Part 2: How does eye movement desensitisation and reprocessing (EMDR) work to combat trauma?
The first part of this article explained how traumatic memory gets stored in the brain and body (http://www.counselling-directory.org.uk/counsellor-articles/part-1-how-does-eye-movement-desensitisation-and-reprocessing-emdr-work-to-comb).
What happens in an EMDR therapy session?
EMDR aims to reprocess/reintegrate those fragmented parts of experience by engaging the bits of the brain that have gone off-line due to it being overwhelmed. Once the brain is back on-line, the therapist helps to desensitise the memory/remove the negative charge and to process it in the way that normal memories are processed (from implicit to episodic to semantic memory). So, what would this look like in the therapy room?
The therapist does a thorough assessment to identify the symptoms that the client wants to change and to understand how they link to events in the past in which the client has felt distressed. She will also ensure that the client has resources around him to be able to look after himself while this is happening – support from others and a home/work life that is stable enough, the ability to ground himself when he is feeling distressed and to remain in touch with the present moment while remembering the trauma.
The therapist asks the client to recall the worst part of the traumatising event along with the negative thought that the person has about themselves when they recall the incident and also to pay attention to where they are feeling the negative charge from the recall, in their body. The therapist then moves their fingers in front of the client’s eyes and asks the client to notice what comes up. This could be in the form of thoughts, images, physical feelings, impulses or emotions. She stops at intervals and asks the client to report back what they notice.
When the client no longer feels distressed at the recall of the incident, she asks them to focus back on the incident and say to themselves what they would like to think about themselves when they recall it. This engages what EMDR calls an adaptive information processing system which, once active, helps the client to integrate the fragmented and traumatic memory by linking it to a more positive or realistic way of thinking. The therapist then uses the same technique to help the person to process any remaining bodily sensations associated with the traumatic memory.
How might EMDR work?
There are three main theories as to the mechanism of change for EMDR.
EMDR has been compared to rapid eye movement (REM) sleep in the way that it reduces trauma by changing the emotionally charged memories into a more generalised form (look at work by Robert Stickgold for more detail).
Another idea as to how EMDR desensitises memory is that it stimulates both sides of the brain and so increases neural links between them.
A third proposed mechanism and one that explains why EMDR does not result in re-traumatisation when the memory is recalled could be because the dual task of moving your eyes and recalling the event visually draw on memory resources or ‘brain power’ which has limited capacity. The competition created by performing both tasks impairs the brain's ability to recall in full vivid traumatic detail. It has been shown that every time we recall an event we restore it. This is why memory is unreliable, particularly as time passes and EMDR takes advantage of this. Recalling the traumatic incident while paying attention to a hand being moved provides a new memory of the event which does not have the same physical charge to it.
Other, more universal, therapeutic factors when treating trauma are the effects of recalling the memory within the safe space of a therapeutic relationship and of moving attention lightly between the memory of the traumatic event and the room.
So these theories offer many ways in which EMDR reduces feelings of distress. Once the emotion has been reduced, the client is able to stand further back from the memory and re-evaluate it without feeling overwhelmed. They are able to tell themselves they are "safe now" or "not responsible" or bring in a preferred way of thinking about themselves. The memory can then be processed and begin to move back in time and fade like any other.
I think that several or all of these mechanisms could be active at once. It should be said no one really knows definitively how EMDR or any other therapy works or indeed why speaking to a good friend can make us feel so much better.
How effective is EMDR?
EMDR has been found to be effective for people who are experiencing a broad range of mental health difficulties and this may be because traumatic events are often present in the onset of most mental health problems including depression, obsessive compulsive disorder (OCD) and prolonged grief.
It was a therapeutic technique discovered by Francine Shapiro in the 1980’s and is now recommended by the World Health Organisation as the treatment of choice for children with PTSD. The National Institute of Clinical Excellence (NICE) cites it as the treatment of choice for PTSD along with CBT. And there is a good reason for this – I have seen it work incredibly effectively, the change can be very quick, and the research to support this anecdotal evidence is strong.
Research outcomes show that it is as effective as CBT, and without requiring the client to engage in hours of homework.
If you have experienced a disturbing event that has not left you and are having flashbacks, feeling anxiety and avoiding things that remind you of the event or are having longer term effects such as exhaustion, disturbed sleep, trouble concentrating, a general sense of anxiety, myalgic encephalomyelitis (ME) and phobias, contact a therapist who practises EMDR to discuss treatment.
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