Two therapeutic techniques I commonly use in my therapy sessions (dealing with trauma) are EMDR and Sensorimotor Psychotherapy. I was trained in these techniques by the EMDR Institute and the Sensorimotor Psychotherapy Institute and am a member of EMDRIA.
Many people are curious to know, “What is EMDR? And what is Sensorimotor Psychotherapy?” Last week, the New York Times posted an article on EMDR that I would like to share here. I also am sharing an excerpt on Sensorimotor Psychotherapy posted by Good Therapy.org. They both do a great job of describing these techniques.
March 16, 2012, 3:55 PM
Expert Answers on E.M.D.R.
By THE NEW YORK TIMES
Francine Shapiro, Ph.D. Recently, readers of the Consults blog posed questions about eye movement desensitization and reprocessing, or E.M.D.R., a psychological therapy pioneered by Francine Shapiro that uses eye movements and other procedures to process traumatic memories. The therapy has been used increasingly to treat post-traumatic stress disorder and other traumas. You can learn more about what E.M.D.R. therapy is like here. Below, Dr. Shapiro addresses reader questions about clinical applications of E.M.D.R., including how the therapy is done, what types of trauma it can treat, whether it helps anxiety or chronic pain, and more. Dr. Shapiro wrote about scientific studies on the therapy in an earlier post, “The Evidence on E.M.D.R.” Additional answers to reader questions will be posted here in the coming weeks. E.M.D.R. and Post-Traumatic Stress Disorder
Please explain the mechanics of how P.T.S.D. occurs and why. Why is it some soldiers end up with P.T.S.D.? Why is it that not everyone raped gets P.T.S.D.? NANA, Dania Beach, FL
Dr. Shapiro responds:
Post-traumatic stress disorder, or P.T.S.D., occurs when an experience is so disturbing that it disrupts the information processing system of the brain. This system has as one of its main functions the transformation of disturbing experiences into mental adaptation. That is, it takes a disturbing event and processes it in such a way that appropriate neural connections are made within the memory networks, which eliminate those aspects of the event (for example, negative thoughts, unpleasant emotions and physical sensations) that are no longer useful.
Sometimes, however, the event is so disturbing that the system is unable to perform these natural functions. The result is that the memory of the incident is stored along with the psychological and physical aspects of the event, including the negative beliefs that it engendered. Such an unprocessed traumatic memory may be stimulated by a current experience, and the encoded negative emotions, thoughts and sensations can emerge and color the perception of the present.
The reason that some people are affected more than others depends on genetics, the intensity of the experience, length of exposure and earlier life experiences. Some people have had positive experiences that contribute to greater resilience. Others have had negative experiences that can make them susceptible to later problems. For instance, an official diagnosis of P.T.S.D. requires that the individual experience a major trauma, like a rape, accident or battlefield experience. However, recent research indicates that in many cases, P.T.S.D. symptoms can occur as the result of less dramatic events. Some examples are hurtful childhood experiences with parents and peers, which can have a very negative effect on a person’s sense of self-worth. These events can set the groundwork for a wide range of symptoms, including a vulnerability to P.T.S.D. E.M.D.R. and REM Sleep
Please explain the process of R.E.M. and E.M.D.R. NANA, Dania Beach, FL
Dr. Shapiro responds:
A Harvard researcher has suggested that the eye movements used in E.M.D.R. seem to stimulate the same processes that exist in rapid eye movement, or R.E.M., sleep. R.E.M. occurs in the same stage of sleep as dreaming, and during this time, scientists believe, the brain processes survival information. The implication is that, like R.E.M. sleep, the eye movements of E.M.D.R. facilitate the transfer of episodic memory, which includes emotions, physical sensations and beliefs associated with the original event, into semantic memory networks, in which the meaning of the event has been extracted and negative associations are no longer present.
The proposed link between E.M.D.R. eye movements and R.E.M. sleep has now been the subject of about a dozen randomized studies. Supporting the hypothesis were findings that E.M.D.R. eye movements decrease physiological arousal, increase episodic associations and increase the recognition of true information. Despite these results, many questions remain about the underlying mechanism for the effects of E.M.D.R. This is not a unique situation, however, since the neurobiological explanation for any form of therapy, and even many pharmaceuticals, remains obscure.
In addition, see my earlier post, “The Evidence on E.M.D.R.,”
for information about studies on E.M.D.R. and R.E.M. How E.M.D.R. Is Done
Will you articulate to me and to the people here how you describe the E.M.D.R. process and protocol? NANA, Dania Beach, FL
Dr. Shapiro responds:
The eight phases of E.M.D.R. therapy begin with history taking, in which the presenting problems and early clinically significant life events are identified, and goals for the client’s fulfilling future set. The next phase involves preparing the client for memory processing. During processing, the client is directed to attend briefly to certain aspects of the memory while the information processing system is simultaneously stimulated. During this phase, the client engages in periodic sets of eye movements (sometimes taps or tones) for approximately 30 seconds each. It is during this time that the process of transforming the “stuck memory” into a learning experience and an adaptive resolution is observed. New and useful emotions, thoughts and memories emerge, and old and counterproductive ones are resolved. For example, the feelings of shame and fear voiced by a rape victim at the beginning of an E.M.D.R. session may be replaced by the feeling that she is a strong and resilient woman. E.M.D.R. therapy specifically addresses issues involving the past, present and future.
You can learn more about the process of E.M.D.R. therapy here
. E.M.D.R. vs. Other Therapies for Trauma
How is E.M.D.R. different from other kinds of therapies for trauma victims? BizB, Rockville, MD
Dr. Shapiro responds:
Besides E.M.D.R. therapy, very few trauma treatments have a strong empirical basis. Two others that are well known are prolonged exposure therapy and cognitive processing therapy. Both are forms of trauma-focused cognitive behavior therapy, which require clients to describe in great detail their traumatic memory.
In prolonged exposure therapy, clients must describe the memory as if it were happening to them in the present. They repeat this two to three times during the session while an audio recording is made. The rationale for this form of treatment is that the reason clients’ problems persist is that they are avoiding reminders of the instigating events. Therefore, it is considered important for them to learn firsthand that they can experience the distress without being overwhelmed. Likewise, they are required to do daily homework between sessions that consists of listening to the recordings of their description of the event and visiting locations associated with it, to cause the disturbance to dissipate.
In cognitive processing therapy, clients are asked to provide details about the traumatic event so that their negative beliefs can be identified and then challenged and changed. This occurs during sessions and by doing daily homework assignments.
In contrast to the preceding treatments, the emphasis in E.M.D.R. is to help the information processing system make the automatic connections required to resolve the disturbance. Specific procedures are used to help clients maintain a sense of control during memory work as the therapist guides their focus of attention. They need only focus briefly on the disturbing memory during the processing while engaged in the bilateral stimulation (eye movements, taps or tones) as the internal associations are made. The client’s brain makes the needed links as new emotions, sensations, beliefs and memories emerge. All the work is done during the therapy sessions. It is not necessary for the client to describe the memory in detail, and no homework is used. E.M.D.R. and Childhood Trauma
I sought out an E.M.D.R. practitioner for the lifelong problems I’ve had from having rejecting, abusive parents. Do you agree that E.M.D.R. isn’t a good choice for someone like me? What do you suggest for someone with a difficult history like mine, who has been chronically anxious since very early childhood? Shaun, Grand Rapids
Why do some think E.M.D.R. isn’t helpful with childhood trauma? From what my therapist told me, it sounds like it is often used with individuals with issues stemming from childhood. Isn’t that the point? But in the past I’ve heard that it may not be indicated for P.T.S.D. related to chronic trauma over a period of years, particularly when the trauma was sustained in childhood. Is that true? If so, why or why not? Ernest K, Denver
Have there been changes in your E.M.D.R. methods over the years to address some of the questions being raised in this forum — specifically for treatment of people with complex trauma (multiple traumas) and childhood traumas like sexual abuse or neglect? benslow, USA
Dr. Shapiro responds:
E.M.D.R. therapy is widely used to treat chronic childhood trauma survivors. However, with this presenting problem, it often takes longer than with adult trauma victims for the client to feel secure and safe enough to do memory processing. Further, because of the larger number of events and earlier onset for childhood trauma victims, the processing work itself generally takes longer.
As I noted above, E.M.D.R. therapy is an eight-phase approach. The first two of these phases — history-taking and preparation — need to be more extensive with multiply traumatized survivors of childhood abuse than with adult trauma survivors. Stabilization and the development of skills and self-capacities, like the ability to self-soothe and tolerate emotions, are the primary focus in the preparation phase of E.M.D.R. treatment. There are often fears related to emotion and connections with others that must be addressed during the early phase of treatment before a survivor is able to move into work that focuses on the past.
E.M.D.R. therapy targets the way in which memories are stored in the brain. These include “takeaway” messages, like “I’m not good enough,” “It’s not O.K. to ask for what I want” and “I’m powerless to protect myself.” These feelings and beliefs are based on the child’s perceptions at the time of the experiences, whether they involved a major traumatic event like the loss of a parent to death or divorce, or something less dramatic but more insidious, like a daily diet of criticism or fear that something bad is going to happen.
The amount of exposure to bad experiences affects the development of symptoms. In general, the more severe and longer the exposure and the younger the age at exposure, the greater the impact will be in the form of pervasive and debilitating symptoms. Not always, but often, the amount of time needed for therapy also depends on whether the person has had any positive role models and significant figures who were supportive and nurturing. When these have been lacking, more time will generally be needed for preparation and comprehensive treatment. For some clients, this process will take longer because they have more negative experiences to process. For others, more stand-alone experiences occurred that changed the course of their lives. And, of course, there’s everyone in between.
These childhood traumatic memories and the pain and symptoms associated with them can be systematically reprocessed over time with E.M.D.R. The bottom line is that given an opportunity, the information processing system of the brain will move toward health.
E.M.D.R. therapy is used extensively in the treatment of chronic victimization and childhood traumatization. In fact, a study conducted by a large H.M.O. reported that within 12 sessions, 77 percent of multiple trauma victims treated with E.M.D.R. lost the diagnosis of post-traumatic stress disorder (Marcus et al., 1997, 2004)
. Another study with adult survivors of childhood sexual abuse also found it to be effective (Edmond et al., 1999, 2004)
. Both adult and childhood abuse survivors are represented in most studies that involve participants with mixed forms of trauma, and 20 randomized studies
have found E.M.D.R. therapy to be effective in the treatment of P.T.S.D.
However, as mentioned above, the amount of treatment needed will vary depending on the type of trauma and how pervasive it was during childhood. For instance, one study compared eight sessions of E.M.D.R. therapy
with eight weeks of Prozac with multiply traumatized adults. It reported that after treatment, 100 percent of adult-onset participants treated with E.M.D.R. no longer received a P.T.S.D. diagnosis, and 75 percent of the childhood-onset E.M.D.R. participants no longer had that diagnosis. But losing a P.T.S.D. diagnosis is only part of the story; at the six-month follow-up, the E.M.D.R. group continued to improve, while the Prozac group became more symptomatic. At that point, 75 percent of the participants treated with E.M.D.R. who were traumatized as adults were symptom-free, compared with 33.3 percent of the E.M.D.R.-treated group traumatized in childhood; everyone in the Prozac group continued to be symptomatic.
In clinical practice it is to be expected that more than eight sessions will be needed for successful treatment of childhood abuse, as comprehensive E.M.D.R. therapy addresses the entire clinical picture. The goal is not only to remove symptoms, but also to bring clients to full emotional health and fulfillment, both individually and in their personal relationships. Initial results from research under way reveal positive effects after approximately 24 sessions for those suffering from severe childhood abuse. These results support clinical observations that although many victims of childhood trauma will need comprehensive E.M.D.R. therapy, significant benefit can be observed within a few months after starting memory processing. It’s also worth noting that once processing begins, it is unnecessary to address each and every memory; treatment effects will generalize from a given memory to other similar events.
In all cases, a three-pronged approach should be used that addresses earlier experiences of abuse, current situations that trigger disturbance, and the skills and education necessary to ensure that the person is not only symptom-free, but able to flourish and thrive in the world. When someone has had an extremely difficult childhood that includes neglect or abuse, it is important to interview prospective clinicians to find someone who is experienced and well trained in phase-oriented trauma treatment for chronic childhood abuse and the use of E.M.D.R. therapy. Ideally, the clinician chosen will also be someone who stays informed with regard to the newest developments in treatment. Who Does E.M.D.R.?
Is it possible to do E.M.D.R. treatment to friends or relatives if one identifies that the person needs E.M.D.R. treatment? Mekdes, Ethiopia
Even though I am a certified hypnotherapist and possess a master’s in health administration, I am not allowed to become an E.M.D.R. practitioner myself. Why not? Julietta, NY
Dr. Shapiro responds:
E.M.D.R. therapy is taught only to people who are licensed to provide mental health services in their state. There are a wide variety of techniques from E.M.D.R. therapy that I have included in my new self-help book, “Getting Past Your Past” (Rodale, 2012)
. However, in this country, major memory processing with E.M.D.R. therapy should be conducted only by a licensed therapist who has had training approved by the E.M.D.R. International Association (www.emdria.org),
an independent professional association that sets the standards for all E.M.D.R. therapy training conducted in the United States.
Comparable organizations exist in most countries worldwide, as well as regional organizations like E.M.D.R. Europe
(www.emdr-europe.org), E.M.D.R. Asia
(www.emdr-asia.org) and E.M.D.R. Iberoamerica
It is widely accepted in the field of psychology that training in any therapy being performed is ethically mandatory. However, clinicians may have been misled in their choices. Unfortunately, there are a number of substandard trainings being conducted in the United States that don’t meet the international associations’ criteria. Therefore, potential clients should interview clinicians to ensure they received the correct training and have experience with their problem, and inquire about their success rate. E.M.D.R. and Epilepsy
Can E.M.D.R. be safely used in patients with well-controlled epilepsy, and can it be successful in increasing seizure thresholds and/or eliminating the cause of the seizures (assuming no cerebral lesions cause the seizures)?
Dr. Shapiro responds:
To my knowledge, there have been no negative reports using E.M.D.R. therapy with epilepsy patients. However, I suggest that the person work with an experienced clinician who can be sensitive to any potential negative reactions. The therapist should also carefully review with the client the cautions described in my text, “Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures,”
so the person can make an informed choice.Two articles have been published that have reported successful results in the E.M.D.R. treatment of psychogenic seizures. E.M.D.R. and Anxiety
My teenage son has had E.M.D.R. therapy for anxiety attacks that were very limiting in his ability to progress (go for job interviews, attend college classes that were intimidating to him). After a period of time here he seemed to improve, he stopped going to therapy and said he felt only life experiences would help him overcome some of his anxieties. After not seeing a therapist for a year, he told me today that he thought he needed to return. Is this a common result? Are patients ever “cured” through E.M.D.R. therapy, or will some patients need recurrent therapy throughout their lives? monkeyboy, Kansas
Dr. Shapiro responds:
I believe the problem here is that your son terminated therapy prematurely. Some clients stop because they feel better and then want to do the rest on their own. However, the full protocol for E.M.D.R. treatment involves (1) processing the memories that set the foundation for the problem, (2) processing the current situations that trigger disturbance and (3) incorporating the experiences into the memory networks that are necessary to overcome skill or developmental deficits.
With longstanding anxieties, this would involve venturing out and noticing any new anxieties that arise. These would be addressed with further processing, since some anxiety responses are not revealed within the confines of the therapy session alone. For stable treatment effects, your son should address his various anxiety issues using this full application of E.M.D.R. therapy. E.M.D.R. and Pain
I am a physical therapist specializing in the treatment of complex and chronic pain. Modern pain science views pain as an output of the brain, and there are novel therapies developed within my field to retrain the brain. Many (though certainly not all) of my patients also have a history of trauma. Is there any research (including functional M.R.I.) showing the effects of E.M.D.R. on chronic pain or on centers in the brain particularly associated with pain processing? Helen Gattling-Austin, Charlottesville, VA
I’ve read about and experienced the resolution of some traumas using E.M.D.R., but can E.M.D.R. resolve chronic pain that resulted from a physical injury? Sally Stone, Northbrook, IL
Dr. Shapiro responds:
In the book “Practical Pain Management” (2001)
, A. L. Ray and A. Zbik have a chapter that describes their use of E.M.D.R. therapy for chronic pain. The authors note that the application of E.M.D.R. that is guided by a theoretical formulation known as the adaptive information processing model appears to provide benefits to chronic pain patients not found with other treatments. Specifically, rather than merely managing pain, the treatment often substantially reduces or eliminates it. This occurs because applications of E.M.D.R. therapy have revealed that the pain is frequently caused by the memory of the experience during which the injury took place.
E.M.D.R. therapy cannot remove pain caused by nerve damage. However, many types of pain that seem to have an organic cause are actually the result of “pain memory.” For instance, four researchers have independently published articles detailing the successful treatment of “phantom limb” pain. The aggregate of these, as well as anecdotal reports, indicates an 80 percent success rate involving the substantial reduction or elimination of the phantom pain once the trauma memory has been processed. Follow-up assessments reported as long as two years later have revealed stable results. Unfortunately, no brain scans were performed, and no randomized trials have yet been conducted on this topic. Long-Ago Trauma?
Is E.M.D.R. effective even if the event took place 15 years ago? Kelly, Atlanta
Dr. Shapiro responds:
Yes, E.M.D.R. is effective regardless of the time since the event. The unprocessed memory remains stored in the brain. However, it can be accessed and successfully processed.
A year ago, an 80-year-old survivor of World War II asked her clinician to contact me. She had lived through numerous traumas during the war in Japan (bombing, rape, losing her mother and father) and had lived a life of “quiet desperation.” However, recently she had become severely dysfunctional because her husband had developed a hearing problem, and his shouting and playing the TV at a loud volume were bringing back reactions that emerged out of the chaos of the war years. This inability to cope any longer is often what brings people into therapy. After the traumas were processed, she told her clinician, “I feel free for the first time in my life.” Even at 80, her brain was able to “digest” and store appropriately the unprocessed information that had been embedded for the past seven decades. It’s never too late. Dr. Shapiro will be responding to additional questions in the coming weeks. Check back for updates. Francine Shapiro, Ph.D., is a senior research fellow at the Mental Research Institute in Palo Alto, Calif., director of the EMDR Institute, and founder of the nonprofit EMDR Humanitarian Assistance Programs, which provides pro bono training and treatment to underserved populations worldwide. Her latest book is “Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy” (Rodale, 2012). SENSORIMOTOR PSYCHOTHERAPY
Posted on Good Therapy.org
updated on 2-29-12
Developed by Pat Ogden
in the 1970’s, Sensorimotor Psychotherapy combines somatic
theory, cognitive applications, neuroscience and techniques from the Hakomi
Bodywork method. As a psychotherapist and body therapist who was interested in helping her clients overcome the disconnect that their physical actions had from their psychological issues, Ogden
chose to blend both psychotherapy and somatic therapy to create this widely recognized and gentle form of treatment. Healing Trauma, Somatic Healing and Sensorimotor Psychotherapy
This method of treatment is highly effective for people suffering from PTSD, dissociation, or emotional reactivity disorders. Many people who have otherwise not been able to recover successfully from traumatic situations, have found that the sensorimotor psychotherapy technique allows them to find relief. Because the emotional and cognitive processing centers are being indirectly accessed, rather than directly, those who cannot work within those realms due to severe trauma have seen beneficial results.
Sensorimotor Psychotherapy strives to address the physiological elements of trauma
through somatic healing. Disruptions occur between emotional, cognitive, and sensorimotor layers when trauma occurs and correction must be implemented to affect healing. This form of therapy combines the emotional and cognitive processing mechanisms with sensorimotor processing in the treatment of traumatic situations. Post-traumatic stress
disorder symptoms are often a result of the maladaptive somatic reactions. The somatic experience allows a client to treat the source of the trauma which will result in improved functioning both cognitively and emotionally. Process of Sensorimotor Psychotherapy
In Sensorimotor Psychotherapy, clients are guided through a physical journey through a somatic experience into discovery of their own body as a vehicle for recovery. By using somatic interventions and strategies, Sensorimotor Psychotherapy creates a fluid, elegant, and dynamically effective body therapy that allows clients to draw their strength from their own inner wisdom. The goal of this method of therapy is to reach deeply into the body and mind in order to powerfully touch the soul. Resources Related to Sensorimotor Psychotherapy™: Sensorimotor Psychotherapy Institute The Trauma Center