Same Same but Different: Variations in the Therapists Application of the EMDR Standard Protocol and the Usage of Minimal Nonverbal Changes

Following the Eye Movement Desensitization and Reprocessing (EMDR) standard protocol, counting down a fixed number of bilateral stimuli (BLS) is the guideline-conforming strategy for determining the optimal length of each set within processing the pathogenic memories. A surprisingly high proportion of EMDR therapists, however, deviates from this recommendation, making the time-point for interruption dependent on the occurrence of Minimal Nonverbal Changes (MNCs) in gestures, facial mimics, muscle tension or breathing, which are supposed to indicate a change in emotional valence. This survey-based pilot study attempts to scientifically examine this important phenomenon within EMDR. Eighty-eight certified EMDR therapists reported on their individual application of the standard protocol. In addition, the frequency, indicator value, and emotional valence of a broad range of MNCs were assessed. Significant individual differences and a high degree of deviation from the standard guidelines were found, with age, gender, therapeutic orientation, and patient clientele as moderating factors. Whereas three-quarters of the therapists determined the optimal length of each set of BLS dependent on MNC, only about a quarter used counting down as the preferred interruption strategy. 98.2% of the therapists estimated that MNCs are highly important. Visible forehead relaxation, smiling, and deepened inhalation and exhalation were considered particularly valuable as indicators for a valence change. The results can serve as a basis for an further experimental design that enables the observation of nonverbal changes and their physiological correlates during an ongoing session.