What is EMDR (Eye Movement Desensitisation & Reprocessing) Therapy and How Does it Work?
EMDR is a powerful, structured therapy that was developed to help people with post-traumatic stress disorder (PTSD). It is recognised by the World Health Organisation and is recommended in the NICE Guidelines as a treatment for PTSD due to the evidence for it's effectiveness at resolving PTSD symptoms.
EMDR is the treatment I prefer to offer for trauma. This is predominantly because it tends to have relatively rapid effects. Most of the people I see recover within 8-12 sessions. In addition, unlike trauma-focused cognitive therapy (which I also offer) it does not require the client to discuss the trauma in detail, which is particularly helpful if the traumatic experience is associated with feelings of shame or humiliation. EMDR also does not involve weekly homework tasks.
What happens in the brain when we experience highly distressing or traumatic events?
EMDR is based on the idea that we have an adaptive information processing system in our brains, which turns the events we experience into long-term, stable memories that have a context in time and place are filed away so that they don't intrude into our day-to-day life. However, when we experience disturbing or traumatic events, the situation can be so overwhelming that the brain cannot fully process what is happening. At these times we are likely to switch into a survival mode and do whatever it is that we need to do to survive, or get through, the situation. We think that complex processing stops, so that we can focus on survival. This is an important, protective mechanism. If you were about to be attacked by a tiger, you would need a rapid, survival-based response, rather than a complex evaluation of the situation and the pros and cons of each solution.
We think that the lack of complex processing during traumatic events means that the event is stored in the brain as a raw, very sensory memory, rather than a stable long-term memory with a context in place and time. Interestingly, neuroimaging studies have shown that trauma memories are located in a different part of the brain compared to long-term, stable memories. The raw trauma memory seems to be stored as a "current" experience and because of its sensory quality can be easily triggered by sensory experiences that are in some way (even a very small way) similar to the event. For example, the sound of a firework may trigger a trauma memory of an explosion. When the trauma memory is triggered the person typically relives the event through a flashback. Flashbacks are vivid memories in which the person feels like they are back there at the time, which is, not surprisingly, very distressing. They may see the things they saw, hear the things they heard, smell the things they smelled and feel the things they felt at the time. Sometimes the person may experience bodily flashbacks without images, which can feel very unsettling as they seem to come out of the blue. This is captured well in this Guardian article about complex post-traumatic stress disorder or CPTSD. The person may also re-experience the traumatic event in disturbing dreams or nightmares, which we think is the brain's attempt to process the event. EMDR has been scientifically proven to be effective at resolving these symptoms in numerous research studies.
How Does EMDR Work?
As described above, the natural processing that helps us to form stable memories of events seems to get blocked after a traumatic event. EMDR works to unblock the blocked processing, so that the brain can use its natural healing process to turn the disturbing trauma memory to a stable, long-term memory that is filed away like all other memories and does not carry an emotional charge.
EMDR is very different to talking therapy. Although it is embedded within a talking therapy, and there is space within therapy to talk about the events, when reprocessing trauma memories, there is little talking. Instead, the therapist takes a back seat, in order to allow the client's brain to naturally heal from the experience and process the memory in a way that has not been possible so far. What I have noticed from seeing many clients for EMDR is that during reprocessing the brain will spontaneously bring to mind adaptive information, insights or new perspectives that are invaluable in helping the person heal and recover. This is one of the things I love about EMDR; my clients essentially heal themselves by accessing the information or thoughts that are most meaningful to them.
During EMDR the trauma memory is brought to mind and the thoughts, bodily sensations and emotions associated with the memory are noticed and processed. By thinking about the trauma during EMDR the person becomes desensitised to the memory, meaning that the emotional disturbance associated with the memory reduces. Also, thinking about the memory whilst also moving one's eyes and/or bilaterally tapping can help form connections between the trauma memory and other, adaptive information. Memories are stored in neural networks in the brain. When a therapist asks a client to bring to mind a specific, distressing experience, this activates the neural network that was active at the time of the experience. This is why for example a client who has been in a life-threatening accident may still "feel" like they are going to die when recalling the memory, even though they "know" that they survivied and are alive. There is a saying that "neurons that fire together, wire together" (Hebb, 1949). Within an EMDR session we bring the trauma memory to mind whilst also helping the client to stay oriented in the present, so that we can essentially rewire the neural network containing the trauma memory. The person is exposed to the trauma memory in the safety of the therapy session, in a tolerable way (eye movements together with tapping and/or counting tax the working memory and usually mean that the memory being recalled is less vivid) and whilst being aware that they are in the present. This process helps the emotional charge associated with the memory to reduce and it also helps the memory to be connected with helpful or adaptive information (in the case of the client above, the memory would become connected to the information that they survived).
Why are eye movements included? Bilateral eye movements seem to replicate the eye movements that occur in REM sleep. It has been documented that processing occurs in REM sleep which can lead to new insights, develop new associations between memories and reduce unwanted emotions (Baldwin & Korn, 2021). In addition, during EMDR we focus not only on the verbal thoughts about an event, but also the bodily sensations and the "felt sense" associated with the memory. This is important because usually the traumatic experience continues to be experienced in the body. For example, a client I saw who had experienced physically abuse noticed that they felt nervous and on edge at the first signs of conflict many later, even though they did not experience any conscious thoughts or fears about the situation. In this situation the implicit (out of conscious awareness) memory of the trauma was being activated. This is a survival mechanism; the brain has sensed a threat and is communicating this to the person through the body and activating the nervous system, ready for fight or flight.
In EMDR we seek to process implicit aspects of the memory during reprocessing and this helps the parts of the brain that hold the implicit memory to communicate with the parts of the brain that "know" that the event is over and in the past, as well as any other valuable, adaptive information. For example, a client who had experienced a traumatic bereavement had felt guilt for many years; she felt helpless when she recalled the memory and had spent many years thinking that she should have done more to help her loved one. When we reprocessed the memory she remembered actions she took at the time which she had not previously been aware off and also remembered how distressing this event had been for her. As we completed processing of this memory she concluded that they she had done her best in a very difficult and upsetting situation. She reported that her guilt reduced and she felt compassion for her younger self. She had sought therapy due to intrusive memories and flashbacks about the bereavement. At the end of therapy she no longer experienced these disturbing memories and instead was able to recall positive memories of the person who had died. She still felt sad when she recalled the event, which is natural, but it no longer had an emotional charge, i.e. it didn't cause a physical disturbance in her body. This illustrates how EMDR can turn an intrusive trauma memory into a stable, long-term memory that is part of a more helpful or adaptive memory network.
EMDR can be used to address current difficulties relating to a range of distressing past events, including difficult or distressing pregnancies and births, accidents, assaults, childhood trauma, bullying, medical experiences, intensive care experiences, natural distasters, witnessing others in a threatening situation and so.
If you would like to learn more about EMDR, there is a wealth of information on the EMDR Association Website and the EMDR International Association website, including details about how EMDR works and the online delivery of EMDR.
Dr Rachel Lee, Chartered Clinical Psychologist, Accredited EMDR Therapist & Director of North Star Psychology Ltd
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