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EMDR Negative And Positive Cognitions

Eye movement desensitization and reprocessing (EMDR) is a therapeutic approach designed to alleviate the distress associated with traumatic memories. The EMDR Negative And Positive Cognitions handout is designed to be used during the third phase of the EMDR protocol, in which the therapist explores critical components of the target memory, including any associated negative and positive cognitions. This is an important step as it can help to activate different aspects of dysfunctionally-stored information. Practically, some clients find it difficult to identify appropriate negative and positive cognitions during this assessment phase, so it is recommended to offer the client a list of negative and positive cognitions from which they can choose.

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Introduction & Theoretical Background

Developed by Francine Shapiro in the 1980s, EMDR is now recognized worldwide as an effective treatment for post-traumatic stress disorder (PTSD) by health organizations such as the American Psychological Association (e.g. Courtois, C. A., et al., 2017) and the National Institute For Health And Care Excellence (National Institute For Health And Care Excellence, 2018).

The adaptive information processing (AIP) model (Shapiro, 1995) suggests that an individual’s experiences are assimilated and stored as memory networks containing representations of images, thoughts, beliefs, emotions, and sensations. It proposes that much of psychopathology is due to the maladaptive encoding or incomplete processing of traumatic or distressing experiences: 

a particularly distressing incident may become stored in state-specific form, meaning frozen in time in its own neural network, unable to connect with other memory networks that hold adaptive information

(Solomon & Shapiro, 2008)

The goal of EMDR therapy is to ‘reprocess’ any dysfunctionally stored information connected to the memory node by accessing it, “stimulating the innate processing system… and facilitating dynamic linkages to adaptive memory networks” (Solomon & Shapiro, 2008). Despite considerable developments in the study of intrusive and ‘pathogenic’ memories since the initial exposition of EMDR, multiple authors have supported the use of the AIP model as a framework for understanding trauma-related psychopathology (e.g. Hase et al, 2017; De Jongh, 2024).

The EMDR protocol consists of multiple phases:

  1. History taking
  2. Preparation
  3. Assessment
  4. Desensitization
  5. Installation
  6. Body scan
  7. Closure
  8. Re-evaluation

During the third phase (assessment) the therapist explores the critical components of the memory which is to be targeted, and records baseline measures. Key components of this phase include:

  • Selecting the image or picture which represents the target event.
  • Identifying the negative cognition associated with the event.
  • Identifying the positive cognition which the client would like to believe about themselves.
  • Rating the validity of the positive cognition.
  • Identifying the emotion associated with the image and the negative cognition.
  • Rating the subjective units of disturbance (SUDs) associated with the image and the negative cognition.
  • Identifying the body sensations associated with the image and the negative cognition.

Shapiro describes the negative cognition as the “negative self-statement associated with the event” (Shapiro, 2017). Arguing that inadequately processed memories are often stored as fragments, Solomon and Shapiro (2008) propose that eliciting the negative and positive beliefs associated with an image activates different aspects of the dysfunctionally stored information that “may help the client make sense of the experience and facilitate storage in narrative memory”. Recognizing this importance, the EMDR Europe Competency Framework requires that an EMDR practitioner is able to establish “negative cognitions that reflect a currently held, negative self-referencing belief that is irrational, generalizable, and has affect resonance that accurately focuses upon the target issue” (EMDR Europe Practice Sub-Committee, 2013).

Traditionally the negative cognition is identified by asking the client to hold an image of the target event in their mind and asking “What words best go with the picture that express your negative beliefs about yourself now?”. If clients find it difficult to identify an appropriate negative cognition during the assessment phase, they can choose from the list of negative and positive in this handout.

In contrast to the negative cognition, the positive cognition is described as the “desired state” of self-belief, which is typically a polar opposite to the negative cognition (Shapiro, 2017). Clients should be encouraged to frame a positive cognition in the same domain as the negative cognition (responsibility, safety, control, etc.), and to consider how they would like to think about themselves at the current time (while acknowledging that the disturbing event did happen). At the time of the assessment, it does not matter that the client struggles to believe the positive cognition as this will typically increase as reprocessing progresses, and more appropriate positive cognitions may emerge during the later processing. It is, however, important that the clinician ensure that the positive cognition is a valid self-assessment – those which contain all-or-nothing statements such as “I will never fail” are inappropriate or unhelpful.

Therapist Guidance

Negative cognition

"This is a list of words that some people who have experienced trauma use to describe themselves. Read through the list of negative cognitions. When you think of your target image, which words best express your negative belief or current beliefs about yourself? Which words most strongly resonate with you most strongly?"

Checklist for clinicians:

  • Has a negative cognition been identified?
  • Does the client’s negative cognition refer to themselves, or serve as a judgment of themselves?
  • Is the negative cognition stated in the present tense? (i.e. “I am …” rather than “I was …”)
  • Does the negative cognition reflect a belief rather than a statement of fact or circumstances (e.g. “I am powerless” rather than “I wasn’t given any choice”)?
  • Is the negative cognition stated in the client’s own words?
  • Is the negative cognition distinct from but appropriate to the emotion the client identified as relating to the target event?

Positive cognition

"When you think of your target image, what would you like to believe about yourself now? If you struggle to think of anything, read through this list of positive cognitions. Which words most strongly resonate with you?"

Checklist for clinicians:

Has a positive cognition been identified?

  • Is the positive cognition in the same domain as the negative cognition (i.e., responsibility, safety/vulnerability, power/control/choice)?
  • Does the positive cognition avoid using the word ‘not’ (e.g., it would be preferable to frame a positive cognition as “I am safe now” rather than “I am not in danger”)?
  • Does the client’s positive cognition refer to themselves?
  • Does the positive cognition avoid generalizing or distorting words such as ‘always’ or ‘never’?
  • If the client has struggled to identify an appropriate positive cognition, would they accept a generic positive cognition such as “I’m safe now”?

References And Further Reading

  • Courtois, C. A., Sonis, J., Brown, L. S., Cook, J., Fairbank, J. A., Friedman, M., & Schulz, P. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. American Psychological Association, 119.
  • De Jongh, A., Hafkemeijer, L., Hofman, S., Slotema, K., & Hornsveld, H. (2024). The AIP model as a theoretical framework for the treatment of personality disorders with EMDR therapy. Frontiers in Psychiatry, 15, 1331876.
  • EMDR Europe Practice Sub-Committee (2013). EMDR Europe Accredited Practitioner Competency Based Framework.
  • Hase, M., Balmaceda, U. M., Ostacoli, L., Liebermann, P., & Hofmann, A. (2017). The AIP model of EMDR therapy and pathogenic memories. Frontiers in psychology, 8, 1578.
  • National Institute For Health And Care Excellence (2018). Post-Traumatic stress disorder. NICE guideline 116 (NG116).
  • Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. New York: Guilford Press.
  • Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (Third Edition). Guilford Publications.
  • Solomon, R. M., & Shapiro, F. (2008). EMDR and the adaptive information processing model: potential mechanisms of change. Journal of EMDR practice and Research, 2(4), 315-325.