Eye Movement Desensitization and Reprocessing (EMDR) is a structured psychotherapy approach which was designed by Francine Shapiro, Ph.D. (1989, 2001) to facilitate the processing of distressing memories and experiences, and to resolve disturbing symptoms resulting from them.
Of the many definitions of EMDR, an especially helpful explanation is available in the introduction to the book, Small Wonders, by my colleague, Joan Lovett, M.D., a pediatrician who does EMDR therapy with children.
Having studied and consulted with Dr. Lovett, I admire and am deeply grateful for her outstanding gifts and gentleness as a physician, therapist, teacher, and mentor. I appreciatively acknowledge her contribution in offering the subsequent descriptions of why and how EMDR works.
Let’s start with the name itself: “Eye Movement” refers to repeated, comfortable left-to-right motion of the eyes, which stimulates both hemispheres of the brain. The term “Desensitization” is the process of becoming comfortable with a memory of an event that was scary or shaming, but which is currently over and now harmless. “Reprocessing” is a psychological term meaning to work on understanding a memory so that the memory becomes useful, instead of just frightening or disturbing. Dr. Lovett suggests that EMDR could also be thought of as Emotional and Mental Development and Reorganization.
EMDR is an integrative therapy, synthesizing elements of many traditional psychological orientations, such as cognitive-behavioral, psychoanalytic, attachment, family-systems, experiential, physiological, and interpersonal therapies, as well as right-left stimulation of the brain. The activation of the brain hemispheres occurs through eye movements, or bilateral auditory tones, or bilateral tapping of the hands. Perhaps the shifting of attention from one hemisphere to another recruits the memory fragments to form a coherent, consolidated memory in a more stable state. We know that the right hemisphere of the brain is responsible for perceiving and storing emotions and nonverbal experience. The left hemisphere of the brain contains the capacity to orient events in time, to use language to gain distance from the source of distress, and to assign meaning to experience. EMDR nonverbally stimulates communication between these two hemispheres, allowing traumatized people to use both right and left resources in resolving painful memories.
EMDR is not hypnosis. In hypnosis there are increases in alpha, beta, or theta brain waves, which are associated with an increase in suggestibility. In EMDR, brain waves are within normal waking parameters, and the person is actually less suggestible than usual to information that isn’t correct. The procedure cannot instill any beliefs that are false, nor can it erase any feelings of pain or anxiety which are appropriate danger signals.
Trauma is the Greek word for wound. A trauma can be any event that wounds our sense of safety, well-being, or worth – leaving us with false or destructive beliefs about ourselves and the world. It can be traumatic to have our self-confidence undermined as a child, for example. Loss and grief always accompany trauma, and the symptoms of this wound can continue long after the precipitating event has been forgotten.
Physiologically, our bodies are programmed to ensure our safety and survival through the “fight or flight” response. We can flee, fight, or – when physical escape seems impossible – shift into a state of physical immobility and psychological/emotional escape or surrender. Danger makes us hyperalert: stress hormones such as adrenaline and cortisol increase, as does our circulation. Our muscles tense, preparing us for action. But if we’re thwarted and cannot escape, we freeze. But the unprocessed sensory and cognitive information relating to the event seems to be stored in an excitatory, state-dependent way in the nervous system. When the system for metabolizing traumatic memories has been overwhelmed, the information processing stops. The lingering immobilizing response keeps us simultaneously in a state of heightened awareness of danger, but with an inhibited ability to regain normal neurophysiological balance. These brain-body changes happen not only when we’re threatened physically, but also in response to emotional distress. Information “encoded” at the time of the threatening event is hard-wired into our complex memory network so that we can avoid or respond quickly to any similarly threatening event in the future.
This elegant system is designed to work in the moment and then return to normal when the danger has passed. But when our shame or danger system is overwhelmed, which is common in the nervous system of children, we can get stuck in emergency mode. Then even the slightest reminder of the traumatic event triggers high-amplitude anxiety, as if readying us to respond to an attack.
Below are background information and current EMDR research: Journal of EMDR Practice and Research, Vol. 1, No. 1, (2007).
EMDR therapy was developed by Francine Shapiro (1989, 2001) to resolve symptoms resulting from disturbing and unresolved life experiences. It is based on a theoretical information processing model, which posits that symptoms arise when events are inadequately processed and may be eradicated when the memories are fully processed and integrated. Shapiro further maintains that a negative sense of onself, inappropriate emotional responses, and self-destructive behaviors are also manifestations of inadequately processed material, and that processing the etiological (causal) experiences underlying these current dysfunctions will transform them, allowing new self-perceptions, emotions, and behaviors to emerge. In addition, new experiences are targeted, processed, and incorporated into memory in order to overcome developmental and skills deficits.
Currently, EMDR is rated in the highest category of effectiveness and research support in the PTSD (Post-Traumatic Stress Disorder) practice guidelines of both the American Psychiatric association (2004) and the U.S. Dept. of Veterans Affairs and Dept. of Defense (2004). Its efficacy has been recognized in the treatment of military combatants, traumatized children, and adult survivors of childhood trauma. It has also been recognized in many international guidelines, in which is is a recommended intervention for the treatment of PTSD. (Journal of EMDR Practice and Research, Vol. 1, No. 1, (2007).
WHAT KIND OF PROBLEMS CAN EMDR TREAT? Scientific research has established EMDR as effective for post traumatic stress. However, clinicians also have reported success using EMDR in treatment of the following conditions:
- • personality disorders
• eating disorders
• panic attacks
• performance anxiety
• complicated grief
• stress reduction
• dissociative disorders
• disturbing memories
• sexual and/or physical abuse
• body dysmorphic disorders
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