EMDR: Eye Movement Desensitization & Reprocessing
Elaine Kindle, Ph.D.
Dr. Kindle is trained in EMDR and is an EMDRIA approved consultant. Client stories are true. Names and some details have been changed to protect confidentiality and anonymity.
Origin of EMDR:
Would you have guessed that a woman taking a walk would stumble onto an intriguing observation that would change the lives of countless people? How did that happen?
One day, a graduate student needed a break from her studies and all the life problems that didn’t subside just because she was working on her Ph.D. Many concerns flooded her mind: The cancer she had beaten, her studies, finances. Who knows the depth of her concerns? As she walked, all of a sudden she realized that the disturbing, distressing thoughts she had been having were no longer there. They simply had stopped on their own. Vanished. What the…? 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 here?” Maybe because she was steeped in research, 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.” The only difference she could see was she was looking at one side of the path, and then the other. Back and forth, back and forth. What? Her upsetting thoughts seemed to have ceased in relation to the pattern of her side-to-side eye movements. She grew curious. Was there anything to this? Or was it just a coincidence? She couldn’t be sure…..
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. Personal reasons often pull people into the field of human behavior. But perhaps her combined interests in these two sciences led her to wonder if there was any significance between eye-movements and their effect on disturbing thoughts. Curious about this phenomenon, she discussed this event with her research colleagues and asked them to experiment with this finding. Good sports, or skeptics, they went along with the “experiment” and allowed themselves to think disturbing thoughts while Francine directed their eyes to move back and forth, as she had done in the park. Since eyes need assistance to sustain side-to-side movement, she instructed her volunteers to follow her fingers, as she held them in front of their face, and then began the movements. Surprisingly, they, too, experienced a cessation of their negative thoughts. “What?” they wondered. Interest grew. Who else would be willing to test out her strange finding? Who, indeed. Those with nothing to lose. In the late 1980’s the choice was Vietnam Vets. Many of them had been unable to put the horrendous events of that war out of their minds. The emotional battle scars they carried haunted them and disrupted their lives. Startle responses, flashbacks, and intrusive negative thoughts and other overpowering symptoms of Post Traumatic Stress Disorder (PTSD) remained part of their daily lives in spite of years of counseling. So Francine Shapiro next tested the relationship between eye movements and distressful thoughts with a group of these men. Skeptics gave a tolerant smile. After these Vets participated in this pilot study, the amazing results showed that a significant number of them had a reduction in symptoms. What was going on here? The results of the eye movement study caused raised eyebrows in the research community.
From that time on, more research studies on EMDR and PTSD have taken place than on any other method to date. Further research with the Veterans caused the Director of the in-patient PTSD program at the VA Medical Center in Coatsville, PA., Steven Silver, with his [then] twenty years of experience with traumatized persons, to comment, “EMDR is producing greater effects in the treatment of PTSD than any other treatment we have used or have seen used.
Since that time, EMDR studies proliferated. In addition to Vietnam Vets, EMDR offers relief to people in many aspects of their lives. 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, when literally “tapped into,” 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 explanations. 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 AI 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, of course, the day Lucy arrives is the time. But this two-headed dragon doesn’t eat just anything. He is particular. Only members from Lucy’s slowly dwindling clan will do. Lucy will be breakfast. Realizing that, she panics, and tries to make a case for herself. Nothing will deter the dragon from his meal. Then Lucy finds out Ricky is arriving the next morning. He will save her. Scene fades to next morning. Ricky/Prince Charming to the rescue. He is dashing. He is brave. He walks right up to the dragon, to take him on. One look at the monster and Ricky’s, aka, Prince Charming, knees buckle. He backs down, leaving Lucy to the fate of the dragon. She will be eaten after all! She is doomed. Lucy awakens at this point. Ricky lies sound asleep in his bed, dreaming his own dreams. Lucy, still in dream mode, grabs her pillow and hits him over the head with it for not saving her. “Whot’s hopping?” asks the dazed and bewildered husband. The credits roll.
This dream demonstrates how disturbing material often cannot be brought to resolution. Like Lucy, we wake up before resolution (or a harmful dragon) can happen to us.
No one had ever taken the 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, reflects on speculations of Robert Stickgold, Ph.D., a Harvard University neurology researcher: “the flow of information from the hippocampus (which stores information) to the Neocortex (which analyzes information) is directionally reversed in EMDR” and 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, 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. Although we know the brain is much more complicated, a basic consideration suffices: 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 you 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. You don’t think about it until something comes up and sets you 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. Right? 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. Nine-eleven 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 of President Kennedy’s assassination. Some gentleman recently answered that question, from his spot in the back of the room. AFifth 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 Aaccelerated 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 may have blocked your life, like obstacles in a path, get resolved. Your life gets back on track. You create new neural pathways for yourself. Traumatic events get unstuck and move into the Hippocampus where they are stored as memories.
The development of new paths reminds me about a time I was a child. Our next door neighbor had a little girl, Linda, who was our age, who was great fun. But a hedge grew between our house and hers. It was a long walk from our front door down the path to the sidewalk, to turn left, walk a few feet, and turn left again to make another long walk up the walkway to Linda’s house. And then, my sister discovered a short cut. We could push our way through the hedge that began from the steps of our front porch to theirs. What a time saver! We cut through the hedge day after day. 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. And so, in sort of the same way, it seems that with the repeated left-right movements, or bilateral stimulation, of EMDR, 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 lives. They can disrupt, interrupt and create excessive and unnecessary difficulties, even in the strongest person.. Both traumas with a capitol “T” or with a lower-case “t” 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 so much whether the trauma is a “T” or a “t” but rather what matters is the way the particular event effects the person. The use of EMDR over time has broadened to recognize traumas of all kinds, and to deal with them effectively and efficiently.
What happens in an EMDR session?
First and foremost, therapists need specialized training in EMDR in order to use it properly. In considering the use of the technique 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, AEMDR is a very powerful psychotherapeutic method that needs to be utilized by a skilled clinician. He continues, AI 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. Gone is the former re-traumatization that often occurred in other “talk” therapies when someone often was asked to give a detailed description of what had happened. Mercifully, the therapist has the client focus on a specific life-disturbing memory of an event, rather than trudge through the event. What’s interesting to think about is how the events in your life colors the way you see yourself. If positive events happen, you tend to have a good outlook about yourself. For example, if you got an A on a test and the teacher told you “good job” you might start to believe “I am smart.” Conversely, if something negative happens to you, you start to develop a negative belief about yourself. Perhaps the logical part of your brain knows it’s not true, but the emotional part hangs onto it. So, in EMDR, the therapists asks for a negative self-referencing belief associated with that memory. The purpose here is to switch out a false negative belief with a more accurate positive belief. So the therapist also asks for a a positive belief about the self, that you want to strengthen. Again, the logical brain might believe the positive belief to some degree, while the emotional belief hangs onto the negative. The therapists asks the client to rate the strength of the positive believe from a “1” (AI don't believe it) to a “7” (AI believe it as strongly as I can). Usually by this time, a client feels some emotions stirring about the event. 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. Now, the “stage” is set for the bilateral movements to occur, while holding the event, plus the negative belief, and the emotions in mind. A set of eye-movements, or other forms of bi-lateral stimulation, such as alternating taps from one knee to the other, occur. While the bi-lateral stimulation occurs, the therapist and the client “get out of the way” and allow the brain to process. Whatever comes up, comes up, trusting the process to take the client wherever s/he needs to go. In between “sets” of the eye-movements, or other forms of bi-lateral stimulation, the client comments on whatever came up during the processing. As the sets of eye-movements continue, the therapist uses clinical judgment to direct the intervention. As the client continues to process the event, the memory might go here or there, through seemingly unrelated territory. In reality, it is all related, although the “how” is not necessarily all that important. The client “just goes with it”. Therapist and client alike stay out of the client’s way of processing. Whatever comes up is important to the client. For example, in seeking out EMDR for exam anxiety, Debbie focused on the exam she was about to take. As the eye movements began, she soon found herself crying. To her surprise, she recalled a time when she had been “outed by a group of friends at work. It had been a painful experience for her, even though it had occurred ten years prior. She was encouraged to “go with” that experience, and as she did, her emotional level dropped, and her positive self-referencing beliefs increased. She got in touch with unfinished business, managed to control her anxiety, and passed her exam. 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, AOh 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. Evelyn had a similar experience. She returned to therapy ten years after her initial start. This time she said she was ready to take on the memories of child abuse that had happened to her thirty years ago. After her third EMDR session, she experienced a drop in her emotions and was surprised by how rapidly the change had occurred. “It should have been harder than that,” she said.
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, AHave you noticed you haven't been so angry at your boss lately? Sam thought about it and puzzled, AOh yeah. His anger level continued to diminish to appropriate levels, and Sam's functioning improved. In time he was able to find another job.
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. AOh yeah, they say. Or as Evelyn put it, Ait 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. She 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, Susan, Sam, Evelyn, and all those who have experienced its power are grateful that Dr. Shapiro pursued her observation about her own disturbing thoughts that day after she walked in the park.