Eye Movement Desensitization
EMDR appears to stimulate the brain to spontaneously process traumatic memories resulting in a more healthy adaptive perspective of the experience. The simplicity of the EMDR procedure and the minimal need for verbalization allows for use with clients of all ages.
Prior to beginning the processing the client is instructed to briefly describe four aspects of the disturbing event.
1. The visual memory. What are the images that
come to mind when thinking about the experience?
2. The thoughts. What negative thoughts come to
mind, particularly those thoughts about self?
3. The emotions. When reflecting upon the event,
image, and thoughts, what emotions are
associated with the experience?
4. The physical sensations. What type of physical
response is noticed as the client is recalling
The client is instructed to focus internal attention on those elements of a traumatic event while watching an external visual stimulus. The most common procedure is for the therapist to wave her hand gently back and forth at eye level, two to three feet in front of the client's eyes. Each set of eye movements lasts about 20-30 seconds. At the conclusion of the set of eye movements the client is asked to notice what comes to his/her attention.
After a set of eye movements the client will report subtle changes in the described elements such as the image becomes less vivid or less threatening. Negative thoughts will become less distressing. The body feels more relaxed. The procedure is continued until resolution of the issue or a feeling of stability is achieved.
The client is instructed to notice any spontaneous recollections of the event or similar situations and to observe the response. If an excessive emotional reaction is evoked it is indicative of the need for further processing.
Duration of Treatment
For what would be termed simple trauma; trauma resulting most often from singular events or minimally recurring events; therapy is often completed in 2-4 sessions. Complex trauma is typically the result of extended or multiple traumas. Repeated instances of sexual, physical, and emotional abuse/neglect are the most common experiences evoking complex trauma. Duration of treatment for this population varies greatly however benefit is typically reported within the first few sessions.
Than You Might Want to Know
The challenge of diffuse attention, requiring the brain to pay conscious purposeful attention to more than one thing, appears to stimulate the brain to process the distressing material stored in memory. Unlike the ‘linear’ processing which occurs with traditional talk therapy, EMDR stimulates activity akin to ‘parallel’ processing wherein nonverbal elements of emotion, physiological elements and sensory memory are subconsciously analyzed.
Nonverbal processing is a normal means by which the brain interprets and generates responses to daily life occurrences. This processing takes place largely outside of awareness and tends to generate a ‘felt’ sense, a gut feeling about situations. It is most commonly referred to as the intuitive sense. Combined with the logic and rational thought associated with conscious processing it allows individuals to negotiate with minimal effort an incredibly complex array of daily challenges and decisions.
The EMDR stimulated processing changes the memory from one that is ‘relived’ to one that is ‘remembered’. The thoughts, emotions, and physical reactions that accompany trauma are automatically resolved as this shift occurs. For many simple traumas, singular traumatic events, resolution typically occurs within 2-3 sessions. Complex trauma requires more extended effort however progress is also observed very early in treatment.
The staff of Midwest Neurofitness has utilized EMDR since 1994. They have worked with victims of sexual assault/abuse, combat veterans, accident victims, cancer survivors, as well as having used the procedure to assist with athletic performance. The simplicity and the immediate therapeutic benefit make EMDR an excellent addition to any therapeutic program.
EMDR is particularly complementary to neurofeedback. As individuals experience the benefit of neurofeedback they often sense a greater capacity to address emotional distress consequent of prior traumatic events. EMDR can be used intermittently throughout training to address traumatic material as it becomes more accessible to the client.
Posttraumatic Stress Disorder
Historically Posttraumatic Stress Disorder (PTSD) has been one of the more difficult syndromes to treat effectively. Well-meaning admonitions to ‘get over it’ or ‘move on with your life’ do little more than add to the frustration with which traumatized individuals view their situation. People who have experienced a traumatic event sense that they are to some degree ‘defined’ by these moments. These resulting thought processes are common to individuals who have experienced trauma.
“Because this happened to me I will think and feel this way forever.”
“Because I did this I am this type of person forever.”
“Because someone hurt me then I can not trust anyone again.”
“Because I did not see the danger I can not trust my judgment”.
These patterns of thought are not rational and this irrationality is often evident to the individual. They will routinely express, “I know I shouldn’t feel/think this way but I do.”
Elements of PTSD include the excessive emotional and behavioral reactions to external and internal stimuli that are reminiscent of the original trauma. Traumatized individuals will report difficulty trusting in themselves, trusting their ability to interpret and respond to life situations effectively. If they have experienced abuse they might also have difficulty trusting others. Their interpretation of their daily life experience will be unduly influenced toward seeing the negative while ignoring, minimizing, or dismissing the positive. They often experience a sustained high level of arousal called “hypervigilance”. Avoidant behavior is another common characteristic.
These disruptions are consequent of the failure of the brain to effectively process the traumatic event and develop a healthy adaptive perspective about the experience. This perceived failure seems to be the brain’s normal reaction to the high level of negative emotional intensity associated with the traumatic event. When the negative emotional response reaches a very high level the brain will spontaneously interpret the event as ‘life threatening’ and shift away from normal processing. This shift appears to occur because the brain is preparing for the possibility of encountering a similar situation in the future. As such it seeks to permanently store detailed information about the event.
The brain stores ‘memories’ about the traumatic event but it is unlike the memory system used for most life experience. Recollections of experiences such as birthdays and school are stored in a system often referred to as declarative memory. Unlike life history stored in declarative memory the traumatic memory is stored much more like a ‘raw data’ form. As a result when people recall a traumatic event the sensory memories (visual, auditory, olfactory, and tactile) are much more vivid and intense. This is accompanied to varying degrees by the associated emotion, physiological arousal (muscle tension, increased heart rate, etc), and distorted thought patterns.
This memory system tends to maintain those elements of the traumatic event throughout the lifetime. Apparently the brain seeks to retain the memory and maintain the central nervous system at a highly reactive state, particularly in preparation for situations that are even vaguely similar to the original trauma. All this occurs in an effort to keep the person alive. The best hypothesis about posttraumatic stress is that it is the consequence of a misguided and intrusive survival mechanism.
Both traditional psychotherapy and medication have not proven to provide significant relief from symptoms or generate resolution of the source disruption. As the brain is compelled to maintain its reactivity, efforts to modify this reaction via conscious control have shown to be limited in effectiveness. Medication is not rehabilitative but for some individuals can suppress a trauma response. However those medications also suppress positive elements of reactivity.
In the mid 1980s, Francine Shapiro reported that while walking in a park, she became aware of a decrease in emotional pain connected to some disturbing thoughts she had been having. Serendipitously she noticed that her eyes had been moving back and forth while this was happening. She then brought up some additional disturbing memories and purposefully moved her eyes back and forth. Once again she noticed a marked decrease in the level of distress associated with these previously painful memories.
Recognizing the potential benefit of this discovery, she conducted her initial research on EMDR with 22 traumatized individuals. Her results suggested that EMDR could reduce the pain associated with traumatic memories. In addition to the desensitization that occurred, EMDR produced a shift in the individual's evaluation of self from negatively held beliefs (I am weak; I am worthless; I deserve to be hurt) to a more realistic, more balanced view of oneself (I did the best I could; I am lovable; I am still a good person even if I make mistakes; I am safe now).
The initial results and claims made by Dr. Shapiro aroused a storm of controversy that has diminished in the decades since the inception of EMDR. Critics questioned the claims she made, the data she reported, and the use of eye movements as part of a therapeutic method. While Shapiro's initial research had several methodological limitations, more methodologically sound replications of her work have supported the positive results she obtained. Today, EMDR is one of the fastest growing methods of psychological treatment with more than 65,000 clinicians trained worldwide. Its primary use is for the treatment of PTSD, but it has also been used to assist clients with a wide variety of other problems, such as phobias, anxiety, and performance difficulties.
For more information about EMDR review the website www.emdr.com.
There are also informative videos about EMDR at www.youtube.com.