by Penny Boreham
How EMDR (Eye Movement Desensitization and Reprocessing) began
Dr Francine Shapiro
It is always fascinating and revealing to unearth how particular therapies were developed.
One of the therapies we use at Khiron House is EMDR. The purpose of this therapy (which involves alternating left-right stimulation of the brain with eye movements, sounds or taps) is to stimulate frozen or blocked information processing.
EMDR therapy was originally developed twenty seven years ago by the psychologist and therapist, Dr Francine Shapiro.
A Walk in the Park
Dr Shapiro describes how the first inklings that led her to develop EMDR came to her when she was walking in the park in 1987. She began then to realise that certain thoughts brought about particular eye movements and that eye movements themselves appeared to decrease the negative emotion associated with her own distressing memories.
“I started paying close attention and I noticed that when [a particular] thought came to mind my eyes started moving in a certain way and the thoughts shifted from consciousness and when I brought them back, it wasn’t that intense.”
She describes her immediate intuition about these eye movements: “I thought I had stumbled upon some mind process that worked with thoughts “
The eye movements she was making were rapid, diagonal movements called “saccadic” movements. So Dr Shapiro immediately started to check whether there was any basis to her intuition that eye movements could have a desensitizing effect, and she found that others also had the same response :-
“So, I wanted to see if it could work deliberately. I brought up something that bothered me and moved my eyes in the same way and I found the same thing. I reached out to all my friends, basically every warm body I could find, and asked them if they had something they wanted to work on. Everyone did… I started having them follow my hand in order to make the same eye movements and that’s how I developed the process. Then I did a controlled study, which was published in the Journal of Traumatic Stress in 1989”.
Dr Shapiro randomly assigned 22 individuals with traumatic memories to two conditions: half received EMD (which was it’s original name), and half received the same therapeutic procedure with imagery and detailed description replacing the eye movements. She reported that EMD resulted in significant decreases in ratings of subjective distress and significant increases in ratings of confidence in a positive belief. Participants in the EMD condition reported significantly larger changes than those in the imagery condition.
She confirmed that it could be a useful tool for those who had experienced deeply distressing and traumatising events and had found their memory had “become frozen at a neurological level”.
Controversy about EMDR
Dr Shapiro encountered resistance in the trauma field:
“The view of the field was that PTSD was pretty impossible to treat and here I published an article on a randomized controlled study showing positive effects after one session and with eye movements, which didn’t make any sense”.
Dr Shapiro has always been keen to point out that EMDR therapists should only be trained through reputable and recognized training bodies. At the same time as becoming more and more convinced of its power so Dr Shapiro began to stress more definitely that it should be a tool in the hands of an experienced therapist.
EMDR contextualized in the the therapeutic space
Dr Shapiro was clear that just as a “scalpel is a tool for a surgeon” and not the expertise itself so EMDR had to be used sensitively in the context of a therapeutic relationship.
A therapy was developed in which the practitioner moved their fingers, or a wand, and asked the client to follow the movements with their eyes at certain points in the session but always in the context of cognitive, behavioural, psycho-dynamic and body centered approaches too. The eye movements part of the treatment “opens up the blocked processes and accelerates those processes without making the client fixate on their most disturbing memories, in this way the therapist is following the client’s process rather than imposing a structure”.
Dr Shapiro always recommends a series of 90 minute sessions so that the EMDR in the context of the the therapy as a whole can allow someone to feel much less disturbed, less triggered, and make room for insight and a sense of “noticing” their responses for the first time. Dr Shapiro says the result is “almost as though a digestion process has taken place”.
“In an average 90 minute session we may be dealing with the earlier memories that set the foundations for the pathology, the perceptions that were there are the time of the traumatic event, the present triggers, and teaching new behaviour patterns,in order to enhance the positive and let go of the negative”
Very early on Dr Shapiro began to think about the connection between EMD (as she called it then) with REM (rapid eye movement) sleep, and she points out that more recently research suggests:-
“that the REM state is when the brain is processing survival-related information. Back in 1989, the view was that the eye movement was the dreamer scanning the dream environment. They had no idea what it was actually doing …”
A wider diagnosis of PTSD
There are over twenty randomized controlled trials underway concentrating on EMDR, and Dr Shapiro says:-
“all of them are showing a positive effect and about half of the studies have been done by memory researchers. Dr Shapiro who believe that the eye movements disrupt working memory [one theory about how it works]. Harvard researcher Robert Stickgold has written [about how EMDR] links into the same process that occurs during REM sleep.”
Dr Shapiro wants PTSD to be more widely diagnosed:-
“What’s quite interesting at this point in the whole field of PTSD is that in order to have the official diagnosis, you need to have a major trauma like rape or combat experience, but the latest research indicates that general life experience can [produce traumatic memories]. There’s a genetic [piece] and there’s also what kind of foundation has been laid. A lot of research lately indicates that childhood adversity can set the groundwork for vulnerability to a lot of later problems. What we’re really looking at in general is that you have an information processing system in the brain that’s supposed to be geared to digest experience, to make sense of it [so that] what’s useful is incorporated [into memory] and what’s useless is let go. When something is too disturbing, it overwhelms that processing system and the memory gets stored along with the emotions and physical sensations and beliefs that occurred at the time, and that’s what gets triggered [in PTSD]”
Dr Shapiro quotes the Harvard researcher Robert Stickgold’ study of memory and EMDR and the conclusion that
“[the traumatic experience] is inappropriately stored in episodic memory — the memory of emotions, physical sensations and beliefs — and through EMDR, it gets shifted to semantic memory [narrative or verbal memory]. It is stimulating the information processing systems of the brain so that the appropriate links are made. So a rape victim may start out saying that she feels shameful, ‘I should have done something’ and has all those emotions; at end, she is saying, The shame is his not mine, and I’m a resilient woman. That’s the digested version: what needs to be learned is incorporated and what’s useless is let go”
Next week we will find out from practitioners, including our own Khiron House therapists, in what ways EMDR has had an impact on their practice.
This is part of our series of blogs which are telling the story of trauma treatment, how it has developed and is still developing every day. In this series our expert practitioners will be sharing their knowledge with you, we will be finding out what recent scientific breakthroughs are teaching us all about the nervous system, and we will be keeping you in touch with the latest news about the life transforming therapies that are becoming more sophisticated and responsive every day.
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