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Basis of the Intervention

The primary goal of individual therapy is to inspire change and improve the quality of life for individuals suffering from mental health issues of trauma, depression, anxiety, psychosis, and others by enhancing their skills of self-awareness as well as self-exploration. When an individual engages in therapy then it helps in building their communication skill thereby making them feel empowered (Wood et al., 2019). Thus, it can be said that therapies help in eliminating or coping with troubling symptoms that make individuals function better and thereby also helps in increasing their well-being by healing them effectively (Wood et al., 2019). Hence the primary aim of the paper is to discuss the effectiveness of Eye Movement Desensitization and Reprocessing EMDR as a trauma intervention therapy and discuss the basis of the therapy. The paper will also highlight how the intervention strategies are used by therapists and counsellors. This will be followed by an outline of the limitations of the treatment and its use along with a comparison of EMDR with other therapies or interventions. Finally, the paper will also discuss some recommendations that can be applied while making use of the therapy.

EMDR is a validated treatment for trauma that helps people cope with their negative life events and feelings and is mostly used to treat PTSD, anxiety, and others. As stated by the theory, trauma, as well as painful events, have the ability to create PTSD issues in a person if it is not processed completely (Wilson et al., 2018). The aim of EMDR is to reduce the symptoms of trauma by making an effort to change how memories of the clients are stored in their brains. In short, a therapist making use of EMDR intervention encourages clients to engage in a series of bilateral eye movements while they recall their trauma or experiences of trigger in small segments until those memories do not cause distress to them (Wilson et al., 2018).

It should be noted that EMDR was first introduced in 1987, to treat posttraumatic stress disorder PTSD and has been guided by the model of Adaptive Information Processing. Unlike other therapies which focus on addressing or altering feelings, thought patterns as well as responses, that are the result of their traumatic experiences, EMDR is a therapy that directly focuses on altering the memory where the therapist makes an effort to change the way that concerned memory is stored inside the brain, thereby helping to reduce and eliminate the negative symptoms (Jongh et al., 2019).

When the EMDR therapy is used, it has been suggested by clinical observations that an accelerated learning process is stimulated by the standardized procedure of EMDR, where eye movements are used along with other types of bilateral movements (left and right movement of the eye) as well as stimulation like tones or taps (Jongh et al., 2019). Thus, it should be noted that when clients recollect their traumatic experience while also simultaneously experiencing bilateral stimulation, then the emotion along with the vividness of the memory is drastically reduced (Hase, 2021).

Working of EMDR

When EMDR therapy proves to be successful for a client then it helps in relieving their affecting distress and reformulating their negative beliefs while also reducing physiological arousal (Hase, 2021). During the therapy, the client is given an opportunity to attend to emotionally disturbing materials in brief sequential doses while also focusing on the external stimulus. EMDR makes use of three protocols- 1. past events that lay the groundwork for dysfunction are effectively processed, by forging new and associative links with the adaptive information (Van et al., 2020).

Secondly, the current events, as well as circumstances that might increase distress are targeted where the internal along with external triggers are desensitized. Lastly, imaginal templates that can be used in future events are incorporated that help the client acquire skills that are essential for adaptive functioning (Van et al., 2020). Repeated studies have shown that by making use of EMDR people tend to benefit from the experience of psychotherapy that initially took years to make difference (Proudlock & Peris 2020). EMDR has been successful in showing that the mind just like the body, has the ability of healing from psychological trauma by making the brain’s information processing system move towards a path of mental healing and health (Proudlock & Peris 2020).

EMDR therapy combines different elements that help in maximizing the effects of treatment. It should be noted that EMDR therapy involves attention pertaining to three time periods- past, present, and future (Fisher, 2021). The primary focus is given to past memories which are disturbing and their related events. The present is focused to see how current situations can cause distress and thereby helps clients to develop skills as well as attitudes that are required for positive actions in the future (Fisher, 2021).

The EMDR therapy is broken down into eight phases, therefore clients need to attend several sessions. Treatment mostly comprises 6-12 sessions, however, more sessions might be required depending on clients’ progress and symptoms (Balbo et al., 2019).

The first phase of the therapy is known as history-taking sessions where the readiness of the client is assessed and a treatment plan is developed. During this phase both the client and the therapist identify possible targets for the processing of EMDR, which might include aspects like distressing memories, current situations that might lead to negative feelings, and incidents of the past (Balbo et al., 2019).

The phase emphasizes the development of effective skills and behaviours which might be helpful for the client in the future. The initial EMDR process might be related to childhood experiences instead of adult stressors or critical incidents which helps clients to gain an insight into their situation that helps in resolving the emotional distress and positive behaviours are demonstrated (Shapiro & Brown 2019).

The second phase is known as the preparation phase where the therapist educates the client regarding different techniques of handling emotional distress by teaching them several imagery and stress reduction techniques that can be used by the client during and between the sessions (Shapiro & Brown 2019). The goal of the phase is to produce rapid as well as an effective change while the client is engaged in maintaining equilibrium during and between the sessions.

Assessment is the third phase where clients are guided to select a specific memory that can be targeted along with some relevant aspects of the memory like painful emotional and physical sensations, intrusive thoughts along with unwanted beliefs (Maxfield, 2019). Two measures are used in the sessions to identify and evaluate changes in emotion along with cognition- Subjective Units of Disturbance SUD and Validity of Cognition Scale VOC (Maxfield, 2019). These scales can also be used during the treatment process, according to the standardized procedures.

 Phases 4-7 are known as the treatment phase where the therapist comes up with techniques to address the targeted memories which takes place through 4 stages. Desensitization is the fourth phase where negative thoughts, images, and memories are focused. Simultaneously, clients are also guided through bilateral stimulation that involves eye movements, tapping, and blinking lights (Russell & Shapiro 2022).

The strategy helps in noticing thoughts as well as feelings that come up spontaneously. After identification of these thoughts, the therapist helps the client to refocus on the specific traumatic memory or might also move on to the next if the memory does not trigger any type of unwanted emotions (Russell & Shapiro 2022).

The next is installation, where the client is encouraged to install a positive belief or image that will help in replacing unwanted thoughts and memories identified in phase 3. This belief can be focused on another process of bilateral stimulation (Schwartz & Maiberger 2018). This is then followed by a body scan where the therapist asks whether the negative or targeted memories cause any physical discomfort and sensations, and if it does, then another process of bilateral stimulation is repeated (Schwartz & Maiberger 2018).

The closure is the next stage, where the therapist explores the progress of the client and also suggests some relaxation techniques along with other coping strategies that will help in maintaining improvements (Rousseau et al., 2019). The last phase is known as the examination or evaluation phase where the therapist examines the progress made in the case of the client. The EMDR treatment and examination processes include examining historical events, current incidents that might increase distress along with some future events which might require different responses (Rousseau et al., 2019).

In other words, the examination phase helps in evaluating the current psychological state of the client, whether the effects of treatment have been maintained, types of memories that have emerged since the last session, and also works with the client to identify some of the targets that can be used for current sessions (Goga et al., 2022).

Thus, the above discussion helps in highlighting the strategies that are used during the EMDR therapy from the beginning to the end.

Every therapy has both advantages and limitations when it is applied to clients, EMDR too, has several benefits and yields some effective as well as positive results for clients suffering from PTSD, anxiety, psychosis, or any negative past and present events (Whitehouse, 2021). One of the most significant benefits of EMDR is that it helps in taking the power away from negative feelings of doubts and apprehensions by making clients understand that these are an only interpretation of events and more valid and positive interpretations are available that helps in transforming beliefs for good (Whitehouse, 2021).

EMDR also helps in recovering from trauma through the technique of bilateral stimulation where both sides of the brain are engaged in reprocessing the distressing memories. Therefore, the therapy helps in treating depression, trauma, anxiety, abuse, bullying, and others (Linder et al., 2022). Another benefit of the therapy is that it helps the client to manage small stressors before they grow where clients making use of the therapy can unburden themselves from stresses that they have been carrying (Linder et al., 2022).

Similarly, just like benefits, EMDR also has some limitations. Since clients are made to focus on their distressing memories and recollection of negative events it might further increase distress among them by leading to further disappointments and apprehensions (Göbelek et al., 2019). Another limitation of the therapy is that during sessions clients tend to face heightened emotions as well as physical sensations which might make them overwhelmed thereby affecting the treatment process (Göbelek et al., 2019).

Apart from this, another limitation of EMDRA is that while encouraging clients and desensitizing them to recollect traumatic experiences and negative feelings, the new traumatic experiences might resurface which might make the client feel discouraged and demotivated and might also increase the length of therapy sessions thereby delaying healthy treatment outcomes.

It should be noted that EMDR has proved to be quite more effective and efficient than other therapies since it makes distressing events for clients less emotionally upsetting by not making clients give attention to those memories completely (Matthijssen et al., 2020). In other words, the bilateral stimulation used during EMDR helps clients to focus on something while they access painful memories and unwanted thoughts (Matthijssen et al., 2020).

EMDR has been proved to be more effective than talk therapy since the latter does not focus on treating individuals from their trauma by focusing on unwanted thoughts and negative experiences as it is done in EMDR (Jaberghaderi et al., 2019). EMDR helps in treating the unpleasant numbness experienced by clients suffering from trauma that cannot be offered by talk therapy (Jaberghaderi et al., 2019).

Similarly, unlike other treatments like cognitive behavioural therapy, PTSD therapy, and others which focuses on directly altering emotions, thoughts as well as responses resulting from traumatic experiences, EMDR is a therapy that focuses directly on the aspect of memory and intends to change the way the memory has been stored in the brain thereby reducing as well as eliminating problematic symptoms (Klockner, 2018).

EMDR is proved to be more effective than other counselling approaches because, unlike CBT which focuses on making a state change in the client that is helping them move from anxious to a calm state, EMDR is focused on making trait changes (Beer, 2018). A state change approaches clients’ problems through the frontal cortex of the brain and assists clients in learning coping strategies to deal with their negative symptoms (Beer, 2018).

On the contrary, a trait change involves looking at the state from underneath through historical memories, the nervous system along with the brain’s limbic part. Therefore, integrating new insights as well as beliefs with the help of bilateral stimulation helps in creating a trait change that helps clients to engage in adaptive viewpoints and responses to unhealthy triggers (Ostacoli et al., 2018). 

It cannot be denied that EMDR goes through some limitations that might hinder its effectiveness, therefore there are some recommendations that can be followed by therapists while using EMDR in the future (Phillips et al., 2022). Firstly, since clients are made to focus on their distressing memories and recollection of negative events which might further increase distress.

Therefore, therapists should not only focus on distressing memories rather they should also focus on helping clients to experience some positive emotions as well as feelings that will not overwhelm them from distressing memories and thoughts. This will thereby help clients not become overtly distressed by negative thoughts (Phillips et al., 2022).

Another issue or limitation of the treatment process is that during sessions clients tend to face heightened emotions as well as physical sensations which might make them overwhelmed thereby affecting the treatment process (Waterman & Cooper 2020).

Therefore, the therapist should work on addressing this issue or limitation by coming up with strategies where the client does not experience heightened emotions along with physical sensations where the therapist can encourage the client in some light-hearted activities that will not let the negative emotions have an impact the client (Waterman & Cooper 2020). This will thereby help in not overwhelming the clients with negative emotions and physical sensations that might affect the treatment process.

Conclusion

Thus, to conclude it should be noted that EMDR is considered to be one of the most effective and efficient strategies for treating traumatic experiences, negative thoughts as well as feelings. To make the intervention successful, all the eights stages of the EMDR process should be effectively used to bring healthy and positive results for the clients. The paper has also highlighted the benefits as well as limitations of EMDR and the types of recommendations that can be used to address the limitations that will further help in making the intervention successful. Additionally, the paper has also successfully highlighted the effectiveness of the strategy with other therapies like CBT, PTSD, talk therapy and others.

References

Balbo, M., Cavallo, F., & Fernandez, I. (2019). Integrating EMDR in psychotherapy. Journal of Psychotherapy Integration, 29(1), 23. https://doi.org/10.1037/int0000136 

Beer, R. (2018). Efficacy of EMDR therapy for children with PTSD: A review of the literature. Journal of EMDR Practice and Research, 12(4), 177-195. https://doi.org/10.1891/1933-3196.12.4.177 

de Jongh, A., Amann, B. L., Hofmann, A., Farrell, D., & Lee, C. W. (2019). The status of EMDR therapy in the treatment of posttraumatic stress disorder 30 years after its introduction. Journal of EMDR Practice and Research, 13(4), 261-269.
https://doi.org/10.1891/1933-3196.13.4.261

Fisher, N. (2021). Using EMDR therapy to treat clients remotely. Journal of EMDR Practice and Research, 73-84. https://pesquisa.bvsalud.org/ 

Göbelek, M., Pirinçcio?lu, F., & Aso?lu, M. (2019). Emdr therapy in a patient with traumatic grief: a case report. Psychiatry and Clinical Psychopharmacology, 29, 263-263. https://www.proquest.com/ 

Goga, N., Boiangiu, C. A., Vasilateanu, A., Popovici, A. F., Dr?goi, M. V., Popovici, R., & Had?r, A. (2022, January). An Efficient System for Eye Movement Desensitization and Reprocessing (EMDR) Therapy: A Pilot Study. In Healthcare (Vol. 10, No. 1, p. 133). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare10010133

Hase, M. (2021). The Structure of EMDR Therapy: A Guide for the Therapist. Frontiers in Psychology, 12, 1854. https://doi.org/10.3389/fpsyg.2021.660753

Jaberghaderi, N., Rezaei, M., Kolivand, M., & Shokoohi, A. (2019). Effectiveness of cognitive behavioral therapy and eye movement desensitization and reprocessing in child victims of domestic violence. Iranian Journal of Psychiatry, 14(1), 67. https://www.ncbi.nlm.nih.gov/ 

Klockner, K. (2018, May). Eye Movement Desensitisation and Reprocessing (EMDR) Therapy: Understanding its use for the Prevention of Post Traumatic Stress Disorder (PTSD). In Australian and New Zealand Disaster and Emergency Management Conference. https://www.researchgate.net/ 

Linder, J. N., Niño, A., Negash, S., & Espinoza, S. (2022). Thematic analysis of therapists' experiences integrating EMDR and EFT in couple therapy: Theoretical and clinical complementarity, and benefits to client couples. Journal of Marital and Family Therapy. https://doi.org/10.1111/jmft.12587 

Matthijssen, S. J., Lee, C. W., de Roos, C., Barron, I. G., Jarero, I., Shapiro, E., & de Jongh, A. (2020). The current status of EMDR therapy, specific target areas, and goals for the future. Journal of EMDR Practice and Research, 14(4), 241-284. https://doi.org/10.1891/EMDR-D-20-00039

Maxfield, L. (2019). A clinician's guide to the efficacy of EMDR therapy. Journal of EMDR Practice and Research, 13(4), 239-246. https://doi.org/10.1891/1933-3196.13.4.239

Ostacoli, L., Carletto, S., Cavallo, M., Baldomir-Gago, P., Di Lorenzo, G., Fernandez, I., & Hofmann, A. (2018). Comparison of eye movement desensitization reprocessing and cognitive behavioral therapy as adjunctive treatments for recurrent depression: The European Depression EMDR Network (EDEN) randomized controlled trial. Frontiers in psychology, 9, 74. https://doi.org/10.3389/fpsyg.2018.00074 

Phillips, R., Pinto, C., McSherry, P., & Maguire, T. (2022). EMDR Therapy for Posttraumatic Stress Disorder Symptoms in Adult Inpatient Mental Health Settings: A Systematic. Journal of EMDR Practice and Research, 16(1). https://10.1891/EMDR-D-21-2021-00022

Proudlock, S., & Peris, J. (2020). Using EMDR therapy with patients in an acute mental health crisis. BMC psychiatry, 20(1), 1-9. https://doi.org/10.1186/s12888-019-2426-7 

Rousseau, P. F., El Khoury-Malhame, M., Reynaud, E., Boukezzi, S., Cancel, A., Zendjidjian, X.,  & Khalfa, S. (2019). Fear extinction learning improvement in PTSD after EMDR therapy: An fMRI study. European Journal of Psychotraumatology, 10(1), 1568132. https://doi.org/10.1080/20008198.2019.1568132 

Russell, M. C., & Shapiro, F. (2022). Eye movement desensitization and reprocessing (EMDR) therapy. American Psychological Association.

Schwartz, A., & Maiberger, B. (2018). EMDR therapy and somatic psychology: Interventions to enhance embodiment in trauma treatment. WW Norton & Company.

Shapiro, R., & Brown, L. S. (2019). Eye movement desensitization and reprocessing therapy and related treatments for trauma: An innovative, integrative trauma treatment. Practice Innovations, 4(3), 139. https://psycnet.apa.org/ 

Van Minnen, A., Voorendonk, E. M., Rozendaal, L., & de Jongh, A. (2020). Sequence matters: Combining Prolonged Exposure and EMDR therapy for PTSD. Psychiatry Research, 290, 113032. https://doi.org/10.1016/j.psychres.2020.113032 

Waterman, L. Z., & Cooper, M. (2020). Self-administered EMDR therapy: potential solution for expanding the availability of psychotherapy for PTSD or unregulated recipe for disaster?. BJPsych open, 6(6). https://doi.org/10.1192/bjo.2020.92

Whitehouse, J. (2021). What do clients say about their experiences of EMDR in the research literature? A systematic review and thematic synthesis of qualitative research papers. European Journal of Trauma & Dissociation, 5(3), 100104. https://doi.org/10.1016/j.ejtd.2019.03.002 

Wilson, G., Farrell, D., Barron, I., Hutchins, J., Whybrow, D., & Kiernan, M. D. (2018). The use of eye-movement desensitization reprocessing (EMDR) therapy in treating post-traumatic stress disorder—a systematic narrative review. Frontiers in psychology, 9, 923. https://doi.org/10.3389/fpsyg.2018.00923 

Wood, L., Williams, C., Billings, J., & Johnson, S. (2019). Psychologists’ perspectives on the implementation of psychological therapy for psychosis in the acute psychiatric inpatient setting. Qualitative health research, 29(14), 2048-2056. https://doi.org/10.1177/1049732319843499 

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