It’s one of those serendipitous moments that so often seem to herald scientific discoveries: A psychologist named Francine Shapiro was out for a walk one day in 1987 and struggling with some painful memories when she noticed that the act of moving her eyes rapidly as she scanned the environment made her feel better. Intrigued, she set out to see if she could replicate the results in a clinical setting.
She did, and after several years of experimentation, research and standardization, a trauma treatment called Eye Movement Desensitization and Reprocessing, or EMDR, was born. It’s a process that involves having the distressed person recall the trauma while simultaneously undergoing alternating stimulation of both hemispheres of the brain, most often by moving their eyes from side to side, by listening to tones in one ear and then the other or through taps on either side of the body.
This process of bilateral stimulation frees the mind to retrieve loosely connected thoughts, which seems to help put the trauma in better perspective. A soldier with PTSD, for example, might at last be able to think of his war experience as something from his past and gain protective distance from the emotions and sensations it provokes, rather than continually experiencing it as a fresh wound.
Effects on “Big-T” and “Small-T” Trauma
Today, EMDR is used in treatment settings around the world to help those who are struggling to move on with their lives, whether their trauma is, as Dr. Shapiro describes it, a “big-T” trauma such as physical or sexual assault, combat or a near-death experience, or a “small-T” trauma, such as rejection, humiliation, neglect or abandonment. EMDR is listed on the Substance Abuse and Mental Health Services Administration’s national registry of evidence-based programs and practices, which notes that young and old can use the technique and that for those with a single, isolated traumatic event – such as being in a car crash, for example – one to three sessions may be enough for recovery. For those with more long-term distress – physical, sexual or emotional abuse or combat trauma, for example – many more sessions may be required.
The American Psychiatric Association, the World Health Organization, the International Society for Traumatic Stress Studies, the Department of Veterans Affairs and the Department of Defense are just a few of the groups that recommend EMDR as a trauma treatment, and more than 20 randomized controlled studies vouch for its effectiveness. A 1997 study of sexual assault victims, for example, reported a 90% in PTSD after just three 90-minute EMDR sessions. And a 2004 study found that 77% of those with multiple traumas and 100% of those whose trauma sprang from a single source no longer had PTSD after an average of six 50-minute EMDR sessions.
EMDR also helps heal beyond the trauma itself. Those who develop addiction, for example, often do so because they are self-medicating with drugs or alcohol as a way to deal with their distress. If the pain of the trauma is overcome, however, the person no longer has the same need to turn to substances. He or she will also be less likely to respond to triggers to use, boosting the chances for a successful recovery.
The Mystery of How EMDR Works
So why isn’t everyone using EMDR? Despite all the scientific evidence and backing, EMDR has struggled to get respect. Some in the clinical community have written it off as overblown, and a few even dismiss it as quackery. Perhaps it’s that it sounds too good – or too weird – to be true. The doubts may also have to do with the simple fact that no one, not even its creator, really knows how EMDR works its magic. But there are many theories.
Shapiro believes it has to do with the brain’s information processing system, which may be unable to correctly store traumatic events because strong negative feelings get in the way. This prevents the formation of connections with other memory networks that help provide context and perspective. It means, for example, that a sexual assault victim may know logically that her trauma is in the past and that it was not her fault but be unable to feel the truth of that emotionally. When a memory of the assault is triggered, she may feel she is reliving the experience with the same overwhelming emotions and sensations. The trauma is, in essence, stuck in the present. The brain stimulation of EMDR is thought to allow the processing that was initially thwarted, thus linking the memory to information that can help in future responses, keeping the trauma in context and diminishing its immediacy.
Studies also point to the possibility that EMDR taps into the same process that occurs during REM sleep, the phase of deep sleep when dreaming occurs and which is marked by rapid eye movements. REM sleep is known to help in the shaping of memories and to play a significant role in mood regulation.
EMDR’s success may also be an effect of what is known as the “working memory theory,” which proposes that when stimulation of the brain taxes our attention, our memories become less vivid and less emotionally distressing. Or it could be a combination of several of these processes, Shapiro noted in a 2012 New York Times blog post explaining the evidence behind EMDR.
Whatever the reason, EMDR has been shown to provide significant relief to many and complete healing for some – and this comes with the added benefit of no side effects. Another big plus is that EMDR minimizes the need for the person being helped to dwell on the trauma. The trauma is, of course, the initial focus, but the real work is done when the EMDR therapist guides the person as they branch off into sometimes seemingly unassociated thoughts and memories. This is important because some who have been traumatized can find speaking in detail about their experience, as is required in many therapy sessions and in exposure therapy, to be further traumatizing. The patient/therapist bond is still important, but EMDR focuses more on the internal, asking the person to notice what they are feeling and to move from mental association to mental association rather than verbally rehashing the incident that sparked the initial pain. The goal becomes moving away from the trauma and to a place in which the past at last becomes the past and healing can begin.