EMDR

EYE MOVEMENT
DESENSITIZATION AND
REPROCESSING
HYPOTHESIS OF THE EMDR
MODEL
The Adaptive Information Processing model is
the theoretical foundation of the EMDR
approach. It is based on the following
hypothesis.
Within each person is a physiological
information processing system through which
new experiences and information are normally
processed to an adaptive state.
 Information is stored in memory networks that
contain related thoughts, images, audio or
olfactory memories, emotions and bodily
sensations.
Memory networks are organized around the
earliest related event. This is called the
touchstone event.
Traumatic experiences and persistent unmet
interpersonal needs during crucial periods in
development can produces blockages in the
capacity of the adaptive information processing
system to resolve distressing or traumatic
events.
When information stored in memory networks
related to a distressing or traumatic experience
is not fully processed it gives rise to
dysfunctional reactions.
The result of adaptive processing is learning
relief of emotional and somatic distress, and
availability of adaptive responses and
understanding.
Information processing is facilitated by specific
types of bilateral sensory stimulation. Based on
observational and experimental data the
technique uses bilateral stimulation to balance
the hemispheres of the brain.
Alternating left-right , visual, audio and tactile
stimulation when combined with the other
specific procedural steps used in EMDR
enhance information processing.
Specific focused strategies need to be combined
with bilateral stimulation in order to produce
adaptive information processing.
EMDR procedures foster a state of balanced or dual
attention between internally accessed information and
external bilateral stimulation. In this state the client
experiences the distressing memory and the present
context.
The approach may increase the vividness of the
distressing memory and related affect, facilitating
access to more adaptive information and forging new
associations within and between memory networks.
Client selection criteria checklist
Is it okay to proceed or are there concerns regarding
the safety of this relationship?
Is it okay to proceed or are there past incidents that you
are concerned might come up during reprocessing that
would be inappropriate for this environment?
Is it okay to proceed or are you concerned about
current life stressors that would be exaggerated as a
result of this process?
 is it okay to proceed or are there medical conditions
that may be of concern.
It is possible that the problems may not be fully
resolved by the end of the session. Is it okay or are you
concerned you may not have the resources necessary to
manage this after the session? Rememebr processing
continues so do you have the necessary skills or
support to manage the residual reprocessing after the
session?
Targeting Sequence Plan Worksheet
What issue or concern would you like to address
today?
Tell me about some specific recent situations where
you have experienced that issue or concern?
Which is the most disturbing incident that represents
your issue?
What picture represents the worst part of that incident?
What words go best with that picture that express your
negative belief about yourself?
 When you bring up that picture, what would
you like to believe about yourself?
Searching for the touchstone:
Past event: When are the other times have you
experienced similar negative thoughts?
Touchstone: When is the earliest time you have
had those negative thoughts?
Float Back Technique: “ Now bring up that picture of -
---- and those negative words----. Notice what feelings
are coming up for you, and let your mind float back to
an earlier time in your life when you had the same
thought and feelings. Don’t search for anything. Just
let your mind float back and tell me the earliest
incident that comes to your mind. What do you get?
If necessary, explore for family of origin issues:
“Any incidents from your family of origin?’
Affect Scan: Use the earliest memory identified from
float back.
“ Bring up that picture of the most recent memory and
hold the image in your mind and your negative
thoughts. What feelings are you experiencing?”
“Where do you feel them in your body?”
“Focus on those body sensations and let your mind
scan back to the earliest time you remember having
body sensations. What do you get?
Any times from your family of origin?
 Future Template
When you think of the present difficulties you
described earlier , how would you like to see
yourself handling them in the future?
Preparation Checklist
Stabilization Techniques introduced.
EMDR Seating Position
Eye Movements- Check distance, speed and alternate
directions.
Tapping
Auditory
“When a disturbing event occurs, it can get locked in
the brain with the original picture, sounds, thoughts,
feelings and body sensations. EMDR seems to
stimulate the information and allows the brain to
reprocess the experience.
 That may be what is happening in the REM or
Dream sleep- the eye movements- tonal quality and
tactile may help to process the unconscious material.
It is your own brain that will be doing the healing and
you are the one in control.
Coping strategies:
1) Metaphor- “ In order to help you just notice the
experience, imagine riding on a train or watching a
video and the images, feelings , thoughts are just
going by”
2) Stop Signal
3) Calm place/safe place- enhance it.
Developing and enhancing a safe
place
“ I’d like you to think about some place you have been
to or imagine being there where it feels very calm or
safe. Perhaps being on the beach or sitting by a
mountain stream. Where would you like to be?
“As you think of that calm/safe place, notice what you
see, hear and feel right now. What do you notice?’
“Focus on your calm/safe place- its sights, sounds,
smells and body sensations. Tell me more about what
you are noticing.”
“Bring up the image of that place. Concentrate
on where you feel the pleasant sensations in
your body and allow yourself to enjoy them.
Concentrate on those sensations and follow my
fingers. ( 4-6 slow BLS) How do you feel?
If positive, say- Focus on that ( BLS) What do
you notice now?
“Is there a word or phrase that represents your safe
/calm place? Think of --- and notice the positive
feelings you have when you think of that word.
Concentrate on those sensations and word--- and
follow my fingers. ( 4-6 slow BLS). How do you feel?
( Repeat and enhance positive feelings by BLS several
times)
“Now I ‘d like you to say that word --- and notice how
you feel.” ( BLS)
“Now imagine a minor annoyance and how it feels.
Bring up that word---- and notice any shifts in your
body. What do you notice?’
( If a positive shift occurs enhance with several sets of
BLS)
“ I’d like you to think of another mildly annoying
incident and bring up that word--- by yourself,
especially noticing any changes in your body when
you focus on your cue word.”
If positive shift occurs- enhance with BLS.
`
“ Now when you think of the original picture of the
incident does the negative cognition –----- still fit or is
there another that fits better now?”
“When you bring up that picture , what would you like
or prefer to believe about yourself now?”-----
“ When you think of that picture , how believble or
true do the words ( PC) feel to you now on a scale of
1-7 where 1 feels completely false while 7 feels
completely true?’
 “When you bring up that picture and those
words ( NC) ----- what emotions do you feel
now?”
SUD- “On a scale from 0-10 where 0 is no
disturbance or neutral and 10 is the highest
disturbance you can imagine how disturbing
does the incident feel to you now?’
“Where do you feel that in your body?”
Begin desensitization- “I’d like you to bring up that
picture those words(NC) notice where you feel them in
your body and follow my fingers.”(25-35 BLS)
“ take a breath, let it go, what do you notice?’ - “Go
with that” ( BLS-25-35)
Repeat – “Take a deep breath, let it go, what do you
notice”
Continue as long as the client reports change or a new
information. Do as many sets as necessary.
When the client stops reporting change for two
consecutive sets of BLS ask-
“ when you go back to the original experience what do
you get now?’ Go with that. ( 25-35 BLS)
“ Take a deep breath, let it go, go with that.”
When there is no change ask for SUD.
Go with that ( BLS- 25-35)
Repeat the above steps till the SUD is 0.
Installation
Do the words (PC) still fit, or is there another positive
statement you feel would be more suitable?
“Think about the original incident and those words (
PC) from completely false-1 to completely true-7 how
true do they feel?
Hold them together ( BLS)
On a scale of 1-7, how true do those words (PC) feel
to you now when you think of the original incident?
Continue BLS till the installation is complete.
“Close your eyes and keep in mind the original
memory and the PC. Then bring your attention to the
different parts of your body, starting with your head
and working downwards. Any place you find any
tension, tightness or unusual sensation, tell me.
If any sensation reported do BLS. If positive /negative
do BLS till installation or reprocessing is done.
Installing future template
We have worked on past experiences relating to
your presenting problem as well as the present
situations that have triggered your distress. Now
I’d like to suggest that we work on how you
will respond in the future to similar situations.
Identifying the future situation- “ I’d like you to
imagine yourself effectively doing --------
“ what are you noticing?”
If positive –add BLS sets as long as additional
positives are reported.
If negative focus on body sensations and add BLS until
sensations go away.
Install Pcto VOC=7
“Hold your positive cognition with that situation. On a
scale from 1-7 how true does it feel” Install to 7 with
BLS.
Problem solving situations
Create a problem solving situation:- “ I’d like you to
think of some challenge you may experience in that
situation?’
“What are you noticing?’
If positive add BLS as long as additional positive are
reported.
If negative focus on body sensations and add BLS till
sensations go away.
Install Pc to VOC7
CONTINUE TO ISTALL PC TO VOC =7
Closure
An unfinished session is when the clients issues have
been unresolved- she is still upset or the SUD is above
1 or the VOC less than 6 or body scan not complete.
Steps : 1) “We are almost out of time and we will need
to stop soon. You have done some very good work and
I appreciate the effort that you have made. How are
you feeling?
Do container exercise/ safe place
Debriefing
“ The processing we have done today my
continue after the session. You may or may not
notice new insights, thoughts ,memories or
dreams. If so just notice what you are
experiencing =take a snap shot of it in a log (
TICES). Use the safe place exercise or
relaxation technique daily.we can continue work
on the material next time. if you feel necessary
you can call me.
EMDR Chronic Pain Protocol
1. Preamble: Pain can occur for many reasons,
pain indicates that something is wrong.long
term pain can lead to changes in the nervous
system, which can maintain the pain. In a way
pain becomes locked in the nervous system.
EMDR is a means of stimulating the nervous
system to help it change the pain response.
Adopt an open mind and just begin to notice the
sensations of your pain as best as you can. Initially the
intensity of the pain may not seem to change or even
increase this is as the pain response shifts in response
to the stimulation. However if the pain becomes strong
raise your hand ( show stop signal)
Just notice the pain all of it, all things about it, imagine
you are a scientist observing it.
I would like you to imagine for a moment that
you can somehow see inside your body and see
what is causing your pain. … you know
yourself better than anybody, you know your
body better than anybody else… what do you
think is wrong with you? What do you think the
pain is telling you…..
EMDR Pain target
Can you describe the pain as you feel it now?
Descriptive terms – size, shape, color,
temperature helps the client to give a
meaningful representation of their pain.
Avoid suggestions or use of imagery
Getting the client to draw a picture of the pain is
helpful.
Negative cognition
are there any words about yourself that go with
the pain?
What is it telling you?
Positive cognition
What would you like to be able to say about
yourself when you think of the pain?
When you think of the pain how true do those
words ( PC) feel to you now on a scale of 1-7
where 1 feels completely false and 7 seems
completely true?
Ask VOC.
Emotions/feelings
Is there a feeling that goes with the pain?
SUD pain rating.
“ on a scale of 0-10 where 0 is no discomfort
and 10 is the highest discomfort or distress you
can imagine , how intense does the pain feel to
you right now.?
Where do you feel the pain in your body?
Desensitization
“Now I like you to focus on the pain the way
you’ve just described it to me, at the same time
as watching my fingers and just let whatever
happens happen. Just notice.”
What do you notice now?
That fine , just go with that.”
continue processing till SUD is 0-4
Installation
When the client reports shifts in pain ask-
…so what’s come in its place?
What’s there now where the pain was before?
If the pain does not change on its own accord then –say
“ Think of something that could take the pain away or
make it better , don’t wory about whether it seems
realistic or not , just let your imagination run wild.”
Once you obtain something concrete- “ what’s that
like? What does it remind you of?
Pair a word with a metaphor and install.
“Is there a word that goes with how you feel
when you think of that image?’BLS
“ when you think of the pain now how true do
those words ( PC) feel to you now on a scale of
1-7 .
Advanced healing imagery
Create a target by asking client to picture the injury
that is causing the pain.
“ what does it feel like is wrong with your body that is
causing the pain?
BLS sets-” Think of that”
“Imagine what it would take to heal the injury that is
causing the pain.”
“ think of that.”
If lost in translation-” what is stopping the pain from
getting better.”
Re-integration
Affect management skills training
Self –Awareness
Discernment
Regulation/ coping
Expression/action
Self awareness
Feelings are messengers that serve to warn us of
danger and provide signals to help us interact
socially. Feelings occur in the body as physical
sensations. Different feelings signal different
needs.
Angry Protection against threat
Physical pain Rest , medical attention
Scared Safety
Sad Grieving a loss
Tired Rest
Humiliated Respect
Unloved Love or ability to feel loved
Helpless Control
Lonely Support, intimacy
Overwhelmed Support or help of others
Discernment and action
Sensation – Feeling –
Upset stomach Tension
Tightness in stomach Fear
Aching , burning, stabbing Pain
Tingling in limbs
Irritation,discomfort
Heaviness
Fatigue
Tight feeling in limbs
Pressure in head, tightness in Anger
chest, feeling hot. Frustration
Numbness or empty feeling loneliness
Action
avoidance
Move away
Rest
Rest
Rest
Protect yourself
Physical activity- discharge tension
Open up and talk to someone.