EMDR Therapy: what does it mean, and how does it work?
Most of us experience stress and upset after a disturbing or traumatic experience. While memories of these events often fade in intensity over time as part of the automatic functioning of the brain, for some people, the emotional impact remains as vivid as the day it happened. It's almost like reliving the event, even years or decades later, with the same emotional intensity. This phenomenon, known as intrusive memories, is an important aspect of the healing that takes place in EMDR Therapy.
Today, let’s look at what EMDR Therapy means, how it works, what you can expect from a session, and how it can help you process those distressing (traumatic) memories which until now have retained their vividness and emotional intensity. So you can go about your life without having to worry that a wave of old feelings, visual flash-backs and physical sensations take over and impact your sense of freedom, safety and joy in the moment.
Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR) was first developed to reduce post-traumatic stress disorder (PTSD) and the treatment of trauma. It was developed in 1987 by Francine Shapiro.
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Let’s look at how our brain processes events
Why do we remember certain events, forget others, and some never seem to lose their emotional intensity?
If I were to ask you what you did on your 15th birthday, which guests attended and what type of gifts and cake you received, those details will have most likely faded away. Yet if your favourite auntie flew over from Australia as a surprise and unexpectedly stood on your doorstep, you will recollect that specific birthday. Likewise, if your parents had a massive row that morning and told you they were divorcing, you will also remember that birthday very clearly. Even mundane details like the weather or which clothes you wore might be retained.
This is because the parts of our brain connected to memory storage, our hippocampus (in charge of holding short-term memories and sending them to long-term storage), working hand-in-hand with our amygdala (the processing centre of our emotions), decide to hold on to emotionally charged and highly emotional arousing experiences (a thread or a reward). While neutral memories are automatically send to long-term storage. So when there is a pleasure or pain attached to the memory, then it’s less likely that the hippocampus moves the memory to long-term storage.
In a nut-shell, the memory of making a cup of tea goes immediately into long-term storage. Burning ourselves while making a cup of tea remains vivid for days. Developing third degree burns and having to go to hospital stays with us forever.
Neuropsychology of Memory
Let’s go a bit deeper into the neuropsychology of the brain and how it stores memories.
Every experience we have begins with a set of sensations (sight, touch, smell, taste, hearing). These sensations, whether pleasurable or traumatic, provide the brain with raw data. Our bodies take in this sensory information, which the nervous system translates into an electrochemical language our brain can understand. This process, called transduction, turns sensations into perceptions. It is this perception that we use to make sense of the experience, not the original sensations. And this perception gets mixed with other perceptions related to other memories.
The part of our brain that receives these perceptions is the hippocampus. It acts as a short-term holding area for memories. Because the hippocampus has limited storage capacity, most memories are eventually discarded and sent to long-term storage in the cerebral cortex. The hippocampus works closely with the amygdala, a brain region responsible for emotional processing. The amygdala helps the hippocampus prioritize memories based on their emotional significance. This is why we're more likely to remember an event like a bicycle accident compared to a routine taxi ride.
However, some memories, particularly those associated with strong emotions (like the pain and pleasure principle mentioned above), may become ‘stuck’ in the hippocampus. This can lead to a phenomenon called memory consolidation failure, which is often seen in individuals with Post-Traumatic Stress Disorder (PTSD) or Complex Post-Traumatic Stress Disorder (C-PTSD). To explain the difference in a simplified way; PTSD is related to a single life-threatening traumatic event. While Complex PTSD relates to experiencing prolonged and repeated interpersonal trauma.
A person with (Complex) PTSD might repeatedly relive a traumatic event, feeling the same intense emotions and sensations as if it were happening again in the present, complete with vivid sensory details and intense emotions. This suggests that the memory has not been fully processed and isn’t yet stored in long-term memory. When triggered the intrusive memory wakes up like a bear from its winter sleep, overtaking one’s emotions, physical sensations and ways of behaving. EMDR Therapy is a simple yet really effective method to transfer these memories into long-term storage, relieved from their emotional intensity.
“While EMDR Therapy can't erase your memories, we can work together to reduce their emotional impact and the associated negative beliefs. You will never forget what happened to you, but you will find relief from the emotional load, and your memories will lose their emotional potency.”
- Karin Peeters -
The definition and meaning of EMDR Therapy explained
What is EMDR Therapy and how does it work?
During Eye Movement Desensitization and Reprocessing (EMDR) Therapy you’re invited to sweep your eyes from side to side while recounting disturbing or traumatic events. This technique helps to dissociate the emotional experience of the trauma from the memory, allowing you to recall disturbing experiences without feeling the same levels of stress.
EMDR Therapy has tested bilateral stimulation - meaning movement from side to side - with visuals (moving your eyes from side to side for example by following the movement of the finger of the therapist), with sounds (by using beeps in one ear at a time) and with touch (by tapping on each shoulder at a time, like in a butterfly hug).
The rationale behind being exposed to bilateral stimulation is that the hippocampus has limited capacity, making it challenging to focus on multiple tasks at once. The hippocampus has to choose what to pay attention to. By diverting part of our attention to an external stimuli, like following your therapist's finger, the emotional intensity and vividness of the traumatic memory is reduced. The hippocampus will move these memories into the long-term storage, without their emotional charge. These bilateral stimulations supress the activity of the amygdala (the part of the brain involved in reward and threat detection - like stress and anxiety), making you less fearful and more at ease.
EMDR Therapy aims to process the original incident(s) by reducing their emotional intensity, so that when an in-the-now event triggers a distressing memory, you can remain calm and in charge of how you wish to respond.
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“Changing the memories that form the way we see ourselves also changes the way we view others. Therefore, our relationships, job performance, what we are willing to do or are able to resist, all move in a positive direction.”
- FRANCINE SHAPIRO -
Let’s make sure you won’t be re-traumatised in therapy
What to expect from an EMDR Therapy session?
When we repeatedly recall a disturbing memory, especially one associated with strong emotions, it can feel like reliving the trauma. This is not what EMDR Therapy is about. It is supposed to make you feel better, not worse. Here is an outline of what you can expect from your EMDR session with your psychotherapist. It might be slightly different as described below, but this will give you a good idea if the therapist is skilled and experienced in EMDR Therapy, and will make you feel safe in having an idea of what to expect from the session.
The standard EMDR Protocol begins with a Life History and a full assessment, giving the therapist a wider understanding of your life and your well-being.
At the beginning, you will be taught simple yet profound techniques to deal with any stress that might arise, for example breathing and grounding techniques. This will help you to feel safe and in control during the EMDR, knowing you have the tools to calm yourself down if needed. And it also helps you between sessions, when you are at home, to regulate your emotions. The Safe Place Meditation is often used in this phase of EMDR Therapy. And so is 12345 Mindfullness of the Senses.
Then you’re asked to describe your recollection of the distressing or traumatic event you’d like to work on.
The next step is to ‘freeze-frame’ the most disturbing part of the memory. This can be unpleasant, and it can help to imagine you’re watching a movie and you are asked to press pause on the remote control at the image that represents the worst part of this memory. This gives us a visual frozen target image to work with.
Now the therapist will inquire what negative words go best with that picture, words that describe your view of yourself now. This is called a cognition, or a negative belief you are carrying with you from the traumatic incident. Your therapist might have a pre-written list of cognitions which you can read, circling those that resonate most with you. Examples of negative cognitions are “I can’t trust myself”, “I am a bad person”, “I should have done something”, “I am weak”, “I am going to die” or “I am powerless”.
Then we’ll measure how true this negative cognition feels right now on a rating scale from zero to seven. This is called the Validity of Cognition (VOC) scale. This is an important aspect, as we will go back to measuring this statement throughout the course of the EMDR Therapy, and it should start to feel less and less true. Eventually it should transform into a more positive cognition, for example “I did the best I could”, “I am good enough”, “I am safe now”, “I have choices now” or “I can safely show my feelings”.
Next is the Float Back Technique. It could be that the memory you have chosen to work with has an earlier history. You’ll be asked to ‘float back’ to a time much earlier in your life, when you have felt similarly and when the same negative cognition felt true. If something arises, the therapist might suggest to work on this earlier memory first. At the FAQs part at the end of this article it’s explained how memories are stored in drawers based on a similar theme, and how doing EMDR on the root event will tidy up the entire drawer.
Once we’ve decided together which memory to work on, you will be asked to hold that frozen target picture in mind. What emotions do you feel? Which sensations do you experience in your body? Which thoughts go through your mind? You will be asked to rate on a scale from zero to ten how disturbed you are feeling, right now, while focussing on the target image. This is called the Subjective Units of Disturbance (SUD) scale. These SUDs will also be measured throughout the course of your EMDR Therapy, and ideally should go all the way to zero.
At this point, the bilateral stimulation will start by following the therapist’s finger, or a horizontally moving dot on the computer screen. This is the desensitization phase (that’s where the name “Eye Movement Desensitization and Reprocessing” comes from). You can hold up your hand at any time if you wish to stop. If you’re OK to continue, the therapist will indicate when to stop the eye movements to process what happened for you. This will repeat itself several times, often over the course of a series of sessions.
Once the disturbance (SUDs) at seeing the target image has gone to zero, and the negative cognition (VOCs) no longer feels true, we will scan your body to check if there is anything left to work on. To firmly secure the new positive belief, the final step of the EMDR Therapy takes place, in which we’ll measure how true to positive cognition feels while holding the target image in mind.
Frequently Asked Questions related to EMDR Therapy
Can EMDR Therapy be done online?
Yes. The therapist might invite you to follow a horizontally moving dot on the computer screen. Or to attach two sticky-notes onto the sides of your own computer, which you will look at in turn.
Why do I find myself talking about the same event many times?
By recounting and repeating the stressful experience your brain uncouples the stress / fear response and the heavy emotional load from the traumatic event. By revisiting the memory through journaling, therapy, or talking about it with friends, we can gradually reduce the emotional intensity and the vividness of the sensory imagery. This is why you might find yourself telling the same story to your friends or therapist many times. It’s a way for the brain to allow the vividness of the sensory mental imagery (the sounds, smells, visual objects etc) to fade away. Over time we remember it more vaguely, and less intensely.
What if I have not one, but many disturbing memories?
The good news about EMDR Therapy is that when we work on one memory, we automatically work with all the memories that have similar perceptions. Imagine your memory as a wardrobe with drawers. Then imagine that each drawer has a theme, like “I’m not lovable”, “I can’t trust people” or “It’s my fault”. When we work on one specific memory and reduce its emotional vividness, naturally all the related memories will lose their intensity. This is because the underlying negative cognition (the belief you developed about yourself in relation to those memories) will be transformed into a healthier self-belief.
Does EMDR Therapy work?
There is no scientific evidence that explains how EMDR works, as we don’t have enough information how the brain processes trauma. We simply do not quite know yet if these eye movements work. But based on the thousands of satisfied patients reports, it seems to make a difference for many.
Is EMDR Therapy possible for trauma from a time you can’t remember?
The amygdala, responsible for detecting threats and rewards, develops earlier than the hippocampus, which is responsible for storing memories. This means that young children can experience fear or anxiety (made aware by the amygdala) without being able to explain why (as it’s not possible to be connected to an actual memory). Before the age of 2 or 3 years old, we often have no conscious memories of traumatic events due to the undeveloped hippocampus. Plus, we literally had no words yet (called the pre-verbal phase in psychotherapy) and therefore a lack of language to describe these events. So we might not have a story to describe our memories, but our body remembers and can suddenly feel frightened, overwhelmed or stressed, without understanding why. These early emotional experiences can shape our later development, even if we don't consciously remember them. And EMDR Therapy can be applied without having much or any details about the memory. We’ll work with the physical sensations, emotions and, if present, thoughts that you are currently aware of.
I hope that reading about EMDR Therapy has taken away your trepidations and that you are now actually looking forward to giving it a try yourself with a skilled and kind practitioner.
May your always feel the freedom to decide your own reactions, instead of being in the awful throw of old painful memories taking over outside of your control. I wish you an ever increasing serenity and stillness, and infinite happiness.
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