Eye movement desensitization and reprocessing is a trauma treatment that often produces results when nothing else will. But what is it, and how does it work?
By Quinton Skinner | Experience Life March 3, 2022
Nancy knew there were things about her mental state that were unusual. On the surface, her adult life was ordinary: She was married with children, living in a small community in Nevada. Yet she could remember only small fragments of her childhood, and she had various inexplicable anxieties, such as a mysterious fear of the dentist and difficulty having her picture taken.
Although Nancy had more or less resigned herself to her fears and curious lack of memory, events in her life spurred a change. After a family member called to reveal having been molested by their grandfather — and coming to terms with this in therapy — Nancy was in shock. She began to wonder about her own experience, which prompted her to explore therapy for herself.
She learned about a treatment called eye movement desensitization and reprocessing (EMDR), which seemed to promise great relief for people who had experienced extreme trauma. She decided to try it.
During therapy sessions, Nancy discovered and revisited serious abuse from her childhood. She learned that she had posttraumatic stress disorder (PTSD) and had spent much of her life in a dissociative state in order to cope.
And she finally began to heal.
Nancy’s story intersects with another that began decades earlier. In 1987, Francine Shapiro was a psychology student taking a walk through a park in Northern California, trying to come to terms with a disturbing memory. She spontaneously began to move her eyes back and forth rapidly. What happened next surprised her.
“The thoughts disappeared,” Shapiro wrote later. “And when I brought them back to mind, their negative charge was greatly reduced.”
Shapiro went on to pioneer EMDR treatment, experimenting on herself and others. She developed a protocol that asks subjects to track a therapist’s finger back and forth with their eyes while calling to mind unpleasant and traumatic memories.
EMDR routinely spurred recovery, though, in the beginning, theories and data to support the success stories were slim. That’s no longer the case.
In 2017, the U.S. Department of Veterans Affairs and Department of Defense named EMDR one of three therapies assigned the highest level of evidence in its clinical guidelines for the management of posttraumatic stress.
The Roots of Trauma
To understand how and why EMDR works, it helps to begin with what trauma is and what it does to the body and mind. “When a traumatic event occurs, the brain perceives it as life-threatening or dangerous,” says Jane McCampbell Stuart, MA, LMFT, a St. Paul, Minn.– based EMDR therapist. “What happens next is one of three primal reactions: fight, flight, or freeze.”
Such a potent experience of fear can scramble our cognitive coherence. “The more intense the visceral, sensory input from the emotional brain, the less capacity the rational brain has to put a damper on it,” writes Boston University psychiatry professor Bessel van der Kolk, MD, in his renowned book The Body Keeps the Score.
A traumatic crisis activates the primal, survival-oriented parts of the brain, most notably the amygdala, which scans for danger and governs the fear response. This adaptive strategy is as old as our species, and it’s a useful one. But when the reaction gets locked into place — as it does when we’re unable to move forward after a traumatic experience— it can create lasting damage.
“Essentially this is the prolongation of responses that are meant to be life-saving,” says James S. Gordon, MD, founder and executive director of the Center for Mind–Body Medicine and author of Transforming Trauma: The Path to Hope and Healing. “Long after the trauma is over, there is a continuing of these responses. It persists. We stay in the state we were in when the trauma happened.”
These aftershocks can be as straightforward as remaining afraid of dogs after being bitten once. But often the effects are more complex and pervasive, such as the PTSD experienced by people who have endured sexual abuse, family violence, or the fallout from war.
“The signs and symptoms are extensive, and their range is incredibly broad,” says psychologist Deborah Korn, PsyD, senior faculty member of the EMDR Institute and co-author (with Michael Baldwin) of Every Memory Deserves Respect.
“When you don’t know your body is holding trauma, you don’t understand the reactions you’re having to otherwise benign stimuli in the world.”
“Classic PTSD symptoms include intrusions: nightmares, flashbacks, and the experience of having the past continuing to intrude into the present. Also, people may have difficulty sleeping, a hypervigilant nervous system, or a tendency to live in a more constricted way, emotionally shutting down and avoiding situations that remind them of the trauma.”
Present events can cause a person to reexperience even a seemingly unrelated trauma. Commonly known as triggers, these experiences can create emotional and cognitive dysregulation that may manifest in substance use, self-harm, relationship difficulties, or a pervasive sense of anxiety.
Research suggests that traumatic memories often produce psychological and physiological reactions that operate beneath our conscious reach. “When you don’t know your body is holding trauma, you don’t understand the reactions you’re having to otherwise benign stimuli in the world,” says Korn. “It’s hard to make sense of why you’re doing what you’re doing, and this can sometimes lead to bad decisions.”
This helps explain why unprocessed trauma can be so disruptive to an otherwise normal life. “Yes, you need to detect whether somebody is getting upset with you,” explains van der Kolk, “but if your amygdala goes into overdrive, you may become chronically scared that people hate you, or you may feel like they are out to get you.”
There are many approaches to healing trauma, including talk therapy, and the results are often mixed. A trauma may feel so deep, so chimeric, that understanding it intellectually simply doesn’t move the needle. This is where EMDR can make a difference.
Integrating the Experience
“Basically, EMDR is a memory-focused psychotherapy,” says Korn. “Because traumatic memory works differently, we don’t want to keep cutting the weeds and having them grow back.”
In Every Memory Deserves Respect, Korn’s coauthor, Baldwin — a trauma survivor and EMDR client (not Korn’s) — describes his phobias, his difficulty forming romantic relationships, and his reliance on status and workaholism as reactions to his core experiences of childhood trauma. Like many, Baldwin went through much of his adult life without considering that trauma had actually shaped his personality.
This is a common blind spot, stemming from the idea that if one’s own trauma doesn’t seem to measure up to that of others, it must have had no impact. “We need to demystify trauma,” Gordon argues. “Trauma comes to all of us, and not because we are singularly cursed. Trauma is part of being human. Indigenous people [who will often use rituals, such as talking circles, to acknowledge harm] have always understood this. It happens to all of us.”
Trauma-related experiences can affect the formulation of our personalities in many ways. If we experience abuse from a caregiver during childhood, for example, this trauma may “lock in” to our nervous system, shaping how we relate with others. EMDR seems to offer hope for unlocking these modes of behavior.
“Trauma comes to all of us, and not because we are singularly cursed. Trauma is part of being human.”
“EMDR purposely tries to examine what memories are being triggered in [someone’s] current life,” explains Korn. “Exploring back from current symptoms, we identify and ask the person to focus on the traumatic memory, and then ask a series of questions meant to fully activate the memory: What image represents the worst part of it? What negative beliefs are you having about yourself? What feelings are coming up? Where are you feeling this in your body?” (See “13 Strategies to Deal With Your Emotional Triggers” for expert advice on handling our trigger reactions.)
There’s no hierarchy of better or worse memories to investigate; all that’s required is the client’s willingness to explore backward into a memory that feels troublesome. Although many traumatic memories are buried beneath conscious reach, more accessible memories can often reveal paths to their hidden counterparts during therapy.
EMDR treatment also relies on a physical practice called bilateral stimulation, explains Korn. This may include clients moving their eyes back and forth, following a light or the therapist’s fingers; listening to tones that alternate between ears; or having their therapist tap their hands, alternating side to side. Sometimes clients cross their arms and tap their own chest or shoulders in an alternating right–left pattern.
Korn explains: “This bilateral stimulation seems to jump-start the brain’s information-processing system, which became dysregulated at the time of the trauma because of too much overwhelm.”
Examining symptoms, exploring memory, and using bilateral stimulation: These EMDR techniques are practical yet powerful, helping patients to retrieve memories that have become locked in to emotional and physical loops and process them peacefully into the cognitive narratives of their lives.
“It’s this beautiful way of rewiring the brain,” says McCampbell Stuart. “Things we had a big reaction to in the past don’t really register the same way anymore. Things that had us on the ceiling can become minor irritations. You face the encounters in the past and go through them in a different way. The emotional charge is gone.”
How EMDR Works
A wide range of meta-analyses have found concrete beneficial effects from EMDR. One that was published by the Permanente Journal cited a range of positive results, with most studies reporting better and faster outcomes than talk therapy alone.
Randomized clinical trials also support EMDR’s efficacy, with the most measurable results appearing to be in treating PTSD. In one study of refugees diagnosed with PTSD, researchers found that at a follow-up assessment conducted five weeks after finishing treatment, 49 percent of participants no longer qualified for the diagnosis.
Other positive results have come in treating populations — including children — who have experienced natural disasters, and individuals enduring trauma from acute sickness as well as chronic disease.
So, what exactly enables people to reprocess traumatic memory and integrate it into a healthier psyche? No one is sure. There are three working theories, each of which is the subject of research:
The Rapid-Eye-Movement (REM) Sleep Model
This first theory proposes that rapid bilateral eye movements create a brain state similar to REM sleep. “The brain has a natural information-processing system,” explains McCampbell Stuart. “You have sights, sounds, smells, and information that we place around them. Then it’s like you have a librarian who figures out how to catalog it all — that happens during REM sleep. The librarian comes in and decides what to keep and where it belongs, so you can check out the book if you want to but don’t have to keep reading it if you don’t.”
Trauma prevents those memories from making it into the information-processing system, she adds. They’re like overdue books sitting at the bottom of one’s psychic closet.
The REM model suggests that EMDR’s bilateral eye movements enable the librarian to process the memory like a book that’s finally been returned. It’s placed back on the shelf and “integrated” with the rest of the collection.
The Orienting-Response Model
Korn explains the second theory this way: “The act of orienting to a moving target forces the brain to constantly shift its attention, from one side to the other and then back again.” This activity appears to downregulate the threat response, allowing the rest-and-digest system to take over. This enables the brain to perform certain tasks or process information more readily.
The Working-Memory Model
More than 40 studies support this third theory. Its central tenet is as follows: “Working memory” allows us to hold a memory in mind while doing something else. Korn cites the example of remembering a recipe while cooking.
But working memory has its limits, so when we focus on a traumatic memory while performing bilateral stimulation — using both types of recall at once — it reduces the reaction. Korn explains: “Trying to do both at the same time overtaxes the system, leading to a reduction in the vividness and emotionality of the traumatic memory.”
For the moment, none of these theories fully accounts for EMDR’s efficacy. Hard data may eventually emerge that connects dreams, EMDR, and waking experience in a thoroughly explanatory way. But for now, researchers have found an effective if inscrutable tool for integrating the memories that dog us. For many trauma sufferers, that’s enough.
Steps to Healing Trauma with EMDR
EMDR is effective, but there is no magic cure for trauma’s aftereffects. Mindful self-care is crucial regardless of the treatment strategy one chooses.
“I’ve seen EMDR make a very important difference,” says Gordon. “My own feeling is that everyone also ought to have the basic techniques of self-care and mutual support, and then build on those foundations with approaches such as EMDR.”
McCampbell Stuart suggests that anyone dealing with trauma make a point of reconnecting with their body, possibly with practices such as yoga and Pilates. “So many of us walk around in a completely dissociated state, out of our bodies, so it’s good to feel your physical core,” she says.
“Everyone also ought to have the basic techniques of self-care and mutual support, and then build on those foundations with approaches such as EMDR.”
When it comes to taking steps to find a therapist, Korn has a simple message: “Don’t wait.”
“Anyone who is suffering, anyone who is having trouble putting the pieces of their life together in a way that is meaningful, should look for help,” she says. “You don’t have to figure it all out before you come to EMDR therapy.” (Thinking therapy may be your next step to healing? Consider the following factors in “How to Find the Right Therapist“.)
For her part, Nancy still attends EMDR sessions regularly. (For some, the therapy can be short-term and specific. For others, it can be more open-ended.) She has processed some of her most profoundly disturbing memories, but she’s also made sense of the story of her life and come to understand her emotions more fully.
She’s overcome her fear of dentists and has been able to place some necessary distance between herself and some hurtful family relationships.
Most importantly, she has found meaning in her experience. “I’ve come out on the other side and feel like the person I was meant to be,” she says. “I really believe that somehow my brain protected me; I needed to be in the right place and it needed to be the right time for me to be able to deal with this — to break the silence and finally say that I’m not going to live like this anymore. My life has forever changed.”
How to Find an EMDR Practitioner
Therapists who are fully licensed in their mental-health field and take specific training in EMDR theories and techniques can become certified to practice EMDR through the EMDR International Association (EMDRIA). EMDRIA maintains a directory of certified practitioners on its website. It’s searchable both by location and by name of the therapist.
Additionally, EMDR Institute, Inc., maintains an online database geared toward finding a certified clinician. The websites for both organizations are also good places for a general audience to find resources such as studies and answers to common questions.
“Find someone who is EMDRIA-certified or an Approved Consultant,” says EMDR therapist Jane McCampbell Stuart, MA, LMFT. “And also trust your gut. If someone doesn’t ‘get you,’ don’t keep going. Find the right person for you.”
This article originally appeared as “All Eyes on EMDR” in the March 2022 issue ofExperience Life.