Trauma Therapy’s New Focus

Watching a therapist’s hands move back and forth in front of your face while recalling painful memories may seem an unlikely way to alleviate trauma. But hundreds of thousands of people have reportedly tried the technique, and some psychologists--and their patients--say it works.

The therapy, called eye-movement desensitization reprocessing, involves a combination of hand movements (or sometimes finger taps or sounds), accompanied by verbal commands. The patient follows the therapists’ movements with his or her eyes while discussing the event or problem that led the patient to seek help.

“EMDR sounds like utter nonsense, but this weird thing has a profound effect on people,” says Dr. Bessel A. van der Kolk, a professor of psychiatry at Boston University who has studied EMDR.

Once employed mostly to treat severely traumatized patients, EMDR is now used for such common problems as depression, loneliness, fear of flying, claustrophobia and stage fright. Since it was first devised by California psychologist Francine Shapiro in 1987, more than 40,000 therapists in the United States and abroad have attended EMDR workshops, and an estimated 2 million patients have been treated with this technique, according to the EMDR Institute in Pacific Grove, Calif., which conducts training workshops in the technique.

Even though no one is quite sure how EMDR works, it has received some notable endorsements. The American Psychological Assn., the nation’s primary professional organization for psychologists, has determined that it’s an effective treatment for civilian post-traumatic stress disorder, and Kaiser Permanente, one of the nation’s biggest HMOs, uses the technique to treat patients at mental health clinics in Northern California.

EMDR’s increasing acceptance is part of a larger trend in psychotherapy. Conventional talk therapy, which can be a lengthy process, has been augmented or supplanted by techniques that emphasize problem-solving, such as cognitive behavioral therapy, which tries to change abnormal reactions to ordinary stresses. Such experiential techniques, which seem to help patients more quickly, have been inspired by new insights into brain chemistry and how the mind deals with trauma.

“We thought that if people can talk about something, they will feel better--but we’ve discovered just talking doesn’t necessarily change your life,” van der Kolk says. Today, psychotherapy has been significantly influenced by research into the brain and how it processes information. Many doctors and therapists, however, doubt that EMDR is any more effective than other treatments. They point out that the placebo effect, which is the belief that a treatment will work, is quite potent in psychotherapy, especially with new treatments. Patients expect a therapy to be effective, and because they trust their therapists, it can become a self-fulfilling prophecy.

Skeptics also argue there’s nothing unique about EMDR, and they fault proponents for touting it as a major breakthrough. They contend it’s just a clever repackaging of existing therapies in which patients are repeatedly exposed to sensations or objects they fear to gradually diminish their anxiety.

“Patch this together with the placebo effect, and it’s not surprising that it’s helpful,” says Richard J. McNally, a psychology professor at Harvard University in Cambridge, Mass. “There are a bunch of syndromes where EMDR does seem to work well--with PTSD, phobias and panic disorder. But people are now using EMDR for everything--even for improving golf games.”

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Pinpointing, Treating Specific Traumas

EMDR was first used on patients suffering from PTSD: Vietnam veterans; victims of rape, incest or child abuse; and survivors of natural disasters or traumatic events, like car accidents, earthquakes, the shootings at Columbine High School and the Oklahoma City bombing. And when terrorists attacked the Pentagon and the World Trade Center, EMDR therapists traveled to Washington and New York to counsel survivors, victims’ families, and rescue and recovery workers.

Therapists who use the technique say it helps people come to terms with their experience without being re-traumatized. “EMDR is much more accurate than conventional therapy,” says Steven V. Marcus, a psychologist at Kaiser Hospital in Santa Clara.

In an often-cited study funded by Kaiser and published in the journal Psychotherapy in 1997, Marcus randomly assigned 67 PTSD sufferers to either EMDR or standard treatment. At the end of three sessions, 50% of the EMDR participants no longer met the criteria for PTSD, compared to 20% receiving standard therapy. After treatment, 77% of the EMDR group no longer met the PTSD criteria, compared to 50% of those receiving standard therapy.

“With EMDR,” says Marcus, “you can pinpoint a specific trauma and target that like a laser beam.”

This fast transformation is a large part of EMDR’s appeal. When Susan Rogers, a psychiatric social worker in Woodland Hills, attended an EMDR workshop two years ago, she was asked to think about an event in her life that was still painful. She remembered an incident 15 years earlier, when she was a graduate student at UCLA. A professor had interrupted her during a practice interview with a client, taken over the session himself and afterward told her that she’d never be a good therapist.

During the EMDR session, she was instructed to think about the episode while watching the therapist’s hand as he waved it back and forth like a metronome. The therapist then told her to think about how she’d like her mental picture to change.

“All of a sudden, his [the professor’s] head behind the desk got as big as a balloon and then it just popped into little pieces, and he wasn’t there anymore,” Rogers recalls. Within five minutes, she says, her feelings of shame and resentment evaporated, and the incident no longer bothers her.

EMDR may work so quickly by focusing on specific disturbing incidents, as opposed to traditional talk therapy that tends to be more wide-ranging.

“EMDR can help resolve all kinds of trauma--anything that has stuck with someone that is controlling his or her emotional life at a subconscious level,” says Ronald M. Doctor, a professor of psychology at Cal State Northridge. “Emotions that have been cut off or repressed can be brought to the surface. Reliving them in a safe place--the therapist’s office--somehow relieves the blockage and creates alternative networks in the brain.”

When people are threatened, the body secretes stress hormones, like adrenaline. Brain scans of rats reveal that prolonged bombardment by stress hormones shrivels the hippocampus, the part of the brain where memories are stored. Similar tests of combat veterans suffering from PTSD showed a marked decrease in the size of their hippocampi, too, which were restored to normal levels when the stress was relieved.

Scientists such as van der Kolk speculate that an oversupply of stress hormones interfere with the normal processing of traumatic events. They say these memories become stored in the wrong place in the brain’s memory banks, which accounts for the flashbacks, nightmares, anxiety and constant feeling that they are reliving their trauma again and again--all symptoms of PTSD.

Life’s everyday stresses can have similar, though not quite as pronounced, effects, say experts like Cal State’s Doctor. A critical parent, social ostracism during high school or an abusive boss can eventually add up to trauma that is imprinted in the brain. Then, when people are confronted by comparable situations, they become gripped by seemingly senseless fears, paralyzing claustrophobia or performance anxiety.

One Hollywood writer and director was on the verge of landing a huge assignment. But based on unsatisfying past experiences, he worried that he wouldn’t be given the freedom to do the job the way he wanted.

“I knew this wasn’t productive, but I was anxious and lost sleep chewing this over in my mind,” he recalls.

His therapist suggested EMDR as a way of resolving these feelings. During a 90-minute session, the therapist asked him to think about why this job possibility was so upsetting. Then she told him to focus on a better outcome.

“I stopped obsessing and torturing myself, and did in a day what would have taken a year in regular therapy,” says the 59-year-old Los Angeles man, who asked that his name not be used.

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A Connection Between Eye Movements and Brain

A typical EMDR session begins with the therapist asking the patient to envision a safe place he or she can call to mind should the person feel threatened. The patient is then told to think of the disturbing experience while focusing on the therapist’s hand movements (or sounds or taps). The therapist then asks the patient to talk about the image and the feelings about it. Next, the client returns to the distressing image and is told to imagine a better solution. The patient is then asked his or her feelings to the solution.

After repeating these steps several times, many patients say they’re able to distance themselves from the traumatic experience.

Even scientists who say EMDR works can’t explain how it alleviates the effects of trauma. But, after three or four sessions, brain scans of 12 people with post-traumatic stress disorder showed changes in the brain regions that govern emotion, memory and impulse control, says van der Kolk, who conducted the research.

“The eye movements seem to cause a shift in the cognitive processes,” says Shapiro, a senior research fellow at the Mental Research Institute, a nonprofit training and research center in Palo Alto. Shapiro stumbled upon the technique while out for a walk about 15 years ago. She noticed that rapidly moving her eyes back and forth eased her disturbing thoughts.

This eye flicking seems to mimic the rapid eye movements of REM sleep, that deep sleep stage when we dream and process the events of the day. But eye movements aren’t the only way to diminish a trauma’s emotional sting. Different types of stimulation were introduced in 1990 when other therapists found they could get the same results using gentle finger taps or tones. Activating both sides of the brain--whether it’s done with eye movements, taps or sounds--seems to be the key element in turning on information processing systems in the brain, according to Shapiro.

Still, EMDR has primarily been studied in people who have been severely traumatized. Donna Bowers, for one, spent nearly 10 years in traditional talk therapy to find some relief from flashbacks, panic attacks, nightmares, insomnia and anxiety--all of which were the emotional fallout from years of physical, emotional and sexual abuse.

“Therapy helped me to understand why I felt this way,” says the 46-year-old Placentia woman. “But it did nothing to relieve my physiological symptoms. I woke up afraid. I went to sleep afraid. and I was so crippled emotionally that it took all my strength and courage to get through every day.”

She decided to try EMDR at her therapist’s suggestion.

After six weeks, Bowers no longer suffered from the panic attacks and anxiety that plagued her all her life, and she says a year of EMDR sessions helped clear away much of the debris left by a damaging childhood.

“EMDR gave me my life back,” says Bowers, now a therapist herself. “I no longer live in the shadow of my past.”