent sessions your therapist will begin by reassessing your treatment goals, noting any insights or effects following your previous session and revisiting your target memory assessing for any changes since the last session.
Future Templates Following the completion of a target memory you will use the newly strengthened positive belief(s) to build your skills and confidence in difficult future situations. Often 3-5 future templates can be completed in a single session. The 3-prong approach of EMDR includes the Resolution of distress around the memory from the past; resolving the symptoms currently experienced; and increasing your sense of capability in future situations with future templates. Addressing all three areas allows you to move forward without the negative impact of the events from your past dictating your emotional experience or decision making.
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