‘One Foot in the Present, One Foot in the Past:’ Understanding E.M.D.R.
Original article written by Dani Blum for the New York Times.
Since PTSD was first included in the Diagnostic and Statistical Manual of Mental Disorders in 1980, clinicians have identified a handful of therapies that help people cope with traumatic memories. Over the past decade, a seemingly unconventional treatment has wedged its way into mainstream therapy.
Eye movement desensitization and reprocessing therapy, better known as E.M.D.R., might look bizarre to an observer. The practice involves coaxing people to process traumatic memories while simultaneously interacting with images, sounds or sensations that activate both sides of the brain. Patients might flit their eyes back and forth, following a therapist’s finger or stare at bursts of light on alternating sides of a screen. The idea is to anchor the brain in the current moment as a patient recalls the past.
In recent years, E.M.D.R. has attracted more attention, thanks in part to increased demand for trauma treatment throughout the pandemic and celebrities who have shared their experiences. Patients who seek out E.M.D.R. may be inspired by another source: “The Body Keeps the Score,” a seminal book on trauma that has stayed on the New York Times best-seller list for over 200 weeks. Bessel van der Kolk, the book’s author, touts the treatment as one of the most effective ways to combat PTSD symptoms. “It’s not really an innovative treatment anymore,” he said. “It’s something that’s very well-established.”
So what is E.M.D.R.?
The psychologist Francine Shapiro developed E.M.D.R. in 1987 as she grappled with her own disturbing memory — first, experimenting on herself, flitting her eyes back and forth as she walked through a park, and then gradually expanding the treatment to other people.
Therapists carry out E.M.D.R. in eight phases that typically unfold over six to 12 sessions, although that number varies from person to person. Each session tends to last between 60 and 90 minutes. First, a therapist will discuss the patient’s current challenges, gathering information about their history, and then propose a plan for treatment, said Deborah Korn, a clinician and co-author of “Every Memory Deserves Respect.”
The patient may need to “float back” from their current symptoms, she said, exploring a recent emotional outburst or panic attack to isolate the triggers that provoked it. The goal is to identify a traumatic memory that a patient can work through in the later E.M.D.R. phases.
Then, the patient and clinician devise coping strategies, like breathing exercises or meditation to help combat dissociation, that a patient can use if they become distressed during or between sessions.
Once those strategies are established, typically after one or two sessions, the therapist instructs the patient to recall the most difficult aspect of the traumatic event. It could be an image, sound or smell that intrudes on their thoughts most often; for some patients, the most vivid memory related to a trauma took place just before an event transpired, said Sanne Houben, a researcher at Maastricht University who studies E.M.D.R.
Patients focus on the sensations and emotions they experience while thinking about this aspect as they engage in activities like moving their eyes, tapping on their body or hearing a faint beeping sound that alternates between their ears. Each set of these bilateral stimulations typically lasts between 30 and 60 seconds.
Periodically, the therapist will ask the patient what they are noticing or feeling, encouraging them to consider the memory from a present-day perspective. “If you say, ‘It’s all my fault,’ a therapist might ask how old were you, did you really think you could protect yourself as a child?” said Vaile Wright, the senior director of health care innovation at the American Psychological Association. “It’s not just that you sit there and think about the memory.”
How does E.M.D.R. work?
Pushing a patient to deliberately revisit the past isn’t a feature of just E.M.D.R.; most therapies for PTSD, including prolonged exposure and cognitive processing therapy, prompt patients to “actively go toward the trauma,” said Dr. Shaili Jain, a PTSD specialist at Stanford University.
Revisiting trauma can activate the body’s stress response — cortisol levels spike and heart rate jumps. But over time, the process can gradually desensitize you to your memories, habituating your body to the stress and anxiety you experience when confronted with a reminder of the trauma.
“That fight or flight response just gets brought down several notches, so you’re back in the driver's seat of your life,” Dr. Jain said. “Instead of ricocheting off triggers.”
Our brains do not have the capacity to completely focus on both the bilateral stimulation and the traumatic memory, Dr. Houben said. The theory behind E.M.D.R. is that memories become less vivid and emotional when a patient can’t focus on them completely.
Is E.M.D.R. effective?
Today, clinicians generally consider E.M.D.R. an effective treatment for trauma. The World Health Organization and American Psychological Association have recommended it for people with PTSD and have issued guidelines for administering treatment. In England, the National Institute for Health and Care Excellence, a rigorous authority in the psychological field, lists E.M.D.R. as a tool for adults grappling with trauma and children who have not responded to trauma-focused cognitive behavioral therapy.
But scientists are debating whether E.M.D.R. is more effective than other trauma treatment methods. Pim Cuijpers, a professor of clinical psychology at the Vrije Universiteit Amsterdam, analyzed nearly 80 studies on E.M.D.R. and found that, while the research pointed to the treatment’s positive effects, “the quality of research is really very bad,” he said.
Many psychological treatments lack rigorous studies, he said, but the evidence for E.M.D.R. was particularly thin, with small sample sizes and potential bias on the part of clinicians conducting the research.
While E.M.D.R. is most likely effective, Dr. Cuijpers said, he cautioned against wholeheartedly endorsing the evidence behind the treatment.
And there are very few studies that show E.M.D.R. works in the long-term, said Henry Otgaar, a researcher and professor of forensic psychology at Maastricht University in the Netherlands.
Dr. Otgaar, Dr. Houben and other researchers are investigating whether E.M.D.R. increases a patient’s susceptibility to false memories. While creating false memories is a risk in many therapies, Dr. Houben said “it’s too early to say if that’s inherent to E.M.D.R.”
Still, there are patients and clinicians who swear by the treatment — and enough “solid data” to back it, Dr. Jain said. Patients report fewer PTSD symptoms after sessions, Dr. Wright said, with fewer flashbacks and intrusive thoughts.
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This E.M.D.R. treatment is currently being used by Presbyterian Hospital utilizing funds from our Behavioral Health Program. Thank you to our funders for the program, the NY State Health Foundation and the NY Community Trust.