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March 27, 2015 by Kathy Brous

What is EMDR – and Why is it So Effective?

lockridge-pastor-dave-150x150During REM sleep, the brain is attempting to process survival information until it’s resolved.

Eye Motion Desensitization and Reprocessing (EMDR) is a potent trauma treatment developed by Dr. Francine Shapiro (left), a literature professor who was diagnosed with cancer.  The shock of suddenly finding her survival was under threat, affected her so strongly that Dr. Shapiro mindfully paid attention to how her body was reacting.

She discovered by accident that when the survival fear got intense, her eyes would sometimes move back and forth diagonally or from side to side, as if in dreaming – following which she felt less upset, much to her surprise.

So Dr. Shapiro began to study mind-body programs for trauma and PTSD – and went back to school for a PhD in trauma psychology.  EMDR, the treatment she developed,  is now used by the Departments of Defense and Veteran’s Affairs, the World Health Organization, and many others.

EMDR, usually by professionals, is known for the apparently simple way the therapist moves a finger or two from side to side in front of the patient’s eyes.  This guides the eyes  from side to side (or diagonally) the way eyes move naturally during the Rapid Eye Movement (REM) phase of the sleep cycle, the phase in which we do most our most active dreaming.  And dreaming can “process” a lot of trauma – move it from our short-term memory banks where it feels like a terrifying flash happening “right now,” into our long-term memory banks where we feel it’s past, and we’re “over it.”

Please note: EMDR is most successful for treating “incident trauma,” but not for developmental trauma, where it can even frighten patients.  EMDR is most useful in trauma due to one, ten or any finite number of incidents, such as battlefield traumas, car accidents, violence, rape, and adult-onset sudden threats such as Dr. Shapiro’s diagnosis. I use EMDR all the time to calm myself from upsetting incidents in the present, such as arguments in which I don’t feel understood or “loved enough.” I also use EMDR to heal grief over specific past incidents such as hurtful acts by a family member.

However, according to Dr. Shapiro herself, Dr. Bessel van der Kolk, and other EMDR proponents, EMDR has not been effective with developmental trauma, which starts with fetal stress “when the sperm hits the egg” and continues while the infant brain is developing until ages three to seven – because there are no discrete incidents. In severe developmental trauma, EMDR has been reported to bring up feelings from infancy so overwhelming to the patient as to be re-traumatizing. (Infants are easy to overwhelm, but healing that pre-concious injury requires intense attachment therapy).

So again, especially for developmental trauma: “Don’t Try This at Home,” that’s my book title.  Do not “Do it yourself.”  Get a highly-trained attachment therapist and whatever healing mode you choose, trust it to the therapist.

When Nightmares are Real

Until you’ve been beside a man/ You don’t know what he wants
You don’t know if he cries at night/ You don’t know if he don’t
When nothin’ comes easy/ Old nightmares are real
Until you’ve been beside a man/ You don’t know how he feels
Bob Seeger

Dr. Shapiro gave a terrific webinar on EMDR which even explained what nightmares are, how they work in trauma, and how we can leverage this to heal traumatic feelings.  It was Dr. Ruth Buczynski’s April 17, 2013 interview for the National Institute for the Clinical Application of Behavioral Medicine (NICABM) “Trauma 2013″ series.1  You can preview her book on amazon by clicking  the cover photo to the right.

“Disrupted REM (Rapid Eye Movement ) sleep is often a marker of PTSD,” Shapiro said. “The earlier memory in PTSD, the trauma, is being held unprocessed with the emotions as physical sensations.  The brain continues to try to process it; sleep researchers say that during REM sleep, the brain is attempting to process survival information until it’s resolved.  That’s why we’ve all had the experience of being disturbed at something, going to sleep, and feeling better about it, with a better understanding of what to do next.

“The brain has done what it’s supposed to do: it’s processed the information, and now it’s guiding us appropriately into the future.  But if a trauma has disrupted that process, although the brain may be again trying to process this (survival information) in dreams, the person continues to wake up in the middle of a nightmare (ie., stop the processing prematurely), because it’s too disturbing.”

“When people are jarred from sleep because of a nightmare, the disturbing images can be difficult to shake,” Dr. Buczynski said on her blog April 12, 2013.  “Even though they’re ‘just dreams,’ nightmares can be very upsetting and can sometimes haunt us long after we’ve awoken. But believe it or not, there may be a good reason for them. Nightmares are part of the brain’s attempt to help us resolve traumatic experiences. But when they wake us up too soon, a key process for healing gets interrupted. So how can we finish what the brain is trying to start?”

“In EMDR,” Dr. Shapiro then explained, “we look for what are the nightmare images that a person can recall. One person would continually wake up from a nightmare of being chased by a monster through a cave.  So (in the EMDR session) we target that dream image, so she’s holding in mind being chased through a cave by the monster.  Then we start the EMDR processing – and it’s like a veil gets peeled back, and the individual sees what the actual experience was, and she reports, ‘OMG, that’s the person who molested me, chasing me through my childhood home!’

“The EMDR processing moves the past memory to resolution, and now the person no longer has that dream, because once it’s processed, it’s integrated with larger memory networks and arrives at adaptive resolution, so that dream image does not come back. So with EMDR you don’t have to try to change their mind about it or talk about it. It’s simply identifying the image and their thoughts that go with it, and then processing it (by EMDR) to complete resolution.”

Dr. Shapiro reports fantastic results especially with rape victims and war veterans.  “These past traumatic experiences get locked into the brain until they can get processed… We try to process how the earlier traumatic memories created the problem, then we process their current situations that are disturbing, and then what might disturb them in future.  If they can’t identify the past memories, we talk about what is currently disturbing them.  That often automatically takes them back to the past experience — and in those instances where it (the past traumatic experience) hasn’t fully been stored (in  long-term memory,) we can see that it shifts (from short-term to long-term memory) and ultimately they’re no longer disturbed…

“My PhD dissertation on rape victims was published in the Journal of Traumatic Stress back when PTSD was viewed as intractable, but I was getting results in a single session,” Shapiro said. “So the controversy was: ‘how could anything be that rapid, and how could eye movements have any effect?’  There were 20 randomized controlled trials introducing EMDR. One done with rape victims was by a very experienced cognitive behavioral researcher viewed as extremely credible; she reported that 90% of the rape victims no longer had PTSD after three EMDR sessions.

“That corresponded to another study at the time published in the Journal of Clinical Psychology which showed the same with a mixed trauma group, that after three EMDR sessions, 84% no longer had PTSD.  We’ve continued to see that… a rule of thumb is, a single trauma can be processed by three 90-minute EMDR sessions.  A study by Kaiser Permanente that used 50-minute sessions found… that an average of 6 EMDR sessions, found 100% of single-trauma victims no longer had PTSD and 76% of multiple trauma victims no longer had PTSD.”

Check out Dr. Shapiro’s video, 4 minutes:
http://www.nicabm.com/nicabmblog/the-brains-attempt-to-help-us-heal-from-trauma/

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

1. Transcripts and recordings of this and five related webinars
at http://www.nicabm.com/trauma2013/trauma2013-post/

More reading:

Shapiro, Francine, PhD, “Getting Past Your Past: Take Control of Your Life with EMDR Therapy.”

Shapiro, Francine, PhD, “The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences,” Permanente Journal, Perm J. 2014 Winter; 18(1): 71–77   A substantial body of research shows that adverse life experiences contribute to both psychological and biomedical pathology. Eye movement desensitization and reprocessing (EMDR) therapy is an empirically validated treatment for trauma, including such negative life experiences as commonly present in medical practice. The positive therapeutic outcomes rapidly achieved without homework or detailed description of the disturbing event offer the medical community an efficient treatment approach with a wide range of applications. Methods: All randomized studies and significant clinical reports related to EMDR therapy for treating the experiential basis of both psychological and somatic disorders are reviewed. Also reviewed are the recent studies evaluating the eye movement component of the therapy, which has been posited to contribute to the rapid improvement attributable to EMDR treatment.  Results:  Twenty-four randomized controlled trials support the positive effects of EMDR therapy in the treatment of emotional trauma and other adverse life experiences relevant to clinical practice. Seven of 10 studies reported EMDR therapy to be more rapid and/or more effective than trauma-focused cognitive behavioral therapy. Twelve randomized studies of the eye movement component noted rapid decreases in negative emotions and/or vividness of disturbing images, with an additional 8 reporting a variety of other memory effects. Numerous other evaluations document that EMDR therapy provides relief from a variety of somatic complaints:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951033/

van der Kolk, Bessel A, MD, “Restoring the Body: Yoga, EMDR, and Treating Trauma , July 11, 2013 interview by  Krista Tippett of OnBeing.Org.  Human memory is a sensory experience says psychiatrist Bessel van der Kolk. Through long research and innovation in trauma treatment, he’s learning how bodywork like yoga or eye movement therapy can restore a sense of goodness and safety:http://www.onbeing.org/program/restoring-the-body-bessel-van-der-kolk-on-yoga-emdr-and-treating-trauma/5801

van der Kolk Bessel A, MD, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, Simpson WB,  “A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance, J Clin Psychiatry. 2007 Jan; 68(1):37-46. Abstract: The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for posttraumatic stress disorder (PTSD). This study compared the efficacy of a selective serotonin reup-take inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up. METHOD: Eighty-eight PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003.RESULTS: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adult-onset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission. CONCLUSIONS: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma:http://www.ncbi.nlm.nih.gov/pubmed/17284128

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