How does EMDR work?
/Eye Movement Desensitisation and Reprocessing, or EMDR as it is more commonly known, has been around since the 1980s when psychotherapist Francine Shapiro first developed the technique. Since then, it has grown in popularity within the therapy world with more and more therapists becoming qualified in EMDR. It has also gained recognition from major health agencies including The National Institute for Health and Care Excellence (NICE), as they recognise EMDR as a treatment for PTSD. EMDR has recently become more mainstream due to famous advocates including Jameela Jamil and Evan Rachel Wood being vocal about how it has changed their lives.
The birth of EDMR
It may sound far-fetched, but EMDR was born during a stroll in a park. Francine Shapiro, experiencing upsetting thoughts and feelings, decided to go for a walk. She was looking around, noticing the natural world around her, and realised that her negative feelings had disappeared. It occurred to her that eye movements may have an impact on desensitising negative feelings. After sharing her experience, Francine found that other people also had a similar response to eye movements.
It was upon a walk in the park that Francine Shapiro serendipitously noticed the effect of eye movement on mood and anxiety.
However, she noted that the eye movements themselves didn’t have therapeutic impact. This led her to develop her standard eight stage EMDR protocol that included a cognitive element. The protocol was developed over the coming years and included enhancements such as the concept of bilateral stimulation, auditory cues, and tapping also having the same impact.
What’s the theory behind EMDR?
There are differing theories on how EMDR is successful, and there is no definitive answer to the science behind it. However, EMDR undeniably helps millions of people each year. EMDR is based on the Adaptive Information Processing (AIP) model. The theory is that the memories we form from our day to day experiences are processed then stored with similar old memories in our brains neural network. For example, if you lose your wallet, this event is linked up with memories of times when you have lost other things, but in those times, it has been ok and you coped. Although you are upset, you are reassured that you will be able to sort out replacement cards and it will be ok. In this instance the brain has processed the event in a helpful way. A useful way to think of it is like how your phone can organise your photos into stories or months. Your brain works to sort memories into the right folder and when the event isn’t a traumatic one, your brain does this with ease.
However, when a person experiences an overwhelming event, such as a trauma, their natural coping mechanism can become overloaded. The emotions and bodily reactions created at the time of the event are associated with chemicals in the nervous system, including adrenaline, and these cause the brain to store or encode the traumatic experience in a different way. These disturbing experiences can then remain frozen in the brain, unprocessed. These unprocessed memories are stored in an isolated part of the memory network (the limbic system) in a raw emotional form, away from the brain’s control room (the cortex), where memories with narrative are stored. With these incorrectly stored memories, often the memory itself is long forgotten, but the painful feeling, such as anxiety, panic, or anger, can be continually triggered in the present by everyday events. This can lead to intrusive thoughts, nightmares, and flashbacks. The event is often experienced as if it is happening in the present moment, although the trauma may have happened years ago.
How does EMDR work?
EMDR makes use of ‘dual attention’ which involves a person recalling the trauma, whilst keeping one foot in the present by bilateral stimulation or BLS, via eye movement, audio cues or tapping. This is the key difference to other types of therapy: instead of talking in depth about what happened to them, a client is guided by the EMDR therapist to think of a troublesome event, without the need for the client to share those thoughts with the therapist should they not wish to. This enables a person to cut through any defences, getting to the core of the matter without potentially reliving a painful trauma.
EMDR allows a person to recall trauma, by maintain a sense of being in the present.
On a neural level, this desensitisation process allows the brain to access the incorrectly stored and traumatic memory, storing it in its correct place. So that photo of the autumn leaves that you accidentally copied to your spring folder gets moved into the autumn folder.
EMDR doesn’t wipe out painful memories, it enables the mind to store them correctly, which means they are no longer experienced as if in the present and no longer trigger painful feelings. The exact mechanisms in the brain which cause the memory to change have not yet been discovered, but the regions of the brain involved with sensory storage, emotions and reasoning all become more active during EMDR.
What does EMDR involve?
EMDR follows an eight-phase protocol, that starts with the therapist building up a picture of a client’s history. It is followed by a preparation phase, where the therapist explores the client’s resources with them, ensuring the client is equipped with the tools to manage the processing of disturbing memories. During the assessment phase the therapist and client agree a target memory to work on; a corresponding negative thought the client has about themselves; what positive thought they would like to believe about themselves; along with any accompanying feelings in their body.
Following the assessment phase is the desensitisation phase where the processing of the memory is carried out using bilateral stimulation. The therapist sits across from the client, with chairs in the ships in the night position. The client is then guided to think about the target memory, emotion and bodily sensation. The therapist then asks the client to follow on their taps, or follow the therapist’s fingers with their eyes. During the tapping or eye movement the therapist won’t talk or offer suggestions; rather they will ask the client to notice the experience, to observe any memories, emotions, bodily sensations and thoughts. At the end of each set of these, a client is then asked to report their present experience. Commonly the emotional or bodily sensations reduce in intensity quite quickly in this process. The EMDR desensitisation phase is complete when the new perspective feels true even when the old memory is recalled.
This entire process may span one session or many. Where there are several different experiences underlying difficulties, it may take a number of sessions to fully resolve them. After the painful memory is cleared, the positive thought the client now has about themselves is installed and the therapist checks in with client on any bodily sensations, before finalising with a debrief, where client discusses what they have learned about themselves and if there are any other memories to work through. EMDR is not hypnosis and clients remain in control, fully alert and awake. Sessions last between 50–90 minutes and treatment can be concluded within a few sessions or many, depending on the intensity of the trauma or topic being worked through. NICE guidelines recommend between 8–12 sessions for a course of treatment.
I’m interested, but is EMDR just for soldiers?
Given its high success rate with trauma, many early EMDR studies were done on veterans. However, PTSD isn’t just something that that only impacts soldiers: PTSD can be triggered by any traumatic event such as divorce, chronic illness, childbirth, abuse, bereavement, and many more situations. EMDR can also be useful for people who experience incidents with a high level of emotional distress, and for those with phobias; in recent years EMDR has been used to treat a variety of other conditions such as OCD, depression, anxiety, and more, with many variants of protocol being developed.
EMDR can be done on its own, or to complement talking therapy. It can be challenging for people to face traumatic memories, thus EMDR can help get to the core of these memories, bypassing the usual defence mechanisms that the brain creates to protect a person. Studies have shown that EMDR treatment has a long lasting impact and can especially benefit people who fear being retriggered by telling their story.
For more information on EMDR, speak to Palmeira Practice counsellor Jessica Hamill.
