EMDR therapy is a structured psychotherapy that primarily focuses on treating individuals who have experienced distressing, traumatic events. The therapy uses an eight-phase approach that includes:
- Phase 1: History-taking
In addition to getting a full history and conducting appropriate assessment, the therapist and patient work together to identify targets for treatment. These can include past memories, current triggers, and future goals. - Phase 2: Preparing the patient
During this phase the therapist is really working to educate the patient about the mechanics of EMDR and helping in the development of strategies to deal with the stress of the trauma, including breathing techniques, imagery, or mediation, Silva said. Sharing peer-reviewed research on EMDR’s effectiveness in this phase can also help reassure patients who might be hesitant, Silver said.
[Related: What is EMDR therapy and why is it used to treat PTSD?]
- Phase 3: Assessing the target memory
This phase, which can take as little as 30 seconds, involves questions to activate the patient’s trauma memory, and bringing it into the patient’s awareness. - Phase 4: Desensitization
The next three phases happen one after the other, Silva said, to help reprocess the memory and bring it to a resolution. The first of these three phases is the most well-known phase of the EMDR protocol—the eye movement/bilateral stimulation. The patient is asked to focus on the traumatic event while the bilateral stimulation takes place. This continues until the client’s Subjective Units of Distress Scale (SUDS) rating reaches zero. The SUDS rating system is used to assess how disturbed one feels about an event, with 10 being the most disturbed and zero being not at all disturbed.
- Phase 5: Installation
When desensitization is complete, the therapist uses bilateral stimulation to help the patient associate and strengthen their preferred positive belief for the event until it feels completely true. “These could be beliefs like ‘I’m worthy,’ or ‘I’m safe now,’” Silva said. “We have them hold that memory, with this new belief, and then ask them to rate how much they believe that to be true.” Bilateral stimulation is used until the patient reports the desired way of thinking is fully acceptable.
[Related: Eye Movement Desensitization and Reprocessing Therapy]
- Phase 6: Body scan
During this phase, the therapist asks the patient to scan themselves from head to toe to see if any negative sensations arise, and if it does, the therapist will continue to offer bilateral stimulation until any remaining negative sensations have been cleared out of the body.
- Phase 7: Closure
This phase is focused on closing the session down and helping the patient return to a state of calm in the present, and ensuring that the patient is in a good place to head back out into the world, Silva said.
- Phase 8: Evaluating treatment results
Each subsequent session opens with a time for the therapist and patient to discuss the patient’s current level of distress around the traumatic memory and how their symptoms are changing. If the patient reports a reduction in distress, they can move on to the next target memory. If not, additional sessions may be needed. The reevaluation stage is also the starting point for each new session, which will help identify future goals and objectives for treatment.
