EMDR

Recently somebody asked about EMDR. This blog has always responded with information and this was a reply from a PhD in the Seattle area. I pass it along for recreational and informational purposes. This is VERY serious technique and is not for everyone. Take care to find a true and accredited professional who is prepared to work with your healthcare professional to avoid any negative repercussions

Are you familiar with EMDR, eye movement desensitization and reprocessing?  What is it and will it make me acknowledge and move on or away from the thoughts and situations that bother me?

EMDR is a recognized but largely un-researched form of therapy dealing with PTSD.  The science behind it is that when we are asleep Rapid Eye Movements occur in deep sleep when the brain is still active processing.  I trained under Dr Francine Shapiro in 1989, but I am not certified in the formal program,  and occasionally do a form of desensitization to work with individuals that need to deal with pervasive and persistent thoughts or memories.

I prefer to do a form where the client is under their own control and can also use the technique themselves at home - instead of once a week in the office.  Done the way that Shapiro recommends the therapy only exists in the controlled circumstance of the clinical setting, with up to twelve sessions to start with!  We have also discovered that there are other repetitive techniques that work just as well and are not nearly as intrusive. 

The issue is to define what are called "Significant Units of Distress" (SUD )  and then to get the brain to automatically deal with them whenever they occur by desensitizing using hand movements, noise ( such as rhythmic tapping ), or breathing instead of cognition or thought.  So it is a form of conditioned response to a stimuli ---- a similar phenomena exists when a behavior is extinguished by snapping an elastic band on the wrist until the sensation outweighs the craving or impulse.

Obviously I have no problem teaching you -  but you may want to think very carefully if you want to learn to turn your brain off around those thoughts.  The motivation has to be very secure ---- you can't do it halfway.  That is you can't say that you want the thoughts to go away when you are living your day-to-day life but want to examine the thoughts when you are feeling angry because you still have unanswered questions.   This means that you have learned a brain process which eventually will kick in automatically whenever you go near, or think about, a stimulus.  True cognitive behavioral programming. 
 
What is an EMDR® session like?
First, client and therapist work together to collect basic information about the traumatic experience. The most disturbing part of the incident is identified and becomes the processing target. Example: Image of the rapist’s face. The negative belief connected to the trauma is identified. Example: I’ll never get over this. And a preferred, positive belief is named. Example: It’s over, I can move on with my life now. Next, client is asked to rate (on a 1-7 scale) how true the positive belief feels when paired with the target. Usually it does not feel very true at this point. Client is asked to name the emotions the target elicits, to rate the associated distress level (on a 0-10 scale), and to locate the disturbance in the body. Example: Fear and shame, with disturbance level 10, in belly and chest. Then, client is asked to hold in awareness the target, the negative belief, and the disturbing body sensations. At the same time, the therapist guides the client’s eyes to move rapidly back and forth. This is done in sets, which may last from a few seconds to a few minutes. During each set the client is instructed to just notice whatever changes occur in mind and body, without controlling the experience in any way. Very often, in the first few sets there is an increase in the disturbance level. After awhile, with each new set, the target becomes less and less disturbing and the positive belief feels more and more true. The target is completely processed when recall of the image no longer brings up disturbing emotions, and the preferred positive belief feels totally true. Example: Client recalls that the rapist’s face was threatening then but does not feel threatened by the image anymore. (Bilateral audio tones are an alternative to eye movements)

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Subjective Units of Disturbance (SUD)

It hurts.
That's right, and on a scale of 1-10 how bad?
EMDR has patients rate their Subjective Units of Discomfort (SUD) at beginning of treatment, and during its course. Not only does this operationalize the presenting problem, but gives the practitioner a means of tracking progress. The rating of the presenting problem in an objective manner, also prevents the subject from denying the significance of positive change when it occurs .
An initial treatment goal--which I point out for those yet unfamiliar with the optimistic expectations of what I'll call "edge therapies"--is bringing even an SUD rating of 9 or 10 down to a 1.

Desired Positive Cognition (VOC scale)

EMDR has patients rate the power of their belief(s) on a Validity of Cognition (VOC) scale (1-7). For example, let us say that an individual has experienced a traumatic event involving a family member from which nightmares are still occurring years later. The individual rates discomfort (SUD) as a "nine"; and there's an accompanying negative belief: "I'm worthless." The latter sufferer may know rationally, and desire emphatically to believe: "I am a powerful and resourceful human being." But what EMDR wants to happen, is that the individual BELIEVES that with the conviction indicated by a strong self-rating, for example, "six," on the VOC scale. Again, the EMDR clinician wants a SUD of "one" or "two" before initiating work with the positive cognition.

Technique

In its simplest form, the technique itself, involves an individual 1) holding in mind a representative image (pictures, sounds, feelings) of "the problem," while 2) watching a clinician's left-right hand or finger movements in short sets.
After each set, the patient/client describes what happened. The original image (sound, feeling, etc.) may change. And the clinician tracks movement in a positive direction. There are several ways in which this "positive" movement may be determined.
A client may report that the original image significantly changed in a way that makes it less troublesome, for example, the image moved farther away, or changed from color to black-and-white. The client may report a decrease in SUD rating. The clinician might note a shift in nonverbal behavior, perhaps fuller, relaxed breathing, or decrease in muscle tension.
Again, the goal is a SUD of 1. As the targeted cognition changes and decreases in negative effect, other targets may surface. Each successive target is then exposed to the EMDR technique.