Therapy proposes that patients relive the past to overcome trauma

Trauma plunges the mind into a hyperactive state. The brain tries to block out fragments of disastrous memories: a shower of broken glass as one car crashes into another, the smell of smoke. People who suffer from PTSD (Post Traumatic Stress Disorder) sometimes limit their lives by avoiding streets, smells or songs that remind them of what they experienced. But the memories reappear in nightmares, flashbacks or intrusive thoughts.

Since the 1980s, when the disorder was included in the Diagnostic and Statistical Manual of Mental Disorders, health professionals have identified some therapies that help people deal with traumatic memories. In the last ten years, an apparently unconventional treatment has been gaining ground among the most widely accepted therapies.

Eye Movement Desensitization and Reprocessing Therapy, better known as EMDR (Eye Movement Desensitization and Reprocessing), may seem bizarre.

The practice involves convincing people to process traumatic memories while simultaneously interacting with images, sounds or sensations that activate both brain hemispheres. Patients can move their eyes from side to side, following the movement of the therapist’s finger, or look at flashes of light on alternate sides of a screen. The idea is to anchor the brain in the present moment while the patient remembers the past.

EMDR has garnered more attention in recent years, thanks in part to the increased demand for trauma treatments throughout the pandemic and celebrities sharing their experiences.

Prince Harry filmed an EMDR session for a documentary series with Oprah Winfrey. Sandra Bullock said she did EMDR after a stalker broke into her home in 2014. “The Good Place” actress Jameela Jamil wrote in an Instagram post in 2019 that the method “saved her life.”

WHAT IS EMDR?

Psychologist Francine Shapiro developed EMDR in 1987 when she was trying to overcome her own disturbing memories. She began by experimenting on herself, moving her eyes from side to side as she walked in a park. Then, little by little, she extended the treatment to other people.

Therapists apply EMDR in eight phases that last from six to 12 sessions, but can vary. Each meeting usually lasts between 60 and 90 minutes.

First, the therapist discusses the patient’s current difficulties, gathering information about the patient’s history. It then proposes a treatment plan, said psychologist Deborah Korn, co-author of “Every Memory Deserves Respect.”

She said the patient may need to “float back” from their current symptoms, exploiting a recent emotional outburst or panic attack to isolate the triggers that triggered it. The goal is to identify a traumatic memory that the patient can work with in later stages of EMDR.

“Most people don’t come in saying, ‘I want to work on my traumatic memories from ages 5 to 11,'” Korna said. “They just say ‘I’m unhappy’.”

Then the patient and therapist devise coping strategies, such as breathing exercises or meditation to help combat dissociation, mechanisms that the patient can use if they are in a state of distress during or between sessions.

Once these strategies are in place, which usually occurs 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, a sound, or a smell that invades your thoughts most often. According to researcher Sanne Houben of Maastricht University and an EMDR scholar, for some patients the most vivid memory linked to trauma occurred just before the traumatic event.

Patients focus on the sensations and emotions they experience while thinking about this aspect. Meanwhile, they do activities such as moving their eyes, patting their bodies, or listening to a soft beep in the left and right ear alternately. Each set of bilateral stimuli usually lasts between 30 and 60 seconds.

Periodically, the therapist asks the patient what he perceives or feels, encouraging him to look at the memory with a current perspective.

“If you say, ‘It was all my fault,’ the therapist might ask how old you were, do you really think you were able to protect yourself as a child?” said Vaile Wright, senior director of health innovation at the American Psychological Association. . “You don’t just sit there, thinking about the memory.”

HOW IT WORKS?

Forcing a patient to intentionally go back to the past is not limited to EMDR. Most therapies for PTSD, including methods of prolonged exposure and cognitive processing, encourage patients to “actively approach trauma,” said Shaili Jain, a specialist in PTSD at Stanford University.

Revisiting trauma can activate the body’s stress response, raising cortisol levels and heart rate. Over time, however, the process can gradually desensitize the patient’s memories, habituating his body to dealing with the stress and anxiety he suffers when faced with something that brings up the memory.

“The fight-or-flight response is reduced by several levels, and the person is back in charge of their life, rather than simply reacting to triggers,” Jain said.

With EMDR, the addition of the bilateral pacing component theoretically anchors the patient in the present as he or she faces trauma. “We use the phrase ‘one foot in the present and one foot in the past,” said psychologist Marianne Silva, a practitioner of the method at the VA New England Healthcare System.

Bilateral stimulation needs to be persuasive enough to distract patients, but not so strong that they focus exclusively on it. For Harvard University psychology professor Richard McNally, repeating multiplication tables, for example, would require too much effort.

For Houben, our brain does not have the ability to fully focus on bilateral stimulation and traumatic memory. The explanatory theory of EMDR is that memories become less vivid and arouse less emotion when the patient cannot fully concentrate on them.

“When the therapy session is over, you put the memory back in the drawer,” McNally said. “She will be in degraded form. She won’t have the same power to evoke your emotion.”

IS THE METHOD EFFECTIVE?

Today most psychologists view EMDR as an effective trauma treatment. The WHO (World Health Organization) and the American Psychological Association recommend it for people with PTSD and have already issued guidelines for treatment with the approach.

In England, the National Institute for Health and Care Excellence, a rigorous authority in the field of psychology, cites EMDR as a tool for use with adults facing trauma and children who have not responded to trauma-focused cognitive behavioral therapy.

But scientists are still debating whether EMDR is more effective than other methods for the same purpose. Pim Cuijpers, professor of clinical psychology at Vrije Universiteit Amsterdam, analyzed nearly 80 studies on EMDR and found that while the research points to positive effects of the treatment, “the quality of the research is actually very poor.”

According to him, many psychological treatments lack rigorous studies, but the evidence in favor of EMDR is especially thin, with small samples and potential bias on the part of the psychologists who performed them.

Cuijpers said the method is likely to be effective, but felt that the evidence substantiating the treatment should not be fully endorsed.

And there are very few studies that demonstrate that EMDR works in the long term, said Henry Otgaar, a researcher and professor of forensic psychology at Maastricht University in the Netherlands.

Otgaar, Houben and other researchers are investigating whether the approach increases patients’ susceptibility to false memories. While creating false memories is a risk that exists in many therapies, Houben said “it’s still too early to say it’s inherent in EMDR.”

Even so, there are patients and psychologists who fully believe in the treatment, and for Jain, there is enough solid data to support it. Patients report fewer PTSD symptoms after the sessions, Wright said, with fewer flashbacks and intrusive thoughts.

WHO IS EMDR SUITABLE FOR?

“Anyone who has experienced trauma” can benefit from EMDR, said Trisha Miller, a psychotherapist at the Cleveland Clinic. People with mental health conditions other than PTSD, such as depression, eating disorders, phobias and addictions, may also benefit from EMDR, she said, although there is still no robust research confirming the treatment is effective for these conditions.

Miller emphasized that anyone looking for a therapist who applies the method should make a point of looking for a certified specialist. The EMDR International Association, which provides certification and training for practitioners who deliver therapy, maintains a directory of practitioners trained and certified by the organization.

“Thinking from a psychologist’s point of view, I would say ‘do what works,'” Jain said. “If EMDR works for you, go for it.”

Translation by Clara Allain