EMDR Q & A
What it is
EMDR is a type of talk therapy. Like all psychotherapies, its purpose is to decrease emotional suffering and promote healing.
How you do it
EMDR is different from traditional talk therapy, which makes use of conversation, often with the therapist asking questions and the patient giving responses. EMDR employs a process akin to free association in which the patient, after targeting a particular issue for the session, lets his/her mind silently flow to whatever thought, image or memory comes next. After 30 seconds of silent observation of this inner activity, the therapist cues the patient to describe whatever came to mind during the interval, and the therapist transcribes the content. The process continues in this way for the entire EMDR session. Rather than engage in a conversation about the generated content, the therapist may say nothing more than, “go with that,” or possibly interject a brief comment. As the patient your main responsibility is to pay attention to your internal process and tell the truth about what you experience.
What does EMDR stand for?
EMDR stands for Eye Movement Desensitization and Reprocessing, the name was coined more than 25 years ago by Francine Shapiro, the psychologist who made a surprising therapeutic discovery and developed a therapy to utilize it. After having been diagnosed with breast cancer, Dr. Shapiro had a moment of distress and happened, simultaneously, to be moving her eyes back and forth from side to side. When she stopped, to her surprise, the distress had decreased dramatically. Fascinated by the effect, she began soliciting her colleagues to be informal research subjects in experiments examining the effects of eye movements on emotional distress. She found the therapeutic effect to be reproducible and developed the therapy that still references eye movements (the EM in EMDR). Hundreds of studies and years of research later, it has been demonstrated that eye movements are not required to produce the therapeutic effect. Instead, what seems to be required is so-called “bilateral stimulation” of the brain while the patient is focusing on something that causes distress. That stimulation can be tactile or auditory as well. Dr. Shapiro considered changing the name of the therapy to reflect these new data, but concluded that name recognition of the well-established therapy was probably more important.
What is happening during EMDR
During traditional talk therapies, the therapist employs a number of different tools to promote healing. The most simple tool is persuasion, such as offering advice (e.g., parenting tips). Other therapies seek to make what is emotionally or cognitively “implicit” more “explicit” which is what happens when a vague and diffuse emotion can be connected to a specific event or pattern of behavior and illuminates possible solutions. Behavior therapies make use of desensitization in which the fear of something is reduced by repeated exposure to that which is feared. As best we understand it, EMDR makes use of the brain’s innate ability to recover from emotional wounds.
The brain’s innate ability to recover from emotional wounds
Call to mind an interaction with a friend that upset you for several hours. Ever notice how the next morning it doesn’t seem so important or upsetting? Maybe you realize that the other person was having a bad day and hadn’t intended to hurt you. Or maybe you find it easier to regard the hurtful incident as a small blip in an otherwise good relationship. Overnight, your brain has been processing the experience, comparing the new information to other information already stored in your brain about this person. You may find that you no longer feel upset or can think of an easy way to address this with your friend that will resolve the issue. Though scientists are not completely certain how this happens in the brain, we do know that emotional wounds and memories that have been “processed” no longer upset us.
What is the role of bilateral stimulation?
The brain has two halves. Touching something with your left hand sends a signal to the right side of your brain, and vice versa. The same is true of sight and sound. A beep heard only in your right ear will send a signal to the left side of your brain; looking to your far right will also send a signal to the left brain. In EMDR, we use equipment (e.g., headphones, tappers, a light bar) to first send a signal to one side of the brain and, a second later, to send a signal to the other side while you are thinking about the topic for that session. This brain stimulation appears to be critical to the effectiveness of EMDR.
How does bilateral stimulation work?
The short answer is that scientists are not sure. One theory offers that we are mimicking the brain activity that occurs during rapid eye movement (REM) sleep during which time, scientists conjecture, recently-acquired information is stored for the long-term (Boyce, Williams, Adamantadis, 2017). According to Stickgold, “...alternating, bilateral visual, auditory, or tactile stimuli of EMDR automatically activates brain mechanisms which...shifts the brain into a memory processing mode similar to that of REM sleep” (Stickgold, 2002). Other theories have been offered and studied however, at present, the exact mechanism of action has not been identified. Just as lithium carbonate treats bipolar disorder and reduces the risk of suicide without a known mechanism of action, EMDR works to treat emotional suffering.
For what problems is EMDR helpful?
EMDR is best known for effectively treating post traumatic stress disorder (PTSD). A traumatic event is generally considered to be a life experience that temporarily overwhelms a person’s ability to cope effectively, such as think clearly, make good decisions, keep emotions in a moderate range, and function as needed. However, you need not have PTSD for EMDR to be helpful. Painful experiences from the recent or distant past can be a source of distress in the present. Whether we are aware of their effect on us or not, old experiences can influence our emotions, actions and choices in the here-and-now in ways that make us unhappy. We’ve all had the thought, “I know it’s irrational and I want to stop doing that, but I can’t help it.” In that moment, we are describing the effect of old experiences (or memories), whether the memory is in, or out, of our awareness. EMDR can also be helpful with these types of troubles, as well.
What changes after successful EMDR therapy?
When it works, EMDR relieves distress. It can reduce chronic symptoms of anxiety and depression. It can also reduce our emotional reactivity to so-called “triggers” (events in real time that stir up big reactions). It can shift our outlook on life from “glass half empty” to “glass half full.” Successful EMDR therapy can help us feel less unworthy, less responsible for everything and less unsafe in the world. And, it can help us see that we have choices. As former patient described it to me, “I cannot even will myself to get upset about that situation anymore! That old reaction is just gone.”
References
Boyce R, Glasgow SD, Williams S, Adamantidis A. Causal evidence for the role of REM sleep theta rhythm in contextual memory consolidation. Science 352(6287): 812-816, 2016.
Rousseau PF, Khoury-Malhame EL, Reynaud E, Zendjidjian X, Samuelian JC, Khalfa S. Neurobiological corelates of EMDR therapy effect in PTSD. European Journal of Trauma & Dissociation 3(2):103-111, 2019.
Shapiro F. Eye Movement Desensitization and Reprocessing [EMDR] Therapy. New York: Guilford Press, 2018.
Stickgold R. EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology 58(1):61-75, 2001.
