About EMDR therapy
EMDR (Eye Movement Desensitization and Reprocessing) therapy is a method of psychotherapy that has gained the greatest popularity due to its effectiveness in reducing the intensity of traumatic memories and emotional reactions. Although there is mixed information about the source of this approach, Francine Shapiro (late 1980s) is usually considered to be the originator of EMDR therapy.
What is EMDR therapy?
The working principle of EMDR therapy is based on bilateral stimulation - although EMDR therapy is best known for directing eye movements, stimulation can also be performed using tapping or sounds. The goal of this stimulation is to make it easier for the brain to process emotionally intense experiences (such as traumatic memories). Although there is agreement among scientists about whether EMDR therapy works, exactly how EMDR works is still debated. Some researchers in this field believe that bilateral stimulation (such as guided eye movements) is tiring for the human mind at the time of recalling intense memories, which reduces their intensity and allows the brain to process and integrate them more adequately. In other words, they believe that EMDR therapy "disrupts" the normal processes of traumatic memories, causing them to lose their significance. Another explanation for the effectiveness of EMDR therapy is based on the idea that we can arouse certain emotions with body movements. That is, another part of researchers believes that paying attention to bilateral stimulation arouses the organism and puts it in a state of alertness (which also means that part of the resources are spent on monitoring the current situation that it assesses as dangerous). In addition to the fact that the recall of the traumatic memory is weakened again under such conditions, the orientation reflex (arousal due to stimulation by new stimuli) weakens over time and relaxation occurs, which our mind then associates with the traumatic memory. Since trauma and relaxation are contradictory, the traumatic memory loses its significance.
EMDR therapy: an example from the animal world
In other words, we could also vividly explain the positive experiences with EMDR therapy through the behavior of meerkats. Meerkats are small mammals that live in groups underground to protect themselves from predators. We most often see them when they come out to play, sunbathe, or search for food. However, their group always has at least one meerkat on guard - a meerkat who does not play or hunt for food - this meerkat carefully monitors what is happening in the environment and warns the other meerkats to return to their burrow immediately at the slightest sign of potential danger. While we are burdened with trauma, our mind behaves like a meerkat on guard that constantly gives an alarm signal without any danger being present at that specific moment. This is bad because the group does not get enough sun, they do not have a place to play (i.e., build relationships and practice important life skills), and they do not manage to gather enough food (which puts the survival of the entire group in question). Just imagine what consequences this situation would cause for the meerkat community over a few weeks, months, or years. Just as a group of meerkats needs a sentinel who can do his job well, we need a cognitive system whose need for self-protection will not harm our resources in the long run. We can imagine the experience of EMDR trauma therapy as a process in which we "calibrate" our inner meerkat sentinel through mental training in safe conditions to ensure that it more accurately distinguishes dangerous and harmless stimuli.
What is EMDR therapy effective for?
EMDR therapy has been shown to be particularly effective in alleviating the negative effects of post-traumatic stress disorder (PTSD), anxiety, phobias, and other trauma-related conditions. For example, Sephery et al. (2021) conducted a meta-analysis to examine the efficacy of EMDR therapy in alleviating symptoms of depression. To reach a general conclusion, they searched all scientific literature in English on the impact of EMDR therapy on symptoms of depression published up to April 2019 in two large databases of scientific journals. The authors considered the results of experimental and cross-sectional studies that compared EMDR therapy with other treatments. Of the 488 unique published scientific papers found, 39 met all the requirements for the meta-analysis. The summary results showed that the experience of EMDR therapy led to a very noticeable reduction in depressive symptoms that could not be explained by medication, the specific EMDR methodology, or the demographic characteristics of the treated individuals.
On the other hand, Yunitri et al. (2020) examined the effectiveness of EMDR therapy in alleviating anxiety symptoms in their meta-analysis. To reach a general conclusion, they searched all scientific literature on the impact of (individual or group) EMDR therapy on anxiety symptoms published up to December 2018 in one of seven large databases of scientific journals. The authors focused on literature that explicitly mentioned treatment according to the principles of EMDR therapy, and the results of people in online treatment were compared with the results of people who did not receive treatment. Out of a total of 1,324 unique published scientific papers reviewed, 17 of them met all the conditions of the meta-analysis. The summary results showed that the experience of EMDR therapy led to a very noticeable reduction in anxiety symptoms, phobias, panic attacks, and physical symptoms (while the small number of included studies on traumatic emotions did not allow for firm conclusions).
A few years later, a meta-analysis conducted by Rasines-Laudes and Serrano-Pintado (2023) confirmed the conclusions about the effectiveness of EMDR therapy for the treatment of depression and anxiety, and, like the meta-analysis of Sephery et al. (2021), pointed to the potential effectiveness of EMDR for the treatment of trauma. This analysis is complemented by a meta-analysis by Jericho and colleagues (2022), which aimed to compare the effectiveness of different treatments for trauma and complex post-traumatic stress syndrome. A meta-analysis was performed on the works published in one of the four large databases of scientific journals, whereby 82 of the initial 220 scientific works met all the conditions of the meta-analysis. The results of this meta-analysis showed that EMDR therapy is one of the most effective and (from the perspective of clients) better accepted therapeutic directions for the treatment of trauma (especially if it is combined with other cognitive approaches).
How is EMDR therapy conducted?
EMDR therapy is typically conducted in eight phases or steps, described in the following paragraphs. It is important to note that not all eight phases are completed in one session in order to ensure the best possible preparation and treatment results.
In the first phase of EMDR therapy, the therapist collects information about the client’s life history, important experiences, and current difficulties. Through the conversation, target events or traumas are identified that will be processed later. Although recall can be uncomfortable, this phase takes place in a safe environment, without pressure for the client to reveal more than they want. The therapist and client plan the course of EMDR therapy together, guided by the principles of safety and gradualness.
The second phase of EMDR therapy is marked by thorough preparation. The therapist explains to the client how EMDR therapy works and introduces them to self-regulation techniques. During this phase, the client learns calming techniques, such as imagining a safe place or directing their breathing, in order to cope with possible emotional discomfort during the sessions. Preparation helps the client gain a sense of control and clarity before starting deeper work.
In the third phase of EMDR therapy, the client and therapist select a specific memory to be processed and identify an associated negative belief the client has about themselves (e.g., “I am helpless”) and a desired positive belief (e.g., “I am strong”). In addition, a visual image of the memory, the emotions, and the bodily sensations it evokes are described. This phase of EMDR therapy allows for a focused and structured approach to emotional processing.
Desensitization is the fourth phase of EMDR therapy. During this phase of EMDR therapy, the client focuses on the target memory while simultaneously experiencing bilateral stimulation (e.g., eye tracking, listening to sounds, or tapping). During this phase, the client experiences changes in thoughts, emotions, and bodily reactions, which can change from moment to moment. Although emotionally intense, this phase often brings profound relief.
After the emotional distress has subsided, in the fifth phase of EMDR therapy, the therapist helps the client reinforce the positive belief they want to adopt. Through repetition of this belief with bilateral stimulation, the new thought becomes increasingly integrated. The client begins to experience themselves from a new perspective – with more self-esteem, strength and inner stability, which is one of the important goals of EMDR therapy.
In the sixth phase of EMDR therapy, the effects of the treatment are checked. The client closes their eyes and listens to their body to detect any remaining tension or discomfort associated with the processed memory. If such sensations occur, the therapeutic process continues until the feeling in the body stabilizes. This phase ensures that the changes achieved during EMDR therapy are fully integrated at the physical level.
The seventh phase of EMDR therapy represents the final phase of EMDR treatment conducted within a single session. Regardless of how much processing has been achieved, the therapist ensures that the therapeutic session ends in a way that allows the client to achieve emotional balance. Relaxation techniques and reflection on the experience during the session are used. The goal of this phase is for the client to emerge from EMDR therapy calm and stable, ready for everyday activities.
The eighth phase of EMDR therapy represents re-evaluation. At the meeting after the EMDR treatment, the client's condition and the effects of the treatment are re-evaluated. The therapist checks whether the positive belief has remained stable and whether there is a need for additional treatment. Reevaluation allows for continuous insight into progress and ensures that EMDR therapy is providing results aligned with the client's actual needs and goals.
Can EMDR therapy be conducted online?
Although the therapy was designed for in-person use, it has been adapted for online use during the COVID-19 pandemic. According to an existing systematic review by Kaptan et al. (2024), online EMDR therapy has also been shown to be effective in treating symptoms of depression and anxiety. In other words, you can experience the benefits of EMDR therapy from the comfort of your own home.
Are there any prerequisites for the EMDR therapy?
Like everything else in life, the effectiveness of EMDR therapy depends on certain prerequisites. In general, for EMDR therapy to produce the desired results, the client's mental stability and a quality relationship with the therapist are essential. Client stability is especially important for EMDR trauma therapy because the treatment itself involves intentional exposure to elements of the trauma - EMDR treatment can also harm mental health if the preparation is not carried out properly. In other words, the prerequisite for using EMDR therapy is quality preparation, which most often takes place through several meetings, during which a relationship of trust with the therapist is developed. The number of EMDR therapies needed to resolve a problem depends on the individual and the situation (or characteristics of the trauma) - the more complex the trauma, the more intensive the treatment needed to resolve it.
What do we offer?
At Rainbows and Clouds, we offer EMDR treatment for trauma (and related conditions) based on the principles of EMDR therapy in our office in Zagreb (Dubrava) or online. Our experienced psychologists combine EMDR treatment with the principles of other therapeutic schools in order to best adapt the treatment to the client's needs.