I’m a strong person; I’m a great person - all because of EMDR. - Asha Nahar, EMDR client at The Village “I’m a strong person; I’m a great person – all because of EMDR.” – Asha Nahar, EMDR client at The Village

Why (and How) The Village for Families & Children is using Eye Movement Desensitization and Reprocessing (EMDR) Therapy to help children and adolescents recover from trauma

Questions and Answers

What is EMDR?

EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. It has been widely assumed that severe emotional pain requires a long time to heal. However, repeated studies show that by using EMDR therapy, within a much shorter time, people can experience the benefits of psychotherapy that once took years to make a difference.

EMDR therapy shows that the mind can heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes.

EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.  [EMDR Institute, Inc.: http://www.emdr.com/what-is-emdr/]

EMDR is listed with the International Society for Traumatic Stress Studies as an effective and empirically supported treatment for a wide range of traumas with diverse populations (www.istss.org)

How is EMDR used?

EMDR was originally developed to treat the symptoms of post-traumatic stress disorder (PTSD), anxiety, and phobias in adults. Some therapists also use EMDR to treat depression, eating disorders, schizophrenia, sexual dysfunction and stress caused by chronic disease. Increasingly, the psychiatric community is employing EMDR therapy to help children process their traumatic experiences.

How prevalent is the use of EMDR therapy with children and adolescents?

Over the past decade, national attention to and use of EMDR for children has grown significantly. The EMDR International Association (EMDRIA)’s membership has doubled over the past five years to 8,800 EMDR trained clinicians. There has been a marked increase in the application of EMDR with children and adolescents: more than half of EMDR members work with infants, children, adolescents or all three. Its largest special interest group is its Child & Adolescents SIG.

Who developed EMDR psychotherapy?

Francine Shapiro, Ph.D., is the originator and developer of EMDR, which is recommended as an effective treatment for trauma in the Practice Guidelines of the American Psychiatric Association, and those of the Departments of Defense and Veterans Affairs.

Shapiro’s adaptive information processing (AIP) model proposes that the integration of both positive and negative experiences into our nervous system is the healthy process by which we grow. When an acutely negative or traumatic event occurs, our own neurobiological effort to cope with the trauma sabotages this information processing by isolating the related associations, images, feelings,

etc. (Shapiro, 2017, in “Exploring the Intersection of EMDR and Play Therapy”, Ann. Beckley-Forest, LCSW-R, RPT-S, in EMDRIA Magazine, Vol.24, Issue 1, March 2019)

Using EMDR with children

While most EMDR research has been conducted with adults, EMDR researcher and pioneer Ricky Greenwald, PsyD, affiliate professor at the SUNY University of Buffalo School of Social Work and executive director of the Trauma Institute and Child Trauma Institute in Northampton Mass., believes the treatment works especially well with children, as they tend to take to the process more quickly. He points out that EMDR has consistently outperformed cognitive-behavioral therapy (CBT) in providing quicker resolution to young trauma victims. (Social Work Today: https://www.socialworktoday.com/archive/032210p20.shtml)

How are children affected by trauma?

Trauma occurs when a child experiences an intense event that harms or threatens harm to the child’s physical or emotional well-being, or to someone close to the child, such as another family member or a friend. Typically, this is an extraordinarily frightening event that overwhelms the child with feelings of terror and helplessness.

Some examples of traumatic events are physical abuse, sexual abuse, emotional abuse/psychological maltreatment, neglect, domestic violence, traumatic loss or separation from a loved one or bereavement, experiencing or witnessing violence in schools or neighborhoods, serious accidental injury/accident, serious illness/medical conditions, forced displacement such as loss of home or recent immigration, being exposed to a natural disaster such as a hurricane or flood, or exposed to events such as war, terrorism or political violence. Prolonged exposure to traumatic events may result in a toxic stress response.

Traumatic events overwhelm a child’s capacity to cope and often result in intense emotional and physical reactions. Physical reactions may include flashbacks of memories of the traumatic event, sleep disturbances and nightmares, depression, anxiety, difficulty regulating emotions, school and academic problems, regressive behaviors, increased irritability, difficulty concentrating, physical symptoms and difficulty forming relationships or attachments with others. (NCTSN, 2019)

Identifying children’s responses to trauma and loss reminders is an important tool for understanding how and why children’s distress, behavior, and functioning often fluctuate over time. Trauma and loss reminders can reverberate within families, among friends, in schools, and across communities in ways that can powerfully influence the ability of children, families, and communities to recover. Addressing trauma and loss reminders is critical to helping children heal.

[National Child Traumatic Stress Network https://www.nctsn.org/what-is-child-trauma/about-child-trauma]  

How many children are affected by trauma?

On average, roughly five million children are exposed to a potentially traumatic event each year in the U.S. What’s more, by age 18, approximately two-thirds of youth have experienced such an event (Dorsey et al., 2017; Perry, 2014).

While not every child who experiences trauma is traumatized (e.g., experiences negative long term psychological and emotional effects) (Lusa, 2019), those who do can suffer greatly if they don’t receive appropriate treatment.

Why and how did The Village for Families & Children add EMDR to the treatment methods its clinicians employ to help children and adolescents affected by trauma?

The Village for Families & Children uses a number of therapy models to treat children who have experienced trauma: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); play-based Cognitive Behavioral Therapy, Modular Approach to Therapy for Children with Anxiety, Depression, Trauma or Conduct Problems (MATCH-ADTCP) and the Attachment, Regulation and Competency (ARC) Framework which includes clinical intervention for both the child and his family/caregiver support network. While therapists can be trained in multiple models, The Village encourages its therapists to receive a strong grounding in a model before receiving training and certification in additional models.

While it’s generally available among private practitioners, EMDR has been under-recognized and underutilized in community mental health, the source of behavioral health care for the majority of Medicaid-eligible children. As a result, too many of Connecticut’s most vulnerable residents have limited access to this effective treatment.

Recognizing these disparities, in 2012, The Village for Families & Children received a four-year grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to expand evidence-based treatment options, including EMDR, in its urban multi-site outpatient behavioral health clinics.

This grant focused on children who screened positively for trauma upon intake and who The Village’s clinical team believed could benefit from trauma treatment. Cases were triaged by clinical managers to determine how EMDR Therapy would benefit clients in comparison to other evidence-based models.

Why EMDR Works with Children

Children don’t always have the verbal tools to describe their traumatic experiences in talk or cognitive-based therapy sessions. In contrast, EMDR therapy asks them to focus on the memory along with the feelings (physical and emotional) and external associations the memory brings on, at the same time they are watching back and forth hand movement, hearing alternating sounds through headphones or feeling alternating vibrations through hand devices that stimulate both sides of the brain.

Talking alone reaches only the left side of the brain, while EMDR stimulates both hemispheres. Researchers have found that the both-sides-of brain stimulation that EMDR provides is similar to the eye movements found during Rapid Eye Movement (REM) sleep.

Drawing upon The Village’s success in using Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with children of highly-mobile families who were unable or unwilling to talk about the traumatic events they experienced, the organization decided to include EMDR in its therapy options because it offered

  • Shorter duration of treatment to observe progress
  • Less focus on verbal processing of the trauma – important for children who are unwilling or unable to talk about their experience
  • The ability to use EMDR in conjunction with other therapies
  • The option to treat children where there is no parental involvement, e.g., for children who have been temporarily removed from their families and/or are awaiting foster or adoptive homes

What happens in an EMDR session?

In the early stages of EMDR therapy, clients discuss their symptoms with their therapist but don’t necessarily have to reveal all the details of the traumatic experience(s). Instead, the therapist helps the patient focus on related negative thoughts and feelings they are still experiencing, decide which of these are causing the most trauma, and which they would like to replace with positive thoughts and beliefs.

The therapist then guides the patient through a process known as desensitization. Eye movements (or other bilateral stimulation such as handheld buzzers or earphones that change the auditory signal from one ear to another, or other movements that stimulate right-left brain movement) are used during one part of the session. After the clinician has determined which traumatic memory to target first, s/he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings.

In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a victim of rape, incest or abuse – physical or verbal – shifts from feeling horror and self-disgust to holding the firm belief that “I survived it and I am strong.” Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes. The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.

[EMDR Institute, Inc.: http://www.emdr.com/what-is-emdr/]

The goal of EMDR is to fully process past experiences and sort out the emotions attached to those experiences. Negative thoughts and feelings that are no longer useful are replaced with positive thoughts and feelings that will encourage healthier behavior and social interactions. Ultimately, clients learn to handle stressful situations themselves.

EMDR therapy typically occurs in eight phases:

1) History and treatment planning

2) Preparation, to establish trust and explain the treatment in-depth

3) Assessment, to determine the negative feelings and identify positive replacements

4) Desensitization, which includes the bilateral movement technique

5) Installation, to strengthen positive replacements

6) Body scan, to see if the client is now able to bring up memories of trauma without experiencing negative feelings that are no longer relevant, or if reprocessing is necessary

7) Closure, which occurs at the end of every session

8) Re-evaluation, which occurs at the beginning of every session

How did The Village begin to integrate EMDR into its therapy options?

In partnership with Trauma Recovery EMDR Humanitarian Assistance Programs (EMDR-HAP), The Village trained eight clinicians in Advanced EMDR seminars to support the work of others, and 75 clinicians in Basic EMDR Part I and II, with 10 hours of consultation practice. Associate Vice President for Intensive Treatment Jennifer Lusa, LCSW, Ph.D., oversees The Village’s EMDR therapy and provides bi-monthly consultation to all EMDR-trained clinicians at The Village to ensure adherence to EMDR protocols.

How did The Village choose the children who would be part of the EMDR evaluation?

The Village chose child and adolescent clients for EMDR from all new intakes who

  • Had been exposed to at least one traumatic event and/or had prolonged traumatic stress
  • Reported symptoms of traumatic stress, behavioral problems, and/or impaired functioning that constituted a diagnosable disorder

With oversight from Yale University’s Institutional Review Board, clinicians at The Village offered EMDR to children they felt would be most appropriate for this method. Those who agreed provided consent to participate in the EMDR evaluation. Clinical staff at The Village measured each child’s status during intake and, for children still receiving services, six months after intake.

Two hundred seventy-eight children from 6-18 years old (average age 12.9 years) received EMDR services between October 2012 and October 2016. Girls made up 49.7 percent of the children treated; 65 percent were Hispanic/Latino; 28.7 percent were Black/African American, 15 percent were White, 7 percent were more than one race and 1 percent were Asian.

The children received EMDR in conjunction with regular talk and/or supportive therapy.

What kinds of trauma did children in The Village’s EMDR evaluation experience?

More than 70 percent of the children receiving EMDR during the evaluation period had experienced five or more traumatic events. Most common sources of trauma were knowing someone who died, being separated from a parent or caregiver, witnessing people physically fighting or threatening harm, seeing a family member get arrested or in jail, being physically hurt or threatened, knowing someone who was badly sick, injured or near death, seen or heard someone using a weapon, watched people using drugs, been in or seen a very bad accident and been attacked by a dog or other animal.

What were the outcomes of The Village’s five-year EMDR evaluation?

Using several national standards to measure demographics, perceptions of care, exposure to trauma and effect on the child’s problem behaviors, the team found significant reductions in the children’s internalizing, externalizing and total behaviors related to the trauma(s) she or he had experienced.

Why are these results significant?

This study showed that EMDR is an effective method for helping children and adolescents of color in poor urban communities deal with past traumatic events. The method’s bi-lateral stimulation, resourcing and skill-building tools help ‘unlock’ the bad memory, allowing children to process it healthily. As a result, they gain resiliency to deal with troubling situations in the future, as well as deal with stressful situations in their day-to-day life.

Given the positive results of the EMDR evaluation, how are clinicians’ use of EMDR expanding across the state to help children and adolescents process and manage the traumatic experiences they have suffered?

More clinicians at The Village and across the state are successfully using EMDR with children.

Funded by a grant from the Connecticut Health Foundation.