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Eye Movement Desensitization and Reprocessing (EMDR) Definition
Eye Movement Desensitization and Reprocessing (EMDR) is a relatively new, nontraditional psychotherapy treatment that can help individuals heal from the symptoms and emotional distress that stem from disturbing life experiences.1 Thus, it has grown in popularity for treating individuals with post-traumatic stress disorder (PTSD).
While traditional methods of psychotherapy employ a combination of talk therapy and medications to help individuals, EMDR uses the individual’s eye movements to desensitize and help them reprocess the emotional stress associated with traumatic experiences or events.2 Now, EMDR is being used in different therapeutic situations, including as part of the treatment approach for some individuals with addiction and co-occurring trauma or abuse.3
EMDR History and How it Works
EMDR therapy originated in the late 1980s because of the observations and experiences of psychotherapist Francine Shapiro.4
Shapiro noticed that her eye movements reduced negative emotional responses she associated with her own unsettling memories.5 She began to experiment with individuals who had experienced devastating trauma and had adjustment issues and others who had been formally diagnosed with (PTSD).6 She began to refine the technique of using side-to-side eye movements to help individuals process the effects of trauma.
The model on which EMDR is based, Adaptive Information Processing (AIP), posits that incomplete processing of traumatic life experiences or the dysfunctional storage of those adverse memories can cause several mental disorders, including PTSD, affective disorders, chronic pain, and addiction.3
The eight-phase, three-pronged process of EMDR therapy facilitates the resumption of normal information processing and integration.7 This treatment approach, which targets past experiences, current triggers, and future potential challenges, helps individuals process the events or memories that cause them problems or distress.7
Through EMDR, the desensitization and reprocessing therapy happens when the individual focuses on a dual attention stimulant—typically eye movement—while holding the memories, thoughts, images, or sensations associated with the traumatic event in their mind.1 This helps the individual process the traumatic memories, and therefore, aids in the elimination of the symptoms of PTSD or other disorders.1
If it’s agreed that EMDR might be a good fit for the individual, the therapist begins by asking the individual to focus on aspects of traumatic experiences. This might include beliefs, emotions, bodily feelings, or something else. While the individual gives attention to the negative event, the therapist begins to use side-to-side eye movements, sounds, or taps that the individual notices and tracks.8
Eye movements are the most popular bilateral sensory stimulation used in EMDR. Horizontal saccadic eye movements, which are quick, jerky movements of the eye, help redirect a person’s line of sight to fix their vision on a moving object.9 Proponents of EMDR, such as Shapiro and her followers, claim that inducing these movements while reflecting on past traumatic experiences helps individuals to reprocess the experience and curbs the emotional response even if it is severe. However, EMDR also incorporates several other principles, including Cognitive Behavioral Therapy (CBT).7
EMDR Phases and Process
The delivery of EMDR can vary from treatment provider to treatment provider; however, in its classic presentation, EMDR involves eight phases.10
- Phase 1 – History and treatment planning: Most often this phase occurs over the first two sessions, but most therapists continue to gather information about the individual’s history and background throughout the entire process. In this phase of treatment, the therapist and individual define the specific “targets” to be addressed in therapy. These can include traumatic events or other presenting problems.
- Phase 2 – Preparation: During this phase, the therapist explains EMDR and instructs the individual on specific techniques that can help them deal with the effects of trauma. These techniques typically include breathing, relaxation, and other holistic practices that may help them deal with stress.
- Phase 3 – Assessment: This phase can be quite lengthy. Typically, the therapist helps the individual identify various “targets”, also known as the main underlying problems or triggers, and then evaluates the emotional impact of each on the individual. The individual and therapist work together to develop more functional, positive approaches to existing emotional reactions. Then, the individual and therapist work together to develop methods of rating current feelings of stress and alternative desired approaches to dealing with stress.
- Phase 4 – Desensitization: The therapist pairs the eye movement desensitization technique with the traumatic events and the individual’s emotional experiences. In addition, the therapist inserts positive emotions with recollections of past experiences that resulted in distress (during phases 3 and 4 most of the cognitive restructuring occurs).
- Phase 5 – Installation: The therapist works to strengthen the positive feelings the individual associates with past events and assesses the individual’s efficacy in dealing with everyday experiences.
- Phase 6 – Body scan: The individual and their therapist reevaluate any remaining tension related to stress that is associated with the “targets” identified in previous sessions. If tension remains, the therapist targets it and helps the individual further process it.
- Phase 7 – Closure: The individual’s reactions are reassessed to ensure they have responded to the treatment and that they feel better as a result.
- Phase 8 – Reevaluation: During the final phase, the therapist and individual reevaluate the entire process to ensure that goals were met and coping techniques are effectively utilized. If any issues linger, the therapy returns to the appropriate stage and works through them. If the goals of the therapy have been met, EMDR treatment is terminated.
Is EMDR Covered by Insurance?
EMDR therapy may be covered by your insurance provider in conjunction with inpatient rehab treatment. This depends on your specific health insurance plan. To see if your insurance provider covers all or at least part of the cost of rehab treatment, use our online verification form below.
Is EMDR Covered by Medicaid and Medicare?
Medicaid, the federal insurance program that provides coverage for lower income families and individuals through the Affordable Care Act, does cover many different types of therapy, including EMDR. That’s because Medicaid covers any therapy with a trained and licensed therapist that is evidence-based, clinically rigorous, and appropriate for the diagnosis.
Medicare coverage may vary on the specifics, but broadly speaking, Medicare covers EMDR therapy for PTSD and acute stress disorder (ASD) if the individual has been diagnosed with the disorder and the therapy is performed by a behavioral health provider specifically licensed and certified in EMDR therapy.
How is EMDR Used for Addiction Treatment?
Many treatment centers utilize EMDR to help treat addiction. Several American Addiction Centers treatment facilities offer EMDR as part of a program to treat addiction and co-occurring disorders. For individuals with PTSD or individuals with a personal history of sexual assault, violence, and other traumatic life events, EMDR can be effective if these past experiences trigger substance abuse since the therapy aids in symptom reduction.
For many, alcohol use disorder (AUD), a medical condition defined by an uncontrollable use of alcohol despite negative consequences, is tied to past trauma. In fact, studies indicate that PTSD and AUD co-occur in 28% to 85% of individuals seeking treatment, and in up to 53% of veterans, who were exposed to combat, seeking treatment.11 Facilities that employ EMDR as part of the program recognize that by treating the trauma, there may be less of a compulsion toward alcohol or other substance abuse. Thus, therapists who use the EMDR therapy for an individual’s AUD, work to reprocess the earlier traumatic memories that started the dysfunction (and led to the addiction), identify the present triggers that activate the unsettling memory, and develop adaptive behaviors that can help prevent future relapses.12
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EMDR Borrows Principles from Established Models
EMDR was originally designed to treat the experience of trauma that results in difficulties with emotional adjustment in individuals. The American Psychiatric Association lists several disorders under the overall heading of Trauma and Stressor Related Disorders in the DSM–5, the latest version of the diagnostic manual. EMDR was intended to help in the treatment of PTSD, adjustment disorders, and ASD, which are still listed in the diagnostic manual.13 And although there is not sufficient evidence to prove EMDR’s effectiveness, some therapists use it to treat other mental health disorders, such as depression and anxiety.14
EMDR includes the following components in its overall treatment package that have empirical validation for their usage:
Session assignments and homework: Most cognitive and behavioral therapies require individuals in therapy to complete practice assignments during the therapy sessions and homework after as well. Homework is an integral part of many therapies.15
Developing a strong therapeutic alliance: EMDR practitioners attempt to develop a strong working alliance between the individual and the therapist during Phase 1.16 This is a longstanding aspect of successful therapy.
Exposure treatment: As part of the reprocessing component of EMDR, individuals are required to reflect on aspects of their traumatic experience that are particularly distressing. The process of this type of reflection—especially when individuals are instructed to visualize by using all five senses—stems from a behavioral psychology therapeutic technique known as exposure therapy.17 The basic premise behind exposure therapy allows the therapist to help the individual systematically approach instead of avoiding a stimulus or event that causes them fear or anxiety.17 The therapist has the individual repeatedly revisit the painful memory or event while in a safe space. Eventually, the fear response dissipates.17 Similarly, EMDR has the person recollect important aspects of the traumatic event while undergoing the eye movement component of the treatment.
Cognitive restructuring: Cognitive restructuring comes from CBT, one of the most popular therapeutic models used by therapists today. Cognitive restructuring involves re-formulating one’s attitudes, thoughts, and belief systems in a manner that is more functional and realistic. CBT works on the notion that many dysfunctional behaviors, such as substance use disorders (SUD) or mental health disorders like depression, are fueled by an irrational and dysfunctional belief system. CBT identifies these core irrational beliefs and, through a therapeutic process, helps the individual restructure them so they are more in line with reality.18 As part of EMDR therapy, the therapist helps the individual develop a different attitude and value system regarding aspects of their traumatic past.
Who is Qualified to Perform EMDR?
Because the formal process of EMDR treatment is rather lengthy and complicated, only therapists who are specifically trained in the technique and certified to perform it should be using EMDR. Therapists performing EMDR need to be licensed by the state and be certified in EMDR to perform EMDR therapy.
The Status of EMDR
While many clinicians use EMDR as part of a treatment protocol for individuals with PTSD, ASD, addiction, and other disorders, its effectiveness still comes into question by some medical and mental health professionals. Research indicates that the eye movement component (part of the name of the therapy) does not actually appear to be an essential part of the treatment.19
Shapiro reported that eye movements were associated with a decrease in emotional distress, but not every therapist uses eye movements as part of their EMDR therapy approach. Sometimes, the therapist uses bilateral tactile taps, auditory tones, or other techniques instead of the eye movement component (especially for those with a visual impairment) in conjunction with the overall EMDR treatment package.1 Research has even shown that imagery without eye movements or other bilateral sensory stimulation still results in the same outcome in symptom relief.19
Supporters of EMDR point to several studies that demonstrated its effectiveness in treating emotional trauma. One such study found that participants with diagnosed PTSD fared better with CBT and EMDR therapies—in terms of a reduction of PTSD symptoms—compared to individuals with PTSD who received other forms of care.20
- Landin-Romero, Ramon, Moreno-Alcazar, Ana, Pagani, Marco, and Amann, Benedikt L. (2018). How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action. Frontiers in Psychology, 9, 1,395.
- McCabe, Susan, Ed.D, APRN, BC. (2004). EMDR: Implications of the Use of Reprocessing Therapy in Nursing Practice. Perspectives in Psychiatric Care, 40(3), 104-113.
- Hase, Michael, Balmaceda, Ute M., Ostacoli, Luca, Liebermann, Peter, and Hofmann, Arne. (September 21, 2017). The AIP Model of EMDR Therapy and Pathogenic Memories. Frontiers in Psychology.
- Shapiro, Francine, Ph.D. (2014). The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences. The Permanente Journal, 18(1), 71-77.
- EMDR International Association. (n.d.) History of EMDR.
- Shapiro, Francine, Ph.D. (1988). Efficacy of the Eye Movement Desensitization Procedure in the Treatment of Traumatic Memories. Journal of Traumatic Stress, 2(1), 199-223.
- Substance Abuse and Mental Health Services Administration. (2014). The Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Services (TIP 57).
- EMDR International Association. (n.d.). Experiencing EMDR Therapy.
- Samara, Zoe, Elzinga, Bernet M., Slagter, Heleen A., and Nieuwenhuis, Sander. (2011). Do Horizontal Saccadic Eye Movements Increase Interhemispheric Coherence? Investigation of a Hypothesized Neural Mechanism Underlying EMDR. Frontiers in Psychiatry, 2(4).
- Menon, Sukanya B. and Jayan, C. (2010). Eye Movement Desensitization and Reprocessing: A Conceptual Framework. Indian Journal of Psychological Medicine, 32(2), 136-140.
- Ralevski, Elizabeth, Olivera-Figueroa, Lening A., and Petrakis, Ismene. (2014). PTSD and comorbid AUD: a review of pharmacological and alternative treatment options. Substance Abuse and Rehabilitation, 5, 25-36.
- Hase, Michael, Schallmayer, Sabine, and Sack, Martin. (2008). EMDR Reprocessing of the Addiction Memory: Pretreatment, Posttreatment, and 1-Month Follow-Up. Journal of EMDR Practice and Research, 2(3), 170-179.
- American Psychiatric Association. (2016). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).
- Hase, Michael, Balmaceda, Ute Mirian, Hase, Adrian, Lehnung, Maria, Tumani, Visal, Huchzermeier, Christian, and Hofmann, Arne. (2015). Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: a matched pairs study in an inpatient setting. Brain and Behavior.
- Tang, Wei, M.D. and Kreindler, David, M.D. (2017). Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features for Mobile Apps. JMIR Mental Health.
- Hase, Michael. (2021). The Structure of EMDR Therapy: A Guide for the Therapist. Frontiers in Psychology, 12.
- Lancaster, Cynthia L., Teeters, Jenni B., Gros, Daniel F., and Back, Sudie E. (2016). Posstraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. Journal of Clinical Medicine, 5(11), 105.
- Chand, Suma P., Kuckel, Daniel P., Huecker, Martin R. (August 26, 2021). Cognitive Behavior Therapy. StatPearls.
- Herbert, James D., Lilienfeld, Scott O., Lohr, Jeffrey M., Montgomery, Robert W., O’Donohue, William T., Rosen, Gerald M., and Tolin, David F. (2000). Science and Pseudoscience in the Development of Eye Movement Desensitization Reprocessing: Implications for Clinical Psychology. Clinical Psychology Review, 20(8), 945-971.
- Bisson, J.I., Roberts, N.P., Andrew, M., Cooper, R., and Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults (Review). Cochrane Database of Systematic Reviews, 12.