Do the Eyes Have It?
Facts and speculation about EMDR
Posted Jun 16, 2009
A few years ago, my friend Ally, who had a somewhat unwarranted confidence in my knowledge of Things Psychological, asked if I knew anything about EMDR; she had suffered some severe childhood trauma, and was thinking of trying it. "EMDR?" I asked, "Is that a new street drug?" I guess that showed her what I knew. She explained that her therapist had suggested this relatively new technique, Eye Movement Desensitization and Reprocessing, that had been shown to ease symptoms of Post Traumatic Stress Disorder (PTSD) in soldiers and rape victims. From what she understood, the therapist would help her to focus on her devastating memories of childhood abuse while directing her eyes to twitch rapidly from side to side. This, according to her shrink, would help her to better "process" her memories. "Sounds like hypnotism," I expertly analyzed. "Who knows, maybe it will work." More recently, when I wrote here about the neurobiological advantages of emotionally "finding a safe place," several readers also wrote in to ask me about EMDR. Now I understand why people want an expert opinion (and I'm no expert, by the way): a heap of controversy surrounds this popular technique.
The guiding principle of EMDR proposes that normally as we store new memories, they are integrated into memory networks, connected to previous experiences, and attached to related thoughts, emotions, sensations or images, so they can be used in later situations. Distressing experiences, however, are ill-processed, improperly stored in an "isolated memory network," according to the model.
These bad memories are stored exactly as they were perceived, along with the distorted thoughts and perceptions that occurred at the time, disconnected from relevant current information. Thus instead of simply remembering, the client has the sensation of actually re-experiencing the trauma, with intense emotional and sensory immediacy, long after the event; for example, a mugging victim, when a friend grabs her gently from behind, might experience intrusive images and sensations of the attack. In theory this happens when the unprocessed visual and sensory elements of her experience are conjured without any related information to temper them; she re-experiences her terror to its fullest degree. In EMDR, rapidly moving one's gaze from side to side and/or receiving other dual-attention stimuli (like bilateral tones or hand-tapping) is believed to enhance information processing in the patient's brain, so she becomes desensitized to the traumatic memory.
EMDR's creator, Francine Shapiro, stumbled upon the idea one day in the mid-1980's, when she took a walk in the park and had some disturbing thoughts. She noticed that her eyes were making spontaneous saccadic bursts upwards and to the right as she walked, and it occurred to her that these movements might be linked to the relief she subsequently felt; she hypothesized that the eye movements had helped her somehow to reprocess the information that had been troubling her. Shapiro's supporters see this intuitive and personal method of discovery as proof of her involvement in her work, whereas her critics find it less inspiring. At the time, Shapiro was searching for a dissertation topic, and she later earned her doctorate at the Professional School of Psychological Studies, which was never accredited and no longer exists. This is also seen by her detractors as a bit of a red flag. Yet she went on to develop a technique that has really caught on.
After her flash of insight, Shapiro tested her theory on her own patients, instructing them to conjure an image, negative thought, or bodily sensation associated with a traumatic memory and simultaneously shift their gaze, following her two fingers as she rapidly moved them from left to right. In 1989 she published her results, which she eventually developed into an eight-phase therapeutic treatment for trauma patients that integrates elements of many other psychotherapies with her eye-movement ideas, all with the aim of essentially pulling up a memory, reprocessing it, and properly integrating it in a memory network . During the key processing phases of this therapy, the patient pays attention to a disturbing memory in sets of 15 to 30 seconds while simultaneously following the dual attention stimulus (eyes following therapist's fingers, ears following tones, or alternate hand-tapping). After each set, the patient tells the therapist "what came up," and often makes this new material the focus of the next set. This process is repeated several times in succession.
Like many people before me, reading about this I scratched my head and wondered what evidence there was of these memory networks, isolated or otherwise. What proof was there that jerking our eyes back and forth would yank out the poorly processed memory and give us a re-do?
One researcher believed that EMDR could induce a physiological state similar to Rapid Eye Movement (REM) sleep, which has been shown to play an important role in memory consolidation. That sounded plausible. But more than anything, I wanted a some physiological evidence. What's actually happening in the brain and body while patients undergo this therapy? And the bottom line: Do the eye movements really make a difference?
After some investigation, I found the data to be roughly equivocal: about half the articles I read concluded that this technique works exceptionally well, and half concluded that it's not so great: either it is ineffective overall, or the eye movements are unnecessary, or it works no better than other therapies. It's a strange feeling indeed to read study after study and still come away so uncertain. I was not up to the task of doing an exhaustive analysis of the literature, so I am not about to argue it either way. Instead, I took a brief look at some work that began to address the physiological and neurological consequences of the eye movements.
One study I found particularly compelling explored whether the eye movement component of EMDR made a significant contribution to the subject's desensitization to a traumatic memory, and simultaneously monitored subjects' autonomic nervous system responses. Patients underwent regular EMDR, EMDR minus the eye movement component, or the same procedure substituting thumb-tapping for eye movement. In this case, EMDR with eye movements worked significantly better than with either thumb tapping or zero bilateral stimulation. Moreover, psychological desensitization to a traumatic memory during EMDR with eye movements was correlated with changes in patients' autonomic nervous system responses: breathing synchronized with their eye movements, heart rate slowed, blood pressure dropped, fingertips warmed, and galvanic skin response indicated relaxation. More recently another group looked at many of the same measurements plus a few more, and concluded that the eye movements during EMDR induced a nervous system response similar to that seen in REM sleep (which argues for a role in memory consolidation).
Possibly the most interesting physiological story I found was in a case study, which of course has none of the statistical power of the others. A patient whose PTSD was decreased significantly after EMDR was subjected to Single Photon Emission Computed Tomography (SPECT) before and after undergoing treatment. When he recalled the traumatic memory during brain scans, two areas of his brain lit up after EMDR relative to before: the anterior cingulate gyrus and the left frontal lobe. This is intriguing because the cingulate gyrus is thought to be involved in integrating emotional and mental components of the mind, and the frontal lobes seem to play an "executive" role in the integration of experience. I'd love to see combined scan data from 1000 PTSD patients.
Is EMDR a miracle cure? Because it is used to address isolated events rather than a patient's entire life, this technique often yields quick results, giving the impression of a particularly effective treatment, and it is now being tried for a range of complaints other than PTSD. Some physicians seem worried that this method will be mistaken for a magic bullet to replace more traditional methods of psychotherapy. But from everything I have read, no matter whether one chooses to believe the naysayer or the evangelist, EMDR appears limited in scope. My friend Ally tried it. She reported that it seemed to help with the particular memory she had focused on, but it had not resolved her issues around trauma that had been on-going over many years. She said she didn't see herself going back to address instance after instance of childhood abuse using EMDR.
If traditional psychotherapy is akin to regular auto maintenance and quarterly tune-ups, perhaps EMDR could be compared to replacing a fuse: important and necessary, maybe even crucial, but often insufficient for long-term functioning of the entire vehicle. It is very important to address specific events, especially in the case of severe PTSD, but from here it seems that just like anti-depressant drugs, EMDR should be considered not as a universal balm, but as a handy tool to use in conjunction with traditional methods.