How do traumatic incidents affect us?
Our life experiences generally set in motion a continued pattern of emotions, behaviour, thoughts and affect how we see ourselves. We have an innate system for processing information; the brain’s natural tendency is to move towards a state of mental health. For example, if we are upset by a social situation in which we felt humiliated, we might think about it, talk to other people about it and perhaps dream about it. After a while, we are no longer bothered by it. We are then able to reflect on it and learn about ourselves and other people, so that we are better able to handle similar situations in the future. But problems occur when this information processing system gets blocked.
When someone experiences a traumatic event or is frequently subjected to distress, an imbalance occurs in the nervous system and the normal information processing system is unable to work properly. The distressing non-verbal and sensory information (e.g. images, physical sensations, emotions) are stored in implicit memory. The amygdala is the part of the brain that senses threat and is where the fight, flight and freeze responses take place. The amygdala stores data on all threat cues so that we can respond quickly to danger, without needing to think about it. So, this can be triggered in present-day situations that have some reminder of the original incident and cause the symptoms of PTSD such as flashbacks, nightmares and intrusive thoughts. You respond as though the trauma is happening again, as things stored in implicit memory have no sense of time i.e. present vs past.
How does EMDR work?
The beneficial effects of eye movements when processing traumatic events was discovered quite by chance. Since then, much research has been carried out on the effects of EMDR and how it works and there is still much debate. It has been shown through randomised controlled trials to be highly effective in the treatment of post-traumatic stress disorder (PTSD) and is now one of the approaches recommended by NICE (National Institute for Health and Clinical Excellence). There is increasing large-scale research evidence for its use with other presentations.
Implicit memory is emotionally and somatically based and these feelings and sensations can be triggered unconsciously. Explicit memory holds the verbal events and facts, requires conscious awareness and has a sense of time. So, it is suggested that the eye movements (or other bi-lateral stimulations such as butterfly taps) help the transfer of the different types of memories across the two sides of the brain so that you can reach a more coherent understanding of the event and effectively time stamp it as in the past.
EMDR enables the information processing system to become unblocked so that the mind can come to a more helpful resolution. Processing the traumatic memories through EMDR allows the more positive thoughts and feelings from the present to become associated with the memories from the past through the brain and the body. We are then able to respond more freely, without the impact of the threat from the past. What is useful from the event is learned and stored away with the appropriate emotions and is available to us when we want/need it. This in turn leads to shifts in our sense of self-worth and capability.
When processing in EMDR, you will be asked to bring up a memory of the trauma. With each set of bilateral stimulations (eye movements, bilateral tapping etc), the distressing information is moved along the appropriate neurological pathways towards more adaptive, helpful information so that it can be resolved. For example, a victim of sexual assault may be able to reach the conclusion that “It wasn’t my fault”.
Memories are stored in networks so that associated information is stored together. Therefore, the processing will need to take into consideration all the relevant memory channels that are related to the specific event that is being targeted. EMDR helps create the connections between your brain’s memory networks, enabling the natural information processing to take place.
What happens in an EMDR session?
Having decided on a particular memory to target, you will be asked to visualise it and identify a negative belief that goes along with this memory. You will be asked what you would prefer to believe in response to this memory. You will be encouraged to connect with the emotion that this memory triggers and asked to rate how intense this emotion feels. You will also be encouraged to notice if you are experiencing any physical sensations. The therapist will then ask you to engage in a set of ‘bilateral stimulations’ in the way of eye movements or alternate hand taps. At the end of each set you will be asked to briefly say what you notice now and then guided into another set. This will continue and the therapist will bring you back to the original incident at times. S/he may also ask you particular questions to help move the processing forwards.
You may be able to ‘complete’ the processing of a particular memory in one session or it may take several sessions. There may be several memories that need to be processed in order to fully address the difficulties you are experiencing. This will be discussed during the assessment phase and reviewed as you complete the processing of each memory.
EMDR is not a form of hypnosis and during EMDR treatment, you will remain fully in control and can stop the process at any time should you wish.
Can EMDR make you feel worse?
As the processing involves connecting with previously unconscious thoughts, feelings and memories, it is often the case that you can feel worse before you feel better. You may find you feel more emotional after a session or that you feel very tired and mentally exhausted. It is important to give yourself some time after each session before having to resume normal activities, so that you can rest and recover. Before starting processing, your therapist will help you develop some strategies to help cope with the emotions that may emerge. If necessary, your therapist will help you to ground yourself at the end of any processing session.
EMDR carried out in the correct way is highly unlikely to cause you to feel worse or function less well in the long-term. But you may need to allow some time in order to feel the benefit of the processing. If you have any concerns about this, you should speak with your therapist.
Where can I get further information?
The following websites provide useful information on EMDR:
Or contact me on 07706 924 550 to discuss how EMDR may be able to help you.
Dr Sarah Swan
Consultant Clinical Psychologist