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Saturday, February 7, 2015

Psychotherapy Blog: How EMDR Works: Part 1 - EMDR and the Brain

As a psychotherapist who specializes in helping clients to overcome trauma, I learned to do EMDR (Eye Movement Desensitization and Reprocessing) about 10 years ago (see my article:  What is EMDR?).  I decided to learn EMDR because the traditional therapy that I learned in postgraduate training didn't help some of the clients who came to me who had PTSD (posttraumatic stress disorder).  I've been using EMDR with many clients ever since with positive results.

How EMDR Works

EMDR and Advances in Brain Research
When I learned EMDR, which was developed by psychologist, Francine Shapiro, Ph.D., researchers still weren't sure exactly how it worked.  They just knew that compared to other forms of therapy and compared to medication, it was more effective.

Since that time, there has been a lot more research on EMDR and brain research, so how EMDR works is starting to become clearer.

EMDR is an integrative therapy.  It combines the best of psychodynamic, cognitive behavioral therapy (CBT), and other mind-body oriented therapies.

Many psychotherapists, myself included, now also integrate Somatic Experiencing and the use of imagination, which has powerfully enhanced EMDR.

How Emotional Trauma Affects the Brain
Before discussing EMDR any further, it's important to understand how emotional trauma affects the brain.

Emotional trauma has a powerful effect on the nervous system.

How EMDR Works: Traumatic Memories and the Brain

People often have problems processing traumatic memories in regular talk therapy because these memories are stored in the nonverbal, nonconscious, subcortical part of the brain, which includes the amygdala, thalamus, hippocampus, hypothalamus, and the brain stem.

Before traumatic memories are processed with EMDR, they're not accessible to the frontal lobes, part of the brain that is used for understanding, thinking and reasoning.

Very often, individuals who are traumatized are unable to give a coherent narrative about their traumatic past because, as previously mentioned, the traumatic memories are stored in the nonverbal part of the brain.

Advances in brain scanning have shown that often when people with a traumatic history remembered these traumatic memories, the left frontal cortex (speech and logic) actually shuts down.

At the same time, the right side of the brain, which is associated with, among things, emotional states, images, and autonomic arousal and includes the amygdala, lit up on these brain scans.

This would explain why traumatized individuals have problems providing a coherent narrative about their traumatic memories--the part of the brain that is associated with thinking and speaking is "off line" when they're asked to think about the trauma.

This is also why, for many people who have PTSD, there are flashes of images from the traumatic event, but no words.

These memories also have a sense of timelessness so that people who suffer with trauma often have a hard time distinguishing "then" from "now" (see my article:  Working Through Emotional Trauma: Learning to Separate "Then" From "Now").

These emotions and sensations are often felt with such immediacy that it feels like they're experiencing the traumatic event now, even though it might have happened many years ago.

For instance, this is a common experience for veterans traumatized in battle as well as for people with other types of emotional trauma.

The corpus callosum is a part of the brain that connects the right and left sides of the brain and it helps both sides to "communicate" with each other.   It helps to integrate the emotional and cognitive parts of the brain.

Trauma, by definition, is overwhelming.  It can cause dysregulation of the body and brain chemistry.

EMDR, the Adaptive Information Processing (AIP) Model, and Bilateral Stimulation (BLS)
Francine Shapiro, Ph.D., developed the Adaptive Information Processing (AIP) model to explain the effects of EMDR.

The AIP model says that all memory is associative, and that learning occurs through the creation of new associations.

How EMDR Works:  EMDR and the Brain

For example, in order to recognize an object, your current perceptions have to link the object with your past experiences.

So, if your only experience of a stick is that sticks were used to beat you, you would have no past memories that could tell you that a stick could also be used for other things, like walking.

But if someone shows you that a stick can be used to help you walk, you can integrate this information with other similar information in your existing memory networks.

Our memory networks help us to survive in the world.  But emotional trauma causes impairment to these networks.

EMDR helps to restore the proper functioning and integration of these networks.

In order to heal from emotional trauma, to start, there needs to be an integration between the right and left hemispheres of the brain.  In EMDR this is done with "bilateral stimulation" (BLS).

Initially, when EMDR therapy was first developed, BLS only consisted of eye movements, hence the name Eye Movement, Desensitization and Reprocessing.

As advances were made in EMDR therapy, researchers and EMDR clinicians discovered that effective BLS in EMDR processing could take many forms, including alternating, rhythmic tapping, pulsing and music that alternates between the right and left ears.

Under normal non-traumatic circumstance, the brain has ways of integrating psychological disturbance.

For instance, if you have an minor disagreement with a stranger, you might feel annoyed, but it's usually not traumatic.

Part of emotional integration might involve talking to a friend or a therapist about the argument, writing about it in a journal or possibly having a dream about the incident.  These are all integrative processes for events that are non-traumatic.

But when there's a traumatic event, which overwhelms the body and the brain chemistry, talking, writing and dreaming often aren't enough to integrate the event, so it remains emotionally unintegrated.

After a while, these unintegrated memories can get triggered by other events.

The most common example that is usually given is when a veteran with PTSD returns from combat and  s/he hears a car backfiring, s/he experiences it as if s/he is back in combat.  This could include the sights, sounds, taste and other sensory experiences from the war.

There are many other types of triggers.  For instance, if you feel belittled by your boss, this could trigger what you experienced if you were belittled as a child.

The problem is that, because these traumatic memories are stored in the nonconscious part of brain, the person who is triggered doesn't realize that much of what they're experiencing is from the past.

As I mentioned before, they often have problems distinguishing "then" from "now" when they're emotionally triggered.

Due to the lack of emotional integration, the traumatic memories are stored in isolated memory networks, which remain just below the surface and ready for reactivation.

EMDR Therapy Was Developed to Help Clients Overcome Traumatic Memories

EMDR was developed to help access and process these memories.

After accessing these memories, the goal of EMDR therapy is to make connections between the isolated memory networks and functional memory networks.   This is done, as previously mentioned, with BLS.

Next Article:  Part 2 of this article: How EMDR Works will give a composite example to demonstrate how EMDR therapy works.

Getting Help in Therapy
Emotional trauma that creates psychological, physical, and interpersonal problems is much more common than most people realize.

Getting Help in Therapy


Research has shown that EMDR is one of the most effective forms of therapy to overcome emotional trauma.

If you are suffering with emotional trauma, rather than suffering alone, you could benefit from working with a licensed mental health professional who is trained as an EMDR therapist.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

I have helped many clients to overcome emotional trauma so they could lead a more fulfilling life.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.




























































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