EMDR (Eye Movement Desensitization and Reprocessing)
A guest article:
EMDR: Eye Movement Desensitization & Reprocessing
by Elaine Kindle, Ph.D.*
Origin of EMDR : Who would have guessed that a woman taking a walk in a park would stumble onto an intriguing observation? More importantly, who could imagine that it would powerfully affect the lives of millions of people?
In1987, a graduate student was out taking a walk. Many concerns flooded her mind. The cancer she had beaten, she hoped would not come back. As she walked, all of a sudden she realized that the distressing thoughts she had been having were no longer there. They simply had stopped on their own. Vanished. She consciously had not done anything to interrupt them. Thoughts don't just disappear without some type of intervention or distraction. Her curiosity piqued. What happened to make the disturbing thoughts go away? She reviewed the scene, play-by-play, in her mind’s eye. “Let’s see, I was just walking down the path, minding my own business. Nothing different. Didn’t run into anyone I know….I was just walking, just thinking, just looking.” Then she realized that her upsetting thoughts seemed to have ceased in relation to the pattern of her side-to-side eye movements. Now she was curious. Was there anything to this?
Perhaps since she was steeped in research she asked those questions. Graduate school does tend to raise questions of all kinds. Francine Shapiro had come to the field of psychology through an interest in physiology and psychology gained while fighting cancer. Perhaps her combined interests in these two sciences led her to wonder if there was any significance between eye-movements and their affect on disturbing thoughts. Curious about this phenomenon, she discussed this event with her research colleagues and asked them to experiment with this finding. They allowed themselves to think disturbing thoughts while Francine directed their eyes back and forth, as hers had done in the park. They, too, experienced a cessation of those negative thoughts. Interest grew. Who else would be willing to test out her strange finding? Those with nothing to lose. Vietnam Vets.
Francine Shapiro next tested the relationship between eye movements and distressful thoughts in a research study with these men who still experienced symptoms of Post Traumatic Stress Syndrome (PTSD) thirty years after that war. Startle responses, flashbacks, and intrusive negative thoughts remained part of their daily lives in spite of years of counseling. After they participated in this study, a significant number of them had a reduction in symptoms. Eye movements caused raised eyebrows in the research community. The Director of the in-patient PTSD program at the VA Medical Center in Coatsville, PA., Steven Silver, had twenty years of experience with traumatized persons. After observing the results of EMDR, he commented, " EMDR is producing greater effects in the treatment of PTSD than any other treatment we have used or have seen used."
From that time on, more research studies on EMDR and PTSD have taken place than on any other method to date. Additionally, EMDR continues to offer relief to people in many aspects of their lives' functioning. For example, people have been helped to overcome not only severe emotional reactions to personal traumatic situations, such as that created by violence of war, abuse, or other crime, but also, people have been helped with concerns such as anxiety, phobias, performance issues, grief, disturbing memories of childhood, and even chronic pain. In additional to bilateral eye movements, EMDR appears to work just as well with bilateral touch (e.g. tapping left knee, right knee) or with bilateral tones set to music. Hence, it is interesting to see how three of our five senses hold the ability to help ourselves heal.
How EMDR works:
In spite of all the research, no one knows for sure why EMDR works. However, several theories offer suggestions. One follows the principle of REM sleep. During this phase of sleep, people dream. Many understand how dreams help a person work through unfinished business, or play out the concerns of the day, or even wake up in an emotional state thanks to the dream. This idea was played out on an "I Love Lucy" show years ago. In that episode, Lucy dreams she visits her ancestral home of Scotland. A hungry two-headed dragon lives in the area, and is preparing for his much-anticipated meal. He eats only once every thirty years, and this is the time. He can hardly wait. But he doesn’t eat just anything. Oh no, he is particular. He eats only members from Lucy’s slowly dwindling clan. Lucy discovers she has arrived just in time to become his breakfast. She is panicked and runs around, back and forth, trying to make a case for herself. Nothing will deter the dragon from his meal. But Ricky is arriving the next morning. He will save her. Enter Ricky/Prince Charming to the rescue. He faces the dragon – and then, Prince Ricky Charming fearfully backs down. Lucy will be eaten after all! Lucy awakens at this point. Ricky is sound asleep in his bed, dreaming his own dreams. Lucy angrily hits him over the head with a pillow for not saving her. “What happened,” says the confused husband. This dream demonstrates how disturbing material often cannot be brought to resolution. We wake up before resolution (or harm) can happen.
No one had ever taken that principle of REM sleep and applied it to the awake state before. When awake, rapid eye movement can be sustained over time, with the guidance of a trained practitioner, who makes sure the client remains safe. David Grand, in his book, Emotional Healing at Warp Speed, points out that Robert Stickgold, Ph.D., a Harvard University neurology researcher, speculates that “the flow of information from the hippocampus (which stores information) to the neocortex (which analyzes information) is directionally reversed in EMDR” and that this reversal, which also happens during REM sleep, allows “the brain to reevaluate information frozen in a system that was overwhelmed at the time of the traumatic event.”
Simplistically stated, another way to look at it might be to consider it as though the bilateral movements of the eyes, from one side of the brain to the other, get the brain “speaking” to itself, as it were. Left side, which is the area for logical thinking; Right side, which is the area for emotion and creativity; back and forth, repeatedly, across the Corpus callosum which divides the brain into these two main sections. As left side/right side movements take place, for some reason, traumatic material, that has been stuck in the neural nets, and down into the Central Nervous System, gets dislodged and as it does, it moves into a state of resolution. Metaphorically, picture the way a large piece of furniture often gets moved by rocking it back and forth, back and forth, until it moves.
In reality, we have made much and yet little progress in our understanding about how the brain works. Traditionally, we have assigned each part of the brain a responsibility for several functions. We know that the brain is much more complicated than that. But, for our purposes, let’s stay basic. The limbic system of the brain holds emotions. The hippocampus stores and consolidates information, including memories. Whatever happens in a person's life on a daily basis process itself, and finally moves into the hippocampus, for storage and retrieval. For example, if someone asked you what you were doing two Thursdays ago, you wouldn't necessarily remember. But if something horrible had happened to you on that day, such as getting fired or getting into a bad car accident, chances are you would remember it in full living color, detail by detail, with your emotions intact. You might cry, feel angry, or get shaky. You might have trouble sleeping, or eating. You might be irritable or jumpy, or depressed. It’s as though you can’t “just get over it.” When a person gets traumatized, the memory of the event stays locked in. The more intense and the more personal the event is, the more detailed the memory, complete with the emotions experienced on that day. Not all traumas are huge ones, but can affect us anyway. Francine Shapiro separates out the concept of intense traumas from lesser ones by referring to them as traumas with a capitol “T” and traumas with a lower case “t.” Much of the time, life goes on, and we don’t think about it until something comes up and sets us back.
Want an example of a trauma? Test yourself: If you were in the U.S. on 9/11, especially if you lived on the East coast, chances are you can give a blow-by-blow description of what you were doing when you heard the news. Can you? Notice, you didn’t even wonder, “What news?” no less “What year?” If you had lost someone you loved on that day, your emotions might feel as strong now as they did then. You may have experienced a “T” trauma. But, on the other hand, can you remember what you were doing on 9/11/99? Not likely. 9/11 is an example of a National T/trauma. In the same way, older Americans can describe in detail what they were doing on November 22, 1963, the day President Kennedy was assassinated. Some gentleman recently answered that question, from his spot in the back of the room. "Fifth grade, Mrs. Kenyon's class." Another person said, “Even today, when I see a tape of President Kennedy and Jackie, sitting on top of the back seat of the convertible that day in Texas, I have to look away. It’s too much.”
Given the rapidity with which EMDR can work, it sometimes is referred to as an "accelerated information processing system." The fact that traumatic circumstances get lodged in the brain is not new. In 1889, French scientist, Pierre Janet, explained that people who had experienced intense emotional reactions often were not able to have memories of those events become integrated into the store of memories as they should. Rather, he said, those memories got cut off from consciousness and were stored in ways that created anxiety, panic, or flashbacks and nightmares. Interestingly, all people have situations, past or present, whose distressing life events contain some element of trauma.
EMDR helps the memory shift to the part of the brain where it can be stored with other memories. When that happens, the intensity of emotion loses its grip.
Whatever happens in the process of EMDR, the fact is, change occurs. Traumas that have blocked our lives, like obstacles in a path, get resolved. Our lives get back on track. We create new neural pathways for ourselves. It reminds me about the time I was a child. To make life easier, we took a shortcut to our next door neighbor’s house, right through the hedge that divided the property. After awhile, as we moved back and forth, again and again through the hedge, an opening cleared where branches and leaves used to be. The path beneath our feet also became cleared of grass. A new pathway was created where none had existed. With repeated bilateral stimulation, our minds apparently clear the path, and even create new ones that allow us to move on with our lives.
Traumas tend to have a negative effect on our lives. They can disrupt, interrupt and create excessive and unnecessary difficulties. Whether a trauma with a capitol “T” or a trauma with a lower-case “t,” both can create havoc. Experiences are unique to each individual. What is major for some is minor for others. While some people cope with stressful live events with resiliency, others seem to be negatively impacted by seemingly minor incidents. What matters is not the degree of the trauma, but the way they affect the person.
As the understanding of trauma has developed and broadened to identify and include minor traumas as well as major, so has the range of EMDR's applicability and efficacy. Many types and intensities of life situations may have created some degree of trauma within a person. As such, EMDR may be a useful vehicle to help the person.
What happens in an EMDR session?
First and foremost, therapists need specialized training in EMDR in order to incorporate it into their client’s treatment plan. In considering using this method, clients first need to be educated about this method, evaluated for appropriateness, and want to include EMDR as part of the process. Dr. Curtis Rouanzoin, Ph.D., past- president of the international association for therapists trained in EMDR, known as EMDRIA, attests to these facts. He states, "EMDR is a very powerful psychotherapeutic method that needs to be utilized by a skilled clinician." He continues, "I have found that EMDR has dramatically changed how I treat victims of trauma. It can result in rapid changes, but must be applied carefully in the context of a comprehensive treatment plan. Patients often respond that they cannot believe the changes produced by EMDR. After years of using this method, I myself am still surprised by its rapid effects."
In EMDR a person does not have to spend a great deal of time talking, or trying to talk, about every detail of what happened. Rather, the therapist has the client focus on a specific life-disturbing memory of an event, and then identify a negative self-referencing belief associated with that memory. As the person recalls the memory and the negative belief, associated emotions may arise. These feelings are rated in terms of intensity (on a scale of 0 – 10; with 10 being intense), together with subsequent locations in the body where the emotions may be most felt. The client also states a positive, more desirable belief about the self, and rates how strong that belief is, from 1 ("I don't believe it") to 7 ("I believe it as strongly as I can"). A set of eye-movements, or other forms of bi-lateral stimulation, follow, after which time the client comments on whatever came up during the processing. As the sets of eye-movements continue, the therapist uses clinical judgment based on training, to direct the intervention. Throughout the course of the session, the client's emotional level in relation to the memory and negative belief about the self decreases, and the work then continues by focusing on the memory combined with the positive statement. The outcome of a successful EMDR session is adaptive resolution, that is, the targeted memory no longer creates distress. The person also experiences a shift in the self-referencing belief from negative to positive.
The AOh-Yeah" Shift
Sometimes the results are dramatic in session. A client may be surprised at the surge of memories and emotions that may come up, seemingly out-of-nowhere. Sometimes the client comments that the experience has been like a roller-coaster ride. For example, Susan's** molestation as a child brought long-forgotten memories to mind. She hyperventilated, cried, and told stories about the sexual abuse she experienced by her uncle when she was nine years old. By her third EMDR session, her memories began to include happier events. When this came to Susan's attention, she paused, and said, "Oh yeah." The trauma she experienced had shifted to the part of the brain that stores memories. She no longer felt the intense emotional impact of those events that had happened some 38 years ago.
Other clients process differently. It may look as though nothing much is happening given the apparent lack of material or affect that comes up during a session. Interestingly, these clients often don't notice anything has shifted until the memory of the event comes up again. Sam was one such client. He had been fired after 25 years on the job for an accident that happened at work on his day off. But as a supervisor, he had been held responsible and dismissed from his job. The fact that he was approaching 50 and full-retirement benefits lay immediately ahead of him made the firing look suspicious. Sam was angry and upset. He directed much of his anger at his boss. Such a reaction might be appropriate, but after a time, the anger stood in the way of his productivity. Sam became more and more depressed. It was hard to get out of bed; and even harder to look for work, only to come away from the job hunt with the feeling that no one wanted him because he was too old. He agreed to an EMDR session in an effort to alleviate the anger. He sat politely through the session and went home and told his wife nothing happened. A couple of weeks later, his wife commented to him, "Have you noticed you haven't been so angry at your boss lately?" Sam thought about it and puzzled, "Oh yeah." His anger level continued to diminish to appropriate levels, and Sam's functioning improved. In time he was able to find another job.
Both Susan and Sam processed their information differently. Yet both were not aware that a shift had taken place. Both responded in a way that seems typical of many when they realize that something has been reprocessed. "Oh yeah," they say. As another client put it, "it should have been harder than that."
“Harder” is not “better.”
Francine Shapiro talks about the fact that at times single incident traumas (either “T” or “t”) can be resolved in a single EMDR session. I heard the material, but I still was surprised with the experience of that happened with Christina. Christina was a therapist trying to pass her licensing exam who sought me out because I was trained in EMDR. She had several unsuccessful attempts at passing her exam. She was experienced. She knew her “stuff.” But still she couldn’t pass. Anxiety blocked her memory. “I’ve done all my Family of Origin work,” she informed me. “I’m here to do EMDR so I can pass my exam.” Instructions duly noted. After the appropriate preparations, we began EMDR to work on her exam anxiety. Very soon into the session, she spontaneously recalled a time when she almost was murdered. Throughout the series of eye-movements, her story unfolded, one colorful, frightening scene after the other. Listening to her, my own heart was beating so fast, as I pictured the event as she described it. It was scary. Horrendous. Even though twenty odd years had passed, she remembered the day as clearly as though it just happened. Her emotions began at a high “10.” As we processed, they began to drop. By the end of the session, her emotions about the event had become a “0.” “Was she blocking information,” the skeptic in me wondered. I had become so caught up in her story that I had quite forgotten that single incident traumas could process in a single session. But there it was, in front of my very eyes, processed. Or was it? Next time she came, she was at peace about the situation. And it remained so throughout the course of our work. Her near-murder all those years ago never came up again as a disturbing situation. But did she pass her exam? Yes. She did pass her exam and stepped up to her position as a licensed professional.
EMDR continues to prove its efficiency and efficacy as the range of problem areas it helps continues to be identified and researched. Meanwhile, those who have experienced its power are grateful that Dr. Shapiro pursued her observation about her own disturbing thoughts that day as she walked in the park.
* Dr. Kindle is trained in EMDR and is an EMDRIA approved consultant in EMDR.
**Client stories are true. Names and some details have been changed to protect confidentiality anonymity.