(Cynthia Horacek, MFT, skillfully explains the history of EMDR, how it works and the specifics of how it's applied to trauma therapy.)
Although EMDR has been in use by therapists for treating trauma, phobias, anxiety and a variety of other "disorders" since 1989, the vast majority of people have no idea what it is, what it does or how it works. EMDR stands for
Eye Movement Desensitization Reprocessing. And even though the words "Eye Movement" are part of the name of this truly amazing technique, eye movements are not necessarily a part of its success. But allow me to explain… In 1989 a psychologist named Francine Shapiro was working with Vietnam Vets who were suffering from Post-Traumatic Stress, or what we now call
PTSD – Post-Traumatic Stress Disorder. It was at various times called various things: combat fatigue, shell-shock… and of course, now we know that PTSD applies to people other than combat veterans. People who have been in a life-threatening situation, where they have witnessed someone else, or have themselves experienced a threat to their lives, frequently suffer the effects of PTSD.
But back to EMDR. However, first, a little brain anatomy to help understand how EMDR works… When we are in a situation that is threatening, our primitive survival skills kick in, and the part of our brain that is responsible for those skills –
the limbic system – churns out a series of chemicals that prepare us to fight, flee (as in flight) or freeze (if you’ve ever come across a bunny on a walk in the hills somewhere, or the old "deer in the headlights," you might have noticed that it will freeze, as if it thinks that if it doesn’t move, you can’t see it and this will somehow keep it safe; this is a freeze response. You can also think of this as being too scared to do anything else – you are so scared, you can’t respond or react; you just freeze).
Your limbic system contains a number of brain structures, among them are two very important ones – the
amygdala and the
hippocampus. The
amygdala holds all of your "body memories." Its function is to regulate arousal, control autonomic responses associated with fear as well as pain and pleasure (rapid heart beat, fast breathing, etc.), emotional responses and hormonal secretions (like adrenalin and norepinephrine). Everything that ever happened to you, from before you were born is stored here on a cellular memory level. When your amygdala processes information, it sends it to the hippocampus for short-term memory processing; then eventually the information is sent to your pre-frontal cortex, the part of your brain behind your forehead, the part that allows you to think logically, and the part that distinguishes us as humans from other animals. Although we may not know as much as we’d like about each structure in the brain, we do know that the next structure in the limbic system, the hippocampus, is very important.
The
hippocampus is a small horseshoe shaped structure next to the amygdala. It functions to consolidate new memories (short-term memory processing) and these memories are closely tied to emotions. It is also responsible for spatial navigation and orientation – that is, it allows you (your brain) to know where you are in space – what is up, down, left, right… basically, it let’s you know if you are standing up or lying down. The size of the hippocampus is affected by a number of things; two of these are depression and estrogen. In people with depression, the hippocampus is actually seen to shrink (this is a good reason to treat depression with medication AND therapy… but that’s another topic.) Estrogen actually increases the number of neurons in the hippocampus, thus increasing short-term memory (another good reason to ask your doctor - if you are a woman entering or going through menopause - about estrogen replacement therapy).
Another structure in the limbic system is the
cinculate gyrus. This structure is responsible for coordinating sensory input with your emotions, regulating your emotional responses to pain and regulating your aggressive behavior.
Next in the limbic system is a small bundle of neurons (nerve fibers) called the
fornix; the function of the fornix is still not clear to neuroscientists. We are still learning much about the brain!
The
hypothalamus is responsible for controlling
autonomic functions (breathing, heart beat – the things we don’t have to think about but our bodies just do…), plays another role in regulating our emotions, influences our endocrine functions (our hormones), homeostasis (regulates our body temperature, fluid balance, etc.), helps to control our motor functions, regulates our thirst and hunger and regulates our sleep/wake cycle, or "biological clock."
Before I discuss the olfactory cortex and it’s importance, I will just mention the
thalamus, the last structure in the limbic system. The thalamus is responsible for motor control, for receiving and processing auditory, somatosensory (emotional/sensory) and visual sensory signals, and for relaying these signals to the cerebral cortex, or the higher processing parts of the brain.
The
olfactory cortex is the part of the brain that is responsible for our ability to smell. If you weren’t already aware of this, there is a very strong association between odors and emotions. The smell of apple pie baking can bring back sentimental, warm memories of home and loved ones, or it might stir up unpleasant memories of abuse if every time a parent got drunk and beat up on the family, someone else baked an apple pie to try to make up for the abuse. (That being said, it is a proven fact that when people have the scent of baked apple spice in their home at an open house, the house has a higher rate of sale than those homes without a scent!) Or perhaps it brings back a memory of the time you overate and spent the entire night in the bathroom, trying to get rid of it. Or maybe the association with a particular aftershave has a bad association for you; or an especially good one, but you don’t really know why.
The olfactory cortex works in your limbic system in memory and trauma reactions in the following way: When you smell something familiar, even if you are not consciously familiar with it, but you have a "every time I smell Old Spice I get sick to my stomach" reaction (for example), your olfactory cortex is signaling your amygdala of an old memory buried somewhere in your subconscious. When your amygdala gets "triggered" by the odor, it kicks in and the same stress chemicals and hormones (if it was a stressful event involved with the odor) that were released during the original stressful event. We are very good at cutting off traumatic memories, especially if they happened during childhood. We call this dissociating from the trauma. Children are very good at teaching themselves how to do this, and the younger they are when trauma occurs; the better they are at dissociating from it. The problem with this is that our brain – our amygdales, our hippocampuses, and our olfactory cortexes in particular remember, regardless of what our consciousness wants to do. So at some point, eventually, something is going to trigger our "hidden" or "buried" memories. Like that odor… or maybe a sound, or a color, or an old song… we never know what it may be. And this is where a treatment technique like EMDR and be especially useful.
When I work with people who have suffered a trauma, I will often hear them say, "why do I need to revisit that in order to heal from it? Why do I need to tell the story again?" Or they may tell me, "You know, I’ve had so much therapy, and I can’t get past these anxiety attacks. How will it help me to tell it again?" The reality is that you DON’T have to "revisit" the trauma or relive it; you don’t have to tell me your whole, painful terrible story. All we need to do with EMDR is focus on one specific aspect of it – and yes, it’s best if it’s the worst part of it, or maybe I should say, the worst part that you can tolerate. You don’t have to do anymore than that – tolerate it. And I’ll be there with you, keeping you in the present and checking in with you the whole time to keep you here.
What we do know about EMDR is that for some reason, when people focus on a particular aspect of their trauma, or their phobia (like a fear of heights) or their pain or their anxiety, the neurons in the limbic system rewire themselves when we do BLS, and the things that are somehow "stuck" there are "reprocessed" and the brain becomes desensitized, the memories are moved from the old limbic system to the prefrontal cortex. In short, instead of being triggered and having a fear (or flight, fight or freeze reaction) people now have a response, like, "That’s not happening to me now; I’m not in danger now; I’m safe" and when they think of the original event, or the phobia or the fear, their neurons in their limbic system no longer light up as they used to (this has been studied in actual brain scans), and the neurons in the high thinking prefrontal cortex light up instead.
There are of course nay-sayers, just like in any field, who call EMDR "quackery" and say it doesn’t work – that it’s a gimmick. There are also those who don’t believe in hypnosis… but that’s another topic altogether. I’ve been practicing EMDR for 7 years, and if I went back and looked in my files, I could probably tell you how many cases I’ve treated with EMDR in that time, but I know it’s over 100. I can tell you that I’ve had at least a 90% success rate among the people I’ve treated with EMDR when it comes to trauma recovery, getting over phobias and healing from panic attacks. EMDR isn’t for everyone; in good psychotherapy, like in good medicine, there is no "one size fits all" treatment. But it’s always worth looking into it. It got me over my fear of heights!
---------------------------
Cynthia Horacek is a Marriage and Family Therapist. She has been in private practice in Agoura Hills, California since 1999. Ms. Horacek specializes in Chronic Pain and Illness, Trauma Recovery, Dissociative Disorders, Anxiety, Phobias and Depression. She works with children ages 7 and up, adolescents and adults. Learn more about her therapy services by visiting
www.odysseytherapy.com.
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Although EMDR has been in use by therapists for treating trauma, phobias, anxiety and a variety of other "disorders" since 1989, the vast majority of people have no idea what it is, what it does or how it works. EMDR stands for Eye Movement Desensitization Reprocessing. And even though the words "Eye Movement" are part of the name of this truly amazing technique, eye movements are not necessarily a part of its success. But allow me to explain… In 1989 a psychologist named Francine Shapiro was working with Vietnam Vets who were suffering from Post-Traumatic Stress, or what we now call PTSD – Post-Traumatic Stress Disorder. It was at various times called various things: combat fatigue, shell-shock… and of course, now we know that PTSD applies to people other than combat veterans. People who have been in a life-threatening situation, where they have witnessed someone else, or have themselves experienced a threat to their lives, frequently suffer the effects of PTSD.
But back to EMDR. However, first, a little brain anatomy to help understand how EMDR works… When we are in a situation that is threatening, our primitive survival skills kick in, and the part of our brain that is responsible for those skills – the limbic system – churns out a series of chemicals that prepare us to fight, flee (as in flight) or freeze (if you’ve ever come across a bunny on a walk in the hills somewhere, or the old "deer in the headlights," you might have noticed that it will freeze, as if it thinks that if it doesn’t move, you can’t see it and this will somehow keep it safe; this is a freeze response. You can also think of this as being too scared to do anything else – you are so scared, you can’t respond or react; you just freeze).
Your limbic system contains a number of brain structures, among them are two very important ones – the amygdala and the hippocampus. The amygdala holds all of your "body memories." Its function is to regulate arousal, control autonomic responses associated with fear as well as pain and pleasure (rapid heart beat, fast breathing, etc.), emotional responses and hormonal secretions (like adrenalin and norepinephrine). Everything that ever happened to you, from before you were born is stored here on a cellular memory level. When your amygdala processes information, it sends it to the hippocampus for short-term memory processing; then eventually the information is sent to your pre-frontal cortex, the part of your brain behind your forehead, the part that allows you to think logically, and the part that distinguishes us as humans from other animals. Although we may not know as much as we’d like about each structure in the brain, we do know that the next structure in the limbic system, the hippocampus, is very important.
The hippocampus is a small horseshoe shaped structure next to the amygdala. It functions to consolidate new memories (short-term memory processing) and these memories are closely tied to emotions. It is also responsible for spatial navigation and orientation – that is, it allows you (your brain) to know where you are in space – what is up, down, left, right… basically, it let’s you know if you are standing up or lying down. The size of the hippocampus is affected by a number of things; two of these are depression and estrogen. In people with depression, the hippocampus is actually seen to shrink (this is a good reason to treat depression with medication AND therapy… but that’s another topic.) Estrogen actually increases the number of neurons in the hippocampus, thus increasing short-term memory (another good reason to ask your doctor - if you are a woman entering or going through menopause - about estrogen replacement therapy).
Another structure in the limbic system is the cinculate gyrus. This structure is responsible for coordinating sensory input with your emotions, regulating your emotional responses to pain and regulating your aggressive behavior.
Next in the limbic system is a small bundle of neurons (nerve fibers) called the fornix; the function of the fornix is still not clear to neuroscientists. We are still learning much about the brain!
The hypothalamus is responsible for controlling autonomic functions (breathing, heart beat – the things we don’t have to think about but our bodies just do…), plays another role in regulating our emotions, influences our endocrine functions (our hormones), homeostasis (regulates our body temperature, fluid balance, etc.), helps to control our motor functions, regulates our thirst and hunger and regulates our sleep/wake cycle, or "biological clock."
Before I discuss the olfactory cortex and it’s importance, I will just mention the thalamus, the last structure in the limbic system. The thalamus is responsible for motor control, for receiving and processing auditory, somatosensory (emotional/sensory) and visual sensory signals, and for relaying these signals to the cerebral cortex, or the higher processing parts of the brain.
The olfactory cortex is the part of the brain that is responsible for our ability to smell. If you weren’t already aware of this, there is a very strong association between odors and emotions. The smell of apple pie baking can bring back sentimental, warm memories of home and loved ones, or it might stir up unpleasant memories of abuse if every time a parent got drunk and beat up on the family, someone else baked an apple pie to try to make up for the abuse. (That being said, it is a proven fact that when people have the scent of baked apple spice in their home at an open house, the house has a higher rate of sale than those homes without a scent!) Or perhaps it brings back a memory of the time you overate and spent the entire night in the bathroom, trying to get rid of it. Or maybe the association with a particular aftershave has a bad association for you; or an especially good one, but you don’t really know why.
The olfactory cortex works in your limbic system in memory and trauma reactions in the following way: When you smell something familiar, even if you are not consciously familiar with it, but you have a "every time I smell Old Spice I get sick to my stomach" reaction (for example), your olfactory cortex is signaling your amygdala of an old memory buried somewhere in your subconscious. When your amygdala gets "triggered" by the odor, it kicks in and the same stress chemicals and hormones (if it was a stressful event involved with the odor) that were released during the original stressful event. We are very good at cutting off traumatic memories, especially if they happened during childhood. We call this dissociating from the trauma. Children are very good at teaching themselves how to do this, and the younger they are when trauma occurs; the better they are at dissociating from it. The problem with this is that our brain – our amygdales, our hippocampuses, and our olfactory cortexes in particular remember, regardless of what our consciousness wants to do. So at some point, eventually, something is going to trigger our "hidden" or "buried" memories. Like that odor… or maybe a sound, or a color, or an old song… we never know what it may be. And this is where a treatment technique like EMDR and be especially useful.
When I work with people who have suffered a trauma, I will often hear them say, "why do I need to revisit that in order to heal from it? Why do I need to tell the story again?" Or they may tell me, "You know, I’ve had so much therapy, and I can’t get past these anxiety attacks. How will it help me to tell it again?" The reality is that you DON’T have to "revisit" the trauma or relive it; you don’t have to tell me your whole, painful terrible story. All we need to do with EMDR is focus on one specific aspect of it – and yes, it’s best if it’s the worst part of it, or maybe I should say, the worst part that you can tolerate. You don’t have to do anymore than that – tolerate it. And I’ll be there with you, keeping you in the present and checking in with you the whole time to keep you here.
What we do know about EMDR is that for some reason, when people focus on a particular aspect of their trauma, or their phobia (like a fear of heights) or their pain or their anxiety, the neurons in the limbic system rewire themselves when we do BLS, and the things that are somehow "stuck" there are "reprocessed" and the brain becomes desensitized, the memories are moved from the old limbic system to the prefrontal cortex. In short, instead of being triggered and having a fear (or flight, fight or freeze reaction) people now have a response, like, "That’s not happening to me now; I’m not in danger now; I’m safe" and when they think of the original event, or the phobia or the fear, their neurons in their limbic system no longer light up as they used to (this has been studied in actual brain scans), and the neurons in the high thinking prefrontal cortex light up instead.
There are of course nay-sayers, just like in any field, who call EMDR "quackery" and say it doesn’t work – that it’s a gimmick. There are also those who don’t believe in hypnosis… but that’s another topic altogether. I’ve been practicing EMDR for 7 years, and if I went back and looked in my files, I could probably tell you how many cases I’ve treated with EMDR in that time, but I know it’s over 100. I can tell you that I’ve had at least a 90% success rate among the people I’ve treated with EMDR when it comes to trauma recovery, getting over phobias and healing from panic attacks. EMDR isn’t for everyone; in good psychotherapy, like in good medicine, there is no "one size fits all" treatment. But it’s always worth looking into it. It got me over my fear of heights!
---------------------------
Cynthia Horacek is a Marriage and Family Therapist. She has been in private practice in Agoura Hills, California since 1999. Ms. Horacek specializes in Chronic Pain and Illness, Trauma Recovery, Dissociative Disorders, Anxiety, Phobias and Depression. She works with children ages 7 and up, adolescents and adults. Learn more about her therapy services by visiting www.odysseytherapy.com.