EMDR Therapy: An Explainer

7-minute read time.

In one of the podcasts I listened to recently, a fellow adult-child-of-a-hoarder explained that she tried EMDR therapy to help her process some of the trauma of living in a level 5 hoarder house. My first thought was, “What the hell is EMDR therapy?” Let’s get into it.

EMDR therapy, otherwise known as eye movement desensitization and reprocessing therapy, is a form of psychotherapy treatment that involves moving your eyes in specific ways while you process traumatic memories. It relies on the Adaptive Information Processing (AIP) model, a theory about how the brain stores memories in that it stores normal and traumatic memories differently. Both EMDR therapy and the AIP model were developed by Francine Shapiro, a previous Senior Research Fellow Emeritus at the Mental Research Institute in Palo Alto, California (1,2)

Shapiro theorized that with normal events, your brain stores information and memories smoothly. It connects them to other memories. But, with traumatic memories, your brain doesn’t connect them to other memories. Instead, the brain stores this traumatic memory in a way that disconnects what you initially felt, heard, and saw and what is stored in memory through language. Because of this, trauma is almost like a wound that your brain can’t heal. And because it can’t heal, the brain didn’t receive the message that there is no more danger, making newer traumatic experiences easier to link to earlier trauma, reinforcing the negative cycle over and over. The same thing can happen with suppressed memories. These traumatic or suppressed memories can be triggered by specific sensory details, like someone with PTSD experiencing a lucid flashback (1).

In EMDR therapy, the patient attempts to access the memories of traumatic experiences in specific, guided ways. With the help of a professional and eye movements, remembering what happened can help you reprocess what you feel about the situation. It consists of eight stages that occur over multiple sessions. Usually, for a single traumatic event, treatment takes between three and six sessions. The eight stages involve:

• Collecting patient history and information: This includes the trauma and memories and the patient’s goals moving forward.
• Preparation and education: This part is essential to make the patient feel more safe and comfortable.
• Assessment: This is where the patient and the therapist discuss the themes and specific memories that will be treated.
• Desensitization and reprocessing: This is the activation stage, where the therapist helps the patient remember specific sensory details. This stage usually involves the patient’s vision, following the therapist’s fingers or light with their eyes.
• Installation: This is when the patient thinks about a positive aspect that they want to build into the memory processing.
• Body scan: This is when the therapist helps the patient focus on their body, what symptoms they are feeling, and how they are changing from session to session.
• Closure and stabilization: This is when the therapist talks to the patient about what to expect in later sessions and helps the patient return to the feeling of safety.
• Reevaluation and continuing care: This involves the therapist discussing progress with the patient, including if other sessions are necessary (1,2).

EMDR is used most commonly to treat those with PTSD, anxiety disorders, depression disorders, dissociative disorders, eating disorders, gender dysphoria, OCD, personality disorders, and trauma disorders (1).

This form of therapy is relatively new in the mental health world. Its first clinical trial was in 1989. Since then, it has received official approval from the World Health Organization and other governments worldwide because of numerous repeated studies proving its success. Over 30 studies have been done on the topic. Now, there is an EMDR Institute, founded by Francine Shapiro, where patients and clinicians can find more information about the treatment (1,2)

• 2004: The American Psychiatric Association recommends it as an effective treatment for trauma.
• 2010: California Evidence-Based Clearinghouse for Child Welfare considers the treatment “Well-supported by research evidence.”
• 1998: The Clinical Division of the American Psychological Association published that the only methods empirically supported for the treatment of PTSD were EMDR, exposure therapy, and stress inoculation therapy.
• 2017: The Department of Veterans Affairs & Department of Defense gave it the highest level of recommendation.
• 2009: In the Practice Guidelines of the International Society for Traumatic Stress Studies New York, EMDR was listed as an effective and empirically supported treatment of PTSD.
• 2005: National Collaborating Centre for Mental Health claims that EMDR therapy is empirically supported for adults with PTSD.
• 2011: The Substance Abuse and Mental Health Services Administration, an agency of the U.S. Department of Health and Human Services, states that EMDR therapy can be used to treat PTSD, anxiety, and depression symptoms.
• 2004-11: Therapy Advisor NIMH sponsored website lists it as one of the three treatments listed for PTSD.
• 2013: The World Health Organization recommends it for children, adolescents, and adults with PTSD.
• 2018: The International Society for Traumatic Stress Studies gave EMDR therapy a strong recommendation as an effective and empirically supported treatment for PTSD in all ages (2).

But regardless, this treatment works for those with traumatic experiences. Why it works is still theoretical, but it works in a nonintrusive way, and fast.

So, would this treatment be fit for those who hoard? How about children and family members of hoarders?

Because trauma might be a leading cause of why hoarding disorder occurs in some people and can impact the emotional regulation needed to maintain a home, EMDR might have potential benefits for individuals with hoarding disorder who have experienced trauma. It might help those with hoarding disorder identify and process the triggers that activate their behavior. But it might not help everyone (3).

For the person in the podcast, living in a hoarder home led to severe trauma, including suppressed memories, which EMDR therapy helped them process and heal from. For my fellow children and family members of hoarders who have experienced trauma from living in that environment, it might be for you, too. Here are some resources to get started, as published by the EMDR Institute (2):

• Book: Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy
• Find a clinician: https://www.emdr.com/SEARCH/index.php
• EMDR Organizations:
  • EMDRIA
    (EMDR International Association)
  • Trauma Recovery/ EMDR HAP
    (Humanitarian Assistance Programs)
  • EMDR Research Foundation
  • EMDR Asia
  • EMDR Australia
  • EMDR Austria
  • EMDR Belgium
  • EMDR Brazil
  • EMDR Canada
  • EMDR Colombia
  • EMDR Costa Rica
  • EMDR Denmark
  • EMDR Europe
  • EMDR France
  • EMDR Germany
  • EMDR Hong Kong
  • EMDR Ibero America – Argentina
  • EMDR India
  • EMDR Israel
  • EMDR Italy
  • EMDR Japan
  • EMDR Korea
  • EMDR Mexico
  • EMDR New Zealand
  • EMDR Singapore
  • EMDR Spain
  • EMDR Sweden
  • EMDR Switzerland
  • EMDR UK and Ireland
  • EMDR Ukraine
  • EMDR Uruguay

References:

1. https://my.clevelandclinic.org/health/treatments/22641-emdr-therapy
   • Hensley BJ. Appendix G: History of EMDR therapy (https://connect.springerpub.com/content/book/978-0-8261-9455-8/back-matter/bmatter7). An EMDR Therapy Primer, 2e. Springer Publishing Company, LLC. 2009. Accessed 3/29/2022.
   • Johnson DC, Krystal JH, Southwick SM. Chapter 19: Posttraumatic Stress Disorder and Acute Stress Disorder (https://accessmedicine-mhmedical-com.ccmain.ohionet.org/content.aspx?sectionid=200980381&bookid=2509#200980513). In: Ebert MH, Leckman JF, Petrakis IL. eds. Current Diagnosis & Treatment: Psychiatry, 3e. McGraw Hill; 2019. SAGE Publications, Inc. Accessed 3/29/2022.
   • Lahutina S, Gargot T. Eye Movement Desensitization and Reprocessing. In: EFPT Psychotherapy Guidebook 2e. 2019. Accessed 3/29/2022.
   • Landin-Romero R, Moreno-Alcazar A, Pagani M, et al. How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6106867/). Front Psychol. 2018;9:1395. 2018 Aug 13. Accessed 3/29/2022.
   • Shapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951033/). Perm J. 2014;18(1):71-77. Accessed 3/29/2022.
   • Shapiro F, Solomon RM. Eye Movement Desensitization and Reprocessing (https://www.researchgate.net/publication/228052027_Eye_Movement_Desensitization_and_Reprocessing). In: Neukrug ES. The SAGE Encyclopedia of Theory in Counseling and Psychotherapy. 2010. Accessed 3/29/2022.
   • Valiente-Gómez A, Moreno-Alcázar A, Treen D, et al. EMDR beyond PTSD: A Systematic Literature Review (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623122/). Front Psychol. 2017;8:1668. 2017 Sep 26. Accessed 3/29/2022.
   • Youngner CG, Rothbaum BO, Friedman MJ. Chapter 27: Posttraumatic Stress Disorder (https://psychiatryonline-org.ccmain.ohionet.org/doi/10.1176/appi.books.9781585625048.gg27). Gabbard’s Treatments of Psychiatric Disorders, 5e. May 2014. American Psychiatric Association. Accessed 3/29/2022.
2. https://www.emdr.com/frequent-questions/
3. https://www.kairoswellnesscollective.com/blog/how-is-hoarding-disorder-related-to-trauma-and-can-emdr-help#:~:text=If%20trauma%20underlies%20or%20contributes,provide%20alternative%20ways%20of%20coping.