Eye movement desensitization and reprocessing -
“What a mouthful!” “Are we sure this is a real thing?” Just a couple of remarks from my clients over the years of using this very effective yet perhaps somewhat daunting idea of a treatment intervention which, in fact, is not a recent idea!
EMDR is a treatment technique, originally just called “eye movement desensitization,” founded by Dr. Francine Shapiro in 1987. During a walk where she was contemplating some distressing memories, she noticed that as her eyes moved back and forth, distress associated with these memories seemed to decrease.
Today, EMDR is one of the most well-researched forms of treatment. Providers working in substance use, veterans affairs, trauma, and mental health all hail its effectiveness. While it is largely used to treat complex trauma, EMDR is also shown to be an excellent method for treating anxiety and depression and other mental health issues.
Trauma and Your Brain
EMDR works by way of accessing the inherent and intrinsic strengths of a person, especially their resilience. A trauma survivor has survived a distressing event, but on a neurobiological level, it is a very complicated experience.
During a stressful event, a person’s brain prioritizes survival over “normal” function, that is, a balance between logical and emotional thought. While the brain re-prioritizes survival, brain functioning is primarily focused on the limbic system, which is responsible for the survival of the species. Our sympathetic nervous system takes over, and reactions to threats look like fighting, running away, freezing (sound familiar?) as well as fawning, nausea, and more, all while the brain makes cortisol, the stress hormone.
During this time of a stress response, the parts of our brains outside of the limbic system decrease their functioning somewhat to focus on survival. Parts like the hippocampus, which is mostly responsible for learning and memory, are not as adept at picking up new information and storing it properly. This is why often, in the acute moments after a threat, recalling various details of events is really challenging, and also why often, reporting of the details of the stressful event may change sometime later as cortisol dissipates, and the hippocampus comes back fully online and tries to organize the event. It usually takes 2-3 sleep cycles for brain function to be back to “normal.”
Because the hippocampus, for one, isn’t working up to its full potential during a stressor, it’s not getting the memories down right, and tends to store memories of the events chaotically. How this manifests down the road from a traumatic event is through triggers.
When we are triggered, because the event the brain is reminded of is stored so chaotically and so disorganized, we can’t always tell what’s happening in the present and it perceives that it’s back in the traumatic event - not a fun place to be. Further complicating this, our neocortex, the front brain that’s responsible for higher-order thinking (spatial reasoning, sensory processing, cognitive thought, etc.) doesn’t always get notified by the limbic system of why we are perceiving a threat, leaving us wondering why we got super sweaty at the grocery store and totally lost track of what on earth we were trying to do.
How Does EMDR Help?
So how does EMDR help? EMDR utilizes bilateral stimulation, also known as dual attention stimuli, to pull up a memory network (that is, the memory to be targeted in EMDR therapy, as well as any associated memories). Your EMDR therapist will set you up for success by getting a comprehensive understanding of the past, present, and future components of your treatment plan, as well as physical and emotional experiences associated with the memory network.
Then, your EMDR therapist will ask you to think of the memory, where you feel it in your body, and begin quick bilateral stimulation with either tapping, buzzers, a light bar, or anything that facilitate that back-and-forth movement in the brain like what Dr. Shapiro experienced on her historic walk in 1987. Your therapist will check in after several passes, and give you a chance to report what you notice, and will continue this process until the intensity of the memory is decreased to a point where you feel significantly less bothered by it, or even not bothered at all.
This faster bilateral stimulation will allow your brain to pull up this memory which was stored maladaptively, or in such a way that you’re reminded of it when you don’t expect to be or don’t want to be, also known as a trigger. By stopping the stimulation after a few passes and checking in, EMDR will allow you to think of the memory while also keeping you solidly grounded in the present, and reminded that the danger is over. This allows the triggers to be desensitized and the brain to notice the memory while NOT in a triggered, sympathetic response, and eventually, store it away in the hippocampus where it belongs. Here, you may be able to recall the memory, but not experience the overwhelming response of a trigger. It’s just a memory now, not an intrusion. Some of my clients have reported that the memory feels “fuzzy” now and is not as detailed.
Resources Required for EMDR
Good EMDR therapy will focus on strong resource development first to fully prepare a client for reprocessing work. Some resources may include the identification of a needed quality or strength to get through the work of reprocessing and desensitization from the memory and its associations. A person may believe that they need confidence to get through it, and various methods for “installing” this resource begin, including considering a time when the person themselves embodied the quality of confidence. They may also draw on a real or fictional person and even animals! Slow bilateral stimulation is used to install this positive memory of effective use of this resource. Sometimes, other treatment modalities, such as Dialectical Behavior Therapy may be used in conjunction with EMDR to install strong resource development.
What questions do you have about EMDR? Does it sound totally ridiculous, or is it something you’d maybe want to try?
What's Next?
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