Tuesday, February 28, 2012

Answers to Questions about EMDR

After my last blog post and the #MHON twitter chat about EMDR, several people asked me follow up questions about EMDR memory reconsolidation and what EMDR looks like.  So here are some answers to the questions and a link to a CBS News video that shows  how EMDR works.

What is memory consolidation?

Memory consolidation involves taking the component parts of a memory and combining them into one unified whole.  In the first few months after an event occurs, it is still fragmented into its component parts. After that the different parts of the memory come together into more of a single whole entity.

What does the term "overconsolidation" mean?

When a memory is overconsolidated, it is continually re-activated  by reminders and does not fade with time. Traumatic memories are often overconsolidated into flashbacks. Every time a flashback occurs, it reinforces the overconsolidation of the memory, making it more and more resistant to change.

What is meant by reconsolidation?

It was previously believed that the consolidation process occurred just once, but research findings indicate that memory retrieval activates reconsolidation, a process that either reinforces or alters memory.* Reconsolidation of the memory means that the whole memory network is altered because of new information.  Younger and weaker memories are more easily reconsolidated than older and stronger memories.*

How does EMDR facilitate reconsolidation?

EMDR reprocessing involves brief retrieval of a traumatic memory with delineation of all of its component parts (sensory, cognitive, affective and somatic aspects). Bilateral stimulation is added to facilitate reprocessing that updates the memory with new adaptive information. This reconsolidation of the memory puts it in a different perspective, so that reminders no longer trigger  flashbacks or fight/flight/freeze reactions.

Trauma-based memory networks are like files in a filing cabinet that are isolated from the other files. With EMDR, the isolated files are able to access files with information needed to put a traumatic event in time perspective, create a coherent narrative and find meaning in the experience.

How is this different than what happens with prolonged exposure (PE)?

With  PE, extinction is achieved by repeatedly re-exposing subjects to the feared situation without the feared result.  In this way, over time, the feared situation no longer elicits the fear-based response. In my understanding, extinction does not involve the elimination of the original association, but involves new learning that competes with the original conditioning to weaken the conditioned response. Therefore, extinction of emotional arousal and urges does not eliminate the underlying traumatic associations, just the symptoms.

With EMDR reconsolidation, the original association appears to be unlinked and the new learning is linked to the original events and resulting beliefs, feelings and body-based symptoms.

In summary, the EMDR and Prolonged Exposure methods of treating trauma involve two different approaches to  therapeutic memory retrieval and initiate two different processes: reconsolidation and extinction. According to recent studies using crab and medaka fish, the duration of the re-exposure may be an important factor regarding the type of memory processing that is elicited: brief retrieval led to reconsolidation, while more prolonged retrieval resulted in memory extinction.*

What does the EMDR experience look like?

 For a taste of what EMDR therapy is like, here is a link to a CBS News report on Healing Post Traumatic Stress about a gulf war soldier who received EMDR from San Diego trauma therapist Sara Gilman, past president of the EMDR International Association (EMDRIA).

Suzuki, A., et al. (2004). Memory Reconsolidation and Extinction Have Distinct Temporal and Biochemical Signatures.  The Journal of Neuroscience, 24(20):4787-4795. http://www.jneurosci.org/content/24/20/4787.full

Wednesday, February 15, 2012

EMDR: An Evidence-Based Treatment for Trauma

Eye Movement Desensitization and Reprocessing (EMDR) was discovered quite by accident in 1987 by Francine Shapiro, PhD.  She went for a walk  in the park and noticed that by the end of the walk she was no longer upset about something that had been bothering her.  When she thought about what had happened, she realized that she had engaged in spontaneous rapid eye movements while contemplating the problem and hypothesized that this had helped her to process and resolve her distress.  She later realized that most people do not spontaneously engage in these eye movements when awake, so she experimented with having people follow her fingers back and forth while focusing on their problems and discovered that it resolved their problems as well. 

In 1988, Dr. Shapiro graduated from using EMDR with "mundane problems" to experimenting with the "highly-charged memories" of people with post traumatic stress disorder (PTSD).*  She had similarly promising results using EMDR with this population.  At the time, PTSD was a fairly new diagnosis (it was first introduced in 1980) and there was no rigorous research about treatment effectiveness, other than studies that came out at about the same time evaluating cognitive behavioral therapy (CBT) as a  PTSD treatment .

There is now a substantial body of research that demonstrates the effectiveness of EMDR for the treatment of PTSD.**  In fact, only CBT and exposure therapy (and to a lesser degree stress inoculation therapy), have as much research supporting their use as a treatment for people suffering from PTSD. Despite this, some clinicians continue to mistakenly believe that EMDR is not evidence-based. 

Other clinicians mistakenly believe EMDR is just another exposure therapy.  EMDR uses brief exposure to the traumatic event, combined with bilateral stimulation (eye movements, tones, vibrations or tapping) and sensory, cognitive, affective and somatic components, to facilitate  adaptive information processing (AIP) and reconsolidation of the traumatic experience.

There are several theories about the role of the bilateral stimulation (BLS). One theory is that focusing on a distressing memory and a neutral visual, auditory or tactile stimulus at the same time helps to keep one foot in the present and one foot in the past to prevent retraumatization and facilitate adaptive reprocessing. Another theory is that the sensory stimulation may help process disturbing events in a mechanism similar  to dream sleep, also known as REM (rapid eye movement) sleep.  A third theory is that the bilateral stimulation activates both hemispheres of the brain to link right brain intuitive, sensory information with left brain logical, sequential, language-based information. Studies have been conducted about each of these theories and research continues to be done to answer our questions about how EMDR works.

What questions do you have about EMDR? What experience have you had with EMDR therapy, as a client and/or as a therapist?  What are your impressions about its effectiveness? Please share your comments and questions below. 

*See the recent article by Francine Shapiro in the Huffington Post online  where she talks about this: http://www.huffingtonpost.com/francine-shapiro-phd/ptsd-military_b_1250202.html)

**See http://emdrnj.com/emdr_research.html for citations and a brief summary of practice guidelines for PTSD treatment from the International Society for Traumatic Stress Studies (ISTSS), the American Psychiatric Association, the American Psychological Association, Cochrane Database of Systematic Reviews,  Department of Veteran's Affairs & Department of Defense (VA/DoD), and the Substance Abuse and Mental Health Services Association (SAMHSA)