Self-administered EMDR without a therapist is very useful for a lot of things!post by Anton Rodenhauser (anton-rodenhauser) · 2023-05-25T17:54:13.389Z · LW · GW · 8 comments
How to do self-administered EMDR How I do self-administered EMDR Some personal anecdotes The risk of doing EMDR without a therapist: Re-traumatization None 8 comments
EMDR (Eye Movement Desensitization and Reprocessing) therapy is a structured therapy that encourages the patient to focus briefly on a traumatic memory while simultaneously experiencing bilateral stimulation (typically eye movements, but also tones or taps), which is associated with a reduction in the vividness and emotion associated with the traumatic memories.
EMDR is usually done with a therapist. However, you can also just do self-administered EMDR on your own - as often and whenever you want without any costs! Most people don't seem to know this great "do it on your own" option exists - I didn't. So my main goal with this post is to just make you aware of the fact that: "Hey, there's this great therapeutic tool called EMDR, and you can just do it!". And bearing some important caveats in mind, I highly recommend it. I've been doing emotional work like extended meditation retreats, Internal Family Systems (IFS), Ideal Parent Figures (IPF), Focusing, etc., for a long time, but self-administered EMDR has actually been one of the most helpful techniques of them all to me!
Also, I've found EMDR helpful for a much broader set of problems than the official EMDR protocol implies. You can use it for anything "trauma" in the broadest sense of the word - any unhelpful emotional schema; any strongly negatively charged emotion, belief, or memory that is kind of stuck in unconsciousness.
EMDR also doesn't have to be this complicated thing at all. I don't think you need to know more than there is in this blog post. You can totally 80/20 this, i.e. get 80% of the benefits from just 20% of the knowledge/effort.
How to do self-administered EMDR
Read here how to do EMDR with a therapist: https://www.helpguide.org/articles/therapy-medication/emdr-therapy.htm
For self-administered EMDR, you simply do the same, just without the therapist! So to summarize the most important steps of the official protocol, you:
- A specific scene or picture that best represents the traumatic event you’re targeting with this treatment. This is your “target.”
- A negative or unhelpful belief that is associated with the traumatic event. For example, “I am helpless,” “I am worthless”, or “I fucked up and therefore I’m a bad person.”
- A more wholesome alternative positive belief you would rather believe instead. This belief should reflect what is appropriate in the present. It should also feel true, at least to your rational current more wise self. For example, perhaps you survived an assault, with the subsequent negative belief: “I’m in danger.” You might replace it with the positive belief: “I’m safe now.”
- Focus on your target (the traumatic memory/event/whatever) while you subject yourself to bilateral stimulation. E.g. you look at a dot moving from left to right on a screen. Pay careful attention to all the negative beliefs and disturbing emotions and bodily sensations that arise. Take note of all your reactions to the processing - good, bad, or neutral, and any new insights, associations, or emotions you experience. During this process, you “digest” or process the feelings, images, and beliefs that occur in relation to the trauma. This step is called "desensitization." You do this until the target is no longer emotionally disturbing.
- Once you've desensitized your target, you can begin the "installation step." Again subject yourself to bilateral stimulation while you focus on your target. But now you also focus on your positive belief and try to override the original negative belief with it. To do this, it might help to alternate between the two beliefs in your mind, but put more emphasis on the positive belief. Do this until the new belief is "installed" and you no longer believe the negative old belief.
Here's what you can do for bilateral stimulation:
- Look at a dot moving from left to right on a screen. When the dot is on the very left of the screen, you should only be able to see it with your left eye, and vice versa. So your screen must be large enough for this, and close enough to your face. There are many EMDR videos for this on YouTube. You can also just wave your own finger in front of your eyes.
- Listen to sounds (usually "clicks") with binaural earphones, such that you can hear some sounds only with your left ear, and others only with your right ear. Usually, there are about 1-3 clicks per second in entirely random patterns.
- Tap yourself on your shoulders or legs in random patterns, using your right hand for your left side and vice versa.
- Again in random patterns with quick succession, quickly alternate between breathing in either through only your left or your right nostril, making sure you smell something different with each nostril. E.g. place an orange to your left and an apple to your right with a barrier in between the two. Just kidding!! This wouldn’t work.
You can also combine some or all of the above stimulations, which is probably a good idea and often done. I have an EMDR software by Psylaris that does even more: You see a dot moving in random patterns on a screen, you hear the binaural clicks, and every few seconds, you see one of three symbols on the screen, with the instruction being to tap yourself at a different body part depending on the symbol. Additionally, you can also set it up such that you get shown a calculation task every 10 seconds or so with the instruction to say the answer aloud. Also, the ball changes colour every few seconds, and you hear a popping sound each time it does so.
I think the general idea with EMDR is that you tax your working memory as much as possible such that you can still just barely also focus on your traumatic target and/or your positive/negative belief, all while activating/engaging as many as possible different brain areas and senses.
How I do self-administered EMDR
Sometimes I actually follow the official EMDR protocol described above, but most of the time I don't. One big problem (which turns out not to be a big problem) is that I don't really know my traumas! I don't have any obvious ones. Instead, all of the following have worked well for me as targets:
- Unpleasant "Felt Senses" that I get during Focusing. I find it to work especially well for stubborn Felt Senses where I can’t get to a “Felt Shift” (terminology from Focusing).
- Unpleasant or emotionally charged memories. So not necessarily traumatic ones, just unpleasant ones that trigger something in me.
- Imagining a triggering scene and using the Felt Senses that came up with that. For example, imagining failing with something important to me. Or getting socially rejected somehow by someone. Or imagining my parents doing something triggering/annoying/upsetting.
- Just any emotionally charged mental objects. Sinking feelings in your chest, tensions in your body that are triggered by certain thoughts, etc. There's no limit to what to work with and how creative to be here!
Also, most of the time I don't go through the formal steps of "identify the target, a negative belief, a positive belief". Instead, my approach is much more "just do it on the go”, often spontaneously whenever something interesting arises.
Example use cases:
- When I meditate and notice some interesting mental object arising, e.g., a strong negative emotion, I might spontaneously start tapping myself on my left/right shoulders with my right/left hands. Or I wave my finger in front of my eyes and focus on it for a minute or so while mindfully holding the object in my consciousness.
- Same when doing Focusing or when I get in contact with an Exile during Internal Family Systems - work. Sometimes I've done IFS work in front of a screen with my EMDR program on and ready, but with my eyes closed, and opening them only when I felt like I needed to do some EMDR.
- I've also done a lot of EMDR during mindful walks while thinking about emotionally difficult topics.
- I've even come up with some Ecstatic Dance/Qi Gong-like dance that I sometimes do when I'm emotionally upset, and that involves taps on my shoulders or legs and focusing on my waving hands in front of my eyes. So really, you can be very creative here!
- Sometimes I just do EMDR as a type of meditation. So instead of focusing on e.g. my breath, I instead focus on the moving dot on the screen and take that dot as my meditation object. I find that this type of "focus on the moving dot" meditation has certain advantages, most notably that a moving dot is much easier to focus on than the breath, and I experience much less mind-wandering with it.
- I also find it helpful to follow a guided breathing exercise while subjecting myself to EMDR. I use the app "Breath Ball" for this, and all it does is play two alternating different sounds - one where I breathe in, and one where breathe out. This way I am less likely to get lost in thought, which you really don't want to happen during EMDR (re-traumatization risk!). Also, when I find the upcoming emotions etc. to be too intense, I can just close my eyes/stop EMDR, and I'm immediately left with just the calming guided breathing exercise.
Some personal anecdotes
Ever since the beginning, whenever I meditated more than a few hours a day for more than a few days in a row, the following experience has been consistently happening to me over and over again: I generally became extremely happy throughout my days in a fairly deep sense of the word. But, the deeper my meditation got, the more obviously I also noticed a certain "sense of doom," a certain tension in my chest, a strong unpleasant Felt Sense of "something just isn't right." This "sense of doom" Felt Sense in the chest would only be there during the deep concentration of long mediation sessions and would immediately go away afterward.
I've been mystified by this for many years, and I've tried everything I can think of to deal with it. I calmly ignored it for hours while just focusing on the breath, but it would just get stronger and stronger. I've spent whole retreats focusing on it directly, making it the exclusive object of meditation, and "bravely stare at it with my mind wide open" - but it never changed anything.
I’ve also tried various visualizations and other things. For example, I've spent hours and days visualizing warm pleasant golden light flowing directly into that sinking feeling in my chest. Or, I visualized an all-powerful superhumanly beautiful healing goddess putting her warm comforting hands directly on my chest right where the pain is strongest. It all just never changed anything!
Only after years, once as I started doing EMDR whenever this feeling came up while focusing on it as hard as possible, did I finally make progress! As I looked at my waving finger in front of my eyes for the first time while focusing on that doom-y feeling, the feeling of tension in my chest became almost unbearably intense, and I got all sorts of very strong bodily reactions. I started to breathe heavily, my whole body shivered, I started to sweat. I also felt strong electrical currents flowing through my whole body. It was extremely intense and lasted for about 20 minutes! And all the while, an enormous flood of thoughts, memories, and intense emotions whirled through my consciousness. I also got glimpses of completely new memories from my childhood. And when it was finally over, my whole body felt a massive sense of relief, an extremely pleasant warm feeling of lightness and relaxation - as if a huge weight had been lifted off my chest.
By now, I've done EMDR with that sinking feeling as my target about 20 to 30 times. Sometimes I get no reaction, and most of the time I get a much weaker reaction than the initial time, and maybe 2 to 4 times I got an equally intense experience. The feeling of doom is still coming back occasionally during meditation, but much less now than it used to. And if it does, I continue to “EMDR it away” and make progress with it.
The risk of doing EMDR without a therapist: Re-traumatization
Many people warn you that doing EMDR alone is very dangerous because you risk re-traumatization. Or, at the very minimum, you risk bringing stuff to the surface that is very destabilizing. I admittedly don't know that much about it, and I'm a bit unsure how to feel about it. Anyway, here's how you minimize the risks of self-administered EMDR:
- Only do it when you feel pretty good and stable in your life. Ensure there's nothing stressful coming up for the rest of the day or even the next day(s). EMDR is not a quick fix to immediately relieve depressive feelings, anxiety, etc. It's more something you do when you don't feel acutely bad and want to work on making permanent progress with your emotional issues.
- If you regularly go to a therapist - even one who doesn't do EMDR - you can just do self-administered EMDR right before you see them such that you can talk to them immediately afterward. That's what I usually do, and it works great for me! I often start my session with them like, "So I just did EMDR with this thing that always triggers me, and this and that happened ... "
- Just because you don't do EMDR with a therapist doesn't mean you can't do it with a good friend or a trusted person. An EMDR trip sitter so to speak.Someone that you can get a hug from and talk to immediately afterward. For me my mom is actually such a trusted person, and I did a lot of self-administered EMDR on a vacation with her while she was just sitting next to me, sometimes holding my hand, and hugging me afterward.
- Know the theory and practical implications of how re-traumatization works. I've written a blog post about just that here. The upshot is: You prevent re-traumatization in the face of overwhelming emotions and memories by staying mindful and keeping in touch with the present moment and sensations, especially body sensations. As long as your mindfulness is strong enough such that you can always do that even when, say, having a panic attack, you are safe! So my personal upshot from this is that I'd only do self-administered EMDR at times when my mindfulness is fairly strong, i.e. at times when I feel well rested and have meditated a fair bit on the same and the previous days. The more you meditate, the less likely you get overwhelmed and retraumatized!
- If you do EMDR with a friend/trusted person, you can also just let the person play the role of the therapist and look at their waving finger in front of your eyes rather than e.g. looking at the moving dot.on a screen. This has the great advantage that your friend can actually check at all times whether you're still "there in the moment" and your eyes are still following the finger. This is the primary mechanism how a therapist makes EMDR safe: They check your eyes and immediately alert you/talk to you/bring you back to the present moment once your eyes don't follow the moving finger. This way it's ensured that you're not "lost in thought" with whatever comes up during EMDR. In a way, you can think of EMDR as a way of meditation where the other person can check whether you're still on it and not mind-wandering. But you don't need a trained therapist for this. Just a friend will do!
- Finally, if everything fails and you feel like you really did get re-traumatized, you can just skip a night or two of sleep! Really!! There are studies that people are way less likely to get PTSD after a traumatic event if they experience substantial sleep deprivation afterward. We know for sure that it works in rats. The idea is that you need sleep to consolidate your memories. If you deprive yourself of that after a traumatic event or re-traumatization, the newly formed bad memories don't consolidate. I really don't want to just skip a night of sleep, and I hope I'll never have to do this. But I find it pretty nice to know that this "Plan B" exists. It gives me the assurance of "Well, I don't have to worry that much about re-traumatization because worst case, I just don't sleep for a while, which is extremely annoying but not a catastrophe."
My intuitive sense is that the risk of re-traumatization from self-administered EMDR is vastly overblown, and I am personally somewhat annoyed by that because I feel like there's this great tool and almost no one is using it because of this vague fear that something could go wrong. Consider what fate meditation would have if it was discovered only today by some eminent psychology professor at Stanford. My guess is that they would run some studies with this "new therapeutic tool called meditation" and find it very promising but certainly with some risk. And because the medical system is always way too cautious, we would probably end up in a world where meditation is never done on your own but always only with a trained therapist, and lots of people would warn you that it's very dangerous to do this on your own because "it might be destabilizing." And in the end, almost no one would end up with a normal meditation routine - it would only be this somewhat obscure thing mostly done by people with very serious mental health problems in specialized clinics. I feel like that's what happened to self-administered EMDR!
That said, you really shouldn't take EMDR lightly. My guess is the risk is somewhat similar to doing a multi-day silent meditation retreat. Even if you have no idea what you're doing going into such a retreat, you're probably fine. Thousands of people do that every year, and only very few of them end up regretting it. But some people do end up regretting it!! Even if you know exactly what you're doing, there's still some risk, especially if you ignore the tips above on preventing re-traumatization.
But also keep in mind what re-traumatization is NOT. It's not the process of previously unconscious suppressed beliefs, emotions, or memories now suddenly spooking around in consciousness, causing you to temporarily feel much worse for potentially quite a long time, maybe weeks. This is entirely normal, and in a way, it's actually precisely what you want to happen! Bringing unpleasant suppressed material to the surface just is what needs to happen for emotional healing. But this can be pretty destabilizing temporarily and may even feel like you've re-traumatized yourself.
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comment by ChristianKl · 2023-05-26T00:21:18.240Z · LW(p) · GW(p)
When it comes to retraumatization, stronger memories carry stronger risk. You likely first want to use a technique like this with medium-level memories and not memories that are strong enough to produce panic attacks.
In clinical settings where people are completely dysfunctional in their lives because they have strong post-traumatic stress disorder there's a higher risk of retraumatization than for most memories that most people have.Replies from: anton-rodenhauser
↑ comment by Anton Rodenhauser (anton-rodenhauser) · 2023-05-28T12:05:04.775Z · LW(p) · GW(p)
That's true. However, it's hard to know in advance how severe a trauma is.Replies from: ChristianKl
↑ comment by ChristianKl · 2023-05-30T16:13:20.176Z · LW(p) · GW(p)
I think the cases that motivate the advice to worry about retraumatization are mostly cases where it's very clear that there's severe trauma.
comment by rhollerith_dot_com · 2023-05-25T18:20:56.427Z · LW(p) · GW(p)
Thanks for the report. With these kinds of reports, I give more weight to reports by those with more experience in the subject matter of the report, so it would be nice to know how long ago you first tried self-administered EMDR.Replies from: anton-rodenhauser
↑ comment by Anton Rodenhauser (anton-rodenhauser) · 2023-05-28T12:08:02.883Z · LW(p) · GW(p)
I've started doing self-administered EMDR about 6 months ago, and I've been using it very regularly since then, maybe 4 times a week. About half of the time that I do it it feels like it does "something", and maybe every 1 in 10 times it feels like a bigger breakthrough. I've noticed big changes in my behaviour and emotional life over the last 6 months. However, I've been combining a lot of therapeutic stuff, not just EMDR.
comment by Blacknsilver · 2023-05-28T02:05:08.912Z · LW(p) · GW(p)
I was just reading about EMDR in "The Body Keeps the Score" and thinking how nice it'd be if my psychiatrist wasn't stuck in the 19th century. I will try this out on my own and edit (or maybe reply) later on with my thoughts and experiences.
comment by Kaj_Sotala · 2023-05-27T09:50:48.487Z · LW(p) · GW(p)
Thanks, I'd tried self-administered EMDR sometime before and didn't get much out of it. Now I gave it another shot and it caused some stuff to surface, so seemed to be doing at least something even if I didn't get to the root of the issue yet.
Do you have any thoughts on how I should try to balance the external stimuli vs. the internal content? I notice that it's easy for either the EMDR stimuli to push the emotional content out of consciousness or vice versa. Should I try to keep them exactly balanced, or predominantly emotional content with some stimuli, or predominantly stimuli with some emotional content?
I also wondered about, when I was focusing on a felt sense and memory fragments started coming up, should I "make more room" for those memory fragments or just ignore them and keep allocating exactly the same amount of mental space to the felt sense.Replies from: anton-rodenhauser
↑ comment by Anton Rodenhauser (anton-rodenhauser) · 2023-05-28T12:13:16.213Z · LW(p) · GW(p)
These are all excellent questions! Unfortunately, I don't have definite answers. I've read somewhere that the idea is to tax the working memory as much as possible such that you can just barely hold an emotional felt sense at the same time as well.
I'd be very interested if someone does some more reading and research on this!
What I personally do: The more intensive the felt sense feels, the harder I focus on the EMDR "distractions", and vice-versa.