Thirty years ago, in the summer of 1991, I went to Denver to visit my high school mentor Andy Sweet. I received my PhD in clinical psychology in 1989 and Andy taught me most of what I knew about working with people suffering from the effects of trauma. As we sat in his backyard, Andy said, “You need to trust me on this, Debbie. There's a new therapy called eye movement desensitization and reprocessing, EMDR for short, and it's unique and potentially powerful." It looked and sounded strange, but it was based on solid principles, and he got wonderful results. “I think this will change our area and bring relief to even more trauma survivors. You have to go and practice this... and you have to run, not walk."
So I did. That same year, I received EMDR training from Francine Shapiro, its developer. She told us about her discovery four years ago: she was walking in the park and reflecting on recent disturbing events in her life. Thinking about them, she noticed that her eyes were moving back and forth, left, right, left, right. And as her eyes moved, she was surprised to realize that the negative emotional charge of her memories seemed to dissipate. She began experimenting to explore the relationship between "two-way" (left-right) eye movements and this "desensitization" of anxiety.
Shapiro developed a treatment procedure that asked patients to focus on the worst part of the traumatic memory while watching her fingers move back and forth, left and right. In 1989, two years before I visited Andy, she published the first controlled EMDR study demonstrating the effectiveness of her method in treating post-traumatic stress disorder (PTSD) in combat veterans and survivors of sexual assault. Over time, clinical experimentation has shown that other forms of bilateral stimulation (listening to tones alternating between each ear, or receiving alternating taps on the back of the hands) generally work as well.
And she made a fascinating discovery: EMDR was more than just a desensitization strategy. Instead, he offered patients the opportunity to completely “recycle” their traumatic memories—to rethink their experience and come to fully know, feel, express, and reflect on what had previously been too overwhelming to approach (let alone share). with anyone else) and, in some cases, even too frightening to fully admit them into your consciousness. I myself have been amazed at how EMDR allowed my patients to seamlessly integrate other perspectives, including information that corrected misconceptions about the past that led to a spontaneous reassessment of their sense of self, security, and control. A During my introductory EMDR training, I was the clinical director of an inpatient psychiatric unit in southern New Hampshire, which treated women recovering from both acute and chronic trauma. Most of them experienced a terrible childhood with prolonged emotional, physical and sexual abuse and, as a result, had a number of mental problems. Many engaged in self-mutilation or made attempts on their own lives. And most struggled with hopelessness, not knowing if they could ever be healed.
It was on this block that I started using EMDR as a therapist. One of my first EMDR patients was Miriam, 23, who was extremely depressed, suicidal, and unable to function for nearly two years after losing her pregnancy at eight months. In one unforgettable session, we used EMDR to determine the moment when the doctor told her that she had lost a child (along with the belief “I am bad and do not deserve to live”). As she processed the memory, she began to cry, addressing the grief she had buried deep inside. Miriam was angry at God and at her boyfriend who left her when he found out she was pregnant. And as she faced a tidal wave of guilt, somehow blaming herself for letting her child down, I asked her if the same thing happened to her best friend, would she hold her accountable, or would she see it too. her loser. She said emphatically, “Of course not! I would tell her that I understand her pain and reassure her that she is not alone.”
Miriam continued to analyze, pausing and checking after each 30-60 second series of eye movements to answer my question, "What do you notice now?" As her eyes moved back and forth, I felt the depression leave her body and leave my office. Her breathing evened out and she sat down in a chair. After another series of eye movements, she reported that she spoke directly to her child, mentally telling him how much she loved him and regretting that she never had the chance to hold him.
put it in your arms. When I asked her to imagine holding him at the moment, she imagined hugging and breastfeeding him with her arms clasped in front of her as if holding a baby. She told with tears in her eyes how she spent eight months dreaming of welcoming him into this world and then lost him.
Still new to EMDR, I was afraid that she was about to fall into despair again, but I decided to trust the process. We continued with more eye movements. And then, 50 minutes into our session, she sat down in her chair again, and this time she actually smiled, the first smile I've ever seen on her face. Near the end of the session, when I asked her to think about the memory again, Miriam reported that her distress had changed on a scale of 0 to 10 from 9 to 0. She said she could fully and completely approve of the new memory. self-confidence – “It wasn't my fault. I am nice and I have so much love to give. I just experienced what my mentor Andy described. I have witnessed a transformation.
EMDR was clearly more effective than "standard care" in reducing PTSD symptoms.
When I started introducing EMDR to more of my patients, I saw the same dramatic changes within a week or even a single session. I was honored to witness their stories and accompany them as they faced and resolved traumatic memories that had haunted and troubled them for years. I have seen their nightmares, flashbacks, depression, panic and suicidal tendencies decrease significantly. Time and time again, my patients have reported a new sense of hope and opportunity. The women new to the department heard about EMDR from other patients and came up to me saying, "I'm going to have the same as her!"
The most profound and lasting changes occurred when patients' sense of self began to change. They went from pathetic self-hatred to a sincere belief that they deserve to exist, that they are "good enough" and "worthy of love." Their nervous systems began to relax as they came out of hypervigilance, coming to a deep belief that “it really is over; Now I'm safe. They began to look at the world around them through the eyes of adults, not children. I've heard statements like, "Now I see that I have a choice and I can act." They began to come out of their isolation, saying, “I don't need to be alone anymore; there are other people like me; I matter and I belong."
What I observed in my small office in the Department of Women's Trauma and Dissociation was soon reflected in published research: EMDR was an effective and efficient treatment for PTSD, significantly reducing or eliminating PTSD symptoms in just three 90-minute sessions in 85 percent. cases of sexual violence; and over 75% of traumatized combat veterans recovered from PTSD in just 12 EMDR sessions. In yet another study, 100% of single trauma survivors and 77% of multiple trauma survivors no longer met the diagnostic criteria for PTSD after an average of only six and a half 50 minutes. EMDR sessions demonstrating that EMDR is clearly more effective than "standard care ", in reducing the symptoms of post-traumatic stress disorder.
To say that I was delighted with the discovery of DPDH would be a huge understatement. I was so frustrated with the limitations of the treatment models that I previously had at my disposal. Teaching patients many cognitive-behavioral coping skills (positive self-talk, distraction, dealing with distorted thinking) and helping them manage their symptoms seemed necessary but not sufficient. They were usually able to achieve some degree of short-term relief, but the "cure" for their complex symptoms and deep suffering seemed elusive to them and to me. Memories associated with fear, shame, and helplessness will continue to be reactivated, requiring ongoing efforts at top-down cognitive self-management.
The more traditional "talk therapy" models lacked the focus and clear path to healing that I was looking for. I was discouraged by the idea put forward in many of these models that treatments must be long-term, sometimes very long-term, to be effective. I have had so many patients who come to me and report that they have been treated for many years, sometimes by different therapists, and with almost no relief. It didn't really surprise me. Early in my clinical work, I came to the conclusion that many of my patients could not find the words to fully describe their traumatic experience or their current state - at least at first. They were often held back by shame, or they were too scared to speak, or yes.
they didn't realize why they felt the way they did. Their traumas existed for them in images and physical sensations and as a "feeling" at their core, but there were no words to describe them.
I needed an approach that went beyond talking and brought my patients back to their bodies and emotional experiences without overwhelming or traumatizing them. That tool was EMDR. This remains my primary psychotherapeutic orientation today. His theory offers me a practical and reassuring lens through which I can look at the difficulties of my patients, and his protocols have provided me with a proven and reliable method to help people change their lives effectively and profoundly in a way that will stand the test of time. .
So that you can fully appreciate the power of EMDR therapy, I want to explain it in more detail. EMDR is an integrative psychotherapy because it includes other approaches, from free association psychoanalysis to bottom-up processing of the new mind-body techniques and experiences that are popular today.
It is also the comprehensive psychotherapy most closely associated with trauma treatment introduced (some would say re-introduced) by psychiatrist Judith Herman in her pioneering book Trauma and Recovery (1992). Herman's model is known as the "phase healing of trauma" because of its three interrelated phases: providing stability and security, coping with trauma, and reconnecting with others. Although EMDR also includes the idea of phases, it offers its own distinct set of procedures and uniquely uses bilateral stimulation as a mechanism for change.
EMDR therapy highlights the role of the information processing system in the brain in a wide range of mental health problems. It is guided by the adaptive information processing (AIP) model, which proposes that psychological difficulties result from the inability to adequately process traumatic memories to the point of "adaptive resolution". Under normal circumstances, we process and resolve complex experiences with ease—we talk, dream, or write about them, think about them, and learn from them by making connections with information that already exists in the neural circuits of our brains. Violations are "neutralized" and "passed away", which allows us to continue to live - perhaps with a little more wisdom, a little more resilience, and certainly less fear and anxiety. In severe traumatic situations, normal day-to-day information processing is disrupted. Traumatic memory with all its components - images and other sensory elements, emotions, physical sensations, impulses, thoughts and beliefs - is "locked" in the nervous system, unable to develop or resolve. These inadequately processed memories lie in wait for being reactivated, often unexpectedly, by internal or external “triggers”—environmental or relationship stressors, emotions, thoughts, or sensory experiences such as sounds and smells—leading to painful psychological or bodily reactions. These may include intrusive images or memories, anxiety or panic, hyper-reactivity or numbness, or feelings of shame. Patients may even experience extreme, unexpected negative reactions to seemingly innocuous situations.
The brain returns to some balance, coming out of the eternal fight-or-flight or shutdown mode.
In terms of the AIP model, these disproportionate responses reflect a memory locked up in the brain during some earlier trauma that is still causing anxiety—days, months, years, or even decades later. If memory is not processed, it stays there, just below the surface, influencing, shaping decisions and reactions, and even interfering with one's ability to function. As a result, people find themselves limited in their ability to adaptively respond to everyday challenges, while still "stuck in the past".
The AIP model states that the information processing system in the brain is no different from other systems in the body, such as the immune system; it is functionally focused on prioritizing survival and moving towards optimal health. When working properly, it works like other body systems that spontaneously and reliably mobilize resources to heal a fracture or wound after an injury. When treating injuries, large or small, we treat a damaged and malfunctioning brain.
Working from this perspective, the EMDR therapist seeks to access memories associated with traumatic psychological traumas while reactivating a stalled information processing system in the brain. Bilateral stimulation, whether it be eye movements, sounds, or tapping, is seen as the key to reactivating this system, allowing it to desensitize and process these trauma-based memories. The goal of EMDR is to help people fully process their traumatic memories so that they no longer cause symptoms and, in
Ultimately, they could be remembered without stress. Eventually, the brain returns to some balance, moving out of the eternal fight-or-flight or shutdown mode and returning to a more orderly state that allows for more accurate thinking, more controlled emotions, and a more relaxed and calm state. active social contact. When people disconnect from the disturbing images, messages, beliefs, feelings, and sensations associated with their traumatic memories, they suddenly begin to think more calmly, clearly, and creatively. They no longer feel obligated to respond in the old formulaic ways. They no longer feel the need to withdraw from others, avoid situations, please everyone, or withdraw from their everyday experiences. And they no longer need to resort to addictive, self-harming and unhealthy behaviors to calm down and escape from the pain. or take a break from your everyday worries. And they no longer need to resort to addictive, self-harming and unhealthy behaviors to calm down and escape from the pain. or take a break from your everyday worries. And they no longer need to resort to addictive, self-harming and unhealthy behaviors to calm down and escape from the pain.
As he completed his 14 months of treatment with me, John, who was sexually abused by a childhood "family friend," stated, "I finally feel like the 'real me' has arrived. I am no longer numb and hiding in a hole, and I am really starting to understand what it means to feel fully alive and closely connected with other people. I no longer consider myself bad or disgusting. And I believe I'm ready to make the right choice for myself." Together we celebrated his triumphant return to life with tears and great joy.
Another client of mine, Katie, was a middle-aged married woman with three adult children. Kathy grew up in the family of an abusive, abusive alcoholic father. Her mother, also a victim of physical and verbal terror from her husband, regularly justified his behavior. Unfortunately, Kathy's older brother identified with his father and often kept Kathy captive in their basement for hours, beating, scolding, and threatening her. She learned to survive by "leaving her body" when things went wrong, ignoring all her own needs, never making waves, and focusing solely on trying to make others happy. She used food to soothe her emotional pain, indulged in self-harming cuts when food didn't help, and battled depression intensely throughout her life. She developed severe digestive problems and high blood pressure. She described her nervous system as always on high alert as she was "waiting for the next bomb to fall from the sky". When news outlets began reporting that immigrant children were being separated from their parents at the border and kept in cages, she began experiencing haunting images and nightmares of the loneliness and terror she had experienced as a child and felt "falling apart". seams." Cathy had held back her memories all her life, but now she realized that it was time to turn to them, and turned to me for help. she began to experience the haunting images and nightmares of loneliness and terror she experienced as a child and felt she was "bursting at the seams". Cathy had held back her memories all her life, but now she realized that it was time to turn to them, and turned to me for help. she began to experience the haunting images and nightmares of loneliness and terror she experienced as a child and felt she was "bursting at the seams". Cathy had held back her memories all her life, but now she realized that it was time to turn to them, and turned to me for help.
In EMDR therapy, we use a three-pronged approach to treatment, identifying and addressing past traumatic memories, present distress symptoms and triggers, and goals for future functioning. Each of them becomes an object of processing. Before Cathy and I could address her traumatic past, we first needed to reduce her fear in the face of emotions and memories that she had avoided for most of her life. We also had to deal with her anxiety that she would not be able to continue functioning after she opened the door to her past.
We did this by making sure she had a good repertoire of skills and resources that would help her stay "sufficiently adjusted", securely connected to the present and connected to me as we worked together. I explained that our goal was to help her maintain "double attention"—always with one foot in the present while she gently slips into the past. I suggested that she imagine herself as a train passenger, just watching the scenery go by, watching from afar, not necessarily "experiencing" Thu
about anything.
We have also worked to strengthen her sense of security and trust in our relationship; I assured her that I would be by her side, moment by moment, as we discussed her past together. We then explored the links between her reactions to current events in her life and various experiences in her childhood. Again and again I asked her to "sail back", following the current obsessive images, feelings, and sensations she was experiencing towards her childhood memories. When she couldn't identify earlier memories, we simply focused on current symptoms and triggers.
In each EMDR session on trauma, I helped Cathy "activate" her memory by asking a standard set of questions asking her to identify the image, negative self-belief, emotions, and sensations associated with our chosen goal. We would also determine what she would prefer to think of herself by setting a clear goal for the work ahead. Once the memory was activated, I administered sets of bilateral stimulation, reminding Cathy that there was no "should be" and encouraging her to "just notice what's going on" during each set and "let it happen." After each set, I asked: “What will happen next? What do you notice? I could remind her that she is dealing with "old things" or encourage her to express rage towards her abuser (out loud or in her imagination) or offer comfort to her "younger self". Processing will continue until the memory no longer carries a negative "charge"; at this point, I would suggest to Cathy that she focus on her previously identified positive belief—the one she wanted to believe—and we continued processing until she felt it was completely true. We have always taken time to completely refocus on the present, reflect on the experience, and imagine how we will clean up next time any material that has not been fully resolved.
EMDR proved to be the most cost-effective of the treatments evaluated.
In the course of our treatment, Katie reworked her horror and shame, feelings that she had since childhood. She mourned her "young self", realizing how lonely and defenseless she was. She imagined that she was bringing young Kathy into the present, comforting her, making her feel safe, wrapping her in kindness and care. She imagined that she had supernatural strength and was freed from her brother and father as they pursued her. With each memory we processed, she reported feeling “lighter” and more compassionate towards herself.
She opened her "voice" and eventually found her own "real truth" that was different from the diluted, twisted story she always told herself about her birth family ("it wasn't all that bad"). and current life ("I have the perfect family now"). By the end of treatment, she was no longer depressed and her symptoms of PTSD disappeared. She made new friends. Her physical health and daily self-care habits improved, and she began to communicate differently with her husband and children, expressing her needs and desires for the first time in her life.
To date, more than 30 randomized controlled trials support the effectiveness of EMDR therapy for post-traumatic stress disorder, and the evidence goes far beyond anecdotal reports. Based on this study, EMDR therapy has been recognized as a first-rate effective treatment for post-traumatic stress disorder in treatment guidelines by organizations around the world, including the World Health Organization (WHO), the International Traumatic Stress Research Society (ISTSS), and the US Department of Veterans Affairs and the Department of Defense. USA. EMDR is just as effective in treating PTSD as other proven therapies such as trauma-focused CBT, but often in fewer sessions and without the hours of homework that CBT requires. A recent meta-analysis compared 11 trauma therapies recommended for the treatment of PTSD in adults; EMDR proved to be effective as well as the most cost-effective of the treatments evaluated.
In 2007, I consulted for a study funded by the US National Institute of Mental Health that evaluated the benefits of eight sessions of EMDR therapy for the treatment of post-traumatic stress disorder compared with the same period of Prozac. At first I was worried that eight sessions would be just a drop in the bucket and would not be of significant value to those who had experienced trauma both in childhood and adulthood. I was even worried that the treatment might bring back memories that were impossible to deal with in the time we had.
So I was genuinely happy when we discovered that
the subjects not only felt good in the short term, but continued to get better and better even after stopping the treatment, as if their brain's information processing system had really come back to work. Even those who had suffered extensive childhood trauma saw significant progress in eight sessions; for this group, EMDR was ultimately superior to Prozac in reducing both PTSD symptoms and depression when symptoms began in adulthood. By the end of treatment, all participants in the EMDR group with adult trauma had disappeared from the diagnosis of post-traumatic stress disorder, as did three-quarters of patients with childhood trauma. At follow-up six months later, 89% of childhood abuse survivors lost their diagnosis of post-traumatic stress disorder, and a third were completely asymptomatic. Our results have been published in the prestigious Journal of Clinical Psychiatry.
Thirty years ago, when I visited Andy in Denver, it was the eye movement component that prompted him to describe EMDR as "a bit goofy." To date, over 35 randomized controlled trials have been published demonstrating the beneficial effects of eye movements. Now we can unequivocally state that eye movements reduce negative emotions, image brightness and emotional arousal, while improving memory and thinking flexibility, but why?
Among hypotheses, researchers have shown that eye movements in EMDR activate the parasympathetic nervous system, resulting in slower breathing and heart rate, and reduced arousal; others have shown that eye movements compete with trauma memories, making them less vivid and emotional; others still speculate that eye movements activate the same neurological processes that occur during rapid eye movement (REM) sleep, when dreams are most intense, leading to a reduction in negative emotions, new associations between memories, increased cognitive flexibility, and improving understanding.
SS Since Shapiro first went for a walk in the park, much has changed in the practice of EMDR. It is no longer seen as a treatment for symptoms associated only with individual traumatic events. It is also not seen as only applicable in circumstances where the patient is dealing with the consequences of a "Big T" injury.
We now recognize that the definition of trauma should include the “small” traumas of everyday life—rejection, humiliation, setbacks, and repetitive racial microaggressions. Trauma can follow the loss of a job, the discovery of an infidelity partner, a breakup, or divorce. Often, the broader context of an event—the person's autobiographical history and the reactions of others to that event—determines whether a particular experience will lead to the development of post-traumatic stress disorder or other serious mental health problems. We have also learned how to best prepare our patients for dealing with trauma by providing effective support to those who feel overwhelmed by modern circumstances or especially vulnerable and do not want to deal with their complex trauma histories.
Currently, EMDR is used to treat people suffering from a number of diseases. It is no longer seen as simply a treatment for adults with identifiable injuries or those who meet the strict criteria for a diagnosis of post-traumatic stress disorder. Evidence is mounting to support the use of EMDR therapy for the treatment of traumatized children, recent trauma survivors, and individuals with complex post-traumatic stress disorder, most commonly diagnosed in patients with a history of long-term and repeated trauma that began at an early age. . In addition to the obvious trauma-related disorders, research is currently under way to support the use of EMDR in anxiety disorders, unipolar depression, pain, addiction, obsessive-compulsive disorder, bipolar disorder, and psychosis. EMDR is used in inpatient and outpatient settings, medical hospitals, schools, prisons, the military and in the field following major disasters and crises. After all, the unprocessed memories of trauma still trapped in the nervous system can exacerbate, trigger, or even cause many of these problems and disorders.
I tell all my patients, “I will be with you every step of the way. I won't let you drown'
And EMDR is used to treat trauma from neglect and deprivation. We now know that the consequences of child neglect, separation, and emotional abuse—often referred to as attachment or developmental trauma—are usually more severe and far-reaching than those of other, more obvious and well-known forms of child abuse. Our therapy
often targets the loneliness that survivors experience, as well as their belief that they simply don't deserve to exist. We give them permission, as in Cathy's case, to imagine that they get what they need but never get, or say things they could never say to a criminal or someone who failed to protect them or act. on their behalf. We invite them to dive into their memory and acknowledge their "younger selves" by providing much-needed, long-neglected care, comfort, and approval. The healing that results can be profound.
Finally, EMDR is no longer viewed as a mere technique or protocol in which therapists are encouraged to stay away while the patient's brain is doing its job; it has evolved into a comprehensive psychotherapy that emphasizes minute-to-minute attunement and collaboration, the relationship between client and therapist. I tell all my patients, “I will be with you every step of the way. I won't let you drown. EMDR therapists strive to recognize and validate their patients' wisdom, provide a healthy perspective, and support their emotional regulation during sessions. We witness their pain and meet them again and again and again with deep compassion, reminding them of their courage and strength and helping them to understand that they are no longer alone.
As I write this in the spring of 2021, the need for effective trauma care continues to grow. It was a challenging time when the COVID-19 pandemic, economic collapse, and political and racial strife brought injury, hardship and loss to millions of people. In June 2020, according to the U.S. Centers for Disease Control and Prevention, more than 40 percent of U.S. adults reported symptoms of depression or anxiety, a sharp increase from the same period in 2019. During this time, my colleagues and I have applied "EMDR Early Intervention" protocols to effectively and efficiently treat first responders and frontline workers, as well as those on ventilators in the intensive care unit and those who have undergone severe loss of loved ones. For many people with earlier traumas, such as my patient Katie, the stress, loneliness and grief brought on by the turmoil associated with the pandemic unearthed memories of previous suffering that we also needed to deal with. But despite the frightening picture of mental health we face, I remain very hopeful.
I am encouraged and encouraged by the results I consistently get with EMDR Therapy. I am inspired by everything we continue to learn through research and clinical innovation. And I am grateful to be part of a resilient and dedicated professional community committed to making a difference in the world.
For some, recovery is fast, and EMDR really does seem like a miracle drug, too good to be true. For others, especially those with complex trauma histories and the endless challenges of today, the road is often harder and sometimes much longer. However, I feel strongly optimistic and regularly tell all my patients: "You are in pain, but you can recover, and it won't take a lifetime."