EMDR: A Comprehensive Approach to Psychological Well-Being
Click Here for EDMR
Click here to download Chapter 1
What Does EMDR Mean?
EMDR stands for "Eye Movement Desensitization and Reprocessing." Yes, this is a long and confusing name, but the name stuck and now it's hard to change it. It would have been easier to call it "Reprocessing Therapy," but EMDR it is.
So what is EMDR and how is it different?
EMDR is not a technique but rather a comprehensive therapy approach that desensitizes emotionally charged memories and past experiences so they can be reprocessed and understood in more adaptive ways.
In addition to desensitizing and reprocessing the past, EMDR also reduces the grip that current triggers and stressors can have us, while also providing tools to learn and develop new skills to respond to life demands.
EMDR is a brain and body-based approach that incorporates many useful and effective strategies from other forms of therapy while utilizing several strategies unique to EMDR, such as bilateral stimulation (which will be discussed below).
Essentially, EDMR helps to make your past experiences become another part of your life story so that they no longer hold you back or cause you to get triggered in the present. When your past is in the past, it becomes easier for you to begin responding to current and future situations rather than reacting to them.
Is There Research Supporting EMDR?
Yes! In fact, due to the research supporting EMDR (at least 20 randomized studies), it is now recognized as an effective treatment for trauma and other disturbing experiences by the American Psychiatric Association(1), the World Health Organization(2), and the Department of Veteran Affairs and Department of Defense(3).
To see a list of international guidelines and organizations recognizing the effectiveness of EMDR, click here(4).
To see a current list of research supporting the effectiveness of EMDR, you can visit the Francine Shapiro Library by clicking here(5).
What if I Don’t Have Post Traumatic Stress Disorder (PTSD)? Will EMDR Still Help Me?
To date, most of the formal research on EMDR and its effectiveness has been in regards to trauma treatment or the treatment of disturbing experiences.
Clinically, however, EMDR has shown to be useful for other concerns such as(6):
Body Image Issues
Preliminary investigations are also indicating the EMDR may be useful for treating:
Body Dysmorphic Disorder(9)
PTSD & the Little Traumas (little t’s) of Life
The difference between big “T’s” and little “t’s” is not so much in what happened to you but in how it impacted you. If it impacted you in a big way, you may develop what is known as Post-Traumatic Stress Disorder (PTSD).
If this is the case for you, you likely experience a range of symptoms such as flashbacks, difficulty feeling relaxed or letting your guard down, difficulty going to or staying asleep, irritability and agitation, and a sense that your life has been or will be cut short.
If your life experiences did not knock you over and completely overwhelm or frighten you, then you may not develop clinical PTSD. Rather, it may feel like your experiences or little “t’s” still had an impact on you and changed how you perceive yourself, others, and the world.
When we are not able to process our little “t” experiences adaptively, these experiences can pave the way for the development of low self-esteem, generalized anxiety, a fear of a certain object or situation, difficulty getting close to others, an inner critic or self-judgement, lack of self-trust, etc.
Very Early Little “t” Experiences
If a distressing event occurs in early childhood or even while you are in the womb, those experiences and the associated emotions and sensations can get “stuck” in the body and continue to be re-experienced to some degree as you grow up. Essentially, as Dr. Bessel van der Kolk(12) puts it, a world renowned trauma researcher and psychiatrist, the body keeps score of what happens in your life. As a result, these very early experiences can pave the path for how your body begins to react to other distressing experiences or challenges. This helps explains why many of my clients will say something like the following:
“I just don’t get why I’m reacting like this. I know different. I know better. I am smarter than this.”
According to the renowned author and cellular biologist, Dr. Bruce Lipton(13), once the body has learned a pattern (aka., a way of responding to stressors), it responds one million times faster than the pre-frontal cortex (which is our thinking brain). As a result, it is difficult to "think our way out of our worries."
The body responds much quicker than our rational logical brains. For healing to occur, we need to release what is being held in the body, re-program the body, and help the body settle and find a sense of calm. By doing this, our bodies can begin to let go of old unhelpful beliefs and begin to incorporate more adaptive and truthful beliefs.
EMDR helps your mind and body to process what it experienced in the past so these experience(s) can be left in the past; thus leaving you more able to respond to current life events and future stressors appropriately.
Simple Self-Assessment Question
An easy way to know if there is something in the past that is contributing to a present concern is to ask yourself this simple question:
Self-Question: “Am I over-reacting to certain situations?”
If you are, then there is likely some “juice” from previous experiences that haven’t been properly digested and therefore, these experiences continue to have an impact on your body’s responses to current experiences.
For a list of big “T” and little “t” trauma examples, click here.
The Adaptive Information Processing Model & EMDR
In order to understand how EMDR works, let's first go over what the Adaptive Information Processing Model (AIP) is, as this is the model that guides EMDR practice.
According to the AIP model, we have a physiologically based information processing system, which means that our experiences and memories (aka: information) are stored in a system of neurobiological memory networks. These memory networks store our experiences and memories with all the related thoughts, images, emotions, and sensations that occurred at the time we had these experiences.
When things go smoothly, life follows the principle “live and learn.” We are able to make sense of our experiences, use the information that is useful to us, disregard the information that isn't, update past experiences with new experiences, and then decide how to respond appropriately.
When our experiences overwhelm us, however, our natural ability to process information and to effectively learn from our experiences gets interrupted. If this happens, our distressing memories get stored in isolation with all the sensations, emotions, and thoughts that occurred during the initial experience. Often, the distressing sensations, emotions, and thoughts are not stored together in a cohesive memory, but rather in separate fragments, clusters, or pockets. This is why we can sometimes remember an image but not experience any emotion when we recall a past experience. Alternatively, this is also why we can sometimes “feel” an old memory but not remember exactly what happened. You might only recall one small part of the experience.
When this occurs, there is little opportunity to allow these experiences to "update" with new information, and thus, they can become "frozen in time." Often, this leads to past experiences getting triggered with all sensations, emotions, images, and thoughts that occurred when the initial experience was first stored in your body and memory. Again, you may recognise this as happening for you if you have ever found yourself saying something like “I know better so why do I react this way,” or “when ________ happens, I feel like ________ is happening all over again.”
Here are three case examples to illustrate what I am trying to describe above.
Example 1 – Being Rushed
Let’s say that as a child, maybe 4-6 years of age, you were struggling to put on your shoes. One of your parents came back inside the house and barked at you to hurry up. You tried to say that you were trying but that you need help getting your shoes on. In your parent’s frustration, he or she yelled back,
“I don’t care what you need, what’s important right now is getting into that car and doing it fast. Let’s go!”
So you scrambled as fast as you could and in a clumsy fashion, you moved towards the car with that one shoe feeling like it is not quite on right. As a child, you don’t have a lot of life experiences to make sense of what just happened, plus due to your young development and your age at the time, you had egocentric thinking and were prone to believe that what happened was your fault. As a result, this experience, which really upset you, was stored in your body with all the sensations, emotions, and thoughts that arose at that time. The sensations may have been feeling rushed, feeling tension in your chest, or a gulp in your throat. The emotions may have been frustration, sadness, feeling alone or feeling unheard. The thoughts that arose may have been:
“What I need is not important,”
“No one listens to me,”
“I’m not good at what I try to do,”
“I can’t get things done…fast enough.”
Over the years, experiences that cause similar sensations or emotions may serve to strengthen these negative beliefs about yourself thus building an unhelpful network of many memories, a network that gets triggered whenever you feel “less than.” Alternatively, this memory may be locked into its own capsule and not consciously remembered as you move through life until a later experience happens to ignite it…leaving you to wonder why you are over-reacting to this new experience.
Example 2 - Humiliation:
If you were humiliated in front of your class when you were young, then you may have thought at the time "I'm stupid" while also feeling high anxiety and tension in your belly and torso. If this experience overwhelmed you, then it may have been stored in its own memory network with little opportunity to connect with other adaptive memory networks. Information stored in other adaptive memory networks may be all the other experiences you had in being able to successfully present to groups, being well-liked by peers, being accepted even though you made a mistake, or being recognized for a job well done. As mentioned above, since this experience of being humiliated is isolated in its own memory network, it has little opportunity to update itself. Therefore, when you find yourself in a situation that seems similar, even mildly similar, to the original humiliation experience, you might find yourself getting triggered and reacting in the same way you did when you were younger. It will likely feel like you are overreacting to the current situation or you may not understand why you are reacting the way you are.
If we were to keep with the above scenario, getting triggered may lead you to feel like you are utterly stupid and worthless because you received one negative comment about your performance. For whatever reason, it may be just too difficult for you to recall or pay attention to the other supportive comments received or to respond appropriately.
If the initial humiliation experience was stored and connected with your other adaptive memory networks, then when you received the negative comment, it would have been easier for you to respond rather than react. For example, you would have been able to review your other memory networks for times you received positive feedback, when you completed your work successfully, your knowledge about the audience's frustrations and their own perspectives, and then been able to decide how you needed to respond to this particular criticism. Your response may have been to approach the person directly and ask for further feedback or to note if the comment was valid and to revise your work according.
Example 3- Being Bullied:
Let's say you grew up being bullied. You may have developed the belief that “something is wrong with me” or “I’m not likeable.” Once you entered university or the workforce, and you began to associate with people who were a better fit for you and whom liked you for who you were, you may have begun to revise your beliefs to be something closer to “being bullied hurt at the time, but that is done and over with. I now know I am likable and that I'm fine the way I am.” Additionally, as your new experiences are connected with your past hurtful experiences, you may start to notice that you no longer feel nervous around groups of people and that it feels easier for you to get to know others. This is assuming that the AIP system is working well and that adaptive connections between your previous distressing experiences and your new positive or neutral experiences are being made.
If there is a hiccup in the AIP system and adaptive connections are not made, then the healthy adaptive associations needed to learn from do not occur. Instead, these distressing experiences are locked away in their own memory networks or capsules with the emotions, thoughts, sensations, and images that that occurred at the time of the distressing event. When this capsule is triggered by a similar experience (i.e., meeting new people, having to introduce yourself, having someone flirt with you, receiving negative feedback from your boss, etc), the old experience can be relived as though it were happening again.
Example 4 - Unmet Needs:
Unfortunately, for some people, their needs may have not been adequately met while growing up. If this was the case for you, you may have learned to shut off your need to be connected with others, your sense of feeling alone, and learned you needed to “be strong and independent.” These beliefs were helpful to you while you lived in an environment that required them in order to not get hurt.
Later on, you may have gotten married, lived life fairly successfully, and then found yourself having to deal with a distressing circumstance. At this point, you may have called your spouse to ask for their help, but since they were about to go into a meeting, they cut you off and said they would call you back later. Somehow, an old wound from the past got triggered and you hung up quickly; immediately declaring that you would never ask them for anything again and that you never needed them anyway.
The current event was unexpectedly coloured by the past experiences (even ones that had not caused you trouble for awhile) of not being supported when distressed. All of a sudden, it felt like you were experiencing all the same emotions, thoughts, self-beliefs, and sensations you had then. If you were able to stay conscious enough to notice this, then you would likely have been bewildered as to why you were acting like this when it made no sense.
Put simply, when our distressing memories and experiences are not connected with our adaptive memory networks, we can find ourselves having a hard time “letting things go,” moving “past our past,” and getting repeatedly triggered by current events or life stressors. This often leads to us continuing to use ineffective coping strategies, such as yelling, shutting down, avoiding certain situations, over- or under-eating, excessive exercise, or using alcohol or drugs, to name a few.
So How Does EMDR Work?
EDMR can jump start and facilitate our natural ability to process information and to create adaptive memory network connections through the use of bilateral stimulation.
This is achieved by having clients focus on identified targets (i.e., concerns, symptoms, triggers, or memories) while using a form of bilateral stimulation (BLS).
The most common form of BLS is when a client is guided to move their eyes left and right. Although the underlying mechanisms of bilateral stimulation are not yet confirmed, it has been hypothesized that the bilateral stimulation in EMDR replicates the same information processing mechanisms that occur while our eyes move rapidly during REM dream states.
Other forms of bilateral stimulation include alternating taps on the knees of clients, having clients hold two alternating pulsators in their hands, or by having clients listen to alternating sounds. The form of bilateral stimulation used is often based on the concerns being addressed and client preferences.
Although it may seem like bilateral stimulation is not doing anything of importance, more than two dozen published randomized studies(14) have shown the effectiveness and positive effects of bilateral stimulation (as compared to not using any BLS), and more specifically with bilateral eye-movements(19). Some of the reported benefits have been:
Reduced vividness of memories
Reduced affect and psycho-physiological arousal associated with memories(15). Put more simply, this means that memories become less distressing.
An increased ability to let go of old beliefs that once felt real while being able to recognize true and more adaptive information (i.e., “I am good enough the way I am” or “I am safe now”).
How does the Bilateral Stimulation Work?
Unfortunately, modern science has not progressed to the point that allows us to understand the underlying neurobiological mechanisms for different forms of therapy, including many pharmaceuticals. This is also the case with EMDR and bilateral stimulation.
There are different theories about how bilateral stimulation (BLS) works. Put briefly, it is hypothesized that bilateral stimulation:
Increases hemispheric communication. This means EMDR helps your emotional right brain (where distressing and traumatic memories are stored) to communicate with your more logical “see the bigger picture” left brain. This bilateral communication helps isolated distressing memories to become connected to other neutral or positive experiences and memories and self-understandings. Through these connections, distressing memories can become a part of your life story, rather than triggers that continue to hold you back in life.
Stimulates a basic relaxation response. Eye movements have been associated with decreased heart rate, heart rate variability (parasympathetic system) and increased breathing rate (many of us don’t breathe properly when we are stressed or remembering something that is distressing)(16).
Improves cognitive flexibility. This means you are able to recognize and be open to more interpretations of your experiences(17).
Elicits an orientating response. This means that through BLS, it will become easier for you to pay attention to new information.
Assists with Reciprocal inhibition. This means that by using bilateral stimulation, your distressing memories become associated with a relaxed state, which then reduces how distressing your memories feel to you.
For a list of current research on EMDR and its effectiveness, please click here(18).
I'm Still Not Understanding How EMDR Works. Please Re-Explain!
Think of it this way, by trying to think positively and using this skill alone, you may be able to reduce the height of the fire’s flames. Possibly even enough to ensure the fire doesn’t get out of control or burn something. But there is still a lot of heat in the center of that fire and you haven’t taken out any of the logs fueling the fire.
Furthermore, as life continues, further experiences may add more logs to the fire or even act as a light breeze that gives more life and energy to the fire; thus causing the fire to burn more brightly.
Through the EMDR approach, we will look at which “fires” are threatening your life and causing concerns and what the fire is doing to your life (i.e., poor sleep, arguments with loved ones, inability to perform at work the way you want to, feeling like your anxiety is getting out of control, etc).
From there, we will look back over your life to identify if there are other times that you felt similar concerns or sensations and how these previous experiences impacted you. Sometimes, clients are able to go back to the first time they ever felt a certain way and we can begin processing this experience so we can lay it to rest.
Other times, clients are not able to remember the first time so we may work with the earlier times they can remember. By doing this, we are taking the logs out of the fire, which helps ensure the fire burns less brightly and thus, your current concerns begin to reduce as well.
From this point, our treatment would begin to focus on reducing what is keeping the fire burning now (i.e., current triggers) as well as what may re-ignite it in the future (i.e., anxieties about the future).
In general, EMDR has a three-pronged approach and focuses treatment by first addressing the past, then the present, and then the future. This approach has shown to have the biggest impact for clients.
For some clients, especially in emergency situations, treatment may only focus on current or future concerns to reduce distressing symptoms enough to allow for a return of some level of functioning.
If this is your preference, it will be important for you to understand that even though your immediate concerns may reduce in intensity a bit, your overall level of distress and symptoms may not be fully resolved. Therefore, you may find that you are able to manage your current concerns somewhat but that at times, you continue to experience “flare-ups.” If this is the type of treatment you would prefer, please contact me directly so that the risks and benefits of this approach can be discussed fully.
To learn more about EMDR please contact Samantha directly by clicking here. To book an appointment, please click here.