About trauma
While many people are able to process negative events using their own resources, some experiences are so traumatic and/or happen at such a vulnerable age, that the brain becomes overwhelmed and is not able to process information as well it would otherwise do. The traumatic experience is then stored in a raw or “unprocessed” form in the brain. This makes it very difficult for the trauma survivor to recall the traumatic event without at the same time re-living the emotions, body sensations, sights, sounds, smells and negative thoughts associated with the event. Psychological distress increases because of intrusive images of the traumatic event and this often results in a strong desire to avoid any reminders of an event. Avoidance behaviors can become a lifestyle through social withdrawal, substance abuse and a constant need to keep the mind occupied. The need for safety and control after a traumatic event can lead to impairment of interpersonal relationships and work performance, as well as changes in mood and self-esteem. A diagnosis of Post-Traumatic Stress Disorder reflects functional impairment brought about by an inability to recover from traumatic events.
Eye Movement Desensitization Reprocessing
Eye Movement Desensitization Reprocessing (EMDR) is an effective psychotherapy approach for treating trauma, recommended by the American Psychiatric Association, the American Psychological Association, the World Health Organization and the International Society for Traumatic Stress Studies, among others.
Current thinking on how EMDR works involve a model of how memory works. Events from the past are stored in long-term memory, which has a large capacity, whereas our short-term, or working memory, is relatively limited. Our working memory is what we use to perform everyday tasks and the more tasks you attempt to do, the more difficult it becomes to perform each task well. In an EMDR session, the client is asked to recall and hold onto an agreed upon traumatic event from their long-term memory, which places the memory into the working memory of the moment. At the same time, the therapist attempts to distract the client from thinking about the memory by introducing a series of tasks that tax the working memory. A competition for the limited resources of the working memory is established and in the process, when a session is successful, it becomes impossible for the client to hold onto the traumatic memory in the same way it was stored previously in the brain. Consequently, the vividness and emotionality associated with the traumatic memory begins to fade, leaving only the recollection of what occurred. Various distraction tasks are used, including but not limited to, following the therapists hand with the eyes, following lights on a light bar or a ball in a software program, noticing changes in colors, tapping, arithmetic, spelling, or moving while standing.
There tends to be two reasons why EMDR may not work. The first reason is that the client is not fully accessing an identified traumatic memory. This can happen, if for instance, the client is embarrassed or ashamed about the traumatic event, or the image of the worst part is so horrific the client cannot bring himself or herself to share it, or the client has concerns about losing control when recalling a traumatic memory. In the case of a client not being willing to share a traumatic memory, the client can be assured that is not necessary to do so for the treatment to be effective. In the case of a client being afraid of losing control, the therapist helps the client identify the worst image of what they are afraid will happen and that image then becomes the first target to work on. After the fear of losing control is removed, the original target can be treated. An alternate approach is to use techniques to recall a traumatic memory in a very gradual and controlled way. The second reason why EMDR may not work is that the therapist is not taxing the working memory enough. People vary on their ability to perform multiple tasks, so the therapist is prepared to increase the diversity and complexity of tasks.
Phases of treatment
There are eight phases in EMDR treatment. The first two phases involve the therapist assessing the client’s readiness for treatment, taking a history of the presenting problem, identifying targets for treatment (considering past, current and future possibilities), developing a treatment plan and preparing the client for treatment. In the first few sessions, the therapist is also determining if EMDR is a good fit. Factoring into this decision is the client’s overall life circumstance, strengths, ability to manage emotions and the presence of substance abuse. The middle phases involve identifying the most disturbing part of a given target, negative thoughts about self and preferred thoughts about one’s self related to the target, emotions and body sensations related to recalling the experience and a rating of distress in the moment. Desensitization to the experience then occurs by taxing the working memory, while the client simultaneously attempts to hold onto the disturbing memory. Body sensations may also become the focus of desensitization. There is a check-in between sets as to what the client is experiencing and a periodic re-rating of the target for intensity. Once the intensity reduces to neutral, or no disturbance, the positive thought the client identified earlier in the procedure is re-rated. The last two phases involve a closing procedure for the session and a re-assessment procedure, at the start of the next session.
Length of treatment
An EMDR session typically lasts 60-90 minutes. The length of treatment varies depending on the amount of trauma a client has experienced. Single incident trauma can often be treated successfully in two or three sessions, whereas with clients who have had multiple traumatic events, as children and/or adults, treatment can take considerably longer. Each persons recovery is unique though and sometimes even clients with complex trauma histories can make rapid progress. The amount of preparation time each person requires prior to the desensitization phase of EMDR can also extend treatment. EMDR can be an intense emotional experience and while every effort is made to reduce distress in a session, it is not uncommon for a session to end with a client having uncomfortable feelings. Therefore, clients need to be prepared for the intensity of sessions and have healthy coping skills for managing their emotions between sessions. Generally, more preparation time is required for clients who will benefit from learning emotion regulation skills.