EMDR and the Sleep Connection

As 2016 closes out, most Americans, and probably most people around the world, will be glad to see it go. Some years produce an abundance of misery and this was one of them. It almost certainly hasn’t been as bad as some years, like 1346 (Black Death starts in Europe), 1793 (the reign of terror in France), 1914 (World War 1 began), or 1941 (Hitler invaded the Soviet Union and Japan attacked Pearl Harbor). On the other hand, it has been a dreadful year for the loss of some great public figures (Prince, Paul Kantner, David Bowie, Leonard Cohen, and Carrie Fisher sadly among them) and for many in the country it has been a time of “cultural trauma,” perhaps akin to what people experienced in 1968. As we see news of the war in Syria and realize that our soldiers are still returning from battles around the world, we know that there is a great deal of trauma and human suffering at this time. There is also a great need for effective treatments to ease it.

I have previously discussed EMDR (Shapiro, 1995) as a treatment for PTSD. In this therapy, a patient selects an image related to a traumatic event and is asked to hold it in mind while engaging in back and forth eye movements that are led by the therapist. After completing a set of eye movements, the patient is directed to note, “what comes up,” such as thoughts, feelings, or other images. The patient then holds whatever was most salient that was noted in mind while another set of eye movements is conducted and so on. Over the course of the session, the patient is helped to process the image and desensitize the trauma. How this treatment works has generated a considerable degree of controversial but it is possible that it works in a way similar to systematic desensitization. In this model, the eye movements serve to relax and distract the patient while confronting painful material related to the trauma as the supportive therapist helps the patient cognitively to make sense of the experiences.

It is also possible that EMDR works by engaging similar brain mechanisms as those that underpin rapid eye movement (REM) sleep. I always found Crick & Mitchison’s (1995) model of “reverse learning” in REM sleep to be extremely interesting. In their model, REM sleep is involved in the processing of the day’s input and the elimination of unnecessary information. Since the publication of their theory, it has become clear that sleep is very much involved in memory and learning.

Everyone is aware of the frightening nightmares and unpleasant over-arousal that causes insomnia in those suffering from PTSD. Indeed, rather than just being a symptom of PTSD, disturbed sleep may be a core feature of the disorder (Spoormaker, & Montgomery, 2008) and treating the attendant sleep problems may be a necessary component of effective treatment.

From the earliest days of EMDR, Shapiro argued that the bilateral eye movements were necessary for the processing of traumatic memories and was related to the activation of brain processes similar to those in REM sleep (Stickgold, 2002). Efforts were made to develop a more comprehensive model of how REM sleep-like processes could do this. Stickgold (2002) proposed that the repeated redirection of attention caused by the eye movements used in EMDR brings about a neurobiological state which resembles REM sleep. In this state, traumatic and emotionally charged memories can be processed into more ordinary and less emotionally overwhelming memories so that the emotional charge of the trauma is relieved. This integrative process would result in the reduction of the power of episodic memories (mediated by the hippocampus) and the associated negative emotion (mediated by the amygdala). Stickgold (2008) presented further evidence that during sleep memory processes are activated that are necessary for the processing and resolution of trauma. While not conclusively proven, this model has some support and does help to explain how EMDR can be so effective.

So as we end this year, let’s hope for a better and brighter one in 2017. Therapeutic advances in techniques such as EMDR give us hope that resolution of trauma, whatever its cause, can indeed be achieved.