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Eye Movement
Desensitization and Reprocessing (EMDR) Stephanie Wilde EMDR
is a relatively new form of psychotherapy used mostly to relieve post
traumatic stress disorders (PTSD). It is both an evolving theory about how
information is perceived, stored and retrieved in the human brain and a
specific treatment method based on this theory. A
Little History In
1989, Francine Shapiro noticed that the upset she felt when thinking
disturbing thoughts went away as her eyes moved spontaneously and rapidly.
She began experimenting with this observation and found out that it worked
that for others as well. Studying these results, she hypothesized that eye
movements could be related to desensitization of traumatic memories and performed
studies that supported that belief. Further studies showed that spontaneous
eye movements were associated with unpleasant emotions and cognitive changes.
Since then, twenty studies have been published on the role of directed eye
movement in therapy and a new form of psychotherapy, EMDR, came into being. How
It's Used During
EMDR therapy, the client focuses on brief sequential doses of emotionally
disturbing memories while an external stimulus (usually directed eye
movements, although hand-tapping and audio stimulation are often used) is
applied at the same time. This split concentration apparently accesses the
network of the traumatic memory, creating new links between the traumatic
memory and other less distressing memories. These new associations appear to
be more easily adaptable which results in new learning, elimination of
emotional distress, and development of cognitive insights.
Practicing
the imagined event lets you learn what the experience could be like and lets
you store appropriate emotions and reactions to call on when you need them,
instead of being at the mercy of the triggering event. It
seems that that our minds are an information processing system that can
process all the multiple parts of experiences until they are broken down into
a state where accurate (undistressed) evaluation of the information can take
place and at that point we can learn to adapt our thinking and reactions. When
a traumatic event occurs, memory is stored in linked networks in the brain
that organize themselves around the earliest related event (so it might be an
earlier traumatic situation, not the current one, that
is the center of this network) and its associations. These networks contain
related thoughts, images, emotions, and sensations. If we do not fully
process the information related to the traumatic event, we store the initial
perceptions, emotions, and distorted thoughts as we experienced them at the
time of the event. And we get to live with the misery. Such
unprocessed experiences often become the basis of current dysfunctional
reactions and cause many mental disorders. So anything that lets us break
through the barrier of dysfunctional information in our minds is a step in
the right direction. EMDR
is not an instant cure, but it has had some very good results in eliminating
PTSD diagnoses. Some patients have had remarkable reduction in these effects
after as few as four to twelve sessions, which is a big improvement over
spending one's life on a shrink's couch. Obviously, folks who have had
suffered many traumatic situations or have complex histories of childhood
abuse, neglect, and the like may require more extensive therapy. EMDR looks
like it will become a serious means of treating PTSD. I've
heard it said that it is like getting the right side of your brain (creative
-- especially when it comes to catastrophizing - dang) to listen to the left
side (boringly logical, which is what we need when we are running on a bad
mental trip) Although
there is not yet any assurance that it will result in long term cures, it
appears that the results are relatively long lasting, with a number of
civilian participants showing long term maintenance over a period of time.
And a single study of combat vets using the full twelve-session course, found
that the improved conditions were still maintained after nine months. But it
does look like if someone has suffered many traumatic events and the
treatment is limited to only a couple of those events instead of all of them,
partial results may be achieved, but not be at all permanent. So it would
seem important to go for dealing with all the traumas relating to the
dysfunction being treated. It
is possible EMDR may be useful in treating specific phobias, such as panic
disorder and agoraphobia, but so far no study has provided strong support for
this theory. It is also possible that EMDR may not be effective with all
phobias: For instance, it may seems most effective in treating anxiety
disorders that follow a specific traumatic experience (like having a fear of
dogs after a dog bite), and less effective for those of unknown onset (like a
generalized fear of snakes or spiders.). There have been some studies looking
into using EMDR to treat panic disorder both with and without agoraphobia
(fear of going outside). The results for panic disorders alone were promising
but not conclusive. However, when agoraphobia was present, the panic symptoms
were rarely eliminated. On the other hand, those improvements that did take
place were generally still there at follow-ups. While
EMDR is not a panacea for all clinical disorders, there have been some
interesting results outside the PTSD arena, for instance: the successful
remission of body dysmorphic disorder and the elimination of phantom limb pain.
EMDR is not expected to fully alleviate symptoms arising from physiologically
based disorders, such as schizophrenia or bipolar disorder, but there are
some reports of folks with such disorders being treated successfully for
distress related to traumatic events. Some
preliminary investigations have indicated that EMDR might be helpful with
other problems like performance anxiety and other disorders. How
It Might Work in the Inner Mind One
model suggests that emotion can be viewed as a collection of loosely linked
threads of physiological, behavioral, and cognitive responses or reactions.
In this case some types of treatment can weaken different threads within the
collection of responses and some treatments may act on several strands
simultaneously. works with strands of imagery,
cognition, affect, somatic sensation, and related memories. This complexity
makes it difficult to isolate and measure the contribution of any single
component, especially as different individuals who have the same diagnosis
may well respond differently to different elements. It
looks as if EMDR works directly with the cognitive, affective, and somatic
components of memory to create new associations, links that are more
adaptable to change. Many treatment elements are used to improve the
processing and assimilation required. These include:
Exposing
clients to anxiety eliciting stimuli is a standard treatment for anxiety
disorders. It has sometimes been assumed that EMDR uses exposure in this
traditional manner and that this accounts for Emir's effectiveness. However,
long term exposure does result in a high stress session for the client. The
fact that EMDR clients often have rapid reductions in distress levels early
in the session suggests that Emir's use of repeated short focused attention
may call up some other means of desensitization than does exposure therapy
with its continual long exposure. Eye
Movements and EMDR Despite
its name, EMDR is not simply an eye-movement procedure. A complex treatment,
it contains a number of other effective components. While the client focuses
internally on a distressful event or situation, eye movement is used to
simultaneously pull the client's attention to an external stimulus. Although
eye movements are a commonly used means of creating dual attention in the
client, a variety of other stimuli such as hand-tapping and auditory
stimulation are used as well. The use of such alternate stimuli has been an
integral part of the EMDR protocol for more than 10 years. This shifting
attention such apparently activates neurobiological mechanisms as rapid-eye
movement (also known as REM, which occurs during the dream phase of sleep),
triggering episodic memories and integrating them into memory. Interestingly,
alternating leftward and rightward eye movements produce a beneficial effect
for episodic, but not semantic, retrieval memory tasks. Use
in Psychotherapy As
with any form of psychotherapy, EMDR may produce a temporary increase in
distress as distressing and unresolved memories may emerge. Sometimes clients
experience unexpected reactions during a treatment including a high level of
emotional or physical sensations. Processing may continue after the treatment
session and other dreams, memories feelings, etc., may emerge. Sounds
Pretty Effective Obviously
how long it will take to work depends on the specific problem and client's
history. However, repeated controlled studies have shown that a single trauma
can be processed within 3 sessions in 80-90% of the participants. While every
disturbing event need not be processed, the amount of therapy will depend
upon the complexity of the history. In a controlled study, 80% of multiple
civilian trauma victims no longer had PTSD after approximately 6 hours of
treatment. A study of combat veterans reported that after 12 sessions 77% no
longer had post traumatic stress disorder. Many
people are conscious of only a shadow of the experience, while others feel it
to a greater degree. Unlike some other therapies, EMDR clients are not asked
to relive the trauma intensely and for prolonged periods of time. In EMDR,
when there is a high level of intensity it only lasts for a few moments and
then decreases rapidly. If it does not decrease rapidly on its own,
clinicians are trained to assist it to dissipate and the client also been
trained in techniques to immediately relieve the distress. There
is no indication that EMDR will cause seizures. In thousands of cases there
have been only three reports of seizures occurring with people already
diagnosed with epilepsy. Two of these cases occurred when using a lightbar.
One case seemed to be caused by the processing of an old seizure. The client
later reported that her experience made later seizures more manageable. This article is my take on the
FAQs located at the EMDR site. For more info or to find a
clinician if you want to try it, go to www.emdr.com |