EMDR: A Remarkable Treatment for Trauma

Trauma

The term "trauma" refers to any a serious injury or shock. It can be physical or emotional, and physical trauma often causes emotional trauma. Traumatic experiences can cause permanent emotional and psychological harm, especially if inflicted deliberately by another person, and repeated over time. The lasting effects of emotional trauma can include Post-Traumatic Stress Disorder (PTSD), Dissociative Identity Disorder, and other, crippling, ills.

The emotional wounds caused by serious trauma can be very difficult to heal. The difficulty is greater, the more severe and prolonged the traumatic episodes.

Yet recovery is often possible, and one interesting technique for enabling recovery is called "Eye Movement Desensitization and Reprocessing." The name is descriptive, but unwieldy enough that the acronym EMDR is used almost universally.

EMDR

EMDR was discovered by accident, when Dr. Francine Shapiro (a very observant psychologist), found that performing certain eye movements, while thinking about distressing subjects, caused her distress to fade. Further research in this area allowed her and others to develop EMDR as it is used today. EMDR is now a widely available technique, still considered experimental, but popular because it is relatively easy to do, does not require medication (which only a medical doctor can prescribe, and which is of limited use in treating trauma), and no clearly superior alternatives are available.

EMDR should be performed by a therapist who has been trained in the technique, and is certified as an EMDR practitioner. A certified therapist is better equipped to provide the insight, guidance, and support necessary to get the best results from the process (and to minimize the possible negative effects) than an "amateur." Yet it remains the case that EMDR itself is a very simple technique, when stripped to its essentials.

What the Therapist Does

EMDR has these fundamental characteristics:

- The therapist provides a stimulus that alternates between the left and right sides of the patient, thus stimulating the right and left hemispheres of the brain.

- While experiencing the stimulus, the patient focuses on a traumatic event that has contributed to his suffering.

The most common approach, which inspired the name of the procedure, is to provide a visual stimulus. The therapist may move his hand back and forth horizontally, while the patient tracks the moving hand with his eyes. Some therapists use a wand, or wand with a light on the end, and wave the wand back and forth.

Less common, and used more often with children, is auditory stimulation. The patient listens to a sound that alternates from side to side. This can be done by listening to headphones, in which one side, then the other, provides a tone.

A third approach is to use a tactile stimulus. The patient may hold or touch vibrating objects with his hands, while the the objects take turns vibrating.

The different techniques may be combined; for example, sound and vibrations can be used at the same time, alternating in synchrony from one side to the other.

What the Patient Does

While experiencing the alternating stimulus, the patient thinks about the traumatic event. "Think" here means not just cognition, but recalling the totality of the experience. This means the patient remembers not only the thoughts, but other attributes of the experience, such as behaviors, feelings (affect), and sensations. It is important to re-experience as many of these threads of the experience as possible.

There is no single technique for summoning up such an experience. Some people can just think back and remember, and everything that needs to happen, does happen. Some need to "get in the mood" first by looking at an object, a picture, or a written description of the experience. Some need to verbalize the experience during the EMDR process itself, walking through the experience in narrative form. What matters is doing what works, where "works" means that the patient summons up some of the feeling, sensations, and memory of actions that went with the traumatic experience.

EMDR is usually performed in many sessions, not just one. One reason is that multiple sessions may be required to treat a single traumatic experience. Another is that several such experiences may need to be addressed. A patient will typically visit whatever events he can recall that seem relevant, and repeat EMDR multiple times for each. When the emotional 'charge' has been drained from a particular experience through repeated EMDR sessions, he moves on to another. He is done when he has exhausted his list of traumatic events, or no longer feels the need for more EMDR, because he has achieved his goal.

What EMDR Feels Like

The emotions that a patient experiences may range from mild to overwhelming. In some people, the feelings can be too strong to bear, and the therapy must either be terminated, or broken into shorter segments.

Typically, one can espect to feel some degree of emotional distress during the EMDR session. (This is not only typical, but a requirement for the process to work.) Over the course of repeated EMDR sessions, the emotional reactions usually decrease, and the impairment of the patient's life fades.

However, nothing is guaranteed, and EMDR is no more a foolproof technique than any other. Some patients who have experienced severe trauma, and severe psychological consequences, may find that EMDR is ineffective, unbearable, or worsens their symptoms.

Why EMDR Works

In the deepest sense, no one knows why EMDR works. In the practical sense, it often reduces the effect of past trauma. Depending on the age, duration, and severity of the trauma, anywhere from a few sessions to dozens of sessions may be required to produce the desired results.

People who have experienced severe trauma manifest a variety of symptoms and disorders, but these manifestations share the common problem that they improve slowly, or not at all, with time. The patient is "stuck" in a state that he wants to leave, but cannot.

EMDR manages to "un-stick" people who are stuck in a traumatized state. Just why this is so is not known, but explanations usually focus on the notion that the brain's ability to process (experience and record) events malfunctions when an event is traumatic. Instead of storing away the various attributes in the usual fashion, some aspects of the experience literally "get stuck" in parts of the brain where they do not belong. As a result, the patient cannot experience memories of the event in the usual fashion. (This means he cannot move on from them, as he would other, unpleasant experiences.) Instead, the different attributes of the traumatic event are dissociated from each other. amd cause permanent changes in the way the patient's thoughts, emotions, and reactions work.

Why a Trained Professional is Important

There are two main reasons.

1) Success is much more likely if EMDR is done by someone who has training and a lot of experience, and thus knows how best to set up the most productive EMDR sessions. This is very important, as someone who lacks this training may have no idea of how and when to employ the technique, no matter how simple the technique itself is. Also, important issues can arise as a result of successful EMDR sessions, and a good therapist will have a much better idea of what to do about the issues.

2) EMDR can re-traumatize the patient (exacerbate the trauma), by producing a traumatic experience that reprises the original one. Significant re-traumatization has the potential to cause serious deterioration of the patient's emotional health, possibly leading to suicide or violence. A trained therapist is more likely to avoid serious re-traumatization, and better able to deal with it if it comes up, than someone who lacks experience in the field.

Can EMDR be Done on a Self-Help Basis?

Some types of therapy can be done without a therapist, by someone who is sufficiently motivated and knowledgeable. Others cannot. As for EMDR, the answer is both "Yes," and "No."

"No" because the EMDR process as taught in certification classes requires a therapist and a patient.

"Yes" because anyone can look back and forth while thinking about unpleasant experiences.

A better question is probably whether it is a good idea to try EMDR by oneself, but I have not found any guidelines on the subject. My suspicion (which is not a recommendation), is that self-administered EMDR might be a harmless way to speed recovery from a bad day at work, but is not wise for someone who is suffering from life-changing trauma.

How to Learn about EMDR

Many books about EMDR are available, including some from Dr. Shapiro herself. The EMDR Institute, whose Web site may be found at www.emdr.com, provides useful information about the technique.

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Kevin Thompson, Ph.D. is the author of Medicines for Mental Health: The Ultimate Guide to Psychiatric Medication. You can find information about treatments for depression, bipolar disorder, schizophrenia, and sexual problems on his Web site at www.MentalMeds.org.