EMDR and Trauma by Lindsey York Epperson, LCSW
EMDR and Trauma: Explained
There’s quite a buzz around trauma in the health and wellness world these days. You can read about it on blogs or social media, hear about it on podcasts or in everyday conversation. Lots of people have trauma; lots of folks are talking about it; and everyone, sufferers and helpers alike, wants to know how to heal it. This post provides a brief overview of what trauma is and what it looks like in daily life and explores one particular evidence-based treatment for traumatic stress: EMDR. Let’s dive in.
How do I know if I have trauma?
Speaking from the perspective of a therapist and someone who is trained in the DSM 5, my first clue that someone might have problems with trauma is if they have lived through a traumatic event (something I try to assess for with each new client). The DSM defines a traumatic event rather broadly as one in which a person directly experienced or witnessed death, actual or threatened serious physical harm, or actual or threatened sexual violation. Experiencing repeated exposure to the details of traumatic events can also be categorized as experiencing a traumatic event.
Symptoms of PTSD can include: intrusive memories of the traumatic event, nightmares, flashbacks, dissociative episodes, avoidance, anxiety, irritability, self-blame or negative thoughts about the self, difficulty concentrating, exaggerated startle response, among others. If you believe that you have symptoms of PTSD it is important to speak with a licensed mental health provider to explore this further and receive a diagnosis if necessary.
As a therapist, when I know that a person has had experience with traumatic events and/or I see the symptoms mentioned above, I know this person has the potential to benefit from trauma focused, trauma informed therapy and I will talk with them about their options. One of their options is Eye Movement Desensitization and Reprocessing – or, EMDR.
What is EMDR?
EMDR got its name due to the eye movements that are sometimes part of the therapy, the anxiety reduction (desensitization) that sometimes results from treatment, and the memory reprocessing aspect that is the goal of EMDR therapy. The creator of EMDR recounts how she discovered the power of rapid side to side eye movements while walking in the park one day. She reports that the eye movements helped her feel calm and work through something that was troubling her. This was intriguing, and she embarked on a quest in her PhD program to discover how and why that could be. Experiments and studies followed and the treatment evolved over time into what we have today: a well-known and thoroughly researched therapy that works by bringing up disturbing memories and holding them in mind while a therapist guides sets of rapid side to side eye movements or other bilateral stimulation.
Why is EMDR helpful?
To answer that question, we’ll talk a little bit about adaptive information processing, which is the theoretical model that guides EMDR. Let’s say a negative or upsetting thing happens to me: maybe someone cuts me off in traffic and nearly causes an accident, or someone shouts at me for mistakenly cutting in line at the grocery store. I might be a little shaken, I might talk about it with a friend, I might ruminate for a while, I might even dream about the experience. Over time, it becomes less troubling and soon I no longer think about it, or if I do think about it perhaps I see it as a learning experience or in a positive light (“I’m quite a good defensive driver,” or “Look carefully to see where the line starts in order to respect those who are already waiting”). With psychologically traumatic events, the stress at the time of the incident might be so high that the usual information processing process is disrupted, and the memory of the event could be improperly processed and stored. This results in the thoughts, emotions, and sensations from the event becoming frozen and feeling as if they are present all the time or just under the surface, easily triggered by a similar event. EMDR allows you, with the guidance of a trained therapist, to access your unprocessed memories safely and process them using bilateral stimulation (i.e. eye movements) so that the memory can be properly filed away as a past event and you can move forward with your life. There are still studies being conducted on why the eye movements, coupled with the rest of the treatment, help the memory be reprocessed – one theory is that the eye movements mimic what happens naturally in REM sleep when your brain is processing events from the day (something that may not have happened at the time of the event if you were under a great deal of stress).
What can I expect from an EMDR session?
There are 8 stages to EMDR treatment. I won’t detail all of the stages, but I will say that the beginning of treatment involves taking a history, providing you with information about how the process will work and teaching some skills such as how to access a safe place mentally and how to stop the process if necessary. For each memory or event that needs to be reprocessed, an assessment will be done to determine how upsetting the memory is and what reprocessing work needs to be done, followed by the actual reprocessing and installing the new learning that takes place from processing. Sessions close down with a body scan and closure script, and toward the end of the treatment a reevaluation will be done to determine if all the necessary work has been accomplished. Sometimes 1-3 sessions are all that is needed, while other times many more are necessary. This is something that will be decided between you and your therapist in treatment.
Who might benefit from EMDR?
As a trained EMDR therapist, here are three situations in which I find myself reaching for EMDR as a treatment.
When a person has PTSD – that is, I am aware that they have a history of traumatic events and they have enough symptoms to qualify for a PTSD diagnosis.
When a person has events in their past that may not be Traumatic per se but had a strong effect on them. For example, perhaps my client has overwhelming anxiety when they must give a presentation at work. Perhaps they try various anxiety management skills and it does not get better. Perhaps during therapy, we learn that the client’s anxiety about presentations started when they were in elementary school and were chastised by a teacher for giving a subpar presentation. EMDR might help my client reprocess that event and they may find that their presentation anxiety is resolved as a result.
Lastly, when a person has been in therapy for a time and seems to have all the tools necessary to change their situation, but somehow still feels stuck, I will consider whether traumatic memories or perhaps negative blocking beliefs are at the root of their presenting concerns and talk with them about giving EMDR a try.
I hope that this information has helped you understand trauma and EMDR a little better. For more information, check out Francine Shapiro’s books, Getting Past Your Past: Take Control of Your Life with Self-help Techniques from EMDR Therapy and Eye Movement Desensitization and Reprocessing [EMDR] Therapy.
If you would like to speak with me about whether EMDR could be a useful treatment for you, please email me at [email protected]. I am looking forward to hearing from you.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edition). https://doi.org/10.1176/appi.books.9780890425596
Shapiro, F. (2018). Eye movement desensitization and reprocessing [EMDR] therapy: Basic principles, protocols, and procedures (3rd edition). The Guildford Press.
Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR therapy. Rodale.