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|"Eye movement desensitisation and reprocessing (EMDR) is now well established as an effective way to treat post-traumatic stress disorder (PTSD). Robin Logie reviews the evidence for this approach, and explains how bilateral stimulation of the right and left sides of the brain enables traumatic experiences to be ‘metabolised’, learned from and stored safely away for reference. However, increasingly, practitioners are successfully using these same techniques with a range of other mental health conditions that are trauma-related, from depression to obsessive compulsive disorder, and in pain management" |
|"Paul Sibson and Robin Ticic describe how memory reconsolidation – the process of uncovering and releasing emotional memories buried deep in the unconscious – can free a client to change deeply entrenched, unhelpful patterns of belief and behaviour. The technique is universal; it is the ‘engine of change’ in a wide range of interventions, including EMDR and emotion-focused therapy (EFT), they point out. Using a case study to illustrate the process, they outline the three main stages whereby a client is helped to identify and bring into their conscious mind an unconscious, emotional learning rooted in early experience, expose it to the light of present-day reality, and replace it with that reality so it no longer dictates how they feel and behave"|
- Category: Features
Less than 20 years after Dr Francine Shapiro discovered Eye Movement Desensitisation and Reprocessing (EMDR), its effectiveness as a psychological treatment is well established
EMDR comes of age
In March last year, the National Institute for Health and Clinical Excellence (NICE) validated EMDR as a preferred method of treatment for post-traumatic stress disorder (PTSD), an outcome based upon an abundance of research studies highlighting its effectiveness. There is still much to be learnt about how and why it works, but there can be no doubt that it does.
After hearing some remarkable results from EMDR six years ago, I decided to undertake some training. Since then, I have come to increasingly integrate EMDR into my practice, using it to treat a wide range of psychological problems successfully. My belief is that much of the scepticism about EMDR amongst professionals stems from misconceptions about its use and application as a therapy. There is also, understandably, a degree of confusion as to how we, as therapists, might expect to use EMDR without compromising or abandoning the various therapeutic approaches we have trained in. Far from threatening the integrity of established therapies, however, EMDR represents a synthesis of the major approaches to counselling and psychotherapy and can be readily integrated into any therapeutic approach. Furthermore, research into PTSD and EMDR, alongside advances in neuropsychobiology and sophisticated techniques such as brain-imaging, is heralding an understanding of how brain and body deal with trauma. This, in turn, might help us to understand how therapy can affect changes on a physiological level – a process that EMDR can accelerate.
Back in 1989…
What are the eye movements all about? In 1989 psychologist Dr Francine Shapiro took a walk through a park, preoccupied by a distressing personal situation. As she walked, she noticed her eyes were spontaneously tracking from side to side. She also realised this was followed by a marked reduction in her level of distress. Shapiro decided to take these observations further, testing them out in clinical trials. Over time, she went on to develop the treatment that became known as EMDR. In the process, she discovered that it was not the eye movements themselves that were important, but the effect that the movements had upon the brain.
This effect is known as bilateral stimulation, whereby each lobe of the brain is stimulated alternately in a rhythmic pattern. As well as using eye movement, the same result can be achieved by tapping the client’s hands, or by auditory cues alternating between left and right through a set of headphones. Thus EMDR can utilise a range of different modalities to achieve the same effect in the brain. A current and convincing theory1 is that this replicates similar brain activity to that which occurs during REM sleep – a time when we process information and consolidate memory. In this way, EMDR sets in motion a natural brain function that allows people to reach an adaptive resolution.
But why is this important? In order to answer this we need to understand what happens naturally in the brain when we process experiences – and what happens when the brain is ‘blocked’ by the overwhelming experience of a traumatic event.
Shapiro2 describes the natural processing function of the brain as ‘Adaptive Information Processing’ (AIP). The AIP model posits that, just like other systems of the body, the physiological systems of the brain that deal with the assimilation of experience have a natural healing mechanism. In much the same way as, when the body is cut, it closes and heals, so, in processing information, the brain naturally seeks means of dealing with and rationalising life experiences in a way that allows them to be understood and managed.
Thus we will think about our experiences; we will talk and express feelings about them; we will dream about them. Over time the ‘emotional charge’ attached to some distressing experiences diminishes. We integrate the experience into our cognitive memory as part of our overall life experience until it has little or no negative impact upon us in the here and now: we develop an ‘adaptive’ understanding of events.
However, when a person experiences a traumatic event, the body will typically go into a fight/flight/freeze response. The part of the brain activated in dealing with the memory is the amygdala, the seat of the limbic system, and the most primitive part of the brain. The amygdala is linked to the primary senses of vision, smell, sound and physical sensation. It does not have a cognitive function, and the stored memory is often fragmented. Thus sensory triggers can often take us immediately back to a traumatic event or, in PTSD, trigger a flashback.
Neuro-imaging with SPECT scans3 have shown that, over time, memory is assimilated, and appears to move to another part of the brain – the neo-cortex. But in some cases the trauma is so overwhelming that the natural, adaptive process is blocked, and the person remains ‘stuck’ with the concomitant distress. With what we might call ‘Big T’ traumas, the symptoms of PTSD may develop. More commonly, we encounter the ‘Small T’ traumas – memories of upsetting incidents, often from childhood, which may continue to have a negative impact on our present behaviour and relationships. In childhood we may lack the cognitive skills or the necessary information to process these events successfully. Most of us would agree that one of the main purposes of therapy is to address the unresolved issues triggered by early experience. How we choose to tackle this will depend on our preferred approach. This is where EMDR can be integrated into any methodology – by targeting memories, both big and small ‘T’ traumas, so that clients develop a more ‘adaptive’ response to them in the present.
In this way, EMDR fits in with a past-present-future model. In desensitising painful memories, EMDR allows the client to shift to a more positive view of themselves in relation to the past event – a view more congruent with their reality in the present. One of my clients described it like having his mind ‘reset to a different default position’. After an EMDR session, he noticed his thought pattern when faced with present anxieties had shifted from ‘I can’t cope with this’ to ‘it’ll be all right because I can handle it’. What is more, he said that, although he had known that intellectually before, he now actually felt it to be true and was no longer getting the same physiological symptoms that had been familiar to him in previous anxiety-provoking situations. In earlier sessions we had discussed his history, identified the sources of his anxiety and the impact on his present. He had learned techniques for challenging his thoughts and managing some of his physiological symptoms. We worked with EMDR as part of the treatment, targeting childhood events that he saw as pivotal to his present view of himself.
EMDR in action
In order to give an example of how this works in action, we’ll look at another client. John, who was in his late 40s, experienced great anxiety about his coming marriage and seriously doubted he would be able to go through with it. Following the breakdown of his previous marriage, two years of therapy had helped him to understand a lot of his issues. He was aware of the impact that a dominating mother and a similarly controlling wife had had upon him. However, here he was, some years later, terrified and panicstricken. I suggested we use some EMDR. The following is an extract from the ‘setup’ phase of the EMDR protocol, preceding bilateral stimulation. It shows how we can bring experiential, relational, emotional, physiological and cognitive aspects together in order to tap into and set off the body’s natural healing mechanism, the AIP system.
We agreed to target a particularly distressing memory of the anxiety he had felt daily from the age of six, waiting for his mother to come home from work, never knowing whether she would reprimand or embrace him.
Therapist and client are sitting in close proximity side by side facing one another. In the interests of brevity and clarity, I have not included the positive and negative rating scales used to assess the level of emotional intensity before and after the treatment.
Therapist: When you think about that distressing memory, John, what image represents for you the worst part of it?
John: I can see myself looking up at the door, feeling very small and hearing the key turn in the lock.
T: As you see yourself in that situation, what negative thought or belief do you have about yourself (now)?
J: I’m really worried that she is going to hit me. I don’t feel safe. Yes, that’s it, my thought is ‘I am not safe’.
T: And thinking about that incident and that negative belief ‘I am not safe’, what would you prefer to believe about yourself now?
J: Well, I’d like to believe that I can take care of myself. I am a grown man, after all. T: And how strongly do you feel that to be true?
J: Looking at that image, I can’t say that I feel it to be true at all. It feels like I am still that little boy.
T: So what emotions are you feeling?
J: Fear, sadness, some anger as well.
T: And how strong do those emotions feel right now?
J:Surprisingly strong actually. I am feeling really tearful and emotional.
T: And where do you feel it in your body?
J: In my chest and stomach mostly and I’m also very tense in my legs.
T: So with that image in mind and those negative words ‘I am not safe’ and noticing where you are feeling it in your body, I’d like you to track my fingers with your eyes and just let whatever happens, happen.
At this point we started with horizontal eye movements from side to side. From that starting point, during 40 minutes of processing and some 20 sets of eye movements, John spontaneously:
– recalled other incidents where his mother and exwife had berated him
– felt intense rage and sadness
– experienced intense physical sensations in his chest, legs, stomach and head
– acknowledged that as a six-year-old boy he could not reasonably be expected to take responsibility for his mother’s outbursts, and felt compassion for himself
– realised that ‘getting it right’ for his mother had been impossible – recognised evidence of his success in life and his personal skills and resources
– acknowledged that his present partner was consistent in her loving responses to him and could be trusted
– felt that he was capable of standing up for himself.
At the end of the processing he reported that the image of the original target was much more distant and that he looked much bigger. He had no emotional response to it but felt calm and relaxed. He was also feeling much more at ease about the future and confident that he could take care of himself.
At the next session, John reported feeling much less anxious and was in fact getting quite excited about the wedding. He had been able to express his fears and communicate with his partner at a level of intimacy he had never before felt safe enough to allow. Furthermore, he decided to visit his mother’s grave, something he had previously been unable to do. We used EMDR at this point to rehearse the upcoming event and process any residual anxieties.
During the processing, following the set-up described, I made no interpretations or connections, although later we talked about what had come up. The processing was entirely client-centred. In many ways the process is like witnessing free association at warp speed. The role of the therapist in EMDR is often one of ‘bearing witness’. Having said this, it is a very active role in that the unusual proximity to the client enables one to notice even slight emotional and physical changes and can result in deeper empathy.
Clients and therapists alike consistently report EMDR as a very powerful therapeutic experience. While the process mirrors a route that might sound familiar to therapists, the journey is travelled at accelerated speed and leads to tangible results. However, it is not a simple technique and a brief description of one phase cannot do justice to the complexity of the eight-phase treatment. EMDR is based on a very precise protocol4 and calls on the therapist to use all their therapeutic skills.
Sian Morgan, Dip Couns is a counsellor and psychotherapist working in private practice in Brighton and Hove. She is trained in both humanistic and psychodynamic approaches and is a senior accredited member of BACP. She is an Accredited EMDR Practitioner and EMDR Facilitator involved in training therapists in EMDR. Sian is also a member of the national executive committee for EMDR and Ireland Association. For further information about EMDR and training in EMDR go to www.emdr-uki.org
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