Your Dreams on Trauma (and How EMDR Therapy Can Help Heal)

I walked next to my grandma through her backyard, listening to the windchimes in the background. I felt this intense sense of gratitude for her visit. She's been gone for about six years. I looked up and said, "Thank you" genuinely, and I woke up.

My dreams have often given me gifts as this. There is a sense of memory and healing in the non-linear parade of images and sounds.

For many individuals living with post-traumatic stress disorder, nightmares and sleep interruptions are common. Sleep is critical for fear extinction memory, the ability to feel comfortable again after we have escaped a troubling situation (Van Liempt, 2012), and this is impaired in PTSD. In PTSD, early morning waking is also common, with some research suggesting this affects close to 50% of people with the diagnosis (Lamarche and Koninck, 2007). Just when they are getting into that dreamy REM sleep, the person jolts awake.

Psychotherapies, including eye movement desensitization therapy (EMDR), are seeking to explore the role of rapid eye movements, such as those we encounter in REM sleep, in processing our experiences.

To better understand the links between dreams, trauma, and healing, I spoke with psychotherapist Lizy Wiggins. She is the CEO of EMDR Restorative Consulting as well as an EMDRIA-approved (Eye Movement Desensitization Reprocessing International Association) EMDR trainer and consultant. (EMDRIA is the primary professional organization regulating the use of EMDR among practitioners.)

Eye Movement Desensitization Therapy

Lizy Wiggins specialized in trauma treatment from day one as a therapist. Still, she didn't start with EMDR.

Like many other therapists who have found the limitations of purely cognitive work when it comes to trauma, I craved new tools. She shares, "It just kind of felt like we weren't getting to the core of things. We were reframing thoughts, reinforcing good decisions and healthy behaviors, and teaching coping skills, but it felt like the trauma was still there."

Cognitive behavioral therapies (CBT) focus on how our thoughts affect our actions and emotions. Traumatic events have a tendency to sway our beliefs into extremes. For example, a person whose home has been robbed may develop a thought of, "My home will never be safe again." They might check the locks of their doors repeatedly and have a difficult time talking about what happened. A CBT approach to these symptoms might focus on challenging these thoughts, facing the story of the burglary, and gradually letting go of excess safety rituals.

For some individuals with PTSD, this is enough. Yet, others struggle with other dimensions of trauma's aftermath, like abstract feelings of being unsafe and body-based changes. Someone might say, "I understand how it doesn't make sense, but it just feels true."

Psychotherapies that use a bottom-up style, rather than a purely talk-based one, offer an alternative.

In Lizy's words, "It's more brain-based and body-based. It's powerful because I don't have to make my clients talk about all the details of their trauma, and still sometimes have symptoms come back or worsen. Instead, we can work through it in a kinder, regulated way, and the progress sticks."

A Level of Controversy and the Secret Sauce of Trauma Treatment

EMDR is considered an evidence-based practice for the treatment of PTSD, and meta-analysis shows comparable results of EMDR therapy to other common psychological therapies (such as trauma-focused CBT) employed in the treatment of PTSD (Hoogsteder et al., 2022; Wright et al., 2024) in both adults and children. This said, there has been some controversy as to the 'eye movement' aspect. As EMDR utilizes many aspects reflective of traditional trauma interventions (for example, exposure to the memory and sharing a narrative), some have argued that it is these, rather than the eye movements, that create the results.

In my experience, response to trauma treatment appears to be highly individualized. It seems that some individuals respond more favorably to EMDR while others may prefer approaches like Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE). The number of trauma treatments available is vast and there remains a level of mystery regarding which elements are most essential for healing. I have met individuals who have taken part in multiple trauma treatments, in some cases benefitting from EMDR when other interventions failed, and in other cases finding others more helpful.

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What is most critical is to have open communication between therapists and clients regarding reception of treatment. Often, adjustments can be made, as well a number of evidence-based therapy practices exist for the treatment of PTSD.

EMDR and REM Sleep

EMDR utilizes therapist-guided rapid eye movements or other bilateral stimulation to assist in processing trauma. Lizy says, "REM sleep is designed to process the events of the day, week, or potentially even longer. It processes them in an emotional way and helps with memory storage, but when something overwhelming or traumatic happens, REM can't always process it—we get stuck because the trauma is perceived as still happening in the present. REM can only process things from the past, so that traumatic material keeps us in panic mode without access to logical thinking about the event."

So how does EMDR help? Here's what Lizy believes: "During REM, the eyes move naturally back and forth—left to right and right to left. With EMDR, we can pick a specific event and replicate that process, where the whole brain is engaged. So, when we have left brain-right brain active at the same time with those eyes moving back and forth, essentially, that bilateral eye movement helps the whole brain process an event. It lets the person access the logic brain and the emotion brain. People feel less distressed about the event, feel more stabilized, and know it is in the past."

Your Dreams on EMDR

Of interest, a study exploring the role of EMDR on sleep recruited 17 veterans diagnosed with PTSD. Polysomnogram recordings were taken one week before EMDR treatment and one week after PTSD remission (Rousseau et al., 2021). The participants showed a greater increase in REM sleep after EMDR treatment. In addition, larger improvements in REM sleep correlated with decreased symptoms of PTSD.

Lizy has seen a noticeable change as well. "A lot of times, people with PTSD wake up between 2 a.m. and 5 a.m., and that's typically when we experience REM sleep. Nightmares are a result of trying to process that information. What we see is once a person has completed a target with EMDR, the nightmares decrease significantly, and they are no longer having as frequent waking in the middle of the night because they aren't having that stress response."

Closing

Sleep plays a vital role in giving our minds a chance to make sense of the day's events. Trauma and PTSD can suspend this. Once the memories have healed, often sleep returns to normal, and we can enjoy the benefits of sleep again.