Eye Movement Desensitization and Reprocessing (EMDR) Therapy

Core Components  

EMDR is an individualised intervention that aims to reduce symptoms of a range of mental health disorders including anxiety and PTSD. EMDR aims to assist recovery from these difficulties by promoting access to, and processing of, trauma memories and anxiety provoking stimuli. It helps to bring fear-inducing situations or trauma memories to an adaptive resolution, thereby reducing symptoms of the mental health condition.   

EMDR therapy is delivered by trained psychological therapists, once weekly, over 6-12 sessions (50-90 minutes per session). People accessing service can receive fewer or greater number of sessions depending on their need and response to treatment. EMDR therapy sessions apply a structured eight phase treatment approach which are;   

• Phase 1: History taking to obtain patient’s full history and flag target memories and triggers for treatment;  
• Phase 2: Client preparation to teach patient techniques for affect management, and to introduce patients to bilateral stimulation components including eye movements, hand tapping, and audio stimulation;   
• Phase 3: Assessment which involves identifying components (i.e. negative images, and distorted cognitions) of the trauma memory or anxiety provoking stimuli;  rating distress levels and sensations triggered by this distress; identifying preferred positive cognition; and rating the validity of preferred cognition. Scales like the Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale are used;   
• Phase 4: Desensitisation, this phase enables the to patient focus on the trauma memory or anxiety provoking stimuli, and engage with bilateral stimulation (BLS). BLS facilitates the incorporation of new thoughts, associations and sensations, and is continued until distress associated with the memory or stimuli is substantially reduced;   
• Phase 5: The installation phase involves strengthening the preferred positive cognitions, by enhancing their validity and integration within memory networks;    
• Phase 6: A body scan to identify and process residual maladaptive sensations in response to trauma memory or anxiety provoking stimuli;   
• Phase 7: A closure phase to ascertain patient stability at the end of session and between sessions;
• Phase 8: This re-evaluation phase starts the next session and is carried out to assess the patient’s present psychological state, and determine if treatment effects have been sustained. Treatment is then shifted to the next target memory or anxiety provoking stimuli associated with the PTSD or anxiety symptoms.    

EMDR doesn’t focus specifically on the alteration of thoughts, beliefs or behaviours associated with the trauma or anxiety provoking stimuli, and it doesn’t include a homework component. EMDR therapy can be delivered to in children, adolescents and adults offered alone or with other therapies.    

Fidelity  

NICE recommends that EMDR therapy for adults should be delivered by trained practitioners with ongoing supervision, typically over 8-12 sessions (or more if clinically indicated). It is necessary that EMDR therapy is delivered as per a validated manual, in a phased manner, and involve repeated within session bilateral stimulation until target memory or stimuli no longer causes distress.   

The EMDR Fidelity Rating Scale (EFRS) is used to assess therapist’s adherence to EMDR therapy’s standard eight-phase treatment approach. The current version was completed by Korn, Maxfield, Stickgold, and Smyth (1).  

Modifiable Components   

Eye Movement Desensitization and Reprocessing (EMDR) therapy sessions can be conducted on consecutive days which facilitates treatment completion over a shorter period. In the treatment of PTSD, EMDR has been shown to be effective in reducing PTSD symptoms in patients with psychosis (2). Most EMDR research in the treatment of PTSD has been conducted in civilian sample, so EMDR can be considered for treatment in non-combat-related trauma.  

Implementation Support  

Implementation support is currently provided by EMDR Association UK and EMDR Europe (the overarching body for EMDR in Europe). EMDR Association UK provides links to accredited EMDR courses, accredited consultants, and accredited trainers. EMDR Europe provides therapist accreditation following fulfilment of specified criteria, and they ensure that all trainers and training courses meet required standards. EMDR Association UK offers membership access to both EMDR Association UK and EMDR Europe.   

In Scotland, anyone delivering psychological therapy supervision should have completed the NES Generic Supervision Competences (GSC) training. There is work ongoing to review the supports for EMDR in Scotland and this will be updated once concluded.  

Start-up Costs  

Information is available via https://emdrassociation.org.uk/become-an-accredited-therapist/training/

Building Staff Competency  

Qualifications Required  

EMDR therapy is delivered by practitioners with mental health clinical background. These include registered psychologists (e.g. clinical, counselling, educational, and forensic), registered mental health nurses, registered social workers, and psychiatrics. Membership of the EMDR UK Association is required for accreditation if this is required or preferred by the practitioner. Accreditation is valid for five years.   

Training Requirements  

EMDR training process has different levels. Please access https://emdrassociation.org.uk/become-an-accredited-therapist/accreditation/ for further information

For information on how to achieve accreditation in EMDR by EMDR UK and Europe please access https://emdrassociation.org.uk/become-an-accredited-therapist/accreditation/

Supervision Requirements  

All evidence based psychological therapies must be delivered by a workforce which is trained in line with recognised competency and supervised by trained and experienced supervisors. In Scottish services there is a requirement for all supervisors of psychological therapies and interventions to have completed the NES Generic Supervision Competences Training (GSC).

Roth, Dudley & Pilling (2021) have developed a competence framework for EMDR (See Appendix 1).

Theory of Change   

Eye Movement Desensitization and Reprocessing (EMDR) therapy is based on Adaptive Information Processing model. This model proposes that symptoms of mental health disorders, such as PTSD and anxiety, are a consequence of past disconcerting experiences that cause continued distress because the memory associated with these experiences have not been sufficiently processed. When these inadequately processed memories are triggered, the maladaptive thoughts, emotions, beliefs and sensations that are contained in these memories are experienced. As a result, symptoms associated with the disorders are produced. EMDR therapy therefore aims to resolve the experiences that act as predisposing factors and contribute to the emergence of symptoms. It focuses on accessing unprocessed memories and applying bilateral stimulation to help the brain process and resolve the traumatic memories, which in turn facilitates a reduction of patient’s symptoms.   

Values  

Eye Movement Desensitization and Reprocessing (EMDR) therapy is an individualised intervention used to assist recovery from a range of mental health conditions, including anxiety and PTSD. EMDR therapy was founded on Adaptive Information Processing model which focuses promoting access to, and processing of, trauma memories and anxiety provoking stimuli for the purpose of bringing them to an adaptive resolution. EMDR therapy can be delivered to in children, adolescents, and adults.

• In what population would you like to deliver this intervention?
• What mental health condition(s) would your service like to address?

Priorities  

Eye Movement Desensitization and Reprocessing (EMDR) therapy focuses on accessing target unprocessed memories, applying bilateral stimulation to help the brain process the memories, thereby facilitating a reduction of patient’s symptoms. 

• Should the focus of the intervention be on unprocessed target memories associated with the trauma instead of the intervention principles of CBT?
• Should the proposed intervention be psychological, psychosocial or pharmacological?

Existing Initiatives

• Are there other interventions used by your service to treat PTSD in adults, adolescents, and children?
• Are existing initiatives practicable and effective?
• Do existing initiatives fit current and anticipated requirements?

Workforce  

Eye Movement Desensitization and Reprocessing (EMDR) therapy is delivered by practitioners with mental health clinical background. These include registered psychologists (e.g. clinical, counselling, educational, and forensic), registered mental health nurses, registered social workers and psychiatrics. Counsellors/ psychotherapists, GPs, as well as clinical and counselling psychologists in their final year of training who meet specific requirements can deliver EMDR. Practitioners can receive specialist training to support EMDR delivery to children and adolescent. Therapists undergo EMDR training and supervision at several levels, to become accredited practitioners, accredited consultants or accredited trainers. Membership of the EMDR UK Association is required for accreditation. Accreditation is valid for five years. EMDR therapy is delivered (to people accessing service) once weekly, over 6-12 sessions (50-90 minutes per session).  

• Does your service have qualified and experienced therapists who are available and interested in learning and delivering EMDR therapy?
• Will your service deliver EMDR therapy to children and adolescents?
• Can your service support the time commitment required for training, supervision, and EMDR therapy delivery?
• Will your service support therapist training to accredited practitioner level, accredited consultant level, or accredited trainer level?

Technology Support

Therapist trainings can be delivered face-to-face or virtually.  

• Does your service have the technology to support therapy/training if delivered virtually?

Administrative Support

EMDR therapy is delivered (to people accessing service) once weekly, over 6-12 sessions, with each session lasting 50-90 minutes.  

• Does your service have a venue for the delivery of EMDR therapy sessions?

Financial Support

Start-up costs include costs of basic training charged at around £1400, accreditation fee at £80, re-accreditation fee at £45, and trainer accreditation fee at £750. EMDR association UK should be contacted for cost of Consultants-in-Training Training course, and membership costs.

• How many therapists will your practice train to deliver EMDR therapy?
• What level of training will therapist(s) in your service receive (i.e. accredited practitioner, accredited consultant, or accredited trainer)?

Comparable Population   

Eye Movement Desensitization and Reprocessing (EMDR) therapy is an individualised intervention used to assist recovery from psychological trauma and other distressing life experiences. EMDR therapy can be delivered to children, adolescents, and adults. In adults, evidence of effectiveness of EMDR in the treatment of PTSD comes from seventeen RCTs that were evaluated in meta-analyses. Also in adults, evidence of effectiveness of EMDR in the treatment of panic disorders (with or without agoraphobia) comes from three RCTs and one pilot study. The studies were conducted in Italy, Netherlands and USA, and included adults aged 18-65 years. In children and adolescents, evidence of effectiveness of EMDR in the treatment of PTSD comes from two RCTs that were conducted in the Netherlands. The studies included children aged 4-18 years with trauma related symptoms or PTSD diagnosis. Outside of case-studies, there is limited evidence showing the effectiveness of EMDR in children with anxiety disorders.    

• Is this comparable to the population your service would like to serve?

Desired Outcome

In the treatment of PTSD, EMDR has been shown to reduce PTSD symptoms, reduce symptoms of comorbidities associated with PTSD (including depression and anxiety), and reverse PTSD diagnosis following early (1-3 months) or delayed treatment (≤ 3months).  Effects have been sustained at follow-up. In the treatment of panic disorders, EMDR has been associated with significant improvements across several outcomes including panic severity, panic frequency, depression, anxiety, and quality of life. Some of the effects have been sustained at 1-year follow-up.

• Is delivering a trauma-focus intervention that aims to assist recovery from psychological trauma and other distressing life experiences in children, adolescents and adults a priority for your organisation?
• Does your organisation have other initiatives in place that effectively and efficiency achieve the above outcomes?