How I use CBT with EMDR

One of the great things about EMDR is that it can be used in tandem with other theories. In my practice, I find that adding CBT (Cognitive Behavioral Therapy) techniques help focus the EMDR sessions when healing childhood trauma, and by using them both together create a much more powerful target with lasting results. This post explains how I use CBT in my practice.

Negative core beliefs from childhood tend to be tinted in black and white, have an absoluteness to them and often are ego based. For instance, say a friend cancels their plans with you and your first thought is that they canceled because they don't like you. Notice the strong presumption around the thought. It offers only two options, that you are either a likable person, or not, and it is focused on the assumption that the person is only thinking about you when making the decision. These are all clues that it could be coming from a negative core belief from childhood.

CBT asks us to challenge this thought by coming up with alternate truths. Perhaps the friend is sick, or had a family emergency. When we are asked to challenge negative thoughts, we do so using our fully developed adult brain which has the ability to think rationally and empathize with others. This is another clue that the original negative thought of "they canceled because they don't like me" could be originating from a negative childhood core belief, simply because it was made before we had the ability to use deductive reasoning to form our beliefs.

The next step is to notice how you feel when you think of the original negative thought, and then notice how you feel when you introduce an alternate suggestion. When we think of the first thought, chances are that unpleasant feelings come up, whereas thinking about the alternate suggestion brings up more neutral feelings and some empathy for the friend's situation. This is another clue that the original thought could be coming from a negative childhood belief.

The key for EMDR is to use these clues to find out where the core belief is coming from and identify it as a target for EMDR processing. Take a moment to focus on the feelings that come up when you think of "my friend canceled because they don't like me." What feelings are coming up, and when was the first time you felt them growing up? Is there a memory attached to these emotions? Did someone say this to you, or make you believe that you are not likable? Take a moment to let your mind float back to that time. If more than one time/memory comes up, focus on the one that stands out the most and has a lot of negative emotion attached to it. Then imagine you are back in that situation and come up with an I statement that represents the belief about yourself during that time. Using our example above, it could be "I am a bad person." Then we want to come up with a replacement belief that comes from your knowledge now as an adult and ability to see things differently. The replacement belief could be "I am a good person". The replacement belief doesn't need to be 100% believable in the beginning, just something that you identify with a little bit, but perhaps because the intensity around the negative belief is so high right now, it's stopping you from being able to fully accept it.

EMDR works by turning the volume down on the intensity around the negative belief by processing any unresolved trauma around it. Once the intensity is at a 0 out of 10 (usually when we start, the intensity will be pretty high on a 0-10 scale) then it will be easier to focus on the positive replacement belief, which will be done through EMDR. Usually what happens in this phase is that we start remembering times throughout our lives where we were shown or learned that we are a good person and the belief becomes more believable as we remember it was there all along.

The difference between just using CBT without EMDR to change core beliefs is that CBT requires you to consciously replace the negative belief with a positive one every time you think about the negative belief. This can take a long time and perseverance on our part, as often these negative beliefs come from our subconscious and will float up to our conscious mind at will, and having to identify and then counteract it every single time can become exhausting. Also, as long as the negative core belief is still unprocessed, it often acts as a block to any sort of conscious progress, because it is a belief.

With targeting these core beliefs through EMDR, we are targeting the unprocessed trauma which served as the irrefutable evidence needed to form that belief about ourselves in the first place as a child. When the trauma is processed, the negative belief won't be so distressing, and will make room for other more positive beliefs to be entertained. Most likely you have built up enough evidence so far in your adult life to know the positive belief is true, but the intensity around the negative belief/trauma was so distracting that it was calling the shots. By using EMDR this way, often we see results much faster than by employing traditional CBT.