From Dr François Louboff,
Psychiatrist and EMDR Practitionner.

Currently called "integrated neuro-emotional therapy through alternating bilateral stimuli", EMDR is a branch of psychotherapy which developed 25 years ago. Its efficiency in treating  trauma is now recognised all over the world. This psychotherapy integrates various elements from other forms of therapy: cognitive behaviour therapy, Gestalt Therapy, Roger Therapy, modified conscience state (hypnotic state, meditation), and psychoanalysis. EMDR doesn't call into question the other forms of therapy, it merely provides clinicians with new possibilities to better use their existing skills and experience.

The Adaptive Information Processing Model

EMDR therapy is based on the Adaptive Information Processing (AIP) Model. Present in all of us, it allows us to resolve difficulties we confront in our lives. This is evidenced by the evolution of our thinking and our beliefs. It's a physiological adaptation enabling us to survive.

Normally, we assimilate and integrate new experiences, enabling us to adapt to our environment.  All useful aspects of these experiences are then retained, that is to say, learned and therefore remain available to us to help us with our future choices. A new experience is thus assimilated into an existing memory structure, and connected with similar experiences, which enables us to give the experience a meaning.

When certain life events are too disturbing, whether they are major traumas (for example rape, a car accident, an attack or an earthquake), or "small" traumas (humiliation in childhood, witnessing violent parental disputes, etc), this information processing is blocked. The negative consequences that result are often of a lasting nature: at worst, Post Traumatic Stress Disorder, but also depressive, anxiety or eating disorders, addictions, various physical symptoms, etc. Trauma is therefore considered a block to this adaptive information processing.  Moreover, this model conceives current painful situations as re-activators of past experiences that remain unresolved and untreated. For example, the anxiety of an abuse victim when they find themselves in an intimate situation, however desired, which is linked to the involuntary (and often unconscious) reactivation of a traumatic past experience.

"Abnormal" processing of experiences

When the brain has not been able to "digest" events, these may become disruptive because they are stored in an "abnormal" or "dysfunctional" way in the brain.  When they can't be stored in our autobiographical memory, they can't be turned into memories.  These events can therefore affect us against our will (flashbacks or nightmares), or influence us in an subconscious way (through anger, eating disorders, self-harm, etc). In some way the past remains present.

Remembering a traumatic memory is often accompanied by a physical resonance. The trauma is stored as a sensory,  emotional  or processing memory and not as a  narrative memory. This means that the patient experiences negative emotions, unpleasant physical sensations, or involuntary physical movements that are connected to the traumatic event, but are still sometimes unable (because of young age, dissociation, forgetting,…) to assimilate them into their autobiographical memory (I remember having experienced such an event, …).

EMDR restarts the information processing system

EMDR seems to enable a connection between the memory network that contains the  traumatic memory and the network containing processed adaptive experiences which have meaning to us.

Access to the memory network containing these traumatic memories to re-process them leads to a reduction or disappearance of symptoms. EMDR stimulates the information processing system that we all have, but also provides a different perspective on the traumatic event, new insights,  better emotional self-management, and changes to the way we perceive ourselves.

With this approach, the symptoms are merely consequences, the cause of the suffering is the traumatic memory that could not be processed normally and remains "blocked", sometimes for decades, like a cyst in our psyche.

How does an EMDR therapy work?

EMDR focuses on emotions (fear, anger, anxiety, shame, guilt, etc), negative irrational beliefs which patients have about themselves (I'm responsible, ashamed, not worthy to be loved, I'm bad…) and physical sensations (I have a ball in the stomach or the throat, pain in the chest, twitches, etc). It is a psychotherapy structured into eight phases, of which the first three (establishing contact, preparation and evaluation) are particularly important and absolutely must precede the phase of desensitisation (where the alternating stimuli are used).

The importance of the emotional and energetic accompaniment and support of the person is underlined, as is  the importance  of assessing the level of disassociation of the patient. This will allow the patient to stay in what is called the "window of tolerance".

The fifth step (installation) enables the consolidation of a more appropriate and positive self-perception by the patient during the treatment. The sixth consists of a verification of the effect of the treatment based on physical feelings (body scan), the seventh closes the session, the last one consists of a re-evaluation (at the beginning of the following session) of the impact of the traumatic memory and a review of the treatment to date.

Very schematically, the therapist asks the person to describe an image which represents the most painful moment of the traumatic memory, negative and irrational beliefs associated with it (I'm responsible, I'm useless, I'm going to die …) and where on the body  they feel their discomfort. The therapist also uses scales to measure the degree of intensity of suffering and progress of the therapy.

Then the therapist put his fingers (or a pen or a rod) in front of the face of the person and asks them to follow them with their eyes, in a relatively rapid sweeping motion from left to right and right to left, repeatedly, sometimes dozens of times.  This visual stimulation may be replaced by a tactile stimulation (tapping on the hands or knees of the patient, in an alternating way, or by using vibrators that the patient holds in their hands), or an alternating auditory stimulation with the help of a headset which sends sound in each ear successively.

The patient must remain in the position of an observer or spectator of what is happening inside them, whether on a psychological level (thoughts, memories,  images, emotions) or a physical one (sensations). The patient is advised to "let what is happening inside themselves happen, and let what comes, come". Their brain often makes a rapid set of associations, retrieving from their memories various elements that are connected, either closely or more distantly, with the traumatic experience.

This association exercise weaves together the irrational and negative beliefs experienced at the time of trauma and the more rational, objective and mature beliefs (an abused child is innocent, I am capable, I didn't die in that accident,…), which allows the patient to metabolise, digest and dissolve the initial negative and irrational perceptions, to arrive at a vision, a reframing of experiences, that is a rational and healthy perspective on the traumatic situation (I'm innocent, I have worth, I am alive …). A transformation can take place very quickly: the traumatic event is integrated into a new positive and constructive framework. The effectiveness of this method can be assessed by the reduction, and often the disappearance, of the suffering.  Indeed, the event no longer transmits fear, anxiety or suffering.

Of course, undertaking  EMDR therapy involves evoking a minimum of the trauma experienced. Unlike behavioural therapy, where the patient is asked to imagine the traumatic event during several hours, the exposure in EMDR only lasts a few seconds, when the traumatic memory is activated at the beginning of the phase of reprocessing. As soon as the patient engages in eye tracking (or when other alternating stimuli begin), they are simply asked to observe what is happening within themselves. They should not remain fixated on the painful memory. The patient should let their thoughts wander where they will, that is to say following the connections in their memory networks. Just like in a moving train, they look out of the window and see all kinds of landscapes unfold. The recommendation is to let come what comes and to let happen what is happening inside themselves (there can be movements, physical sensations, images, thoughts, memories which appear, some tears also of course, but their painful impact is most often brief). At the end of the series of alternating stimuli, the therapist simply asks the patient to say to them briefly (and if they wish), the first thing that comes to their mind, whatever it is (and regardless of whether it feels important to them, in  relation to the starting point or not). Then a new series of stimuli begins, and the process is repeated in the same way.

Gradually, often quickly, the memory of the trauma evolves, transforms, becomes more distant, blurs, and loses its painful weight. The view of the event changes as does the perception of it. A life-lesson can often be drawn from what has happened, as with all learning processes. The trauma becomes a memory, it is not forgotten, but it is situated in the past, with a beginning and an end.  The negative beliefs spontaneously evolve towards a positive, realistic, adapted belief (I'm innocent, I'm respectable, I'm a good person, …) A greater self respect emerges.

The person leaves behind his victim status.

How does it work?

A frequently asked question is what makes the therapeutic effect so spectacular. The answer is disappointing - we don't really know. By way of consolation: the answer is the same, regardless of the proposed psychotherapeutic method asked about (and there are more than 400!). Let us say, nevertheless, that many recent research studies provide some interesting hypotheses. EMDR favours, by alternating activation of both hemispheres of the brain, an improved synchronisation between them, therefore allowing the integration of traumatic memory (the left hemisphere would process information attached to a positive emotion while the right would process a negative emotion). We also know that eye movements decrease the heart rate and skin conductivity (the lower the stress level, the lower the conductivity of the skin). This induced relaxed state stimulates the cerebral parasympathetic function, allowing the integration of painful memories. In addition, adopting an attitude of 'dual awareness', that is to say being attentive to what is happening outside oneself (by following the fingers of the therapist for example) while being attentive to what is happening within oneself (the images, emotions, and sensations that appear), seems to have a therapeutic effect. This attitude is similar to the one adopted during mindfulness meditation, where one is asked to be an observer of the thoughts, emotions or feelings that arise from moment to moment.

Much more research is underway to help us to better understand the effectiveness of EMDR.

Using ambivalence to heal

EMDR, like other therapies, can highlight certain human phenomena, like ambivalence. We are feeling bad, we suffer, we no longer want to suffer, but a part of us seems curiously opposed to this. This ambivalence is normal, because every change is a source of anxiety. And EMDR makes change possible. This normal anxiety makes it absolutely vital that there is a therapeutic alliance between patient and therapist to be able to engage, safely and with confidence, on this new path of change, self-discovery and healing.