EMDR: Eye Movement Desensitization & Reprocessing
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 the results of that observation have since affected the lives of millions of people?
In 1987, Francine Shapiro, was out walking, thinking about life’s difficulties. As she walked, her eyes moved back and forth, from side to side. Suddenly, she realized that her disturbing thoughts had stopped on their own. She consciously had not done anything to interrupt them. Thoughts don’t just disappear without some type of intervention or distraction. Her curiosity piqued. She realized that the thoughts seemed to have suddenly ceased in relation to the pattern of her side-to-side eye movements.
At the time of her discovery, Francine Shapiro was a graduate student in psychology. She had come to the field of psychology through an interest in physiology and psychology gained while fighting cancer when pursing a doctorate in English. Perhaps her combined interests in these two sciences led her to wonder if there was any relationship between eye-movements and their affect on disturbing thoughts. Curious about this phenomenon, she discussed this event with her colleagues and asked them to experiment with this finding. They, too, experienced similar results with their eye movements. Interest grew.
Francine Shapiro tested the relationship between eye movements and distressful thoughts in a research study with Viet Nam Vets. These men still experienced symptoms of Post Traumatic Stress Syndrome (PTSD) thirty years after that war. Startle responses, flashbacks, and intrusive negative thoughts remained part of these Vets’ daily lives in spite of years of counseling. As they participated in this study, a significant number of them had a reduction in symptoms. 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, with concerns such as anxiety, phobias, performance issues, grief, disturbing memories of childhood, and even chronic pain.
How EMDR works:
Rapid eye movement seems to be a naturally occurring phenomenon, but no one had ever deliberately harnessed this event before, much like electricity and Ben Franklin’s kite. In spite of all the research, no one quite understands yet how EMDR works. One good guess comes from brain research, particularly, how trauma interacts with the brain. The part of the brain called the limbic system is responsible for emotions. Basically, whatever happens in a person’s life on a daily basis just passes on through the neural-nets of that part of the brain, and moves into another location, the hippocampus, where memories are stored and consolidated. For example, if someone asked you what you were doing two Thursdays ago, you wouldn’t necessarily remember. But if you had been fired on that particular Thursday, you would be able to describe it in detail, complete with the emotions of that event. More dramatically, there is a certain age range of people from the U.S. who understand how memory gets stuck all too well. If someone asks them, “What were you doing on November 22, 1963” many can describe in detail what they were doing and what was going on around them. “Fifth grade, Mrs. Kenyon’s class,” a middle age man recently said in answer to this question. The news of President John F. Kennedy’s assassination remains vividly lodged in the minds of such people. The memory and even much of the affect has stayed locked into the “national brain”, as it were, from that traumatic event so many years ago.
Thus, in EMDR it appears that the neural-nets of the brain are able to allow traumatic material, hitherto stuck, to pass on through the limbic system, and to do so quickly. For this reason, EMDR often is referred to 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. 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.
Another theory likens EMDR to Rapid Eye Movement (REM) sleep. REM sleep is the part of the sleep cycle when people dream. Dreams help people process emotional material. Sometimes the events are too disturbing to be fully processed so people may wake up in emotional distress. Some feel the emotion so intensely that they wake up crying or wake up angry at another, often their spouses, thanks to their dream. For example, this idea was played out on an “I Love Lucy” show years ago. In that episode, Lucy visits her ancestral home of Scotland just in time to be offered up the following morning to the hungry two-headed dragon whose once every thirty years meal consists of family members from her dwindling clan. Enter Prince Charming/Ricky to the rescue. But when the next morning arrives, he fearfully backs down. Lucy awakens at this point and angrily hits the innocently sleeping Ricky over the head with a pillow. This dream demonstrates how disturbing material often cannot be brought to resolution because a person wakes up in distress. In EMDR the eye-movements replicate those in REM sleep, but they are assisted by the therapist who is guiding the client toward resolution and adaptation of the disturbing events associated with the memory.
Interestingly, all people have situations, past or present, whose distressing life events contain some element of trauma.
Traumas tend to have a negative effect on our lives. They can disrupt, interrupt and create excessive and unnecessary difficulties. The understanding of traumatic events increased over recent years to include many kinds of situations, some seemingly more significant than others. Dr. Shapiro describes these events as falling into categories that are major, which she identifies as trauma with a big “T”, and traumas which are minor, or little “t”. Regardless of degree, she points out that both can create havoc. Experiences are unique to each individual. What is major for some is minor for others. For example, while some people cope with stressful live events with resiliency, others seem to be negatively impacted by seemingly minor incidents. In spite of the minor nature of those life events, the way they affect the person matters. Thus, 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 clients’ treatment plan. Prior to using this method with a client, that person needs 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 to discuss his experience with this method in therapy. He says, “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 nine years of using this method, I also 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; 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 (not so) to 7 (strongly felt). 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 “Oh-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 the 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 replied, “Oh yeah.” The 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.”
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.