The delivery and administration of medical services worldwide have changed drastically since the pandemic came into the picture, forcing many mental health and wellness therapists to move their practices online. One of the affected fields is psychotherapy, including Eye Movement Desensitization and Reprocessing (EMDR). Can EMDR therapy be done virtually?
EMDR therapy can be done virtually through online sessions, cloud software embedded in therapist’s websites, video conferencing, and mobile apps. Screen-sharing programs allow clinicians to control their choice of bilateral stimulation techniques remotely.
Clinicians have employed resourceful, innovative methods to deliver EMDR therapy online, including Telehealth. Read on to find out the other modalities, discover the benefits of virtual EMDR, the technological advances that support it, and how to take advantage of it.
What Is EMDR Therapy?
EMDR therapy is a unique form of psychotherapy that is a research-backed treatment for eliminating mental and emotional distress caused by depression, anxiety, grief, Post-traumatic Stress Disorder (PTSD), and other mental health conditions. EMDR therapy uses eye movements to stimulate the left and right brain hemispheres to reprocess and reorganize upsetting experiences, diminishing their power over patients.
EMDR proponents claim it works faster and its effects last longer than more popular forms of mental health treatment, such as cognitive-behavioral therapy, talk therapy, medication, and hypnosis.
How Does Regular EMDR Work?
Trauma affects the brain like a virus infects a computer. The virus causes the machine to malfunction, forcing its memory to replay in an endless loop and renders it unable to process information normally. Computers can be rebooted, but the human brain is a bit more complicated.
The regular working brain, like a computer, also takes in and processes information but does this while we are sleeping, in a state known as rapid eye movement (REM) sleep. When we suffer a traumatic event from an accident, tragedy, war, or abuse, the sudden stress causes our brains to freeze, fail to process memories normally, and compels memories to play over and over.
Since our emotions have not been processed properly, we feel pain, anger, and fear every time a memory replays, and we are powerless to control this. EMDR therapy can reprogram our brains the way the reset button can bring a computer to its original state, and it is like a system reboot for a besieged brain. By replicating REM sleep, it stimulates our brains to process traumatic memories properly.
EMDR rewires the nerve connections in our brains, making them work properly again, which is why EMDR works effectively for most kinds of emotional pain. Scientific studies have proven this, and according to EMDR Expert, over 80% of their patients have reported success after just a few sessions.
EMDR Procedure
Patients visualize and relive past trauma while therapists subject their brains to a left-to-right rhythm called “bilateral stimulation” (BLS), aka “dual attention stimulus” (DAS). This back-and-forth pattern decreases the patient’s psychological attachment to the trauma.
Therapists accomplish this by asking patients to do one of these:
- Follow the movements of the therapists’ fingers/hands with their eyes
- Track the movements of blinking lights from a light bar
- Hold vibrating pod-like gadgets called “tappers” (tactile or touch-based BLS)
- Listening to tones or music that play alternately in each ear through headphones
How Does Virtual EMDR Work?
Virtual EMDR does everything standard EMDR does, except that it is delivered online via video conferencing, specialty software, or apps.
How Have Therapists Adapted EMDR Online?
EMDR is typically done in a therapist’s office because it’s a hands-on treatment method using tangible BLS tools. The challenge was how to execute the therapy without these instruments (light bars, tappers) and the therapist’s physical presence (moving fingers).
These tools are necessary for therapists to provide the back-and-forth movement needed to stimulate both sides of the brain.
Alternatives to Standard BLS Tools
Therapists have solved that issue (with their patients at home) by asking them to:
- Watch a moving dot on the screen of a computer or mobile device through a screen-sharing program, such as Simple Practice, as it allows therapists to start and stop the left-right stimulation remotely.
- Physically tap knees, legs, or shoulders with their hands in place of the vibrating tapping gadgets. The last variant is called the “butterfly hug,” wherein clients cross their arms over the heart and alternately tap each shoulder. Some virtual EMDR practitioners prefer this technique because it is more grounding for patients.
- Use virtual EMDR apps.
- Download the audio tones from websites or apps.
- Use virtual light bars from YouTube.
- Move their eyes left to right and back and forth from the corners of their room. Therapists without screen-sharing capabilities verbally guide patients if they need to increase the duration and speed of each set of eye movements.
Resourceful Maneuvers by Therapists To Administer EMDR Virtually
Washington DC psychotherapist Annie Miller uses a hybrid tool that combines a virtual light bar with an audio component, which allows patients to engage in sound and sight simultaneously. This virtual EMDR tool has its own window separate from the telehealth platform. Patients watch a ball move across the screen with optional sound, while Miller controls the tool’s volume and speeds remotely.
Mental health counselor Dana Carretta-Stein, the founder of Peaceful Living Mental Health Counseling, puts her existing light bar in front of her computer’s camera. Both the light bar and the patient are a comfortable distance apart so that the patient can achieve an entire sweep of the eyes.
Caretta-Stein controls the speed, length, and duration of BLS sets from her smartphone. No other program, link, or screen-sharing software is needed, and it’s the easiest way to deliver BLS virtually.
EMDR via Video Conferencing
EMDR consultant and EFT (emotional freedom technique) provider Bruce Woods Patterson holds EMDR video sessions. He believes bilateral stimulation is the hallmark of EMDR, which he considers a power device in his clinician’s toolkit, and feels that he is 70% more effective as a psychotherapist because of it.
Patterson had been practicing virtual EMDR even before the pandemic hit. He got into virtual EMDR out of necessity because his client from Manhattan relocated to Texas. He refused to switch therapists and wanted to do EMDR long-distance. So Patterson sent him a bilateral audio CD that played music slowly from one ear to the other. It was a substitute for eye-movement BLS.
Patterson prefers to hold EMDR sessions through video conferencing because he is wary of apps and small-screen EMDR technology. He says that the left-to-right eye movements have to travel across a certain distance to be effective.
He explains that the patient’s (visual) awareness has to go back and forth across the midline of the body to encompass his peripheral vision on each side. Thus, the screen has to be large or wide enough to accomplish this, and mobile devices don’t provide this feature.
He pointed out that the late Dr. Francine Shapiro, the creator of EMDR and author of Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures, preferred eye movements. “That’s her bias because that’s how she discovered EMDR.”
Can Therapists Remotely Monitor Patients Effectively?
Clinicians can monitor a patient’s affect using a new technology initially used by dermatologists, which they say is more effective than the naked eye.
They use cameras to pick up subtle variations in the patients’ skin coloring to tell therapists their pulse, and changes in pulse show one’s emotional state. The tech is like neurofeedback devices or Apple watches that monitor pulse, temperature, and other vital signs, which the clinician can view at their end.
Therapists Use Virtual EMDR Apps
These apps use EMDR-type techniques to help deal with stress and anxiety. Note that these should only be used as supplements to standard EMDR treatments or to treat less-intense stressors or minor phobias. Complex phobias and trauma like PTSD should only be treated by certified EMDR practitioners.
These virtual EMDR apps and online programs allow therapists to administer audiovisual BLS and control the speed and duration of each set. Many are free, while others need subscriptions.
- EMDR Remote – allows therapists to control an online light bar to administer BLS remotely
- EMDR Therapy – uses sounds and images to deliver BLS to both juvenile and adult patients
- Remote EMDR – a popular EMDR telehealth site that allows therapists to administer EMDR remotely for off-site patients
- Easy EMDR – combines an EMDR light bar with a bilateral auditory stimulus.
- Anxiety Release based on EMDR – uses a brain-training session and guided instructions to relieve agitation through BLS.
- EyeMove EMDR Therapy – allows patients to choose an item to follow with their eyes. They can change this object’s speed, size, and color.
- EMDR 101 – Patients can use these combo EMDR sessions and bilateral visual stimulation by themselves or guided by a therapist.
- Virtual EMDR – The EMDR Kit is an audio-only meditation tool that uses BLS to help patients deal with stressors and is designed to be used at home online, with or without a therapist’s guidance. It also offers free diagnostic tests that mental health professionals typically use to assess potential patients for mental health conditions, but they are not meant to replace formal assessments.
Safety Issues
Virtual trauma therapy presents specific concerns, particularly patient safety from a distance. Therapists need to see the patient’s entire body to determine what’s happening at their end and keep them safe, and video conferencing helps in this regard.
Also, the processing of traumatic experiences is serious and may bring about volatile reactions that can be a challenge for therapists to contain.
To address this concern of a client potentially facing dysregulation (getting impaired while undergoing a physical or psychological process), Utah therapist Sarah Stroup relies on patients’ emergency contacts and informed consent as an emergency precaution to ensure their safety.
Conclusion
We may be unaware of it, but we participate in some form of natural bilateral stimulation, like walking or playing musical instruments. Virtual EMDR is simply another form of brain stimulation that taps into the body’s natural ability to heal itself.
Although we can self-treat minor stressors with virtual EMDR apps, we need experts to address complex medical conditions. EMDR isn’t a miracle fix but part of a multi-technique approach to resolving mental health issues. Its success rate is higher when combined with traditional psychotherapy. Whatever format we choose, it’s prudent to have a medical professional guide us.