EMDR Therapy
A (very) Brief History
Eye Movement Desensitization and Reprocessing (EMDR) therapy was developed after Dr. Francine Shapiro noticed her distress went down on her walks. This observation sparked a curiosity for Francine and made her wonder if there was something occurring specifically because of the eye movements when she was looking back-and-forth, taking in her surroundings.
Many decades later, and over 30 randomized controlled studies conducted (the most rigorous kind of research), the treatment she developed from this curiosity has since been established as an evidence based therapy. Primarily, its been proven effective with PTSD, but can also be applied to a wide range of mental health difficulties such as anxiety, depression, phobias, OCD, grief, and eating disorders. Research has demonstrated that EMDR reduces symptoms significantly quicker than conventional talk therapy. Such as:
100% of single trauma clients and 77% multiple trauma clients no longer had PTSD after six 90 minute sessions
77% of combat verterans were free of PTSD symptoms after 12 sessions
You can see more about this research here.
Theory Behind EMDR
Because our brains are so complex, it’s easier to prove something works with controls like no treatment or comparing it to other proven therapies, but the exact reason for why is more likely to be based on what we do know so far, and the rest is theory. The current theory for EMDR is that trauma can get stuck and go unprocessed, appearing in symptoms of our present day. As I’ve mentioned in previous posts, the human brain learns from past experiences. If something happens that floods our system with lots of distress, our brain can take note of that event, pick out whatever things we took in at that time with our senses (sight, touch, smell, etc.), and use that to look for the same threat in future situations. Difficulty is, we don’t necessarily control what our brain decides is the cue to signal that the danger is happening again. This is why sometimes with PTSD someone may respond to something that seems innocuous and non-threatening like a song or smell that reminds them of a past traumatic experience. Similarly, the level of distress we respond with when triggered can mirror the intensity of the original event our brain perceives is happening again, or at risk of happening.
This mechanism is for our survival, much like breathing, and so it is designed to be automated. Additionally, the same hardware we have for responding to an immediately threating thing to our survival, like a bear attack, is still operating in the background while navigating our every day life and existance, and for interpreting interpersonal threats as well. It’s working on a spectrum of mild to louder reactions. The system just has to be activated enough outside of our windown of tolerance and it can feel like we’re confronting a very threatening interaction, that may otherwise be not actually unsafe.
Tools like mindfulness, being aware of our triggers, can bring down the alarm bells of our brain, slow things down, and help us iterrupt these cycles. Still, sometimes these systems are so overwhelmed, or so entrenched through repeat cycles of trauma respones, that no amount of logic helps bring us down (but causes further shame because we aren’t fully feeling in control), and it can be very difficult if not feel impossible to manually override it. Tools like EMDR can be very helpful for using our body’s own mechanisms to rewire these connections.
General Process
EMDR involves going in and out of rapid eye movement while reprocessing adverse or traumatic memories, pausing throughout at different intervals to ask what’s coming up, and then going back into the memory. We have one foot in the past when revisiting the experince with eye movements and one foot in the present when coming back to report on what we noticed. In this process, we start to separate the past from present. The process of EMDR seems to turn on our parasympathetic nervous system, which is the rest and digest part of our body, the calming system, that gets to be on when we’re oriented towards safety.
As reseach has expanded, it’s been found that eye movements aren’t necessary for EMDR to still be effective. Even rapid tapping or other types of bilateral stimulation, aka rapid alternating movement between left and then the right side of the body, can be effective. Eye movements appear to be more potent than other other types of bilateral stimulation, but it seems the pinging of the right and then the left side of the brain in some way is enough to get things less stuck in how it’s being processed and create movement for the entrenchment of trauma reactions.
What normally happens is while going down the path of recalling the memory, it’ll at first bring up the familiar feelings of the past and original distress, then softens, then material comes up again to be reprocessed, distress goes down with more passess of eye movements, and so on. What I’ve seen is distress levels, measure by a scale, does go down, creating room for new meaning making, and then we go into reprocessing what is it that the person would like to instead believe. Going from “I cannot keep myself safe,” for example, to “I can be safe.”
While this sounds like a very simplistic process, the reason why it’s done with trained professionals is because it does have a strucutre to it that requires a facilitator. What has been proven to be effective is the specific process that involves a therapist administering it. Also, sometimes blocks come up and a therapist is needed to help move through it. Sometimes it’s very overwhelming and there are things the trained therapist can do to help bring down distress, that would be difficult to do by ourselves without that support. Typically, folks also don’t jump right into doing EMDR. Before starting the formal process, we work on stabalization and developing some tools to help regulate and modulate emotion, to some degree. We wouldn’t throw someone into the deep end without first helping them learn how to tread water. We also map out memories to target, which involves a therapist helping with exercises that identify past experiences related to current symptoms we’re targetting.
Beyond PTSD: EMDR and it’s Uses
A reason why EMDR can be effective for treatment of symptoms that aren’t explicityly from trauma or PTSD is because human beings learn behaviourally. Similar to one very traumatic experience can cause us to anticipate the threat in future instances, and have blown out reactions disproportionate to current stressors, accumalted experiences that reinforce rigid patterns of coping can lock in different mental health symptoms —one experience can build off of others to develop patterns in how we handle and perceive stress.
So, for example, if you grow up with a parent that is very anxious and reinforces perceiving stress as dangerous, it can influence how we internalize managing stressors. We may develop a bias from life events that reaffirms a way to handle stress is to be acutely aware of how anything could go wrong and even imaging things going wrong beyond reason (to brace against any possible fallout). Maybe we lose a job at one point and we find ourselves spinning out afterwards, more than we usually do, and this already rigid mechanism for coping by anticipating future threats starts going into hyperdrive. The distress of not being able to imagine being okay with something going wrong, that failure can even be good, could be very distressing when no solutions for a current problem are immediately available. We may get stuck on cycles of worrying.
In this example, these patterns could cause someone to develop a baseline of living with ongoing anxiety. I’m making it a bit simplistic, people with this life experience don’t have to deterministically fall down this path. However, for the sake of an example, EMDR could then be used to outline memories and experiences that got processed as a confirmation bias of this core belief —that the best way to be safe is to be imagine all the ways you could not be safe, continually veering towards perceiving and planning for future risks, and blocking off an ability to be in the present. Decensitizing the distress of these experiences and reprocessing them to have different takeaways can then change how we move forward with future stressors.
Aside from reprocessing past experiences, EMDR can also be used to descensitize current triggers and integrate more connections with how else we want to repond to stress in the future. These two approaches usually happen after reprocessing past experiences, but as the field continues to expand there are many different protocols and approaches that continue to be developed, creating many creative ways to use EMDR.
If you think this therapy may be a fit for you or you have further questions, feel free to book a free consultation.
