Eye Movement Desensitization & Reprocessing
Have you been to therapy before and felt it was a waste of time? Maybe you've thought, "Why pay a co-pay when talking to my best friend is just as helpful?" Or maybe you've been in therapy for years but you're not as far progressed as you'd like: still struggling with low self confidence, high anxiety, depressive symptoms, overfunctioning for others, controlling behaviors, or something similar.
EMDR is unlike any therapy you've encountered before. In one session, a year's worth of regular talk therapy progress can be made. There are multiple EMDR protocols that work with various diagnoses and presenting concerns, including singular incident trauma, complex trauma (multiple traumatic events that have happened), early childhood trauma and neglect (including preverbal incidents), and even anticipatory events (preparing for a job interview or stressful event). Depending on the severity of symptoms, treatment goals can be met in as little as one session, but with more serious diagnoses can take a couple years (however, using talk therapy and cerebral methods alone, such cases would be institutionalized).
What is EMDR? Where did it come from?
EMDR stands for Eye Move Desensitization and Reprocessing. It was founded by the late Francine Shapiro, by a complete chance encounter. One day, she was walking in a park with distressful thoughts on her mind. As her eyes darted between the trees, she noticed that her thoughts were no longer distressful. From there, she worked with scores of volunteers to standardize her protocol and maximize the benefit of treatment. This success led to a randomized controlled study with trauma survivors that proved EMDR to be an effective tool to desensitize trauma symptoms. At the time it was only called EMD, as they did not quite understand that the brain can also reprocess. Such things that they discovered were being desensitized included: nightmares, flashbacks, intrusive thoughts, aggression, memories of the traumatic events, and other symptoms of trauma.
At its inception, eye movements was the utilized strategy of desensitizing disturbing memories. A clinician would hold her fingers up in front of a patient’s face and move them quickly from side to side. What subsequent research has now taught us, is that the mere bilateral stimulation of right and left hemispheres of the brain is what is responsible for jump starting the adaptive processing that takes place during EMDR, not the actual eye movements themselves. Over 30 years later, many clinicians have developed other models for using bilateral stimulation in lieu of eye movements, but some still prefer the original model.
About the brain:
Unlike the rest of our body, when we are born, our brains are not this fully developed organ that gets bigger over time. It actually grows up. This is the equivalent to us being born with just our feet, and at our first birthday we have our legs, and then our knees, and so on. The part of our brain that is developed is our limbic system. It is responsible for survival. It is completely automatic and functions without our conscious awareness. It is constantly absorbing information. In fact, by the time we’re conceived, it’s already inherited survival information from our parents and grandparents. It has no analytic process at all. It controls our internal body temperature by making us sweat or shiver, it sends signals to the rest of our body to eat or hydrate through hunger pangs or dry mouth, and it’s even responsible for our fight/flight/freeze response.
This part of the brain is completely developed by the time we are six years of age, and it continues to run the show while the prefrontal cortex takes its sweet time to develop. The prefrontal cortex is the part of the brain that is responsible for critical thinking, sound decision making, future orientation, perspective taking, impulse control, emotional regulation, and analysis. This part of the brain doesn’t fully develop until the mid-20’s. For individuals with trauma or substance use disorders, there may be emotional development delays.
The first thing in our brain to process information (such as how you’re going to walk through a doorway or pick up a piece of fruit) is a little almond shaped area called our amygdala. No language exists in this part of our brain. Its sole responsibility is to assess, predict, and respond to danger instantaneously. This is like the guard dog of our brain. If it deems information to be safe, it allows the information to enter, where its next stop is our hippocampus. Our hippocampus provides context. By this, I mean that we are oriented to the present moment. I will return to this concept in a moment. As information continues to travel through our brain, it will make its way upstairs, adaptively, to our prefrontal cortex where it will be stored with our explicit memory, where we can recall it with language (ie. “I walked through the door and picked up a piece of fruit.”)
When our guard dog, the amygdala, deems that information is not safe to enter our brain, it will hold it in the amygdala and never let it enter the hippocampus. When this happens, the information will never be filed away in an adaptive manner with explicit memory in the prefrontal cortex. We will, however, maintain implicit memories, meaning our body still remembers via images, sensations, sounds, and emotions whatever our amygdala deemed threatening. This could range from Big “T” trauma events where our lives were immediately in danger, to little “t” trauma events where our esteem was assaulted, shamed, and neglected consistently enough that our amygdala aimed to protect us from impending social exile. We are mammals, and without each other, we die. Just as our amygdala sends hunger pangs to keep us from starvation, it also sends us cues of shame to make sure we stay in belonging.
Why EMDR works:
We process information from the bottom up: amygdala to prefrontal cortex. Most other intervention models start with the prefrontal cortex because that’s where language exists and that’s where it’s easiest to engage clients. EMDR directly targets where information is stored within the amygdala. By connecting the body with present day symptoms, we access the memory networks that are underlying the distress. Utilizing bilateral stimulation with years of advanced training in specialized procedures (I will always explain my rationale behind my approaches and ask for consent to use a protocol that might be new to you) we will move information from the amygdala, through the hippocampus, and store it adaptively in the prefrontal cortex.
Think of a time where you were embarrassed by something to the point it made your whole body have a physical reaction. EMDR desensitizes, meaning the physical reaction would neutralize so that when you think about that embarrassing moment, you no longer have that response. It also reprocesses. If you previously thought about yourself “I’m an idiot” when imagining that moment, after an EMDR session you would believe, “I’m loveable.” These aren’t affirmations that you repeat in the mirror until you believe them, they feel true to 100% of the self.
Depending on the severity of symptoms, a person’s history, how supportive their social system is, it could take as little as one 90 minute session to as long as a couple years to meet your full treatment goals, however relief can be felt immediately.
What does EMDR work for?
Research supports the use of EMDR for PTSD, phobias, anxiety, panic, anger management, grief, performance anxiety, low self-esteem, depression, childhood trauma and abuse, physical and sexual abuse, natural disaster, witness to violence, victim of violence, injury, traumatic loss, rape, fire, and robbery. Experience from colleagues with specific addictions protocols suggests success with substance use disorders as well, though this has not been formally studied. When working with clients with a substance use disorder who are struggling with chronic relapse, when we cease to treat the symptoms and instead focus on the root, stabilization does occur and purpose and meaning are restored to life.
Contrary to popular belief, EMDR is also effective in the treatment of dissociative symptoms and formal dissociative diagnoses, pending the practitioner is specially trained in the advanced protocols to treat such cases. Adrienne Loker, LCSW has studied directly under Dolores Mosequera of Spain and Katie O'Shea of Idaho in treating this population, as well as seeks ongoing consultation with local specialists.
Who supports EMDR?
International Society for Traumatic Stress Studies – 2009 assigned "EMDR as an evidenced-based level A treatment for PTSD in adults”
The American Psychiatric Association – 2004
The Department of Veterans Affairs and Defense – 2010
SAMHSA – 2011
The World Health Organization – 2013
National Institute for Health and Care Excellence (UK) – 2005 advised "EMDR therapy for treating trauma”
Australian Centre for Posttraumatic Mental Health – 2007
The Dutch National Steering Committee Guidelines Mental Health and Care – 2003