EMDR: An Overview
While there are many approaches and modalities that can be used to support mental health there are some that stand out as more targeted and effective for certain conditions. EMDR falls into a category of treatments that specializes in trauma recovery. However, EMDR for many, is shrouded in a lack of clarity and possibly worries that can put them off from exploring if it would be a helpful therapy for what they are experiencing. This post is aimed at providing an overview that covers the basics of EMDR to help you feel more confident in finding out if it would be useful in your therapy journey.
A Brief History of EMDR
Trauma therapy has been an evolving area of practice for the mental health field as we learn more and more about the impacts of it across the lifespan in ways previously unknown. For example, only recently has the concept of CPTSD or complex trauma been officially defined and researched leading to insights about unique needs when it comes to treatment. Dr. Francine Shapiro was the pioneering psychologist who explored the connection between eye movement and psychotherapeutic processing of traumas. Among the first clear utilizations of it as an effective therapy was actually by an FBI agent who connected victims of the Oklahoma City Bombing to EMDR practitioners leading to a majority of them seeing beneficial effects. Since then EMDR has been continuously researched and refined as a treatment, even expanding beyond trauma centered on PTSD to more broad anxiety, depression, and other cases.
Why Eye Movement?
The E-M of EMDR stands for Eye Movement and was the original physiological connection utilized for trauma processing. However, since that time effective change has been seen with other forms of what is called bilateral stimulation or also termed dual attention stimulus (DAS). The idea here being that while working through the ‘in-the-mind’ traumatic memories we are also working other parts of the brain having to do with motor control and attention through eye movement, sounds, vibrations, or tapping.
As a matter of transparency the sole reason EMDR works is not yet known; but, the following theories have been deemed likely with one or a mix of them being the underlying mechanics that effect change.
Mimicking REM Sleep Processing
During REM (Rapid Eye Movement) sleep our brain is processing and filing away information. By mimicking the same eye movement while holding a particular trauma memory in the mind, it may be that the brain is re-filing or integrating the information in a way that adapts the parts of it associated with reactivity, thus, leading to desensitization without changing the memory itself.
Challenging ‘Working Memory’
Working memory is a form of memory that is used in the moment for immediate recall such as following directions, spelling/math, or spatial awareness. By requiring the person to focus on something (i.e. following a light, tapping, or listening) we keep the brain from emotionally spiraling when recounting a traumatic memory. By bringing the memory up without being able to fully fall into overwhelm the memory becomes less triggering over time.
Relaxation
By initiating a patterned stimulus like a light moving left to right, a sound pinging, or tapping in a rhythmic form while also recounting a traumatic event we experience two opposing stimuli; one calming and one activating. Engaging in both at the same time blunts the effect of panic associated with the trauma allowing for calmer recall and deeper insight as the mind does not only have to focus on fear.
Common Questions/Worries
Many people may come to therapy with concerns and questions about the safety and effectiveness of EMDR. There are plenty of stories online from people who have tried it and found both immense healing as well as unexpectedly strong reactions which led to feeling nothing or maybe even worse for a time. The most important part of EMDR is before any processing even takes place. This is because setup provides time to slowly work through the preparations to make sure you are safe and ready to engage in a therapy that can absolutely bring about intense feelings. These first steps include history gathering, current support and risk assessment, resourcing (therapeutic development of emotional regulation tools), and psychoeducation. Below are some of the common questions that arise during this preparation period and their answers.
Will my traumatic memories go away?
Traumatic memories will never be wiped away as a result of EMDR.
Will my memory be changed?
Memories will not change but you may find that you remember certain details of before or after the event/s that add new context to the original memory. This may inform a new perspective but will not change details.
I’ve read about people having to go into inpatient care after an EMDR session.
Some people have had to go to a higher level of care due to a variety of reasons. This can come about because the client was not fully transparent about their past and an unexpected/unknown traumatic event came up in processing leading to an acute emotional reaction necessitating observation to ensure the individual was able to keep themselves safe. Sometimes the clinician may not do their due diligence or properly work through safeguards such as resourcing leading to the individual feeling unable to cope on the days between sessions and deciding to go inpatient to, again, maintain safety. Cases such as these are exceedingly rare and typically only require methodical planning, safeguards, and transparency to avoid.
How is this any different from hypnotizing?
EMDR has no processes for implanting false memories or feelings - rather it is designed to allow exploration of what is already there. The eye movement or DAS is simply a way to keep working memory in the present so a full, uncontrolled, reliving of the memory does not cause re-traumatization.
What if I don’t feel anything?
If that is the case the therapist can adjust the focus from a thought/memory to a feeling in the body to possibly connect with subconscious processing and lead to the same expected healing.
What if it doesn’t help?
Some people may not connect with EMDR for a number of reasons. In the case of no change following earnest attempts it may indicate a need for a different therapeutic approach. This does not mean your trauma is not “bad” enough or you cannot find healing. It may simply mean your brain works in such a way that EMDR is not the most effective approach and trying other modalities such as SSP, Biofeedback, TMS, or others would be better.
Conclusion
EMDR can be a transformative therapy for trauma patients as well as other mental health conditions. While the specific mechanism of action for healing is not settled there are a few main theories which reasonably explain how it may be helping. Ultimately, we do know EMDR as a therapy is safe and effective for treating trauma and continues to evolve as a treatment for more and more specific needs. No therapy is without risks however, so taking the time to become comfortable enough with a therapist to be fully honest and able to ask questions so that you are prepared is imperative to safely engaging with this modality.
At Raft Counseling we have many clinicians who have gone through the gold-standard training to become EMDR practitioners. If you or a loved one is seeking support for trauma or other concerns that may benefit from EMDR, reach out to get connected with a therapist who can walk with you on your journey to mental wellness.
Resources For Further Exploration
https://www.emdr.com/history-of-emdr/