How I Maximize the Effectiveness of Eye Movement Desensitization Reprocessing (EMDR)

How I Maximize the Effectiveness of Eye Movement Desensitization Reprocessing (EMDR) by Incorporating Cognitive Behavior Therapy (CBT) and Dialectical Behavior Therapy (DBT) in the EMDR Protocol

I have discovered that blending CBT and DBT with EMDR facilitates excellent results in clients’ ability to gain new insights into their traumatic experiences. I use CBT to reinforce what the client may know about his or her trauma to be true, yet not be able to feel that truth emotionally. I use DBT to bring a synthesis between diametrically opposed cognitions.

 For example, an adult female victim of rape may know that she did nothing to warrant sexual assault, but almost invariably has a sense of shame and/or guilt. She does not feel on an emotional level that she bears no responsibility for the assault. She may have the distorted thought that perhaps in some small way she was responsible for being assaulted. As I explain to my clients, there is no justification for sexual assault regardless of the circumstances. I use CBT to reinforce and solidify that truth

In EMDR, I would use the thought that she had some responsibility for being raped as a false core belief. The Positive Cognition would be simply that she had no responsibility for having been assaulted. After successfully undergoing EMDR, the client replaces the Negative Cognition with the Positive Cognition. EMDR allows for the client to have a genuine belief and positive cognition of bearing no responsibility for being a victim. EMDR facilitates structural and permanent change.

The limitation of CBT in treating trauma is that it is based on identifying negative cognitions and reframing them. The therapy is cognitive based, requiring rational thinking. But emotions are not necessarily rational. CBT does not address feelings per se; it focuses on thought distortions. EMDR, on the other hand, concentrates on the client’s feelings about negative cognitions. A client might know something to be true on a rational level but cannot bridge the gap between knowing and feeling. EMDR bridges that gap.

After the client has discovered a new way of thinking, I use DBT and its focus on radical acceptance and accepting change to facilitate the paradigm shift to a healthier way of thinking. I contrast the positive and negative cognitions used as diametrically opposed concepts in EMDR, and help the client see and feel the huge transformation that took place in their understanding of their traumatic experiences.

I use CBT to reinforce new insights which have resulted from undergoing EMDR successfully. I also use CBT to identify how the client’s feelings about a negative thought were distorted, allowing for the client to have an entirely new and more positive perspective.

Going back to the example of the rape victim, the client now knows and feels that she was in fact the victim of a horrific crime. Her feelings are likely to shift from guilt and shame to sadness and anger. The latter two emotions are of course appropriate.

The healing which takes place by using CBT, EMDR and DBT in different stages of the EMDR protocol has brought healing to many clients which has amazed and inspired me. There is nothing better than seeing a client smile and express appreciation for the help they received. It makes it all so gratifying, for both the client and the therapist.