Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy technique used to treat trauma. It was developed in the 1980s by Francine Shapiro and incorporates elements from different treatment approaches. During EMDR, a person recalls distressing memories while simultaneously focusing on an external stimulus like eye movements or hand tapping. This is believed to help the brain reprocess traumatic memories in a healthy way. EMDR usually proceeds through 8 phases, beginning with gathering history and assessing traumatic memories, then using bilateral stimulation during desensitization and installation of positive beliefs to reduce distress related to the memories. EMDR has been empirically validated for treating conditions like PTSD and has helped millions of people relieve psychological stress from trauma.

1. Eye Movement
Desensitization and
Reprocessing

2. What is EMDR?
⚫ “Eye Movement Desensitization and Reprocessing (EMDR) is an
integrative psychotherapy approach that has been extensively
researched and proven effective for the treatment of trauma.
EMDR is a set of standardized protocols that incorporates elements
from many different treatment approaches. To date, EMDR therapy
has helped millions of people of all ages relieve many types of
psychological stress

3. History & Overview of EMDR
⚫ Francine Shapiro, PhD, founder-1980s,1987
⚫ Adaptive information processing theory
⚫ Psychotherapeutic approach vs. technique
⚫ Requires therapist basic clinical skills
⚫ Basic EMDR protocol
⚫ Advanced protocols developed (adapted for specific
types of trauma: recent events, eating disorder, pain
issue, working with children, traumatic grief, chronic
childhood trauma/attachment issues, etc.)

5. Trauma and the Memory Processing
⚫ PTSD: persistent re-experiencing, arousal, and
avoidance
⚫ Normal brain processing is not completed,
reprocessing is needed
⚫ In comes EMDR (the desensitization to combat the
avoidance so that reprocessing can occur)
⚫ It is not in the past, and you can’t just get over
it!!!
⚫ The past is present

6. EMDR as a Trauma Treatment
► Uses the natural processing of the brain
► Traumatic memory fragmentation
► Actually treats trauma at a biological brain level
► Processing occurs at a heightened speed, not all
elements are discussed as in talk therapy
► Focus also on body /physiological reactions
► Three-pronged approach: Addresses the past
memory, current trauma reminders, and future
anticipation of trauma reminders

7. Target Populations
► Empirically researched and validated treatment for
trauma
► Evidenced-based treatment approach for Post Traumatic
Stress Disorder (PTSD)
► Anecdotal evidence for the treatment of phobia(s) and
panic disorder(s)
► Limited research exists regarding efficacy
► Recent research throws light on treatment of Depression
using EMDR
► Resilience building

8. Components of the Model
► Phase 1: History taking & Client selection
► Phase 2: Preparation Checklist
► Phase 3: Assessment
► Phases 4-7 (Reprocessing Procedures):
Desensitization; Installation; Body Scan;
Closure
► Phase 8: Reevaluation

9. Phase 1: History taking & Client
selection
⚫ The goal(s) of Phase 1 is to collect routine background
information about the client
◦ Clinicians use their typical history or intake forms (i.e. Psychosocial
Assessment);
◦ Informed consent is obtained;
◦ EMDR is explained and incorporated into the client’s treatment plan
⚫ The clinician must determine the client’s ability to engage in
the EMDR process, as well as the client’s ability to cope with
stressful situations
⚫ Oftentimes, before the EMDR process is started, the client and
clinician spend time developing resources and coping skills

10. Phase 1: History taking &
Client selection
� Adaptive Information Processing (AIP) Case Conceptualization
► The clinician assesses if current symptoms are caused by earlier, unresolved
traumatic experiences
►Single incident/single issue or symptom
►Multiple issues/symptoms
► Strengths and deficits are assessed
► “Target memories” are explored
► Coping skill building

11. Phase 1: History taking &
Client selection
► Three-Pronged Protocol
► Past
► What incidents are contributing to current problems?
► What skills are needed?
► Present
► What distressing symptom(s) is the client experiencing now?
► Future
► What does the client want to happen?

12. Phase 1: History taking &
Client selection
► Clinical concerns
► Client stability
► Rule out Dissociative Identity Disorder
► Acute presentations
► substance abuse; suicide; self injury
► Stabilization/appropriate coping skills
► Medical considerations
► Medications; eye pain
► Time considerations
► Is the client and therapist available for needed sessions?

13. Phase 1: History taking &
Client selection
⚫ Targeting Sequence Plan
◦ The clinician begins exploring dominant irrational beliefs and developing
positive beliefs that will be installed during future sessions
● Dominant irrational beliefs about the self translate in to negative cognitions (NC)
● I am a bad person
● I cannot trust anyone
● I am weak
● I deserve to die
● What the person prefers to believe about the self translates in to the positive cognition
(PC)
● I am fine as I am
● I did the best I could
● I am adequate

14. The NC is always in reference to self-
3 categories of NC- Responsibility , Safety and
Power/helplessness

15. Phase 2: Preparation Phase
► This phase takes one to four sessions for most
clients (for others with traumatized background or
other diagnoses, it can take longer)
► The therapist will be working on three main areas
► Establishing a therapeutic relationship of trust between the
client and the therapist
► Psycho-education: Explain the theory of EMDR, how it is done,
and what the person can expect during and after treatment
► Teach the client a variety of relaxation techniques for self
soothing in the face of any emotional disturbance that may
arise during or after a session (Resource Development)
► When the client is ready, therapist works with client
to identify the first target to be worked on (can be a
current trigger or past memory)

16. Phase 2: Preparation Phase
⚫ Resource Development: What does the person need to be able to
face the terrifying experience?
◦ Think of a beloved friend or family member
◦ A place of safety
◦ A comforting memory or experience
◦ A special object
◦ A quality of courage, strength, compassion, confidence, love, etc.
⚫ Using bilateral stimulation (slow movements) to reinforce positive
memory networks
⚫ Relaxation exercises & Self-soothing techniques
◦ Exercise: Calm/Safe place

17. Phase 3: Assessment
► Setting a baseline before reprocessing
► Activate memory with image
► Identify negative cognition or belief
► Create positive belief (gives hope)
► The emotions, the body, and SUDS
► TICES- trauma, image, cognition, emotion and sensation

18. Phase 3: Assessment TICES
⚫ Select a target memory
◦ “I almost drowned in a pool when I was 14 years old.
⚫ Image
◦ “The bottom of the swimming pool.”
⚫ Negative Cognition (NC)
◦ “I am not in control.”
⚫ Positive Cognition (PC)
◦ “I am now in control.”
⚫ Validity of PC
◦ Clinician utilizes 1-7 scale
⚫ Emotions
◦ Terror, out of control, “I am dying”
⚫ Physical sensation
◦ Tightness in chest, can’t breathe, stomachache
⚫ Subjective Units of Disturbance Scale (SUDS)
◦ Clinician utilizes 0-10

19. Phases 4-7 (Reprocessing Procedures):
Desensitization; Installation; Body Scan;
Closure
⚫ Phase 4: Desensitization
◦ BLS is used to process the image,till SUDS =0
◦ This part can take most of the session or multiple sessions
⚫ Phase 5: Installation
◦ BLS is used to install the PC; the goal is to have a VOC of 7
⚫ Phase 6: Body Scan
◦ BLS is used to process any physical sensations left in the body
⚫ Phase 7: Closure
◦ It is important to debrief the client and advise that reprocessing may
continue after the session
◦ Determine if containment or relaxation exercise is needed by client to
tie up loose ends

20. Phase 8: Reevaluation
� Once reprocessing of the original memory target is
complete and client returns in the next session,
disturbance related to the re-processed memory is
once again assessed
⚫ Why? Sometimes target was not completed or
other material was triggered between sessions
◦ Therapist assesses current level of disturbance
◦ If client remains at a SUDS=0, resourcing or new target may
be tackled
◦ If client shows some level of disturbance when the original
target is brought up, reprocessing continues with current
upsetting image and baseline (NC/PC do not need to be
elicited again)
⚫ Reevaluation occurs throughout course of therapy

21. Other types of Trauma
Treatment
⚫ Cognitive Processing Therapy (CPT)
⚫ Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)
⚫ Art therapy
⚫ Hypnotherapy
⚫ Structured Play Therapy
⚫ Somatic Experiencing
⚫ Trauma Focused Yoga / trauma sensitive yoga

22. Light bars are often used
to simulate the BLS
(visual)
BLS can also be simulated
while holding pulsating
devices (tactile)
Finger puppets are often
used for BLS with
children
The client
can also
listen to
music
alternating
from ear to
ear
(auditory)

23. Any questions?
Thank you!