by Francine Shapiro, PhD
Over the past two decades, the use of eye movement desensitization and reprocessing (EMDR) therapy has provided researchers and clinicians with the ability to observe how symptoms develop and can be rapidly treated. Over 20 randomized studies have demonstrated positive treatment effects, and EMDR has been declared an effective trauma treatment by organizations worldwide, including the American Psychiatric Association and the Department of Defense. Three randomized studies have demonstrated that 84 to 100 percent of those suffering from a single trauma no longer had posttraumatic stress disorder (PTSD) after an average of three 90-minute sessions. Changes that typically took months or years with other forms of therapy occurred within weeks. This rapidity allows both clients and clinicians to observe firsthand how the brain’s internal connections are made.
EMDR therapy places the information-processing system of the brain first and foremost in both the development and treatment of pathology. This system functions to take disturbing events and make the appropriate connections that allow a return of emotional equilibrium. For instance, a fight with a family member may cause us to have negative emotions, thoughts and body reactions, but they are usually resolved through thinking about it and during the period of rapid eye movement (REM) sleep. We may end up feeling, He must have been having a bad day. We’ve had good experiences before and can resolve this glitch. This resolution occurs because our brain has made the appropriate connections, and our negative reactions disappear. But when an event is too disturbing, it can overwhelm the information-processing system, and this negative experience is stored in memory along with the unpleasant emotions, physical sensations and beliefs. Since everything that happens in the present links into the memory networks to be interpreted, any future encounter with the person can trigger these unprocessed memories and the negative responses arise.
Rather than rely on the deliberate manipulation of beliefs and behaviors as occurs in cognitive behavior therapy, or the use of the relationship as in psychodynamic therapies, EMDR therapy identifies the earlier life experiences that are the basis of current problems and, after accessing the memories of the events, activates the brain’s information-processing system. This is done by means of standardized procedures that include the use of bilateral eye movements, taps or tones. The eye movements have been found to cause an immediate decline in negative emotions and imagery vividness, as well as increased memory accuracy and episodic retrieval. These observations support two theories: that the eye movements disrupt working memory, and that they link into the same processes that occur in REM sleep.
In EMDR therapy, it is during the sets of eye movements—each of which lasts approximately 30 seconds—that the brain makes the associations and neural connections needed to integrate, or digest, the disturbing memory. What is useful is incorporated and what is useless is discarded. For instance, a rape victim may begin by feeling, I’m useless and shameful. I should have done something. At the end of treatment, she feels, The shame is his, not mine. I’m a strong, resilient woman.
Since the client is asked, “What do you get now?” after each set of eye movements, the clinician is able to witness firsthand the often startling connections that have caused the client’s problem. For instance, one of the cases reported in my recent book, Getting Past Your Past, involved an earthquake victim (“Lynne”) who had come for treatment to the Mental Research Institute. Although she had not had any problems after previous earthquakes, she developed PTSD after a recent one. After preparation, she targeted the disturbing image of hiding in a doorway with her son and after a few sets of eye movements, she made the following associations after consecutive sets:
Lynne: Yeah I was thinking about my sense of betrayal with my brother that he molested me, and how I really admired him (crying).
Lynne: Yeah. (crying) Something occurred to me like, “Duh”: How much—that it shook my sense of reality.
Here we can see how unexpected and significant the different unconscious memory associations of the brain can be. The ground is literally shaking during an earthquake, and this is connected to a major event in childhood when Lynne’s trust was betrayed. In both instances what should have been a firm foundation became shaken.
After further sets:
Lynne: What comes really clear—is getting sick when I was around the same age.…I had a really bad pain in my side, and then they just decided that I had some kind of mental problem. I guess that was the only way that I could express it.
Lynne knew she had a bad pain, but no one believed her, and they concluded that she couldn’t trust her own perceptions. Once more there was no firm ground to stand upon.
Subsequent sets of eye movements brought her to associations of hiding in bed under the covers while her parents fought. The chaos of her troubled childhood and this scene seemed clearly linked with the chaos of the earthquake and hiding with her son. It helps explain why this particular earthquake resulted in her getting PTSD. At the end of the processing session, the appropriate connections had been made and the earthquake no longer troubled her. At one-month and one-year follow-ups, she no longer had PTSD.
Traumatization is a widespread problem. In fact, recent research has demonstrated that general life events can cause even more symptoms of PTSD than major trauma. Many of the negative emotions, thoughts and body reactions people have are caused by unprocessed memories stored in the brain. In Getting Past Your Past, readers can identify the basis for their own problems and learn EMDR self-help techniques to immediately change negative responses. For instance, if you are troubled by a negative image, try imagining it on top of paint in a can and stir it up. This disrupts working memory and can help get rid of the image. Other techniques will help you change negative thoughts, emotions and body reactions. There are also guidelines to know when you need full memory processing. The clinical work with EMDR therapy has clearly shown that unprocessed memories of all kinds are the basis of a wide range of pathologies.
Brain scans have clearly demonstrated pre-post changes after EMDR therapy, including increases in hippocampal volume, which have implications for memory storage. The bottom line of EMDR outcome research is that clinical change can be both profound and efficient. It also shows how mental problems are actually caused by physiologically stored, unprocessed memories. Hopefully, this recognition will help remove the stigma of receiving mental health treatment. We have no hesitation about getting a broken leg realigned by a physician so that healing can take place. If self-help techniques are not sufficient, we should likewise not hesitate to receive professional help to allow the information-processing system of the brain to resolve our mental health issues.
Dr. Francine Shapiro is the originator and developer of EMDR therapy and the recipient of numerous awards, including the International Sigmund Freud Award for Psychotherapy of the City of Vienna. Her most recent book is Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy (Rodale Books).