David Coates sat in his therapist’s office holding a palm-sized electrode in each of his hands, describing the last time he ever saw his mother. The electrodes alternately pulsated, left and right, as he talked.
Coates, 37, recounted his mother saying he was scaring her. In a haze of rage and drug impairment, he had punched a wall and shattered a picture frame. She fled and told him that if he was at her home when she returned she would call the police. It was the last time they spoke. In a few months, he would be in jail and she would be dead from breast cancer that had spread to her brain and lungs. As he spoke, Coates, a tattoo artist living near Boulder, Colorado, kept some of his attention on the electrodes that buzzed on and off in his hands.
Coates was participating in eye movement desensitization and reprocessing (EMDR), a form of therapy in which a patient relives a traumatic event while keeping track of a stimulus that alternates from one side to the other. Visually following a therapist’s slow side-to-side hand movements was the original form of EMDR, but other stimuli have been introduced over the past 20 years. Between various electronic handhelds and light signals, some EMDR therapists build extensive tool chests. But there’s one constant: The client discusses something terrible while keeping up a monotonous physical response to bilateral stimulation.
EMDR is practiced by an ever-growing multitude of certified therapists. It’s been endorsed by celebrities, included in pop culture (see this year’s Russian Doll), and buzzed about on social media. Though its proponents say it helps neutralize the triggers and physiological impacts of trauma, no one is exactly sure how it works.
There are various tools for EMDR but there’s one constant: The client discusses something terrible while keeping up a monotonous physical response to bilateral stimulation.
“We don’t know what goes on in the brain” during a session, said Robbie Dunton, administrative director of the EMDR Institute, which oversees the training of therapists in the process. “People have had different theories on it [but] there are so many studies showing the effectiveness that it’s been accepted into the mainstream.”
Some skeptics have attributed the positive results of EMDR to the therapeutic basics—being in a caring atmosphere and having a chance to talk—and dismissed the eye movements and hand buzzers as mere gimmicks. But those who have experienced it say there’s something more.
Coates grew up in a gang-occupied area of Fresno, California, and since his teenage years has dealt with an addiction to intravenous methamphetamine. He was working as a loan shark for dealers when he ended up firing a round at a fellow user who fought back. No one was hit, but Coates faced serious charges, including attempted murder. He was only convicted of burglary. “My more deeper trauma are stemming from being locked up and my mother passing away,” he said. “I didn’t get a chance to put it positive or hug her goodbye. I didn’t get a chance to amend the terrible things I did and said.”
He hasn’t been able to think about the loss without clenching up and mentally shutting down, he said. So when he heard about EMDR in his addiction-recovery circle, he decided to try it. After four of eight planned sessions, the clenched-up feeling is starting to change. “Part of the therapy is she tries to get me to really understand my physiological triggers,” Coates said of his EMDR therapist. “If it’s sadness or sorrow, I can feel it deep in my chest.”
Clinical psychologist Francine Shapiro had the initial idea for EMDR in the late 1980s, when she became aware of darting her eyes back and forth along a path on a nature walk. She shepherded a similar technique through initial clinical trials, starting in 1989.
After four of eight planned sessions, Coates's clenched-up feeling is starting to change.
Some late-nineties studies of small pools of participants showed promise for the method: A 1997 study of 66 people, about half of whom had been diagnosed with PTSD, found a 68 percent reduction in related symptoms through EMDR. Another showed a 90 percent reduction of symptoms in sexual assault victims, when compared to a control group who had received no treatment (while they were on a waiting list).
Dunton, who is also Shapiro’s colleague, said the two of them used EMDR in Israel and Europe before bringing it back to the U.S. Now, the institute has a yearlong calendar of workshops, taught by a team of psychologists, to certify therapists in EMDR. They don’t have an exact count of those who are EMDR-certified but Dunton said it’s in the hundreds of thousands.
That doesn’t mean they have the science down yet. “I’ll be the first to admit we don’t know how it works,” Dunton said. “It just does.” She’s seen the treatment ease PTSD symptoms countless times: “Patients have come in with a floating trauma, a lot of anxiety. This breaks the sensations and experiences” they have been reliving.
A slew of theories have been attached to EMDR. Some say the bilateral focus can mirror REM, the sleep stage associated with processing memories. Others have suggested the tic-toc mental task prevents the physiological tight grip that can overtake the body and mind when a person is triggered, allowing the thought and related emotions to be processed properly. Yet another theory is that practicing left-to-right coordination can increase communication between the two hemispheres of the brain. And Shapiro has suggested that because following bilateral stimulation takes up mental resources one would otherwise employ in reliving a horror, “the memory becomes less vivid, less complete and less emotional.”
"I’ll be the first to admit we don’t know how it works,” Dunton said. “It just does.”
After 30 years of different theories, the skeptics remain unsure. Harvard psychologist Richard McNally compared the spread of EMDR to the rise of mesmerism, the 18th-century health craze that tried to heal ailments through manipulation of an invisible life force. Steven Novella, executive editor of the skeptics’ website Science-Based Medicine, somewhat more kindly compared it to acupuncture, saying both were “nothing more than a ritual that elicits non-specific therapeutic effects.”
One study showed that EMDR lead to no better results than exposure therapy, in which a professional creates a therapeutic setting for discussing and reliving traumatic experiences. A naysayer asked Shapiro in a The New York Times forum, “Is EMDR (as I have always suspected) just another version of prolonged exposure using snapping, waving of hands or light bars to induce eye movements that have no clinical relevance?” In response, Shapiro shot off a long list of studies suggesting EMDR was as effectively as cognitive behavior therapy or slightly more effective.
In 2008, an Institute of Medicine report stated that more research was needed to determine the efficacy of EMDR, but since then skepticism from the psychological and medical establishment has cooled, and the treatment has gained endorsements from the American Psychiatric Association, the U.S. Department of Defense, the World Health Organization and the U.K.’s National Health Service. Recently, EMDR has found celebrity advocates in Rachel Evan Wood and Brie Larson, who have publicly lauded the effect it’s had on them.
The standard EMDR treatment is eight sessions. At the first session, the therapist inquires about a client’s history and symptoms and considers a traumatic memory to target. “It’s a typical intake [appointment],” said Lynn Lauria, a therapist in Western New York who practices EMDR. “I’m also deciding if EMDR is appropriate.” In the second, the therapist explains the technique, including the bilateral stimuli (the hand motions or electronic tools) and a “stop signal” if a session becomes too intense.
At the third, they develop a game plan: The therapist and client agree to a trauma to target and the latter conjures up the most salient image associated with that memory (like Coates’ memory of his mother walking out as he stared at the shattered photo frame). The client states a negative belief stemming from that memory and the two come up with a positive belief to replace it.
In the following three sessions, the therapist and client revisit the traumatic memory and the images, emotions and beliefs associated with it, while using the bilateral stimuli. “When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session,” reads the EDMR Institute website.
The eighth session is a wrap-up, though for many patients the sessions go on for longer before they’re finished.
Lauren Withrow, a Marine Core veteran near Tyler, Texas, went through an eight-session treatment after a suicide attempt. Withrow had endured years of non-combat-related PTSD. “I used to sleep next to the door because I was expecting someone to come in and hurt us,” she said. (The original source of her trauma she will only share with her therapists, she said.)
Last year, she was raising two daughters and working as a reporter and photographer for a small-town newspaper. When she was photographing the high school football team, the thought entered into her mind: She needed to kill herself. “It’s not rational and it’s not like anything that had happened to me before,” she said, “but I acted within a few hours.”
After her attempt, Withrow went from an intensive care unit to a psych ward at a local Veterans Administration hospital. She temporarily gave physical custody of her daughters, both teenagers, to a family member. Then she heard about EDMR through social media. Through eight sessions, she and her therapist tried to disarm the triggering memory of being in the ICU and informing her daughters she tried to kill herself.
Withrow and her therapist used a variation of the negative/positive belief switch-up. They are trying to expunge her belief that the suicide attempt means she is a “terrible mother.” Instead, they worked to implant a “future memory,” in which she imagines a specific scene in an optimal future: “I try to see myself when we’ve reconnected and I’m with my youngest child at a boutique,” Withrow said.
Although reactions caused by PTSD can seem erratic and irregular to outsiders, Withrow says the effect is like a predictable computer algorithm. For months, when she thought of her daughters, a program played out: She felt revulsion, guilt, and failure. It meant she couldn’t refocus to figure out how to reconnect with the girls.
Now, she said, she is able to picture a future together, where they are happy for a day and having normal mother-daughter time. “The way I had been thinking with PTSD, there was a pattern,” Withrow said. “Now, there’s a glitch in the programming that stops it from completing.”
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