By Deborah L. Korn, PsyD
Eye Movement Desensitization and Reprocessing therapy, EMDR therapy for short, is a memory-focused psychotherapy that can help veterans and their families deal with the impact and legacy of trauma and adverse experiences in their lives. Over three decades ago, Francine Shapiro, the developer of EMDR therapy, discovered that purposely moving your eyes horizontally back and forth while focusing on a traumatic memory leads to a reduction in the vividness and intensity of that memory. She developed a protocol incorporating these eye movements, with the goal of treating PTSD and other trauma-related problems. Shapiro studied its application with combat veterans and rape survivors, publishing the first research study in support of EMDR’s effectiveness in 1989.
Over time, it became clear that EMDR was much more than a “desensitization” technique for reducing the fear and anxiety associated with traumatic memories; it also facilitated the “reprocessing” of thoughts, beliefs and feelings, leading to a significant transformation of one’s sense of self. Over the course of EMDR therapy, beliefs like, “It’s my fault; I’m ashamed and don’t deserve to live,” shift to “I did the best I could under the circumstances; I’m worthy and deserve to have a good life.” Those living with a sense of dread and powerlessness often experience a shift from, “I’m in danger” and “I have no control” to “I’m safe enough” and “I have choices and can take care of myself now.”
Other forms of back-and-forth “bilateral” stimulation can also help patients desensitize and reprocess their traumatic memories. EMDR therapists might have patients follow their fingers or track a light moving horizontally back and forth while focusing on a traumatic memory. Or they may play alternating tones through headphones or tap back and forth on their patients’ hands.
The theory behind EMDR is that psychological problems come from a failure to adequately process traumatic memories. Unprocessed traumatic memories, frozen or locked in our nervous system, continue to affect how we perceive things, decisions we make, reactions we have and the beliefs we hold about ourselves and others. Present day triggers—situations that somehow remind us, consciously or unconsciously, of traumatic events from earlier in our lives—activate these unprocessed memories. This leads to destabilizing symptoms like nightmares, flashbacks, phobias, negative thinking and extreme episodes of anger, grief, shame and guilt.
In EMDR therapy, a “target” trauma-related memory is identified, and the therapist activates it with a set of focused questions. The brain’s information processing system is then jump started with 30-60 second sets of bilateral stimulation. EMDR stresses the importance of “dual attention,” that is, keeping one foot in the present at all times while accessing the past. We remind our patients that what they are remembering is “old stuff” and ask them to “observe from a distance.” After each set of bilateral stimuli, the patient is asked to simply notice what (if any) changes occurred and to report any images, thoughts, feelings, sensations, impulses or insights observed.
In the course of reprocessing, patients sometimes spontaneously imagine saying or doing what they were not able to say or do in the past. They may express rage, imagine fighting back with superhuman strength, or find themselves saying “goodbye” or “I’m sorry” to someone they’ve lost. Patients may see a younger version of themselves in their mind’s eye, giving them the opportunity to offer compassion or understanding to their younger self, instinctively knowing what is needed for movement toward healing and self-forgiveness.
With reprocessing, the distress eventually decreases, the past is finally moved into the past, and patients are able to see and experience their present reality with greater clarity and perspective. There are shifts in thoughts, feelings, behaviors and physical sensations. Healing involves spontaneous movement toward more positive thinking, more manageable feelings, and a dramatic reduction in the level of disturbance experienced in one’s body.
Research involving veterans demonstrates the effectiveness of EMDR in reducing PTSD symptoms as well as a wide range of other clinical symptoms beyond PTSD, including depression, anxiety, anger, chronic pain and addiction. There have been hopeful reports of effective treatment for combat-related medically unexplained symptoms (MUS), phantom limb pain, tinnitus, headaches, insomnia, moral injury and complicated bereavement. There is also support for the treatment of acute stress reactions in active-duty military personnel and for intensive, short-term (e.g., 10 days), consecutive-day treatment of veterans with full-blown PTSD. EMDR is also being used to treat both victims and first responders in group settings in the immediate aftermath of tragedies.
There have been more than 30 randomized controlled trials (RCTs) demonstrating the effectiveness of EMDR for the treatment of PTSD in adults. EMDR is considered an evidence-based, top-tier treatment for this condition. In a study published by Carlson et al. (1998) in the Journal of Traumatic Stress, 78% of treated veterans no longer met the full criteria for PTSD after only 12 sessions of EMDR. The National Center for PTSD, part of the U.S. Department of Veterans Affairs, has stated that, “[EMDR]…is one of the most studied treatments for PTSD. A large number of studies demonstrate it is effective to treat PTSD when administered over approximately three months. EMDR has the strongest recommendation for being an effective treatment in most clinical practice guidelines for the treatment of PTSD.” A 2019 study published by Mavranezouli et al. in PLoS One reported that EMDR was not only clinically effective but also the most cost-effective of the 11 trauma therapies evaluated in the treatment of adults with PTSD.
EMDR doesn’t require that patients provide detailed descriptions of events, engage in prolonged exposure to traumatic memories, or complete homework between sessions. In a full course of treatment, the therapist and patient, together, address past traumatic experiences, current triggering situations, and behavioral goals for the future. By the end of treatment, patients often say that they feel less haunted by the past and more mobilized in caring for themselves, connecting with others and working toward future change.
For veterans and their families interested in learning more about EMDR therapy, here are some resources:
The EMDR International Association (EMDRIA)
The National Center for PTSD
MakeTheConnection.org
Deborah Korn, PsyD, is an internationally renowned pioneer and expert in EMDR Therapy. She is on the faculties of the EMDR Institute in California and the Trauma Research Foundation in Boston and is a respected member of the EMDR International Association. Dr. Korn is the co-author of Every Memory Deserves Respect: EMDR, The Proven Trauma Therapy with the Power to Heal with Michael Baldwin.
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