What is EMDR as Used in Trauma and Addiction Treatment?

EMDR (Eye Movement Desensitisation and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. EMDR is based on physiological as well as psychological principles. EMDR incorporates eye movements [and other forms of bilateral stimulation] into a range of standardised psychological procedures, in a structured and systemic manner, stimulating the neural pathways that help the brain to put information “in context”.

Dr Francine Shapiro, a clinical psychologist, originated EMDR Therapy after discovering the effects of eye movements on memory in 1987. In Shapiro’s model, psychopathology (mental and emotional disorders), are viewed as heavily related to memory. Unprocessed memories (such as traumatic ones which overwhelm the individual) can result in problems with cognition [thinking], emotion [feeling] and behaviour (acting). The disruption of healthy information processing in the brain by traumatic events  causes the memory of the event to be  held in a state specific form as stable episodic memory associated with high levels of autonomic arousal– which basically means that memory of the event remains the same as when it happened causing the person to experience very disturbing feelings.

How Does EMDR Work?

Eye movements (or other forms of bilateral stimulation) are used during one part of each session. After the clinician has determined which memory to target first, he or she asks the client to hold different aspects of that event or thought in mind and to use his or her eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision.  As this happens, biological mechanisms involved in Rapid Eye Movement (as found in REM sleep state) cause internal associations with the memory to arise and the client begins to process the memory and related disturbing feelings.

EMDR involves attention to three time periods:  the past, present, and future.  Focus is given to past disturbing memories and related events, current situations that cause distress, and to developing the skills and attitudes needed for positive future actions.  With EMDR therapy, these items are addressed using an eight-phase treatment approach as follows:

Phase 1

Identifies possible targets for EMDR processing.  These include distressing memories and current situations that cause emotional distress.  Other targets may include related incidents in the past.  Initial EMDR processing may be directed to childhood events rather than to adult onset stressors. The length of treatment depends upon the number of traumas and the age of onset.  Generally, those with single event adult onset trauma can be successfully treated in less than five sessions.  Multiple trauma victims may require a longer treatment time.

Phase 2

During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress.  The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR is to produce rapid and effective change while the client maintains equilibrium during and between sessions.

Phases 3-6

In phases three to six, a target is identified and processed using EMDR procedures.  These involve the client identifying three things:

• The vivid visual image related to the memory
• A negative belief about self
• Related emotions and body sensations.

In addition, the client identifies a positive belief.  The therapist helps the client rate the positive belief as well as the intensity of the negative emotions

Phase 7

In phase seven, closure, the therapist asks the client to keep a log during the week.  The log should document any related material that may arise.  It serves to remind the client of the self-calming activities that were mastered in phase two.

Phase 8

Phase eight consists of examining the progress made thus far.  The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.

Source: EMDR Institute

Case study: world-famous “saffron revolution” activist U Gambira’s experience.

EMDR  – Applications and Efficacy

Repeated studies show that by using EMDR people can experience the benefits of psychotherapy that once took years to make a difference. Numerous positive controlled outcome studies have been done on EMDR showing that significant reduction in PTSD symptoms occur after relatively few sessions of EMDR – (typically 8 one hour sessions).

EMDR Therapy is now widely recognised as having Level 1 evidence for its clinical efficacy in the treatment of PTSD and evidence is accumulating for its clinical efficacy across a wide range of psychopathologies.

The following organizations have recommended EMDR for the treatment of PTSD and Trauma and Stress Related Disorders:

• 2004    American Psychiatric Association
• 2004    US Departments of Veteran Affairs and Defense
• 2005    UK National Institute of Clinical Excellence [NICE]
• 2007    Australian National Health and Medical Research Council
• 2012    Australian Psychological Society
• 2013    World Health Organization [WHO]

In its recent recognition and recommendation of EMDR, The World Health Organization stated:

“Trauma-focused CBT and EMDR Therapy are recommended for children, adolescents and adults with PTSD. Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve [a] detailed descriptions of the event [b] direct challenging of beliefs [c] extended exposure, or [d] homework.”

Source: Guidelines for the management of conditions that are directly related to stress – WHO, 2013

The above gives some insight into the inherent safety of EMDR Therapy, when fidelity to the standard protocol is practiced, as it carries less risk of “re-exposure” trauma [re-experiencing] than other therapies.

Trauma and Addiction – What is the Correlation?

Trauma and addiction are frequently co-occurring disorders, as those suffering from a traumatic event will often turn to drugs or alcohol in an effort to self-medicate. Symptoms of trauma include anxiety and for those who have experienced trauma, living in constant fear is a reality. Drugs and alcohol can help to soothe these feelings, and without proper treatment for trauma, addiction can easily take hold.

The Importance of Treating Trauma and Addiction Together

Our specialised trauma counsellors make it possible to treat trauma and addiction simultaneously while residing at The Cabin Chiang Mai for addiction treatment. In the case of those suffering from trauma as well as addiction, one-on-one sessions will include trauma counselling and EMDR therapy.

It is incredibly important that those suffering from trauma and addiction are treated properly for their trauma. Otherwise, their chances of relapsing are incredibly high. Co-occurring disorders are one of the leading causes of addiction and thus must be treated alongside addiction.