What is EMDR and How Does it Work

Eye Movement Desensitization and Reprocessing (EMDR) is one of my main specialities as a mental health therapist. It is a powerful style of therapy that helps people process trauma and other intense disturbing emotional experiences. One of the main ways that I practice EMDR is to help people understand the basics of how it works.  

The first part of understanding EMDR is understanding how trauma and overwhelming emotional experiences work physiologically in the brain. Studies in neuroscience and neurobiology have shown that when people experience more intense emotions than they know how to cope with, and have inadequate support in coping with, the memory that forms is locked in that exact state. Those memories are then held in a dormant state until an experience occurs that reminds that person of one of them, or of a pattern of memories. When that happens, the brain uses that memory to determine how to react to the present situation. The problem with that is that because that original event that became memory was never resolved, it later informs the brain when triggered that one doesn’t know what to do, can’t handle their present situation, isn’t safe, or some other negative belief about their self or circumstances.  

If someone was in a car wreck and had an overwhelming sense that they would die, and was alone for an hour before they were discovered, this could easily become a traumatic memory. Even after being found, receiving medical treatment and recovering from any injuries, that memory may not be resolved as the harm was already experienced and was able to be frozen in memory due to its intensity and/or duration. When that person subsequently gets into a car, or drives on that same road, their brain may then, based on that memory, inform that person that they are wrecking or about to wreck in the present (even if they are perfectly safe). 

EMDR uses eye movements and other types of bilateral stimulation (BLS) as a primary tool for helping clients experience reprocessing of memories. The strategy of using BLS is based in research that has shown that this helps memories to lessen in disturbance. Research trials showed that people who utilize BLS within the context of EMDR therapy report significant and lasting improvements in emotional regulation and trigger resilience. Later, brain imaging helped prove this by displaying what is actually taking place in the brain and nervous system. The part of the brain where traumatic memories are held (called the amygdala) activates at the same time as the part of the brain that processes information more adaptively (the prefrontal cortex). These two parts of the brain communicate, and the more adaptive part “reprocesses” the memory, and henceforth tells the brain it is resolved and no longer happening whenever it is triggered. 

When a memory is completely reprocessed, its contents no longer feel nearly as intense or disturbing, and often does not feel disturbing at all.
 

By James “Drew” Sewell, LCMHC-QS
Owner/Director

Evexia Counseling and Consultation, PLLC

 Memory is more than just recollection of an event. It is any event or circumstance that activates the brain’s “file” of past experience related to the present (“trigger”). But a memory is also made up of sensory input, cognitions, emotions, and sensations. In this way a memory is like a tree with five branches. 

The first “branch” of memory is the trigger, or any event or circumstance that activates the memory. Using the example from my first blog post on EMDR, let’s say the event was a car wreck and later triggers are getting into cars, driving, seeing other cars, knowing a loved one is driving or riding in a car, and so on. Essentially, the original event is a trigger for the entire formation of memory, which consists of other things. Later situations that remind the survivor of the wreck of the original wreck are also triggers of the greater memory structure in the brain and body, as well.  

The next part of memory is cognition, particularly beliefs held about the self or one’s own circumstances that form and lock into place during a traumatic experience. Such as a belief from a car accident like “I’m going to die,” or “it’s my fault.” Any trigger or activator for the memory may bring with it such ominous thoughts, even if the person with such thoughts doesn’t consciously associate such thoughts with their origin in the traumatic event. 

A fairly easy part of memory formation to grasp is emotions. The terror one might feel during a life-threatening event such as a car wreck often makes sense. What often becomes problematic is how such an emotion may lock into the neural pathways that associate aspects of ongoing life with the past. This often leads to what seems to be an irrational emotional response to present life events, sometimes even decades after the original trauma, as the brain reverts to the memory of the event itself. 

Finally, memory also consists of body sensations. The surge of intensity present in a traumatic event often is reflected in the body’s mobilization of survival reactions. These may include tense muscles, a pounding heart, shallow and rapid breathing, feeling hot/cold, feeling a buzzing sensation as energy is reallocated from general bodily functioning to preparation to run or fight 

When any one of these parts of memory is activated in ANY circumstance, it can potentially dump other branches of the traumatic experience into one’s current attention. This is one of the most prominent ways that traumatic memories manifest. 

By James “Drew” Sewell, LCMHC-QS
Owner/Director

Evexia Counseling and Consultation, PLLC

EMDR treats dysfunctionally stored memories of trauma. But what if it gets more complicated than addressing one memory? As previously mentioned, memories form like a tree with five main branches. However, our are not made up of only one memory. Rather, they are made of millions of memories. And, as therapists are often found to claim, we treat the mind.

If we expand the analogy of comparing a memory to a tree, then the mind is a vast forest, with a thick canopy of trees with branches intersecting, growing together, and creating a complex interconnected system of identity.  

Another way to think about this system is through the lens of a painting. Specifically, the painting featured with this post: A Sunday Afternoon on the Island of La Grande Jatte. If you look closely, you’ll notice that rather than brushstrokes of paint, the image is made of dots of paint. Together, the dots make several different forms, shapes, and images that coalesce into the greater scene. If each dot represented a memory, this would largely be how memory contributes to the emergence of identity. 

This painting is a relatively pleasant image. If we continue the analogy about self, imagine that someone with multiple traumas that formed a more disturbing image representing their perception of the world, others, and even themselves. What if their trauma was experienced at the hands of one or more persons meant to be safe for them, who often expressed love and kindness when not causing terror and harm?

In complex cases such as these, EMDR is about much more than addressing traumatic events. It works in tandem with other therapeutic modalities and tools to treat fractured identity and help people to attain security and stability in the formation of their sense of self. By targeting key memories that teach the brain how to format other experiences, therapists help clients change large swathes of area into what the client determines in a positive and adaptive frame. 

For example, let’s take someone who has been humiliated much of their life by a caregiver or parent. As an adult, one would wonder what in the world that parent is thinking. But as the subject of such humiliation, particularly from childhood with little understanding of a parent’s potential to act corruptly, one may not think that. Instead, that person may wonder what is wrong with him- or herself. In adulthood, this may lead to beliefs of being bad, unworthy, stupid, unimportant, unloveable, etc.

By targeting several of the key memories that teach a brain to think in such a way, EMDR therapy helps identity to shift from one of more shameful self-identification to one of “I am worth,” and “I am loveable.” And whatever variation of negative belief someone holds, the strong majority of those utilizing EMDR therapy can be helped to feel that good things are true about themselves.

By James “Drew” Sewell, LCMHC-QS
Owner/Director

Evexia Counseling and Consultation, PLLC