What is EMDR? Understanding Trauma Therapy Practices

Trauma pushes the mind into overdrive. The brain tries to stop the shards of disaster: shards of broken glass spewing out when one car hits another, the smell of smoke. Humans with post traumatic stress disorder sometimes narrow their lives, avoiding streets or smells or songs that make them think about what they’ve been through. But memories make them known – in nightmares, flashbacks and intrusive thoughts.

Since PTSD was first included in the Diagnostic and Statistical Manual of Mental Disorders in 1980, clinicians have identify a handful of therapies help people cope with painful memories. Over the past decade, a seemingly unconventional treatment has become mainstream therapy.

Eye movement reprocessing and desensitization therapy, or EMDR, can look strange to the observer. This method involves coaxing people to process traumatic memories while simultaneously interacting with images, sounds, or sensations that activate both sides of the brain. Patients can roll their eyes back and forth, follow the therapist’s finger, or stare at beams of light on alternating sides of the screen. The idea is to anchor the brain to the present moment as the patient recalls the past.

In recent years, EMDR has gained more attention, thanks in part to the growing need for pandemic trauma treatment and the celebrities who have shared their experiences. Prince Harry filmed an EMDR session for a documentary series with Oprah. Sandra Bullock said she switched to EMDR after a stalker broke into her home in 2014; “The Good Place” actress Jameela Jamil wrote in an Instagram post in 2019 EMDR that “saved my life.”

Patients seeking EMDR may be inspired by another source: “The Body Keeps the Score,” a book about trauma that has been on the New York Times bestseller list for more than 200 weeks. Bessel van der Kolk, the book’s author, considers treatment to be one of the most effective ways to combat PTSD symptoms. “It’s not really an innovative treatment anymore,” he says. “It’s something that’s been very well established.”

Psychologist Francine Shapiro developed EMDR in 1987 when she struggled with her own disordered memory – first, test yourselfShe rolls her eyes back and forth as she walks through a park, and then gradually opens her eyes to other people.

Therapists perform EMDR in eight stages that typically last for six to 12 sessions, although that number varies from person to person. Each session tends to last between 60 and 90 minutes. The therapist will first discuss the patient’s current challenges, gather information about their medical history, and then recommend a treatment plan, says Deborah Korn, clinician and co-author of “Every Memory Deserves Respect” says.

Patients may need to “come back” from their current symptoms, she says, exploring a recent emotional outburst or panic attack to isolate its triggers. The aim is to identify traumatic memories that the patient may experience in later stages of EMDR.

“Most people don’t show up saying, ‘I want to work on my traumatic memories between the ages of 5 and 11,’” Dr. Korn says. “They say, ‘I’m miserable.’

The patient and clinician then devise coping strategies, such as breathing exercises or meditation to help combat dissociation, that the patient can use if they become distressed during or between episodes. treatment session.

Once those strategies are established, often after a session or two, the therapist guides the patient to recall the most difficult aspect of the traumatic event. It may be the sight, sound, or smell that enters their thoughts most often; For some patients, the most vivid memory related to trauma occurs just before an event occurs, said Sanne Houben, a researcher at Maastricht University who studies EMDR.

Patients focus on the sensations and emotions they experience while thinking about this aspect as they engage in activities such as moving their eyes, tapping on the body, or hearing a small beeping sound that alternates between the ears. their. Each set of these bilateral stimuli typically lasts between 30 and 60 seconds.

Periodically, the therapist will ask the patient what they are noticing or feeling, encouraging them to consider the memory from a present perspective. “If you say, ‘It’s all my fault,’ a therapist might ask you how old you are, do you really think you could protect yourself as a child?” Vaile Wright, director “It’s not just you sitting there and thinking about the memory,” said senior health care innovation officer at the American Psychological Association.

Pushing the patient to intentionally revisit the past is not a unique feature of EMDR; Shaili Jain, a PTSD expert at Stanford University, says most PTSD therapies, including prolonged exposure and cognitive processing therapy, prompt patients to “positively face the situation.” injury”.

Revisiting trauma can trigger the body’s stress response — a spike in cortisol levels and a jump in heart rate. But over time, this process can gradually cause you to lose your mind about your memories, causing your body to become stressed and anxious in the face of trauma reminders.

Dr Jain said: “The fight or flight response is only brought down to a few aspects, so you’re back in the driver’s seat of your life. “Instead of cutting out the triggers.”

With EMDR, the added bilateral stimulus would theoretically keep the patient in the present moment when they are going through a trauma. “We use the phrase: one foot in the present and one foot in the past,” says Marianne Silva, clinical social worker and EMDR physician at the VA New England Health Care System.

Bilateral stimulation needs to be persuasive enough to distract the patient, but not so overwhelming that they are fully focused on it. A multiplication table, for example, would require too much effort, says Richard McNally, a psychology professor at Harvard University.

Our brains are incapable of fully focusing on both bilateral stimuli and traumatic memories, says Dr. The theory behind EMDR is that memories become less vivid and emotional when the patient is unable to fully focus on them.

“At the end of the session, you put it back in storage,” says Dr. McNally. “It is in a degraded form. It doesn’t quite evoke emotions. “

Today, clinicians generally consider EMDR to be an effective treatment for trauma. The World Health Organization and American Psychological Association has recommended it for people with PTSD and has issued guidelines for treatment management. In the UK, National Institute for Health and Care ExcellenceA rigorous authority in the field of psychology, lists EMDR as a tool for adults struggling with trauma and children who are unresponsive to trauma-focused cognitive behavioral therapy.

But scientists are debating whether EMDR is more effective than other trauma treatments. Pim Cuijpers, professor of clinical psychology at Vrije Universiteit Amsterdam, analyzed nearly 80 studies on EMDR and found that, while the study showed positive effects of the treatment, “the quality of the study was really bad,” he said.

Many psychological treatments lack rigorous studies, he said, but the evidence for EMDR is particularly thin, with small sample sizes and potential bias toward the clinicians performing the studies.

Dr Cuijpers said that while EMDR is most likely to be effective, he cautions against wholeheartedly endorsing the evidence behind the treatment.

And there is very little research showing that EMDR works in the long term, says Henry Otgaar, a researcher and professor of forensic psychology at Maastricht University in the Netherlands.

Dr. Otgaar, Dr. Houben and other researchers are investigating whether EMDR increases a patient’s susceptibility to false memory. While creating false memories is a risk in many therapies, Dr Houben said “it’s too early to say if that’s related to EMDR.”

When EMDR began to become more widely publicized in the late 90s and early 2000s, Dr. McNally, then a trauma researcher, was one of the most outspoken critics of the method. value – write that EMDR is “merely one of the many therapeutic fluff balls that dot the psychological landscape today,” In an edition of the Journal of Anxiety Disorders. He acknowledges that EMDR can desensitize people to their memories, but doesn’t say there’s convincing evidence that the therapy’s most distinctive feature – eye movements – has any added benefit. any. Today, the question of whether treating trauma with a therapist leads to the same outcome is still a matter of debate; Dr. Jain calls it the “multi-million dollar question.”

However, there are patients and clinicians who swear by the treatment — and enough “solid data” to back it up, Dr Jain said. Patients report fewer PTSD symptoms after treatment sessions, with fewer flashbacks and intrusive thoughts, says Dr.

“Anyone who has been through trauma” can benefit from EMDR, says Trisha Miller, a psychotherapist at the Cleveland Clinic. People with mental health conditions in addition to PTSD, such as depression, eating disorders, phobias, and addictions can also benefit from EMDR, she added, although there’s still no strong research confirming it. recognize that the treatment is effective for those conditions.

Ms. Miller stresses: Those looking for EMDR practitioners should make sure they find a certified professional. The EMDR International Association, which administers certification and training for therapy, holds a category of trainees who have been trained and certified.

Dr Jain said: “From a clinician’s point of view, I like, ‘whatever works’. “If EMDR is right for you, do it.”

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