April 30, 2020

A Widely-Used Treatment Modality for Healing Trauma: EMDR (Eye Movement Desensitization and Reprocessing)

The human brain is a powerful machine built to take in details and use those details for survival; it has the ability to develop millions of neural pathways by adapting to new information. When injured, the mind has the capability to naturally heal itself, similar to healing from physical injuries. A natural coping mechanism our brains use every day to heal is sleeping. Specifically, during the fourth stage of the sleep cycle, REM sleep (rapid eye movement sleep). Research studies actually suggest that our brains are more active during the 90 minutes of REM sleep than when we are awake (Asp, 2015). Quite the paradox, right? During REM sleep, our eyes move side to side rapidly which assists the brain in unconsciously processing memories by tracking each of its mental images. Some researchers theorize this is our dream state (2015). In 1987, Francine Shapiro developed EMDR, Eye Movement Desensitization and Reprocessing treatment, which mimics the REM sleep mechanisms to process (or heal) traumatic memories or other types of complex life experiences such as:

  • abuse
  • bullying
  • grief
  • domestic violence
  • both behavioral and chemical addictions
  • military combat trauma
  • attachment trauma 

EMDR is a treatment modality which stimulates left and right hemispheres of the brain in order to surface historical, distressful experiences that created thought patterns, both subconscious and conscious, in order to reprocess memories and replace negative cognitions (beliefs) with positive cognitions (Thompson, 2019; Shapiro, 2001). However, while EMDR mimics REM sleep, the person receiving EMDR treatment is awake, conscious, and in complete control. That might seem too good to be true, so, how does EMDR work?

To understand how EMDR works, it is crucial to understand how trauma is stored in the brain. Before we delve into that, understand that every person experiences trauma. Trauma is not exclusive to those who have Post Traumatic Stress Disorder (PTSD) or those who have served in military combat. Trauma is any event that occurs when a person was not emotionally equipped to handle the event at that time. When a person experiences internal or external stimuli similar to the trauma, the person may “re-experience” the event by the brain releasing similar sensations, emotions, and thoughts, which is the foundation of PTSD (2008). This is referred to as a “trigger” which can take the form of an emotional, and sometimes physical, remembrance of a traumatic memory.

The brain is composed of three main structures: the reptilian brain, the limbic brain, and the neocortex brain. Humans function primarily in the neocortex, which is the higher brain function. During high intensity stressors, the limbic and reptilian part of the brain takes over and the brain functions in a lower, more impulsive state. The pre-frontal cortex (higher brain function) disengages during a traumatic event, and turns on the fight or flight response (the limbic and reptilian brains) which floods the body with adrenaline and cortisol (Huso, 2010). At this point, the brain’s primary responses are to anticipate, or to protect itself from potential danger – fight. The limbic and reptilian brain functions rely on automatic processes, such as blood rushing to extremities to flee – flight. Trauma occurs when the survival brain becomes stuck which leads to the brain no longer having the ability to determine what is safe from what is unsafe. In simpler terms, the brain can no longer distinguish between imagining the past trauma and actually experiencing it. Similar to a physical injury, the brain at this point, is injured and cannot reset itself. This inability to reset itself is problematic when a person experiences a triggering event. The brain responds by imagining the same traumatic event and setting off the response it did in the initial traumatic event (Posmonteir, Dovydaitis & Lipman, 2011). This makes the images in the mind feel real inside the body. Dr. Shapiro suggests that any emotional problems that a person struggles with are manifested from unprocessed traumatic memories “locked” in the brain (Shapiro, 2018; Gomez, 2020). So, how do these memories become locked in the brain?

 

The Brain’s Event Processor: Adaptive Information Processing Model

The Adaptive Information Processing (AIP) model theorizes that all humans have an “information processing system” within the brain which understands external stimuli and stores them into “existing memory networks” – locking the memories into existing events in the brain (Christman & Propper, 2008). Abnormal cognitive patterns or pathology occur when traumatic experiences are not properly processed and are stored disorderedly with other unprocessed sensations, thoughts, and emotions (Thompson, 2019). The primary reason EMDR consistently yields the ability to process traumatic memories is because of its alteration of the brain’s “structures involved in memory” (2008). By using bilateral eye movements or bilateral stimulation, both the right and left hemispheres of the brain are stimulated making it possible to reprocess the memories with positive, adaptive information which will then be stored orderly in the brain. These new positive adaptations allow for hyperarousal “processing systems” to better facilitate “the distinction between real threats and traumatic memories” (2008).

In simpler terms, the AIP model theorizes that the brain has an “inherent information processing system” that becomes blocked when exposed to traumatic adversities causing the original images, sounds, smells, thoughts, feelings, and other body sensations associated with the trauma to stick in the brain (Gomez, 2020). Thus, when a reminder of the traumatic event occurs, those same thoughts, feelings, and sensations are also experienced (Gomez, 2020). A person who is triggered may freeze, dissociate (check out of their body; numb), fight (maybe yell or physically fight), run away (flee), or develop other types of behavioral and/or chemical addictions to try to alleviate emotional and psychological distress caused by trauma (Thompson, 2019).

Furthermore, Francine Shapiro stated the following:

“when a woman experiences psychiatric symptoms after sexual trauma, memories of the experience can become locked in her neural memory network…If the original traumatic event becomes the lens through which she perceives the world, she may fear going outside or engaging in intimate relationships, and she may suffer decreased self-esteem and powerlessness. A woman who experiences sexual violence may turn to substance abuse to lessen the psychological pain, or she may form relationships with violent partners in order to resolve the original trauma (Shapiro, 2001).

 

You might be asking: what is considered an “unprocessed” memory? Let’s break that term down to an easy explanation: 

When a person has a negative experience in life, such as sexual assault, the brain creates a “file” which includes the feelings, thoughts, and body sensations connected to that negative experience (Gomez, 2020).

For negative events that are not as traumatic, the brain has the capability to work on these files prior to storing and locking them into memories. Therefore, what is stored has also been organized and sorted out allowing the brain to learn from the experience. An example of a negative experience with a good outcome is learning that drinking hot chocolate can temporarily burn your tongue but your brain learns to be hesitant next time drinking hot chocolate and wait until it cools before drinking it.

When a negative event is traumatic and/or has occurred several times, the brain gets overloaded and cannot sort and organize all pieces of the event. Subsequently, these mixed up pieces of memory in the brain make a person susceptible to being triggered by different life events such as being ignored, being teased by peers, being called a name, or being touched/hugged without consent. When these trigger the mind, a person will start to experience the negative feelings, thoughts, body sensations/reactions when the original negative events happened.

EMDR can assist the mind organize these out-of-place pieces, so a person will not be triggered. In fact, a research study conducted on 70 patients with Post Traumatic Stress Disorder (PTSD), symptoms concluded that bilateral stimulation of the brain results in the activation of the AIP system, which “facilitates reprocessing of distressing thoughts into positive thoughts” (Greenwald, 1994).

Francine Shapiro compares psychiatric healing to physical wound healing: “the body’s natural defenses are activated and called to the site of trauma. Thus, just as the immune system is called into action for wound healing, the woman’s AIP is called into action for psychiatric healing” (Shapiro, 2001).

Below are questions to ask yourself to see if EMDR may be relevant for you (Gomez, 2020):

  • Do you feel annoyed, angry or bored often?
  • Do you isolate from others?
  • Do you feel that you are not as good as others are?
    Do you engage in ego dystonic behaviors? Ego-dystonic behaviors are when a person is aware of their compulsive drive to engage in particular behaviors that illicit distressing consequences to self and possibly others, but they cannot stop (Thompson, 2019; Joelson, 2019).
  • Do you have nightmares or have a hard time falling asleep or staying asleep?
  • Do you have negative events that happened to you?
  • Do you tend to keep things inside and not tell anyone?
  • Do you use drugs or alcohol or do you do other things to harm your body to numb or escape the uncomfortable feelings?
  • Or do you do this to fit in because you don’t feel connected to others, or you don’t feel as good as others?

 

What does EMDR have to do with childhood sexual abuse?

Childhood abuse often creates shame and irrational beliefs about oneself. It is not a person’s fault for the way that their brain stores trauma, as this is simply the way that the brain stores memories. “A child’s earliest experiences” with caregivers develops both subconscious and conscious beliefs regarding “self-worth, safety and security, and the trustworthiness of others” (Potter & Wesselmann, 2009).

EMDR treatment has become a leading method of intervention for those with trauma and PTSD producing effective results in an extremely short time” (Cox & Howard, 2007). This treatment seeks to identify the specific negative cognitions attached to historical distressing memories in order to replace those negative beliefs about self with positive cognitions about self. The goal being persons no longer feeling a sudden onset of anger, sadness, shame, or aggression; removing thoughts of “I am unworthy,” “I am inadequate,” “I am unlovable.” EMDR mimics REM sleep, by using bilateral stimulation. When a person tracks a therapist’s fingers moving side to side (bilateral eye movement) while holding the traumatic memory, the client’s brain will bring up several details of the memory at an extremely fast rate until the memory loses its emotional charge. When the memory loses its emotional charge, a person’s thinking about the memory changes. A person will notice this because they will think less worthless and powerless, and more empowered, and worthy.

 

Why is EMDR so popular?

One of the primary factors that deters survivors of sexual abuse and/or sexual assault from receiving counseling treatment is not wanting to “re-live” the traumatizing memories. More often than not, those who have survived want to do everything in their power to avoid even the thoughts of their trauma. EMDR does not require a person to speak the traumatic memories out loud, but allows the brain to rapidly move through the memories – we think faster than we talk, roughly seven times faster (Huso, 2010). Therefore, EMDR is different than many trauma therapy methods because it does not require the client to discuss the details of the memory.

A major reason why people tend to not entirely heal from these sorts of traumatic experiences is because they drop out of treatment as several modalities take years to reach full recovery. In contrast to traditional psychotherapeutic modalities, psychotherapists can use EMDR to facilitate rapid, cost-effective psychiatric recovery in as few as three to four 90-minute sessions for appropriately screened clients” (Shapiro & Maxfield, 2002). Research suggests through evidence-based studies that bilateral stimulation or bilateral eye movements allow the memory to unlock “stuck” traumatic information including the images, thoughts and feelings associated. These traumatic and shame-inducing memories are reprocessed and desensitized reducing the negative behaviors and feelings (Christman & Propper, 2008).

 

Closing Thoughts

First and foremost, ensure that your therapist is trained by the EMDR International Association. I implement EMDR with my clients and witness incredible healing and transformation. It is important to understand, however, that EMDR is not a quick fix to life’s problems because it does take effort from the client – but it is worth it. Lastly, counseling success is primarily derived from the therapeutic alliance between a client and therapist. Simply put, if you do not feel like you have a good fit with your counselor, find a new one, because counseling is about your personal healing. “Over the years, research has confirmed what so many therapists have known intuitively, that the therapeutic relationship itself is essential to the success a patient experiences” (Firestone, 2016).

EMDR is an approved therapy approach by the Substance Abuse and Mental Health Services Administration and the National Registry of Evidence-based programs and practices (Gomez, 2020). Some people who have experienced significant childhood trauma will abuse substances such as alcohol and/or drug to tolerate uncomfortable emotions that surface when reminded of trauma. Individuals who engage in this behavior may never stop their maladaptive behaviors until part of the “emotional charge” is reduced from their “emotional past” (Yeary & Zweben, 2006). Individuals are engaging in harmful behaviors because it helps them not experience the painful emotions, therefore, processing some of the underlying trauma may reduce the compulsion as sometimes abstinence is unattainable until historical trauma is addressed (Cox & Howard, 2007). Instead of solely concentrating on reducing triggers that initiate the motivation to engage in maladaptive behaviors, EMDR alters the neural pathways and can change “adult attachment” wounds caused by the traumatic event (Potter & Wesselmann, 2009). EMDR protocols can process the original causation of the distressing emotion and replace the negative cognitions with positive cognitions (Craparo, 2014). Specific EMDR protocols are used to surface specific intolerable emotions and the earliest trauma that is associated with that emotion in order to desensitize its power and reprocess it properly (Shapiro, 2014). To be clear, EMDR does not erase a person’s memories, it decreases the power of the negative memories while replacing negative beliefs, with positive beliefs. One of the reasons I enjoy utilizing EMDR in clinical practice is because the individual is in control and that in itself is empowering when control was taken in victimizing events.

References

Asp, K. (2015). REM Sleep: What it is, why we need it. Retrieved April 10, 2020, from https://www.sleepresolutions.com/blog/rem-sleep-what-it-is-why-we-need-it

Cox, R. P., & Howard, M. D. (2007). Utilization of EMDR in the treatment of sexual addiction: A case study. Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention, 14(1), 1-121. doi:10.1080/10720160601011299

Craparo, G. (2014). The role of dissociation, affect dysregulation, and developmental trauma in sexual addiction. Clinical Neuropsychiatry, 11(2), 86-90.

Firestone, L. (2016). The Importance of the Relationship in Therapy: A strong therapeutic alliance can lead to real change. Retrieved April 5, 2020, from https://www.psychologytoday.com/us/blog/compassion-matters/201612/the-importance-the-relationship-in-therapy

Greenwald R. Criticisms of Sanderson and Carpenter’s study on eye movement desensitization. Journal of Behavior Therapy Experimental Psychiatry. 1994;25(1):90–91

Gomez, A. (2020). What is EMDR – for Adults . Retrieved April 16, 2020, from https://www.anagomez.org/what-emdr-adults/

Huso, D.R. (2010). Treating child abuse trauma with EMDR. Social Work Today, 10(2), pg. 20

Posmonteir, B., Dovydaitis, T., & Lipman, K. (2011). Sexual Violence: Psychiatric Healing With Eye Movement Reprocessing and Desensitization. Healthcare Women International, 8(31), 755–768. doi: 10.1080/07399331003725523

Potter, A.E., & Wesselmann, D. (2009). Change in adult attachment status following treatment with EMDR: Three case studies. Journal of EMDR Practice and Research, 3(3) 178-191

Shapiro, F. (2001). Eye movement desensitization and reprocessing. 2. Guilford Press. New York.

Shapiro. F. & Forrest, M. (1997). Healing the ravages of rape. EMDR eye movement desensitization & reprocessing: The breakthrough “eye movement” therapy for overcoming anxiety, stress and trauma.

Shapiro & Maxfield. (2002). Eye movement desensitization and reprocessing (EMDR): Information processing in the treatment of trauma. Psychotherapy in Practice. 58, 933–946. doi: 10.1002/jclp.10068

Thompson, A. (2019). The Effectiveness of EMDR as a Treatment Intervention in Sexual Addiction.

Yeary, J. & Zweben, J. (2006). EMDR in the treatment of addiction. Journal of Chemical Dependency Treatment, 8(2), 115-127. doi: 10.1300/J034v08n02_06

 

 

This article was written by Ali Thompson, licensed master social worker, who practices clinical counseling. 

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