What Is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) is a guided process that supports trauma work by using “bilateral stimulation” (BLS), or stimulating each hemisphere of the brain alternately via the senses. EMDR also involves talking, deep breathing, and other ways of grounding the nervous system. (“To ground” the nervous system means to bring its level of activation back or closer to the “ground” or baseline level.)
There are many kinds of BLS that can work well, although eye movements have been shown to be the most effective. In my practice, I use a combination of eye movements (watching a light or my finger moving back and forth), as well as sounds alternating in each ear through headphones—whichever the client prefers.
When we first meet, I work together with my client to figure out what combination of sounds and colors feels best. (A person’s own report is the best indicator for what kind of stimulation works best for them.)
Rather than medicalizing distress, EMDR provides a way of healing from trauma. EMDR isn’t about trying to treat the symptoms of an illness. It’s about healing from the root cause.
What Can EMDR Treat, and What Is It Not Helpful for?
EMDR can be very useful for trauma, specific anxieties and phobias, and many forms of impact left behind by difficult experiences or relational patterns. EMDR can be effective for Complex Post Traumatic Stress Disorder (C-PTSD) and developmental traumas.
Another form of EMDR called Eye Movement Desensitization (EMD) can be helpful to reduce distress due to overwhelming or complex traumas and triggers, which can be used in place of or in preparation for additional reprocessing.
EMDR can be used to prepare for specific future actions (public speaking being one common example).
It is even possible to use EMDR for memories that may be vague, pre-verbal, or otherwise not fully available to consciousness. This is accomplished by processing the physical responses and triggers we have in the present.
EMDR is less directly useful for depression, grief, the impact of neglect, and other experiences we might characterize with the word “lack.” Many or most forms of difficult human experience involve both fear and loss, and working on the somatic or body-based reactivity to trauma with EMDR can allow grief work to become tolerable. In other words, EMDR can open the way for other therapies (such as psychodynamic, existential, and other “talk” therapies) to be more effective.
What Is the Difference Between a Traumatic Memory and Other Memories?
Each memory we have is stored in a “neural tree,” which (in theory) is a structure of cells that we could pick up and look at. Our non-traumatic or ordinary memories have many “branches” into the frontal cortex of the brain, which allows us to describe the memory with language, and into the hippocampus, which allows us to put the experience into the context of time (i.e. we know it happened in the past and therefore that it is now over).
Conversely, the neural trees of traumatic memories have fewer of these branches, and they also have a greater number of “roots” that anchor them to the amygdala, which is the fight/flight/freeze center of the brain. (“Freezing”, or dissociation, can be thought of as a protective numbing response to the “fight or flight” responses of anger, anxiety and fear. “Drifty,” “numb,” and “confused” are some words clients who experience dissociation have used to describe how it feels to them.)
This makes it much easier for a traumatic memory to activate the adrenal glands, and thereby the threat response system throughout the whole body. This is what we mean when we colloquially use the word “trigger”: the body has been activated for survival in response to a present stimulus that is meaningfully reminiscent of the past.
What Is Trauma Work?
“Trauma work,” “trauma processing,” or just “processing” are all shorthand ways we refer to helping neural trees grow more branches and untwine their roots! EMDR can make this process much easier and faster, though the process itself is ancient. We say that the brain “knows” how to heal itself, much like how the skin “knows” how to heal a cut. EMDR gives the brain support—much like how antiseptics and bandages can support healing wounds of the skin.
As we said above, unprocessed traumatic memories are less connected to the frontal cortex. This means we have less ability to use language to “look at” the memory, instead of “be in it,” and it’s much harder for our systems to believe that the memory is in the past and that the threat is over—it can feel like it’s happening all over again. “Naming it to tame it,” or putting experience into words (which, in EMDR, happens between doses or “sets” of BLS), helps grow more connections to the frontal cortex.
Another reason doing trauma work is one of the greatest challenges we face is because the brain and body don’t have a system that tells us we are in “mild distress.” We can only adjust between “life and death (fight, flight or freeze)” and “calm (rest and digest).” Recalling traumatic memories, alternating with taking breaks, helps the “roots” into the amygdala unwind and the survival system to quiet.
So even contemplating trauma work can feel like life and death! It’s important to be aware that there’s a reason for this intensity, and that after successful processing, it will fade. Working on trauma is not likely to be comfortable, but if it is not tolerable for my client, we stop (using a stop signal we agree on before we begin). If that happens, we focus on support and using grounding skills until their nervous system is closer to baseline. Trauma work is not as hard as trauma!
How Does EMDR Work?
EMDR allows us to process trauma by activating traumatic memories at the same time as it gives the nervous system cues for safety. This creates an “in and out” rhythm, which helps the brain get back in sync, and supports your brain in building connections to the neurons that store these memories.
We have data that clearly show that EMDR gets good results. Science is still exploring the reasons why EMDR works, but here are some of the most popular current theories, one or all of which could be true:
- The back-and-forth visual motion communicates to the amygdala that your body is in motion, which tells the brain that it is safe, active, and not trapped.
- The ocular nerve or other sense organs are stimulated, the activity of which facilitates rewriting (basically, it gets the area “warmed up” and ready for change).
- Stimulation of the sense organs takes up some of the brain’s bandwidth and resources (such as oxygen and glucose), which means less is available to fuel panic responses.
- The eye moments mimic what happens in REM sleep, another time when the brain is processing and storing memories. (This process is not fully understood, but it’s theorized to be similar to how EMDR and BLS work.)
- Trauma disrupts the natural rhythm of brainwaves, and EMDR provides a “corrective” rhythm to resonate with the brain as it processes disruptive memories.
- Predictable structure while talking about trauma is distracting and calming.
Any form of verbalizing trauma while in the regulating presence of a trusted other will have beneficial effects, for at least two reasons. First, “If you can name it, you can tame it”: Language activates the frontal cortex, which helps to build neural bridges, as well as causing a release of endorphins and other soothing neurotransmitters.
Second, our nervous systems are built from birth to monitor the internal state of others (including breath and pulse rates), and to resonate with them—so sharing a story with someone who is calm can help us calm ourselves while we tell it.
What Happens During an EMDR Session?
EMDR has a few different phases. In the first phase, I lay the groundwork with my client, including practicing grounding skills, setting up a stop signal, getting more familiar with BLS, and making sure they have a crisis plan and other supports in place in case they need help between sessions.
Next, we work together to come up with some “headlines” of memories to target, and explore the client’s feelings and beliefs about these memories. This doesn’t mean it’s not ok if we discover more along the way, but it can help us find some good places to start. In fact, we might say that it’s more likely than not that other memories will come up. That’s neither good nor bad, it’s just the brain going through the networks of association it has.
If relevant, we may also set goals at this point for a future action the person is working towards.
Most often, BLS is not used until session two (although this does not mean that processing cannot begin in your brain before that!). At that point, I work with the person to bring up the memory we agreed to use as a starting point, paying attention to the sense information, body feelings, and emotions that go with the memory.
Then, we do about 20 to 30 seconds of BLS. During that time, I ask my clients to “just notice,” “go with,” or “follow” what they’re noticing inside themselves. At the end of every “set,” I ask them to take a deep breath, tell me a sentence or two about what they’re noticing, and then we repeat.
It’s kind of like you’re on a train ride, and I’m on the phone with you, asking you what you see out the window.
Sometimes, what a person feels and notices from set to set will change, and sometimes it won’t. It’s even perfectly normal to have periods of feeling nothing at all. This is often the brain’s way of resting, assessing safety and connection, or otherwise taking care of you, and sometimes the best thing to do is just notice that feeling for a few minutes.
Although I keep a close eye on how my client is feeling as we go, I trust their own report most of all—as a person is their own best guide to how they’re doing. Some experiences are not always visible from the outside, such as “red lining” (panic, fury, etc.) or “blue lining” (dissociating).
I always tell my clients that if they think they’re feeling too much or too little, or are otherwise outside of their “zone of tolerance,” it’s important for the healing of their nervous system that they let me know. That way, we can take a break and use grounding skills before we continue.
Most sessions are spent doing sets for about 20 to 40 minutes. At the end of every session, we wrap up by using grounding skills to return the person’s nervous system to a tolerable state. I also ask if there’s anything they want to “leave in the container of therapy” (which doesn’t mean it won’t come to mind between sessions, but rather that they will set the intention not to continue to focus on it). Then we check in for a minute or two so we can both share thoughts and observations about the session.
Reprocessing can take several sessions. On average, it ranges from 3 to 12 weeks, though it can be significantly shorter or longer. Sometimes a person may feel different by the end of a session, and sometimes they may not.
What Do I Do Between Sessions?
In between sessions, clients may continue to process memories, meaning they may still be remembering, feeling, or even dreaming things. If that happens, their job is to notice it as much or as little as they’d like to, and then use a grounding skill. (“They don’t work if you don’t use them!”)
The client’s most important job, and their only “homework,” is to keep their nervous system and emotions within tolerable limits as much as they can. (It’s ok if they can’t do this perfectly, but it’s important to set it as a goal to strive towards.)
There are a number of questions we check in about as we prepare to engage in EMDR:
- How will you know if you’re outside of your tolerable zone?
- What grounding skills will you use?
- What friends and family can you connect with, whether to ask for help using grounding skills, talk about what you’re feeling, or just to share space?
- If you are unable to ground yourself on your own or with the assistance of loved ones, what hotlines and/or mental health professionals will you call and how?
What Might Be Different After EMDR Is Complete?
The good and bad news is that EMDR does not make you forget what has happened. After processing, accessing memories of a traumatizing event will feel much like accessing any other memory. The most noticeable difference will likely be that the memory no longer creates an overwhelming body response.
After EMDR, it’s common for a phase of grief work to begin. This can involve feeling sadness and anger, as well as (in some cases) shifts in sense of identity or what is important to us. Sometimes we need support to explore questions like “Who am I without this fear?” or “Is it ok to get better?” Continuing in talk therapy after EMDR is over may help people continue to integrate their experiences and to heal.
To anyone contemplating EMDR, I wish you good healing, and congratulations to anyone who is willing to take the risks to talk about the hard stuff. I believe the greatest gift we can give to ourselves and to others is to make room for our feelings.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.