What is EMDR?

What is EMDR (Eye Movement Desensitization Reprocessing)? In 1989 psychologist Dr Francine Shapiro took a walk through a park, preoccupied by a distressing personal situation. As she walked, she noticed her eyes were spontaneously tracking from side to side. She also realized this was followed by a marked reduction in her level of distress. She decided to take these observations further, testing them out in clinical trials. Over time, she went on to develop the treatment that became known as EMDR. In the process, she discovered that it was not the eye movements themselves that were important, but the effect that the movements had upon the brain.

This effect is known as bilateral stimulation, whereby each lobe of the brain is stimulated alternately in a rhythmic pattern. As well as using eye movement, the same result can be achieved by tapping the client's hands, or by auditory cues alternating between left and right through a set of headphones. Thus EMDR can utilize a range of different modalities to achieve the same effect in the brain. A current and convincing theory is that this replicates similar brain activity to that which occurs during REM sleep – a time when we process information and consolidate memory. In this way, EMDR sets in motion a natural brain function that allows people to reach an adaptive resolution.

But why is this important?

In order to answer this we need to understand what happens naturally in the brain when we process experiences – and what happens when the brain is 'blocked' by the overwhelming experience of a traumatic event.

Shapiro, the creator of EMDR (Eye Movement Desentization and Reprocessing), describes the natural processing function of the brain as 'Adaptive Information Processing' (AIP). The AIP model posits that, just like other systems of the body, the physiological systems of the brain that deal with the assimilation of experience have a natural healing mechanism. In much the same way as, when the body is cut, it closes and heals, so, in processing information, the brain naturally seeks means of dealing with and rationalizing life experiences in a way that allows them to be understood and managed.

Thus we will think about our experiences; we will talk and express feelings about them; we will dream about them. Over time the 'emotional charge' attached to some distressing experiences diminishes. We integrate the experience into our cognitive memory as part of our overall life experience until it has little or no negative impact upon us in the here and now: we develop an 'adaptive' understanding of events.

However, when a person experiences a traumatic event, the body will typically go into a fight/flight/freeze response. The part of the brain activated in dealing with the memory is the amygdala, the seat of the limbic system, and the most primitive part of the brain. The amygdala is linked to the primary senses of vision, smell, sound and physical sensation. It does not have a cognitive function, and the stored memory is often fragmented. Thus sensory triggers can often take us immediately back to a traumatic event or, in PTSD, trigger a flashback.

Neuro-imaging with has shown that over time memory is assimilated and appears to move to another part of the brain – the neo- cortex. But in some cases the trauma is so overwhelming that the natural, adaptive process is blocked and the person remains 'stuck' with the associated distress.

Getting unstuck with EMDR therapy

A 2007 study ran SPECT scans on participants diagnosed with PTSD. After EMDR, cerebral perfusion increased in bilateral dorsolateral prefrontal cortex and decreased in the temporal association cortex. The differences between participants and normal controls also decreased. Changes appeared mainly in the limbic area and the prefrontal cortex. These results are in line with current understanding of neurobiology of PTSD. EMDR treatment appears to reverse the functional imbalance between the limbic area and the prefrontal cortex.

The proof is in the pudding

Neuroscience has shown us that EMDR is a powerful tool for working through trauma. And one that can be adapted to telehealth—where a client administers “taps” to themselves while we talk through key life events. Or if preferred, we will use equipment in-person to facilitate bilateral stimulation at my office in St. Louis.