Christina Hoppin, MS, LCPC
Brief and Simple Introduction to EMDR
EMDR (Eye Movement Desensitization and Reprocessing) is a method of therapy widely used today. For the purposes of this article, EMDR will be discussed in regard to how it can help people who have experienced trauma. Very simply stated, EMDR involves a participant accessing traumatic material/events followed by an EMDR Trained therapist starting “bilateral stimulation.” EMDR allows the participant’s brain to process the traumatic material in an adaptive way, leaving the participant less distressed about the traumatic event/s.
What Do the Letters “EMDR” Mean?
Shapiro named the method she stumbled upon many years ago, Eye Movement Reprocessing. Desensitization was added to the name by Shapiro in 1990, after she had more observation of what was happening during EMDR. She admitted (2001, 1) that this name does not accurately portray the complex method.
The EM stands for eye movement. In truth, eye movement is only one type of bilateral stimulation. Eye movements were the only type of bilateral stimulation known at the time EMDR was founded/named and therefore the only type that made it into the name.
The D stands for Desensitization and means a reduction in emotional or physical reactivity. After EMDR, a person will be able to think of a once traumatic event and not become as distressed or overwhelmed emotionally. They will have healthier beliefs about themselves and the world around them. The physical sensations related to the trauma should decrease if not disappear. EMDR can also be used to strengthen positive feelings, thoughts, and states. EMDR can help people improve performance. EMDR can also help people build confidence for future events. Thus, “desensitization” is not the only benefit EMDR can offer (Shapiro 2001, 1).
The R stands for Reprocessing. This term does not capture everything that happens during EMDR. When one employs this type of therapy, the information being processed is being processed adaptively for the first time. So, the word “REprocessing” is not entirely accurate. Furthermore, as noted above, reprocessing is not always the goal for EMDR. EMDR can be very helpful in building support for people, such as skills not previously taught, self-soothing, confidence in responding well to future events.
Accessing Traumatic Material
In her book, Eye Movement Desensitization and Process Second Edition, (2001), EMDR founder, Francine Shapiro discussed the components helpful in gaining access to a traumatic event/memory. A participant can access traumatic material in several ways. One way is by thinking of the traumatic material, being in a car accident for example, and briefly concentrating on one image of the accident, such as the passenger’s arm flailing. Another way to access the traumatic material is by briefly concentrating on the emotions, such as fear or sadness, that come up when a participant thinks of the traumatic material. A participant can gain access to traumatic material by identifying a negative belief that formed as a result of the accident, such as, “Driving is never safe; I have no control.” Lastly, another way a participant can access the traumatic material is by briefly concentrating on the bodily sensations that come up when the participant thinks of the accident. Trauma is stored in the body as well as in the brain, so people often experience physical sensations when addressing traumatic material. In the case of a car accident, a participant may notice sensation where their injuries occurred or where/how their body wanted to move during the traumatic event but could not. If the participant was trapped in the car, for example, the participant might experience an urge to move their legs.
Why is it helpful to identify so many different “components” (image, emotions, negative beliefs, and physical sensations) of the traumatic material? Because, according to Shapiro, (2001) the brain stores traumatic material in a fragmented way, rather than in a cohesive, clear, and chronological way. For example, a person might experience intense emotions at times but not have any imagery or conscious understanding of what the emotion is related to; the imagery and emotions of the traumatic event are not stored together. A specific example would be getting into a car crash at 8 years old, not having any imagery or knowledge of the car crash accessible to conscious memory as an adult but experiencing intense emotions, bodily sensations, or negative and unrealistic beliefs anytime this adult is in a vehicle. For the purposes of EMDR, identifying any of the components (image, emotion, belief, physical sensation) will help get access to the traumatic event. Ideally, the participant will be able to access all of the components, as that suggests the traumatic event will process more quickly. The participant might not consciously link the components together or remember the event but starting with one component and adding bilateral stimulation can lead to processing the traumatic event in an adaptive manner.
According to Shapiro, (2001), “bilateral stimulation” is what allows traumatic material, even if stored in fragmented ways, to be processed rapidly and adaptively. Bilateral stimulation in EMDR means that the therapist and the client work together to rhythmically stimulate both sides of the participant’s body, which leads to stimulation of both sides of the participant’s brain. When the participant is accessing the traumatic material and bilateral stimulation is added, the traumatic material is processed adaptively by both sides of the brain working together, as they normally do when processing all information coming into our nervous system. According to Shapiro (2001), bilateral stimulation can be achieved in different ways. Eye movement across the centerline of the body in a rhythmic manner is one way to create bilateral stimulation. The clinician will move an object back and forth in front of the participant’s eyes from one side of the participant’s peripheral to the other. Eye movements were the only bilateral stimulation mode known at the time EMDR was named, so eye movements are the only mode that are included in the name, EMDR. There are other ways to create bilateral stimulation that are just as effective. One way is holding rhythmic pulsators in each hand. Another way is listening to audio tones as they sound in one ear and then in the other ear rhythmically.
We do not know exactly how/why bilateral stimulation works to allow for adaptive processing and why it allows forrapid processing of traumatic material. We know that the participant must be able to stay grounded and present during EMDR for the material to process. If a participant dissociates, the material will not be processed. Bessel Van Der Kolk wrote in his book, The Body Keeps the Score, (2014, 219-220), “[a] trauma can be successfully processed only if all [the] brain structures are kept online.”
Adaptive Processing vs Trauma-Affected Processing
EMDR founder, Francine Shapiro introduced the Adaptive Information Processing (AIP) model. In her book, Eye Movement Desensitization and Process Second Edition, Francine Shapiro asserted that the brain and body naturally work toward healing (2001, 15). If we get a small cut, the body will heal the cut without any intervention by us. The AIP model asserts the same about the brain. Normally, the brain processes incoming information adaptively–so we can link new information to old, we can learn from the new information, we can integrate all parts of the information together (emotional, visual, etc.), and we can think of the information/event without overwhelming distress (Shapiro 2001, 15).
So, when might the brain and body be unable to function normally? According to Shapiro (2001, 15), “The system [brain and body] may become imbalanced because of a trauma or because of stress engendered during a developmental period.” What does Shapiro mean by “trauma” and “stressed engendered during a developmental period?” For trauma, she is referring to any event/s that cause the brain and body to shift from functioning normally to overwhelm. When overwhelmed, similar to conscious overwhelm, the brain and body cannot perform at their ideal levels. For example, an injury such as a deep cut leaves the body overwhelmed. The body is not capable of healing a gashing wound on its own. The wound will require professional intervention (stitches). A car crash can be overwhelming enough to the brain to cause Post Traumatic Stress Disorder (PTSD) symptoms for longer than 6 months and to require professional intervention to heal. An event becomes a traumatic event when it overwhelms the system to the point that the system cannot heal from the event on its own. This will lead to the traumatic event ending up stuck, locked, fragmented, and insufficiently processed in the nervous system.
When an event cannot be processed, different parts of the event (details, emotions, beliefs, images, bodily sensations related to the event) get stuck in the nervous system. This is why survivors of such events experience PTSD symptoms: flashbacks - feeling as if they are re-living part of the traumatic event; fragmented memories of the event - when the survivor remembers certain parts of an event but not the entire event or when the survivor experiences intense feelings without imagery to inform them why; the survivor might hold strongly to negative and unreasonable beliefs, such as (using the car crash example), driving will always be dangerous and or will always end in an accident; Finally, the survivor might experience great difficulty and distress when even thinking about driving a car.
That explains what Shapiro meant by trauma and how trauma imbalances the system. What did she mean by “stress engendered during a developmental period?” She is referring to what has become known as Developmental Trauma and/or Childhood Relational Trauma (neither formally recognized in the most recent Diagnostic and Statistical Manual). If the brain is overwhelmed during a specific developmental period, deficits related to that period in development may last throughout adulthood unless there is trauma-informed intervention. Childhood Relational Trauma includes, but is not limited to, chronic or ongoing abuse, neglect, maltreatment, or suffering a significant loss in childhood and/or adolescence. Relational Trauma disrupts attachment, identity, security, safety, relationships, meaning-making, mood, etc. throughout adulthood without trauma-informed intervention. Shapiro (2001, 16) stated, “...the [AIP] model regards most pathologies as derived from earlier life experiences that set in motion a continued pattern of affect, behavior, cognitions, and consequent identity structures.”
Developmental and Relational Trauma healing often requires much more time and work than PTSD caused by specific, isolated incidents, such as a car crash. Prior to starting EMDR processing, a participant will need to have or build self-soothing techniques to help manage the distress EMDR might bring up. (Shapiro 2001, 121). Shapiro discovered that using bilateral stimulation in a slower manner actually strengthened what the participant was experiencing at the time (2001, 126). From there, Shapiro developed guided imagery exercises for an EMDR Trained therapist to use with participants and added slower bilateral stimulation, which strengthened the feeling of safety or calm in the participant (2001, 126). In Laurel Parnell’s Attachment-Focused EMDR Course: A Clinician’s Guide to Healing Trauma and Developmental Deficits (online course 2018), Dr. Laurel Parnell discusses that some participants of EMDR require some structures to be added to their resources before EMDR processing begins. This idea is similar to needing to teach what to do, not just what not to do. Skills may need to be taught. The abstract may need to be defined. If a child did not experience nurturing, for example, the idea or structure of nurturing in the brain and body will need to be built. Parnell uses a combination of imagination and bilateral stimulation to repair such developmental deficits. For example, the therapist can help the participant imagine what a nurturing mother would look like and feel like and how this nurturing mother would respond to the participant in a nurturing manner. Then the therapist can use slower-paced bilateral stimulation to strengthen the understanding and imagery and feel/sense of nurturing.
Where Did This Bizarre Technique Come From?
In 1987, EMDR Founder Francine Shapiro (2001, 7) “While walking one day, I noticed that some thoughts I was having suddenly disappeared. I also noticed that when I brought these thoughts back to mind, they were not as upsetting or as valid as before… Fascinated, I started paying very close attention to what was going on. I noticed that when disturbing thoughts came into my mind, my eyes spontaneously started moving very rapidly back and forth and in an upward diagonal. Again the thoughts disappeared, and when I brought them back to mind, their negative charge was greatly reduced.” Shapiro re-created her experience with others, leading them in eye movements similar to what she experienced that day. And here we are. It is interesting to think back to the rhythmic movements, dances, music, noises, rituals our ancestors created and practiced on a consistent basis. Maybe they did not have the science down, but had they unlocked the miracle of bilateral stimulation?
How Has EMDR Evolved?
EMDR continues to gain momentum today in the ways it can help people. There are now EMDR “scripts” or protocols for almost anything one can imagine. Staying loyal to the overall protocol that Shapiro introduced long ago, we have also learned ways to modify EMDR and to use it in other helpful ways. Maybe one day we will unlock the secret behind the mystery of how and why EMDR works. Until then, I encourage you to wonder if EMDR could help you. I encourage you to research it. If you decide to participate, please ensure the clinician you are working with has completed the Basic EMDR Training.
Shapiro, Francine, Eye Movement Desensitization and Reprocessing Second Edition. 2001, The Guilford Press
Van der Kolk, Bessel, The Body Keeps the Score. 2014, Viking Penguin
Parnell, Laurel, Laurel Parnell’s Attachment-Focused EMDR Course: A clinician’s guide to healing trauma and developmental deficits (Online Course) 2018, PESI In