Over the past year I have been receiving an increase in new clients who are requesting EMDR therapy from the onset because a friend had a good experience and made the recommendation and believed it might be a good fit for them. EMDR is becoming more recognizable by the general population because people are talking more about their mental health and the treatment process. They’re also seeing EMDR in movies and TV programs and Prince Harry has been transparent about his own experience with the treatment.
What exactly is EMDR?
EMDR or Eye Movement Desensitization Reprocessing is a trauma therapy developed in 1987 by psychologist, Dr. Francine Shapiro. It is an evidence-based therapy with lots of research for PTSD but used with a range of other difficulties like anxiety, depression, addictions and eating disorders. It has shown really good results for single incidents like car accidents, dog bites, grief, and loss as well as complex trauma. EMDR is profoundly healing if done in a way that feels safe for the client.
How Does Trauma Affect the Brain?
I could write an entire article on that topic alone! To keep it simple, there are several brain structures that are involved in trauma, including the amygdala, hippocampus, prefrontal cortex, and limbic system. These structures work together to process and store traumatic memories, but the memories are stored in a fragmented and disorganized way, making them difficult to access and process. This can lead to symptoms like nightmares, noticing certain smells, flashbacks, dissociation, anxiety, depression, anger, and fear. When triggered, they don’t connect fully to the fact that your trauma is in the past and that you are safe in the present.
Trauma can have a significant impact on memory. Some people can recall traumatic events with vivid detail, while others struggle to remember details from the trauma. This is because the brain stores traumatic memories differently than everyday memories. Trauma can cause changes to the structure, function, and chemistry of the brain and yet it doesn’t just impact the brain, it is a total body experience and until the trauma is safely processed the body will continue to “keep the score.” You might find that you are more prone to sickness, anger outbursts, have difficulty in regulating your emotions, experience headaches, body aches or other physiological symptoms. Trauma can lead to a decrease in the size of the hippocampus, a part of the brain involved in learning and memory. It can also cause an increase in the amygdala, the part of the brain involved in emotions.
Why EMDR and how does it work?
Traditional talk therapies don’t work with trauma and PTSD. You can spend years talking about your trauma and not get any better because the therapy is not reaching where the trauma is stored in the brain.
There are different variations of EMDR based on where the therapist has received training. The type of EMDR I am trained in is relational, personal, and infused with mindfulness techniques that ground you in the “here and now.”
EMDR begins with a detailed client history to get an understanding of who and what I am working with, we then work on resourcing you and ensuring you have adequate coping skills, ego strength to handle the trauma processing and the capacity to feel strong emotions. EMDR relies on the use of imagination and bi-lateral stimulation. I use tactile pulsers that you grip, but some therapists, use visual or auditory stimulation. During EMDR, you will go to hard places that are uncomfortable, you will ride the waves of strong affect and if you can’t tolerate that, we will need to go at a slower pace and work on something different for a while.
It takes as long as it takes to begin actively processing a traumatic event. It can be very intense and provoke powerful emotions that can be overwhelming, so we don’t want to jump into the deep end too soon.
In a nutshell typical protocol looks something like this:
Discussion of existing coping skills and support system
Emphasis on safety
Somatic training for client
Installation of container and calm peaceful place (these are mindfulness strategies used in EMDR sessions and whenever you need them away from session)
Installation of nurturing figures, protective figures, wise figures (real or imagined)
Emotional regulation training for client
Identify client’s negative cognitions
Explore client’s first/worst/most recent memories associated with the negative cognitions
Agree on a target memory to process
Set up of the target begins (ex. Car wreck)
What picture represents the worst part? (ex. “The moment right before the car hits me"
What is the negative belief you have that goes with the worse part? (ex. I'm going to die")
What is the positive belief you would like to have when you go to the worst part? (ex. "I am safe now")
What emotions are present when you go to the worst part/negative belief? (ex. "Terror")
What is your distress level now? ("10)
What do you notice in your body? (ex. "Sick to my stomach, shaking")
Bi-lateral stimulation is started and EMDR processing begins
Once the bi-lateral stimulation starts and processing begins it is like putting your foot on the accelerator as it sets off a rapid processing effect like mind/body free association.
After each “set” of the bi-lateral stimulation, there is a check in, “Take a deep breath, what are you noticing now” Client tells me (in a sentence or less) and I say, “Go with that.” I keep checking back in with the worst part of the original incident until the distress is gone from the body and there is no emotional charge, and the client has a new view of the incident. A positive belief is installed and is linked up with how the client views the worst part. So, that is in a nutshell what a session looks like.
A closed EMDR target will feel like you’re reading about it in the newspaper, the brain is no longer activated in the same way. The caveat here is that the original trauma can link up with another traumatic memory from the past and become something else, so the therapist needs to be skilled in managing that in a way that feels safe for the client. We don’t want to have all these different traumas opened at the same time.
What happens in the brain during EMDR?
It’s not fully understood on a cellular level but is believed to be similar to what happens in the brain during REM sleep. The client holds the tappers, and an image of the worst part, when bi-lateral stimulation (tactile, visual or auditory) is applied it sets off a rapid processing effect, the eyes move naturally, and the client goes back and forth between the two hemispheres revisiting the side where the trauma is stored and the side where language is stored. This integrates information that is stored in different parts of the brain and desensitizes what is highly charged until it loses its charge.
Is EMDR right for you?
We will have to decide that together. It is human to want to push down the trauma and avoid thinking about it, EMDR asks you to look at the worst part of that trauma in order to desensitize you and reconcile it in the brain and change how it is stored. That isn’t easy, but I am here to walk with you through the process, help stabilize your emotions and increase your sense of safety. If you would like to set up an intake and learn more about EMDR and whether it is right for you, please email me at jennycompton@bewellcounselingnc.com.
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