I tested the procedures in a randomized study that was published in the Journal of Traumatic Stress in 1989. Then I continued the development of the procedures and published a textbook on EMDR therapy in 1995.
2. Can you give us a glimpse into an EMDR session with a client with PTSD?
EMDR therapy is an eight-phase approach. It begins with a history-taking phase that identifies the current problems and the earlier experiences that have set the foundation for the different symptoms, and what is needed for a fulfilling future.
Then a preparation phase prepares the client for memory processing. The memory is accessed in a certain way and processing proceeds with the client attending briefly to different parts of the memory while the information processing system of the brain is stimulated.
Brief sets of eye movements, taps or tones are used (for approximately 30 seconds) during which time the brain makes the needed connections that transform the “stuck memory” into a learning experience and take it to an adaptive resolution. New emotions, thoughts and memories can emerge.
What is useful is learned, and what is now useless (the negative reactions, emotions and thoughts) is discarded. A rape victim, for example, may begin with feelings of shame and fear, but at the end of the session report: “The shame is his, not mine. I’m a strong resilient woman.”
3. EMDR helps clients process their experiences, but they don’t necessarily have to discuss the details or relive them. So how does EMDR help clients process problematic experiences?
There are very few research-supported trauma treatments. The other two besides EMDR that are best known ask the client to describe the memory in detail because it is necessary for the therapy procedures that are used.
In one of these (Prolonged Exposure therapy), the clients are asked to describe the memory in detail 2-3 times during the session as if reliving it. The rationale for this treatment is that “avoidance” is causing the problem to persist and the clients need to learn that they can experience the disturbance without going crazy or being overwhelmed. For the same reasons, they are also asked to listen to recordings of the event for homework and visit places they previously avoided in order to allow the disturbance to abate.
The other form of treatment (Cognitive Processing Therapy) asks clients for details of the event in order to determine what negative beliefs they hold so they can be challenged and changed. This is done during sessions and with homework.
In EMDR therapy, the emphasis is on allowing the information processing system of the brain to make the internal connections needed to resolve the disturbance. So, the person only needs to focus briefly on the disturbing memory as the internal associations are made.
A Harvard researcher has published a couple of articles detailing how the eye movements in EMDR therapy seem to link into the same processes that occur during rapid eye movement (REM) sleep. This is the time that dreams take place and the brain processes survival information.
According to the theory, the memory is then transferred from episodic memory, which holds the emotions, physical sensations and beliefs that were stored at the time of the original event, into semantic memory networks, where the person has “digested” the experience so that the accurate personal meaning of the life event has been extracted and those negative visceral reactions no longer exist.
In an EMDR session you can observe these connections being made as learning rapidly takes place through the internal connections.
4. Is there an explanation why trying to reproduce REM responses helps people recover from PTSD? In other words, do we understand the underlying mechanism any better yet?
There are now about a dozen randomized studies that have examined the effects of the eye movement component in the context of the REM hypotheses. They have found supportive results such as decreases in physiological arousal, increases in episodic associations and increased recognition of true information.
Another dozen studies have shown that the eye movements serve to disrupt working memory.
About another dozen studies using brain scans have observed significant neurophysiological pre-post EMDR therapy changes, including an increase in hippocampal volume.
However, there are still more questions to be answered. In fact, there is no definitive neurobiological understanding as to why any form of therapy, as well as most pharmaceuticals, works.
5. Since EMDR therapy is done by a trained professional, what kinds of self-help techniques do you discuss in the book that take from the EMDR world of techniques and theory? (Please give an example or two of specific techniques mentioned in the book).
I’ve included a wide range of self-help techniques that will allow people to (a) manage stress, (b) change their emotions, physical sensations and negative thoughts in the present, (c) help get rid of negative intrusive images, (d) identify situations that trigger these kinds of reactions and help prepare for them in advance, and (e) identify the unprocessed memories that are causing the negative reactions.
Additional techniques include ones taught to Olympic athletes to achieve peak performance. These can also help people prepare for future challenges such as presentations, job interviews and social situations.