EMDR as a Treatment for Trauma

EMDR is a therapeutic modality that stands for Eye Movement Desensitization and Reprocessing. It was developed by a therapist named Francine Shapiro in in 1989, when she noticed a healing effect from side to side eye movements for anxiety and mental distress. The approach has evolved in many ways since that time. I recently attended a 3-day EMDR training to learn how to use this modality with my clients, and I am so excited to share it, especially for those individuals with either complex or single-incident trauma in their history.  Complex trauma involves repeated exposure to abuse, neglect, life-threatening or terrifying situations. Single incident trauma, in contrast, occurs as the result of a one time traumatic event. EMDR is helpful for all types of trauma.

EMDR doesn't always involve eye movement. Researchers have found other types of "alternating bilateral stimulation" to be just as effective. I use a tool called the Theratapper, which clients hold in either hand as it pulses in one hand then the other. Below is a photo of the device. We use this tool once clients have a clear understanding of the clinical reasoning behind it, and how this bilateral stimulation seems to have a healing effect on the brain's ability to process difficult memories and experiences. 

Modern research into trauma treatment tells us that the physical body is highly involved in how survivors cope with and re-experience terrifying situations. The fight, flight, freeze response is an energetic process that occurs in concert between body and mind, and is designed to protect us. However, neural pathways that are laid down to respond in times of crisis or in times of chronic stress became habituated to be set off in similar but "triggering" non-threatening situations, which can significantly disrupt the daily lives of survivors. Disruption occurs because traumatic memory is  implicit. Implicit memories are retrieved unconsciously, beyond our desire or will, such as flashbacks and intrusions. In contrast, explicit memory is consciously retrieved when and if we desire to. This distinction is key to understanding how EMDR works in the brain to heal the lasting effects of trauma. For more information about the complex but immense wealth of knowledge we now have in trauma treatment, here are a few highly regarded books about trauma's effect on the brain and body. Much of this research supports the use of EMDR as a treatment for trauma.

• The Body Keeps the Score, by Bessel Van der Kolk
• Waking the Tiger, by Peter Levine
• The Body Remembers, by Babette Rothschild

The Essential Stages of EMDR
(from Laurel Parnell, A Therapist's Guide to EMDR)

Laurel Parnell has modified the original eight stage protocol that was developed for EMDR, to simplify the process and allow for modifications when necessary. She sums it up with these four basic steps. You'll see the first step is the most critical and takes the most time.

1. Start with Safety
EMDR therapy starts the same as any other type of therapy, with a solid assessment of the presenting concerns, and building of the therapeutic relationship. We move then into the resource-building phase where coping skills are instilled to help clients stay stable before processing their traumatic memories. The below guided imagery exercises can be used to build resources.

• We might in great detail imagine a container for the difficult mental experiences, and practice placing thoughts, feelings, memories, situations in this container when we don't have the energy or desire to manage them. 
• We might create in the mind's eye a nurturing figure that can accompany us to ease painful experiences, and ask this figure to stay with us while we are hurting. The figure can be a real person, an imagined, person, an animal or object.
• We might imagine the most comfortable place we can. This place is relaxing, calming, and safe, and it's accessible to us at any time. We use this place when we need comfort.

Resource building also includes identifying and practicing regular self care activities that help us live a balanced lifestyle, such as following a healthy diet, exercising, meditating, and engaging in activities that are enjoyable and safe. We may use the theratapper for alternating bilateral stimulation while clients are building these resources, which strengthens connections in the brain and make these resources easier to access when needed. 

2. Stimulate the Memory Network
​Once these resources and coping skills are in place, clients are ready to work with the traumatic material. The speed and way in which this traumatic material is worked through is always dependent upon the client's ability to stay emotionally stable while doing so. Clients are asked to recall what represents the worst of the trauma for them, including any emotions, beliefs or bodily experiences.

3. Add Bilateral Stimulation
​Bilateral stimulation activates the resources and coping skills needed while processing the traumatic material. Alternating bilateral stimulation activates the prefrontal cortex, keeping clients present in the moment while also intentionally contacting the traumatic memory, Activation of the prefrontal cortex moves memory from implicit (unconsciously retrieved such as in flashbacks and triggers) to explicit (retrieved when we consciously try to.) We work at the client's pace, stopping at any time the client wants to stop. A key part of trauma treatment in instilling the sense of personal choice. 

​4. End with Safety
​It's essential that after a session of trauma processing, clients are able to leave feeling safe and emotionally stable. This can be accomplished by a few moments of wrapping up, speaking about what they will be doing when they leave the session, going over other treatment goals and making a plan for the next session, having a few moments of silence, taking a few moments of intentional breathing, or using any of the resourcing activities described above that can maintain emotional stability. 

For more information about trauma, EMDR, and other treatment interventions, I recommend visiting Linda Curran's website at ​https://www.trauma101.com/ and our page discussing treatment for trauma at Flourish.