‘One foot in the present and one in the past’: understanding EMDR therapy

A clinical social worker demonstrates Eye Movement Desensitization and Reprocessing, or EMDR, therapy using a stimulation technique called a

A clinical social worker demonstrates Eye Movement Desensitization and Reprocessing, or EMDR, therapy using a stimulation technique called a “butterfly hug,” which includes alternating hand clapping, in Cambridge, Massachusetts, on Sept. 15, 2022. (Sophie Park/The New York Times)

Trauma causes the mind to work too much. The brain tries to block out parts of an accident: the spray from shattered glass when one car collided with another, the smell of smoke. Sometimes people with post-traumatic stress disorder (PTSD) restrict their lives and avoid streets, smells or songs that make them think about what they have experienced. But the memories are present: in nightmares, flashbacks and intrusive thoughts.

Since PTSD was included in the Diagnostic and Statistical Manual of Mental Disorders in 1980, therapists have found a number of therapies that help people cope with traumatic memories. Over the past decade, a seemingly unconventional treatment has become part of the established therapies.

Eye Movement Desensitization and Reprocessing therapy, better known as EMDR for its acronym in English, might seem far-fetched to an observer. This practice involves convincing people to process traumatic memories while simultaneously interacting with images, sounds, or sensations that activate both sides of the brain. Perhaps patients move their eyes from side to side following the therapist’s finger or fixate on bursts of light that appear alternately on the sides of a screen. The idea is that the patient’s brain is grounded in the present moment while remembering the past.

In recent years, EMDR has garnered a lot of attention, thanks in part to increased demand for trauma treatments during the pandemic and celebrities sharing their experiences. Prince Harry filmed an EMDR session for a documentary series with Oprah. Sandra Bullock mentioned that she turned to EMDR after a stalker broke into her home in 2014; “The Good Place” actress Jameela Jamil wrote on Instagram in 2019 that EMDR “saved my life.”

Perhaps patients seeking EMDR do so from another source: “The Body Keeps the Score,” the influential book about trauma that has been on the list for more than 200 weeks. New York Times bestselling books. Bessel van der Kolk, the book’s author, promotes the treatment as one of the most effective ways to combat PTSD symptoms. “Actually, it is no longer an innovative treatment. It’s a very well established thing,” he noted.

What is EMDR?

In 1987, facing her own disturbing memories, psychologist Francine Shapiro developed EMDR, first experimenting on herself, moving her eyes from side to side as she walked through the park, and then slowly beginning to bring the treatment to others.

Therapist Deborah Korn demonstrates Eye Movement Desensitization and Reprocessing, or EMDR, therapy using tactile sensations with a clinical social worker at her office in Cambridge, Massachusetts, on September 15, 2022. (Sophie Park/The New York Times)

Therapist Deborah Korn demonstrates Eye Movement Desensitization and Reprocessing, or EMDR, therapy using tactile sensations with a clinical social worker at her office in Cambridge, Massachusetts, on September 15, 2022. (Sophie Park/The New York Times)

Therapists apply EMDR in eight phases that typically take six to twelve sessions, though that number varies from person to person. Each session lasts between 60 and 90 minutes, approximately. The therapist first asks about the patient’s current challenges in order to gather information related to her history, and then comes up with a treatment plan, explained Deborah Korn, therapist and co-author of “Every Memory Deserves Respect.”

The patient may have to “go back in their minds” to something before their current symptoms, Korn said, and analyze a recent emotional outburst or panic attack in order to isolate the triggers that caused them. The goal is to identify a traumatic memory that the patient can overcome in later phases of EMDR.

“Most people don’t come in saying, ‘I want to deal with my traumatic memories from ages 5 to 11,’” Korn explained. “Rather they say: ‘I am very unhappy’”.

The patient and therapist then devise coping strategies, such as breathing exercises or meditation to help combat dissociation, which the patient can use if they become distressed during or between sessions.

As these strategies are determined, almost always after one or two sessions, the therapist asks the patient to recall the most difficult aspect of the traumatic event. It could be an image, a sound or a smell that intrudes on her thoughts more often; for some patients, the most vivid trauma-related memory occurred just before the event occurred, said Sanne Houben, a researcher at Maastricht University who studies EMDR.

Patients focus on the sensations and emotions they experience while thinking about that aspect while engaging in activities such as moving their eyes, patting their body, or listening to a distant beeping sound that alternates from one ear to the other. Typically, each series of these bilateral stimuli lasts between 30 and 60 seconds.

The therapist periodically asks the patient what they are noticing or feeling and encourages them to view that memory from a today’s perspective. “If you say, ‘It was my fault,’ the therapist may ask how old you were and if you really think you could protect yourself as a child,” said Vaile Wright, senior director of healthcare innovation at the American Psychological Association. . “It’s not just sitting still and thinking about the memory.”

How does EMDR work?

Making the patient relive the past on purpose is not unique to EMDR; most therapies to treat PTSD, such as cognitive processing therapy and prolonged exposure therapy, encourage patients to “actively go into the trauma,” said Shaili Jain, a PTSD specialist at Stanford University.

Reliving the trauma can activate the body’s stress response: cortisol levels skyrocket and heart rate accelerates. But over time, the process may gradually desensitize you to your memories, habituating your body to the stress and anxiety you experience when faced with something that reminds you of that trauma.

“The fight-or-flight reaction goes down quite a bit, so you’re back in control of your life,” Jain said. “Instead of spreading detonators.”

With EMDR, in theory, the added component of bilateral stimulation anchors the patient in the present moment as they deal with the trauma. “We use the phrase: one foot in the present and one foot in the past,” said Marianne Silva, a clinical social worker and EMDR practitioner at the New England Department of Veterans Affairs Health Care System.

Bilateral stimulation needs to be persuasive enough to divert patients’ attention, but not so overwhelming that they focus entirely on it. For example, multiplication tables would require too much effort, explained Richard McNally, a professor of psychology at Harvard University.

Is EMDR effective?

Today, EMDR is generally considered by therapists to be an effective treatment for trauma. The World Health Organization and the American Psychological Association have recommended it for people with PTSD, and have published guidelines for applying the treatment. In England, the National Institute for Health and Care Excellence, a very rigorous authority in the field of psychology, lists EMDR as a tool for adults coping with trauma and for children who have not responded to cognitive therapy trauma-focused behavioral

However, scientists debate whether EMDR is more effective than other methods of treating trauma. Pim Cuijpers, professor of clinical psychology at the Free University of Amsterdam, reviewed nearly 80 studies on EMDR and found that while the research pointed to positive effects of the treatment, “the quality of the research is actually very poor,” he said.

Cuijpers noted that many psychological treatments lack rigorous study, but the evidence for EMDR was especially weak; the sample sizes were very small and there was potential bias on the part of the therapists conducting the research.

He also stated that while EMDR is very likely to be effective, unconditional endorsement of the evidence behind the treatment is not recommended.

Also, there are few studies showing that EMDR works in the long term, said Henry Otgaar, a researcher and professor of forensic psychology at Maastricht University in the Netherlands.

Otgaar, Houben and other scientists are investigating whether EMDR increases a patient’s susceptibility to false memories. Although the generation of false memories is a risk in many therapies, according to Houben, “it is too early to know if that is inherent in EMDR.”

When EMDR became more widely publicized in the late 1990s and early 2000s, McNally, then a trauma researcher, was one of the most outspoken critics of the treatment, writing in the Journal of Anxiety Disorders that EMDR was “just one of many therapeutic fluffballs currently littering the landscape of psychology.” He acknowledged that this therapy can desensitize people to their memories, but he didn’t think there was convincing evidence that the therapy’s most distinctive feature—eye movements—had any additional benefit. At this time, it is still debated whether processing traumas with a therapist would produce similar results; Jain calls it “the million dollar question.”

However, there are patients and therapists who swear by this treatment, along with enough “hard data” to back it up, Jain said. According to Wright, patients report fewer PTSD symptoms, as well as fewer flashbacks and intrusive thoughts after sessions.

© 2022 The New York Times Company

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