What is EMDR?

EMDR is a psychotherapy technique used for trauma and anxiety. EMDR creates a bilateral movement of attention whilst simultaneously the patient engages with  anxiety provoking thoughts. This is repeated with occasional checks by the therapist to see how the patient is feeling or if any particular thoughts of memories have arisen. The bilateral movement is created in a number of ways;

• Simulated REM – The most common forms of EMDR is to get the patients eyes to replicate rapid eye movement (REM) by directing the patient to focus their vision on something which moves left to right and then right to left. Usually this is done by the therapist holding their fingers up level with the patients eyes and then instructing them to keep their head still whist the move them on a level with the eyes.
• Butterfly taps – Often used when eye movement is impractical in some way. The patient is instructed to cross their arms across the body with the right hand on the left shoulder and vice versa. They then create the bilateral movement by tapping the should, alternating between left and right. Variations on the tapping approach exist, with some therapists tapping the back of patients hands.
• Auditory simulation – occasionally a therapist will initiate the cross lateral stimulation by making sound on either side of the head. This can be very hard on a therapists joints so some have special machines for it.
• EMDR machine – a number of devices exist which stimulate bilaterial movement. These could be a simple led set up which moves a light from left to right and back again, or programme for a set of headphones to create alternating sounds, or a more integrated device which does both of these synchronously and possibly more.

So we’ve looked at the mechanics of what EMDR is, but this tells us nothing about how it works?

How does EMDR Work?

No one can currently say for certain how EMDR works but a two of the commonly given explanation are

• Bilateral processing – the idea here is that bilateral activities, such as REM, cause information in the brain to be processed in both left and right hemispheres of the brain. Because the left and right hemispheres of the brain fulfil different roles (Left =logic/reason, right = creation/emotion) the bilaterial stimulation encourages integration of the thoughts/memories which are currently active whilst the stimulation is active. In real terms this means that by accessing a traumatic memory, essentially a right brain memory (emotional memory), and then initiating bilateral stimulation the left brain is activated simultaneously to the left brain, ultimately resulting in the previously solely right brain memory now being integrated into the left brain, where the lefts brains distinct function (logic/reason) acts to moderate and process it. (2)
• Neurological rewrite – there is a brief period after every memory is accessed where it is open to being altered (3). One theory goes that by applying immersive stimulation, the bilateral movement, during this brief window the memory is changed and by repeating this many times in a therapeutic context with an explicit goal the memory is adjusted with that goal in mind.

These are but two of a number of possible explanations for why EMDR works, now let’s look at how and what it works for

What does EMDR help with?

Originally developed as an intervention to help with trauma(2), there is evidence for EMDR’s effectiveness in treating;

• Trauma (4, 5)
• Depression (5, 6)
• Anxiety and related conditions (7)

Further, evidence exists that it can be effective at reducing the experience of cravings in recovering addicts (8), and perhaps most importantly it has been seen to have a low risk for side adverse reactions (9).

Is EMDR a sort of a psychotherapy ‘wonder drug’?

Like most psychological intervention EMDR sometimes has miraculous effects. As a practitioner myself it certainly feels like miraculous change happens with more frequency than with a lot of other interventions, but not always and not for everyone. As with most techniques there is a skill in when and where to apply it. This means that EMDR often works best as part of a larger therapeutic intervention where techniques are introduced to prepare the patient for change before the EMDR is applied, and then other techniques are used to ensure that the changes are effectively embedded into ongoing life.

EMDR is however a highly versatile therapeutic tool. I have applied it successfully in all the evidence based areas (trauma, anxiety, depression) and also with issues like relationship breakup, weight loss, pornography addiction, functional dyspepsia, erectile dysfunction, driving anxiety, bereavement and many more.

References

1. Shapiro F. EMDR 12 years after its introduction: Past and future research. Journal of clinical psychology. 2002;58(1):1-22.
2. Shapiro F. Eye movement desensitization and reprocessing. 1995.
3. Shaw J. The memory illusion: Remembering, forgetting, and the science of false memory: Random House; 2016.
4. Torres-Giménez A, Garcia-Gibert C, Gelabert E, Mallorquí A, Segu X, Roca-Lecumberri A, et al. Efficacy of EMDR for early intervention after a traumatic event: A systematic review and meta-analysis. Journal of Psychiatric Research. 2024;174:73-83.
5. Villegas-Ortega J, Galvez-Arevalo R, Castilla-Encinas AM, Gutiérrez-González B, Apolitano-Cárdenas CI, Alvarez-Arias PM, et al. Effects of EMDR vs. waiting list for adults with post-traumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders. 2025:120134.
6. Sepehry AA, Lam K, Sheppard M, Guirguis-Younger M, Maglio A-S. EMDR for depression: A meta-analysis and systematic review. Journal of EMDR Practice and Research. 2021;15(1):2-17.
7. Yunitri N, Kao C-C, Chu H, Voss J, Chiu H-L, Liu D, et al. The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials. Journal of psychiatric research. 2020;123:102-13.
8. Martínez-Fernández DE, Fernández-Quezada D, Garzón-Partida AP, Aguilar-García IG, García-Estrada J, Luquin S. The effect of eye movement desensitization and reprocessing (EMDR) therapy on reducing craving in populations with substance use disorder: a meta-analysis. Brain Sciences. 2024;14(11):1110.
9. Wright SL, Karyotaki E, Cuijpers P, Bisson J, Papola D, Witteveen A, et al. EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis. Psychological medicine. 2024;54(8):1580-8.

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Vaginismus is ‘persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger, and or any object, despite the woman’s expressed wish to do so.’ (Basson et al 2004) This tightness is usually caused by a tensing of the vaginal muscles, although infact in most cases it has been observed that the woman will tense all her muscles, as if responding to a threat. Over the years vaginismus has been confused with dyspareunia, a condition in which vaginal pain causes the vaginal tightness, this has led to a combined definition which covers the two conditions ‘Genito-Pelvis Pain / penetration Disorder’ (GPPPD) (Binik and Hall 2014)

Vaginismus can be sub-categorised as either (Crowley et al 2009)

• Primary; lifelong
• Secondary; acquired after a period normal sexual functioning.

Some Gynaecologist employ the Lamont scale (from Pacik 2011) when classifying vaginismus, it is specifically intended for responses in a gynaecological examination but may still be useful in providing some measure with which to judge the severity of symptoms.

What is vaginismus? – how common is it?

Vaginismus has been observed in a wide variety of counties and cultures, including Sri lanka (Munasinghe et al 2004), Ireland (O’Sullivan, K. 1979), Turkey (Kabakci & Batur 2003, Dogan 2009), Scandinavia (Wijma & Wijma1997) and traditional Islamic populations (Yasan & Akdeniz, 2009). Historically its general prevalence has been difficult to identify (Spector & Carey 1990). One study (Read et al 1997) study of 170 women presenting at the general practitioners (GP’s) who agreed to conduct a questionnaire on sexual problems found that 30% reported Vaginismus, however this can be contrasted with a study from Morocco which found only 6.2% (Kadri et al 2002). Simons, & Carey’s 2001 review of the previous decade’s evidence suggested a general population prevalence of 0.5-1%.

What is vaginismus? – causes

There is no one simple answer to this question as no single cause has ever been established. Most of what we suspect to be causes are in fact correlation which often appear with vaginismus but cannot be said with certainty to be causes.  These possible causes include pain, threat and disgust regarding sex or penetration, a history of sexual abuse may also be a factor as can be low-self esteem or a strong moral upbringing. For a more detailed see ’causes of vaginismus’ 

What is vaginismus – treatment options

There are a number of options to treat vaginismus the most well researched are the psychological and behavioural approaches which include;

Cognitive Behavioural Therapy (CBT) – this helps the sufferer to identify their own assumptions, beliefs and automatic thoughts about sex, to challenge the limiting ones and then to enter sexual situations with new beliefs.

Desensitisation – a process of graded exposure in which the patient is deeply relaxed and then enters, or imagines entering, sexual anxiety producing situations. With depth of relaxation and repetition the body learns to be relaxed in that situation. Sometimes this is used in CBT for greater efficacy.

Pelvic floor exercises – these strengthen the pelvic floor muscles, which many consider to be potentially counter productive but may actually improve things by enhancing control of these muscles.

REFERENCES

For more on treatment options  

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You may already know what vaginismus is, and regardless of whatever the causes of vaginismus there are a number of vaginsimus treatment options. In this blog we explore some of the most well known and most easily accessible.

Vaginismus treatment options – Botulinum neurotoxin (Botox)

Although a variety of techniques have been used, most botox approaches use injection into the pelvic floor muscles (Pacik 2011). Success rates vary from 75% (Ghazizadeh &, Nikzad  2004) up to 100% (El-Sibai 2000), at completion of therapy, with many studies showing a good retention of benefits at 1 to 2 year follow up (Pacik 2011, Bertolasi et al 2008).  However, many women are uncomfortable with this approach.

Vaginismus treatment options – Exercises

Although research is in its early days Pelvic floor muscles exercises have demonstrated some additive benefits to dilator therapy (see desensitisation below) (Reissing et al 2013). Sphincter muscle exercises have also been seen to be effective (Zukerman et al 2005). One study used Functional electrical stimulation (FES) a system in which a small electrical charge is applied to create muscle stimulation to help with training of the pelvic floor muscles, which when combined with desensitisation proved highly efficacious (Seo et al 2005). Pelvic floor exercises appear to be a good addition to desensitisation approaches (see below).

Vaginismus treatment options – Desensitization

Desensitisation is a process of graded exposure which can be done in real life, known as in-vivo, or can be done in the imagination, known as in-vitro. The therapist combines relaxation with the anxiety producing stimuli (in this case vaginal penetration) and through a process referred to as reciprocal inhibition the old anxiety response is over written with the new relaxation response. It is usual to start off with a relatively mild anxiety trigger (such as the thought of penetration by a very slim object) get the subject relaxed with that and then progress on to the next, slightly more, challenging trigger.

Because of the intimate nature of vaginismus often the patient will have the approach explained to them, be taught how to relax and then they will conduct the work at home with a set of vaginal dilators or their fingers. Many therapists will go through the process in the imagination in preparation for the woman to go through it in reality at home, this approach is particularly common amongst hypnotherapists.

Studies of both In vivo and In vitro approaches have achieved high levels of success. Many small scale studies obtained 100% achievement of intercourse at or before the completion of the study (Biswas & Ratnam 1995, ter Kuile et al 2007, Reamy 1982,) and larger scale studies (120ss) still producing strong positive results (93.3%, Jeng  et al 2006, Schnyder et al 1998 ). Results appear to have been achieved in about 1-6 sessions (Reamy 1982, ter Kuile et al 2007) and show good levels of retention at follow up, with 100% retention at one year follow up in Reamy’s (1982) small scale (10ss) trial and 83.3% of the women in Jeng et al’s 2006 study having regular intercourse with orgasm at one year review.  Schnyder et al’s 1998 study which compared women receiving in vivo desensitisation with those receiving in vitro found no statistically significant difference between the two groups, whilst repeating the trend for high efficacy 97.7% of participants were able to have sex by the end of the study, of whom all retained this ability at follow up, average 10 month follow up and over half of whom reported total freedom from symptoms. Hypnotherapy enhanced desensitisation has been tested in several studies with a high degree of success (Al-Sughayir 2005, Degun & Degun1982, Fuchs et al 1973). With all desensitisation approaches demonstrating such high rates of success it is hard to say if the addition of hypnosis to the desensitization procedure makes a significant difference or not. Al-Sughayir’s 2005 does suggest a trend towards a faster response when hypnosis is used, but nothing else.

Vaginismus treatment options – Couples therapy

Traditional couples therapy approaches appear to yield results. One study of 56 couples achieved an 80.3% success rate as defined by achieving penetration (Munasinghe, et al 2004), with another similar study achieving a remarkably similar outcome, which was sustained at a three month follow up (Hawton & Catalan 1990).

Vaginismus treatment options – Cognitive Behavioural Therapy (CBT)

CBT is a psychotherapeutic approach which encourages the examinations of beliefs, assumptions and automatic thoughts, adopting new thoughts and then testing these in real life situations.  It has been demonstrated to be efficacious in treating vaginismus when targeting fear of coitus cognitions and avoidance behaviours (ter Kuile et al 2007).  Other CBT therapists have combined education, both general and vagina specific muscle relaxation, and graded desensitisation (see above) via the patient’s own finger (Wijma,& Wijma,1997), which has been shown to be highly efficacious at completion of therapy with Mousavi & Farnoosh (2003) reporting a 91.42% success rate. Other studies have shown even higher success rates (100%). However, these successs have to be seen in the light of high dropout rates by patients prior to treatment, which have in some cases been as high as 50% (Kabakci & Batur 2003). This suggests that a self-selecting group has a high chance of success.

Bibliotherapy, self-directed CBT via book, with minimal contact, and group therapy CBT approaches have both produced statistically significant benefits but at a low level (Van Lankveld 2006). Engman et al’s (2010) follow study of woman who had received an average 14 sessions of CBT found after 3 years 81% of respondents (respondents = 74.6% of the original woman who responded to contact) were able to have intercourse, although only 6% reported it was pain free, however most still reported enjoying it. When hypnosis was combined with the CBT approach by Eserdag Et al (2011) in a large-scale study (460ss, receiving between 2-10 sessions each) 100% success was found at three month follow up, with similar results at the 1 year mark, although at this point not all the women were achieving orgasm, and a small number were participating in but not enjoying sex.

references

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Considering porn addiction therapy? In this article we take a look at 3 of the most well researched porn addiction therapy approaches (What is porn addiction?) . 

Porn addiction therapy

1. Family based therapies

How it works?  – Family based therapies seek to explore the family dynamics and assumptions. The therapist will often ‘become a member’ of the family in order to understand its workings and  then they will look to help the family to challenge unhelpful behaviours and unspoken rules which may create or sustaining the problem.

Does it work? – Family based therapies has enjoyed some success as a porn addiction therapy (Ford, Durtschi, Franklin 2012, Wonder 2013), however a lot of people presenting for porn addiction therapy are embarrassed by their behaviour (Chrisholman 2015) and are not ready to challenge this in an open family setting. 

    2.  Acceptance and Commitment Therapy (ACT)

How it works? – ACT works as a porn addiction therapy by helping a person to accept their desires without having to act upon them. Practical behaviour changes and desensitizing exercises are often used to reduce temptations and the therapist helps the person to identify their values in life so they can direct more energy towards what they want. The aim of therapy is flexible and often will look to reduce porn usage to ‘normal’ levels rather than completely stop, although this can be considered.

Does it work?  – Although it is early days there is a growing body of evidence that ACT is effective as a porn addiction therapy (Twohig 2010, Wetterneck et al 2012, Twine 2015) 

    3. Cognitive Behavioural Therapy (CBT)

How it works? –  CBT works by challenging assumptions and beliefs and then adopting new beliefs, which are then reality tested. As a porn addiction therapy CBT will often concentrate on assumptions around the ability to control biological impulses and the strength of those impulses. As with ACT practical lifestyle changes are likely to be part of the therapy.

Does it work?  – Although currently there appears to be little direct evidence for CBT’s efficacy as a porn addiction therapy it is looking promising (Fjerkenstad 2012, Twine 2015). 

Hopefully this article will help you to decide for yourself which therapy approach is right for you.

The author – Matt Krouwel is a hypnotherapist in Birmingham (UK). He has extensive experience working with sex and pornography addictions and has taught the use of hypnotically enhanced ACT and CBT.

 References – Porn addiction therapy 

Chisholm, M., & Gall, T. L. (2015). Shame and the X-rated Addiction: The Role of Spirituality in Treating Male Pornography Addicition. Sexual Addiction & Compulsivity, 22(4), 259-272.

Ford, J. J., Durtschi, J. A., & Franklin, D. L. (2012). Structural therapy with a couple battling pornography addiction. The American Journal of Family Therapy, 40(4), 336-348.

Fjerkenstad, J. (2012). In my opinion: Treatment that mirrors the dark world.Sexual Addiction & Compulsivity, 19(1-2), 156-160. 

Twine, S. L. (2015). ANCOVA Study of Psychotherapy Treatment of Internet Pornography Addiction in Heterosexual Men. Fidei et Veritatis: The Liberty University Journal of Graduate Research, 1(1), 3.

Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of consulting and clinical psychology, 78(5), 705.

Wonder, N. (2013). TREATING PORNOGRAPHY ADDICTION WITH IFS.Internal Family Systems Therapy: New Dimensions, 159.

Wetterneck, C. T., Burgess, A. J., Short, M. B., Smith, A. H., & Cervantes, M. E. (2012). The role of sexual compulsivity, impulsivity, and experiential avoidance in internet pornography use. The Psychological Record, 62(1), 3.

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Hypnotherapy is the combination of traditional hypnosis with suggestion, imagery and psychotherapeutic techniques to help achieve change, but what does this really mean? In this blog we are going to look at the structure of a  hypnotherapy session in detail so you know what to expect.

What happens in a hypnotherapy session?

Traditionally a hypnotherapy breaks down in to 5 sections

1. Talk – It doesn’t matter if you are on your first session or fifth the hypnotherapist is going to take a little time to chat.  This will normally be about the condition you have come to work on so the hypnotherapist can get a clearer picture to aid in the hypnotherapy Don’t be surprised if you find you are discussing your work and leisure interests, such information can be very helpful to the hypnotherapist.
2. Induction & deepening of hypnosis – Getting into hypnosis for hypnotherapy reasons is usually achieved through relaxation or focusing exercises. Several exercises may be presented to allow you to access the right level of trance for you. The hypnotic trance itself will usually leave you aware of your surroundings.
3. The therapy – Once you are comfortable in the trance the formal therapy begins, this could be:

• Visualisation – An exercise which uses the imagination to convey ideas to the unconscious mind.  A good example is imagining a warm colour to help relax muscles.
• Suggestions – These are simple direct ideas which the hypnotherapist ‘suggests’ to the unconscious mind, for example “you have no desire to smoke”. Suggestions are the most direct tool most hypnotherapists employ, and yet there is still a lot more skill to crafting a suggestion than most people would believe.
• Psychotherapy – hypnotherapy uses knowledge from many ‘schools’ of psychotherapy including Behavioural psychology, Psychodynamics, Cognitive psychology, Neurolinguistic Programming (NLP) and Mindfulness based approaches. The hypnotherapist will select approaches based on what they think will fit with your personal psychology and condition.

4. Awakening – You will be brought back to full waking consciousness so that you are fully orientated to the present.
5. Homework – Hypnotherapy is usually accompanied by some form or task or action. This could be as simple as throwing all your cigarettes away, but is most commonly a relaxation or self-hypnosis exercise.

Hopefully this understanding makes it a little more comfortable to go for hypnotherapy.

The author –

Matt is a hypnotherapists in Birmingham with over 16 years experience. He has taught hypnotherapy around the world in universities and medical school and specialises in the treatment of anxiety conditions. He is currently conducting research into the treatment of Irritable bowel syndrome (IBS) with hypnosis.

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