Eye Movement Desensitization and Reprocessing (EMDR)
Brief Description
The information in this program outline is provided by the program representative and edited by the CEBC staff. The Eye Movement Desensitization and Reprocessing (EMDR) program has been rated by the CEBC in the area of: Trauma Treatment (Child & Adolescent).
- Types of Maltreatment: Physical Abuse, Sexual Abuse, Physical Neglect, Emotional Abuse, Exposure to Domestic Violence
- Target Population: Children and adults who have experienced trauma. Research has been conducted on Post-Traumatic Stress Disorder (PTSD), post-traumatic stress, phobias, and other mental health disorders.
EMDR is an 8-phase psychotherapy treatment that was originally designed to alleviate the symptoms of trauma. During the EMDR trauma processing phases, the client attends to emotionally disturbing material in brief sequential doses that include the client’s beliefs, emotions, and body sensations associated with the traumatic event while simultaneously focusing on an external stimulus. Therapist directed bilateral eye movements are the most commonly used external stimulus but a variety of other stimuli including hand-tapping and audio bilateral stimulation are often used.
Essential Components
The essential components of EMDR include:
- EMDR is based on Adaptive Information Processing (AIP) theory which postulates that symptoms arise from maladaptively stored memories that include the thoughts, beliefs, emotions, body sensations, and sensory experiences that were stored at the time of the traumatic event.
- EMDR taps into that information system, activating the traumatically stored information, and, through reprocessing, helps move the traumatically stored information to adaptive resolution. As an integrative psychotherapy driven by Adaptive Information Processing (AIP) theory, EMDR integrates and is compatible with elements of other treatment interventions.
- When working with child clients, EMDR integrates play therapy and other efficacious treatment tools for working with children. With the theoretical underpinnings of AIP and the therapeutic relationship, case conceptualization with appropriate target assessment and reprocessing are all enacted throughout the complete eight-phase integrative psychotherapy of EMDR. Therefore, even though some elements of the goals and objectives of the phases of EMDR may be evident in other treatment modalities, it is the aggregate of the theory, case conceptualization and accurate implementation of this integrative psychotherapy that truly defines EMDR.
- EMDR consists of 8 phases of treatment with specific goals and objectives for completion of each phase.
- The first phase is Client History and Treatment Planning during which the therapist assesses the clinical landscape, evaluates the client's readiness for EMDR, and develops a treatment plan.
- Afterwards, during the Preparation Phase the therapist ensures that the client has adequate methods of handling emotional distress and self-soothing and calming skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on developing these needed skills for continuing with trauma reprocessing. During this phase, the therapist also teaches the mechanics of EMDR and reviews informed consent to assess for any forensic issues.
- In phases three through seven, a target memory (or image) is identified with the client identifying the image that represents the worst part of the target memory, the negative cognition associated with the image and a positive cognition (PC) that the client would like to believe instead (which is the goal for this phase of therapy) and the PC is then measured on the Validity of Cognition (VoC) Scale of 1-7 with 1 being completely false and 7 being completely true. Once the clinician has assessed the client’s current feelings about the VoC, the client is asked to identify the emotions associated with the target and then to measure the disturbance associated with the emotions on a Subjective Units of Disturbance Scale (SUDS) ranging from 0 being no disturbance to 10 being the most disturbing. Then the client is asked to identify where the client feels any disturbance in the body sensations associated when bringing up the target. After the client is guided through these series of questions, the client is then asked to hold together the target and the negative cognition along with the body sensations and the therapist starts sets of bilateral stimulation. This Desensitization Phase of EMDR continues until the disturbance is assessed by the client to be a SUDS rating of zero. Although eye movements are the most commonly used external form of bilateral stimulation, therapists often use auditory tones, tapping, or other types of tactile stimulation especially with children. The client is instructed to just notice whatever happens.
- The clinician then instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report, the clinician will facilitate the next focus of attention and restart bilateral stimulation. In most cases, a client-directed association process is encouraged. Client-directed association refers to following what the client responds to after doing the eye movements. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume reprocessing. Parents can be included in sessions and taught to assist children between sessions with symptoms and cuing children to use self-soothing and calming techniques and skills.
- When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements.
- In phase seven, closure, the therapist reminds the client of the client’s self-soothing and calming skills and to note any targets, images, cognitions, emotions, and/or sensations (TICES) that arise between sessions, and then to report these to the therapist at the next session. For children, parents and caregivers are asked to assist in identifying any progress or new symptoms that the child might evidence between sessions.
- In phase eight, re-evaluation of the previous work, and of progress since the previous session, takes place.
- EMDR treatment ensures processing of all related historical events, current incidents that elicit distress and future scenarios that will require different responses. Re-evaluation continues through each session as targets are reprocessed and the treatment plan is followed toward discharge planning.
Child Component
Eye Movement Desensitization and Reprocessing (EMDR) was designed with a child component that addresses the following presenting problems and symptoms:
- PTSD, anxiety, fears, and behavioral problems.
Age range: 2 – 17
Developmental Delays:
This program was developed for children with developmental delays; but has not been tested for children with developmental delays.
Parent / Caregiver Component
Eye Movement Desensitization and Reprocessing (EMDR) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:
- Parent of a child who has experienced trauma.
Group Format
Eye Movement Desensitization and Reprocessing (EMDR) was not designed to be conducted in a group setting; but has been tested for use in a group setting.
Recommended group size:
8-10 depending on the age of the children.
Testing References:
Jarero, I., Artigas, L., & Hartung, J. (2006). EMDR integrative group treatment protocol: A postdisaster trauma intervention for children and adults. Traumatology, 12(2), 121–129.
Fernandez, I., Gallinari, E., & Lorenzetti, A. (2004). A school-based eye movement desensitization and reprocessing intervention for children who witnessed the Pirelli Building airplane crash in Milan, Italy. Journal of Brief Therapy, 2(2), 129–135.
Zaghrout-Hodali, M., Alissa, F., Sahour, B. & Dodgson, P.W. (2008). Building resilience and dismantling fear: EMDR group protocol with children in an area of ongoing trauma. Journal of EMDR Practice and Research, 2(2), 106-113.
Recommended Parameters
Recommended Intensity:
Usually one 50-minute session per week.
Recommended Duration:
Length of treatment is impossible to predict and is dependent upon the severity of the trauma, etc. Often major gains are apparent within a few weeks ranging from 3-12 sessions.
Delivery Settings
This program is typically conducted in a(n):
- Community Agency
- Hospital
- Outpatient Clinic
- Residential Care Facility
- School
Homework
This program does not include a homework component.
Languages
Eye Movement Desensitization and Reprocessing (EMDR) has materials available in languages other than English:
Chinese, Danish, Dutch, Flemish, French, German, Haitian Creole, Hebrew, Italian, Japanese, Mandarin, Spanish, Swedish, Swiss
For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).
Resources Needed to Run Program
The typical resources for implementing the program are:
- Office space to conduct treatment.
Minimum Provider Qualifications
Qualifying individual providers must be either fully licensed mental health professionals or be enrolled in a Master's or Doctorate level program in the mental health field (Social Work, Counseling, Marriage Family Therapy, Psychology, Psychiatry, or Psychiatric Nursing) currently involved in the practicum and/or internship portion of the program they are enrolled in (first year students not eligible) and on a licensing track working under the supervision of a fully licensed mental health professional.
Education and Training Resources
There is a manual that describes how to implement this program, and there is training available for this program.
Training Contacts:
- Robbie Dunton, Commercial Trainings Contact
EMDR Institute
www.emdr.com
phone: (831) 761-1040 - Bob Gelbach, Executive Director of EMDR HAP (for Nonprofit Trainings)
www.emdrhap.org
phone: (203) 288-4450
Training is obtained:
Commercial trainings are held throughout the country. Nonprofit trainings are often onsite.
Number of days/hours:
There is a Part 1 and Part 2 of training. Each training lasts 3 days and the trainee also participates in 10 hours of consultation to learn to implement the protocol.
Additional Resources:
There currently are additional qualified resources for training:
Additional qualified trainers are listed on the following webpage: www.emdria.org
Implementation Information
Since Eye Movement Desensitization and Reprocessing (EMDR) is highly rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.
Relevant Published, Peer-Reviewed Research
This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. Please see the Scientific Rating Scale for more information.
Child Welfare Outcome: Child/Family Well-Being
References
Adler-Tapia, R., & Settle, C. (2009). Evidence of the efficacy of EMDR with children and adolescents in individual psychotherapy: A review of the research published in peer-reviewed journals. Journal of EMDR Practice and Research, 3(4), 232-247.
Adler-Tapia, R.L. & Settle, C.S. (2009) EMDR psychotherapy with children. In, A. Rubin & Springer (Eds.) Treatment of traumatized adults and children: Part of the clinician’s guide to evidence based practice series. New York: Wiley.
Chemtob, C. M., Nakashima, J., Hamada, R. S., & Carlson, J. G. (2002). Brief-treatment for elementary school children with disaster-related posttraumatic stress disorder: A field study. Journal of Clinical Psychology, 58, 99-112.
Contact Information
- Name: Robbie Dunton, MA
- Agency/Affiliation: EMDR Institute
- Website: www.emdr.com
- Email: rdunton@emdr.com
- Phone: (831) 761-1040
- Fax: (831) 761-1204
Date Reviewed: July 2010 (originally reviewed in May 2006)