Wanting to find out more about EMDR therapy and how it is used in the treatment of trauma and PTSD? This article is for you …
EMDR is a therapy used by psychologists to help heal the wounds of traumatic events.
By wounds, I mean those fear-based memories, images, and beliefs that combine during and after a severe threat to life and limb, for example:
- motor vehicle accidents;
- workplace injury;
- sexual assault;
- and /or other ‘catastrophic’ events.
These wounds are enduring and can last for months or years after a traumatic event. In the language of psychology, such wounding is formally named as Post Traumatic Stress Disorder or PTSD.
Symptoms of PTSD can be found on several reliable websites. But in brief, they generally include:
- upsetting memories, flashbacks or dreams of the event;
- feeling physically and psychologically distressed when something reminds you of the event;
- trouble remembering important parts of the event;
- having very negative beliefs about yourself, others or the world;
- persistently blaming yourself or others for what happened;
- persistently feeling negative, angry, guilty or ashamed;
- feeling less interested in doing things you used to enjoy;
- feeling cut off from others;
- having trouble feeling positive emotions (eg love or excitement);
- difficulties sleeping (eg bad dreams, finding it hard to fall or stay asleep);
- easily startled (1).
The ‘offending’ event usually gets its start and power when the individual is confronted with a situation which is perceived as an imminent danger to life and limb (ie you sense you may soon be killed or injured); although post-trauma issues may also develop if you have been a victim of childhood abuse (physical, mental, sexual).
It is also possible to acquire a post traumatic disorder if you witness one or more others being killed/injured – or threatened with such outcomes.
What EMDR Therapy Involves
But what does EMDR actually stand for, and what does it mean?
EM stands for Eye Movement, and is the primary method for the therapist to stimulate a release of latent (buried, hidden) memories.
Desensitisation means that while observing (or hearing or feeling) moving stimulus, you will be asked to recall your memories of the original traumatic event. Most traumatic events get stored in the body and mind as locked up energy, and after a trauma these ‘lie buried’ as fragments of images, feelings and beliefs.
As a result of trauma these fragments remain unconnected and can surface anytime; hence the issue of flashbacks (the sufferer starts reliving the traumatic event). As flashbacks they can be unpredictable and at the same time, drain you of energy as you go about your life, as well as disrupting family and work time. The goal of EMDR therapy is to gradually – and quite intentionally – surface these memory fragments.
After giving you a general orientation and obtaining your informed consent, the therapist will treat you with a series of stimulus switching exercises. He or she will ask you to watch a moving stimulus, such as the therapist’s index finger or another type of sensory stimulus (usually a digitally produced sound switching from ear to ear, or a physical tap on the knees, alternating left and right).
The therapist will keep switching their movement, going from left to right, up to two dozen times. At the same time the therapist will ask you to recall a scene of your traumatic event. This scene usually surfaces quite easily (2).
By repeated and guided exposure you will find yourself working through (discharging) and forging a new meaning around the trauma.
Reprocessing means that you will be guided to change the ‘psychic charge’ (meaning and emotional tone of the memory) after each desensitisation sequence, by following a line of therapist questions. These questions are designed to enable you to see/understand the traumatic event as being past/unreal. For many clients, this can demonstrate how the fight or flight response will hijack your emotions via a fast-track alarm circuit, one that bypasses your executive and self-awareness brain centres.
Reprocessing continues post-session. This is because the therapist gives you various mental (psychological) take-home tools – called Resources – to deploy when you leave the safety of the session to return home or to daily life. Such resources are typically drawn from the field of Mindfulness-based Stress Reduction (MBSR); they include such techniques as:
- Visualisations of Safe Places;
- Slow Abdominal Breathing;
- Yoga-based Stretching;
- Autogenic Training;
- and other Mindfulness Exercises.
These resources are designed to assist you as post-sessional trauma memories will resurface. When introducing the idea of a resource to clients I use the term Emotional EpiPen; you deploy an EpiPen when your allergy acts up and your doctor or nurse is not available to inject you. You “inject yourself” to get you through the hard times.
The Risks and Benefits of EMDR
EMDR is no longer in its infancy or trial stage; however only a small percentage of therapists are certified in its use.
EMDR has demonstrated it is an effective treatment for PTSD, as well as childhood-based trauma disorders (3). It seems to work by getting new neural pathways to form between the two hemispheres, allowing integration of memory, emotion and belief elements that became separated when the original trauma occurred. In this way it works along lines similar to Rapid Eye Movement during sleep.
As mentioned above, EMDR does its work over several weeks. In EMDR, you will allow the therapist to intentionally resurface unpleasant memories, feelings, and sensations, mostly in the EMDR treatment session. However, some resurfacing of memories may also happen spontaneously outside of the sessions..
But as with any psychological attempt to heal, your initial EMDR treatment session might not work out as planned, or work poorly. This can be due to a lot of factors, not least of which is the trust and openness you bring into the therapist’s room.
One risk of EMDR is if your therapist ‘forgets a component’ or does not provide a take home guide sheet, and you thus find yourself home without any kind of tools or resources to handle your resurfaced memories with their attendant panics. In this case, you’ll be dealing with your ‘stuff’ as you did before therapy, eg low mood, flashbacks, intrusive thoughts. However most trained therapists practice due diligence, so this is unlikely to occur – and you can ask anytime for resources should they seem to be lacking.
At the same time, it’s important to take a holistic nuanced view of these re-surfacings. In EMDR Therapy it’s a positive thing for the resurfacing memories to occur while a stimulus switching session is happening between you and your therapist.
Most formal training in EMDR instructs the therapist to guide you through eight milestones or stages; the idea being that by Stage Eight, most clients will be desensitised to the original ‘movie’ of their traumatising event, and much of the reprocessing has also been achieved.
This all means that the trauma sufferer has now witnessed and integrated their formerly fragmented experiences into their current expanded memory and self-awareness ‘circuits,’ and all this is accompanied by a dissolving of the original emotional charge (fear, terror, panic). Flashbacks, intrusive thoughts and triggered anxieties tend to disappear as a result.
In fact, I have heard many of my clients report that they can now integrate the event into their life story, all without reliving the trauma. They can calmly retell their original trauma to others without revisiting the negative affects of fear, terror, anger, etc.
The statistics bode well for the future of EMDR, with one study showing that 77% of respondents achieve a complete recovery. Other studies vary between 60% and 88% depending on the definition of recovery, the quality/completeness of the EMDR therapy, and the time that has elapsed since last session (4).
What is the Evidence for EMDR?
What would be the result of refusing EMDR and simply “soldiering on” or “going onto meds” (medications)?
Clinical studies that compare EMDR to antidepressants and placebo pills seek to answer this question. A world recognised authority on trauma, Dr. Bessel van der Kolk, summarised these results from his National Institute of Mental Health study (5):
“However the patients on EMDR did substantially better than those on either Prozac or the placebo. After eight EMDR sessions one in in four [25%] were completely cured (their PTSD scores had dropped to negligible levels) compared with one in ten [10%] of the Prozac group.
But the real difference appeared over time: When we re-interviewed our subjects eight months later, 60% of those who had received EMDR scored as being completely cured” (page 254).
Despite all the above work with interventions we still are not 100% sure why some people don’t require therapy despite suffering trauma. It seems there is a relatively small subset of the population that seems to possess inherent resilience factors, or have a knack for finding relief in non-professional treatments (self treatment). Or it could be that just time itself allows some people to heal themselves.
Dr. Van Der Kolk’s book explores and outlines these, while new findings on this question appear in numerous journals and science news magazines and blogs each week.
Should I try EMDR Therapy for Trauma?
Visiting a therapist trained in EMDR might be the way to go if you (or your family or friends) find that a month or more after the incident, you are still plagued by symptoms (as outlined earlier in this article).
The other method of treatment which has been found useful is a sub-specialty of CBT called Prolonged Exposure Therapy. This is a longer and more literary oriented way to the same goals (ie being symptom free and getting a new lease on life).
Evidence supports the use of CBT or EMDR for individuals seeking relief from the symptoms of PTSD; both do not rely on medications or ‘invasive’ procedures which makes them popular options for treatment.
Mental illnesses (diagnoses) can be seen as (modelled) as layers of an onion, and therapists will often draw for the client such a model on their whiteboards. In this model, serious trauma (PTSD) can be seen as a laying down of pain-emotion as an early layer. And as life unfolds, other traumas and issues happen. The individual can experience further layers and lay these over the original one; thus subsequent layers (shame, guilt, pain of remembering) get laid down, burying that inner layer, making it obscure. Many people turn to various avoidances or addictions to deal with such pain, and relationships will often suffer.
EMDR has the advantage of ‘drilling down’ and resolving the earlier core layers, freeing up resources and energy to work on the later secondary layers.
I have found that almost all of my EMDR clients report on this newfound sense of energy as a joy or relief, if not a cure. To keep you improving post EMDR, your therapist may also recommend lifestyle (eating, sleeping, exercise) changes as well; I have found that it has been instrumental in helping my clients return to normal lives.
You can choose to avoid treatment for your PTSD, but if the symptoms become too disruptive (flashbacks, intrusive thoughts, nightmares, agitation, numbing, anger outbursts, startling to triggers) then I would recommend if you are in Brisbane, that you consider booking in for a free Emotional Health Checkup at M1 Psychology Loganholme to discuss your symptoms and options for treatment.
To make an appointment try Online Booking. Alternatively, you can call M1 Psychology Brisbane on (07) 3067 9129
- This symptom list is from https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/ptsd
- Since such left-to-right eye movement was the original point of discovery and is now the most studied and most used method, the term Eye Movement was retained and put front and center in the term EMDR. It could have been called Stimulus Switching Desensitisation and Reprocessing.
- Van der Kolk, Bessel. (2014) The Body Keeps the Score: Brain, Mind & Body in the Healing of Trauma New York: Viking Press.