Eye Movement Desensitization and Reprocessing: A Neuroscientist’s Perspective

My professional role requires me to constantly translate concepts from the scientific literature and clinical best practices into meaningful bits of information for healthcare executives, health tech developers, and folks in the general population who are affected by brain-body issues. So it probably comes as no big surprise that I’m constantly asked some version of this question: “Hey, you know that ________ therapy? Does it actually help people? How does it actually work?” I take a lot of care to stay on top of emerging therapies and to get a reasonable sense of how they work (what fancy-pants scientists and doctors like to refer to as the mechanism of action). Often times, mechanisms of action are super drilled down, focused solely on a single molecule (in the case of a drug therapy) or a single process in the body. But the way many therapies work is quite complex, with interesting interactions that span changes in the body, brain, environment, and behavior.

One therapy that has frequently come up in these conversations is Eye Movement Desensitization and Reprocessing (EMDR). Created by Francine Shapiro in the 1980’s to help alleviate the distress caused by traumatic memories, EMDR has gained a lot of traction and popularity in clinical practice over the past decade. EMDR therapy is particularly fascinating because it combines several uncommon elements — eye movements, recall of traumatic memories, and bilateral stimulation — to facilitate the brain’s natural healing processes. This approach is designed to help individuals process and integrate traumatic memories into their standard cognitive framework, reducing the emotional distress associated with them. So if you’ve ever wondered about if this therapy is legit (or if you’ve never even heard of it at all!), let’s delve deeper into the neuroscientific principles behind EMDR, exploring how this therapy activates specific areas of the brain involved in stress response and memory processing. Once we understand what happens in EMDR sessions, we can better examine its effectiveness in treating various psychological conditions.

What Happens During EMDR Therapy

While each therapist may engage their patients in slightly different ways, an EMDR session is generally characterized by the following steps:

1. History Taking and Treatment Planning: The therapist assesses the client’s history to understand the problems and behaviors to be treated.
2. Preparation: The therapist explains the EMDR process and equips the client with stress-reduction techniques.
3. Assessment: Identifying the specific target memory and its components (images, thoughts, affect/mood, and body sensations).
4. Desensitization: The client focuses on the memory while engaging in EMDR processing using bilateral stimulation, which is believed to lessen the emotional impact (don’t worry, I’ll explain this in more detail down below).
5. Installation: The therapist aims to help their patient strengthen positive beliefs associated with the targeted memory.
6. Body Scan: After the positive belief is installed, the client is asked to think about the original memory and notice if any residual tension is sensed in the body.
7. Closure: This ensures the client leaves at the end of the session feeling better than at the beginning.
8. Reevaluation: At the beginning of the next session, the therapist checks in with the patient to ensure the treatment effects have been maintained.

So what exactly is bilateral stimulation?

The most distinctive element of EMDR is its use of bilateral stimulation, which typically uses guided eye movements (although auditory tones or tactile taps can also be used) to mimic the brain’s physiological state during Rapid Eye Movement (REM) sleep, which is associated with processing memories and emotions. Therapists often use special equipment that helps cue patients — one of the most common is a machine that patients follow back and forth with their eyes to achieve the proper eye movements.

An example of an EMDR setup using cued eye movement, tactile sensation, and auditory cuing — the therapeutic grand slam! (Image courtesy of SE Factory)

The purpose of bilateral stimulation in EMDR is to help with the neurological processing of emotional experiences. The theory is that the bilateral stimulation activates both hemispheres of the brain, aiding in the integration of emotional and cognitive processes. This is supposed to help reduce the vividness and emotional intensity of the traumatic memories, making them less distressing and more like ordinary, less disturbing memories. This combination of targeted memory recall and bilateral stimulation is what sets EMDR apart from other therapies, leveraging the brain’s natural healing mechanisms to treat trauma.

Neuroscientific Foundations and Mechanisms of EMDR

EMDR therapy’s effectiveness in treating trauma and other psychological stressors is rooted in theories related to the brain’s inherent processes of memory and emotional regulation. Understanding the neuroscientific basis of EMDR helps clarify why it is effective for many individuals suffering from post-traumatic symptoms and other emotional disturbances.

Replication of REM Sleep Neural Activity

EMDR stimulates communication across the hemispheres of the brain, which is believed to help process and integrate traumatic memories. This follows observations of the brain’s natural healing processes engaged during REM sleep, where similar eye movements occur. This stage of sleep is crucial for memory consolidation and emotional processing, and EMDR’s bilateral stimulation is thought to mimic these natural brain rhythms, thus promoting the integration of traumatic memories into the general memory network (much like what we see happen in healthy REM sleep).

Memory Processing

Bilateral stimulation during EMDR is believed to reduce the vividness and emotionality of traumatic images. Research suggests that this stimulation works by reducing limbic system arousal (the part of the brain responsible for emotional intensity). This reduction in arousal allows the individual to access and process traumatic memories more effectively during therapy, without becoming overwhelmed by intense emotional reactions.

Neuroplasticity (of course!)

I sometimes like to think that if this blog were an episode of Pee Wee’s Playhouse, “neuroplasticity” would be the secret word that made readers scream real loud every time I say it (sorry non-Millennials if you don’t get that reference). EMDR is a valuable trauma therapy because of its ability to promote neuroplasticity (if you’re new here, neuroplasticy is the brain’s ability to reorganize itself by forming new neural connections — you can learn all about it here). This reorganization is essential when dealing with trauma, as the brain needs to reconfigure its response to past experiences, which are no longer threats in the present environment. By fostering new patterns of thinking and reacting, EMDR helps decrease the pathological impact of old memories on an individual’s current life, letting them create new, safe experiences that support a feedback loop of healing and recovery.

What Do the Data Say?

EMDR has received considerable empirical support in multiple scientific studies, particularly when it has been used for the treatment of PTSD. Numerous studies and meta-analyses (when scientists take data from a bunch of different studies that have been published and run statistics on them to understand larger effects) have demonstrated its efficacy in reducing the symptoms of post-traumatic stress disorder and other anxiety-related disorders. For instance, a systematic review by the Cochrane Database, which is the cream-of-the-crop gold standard for reviewing healthcare interventions, concluded that EMDR is effective for treating PTSD, with clinical improvements similar to those achieved through cognitive-behavioral therapy (CBT). The assumption that EMDR works by replicating neural activity seen during REM sleep has been supported by neuroimaging studies that have shown changes in brain activation patterns during EMDR sessions, particularly in areas involved in emotion regulation and memory processing (if you’re looking for extra credit, this includes brain regions like the amygdala, hippocampus, and prefrontal cortex).

But Not Everyone Is On Board…

Despite the positive findings, some researchers and clinicians remain skeptical of EMDR’s effectiveness and the mechanisms proposed to explain it. Critics argue that the eye movements in EMDR are unnecessary and that the therapy’s success is primarily attributable to its incorporation of effective elements from other therapies, like exposure and cognitive restructuring. Some meta-analyses have also suggested that while EMDR is effective, it may not offer any significant advantages over other established therapies, particularly when considering the cost and training required to properly administer EMDR. There is also an ongoing debate regarding the neurobiological underpinnings of EMDR. While some studies suggest that the bilateral stimulation of EMDR could help with emotional processing by mimicking aspects of REM sleep, others fail to find a robust neurological mechanism that can definitively explain the efficacy of the eye movements themselves. This inconsistency has led to calls for more rigorous, well-designed research studies to better understand how EMDR works at a neurological level.

This guy probably has some thoughts on the matter… (Image courtesy of the New York Public Library Shop)

Bringing It All Together

EMDR is a psychotherapy that is unique in its use of bilateral stimulation (eye movements, auditory tones, or tactile taps that are meant to simulate REM sleep) that is integrated into a multi-phase treatment process. This structured approach aims to desensitize individuals who experience distressing memories and reprocess those memories in a way that reduces their negative psychological impact. The body of research on EMDR provides substantial evidence of its effectiveness, especially for PTSD and trauma-related conditions, with results comparable to those of other established therapies like cognitive-behavioral therapy. Despite its clinical success and theories about mimicking REM sleep, there is still no consensus on the exact neurobiological mechanisms that underpin EMDR. While some propose that bilateral stimulation is central to its effectiveness, others argue that the therapeutic elements similar to those found in more traditional therapies might play a more significant role, suggesting that EMDR’s unique components may be supplementary rather than essential to its success.

Diving Deeper

For those inspired by the potential of EMDR therapy and eager to explore its principles and applications further, a ton of resources are available to help you. Whether you are a practitioner, a patient, or just a neuropsychology nerd like your’s truly, these resources will deepen your understanding and provide practical insights into the use of EMDR in various contexts.

• “EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma” by Francine Shapiro. This book by the founder of EMDR offers insights into the development of the therapy and its fascinating impact on treating trauma.
• Journal of EMDR Practice and Research. This publication offers the latest clinical and research findings on EMDR and is an invaluable resource for professionals seeking to stay up-to-date with advancements in EMDR therapy.
• The EMDR International Association (EMDRIA). EMDRIA provides a hub for professionals and the public to access resources, find certified EMDR therapists, and explore educational opportunities. Their website includes a comprehensive list of resources and training programs

Call to Action

What has been your experience with EMDR, or what are your thoughts on its application in therapy today? No matter your role in psychological therapy — whether you deliver it or receive it (or both!) — your perspectives and experiences can help illuminate this this topic even more, and provide helpful insights for those who are interested in this growing therapy. Share this article with your network to spark more informed conversations or bring it to the attention of those who might benefit. Join the dialogue on social media using #EMDRJourney and let’s collectively deepen our understanding and appreciation of how innovative therapies like EMDR are reshaping mental health care!