EMDR Therapy and Post Traumatic Stress Syndrome

Eye-Movement Desensitization Reprocessing (EMDR) Therapy

EMDR therapy has become increasing popular  in recent years because both clinicians and researchers are seeing it’s effectiveness in treating post traumatic stress syndrome.  Many people are curious about it.  In order to understand it better, we first have have to review some of the basic facts about psychological trauma and it’s stress symptoms.

Understanding Post Traumatic Stress Syndrome

Post traumatic stress syndrome is often referred to as posttraumatic stress disorder or PTSD.  People who suffer from  it often don’t know what it is, but the are highly aware of panic attacks, anxiety, depression symptoms, and relationship difficulties that are it’s notorious effects.  In this article, I want to describe the most basic, clinical definition of post traumatic stress syndrome as most mental health practitioner think of it.

At what point do painful memories become a full-blown anxiety disorder or depression? The following checklists are from the standard diagnostic manual used by mental health professionals. It’s a summary of the criteria for Posttraumatic Stress Disorder of PTSD.

Post Traumatic Stress Syndrome:  A Brief Definition

Post traumatic stress syndrome is the persistent or delayed reaction to a life-threatening event that involves:

1. reexperiencing the event in distressing ways (nightmares, flashbacks, anxiety attacks, depression)
2. various tricks of the mind to avoid any reminders of the event
3. symptoms that show that the person is much more keyed up than they used to be (sleep problems, irritability, outbursts of anger, exaggerated startle response).

This type of stress becomes a disorder when it negatively impacts one’s life in significant ways. When this happens it is often referred to as post traumatic stress syndrome or Posttraumatic Stress Disorder (PTSD).

What is a trauma?

A trauma is an overwhelming event or situation that forces a person to develop a cluster of symptoms. Traumatic stress is the cluster of distressing symptoms. It is called posttraumatic stress because it often has a delayed onset. Many New Yorkers who seemed to be doing well after the September 11 attacks began to develop major problems months later.

Clinical Criteria for a Diagnosis

It is important to understand that people usually cannot make these symptoms disappear just by trying hard to “put the past behind them.” The American Psychiatric Association diagnostic manual (DSM-IV) defines Posttraumatic Stress Disorder (post traumatic stress syndrome) with specific clinical criteria in order to make a diagnosis:

Criterion A: Post traumatic stress syndrome involves EXPOSURE TO A LIFE-THREATENING EVENT or one in which there is a threat of serious injury. Whatever causes it, there must be intense fear at the time of the event. This can also include witnessing a violent act or being in a situation of extreme danger.

Criterion B: Post traumatic stress syndrome means that THE EVENT IS PERSISTENTLY REEXPERIENCED in one of the following specific ways:

1. distressing memories of the event that intrude suddenly or will not go away;
2. persistent nightmares;
3. acting or feeling as if the frightening event is happening all over again, such as with flashbacks or distorted perceptions;
4. intense mental anguish that is triggered by cues or symbols that mimic some aspect of the original traumatic event;
5. intense physiological reactivity such as tension or pain also triggered by reminders of the event.

Criterion C: Post traumatic stress syndrome involves EMOTIONAL NUMBING AND A STRONG TENDENCY TO AVOID TRIGGERS OR REMINDERS in at least three of the following ways:

1. the person makes efforts to avoid thoughts and feelings related to the trauma (he or she won’t talk about it)
2. the person avoids activities, people or places that might remind them of the trauma
3. the person can’t remember the event or can’t recall aspects of what happened;
   the person shows a noticeable loss of interest or participation in significant activities
4. he or she has the feeling of being estranged, disconnected or detached from other people
5. the person has awkward barriers to the full range of emotions such as an inability to feel affection from another or to have loving feelings
6. he or she has a distorted and short view of the future such as not expecting to have a career or normal life span.

Criterion D: Post traumatic stress syndrome involves PERSISTENT SYMPTOMS OF INCREASED AROUSAL as shown by at least two of the following:

1. difficulty falling or staying asleep
2. outbursts of anger or irritability
3. difficulty concentrating
4. hypervigilance (scanning the surroundings for possible danger); and
   exaggerated startle response.

Criterion E:  SYMPTOMS PERSISTING FOR MORE THAN ONE MONTH.

Criterion F: THE SYMPTOMS NEGATIVELY IMPACT THE PERSON’S LIFE by causing intense distress or impairment in important areas of living such as the person’s social life, close relationships, school, or work.

This definition of post traumatic stress syndrome is very useful as a checklist of symptoms that can arise after an overwhelmingly dangerous event. However, I do not find it very useful in deciding who needs treatment. Apparently, I am not alone. Dr. John Briere, a trauma specialist at USC Medical School once said that the most traumatized individual he had ever treated did not meet the exact criteria for PTSD. The definition is so tightly crafted (by a committee) that many people who suffer intensely from post traumatic stress syndrome end up with another diagnosis that does not highlight the trauma-based roots of the problem.

The real value of the diagnostic criteria is in providing a partial list of trauma-related symptoms. It can be a starting point for understanding what’s going on inside your head. For example, one set of symptoms (Criterion B) involves replaying the tape of the trauma over and over. The next set of symptoms (Criterion C) involves avoiding anything related to the traumatic event. It is as if the brain is moving in opposite directions at the same time.

When you consider the collision of these two brain processes, it’s not hard to see how trauma can be confusing and frustrating.

Why EMDR Therapy for Post Traumatic Stress Syndrome?

EMDR Therapy has shown very promising results clinically as well in the context of research.  One of the problems is that it’s a bit frustrating for researchers.  Consider this:  if you are researcher and your studies show that a particular treatment is effective, then you would probably want to be able to explain how it works and why it works the way that it does.  We know that antibiotics are often effective in treating infections and we can explain how they work on the body.

EMDR therapy, on the other hand, has been demonstrated to be effective, but no one can say with certainty how it works.  That’s a bit embarrassing for psychology researchers who are already smarting from accusations that they are a “soft science.”

But there are some theories of how it works.  Here are two that make sense to me:  First, we have strong indication that the dreaming process during the REM stage of sleep has a lot to do with processing or reprocessing emotions.  Rapid Eye Movement (REM) sleep is a fact of science.  Is it really so far-fetched to think that a procedure like EMDR therapy using eye movements ends up aiding the reprocessing of traumatic memories?

A second explanation is advanced by Francine Shapiro, the inventor of EMDR therapy.  EMDR therapy in all it’s forms involves having the patient maintain simultaneous attention on two different things.  The patient thinks about the past (e.g., the painful memory) and at the same time that he or she is giving direct attention to a present, sensory stimulus (e.g., a light moving back and forth).  She suggests that the mind’s dual focus on a present sensory signal with a fragmented memory of the past seems to help the brain integrate the past with present.  If we compare human memory to a computer hard drive, we might say that the brain opens the file where the traumatic memories are stored.  The file exists on the hard drive in fragments.  The brain opens the file, defragments it, spell checks it, etc. and the re-saves it as one unified  file in a neat and tidy folder.