What is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) is a specific type of trauma therapy that has been largely studied over the years as showing to reduce the symptoms of post-traumatic stress disorder (PTSD). Continued research on EMDR treatment shows positive outcomes for other disorders, such as depression, anxiety, OCD, and many others. It has been recognized by many major associations to be an effective treatment for trauma. For further detailed information, the EMDR International Association has several helpful resources: https://www.emdria.org/
How does it work?
From decades of research on neurophysiology, there are several theories on how EMDR truly works in reducing or eliminating symptoms of PTSD. The most commonly backed theory goes that, as with most other organs within our bodies, our brains work together with other systems to help naturally process (or metabolize) traumatic memories or other unpleasant experiences so we can return to a regulated state, allowing us to feel assured that the traumatic or unpleasant experience has ended. However, in some cases, based on a wide variety of factors, the brain does not fully work through this naturally occurring process to metabolize a traumatic memory, and as such the memory is stored in an incorrect (maladaptive) area of the brain, keeping the memory active as if it has not ended or is happening over and over again. (e.g. A person driving through the intersection where they experienced a terrible accident, the sounds and smells and feeling of the crash may come rushing back, as if the accident is happening again in that very moment, when the accident happened two years prior. Or, when a person grew up in a household where loud yelling often led to physical violence, hearing someone yell can trigger the same bodily sensations as they had when they were a child.)
As part of a very high-level summary of the naturally occurring process of metabolizing memories, we can think of our brains as essentially having two types of memory: short-term and long-term. Our short-term memory contains information for the somatic sensations (physical feelings, smell, touch, taste, etc.) that occur during all experiences we have, including our day-to-day. Our long-term memory contains autobiographical information that we interpret as experiences of our lives that have already happened. When we have any experience throughout the day, our brains will take in the information in the short-term memory, and when we sleep at night, our rapid eye movement (REM) sleep stage "distracts" the part of the brain that holds the experiences in the short-term memory from the day, allowing them to metabolize over to long-term memory. Now the experiences of that day are within our life story, stored in the long-term memory with little to no somatic sensations associated with them. However, when it comes to certain traumatic experiences, the process is a bit different. With some traumatic experiences, typically the somatic sensations are quite intense, overwhelming our bodies and activating our sympathetic nervous system into a state of fight/flight/freeze. Because our brains are hard-wired to pay special attention to these sorts of experiences (which has been hugely beneficial for our survival as a species), these memories don't always fully metabolize over to the long-term memory, often times being stored in the short-term memory for easy recall and a bodily response that will theoretically help us to survive when faced with the same threat again. This is why when we come across a certain scent, or when we drive by a certain location, hear a certain intonation of voice, etc., the traumatic memory is quickly recalled from the short-term memory, including with it the intense sensory sensations and a heightened sympathetic nervous system (fight/flight/freeze response), letting us know that a similar situation has put us in danger before and we should respond exactly how we did the previous time, as that's what kept us alive. This often feels like actually reliving the traumatic experience physically, mentally, and emotionally, rather than just recalling it. This is a very important system to have when we are in fact faced with a life threatening situation. However, as with PTSD, when we are not facing danger in the moment, but instead facing a trigger to a previous danger, our bodies respond the same, perpetuating a cycle of dysregulation that leaves us feeling exhausted, frustrated, frightened, confused, and sometimes hopeless as our bodies can feel out of our control. EMDR can be quite effective in helping to break this cycle. When we reprocess memories through EMDR, we lightly recall the traumatic memory that is currently being stored in short-term memory, and essentially recreate the REM sleep cycle with sets of side-to-side eye movements, distracting the brain enough to allow that memory to metabolize fully into long-term memory. No memories get erased, they just become an actual long-term memory, part of our autobiographical information, and will have little to no somatic sensations attached. The memories can be recalled without being relived. This does not mean that we will not be able to adequately respond during a threat, but instead our bodies will not be misfiring consistently during the absence of a threat.
What does it actually look like?
When beginning EMDR therapy, there are sessions for preparation, and there are memory reprocessing sessions. To get started with the prep phases, your therapist will ask you to complete some questionnaires (or will work with you together on the questionnaires) that will assess for level of dissociation and other underlying factors. Next, your therapist will work with you on a series of mindfulness-based visualizations that will be utilized throughout EMDR therapy. These visualizations are incredibly helpful in regulating the body's central nervous system, along with providing powerful tools to utilize during the reprocessing of memories and for helping to effectively close EMDR sessions. After the visualizations are practiced, your therapist will work with you to create a list of the most appropriate memories to reprocess with EMDR (some memories will be obvious, and some will be revealed through the process), aiming for around 10 of the most challenging memories (though this amount varies). From here, the memories are sequenced in an order that makes sense, and reprocessing of memories will begin. Each of the initial steps leading up to the reprocessing sessions can take a session or two each. These are extremely important foundational steps in the EMDR process, and though sometimes we are eager to get started on reprocessing memories, it is essential for the effectiveness of EMDR therapy to spend the amount of time needed in the preparatory phases. There is no set amount of sessions to be spent working with EMDR, though as a loose estimation, the process can average about six months of weekly sessions.
EMDR, with slight variation from therapist to therapist, generally includes a brief period of accessing (recalling) the troubling memory or experience, and then utilizing multiple sets of bilateral stimulation (side-to-side eye movements, alternating left side/right side taps or tones) until the memory's level of disturbance or vividness is reduced. This process essentially aims to mimic the naturally occurring mechanisms in the brain that process (metabolizes) traumatic or unpleasant memories when certain memories are, for a variety of reasons, unable to metabolize naturally.
For a video demonstration of a mock EMDR session, please click here.
What if part of me is interested in trying EMDR...and part of me is hesitant?
It makes complete sense to have conflicting feelings about EMDR! Essentially we are being asked to recall some of the most difficult experiences of our lives, which generally come with unpleasant physical sensations and dysregulation. With EMDR, we try to think about holding these experiences within what we call the "zone of tolerance," meaning we just want one foot (or sometimes one toe) in the memory, and the other here in the present, just enough to intentionally activate the memory so we can help metabolize it to long-term. Think of it as viewing the memory rather than re-living it; and sometimes we view it from a mile away, just enough to tell our brains which memory we want to metabolize. Also, sometimes we have a fear that this extremely important, albeit traumatic, memory will get erased through the process of EMDR. EMDR does not erase any memory ever, it simply allows the memory to be recalled as having happened in the past, rather than reexperiencing the memory in the present day. Hesitation or resistance to any kind of therapy is so very common. Please speak with your therapist and share any concerns or questions you have.