Introduction to EMDR
The precise neural mechanism for how eye movements affect emotional status is unclear, but the fact is they do. It is almost as though a broad view of the horizon from left to right, and right to left also helps the mind to place events within the broader context, or for both hemispheres of the brain to work together.
In some respects this is nothing new. We have all experienced the calming effects on a stressful day of going for a stroll in the countryside, enjoying the view from a hill-top or from looking out over the sea. However, in some instances such as child abuse, sexual assault, physical assault or other severe traumatic events the experience can become mentally ‘blocked’, and unless worked through – or ‘processed’ can become utterly debilitating.
EMDR now has an excellent evidence-base for demonstrating its effectiveness, in the right safe, therapeutic environment for treating patients who have suffered from these forms of trauma. Some senior psychologists have explained the therapeutic effect of eye movement in technical terms such as, “tasks, such as eye movements, that tax working memory during recollection of stressful memories attenuate their vividness and emotionality during subsequent recollection”. In plain English this means that EMDR therapists can help their patients to re-visit the situation without causing undue stress.
Is EMDR really different from CBT?
The World Health Organization (WHO) describes the difference between Cognitive Behavioural Therapy (CBT) and EMDR. As EMDR is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories, treatment involves focusing simultaneously on the following:
- Spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and,
- Bilateral eye stimulation.
In this way EMDR reduces distress whilst also strengthening positive attributes that are related to the traumatic event. However, unlike CBT, EMDR does not involve detailed descriptions of the event, direct challenging of beliefs or extended exposure, or even the need for homework.
My Approach with EMDR
Many nations let alone individuals have suffered immense trauma. The Polish suffered huge deprivations and violence during the wars and have a saying, “What doesn’t kill you can make you stronger”. Possibly the most important word in this sentence is ‘can’, because it is about whether the experience is processed positively (healthily) or negatively – and this is where professional help is often needed. It must be emphasised that post-traumatic stress is not a form of weakness, it is a perfectly normal human reaction, but the memory has to be processed appropriately.
One of my patients as a small boy had been beaten up by a gang of other older boys who also used a knife on him. The patient had suppressed this event for years and was initially very unwilling to discuss his experience. This reluctance was not because of the nature of the assault itself, but because the event had terrified him and he was ashamed of the fact that he had been scared. He felt that a ‘real man’ would have reacted differently.
Anyone else looking at this situation objectively can see it for what it is. However, because the traumatic event had not been appropriately processed the patient had become ‘stuck’. This lack of processing manifested itself in later life in symptoms including mental paralysis or panic attacks, even in relatively non-fearful situations, and was therefore utterly debilitating.
The application of EMDR within a totally safe environment allowed this patient to speak of the event, re-explore the experience, to put things in context and to see things for what they were. The positive effect of understanding that the fear was only of fear itself was profound and effectively turned a massively negative experience into a positive one.
My Therapeutic Approach
EMDR should really be conducted within a highly supported environment, such within a professional rehabilitation centre, where the patient feels completely safe. EMDR utilises a series of psychological techniques to place the patient in a calm and serene state of mind, but does not involve hypnosis and the patient remains completely in control. I use a series of sense-related mind scenarios that helps the patient to be placed in a situation that means complete safety, such as being on a beach, listening to music or cuddled in the arms of a loved one. However, this safe place must not be contaminated in any way by any part of the trauma.
It sometimes takes a series of sessions and I will always avoid going in too deep until the patient feels entirely comfortable. However, at some point during the therapy the patient will be encouraged to explain and describe the most horrific part of the incident. For example, the worst memory in the event of a stabbing may not be the physical assault itself, but the look in the eyes of the attacker. The patient might be asked, “if we were watching a DVD, at what point or view would you pause?”
The real point about EMDR is that you can talk about things until the cows come home, but at some point the trauma will need to be physically removed and this requires re-living the experience. What is quite remarkable is that the patient will sometimes re-experience the actual physical pain. In one patient who had been strangled, the symptoms of the bruising actually reappeared temporarily on her neck. However, the effect is only short-lived and the beneficial impact of unblocking and immediate reprocessing is immense.
EMDR can be used to treat a range of different problems including trauma. Various athletes use the method to overcome situations where they have a block, and it can also be used to treat phobias.
Although EMDR is a relatively new therapeutic approach originally used to treat PTSD by the Department of Health it is causing a lot of excitement and there is a rapidly expanding wealth of evidence to support the use of this method. However, I must stress that this is a technique that should only be performed by a highly trained practitioner and within the right, safe environment.