EMDR (Eye Movement Desensitisation and Reprocessing) is a powerful psychological treatment that was developed in 1987 by a clinical psychologist, Dr Francine Shapiro, who famously discovered its effectiveness with distressing material, while walking in the park, and noticing that bilateral eye movements reduced the distress.
A traumatic event is an out of the ordinary occurrence which overloads our nervous system, and the disturbing experiences are held in our bodies, unprocessed. This means we will have all the sensory information: smells, colour, sounds, textures and images in their original form, without being put in a timeline and placed in order or in a logical, sequential story.
These traumatic experiences are frozen in our brain and body and the limbic system (emotional brain) and the memory. They get triggered in the “here and now” when any of this sensory material is activated. The memory feels fractured – like unexpected bits of a broken picture or other sensory material but as this is unprocessed or incomplete and when triggered, all the emotion and overwhelm of the original experience is as active as it was at the time of the traumatic event.
This is because sometimes an experience is simply too overwhelming - large, painful, or shocking to process alone. EMDR therapy can help “reprocess” this experience. EMDR can be used to “jump-start” our natural processing system. EMDR allows the overwhelming experiences to reprocess until they no longer feel disturbing, desensitising the symptoms and so EMDR can reduce the emotional activation attached to the memory.
This information is taken from EMDR International Association (EMDRIA) because it explains it so succinctly:
“When an individual is traumatised, he/she may experience such strong emotions that their brain becomes overwhelmed. The brain consequently is unable to cope with, or process information as it usually does. Distressing experiences become ‘frozen in time’. Such events are stored in the brain in their original ‘raw’ form and can then be repeatedly remembered as ‘action replays’ or intrusive memories. As a consequence the person repeatedly re-lives the original unpleasant event/s. Remembering in this way may feel as bad as experiencing it the first time because the images, sounds, smells, and feelings don’t change or process. Such memories have a lasting negative effect on the way a person sees themselves, the world and other people. It can have a profoundly negative effect on all aspects of their lives.”
Usually when we receive information from our senses it passes through our amygdala, in the limbic system of our brain. (See Trauma and PSD section). From there the information usually travels through our hippocampus, which processes information for time and space (sort of, date stamps it) and this then allows it to pass to the left hemisphere of the brain where it is stored, processed. The experience has then been stored in memory and a new experience has been learned. It has been placed in the past.
When the traumatic incoming sensory information has a high emotional charge, it can get stuck in the central nervous system in the right hemisphere of the brain. This stuck information then doesn’t get processed. When we get reminders or triggers of the event, the stuck memory is emotionally re-experienced, as if it is happening in the present. This is why we get flashbacks, intrusive thoughts and nightmares – all symptoms of PTSD.
EMDR seems to affect the way we process information in a healthy way. It won’t erase the trauma memory, but it can neutralise the high emotional charge that has been linked to it.
EMDR helps the brain with Adaptive Information Processing through bilateral (left-right) stimulation. This means both staying in the “here and now”, while visiting parts of the distressing memory, the “there and then”. EMDR helps reprocess traumatic memories by repeated left-right (bilateral) stimulation of the brain, while noticing different aspects of the traumatic memory. This is dual attention.
Our mind, like any other part of our body will try to heal if it can – a bit like a wound will heal naturally. EMDR may work in the same way that REM sleep does, when we naturally process information from our day. EMDR therapy helps the brain to process these memories, and to allow normal healing to resume. The traumatic experience is still remembered, but the fight, flight, or freeze (fear/unsafe) response from the original event is resolved. For these reasons EMDR has been described as having “a foot in the past and a foot in the present” while it facilitates the mind to activate its own healing.
What happens in EMDR Processing?
Explanation of EMDR from www.EMDRWorks.org:
"Old disturbing memories can be stored in the brain in isolation; they get locked into the nervous system with the original images, sounds, thoughts and feelings involved. The old distressing material just keeps getting triggered over and over again. This prevents learning/healing from taking place. In another part of your brain, you already have most of the information you need to resolve this problem; the two just cannot connect. Once EMDR starts, a linking takes place. New information can come to mind and resolve the old problems. This may be what happens spontaneously in REM or dream sleep when eye movements help to process unconscious material.”
“We'll do the eye movements for a while, and then we'll talk about what came up. What we will be doing is a simple check on what you are experiencing, so all you need to do is to give me as accurate a feedback as you can as to what is happening, without judging whether it should be happening or not. Sometimes things will change and sometimes they won’t. There are no right answers in this process. Let whatever happens happen”.
After a thorough assessment, and if we decide that EMDR would be a good fit then we work through these eight phases together. Sessions can be 60 to 90 minutes. Attention will be given to a negative image, belief, emotion, and body sensation related to this event, and then to a positive belief that would indicate the issue was resolved.
EMDR has eight phases:
1) History taking and treatment planning, when history is discussed and a treatment plan is developed. Risk factors and identifying previous trauma and ways of coping are all part of this assessment.
2) Preparation, I explain the EMDR therapy process. There is a strong focus on safety and stabilisation, resourcing, containment and we work to identify a “calm place”. I will check for your level of dissociation and we will measure of impact of traumatic events (using scales).
Before we begin to process “desensitize” it’s important to have some internal resources so we develop support, like a scaffolding to help you feel stronger and supported going in into the memory. This is to help keep you inside the “window of tolerance” – so you don’t get hyper aroused (anxious angry overwhelmed - fight flight) - or hypo aroused (Spaced or zoned out numb frozen – when your body wants to shut down). The therapeutic relationship is most important to build trust and safety so that it feels okay to do the work, with you feeling supported and safe and not isolated. People often feel isolated when the trauma happened, so it’s important not to feel isolated in therapy, to allow healing.
3) Assessment, This targets the memory - the event to reprocess (also known as the target memory) along with images, beliefs, feelings, and sensations you have developed about the event. Baseline measures are used - the Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale.
4) Desensitization, involves bilateral stimulation, where the side to side eye movements, sounds, or taps are begun, while focusing on the traumatic event, and will continue until the distress level reduces to zero (or 1 if appropriate). During this time, new thoughts, sensations, images, and feelings may emerge. We pause regularly to check to notice change or no change. There isn’t usually a lot of talking during processing, just headlines or highlights noticed. We just go with that each time.
5) Installation, This phase is to link and strengthen a positive belief to the target event until it feels completely true.
6) Body scan, you will be asked to hold in mind the target event and the positive belief while scanning the body from head to toe. Any lingering disturbance from the body is reprocessed.
7) Closure, you are assisted to return to a state of calm in the present moment whether the reprocessing is complete or not. Reprocessing of an event is complete when you feel neutral about it (SUD=0), the positive belief feels completely true (VOC=7), and your body is completely clear of disturbance.
8) Revaluation is how each new session begins after reprocessing. We discuss recently processed memories to ensure that distress remains low and that the positive cognition is still strong. Any future targets and directions for continued treatment will be identified.
As a therapist my biggest learning has been that you don’t need to talk about the trauma to heal, and EMDR allows you to access resources and healing that you may not even know you have yet.
I’ve had to step back from talk therapy and left brain analysis which I’ve done or many years, and trust the process – to hold the frame for the healing to happen. I think the hardest thing is to suspend our left brain analytical self from trying to understand why and what’s happening and to let our subcortical brain, nervous system and body use its own incredible natural processing wisdom to heal.
I am in awe of the courage people show to work with trauma memories and it’s an honour to be able to use the eight phase model to help a person jump start their natural healing ability to resolve trauma.