How EMDR Therapy Works: 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) in 2005 (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.

EMDR Therapy For Trauma

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.

EMDR Therapy 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 a 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 For Trauma

EMDR was developed to help access and process these traumatic 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 to Overcome Trauma With EMDR 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, AEDP, EFT, Somatic Experiencing and Sex 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 (see my article: What is a Trauma Therapist?).

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

To set up a consultation, call me at (917) 742-2624 during. regular business hours or email me.

EMDR Therapy for "Big T" and "Smaller t" Trauma

As a New York City psychotherapist who is an EMDR therapist, I see clients for EMDR treatment for both "Big T" and "Smaller t" trauma. I will clarify what I mean by "Big T" and "Smaller t" trauma below.

What is EMDR?
First, as I have written about in earlier posts, I want to reiterate that EMDR (Eye Movement Desensitization and Reprocessing) is a form of psychotherapy which has been found to be effective for healing trauma. Francine Shapiro, Ph.D., who is a psychologist, developed EMDR in the late 1980s.

EMDR Therapy For "Big T" and "Smaller t" Trauma

Since that time, EMDR has been one of the most well-researched forms of psychotherapy for posttraumatic stress disorder (PTSD) and other types of trauma. It has been recognized as a safe and effective form of treatment by the Veteran's Administration, the American Psychiatric Association, the International Society for Traumatic Stress Studies, the Israeli National Council for Mental Health and the United Kingdom Department of Health, among other mental health organizations.

EMDR uses bilateral stimulation of the right and left brain hemispheres (through eye movements, alternate taping, bilateral music, and other similar methods) to activate the brain's "information processing system" to heal trauma.

When we are overcome by experiences that produce overwhelming emotional and physical reactions, often, our minds are unable to process these experiences.

Under certain circumstances, which are unique to each person, these overwhelming experiences can produce adverse reactions, like debilitating depression, anxiety and other psychological difficulties. EMDR allows clients to reprocess these experiences, allowing us to get to the root of these emotional processes, and usually produces a long-term cure.

EMDR therapists, who have advanced training, know how to work with clients in a way so that they are not overwhelmed with the EMDR reprocessing. Each client's experience is unique.

Generally speaking, high levels of emotional reaction tend to dissipate with EMDR treatment. Also, an experienced EMDR therapist makes sure that clients are well prepared for EMDR processing before the actual processing begins by working with clients to develop internal resources (coping skills) to deal with any uncomfortable reactions that might take place during the reprocessing of emotional trauma.

What is the Difference Between "Big T" and "Smaller t" Trauma?
EMDR is usually associated with what is referred to in psychological literature as "Big T" trauma. However, it seems that it is less well known that EMDR is usually very effective for "Smaller t" trauma as well.

"Big T" Trauma
When we refer to "Big T" trauma, we are usually referring to trauma that occurs during war or natural disaster, rape, kidnapping, physical attack, and other similar types of trauma. These types of trauma are usually so overwhelming for most people that they are unable to cope.

An example, of this is the Vietnam or Iraqi veteran who has witnessed atrocities during war and who comes home, relives these atrocities through flashbacks, where it adversely affects his or her ability to function in every day life.

Another example of "Big T" trauma is when a woman who has been raped continues to have nightmares about the rape; she ruminates about what happened, reliving the event over and over again in her mind.

She might be too afraid to start new relationships or to even go outside.

Generally, "Smaller t" trauma is trauma that is more subtle than "Big T" trauma.

An example of "Smaller t" trauma can occur when we're children and we witness events that are upsetting and overwhelming to us because our child-like minds are unable to understand or process these events.

An example of a "Smaller t" trauma could be when a child witnesses loud arguments between his parents and he fears that they are going to get a divorce. As a child under these circumstances, it's normal to be concerned about his safety and well-being. After all, he worries about what will become of him and who's going to take care of him if his parents are not together.

These kinds of experiences can leave a mark on a child's psyche, leaving him vulnerable to feeling anxious, depressed, or insecure later on in life.

There are many other everyday examples of "Smaller t" trauma that people often don't recognize at the time when they're occurring. The emotional damage that has been done often does not show up until later on in life. Sometimes the events that led up to these problems later on are apparent and, other times, they're not. Either way, EMDR is usually an effective form of therapy to overcome the effects of "Smaller t" trauma.

Since most literature focuses on "Big T" trauma like PTSD, I would like to focus on "Smaller t" trauma in this post to illustrate its effects and how EMDR can help. The following vignette is a composite of many cases with all identifying information changed to protect confidentiality:

John:
When John first came to treatment, he was in his late 30s. He worked as an attorney in a large corporate law firm. Like most attorneys in his law firm, John hoped to become a partner one day in his firm.

Generally, he liked corporate law and enjoyed working with his clients. However, he felt very anxious around his boss because his boss was a bully. Whenever his boss felt that John fell below what was considered an acceptable rate of "billable hours," he berated him in the most demeaning way.

John understood the importance of "billable hours" and knew what was expected of him. He felt that, overall, he was a knowledgeable and capable attorney. However, whenever his boss berated him, John felt emotionally paralyzed.

John felt his confidence plummet and he would ruminate for days about whatever his boss told him. His colleagues experienced the same bullying from the boss and, although they were concerned about it, they were not as affected by it as John.

John recognized this and he knew he needed to get help or his boss's tirades continued to be detrimental to him. He realized that his reaction to his boss's comments were out of proportion to the current situation.

The First Phase of EMDR Treatment: During the first phase of EMDR treatment with John, I obtained a detailed history from John about his background. From his family history, I learned that John's father was very much like his boss. He was hypercritical of John and often berated him, leaving him feeling like he could never please his father. If John came home with a report card with all A's and one B, John's father focused on the "B" and berated him for not getting an "A" in that subject, leaving John to feel badly about himself.

Developing Coping Skills: During that initial phase of treatment, I also helped him to develop basic coping skills. Since he didn't do anything to manage his stress, John began working out and going to yoga class. I also taught John to meditate.

In addition, we developed internal resources that he could use during EMDR processing. For instance, John learned to think about and visualize certain "protective" figures from his life (his grandfather, a kind uncle, his nurturing older sister, as well as a lifelong friend and confidant). Through EMDR processing, we worked to help John to internalize these protective figures in such a way that he could "call on them" (essentially, remember, visualize and sense them) when he felt emotional distress either in the psychotherapy session or outside. Just using these internal resources whenever he had to deal with his difficult boss helped John tremendously.

EMDR Processing: During the next phase of treatment, John chose a particular incident that occurred at work with his boss and we began to process that incident using EMDR eye movements. 

Before the processing, John rated this incident as a "9" out of a possible 10 in terms of how emotionally disturbing it was to him (with 0 being no disturbance and10 being the highest level of disturbance). So, overall, it started out as being very disturbing to him. 

However, as we continued to do EMDR processing, the incident became less and less disturbing. It gradually went down to a 5 for John. He felt relieved, compared to how he felt originally, but it was still disturbing. Further processing of that incident did not decrease John's level of disturbance.

When Processing of Trauma Gets Blocked: When the level of processing gets "blocked" (meaning that it stays at a certain level of disturbance and it won't go down to 0 or 1), it generally means there is underlying trauma that is feeding into the current situation and is making it more emotionally charged than it might normally be. Having already obtained John's family background, I was aware that John's relationship as a boy with his father was probably feeding into his current problems and activating his emotional response.

The Difference Between EMDR and Regular Talk Therapy for Trauma: If we were doing regular talk therapy, we might have discussed John's relationship with his father and how if affected him now.

It probably would have been enlightening to John but, usually, this would only remain as an intellectual insight. In other words, it's interesting and informative to know, but it doesn't produce any change. And therein lies the problem with regular talk therapy and trauma.

In addition to my EMDR training, I'm also trained as a psychoanalyst, so I understand and value psychodynamic treatment for most problems. However, when it comes to trauma, regular talk therapy is often limited in terms of resolving and healing trauma.

Processing the Earlier Trauma that Triggers the Current Trauma: So, knowing that there were probably earlier memories that were feeding into and triggering John's emotional reaction to his current situation, we did what is known in EMDR as a "float back."

During a "float back," the client thinks back to an earlier time when he might have experienced these same feelings. An experienced EMDR therapist might have a sense of what those memories might be, but he or she doesn't make any suggestions about them. The EMDR therapist allows the client to come up with whatever he or she remembers or senses.

In John's case, his earliest memory of feeling the same way as he did in his current situation was when his father berated him during Little League practice. According to John, he struck out each time that he was up at the plate during a big game with a rival team.

Afterwards, he was feeling bad enough, but when his father yelled at him in front of his team mates and the other parents, John was mortified. John rated his level of disturbance as being a "10" for this memory. Gradually, as we continued to process the memory with EMDR, his level of disturbance went down to a "0." When it went down to 0, he, of course, remembered the memory with all of the details, but he no longer felt disturbed by it.

Resolution of the Trauma: After we processed this earlier memory, which was emblematic of his experiences with his father, we went back to the current situation with his boss. As is usually the case, having reprocessed the earlier "Smaller t" trauma produced a "0" in terms of John's level of emotional experience in the current situation.

John was really surprised and greatly relieved. He was able to go back to work, deal with his boss, and when his boss saw that he could no longer intimidate John the way he used to, he stopped ranting at him and chose to bully another more vulnerable attorney instead.

EMDR Follow Up: When John checked in with me several months later, he told me that the results of our work continued to hold. He also said that his self esteem was now higher than it ever had been and his boss told him that he was on track to become a partner, which made John feel very happy.

The above vignette is one brief example that demonstrates how EMDR can work. Everyone's experience of EMDR is unique.

EMDR is an effective treatment for dealing with trauma, and it is usually faster than regular talk therapy.

Getting Help in EMDR Therapy
If you have unresolved trauma, you could benefit from working with an experienced EMDR therapist who is a licensed psychotherapist.

About Me
I am a New York City licensed psychotherapist and EMDR therapist.

I work with individual adults and couples.

I have helped many clients resolve both "Big T" and "Smaller t" trauma.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.