The majority of clients that walk through our doors are victims of domestic violence (DV). Their stories are painful and the complex symptoms that emerge following chronic interpersonal traumatization have a profound effect on their sense of self, ability to regulate moods and impulses and their ability to form and maintain healthy, secure attachments. Many of these clients meet the criteria for posttraumatic stress disorder (PTSD) as currently outlined in the DSM-V(American Psychiatric Association, 2013).
All of our therapist interns at the YWCA of Monterey County are trained to provide therapeutic treatments that have been widely studied and have been proven to reduce the effects of trauma on these individuals and families. Recently, two YWCA interns completed additional training to begin using EMDR, an evidence-based treatment technique that has proven effective for victims of trauma. I am one of those interns and the initial feedback from my clients has been promising.
One tremendous benefit of EMDR is the ability to relieve symptoms quickly in selected clients. Research has shown that brief EMDR treatment produces substantial and sustained reduction of PTSD and depression in most victims of adult onset trauma. In one study, researchers examined 24 subjects who had just five sessions of EMDR therapy for the treatment of PTSD. After the five-session treatment, 67% of the subjects no longer met criteria for PTSD (compared to 10% of the control group), and there were significant differences post-treatment between the groups in Global Assessment of Function (GAF) scores and Hamilton Depression scores(Högberg, Pagani, Sundin, Soares, Aberg-Wistedt, Tärnell, Hällström, 2007). I have seen positive results in two of my trauma clients after only two EMDR sessions. The first client had a significant reduction of anxiety symptoms and increased feelings of empowerment after the initial session of EMDR and the other found that her feelings of generalized fear and worthlessness were significantly reduced following two sessions.
Clients who are victims of long-term childhood neglect and emotional abuse may take longer to prepare for the intensive emotional processing of EMDR. These clients are showing slower but significant improvement in affect regulation and self-esteem. Trauma treatment experts have come to a general consensus that work with survivors of childhood abuse and other forms of chronic traumatization should be phase-oriented, multimodal and titrated (Korn, 2009). With these clients, a phase-oriented EMDR model works well in combination with other forms of evidence-based psychotherapy such as trauma-focused cognitive-behavioral therapy (TF-CBT), mindfulness-based therapies and psychodynamic therapy.
So what makes EMDR effective?
Emotional Trauma:
When disturbing events occur, they are stored in the brain as a memory, with all the sights, sounds, thoughts and feelings that accompanied the event. These memories become frozen, or stuck in the brain in what is referred to as an isolated neural network. You can think of these memory fragments as individual puzzle pieces stored in the nervous system. Usually, an individual goes through their day without consciously thinking about the past traumatic event. However, the trauma, accompanied by negative messages about the self, remains locked in the brain.
Emotional triggers seem to bring these negative thought patterns to the surface and the individual feels the same way she did when the trauma occurred. She might even experience the same smells and sounds that occurred during the original event. Painful negative thought patterns such as “I am worthless”, “I am unlovable” or “I am not safe” often accompany the feelings.
How does EMDR work?
The EMDR technique unlocks the negative memories and emotions that are stored in the brain. EMDR helps put these memory fragments or puzzle pieces together and connects the isolated neural network to the rest of the brain network. This new neural pathway can then eventually replace the old pathway – the one that caused the individual to feel, think and react in a negative way.
It is not clear to researchers precisely how EMDR works to integrate the memory, but a recent neuroimaging study measuring brain electrical signals using electroencephalography (EEG) monitoring during EMDR therapy has proven there is a neurobiological effect (Pagani, Högberg, Fernandez & Siracusano, 2013).
It is believed that the bilateral brain stimulation that occurs when an individual glances back and forth while remembering the trauma during EMDR sessions helps to reprocess the memory in a more healthy and adaptive way. The effect may be similar to the rapid eye movement (REM) that occurs while we sleep.
The bottom line is, EMDR can enable a client to gain a new perspective and self-awareness that helps her choose her actions, rather than feeling powerless as she reacts to traumatic memories. While EMDR techniques are not appropriate for all individuals, so far it has been an extremely useful tool to accelerate the therapeutic process for many of my clients.
Cindy Mangiola, M.A., MFTI
Marriage and Family Therapist Intern
YWCA of Monterey County
References
American Psychiatric Association, (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing.
Högberg G, Pagani M, Sundin O, Soares J, Aberg-Wistedt A, Tärnell B, Hällström T. (2007). On treatment with eye movement desensitization and reprocessing of chronic post-traumatic stress disorder in public transportation workers–a randomized controlled trial. Nord Journal of Psychiatry, 61(1): 54-61.
Korn, D. (2009). EMDR and the treatment of complex PTSD: A review. Journal of EMDR Practice and Research, 3(4): 264-278.
Pagani, M., Högberg, G., Fernandez, I., & Siracusano, A. (2013). Correlates of EMDR Therapy in Functional and Structural Neuroimaging: A Critical Summary of Recent Findings. Journal Of EMDR Practice And Research, 7(1), 29-38.
YWCA Monterey County 