Devastating events can happen in an instant and be over in moments, but their effects can linger for years.
An estimated 13 million Americans are suffering from post traumatic stress disorder, haunted by experiences that may have occurred decades ago. But the originator of a controversial new therapy technique says she can free them in a few blinks of an eye.
The treatment, called eye movement desensitization and reprocessing (EMDR), actually involves a complex combination of traditional psychotherapy approaches, but its distinctive central feature is the belief that rapid eye movements during the recollection of a traumatic event can somehow defuse the memories.
Francine Shapiro, Ph.D., the California psychotherapist who developed the technique, knows her claims are bold and admits she can't explain how EMDR works, but tells her critics that the proof is in the patients who have been liberated in a way that years of talk therapy couldn't accomplish.
Post traumatic stress disorder (PTSD) is itself a condition that was only fairly recently formally recognized and defined by the mental health community. While most commonly associated with military combat veterans, its victims are just as likely to be women or children who have experienced rape, some other form of violence, accident, or natural disaster.
For each, it's as though the memories themselves are repeatedly assaulting them, just as suddenly and intensely as the original event did. The result is a state of persistent distress in the victim which, according to the National Center for PTSD, can include heightened anxiety and agitation, inability to concentrate, fear and avoidance of reminders of the event, emotional numbness and withdrawal from relationships, and a sense of helplessness regarding the vivid flashbacks, whether they come in nightmares or during waking hours.
Eye Movement Desensitization & Reprocessing
How Eye Movement Desensitization and Reprocessing Works
Perhaps the intensity of the problem, in contrast with the simplicity of the eye-movement solution, makes EMDR's promise of a real cure seem so unbelievable to many. EMDR treatment begins typically enough, with therapist and patient identifying the traumatic event and the negative beliefs (such as feelings of worthlessness or fear) the experience has created in the patient, as well as establishing how the patient would prefer to feel.
Next, with the therapist sitting very close, the patient is encouraged to bring the traumatic memory to mind and experience the negative emotions that come with it. During this time, the therapist moves his or her hand back and forth in front of the patient's face to produce rapid movements of the patient's eyes. This is the "desensitization" phase of treatment.
Later, the patient is asked to think positive thoughts while making a different set of eye movements, in the "reprocessing" phase.
There are eight steps in all, and Shapiro claims that as many as 90 percent of those who undergo EMDR are cured of PTSD, most within only three sessions.
"The beauty of it," she explains, "is you can take a rape experience, for instance, and the victim who starts out saying, 'I'm damaged goods, and it was my fault, and I'll never be any good' and a partner touches her in a certain way and she jumps, even if it happened 10 years ago.
With EMDR, at the end of the three sessions she's saying, 'You know, I did really well. He had a knife at my throat, and I got out alive. The shame is his, it's not mine. I'm a strong, resilient woman.' And if her partner touches her in the same way, she's not gonna jump anymore, because it's out of her system."
Shapiro says the secret came to her while walking through a park one day in 1987. "I noticed some disturbing thoughts I was having were suddenly disappearing, and when I went to bring them back they just didn't have the same charge anymore." She started paying close attention and, "noticed that when that kind of thought came to mind, my eyes spontaneously started moving in a certain way, and I noticed the thought shifting. So, I thought I'd stumbled on the natural process that's there for everyone, and I was just lucky enough to have noticed it."
How Does EMDR Work?
Shapiro has spent the last 12 years developing the EMDR method and training more than 30,000 practitioners around the world. Yet she still isn't sure precisely why it's effective. She believes, along with others who have studied her technique, that the eye movements might be helping the brain to process memories in a way similar to what happens during the rapid eye movement (REM) phases of sleep. "That's what the REM sleep is for," Shapiro explains, "it's for the learning to take place of the day's experience."
Shapiro thinks traumatic memories that continue to feel as intense as the original experience are stored in "the wrong form of memory." They are "still hot," as she puts it, because they're still directly linked to the emotions and physical sensations that accompanied the original experience. "When we work with EMDR, Shapiro explains, "we target those earlier experiences and we set in motion this information-processing system that for some reason didn't allow that experience to be appropriately digested at the time. And then what's useful from that experience is learned, it's absorbed, it's stored with appropriate emotion, it can guide the person in the future, and what's useless, the negative emotion, physical sensation, all of that's able to be let go."
In 1998, a Boston University trauma specialist, Dr. Bessel A. van der Kolk, attempted to trace the process by performing photon emission computed tomography (PET scans) on the brains of 12 PTSD sufferers before and after EMDR therapy. Following three EMDR sessions, the patients' PET scans showed increased activity in the frontal lobes of the cerebral cortex, the so-called seat of "reason," and decreased activity in the limbic system, the more primitive area of the brain associated with fear and emotion. Dr. van der Kolk theorized at the time that stress-response chemicals flooding the body and brain during a traumatic event interfere with information processing, causing memories to be stored as episodic fragments and sensory impressions. EMDR, he concluded, somehow allows the frontal lobes to act as a filter, stripping the memories of their "emotional valence."
A Real Breakthrough?
EMDR boosters say it doesn't really matter how it works, but that it does. The technique has been used on thousands of patients, from Vietnam War veterans to disaster victims, including survivors of earthquakes in Mexico and Turkey, the Oklahoma City bombing, the Columbine High School shootings, and families of TWA flight 800 passengers. Many adult and child victims of rape, molestation, assault, and car and plane crashes have also been treated with EMDR.
Fewer than two dozen studies of EMDR's effectiveness have been done, yielding mixed results. Some show a majority of patients treated with EMDR experience a significant, lasting reduction in PTSD symptoms compared to patients who receive no treatment. But EMDR-treated patients rarely seem to fare much better when compared with patients who receive other kinds of therapy, leading Shapiro's many critics to say all she's done is to add sleight of hand to an amalgam of old therapies. In 1997, clinical psychologists Gerald Rosen and Jeffrey Lohr wrote, "What appears to have happened is that Shapiro took existing elements from cognitive-behavior therapies, added the unnecessary ingredient of finger waving, and then took the new technique on the road before science could catch up."
Shapiro is the first to acknowledge that her eight-step EMDR method incorporates elements from several existing therapies in addition to the unique eye-movement stimulation technique. "But all we have to do," she says in response to detractors, "is keep allowing the research to come out, which keeps showing that EMDR works. And the idea is healing people, it's not having a theoretical argument." Patients who feel better after EMDR agree.
Laurie Sprinzen was napping on a Long Island Railroad commuter train one evening in December 1993, when she awoke to the sound of gunshots. A man named Colin Ferguson had opened fire, killing six passengers before being overpowered by others. Sprinzen recalls "pandemonium," and remembers standing on the station platform later, "looking around, and still not really knowing what was going on, and seeing somebody's head against the side of the train, and there was blood visible." In the days that followed, Sprinzen says she "Freaked out. I wouldn't even drive to the train station. I was really afraid, because every time I closed my eyes, I saw that head against the window."
Sprinzen sought help from a therapist who had treated her for another problem years earlier, and this time he offered to try EMDR. After just three sessions, she says, her fears were gone. "I really don't know [how it works]," she told She TV, "but what I think it does is you're concentrating on one level, whether it be following a hand or the tapping, cause you get into the rhythm of that hand going back and forth, that it's almost like you zone out of what you were thinking about, for even that 10 seconds with the fingers going back and forth. And then when you get back into the question, it's not as imperative anymore. It changes your focus. You don't have to walk around being scared about a thing. I mean, I could not get on a train that I had been doing for 15 years, so, you know, it worked for me."