How does EMDR work? A neuroscience explanation.

21/08/2023 By Des 8 Comments

With more than a quarter-century of credibility, Eye Movement Desensitisation and Reprocessing (EMDR) stands as an evidence-based treatment. The query “Does EMDR work?” has evolved into a grander question: “How does EMDR work?”

There are a number of theories but the one that makes sense to me is in the article Eye Movement Desensitization and Reprocessing and Slow Wave Sleep which I will try and summarise as I understand it (all errors of interpretation are mine, email your corrections).

The Overwhelm Loop: Emotional vs. Rational

When we experience something overwhelming and relive the traumatic event there is reduced control of the pre-frontal cortex over the activated amygdala and hippocampus (the amygdala and hippocampus become overstimulated). In other words, when you are triggered, the rational thinking part of your brain can’t control the emotional part of your brain. This is why when you get triggered, you can’t think and you feel overwhelmed.

Unprocessed Stuck Memories

Traumatic memories are “stuck” in the amygdala-hippocampal complex and when triggered, they seem to occur in the present. “Stuck” memories are thought to be unprocessed memories.

The Sleep Connection: EMDR and Dream Sleep

During sleep, we process and consolidate memories from the hippocampus to the neocortex. Normal, less traumatic memories, don’t become “stuck”, because at night when we dream (Rapid Eye Movement or REM phase), these are moved out of the amygdala-hippocampal complex and processed by the rest of the brain. This is one of the reasons we feel so much better after a good night’s sleep.

Neuroscientists propose that what happens during REM (dream) sleep happens during EMDR.

During EMDR, therapists move your eyes from side to side whilst getting you to focus on a fragmented traumatic memory or emotion. Much like when your eyes move side to side when you dream.

EMDR’s Brain Synchrony

EEG tracings show that the eye movements (much like in REM sleep) elicit a synchronisation of all cortical activity at a frequency in the delta range like slow-wave sleep. EMDR temporarily slows your over-stimulated amygdala down and synchronises your brain waves helping you process the traumatic memory.

Trauma Unraveled

This suggests that during EMDR therapy the traumatic memories are continuously “reactivated, replayed and encoded into existing memory networks”. In other words, EMDR helps traumatic memories become “unstuck” and processed like normal, less traumatic memories.

To quote the article:

“In fact, we posit that bilateral stimulation mimics the low-frequency stimulation typical of SWS (slow-wave sleep), inducing a depotentiation of the AMPA receptors of amygdalar synapses, which in turn lead to a weakening of the traumatic memory. This reduction of the over-potentiation of amygdalar synapses makes traumatic memory more accessible, and facilitates the connection between emotional memory and episodic memory, thus promoting a shift of memory to associative and neocortical areas.”

Essentially, the bilateral movements used in EMDR rapidly allows us to process stuck traumatic memories as we would normally do with less traumatic memories during sleep.

They have a great picture of an EEG tracing that show how the bilateral movements mimic slow-wave sleep. Click to see it in the original article.

EEG tracing upon eye movements during an eye movement desensitization and reprocessing (EMDR) session. Note the slow-wave sleep (SWS)-like frequency from the beginning to the end of bilateral stimulation.

A Glimpse at the Future

EMDR bilateral stimulation (moving your eyes side to side) mimics slow-wave sleep, calming the amygdala and allowing it to synchronise with the rest of the brain. Thus allowing your brain to process a traumatic memory. What we do in therapy (move your eyes side to side), is what you do every night when you dream.

Remember, curiosity keeps us learning, so delve into the original article if you’re intrigued. Stay open to new revelations.

Stay curious, always.

I look forward to hearing from you.

Kind regards,

Desne Doman

Clinical Psychologist MAPS

EMDR Accredited Practitioner.

References:

Keywords: EMDR, mechanism of action, eye movements, sleep, slow-wave sleep, REM, orienting response, working memory

Pagani M, Amann BL, Landin-Romero R and Carletto S (2017) Eye Movement Desensitization and Reprocessing and Slow Wave Sleep: A Putative Mechanism of Action. Front. Psychol. 8:1935. doi: 10.3389/fpsyg.2017.01935

Pagani, M., Di Lorenzo, G., Verardo, A. R., Nicolais, G., Monaco, L., Lauretti, G., et al. (2012). Neurobiological correlates of EMDR monitoring – An EEG study. PLOS ONE 7:e45753. doi: 10.1371/journal.pone.0045753

How to find a good EMDR therapist Step by Step

21/08/2023 By Des 1 Comment

Three steps to find good EMDR Therapy and Three questions you must ask to find a good EMDR Therapist.

Are you seeking effective EMDR therapy for yourself or a loved one? As a seasoned Accredited EMDR Practitioner, I understand the importance of finding a skilled therapist who can make a difference. Here are three essential steps to locate a proficient EMDR therapist and three crucial questions to ask during the selection process.

Don’t Rely on Google Reviews for Choosing a Psychologist

When it comes to choosing a psychologist, Google reviews are not the most reliable source of information. This is because regulations from the Australian Health Practitioner Regulation Agency (AHPRA) prevent clinical psychologists and psychologists from having reviews. AHPRA oversees various healthcare professionals like GPs, clinical psychologists, and psychologists to ensure their competence and safety in practice. Their role is to verify the authenticity of medical practitioners.

Google reviews, according to AHPRA, are considered as unlawful advertising. If you come across a psychologist with more than two of accidental reviews, it could indicate that they might not be accredited, registered, and hence, might not offer you the level of protection you need.

Watch Out for Titles: Therapist vs. Psychologist

It’s important to be cautious about titles when seeking help. Anyone can label themselves as a therapist, counselor, or psychotherapist, which might not guarantee their qualifications. However, using the titles “psychologist” or “clinical psychologist” is restricted and regulated by AHPRA. These titles are reserved for those who have undergone proper training and accreditation, assuring a certain level of expertise.

Three steps to find a good EMDR therapist.

Step 1 : Navigate EMDRAA’s Accredited Database.

Begin your journey by accessing the EMDRAA Find a Therapist tool, a trusted resource backed by the EMDR Association of Australia. The site’s load time might test your patience, but it’s a goldmine for identifying qualified professionals.

Goto EMDRAA Find a Therapist and click Accept Terms

Step 2: Pinpoint Your Search

Enter your postcode and, if necessary, repeat the same search three times. Pay attention to the little blue labels, which indicate how close they are to you.

IF NO RESULT – TRY SAME SEARCH AGAIN! You must select one of the drop down options otherwise no result.

The resulting list will start with the Accredited Trainers/Consultants/Practitioners (most experienced) and then Members within the radius you specified

(Look at the little blue labels ). Scroll down to find someone close to you.

Step 3 – Assess Availability, Experience and Medicare Rebates

Check 1. Availability – Are they Accepting new clients?

Practitioners that are not accepting new clients may have a wait-list, ask to be put on it

Check 2. Experience – Are they an Accredited Practitioner or an Accredited Consultant?

If they are a Member – do some more research (see below) as there is no guarantee of experience.

3. Medicare Rebates – Do they offer a Medicare Rebate? This means that your practitioner is regulated by the AHPRA. To receive a rebate, you must be referred by your GP or psychiatrist with a referral letter and Mental Health Plan. Rebates in 2023 for a 50+ minute session are – Clinical Psychologist ($136.35), Psychologist ($92.90) see MBS Online .

The 3 questions you must ask to find a good EMDR therapist

Some EMDRAA Members are highly experienced, others do the training and rarely use it and its hard to know the difference. Try this.

Therapeutic Approach – Call them up and ask them what therapeutic approach (modalities) they mainly practice. (Don’t specifically ask if they practice EMDR, By avoiding direct mentions of EMDR, you’ll gauge the extent to which they rely on this powerful technique.)
EMDR Utilization – Ask them how often they use EMDR. I use it in 90% of my sessions each day.
EMDR 2.0 Proficiency – Ask them if they have trained in EMDR 2.0? This is using the latest techniques and clients report that it can be more energising and fun

There are 3 grades of EMDR experience.

In Australia, EMDR therapists are graded by the EMDR Association of Australia (EMDRAA) according to there training and experience.

EMDR Member (Basic):

This level signifies foundational EMDR training. While a starting point, further accreditations showcase heightened expertise.

EMDR Accredited Practitioner (Advanced):

A practitioner at this level goes beyond basics, boasting additional supervision and experience. They would have treated a substantial number of clients and undergone rigorous evaluation.

Accredited Consultant (Exemplary):

These practitioners are Accredited Practitioners while also possessing the experience and skills necessary to provide supervision to fellow therapists.

Finding the right EMDR therapist is a vital step toward healing and growth. Use these steps and questions as your compass, to find the best EMDR therapist who can truly make a difference.

I look forward to hearing from you.

Kind regards,

Desne Doman

Clinical Psychologist MAPS

EMDR Accredited Practitioner.

How is the new enhanced EMDR 2.0 different from EMDR?

18/08/2023 By Des Leave a Comment

EMDR 2.0 is built on the original EMDR protocol but includes several adjustments to improve its efficiency in treating patients with complex PTSD. It still uses the eight-phase protocol of standard EMDR, but does not necessarily replace it.

How does EMDR 2.0 work?

EMDR 2.0 includes a stronger emphasis on activating memory and challenging working memory. Working memory is like your brain’s temporary storage and processing system. It’s what you use to hold onto information for a short time while thinking or doing something. Your working memory is limited, so you can’t hold too much at once.

There are three main things that EMDR 2.0 does

First, the therapist talks to the person to help them put the difficult memory in their mind (working memory). This helps the person prepare for the therapy and understand how it works.
Then, they help the person makes the memory stronger, by helping the person to focus on all aspects of the memory like taste, smell, sound, feel etc.
Finally, the therapist uses different tasks to help the person deal with the memory. These tasks could include superfast eye movements, tapping, counting, clapping and V-steps. The therapist may use tasks that fit the type of memory being worked on. For instance, if the memory has a strong sound part (like a sigh), they might use tasks that involve listening or speaking, like counting or spelling. This helps make the therapy more effective.

Because the working memory has limited capacity, the doing of the tasks competes with the difficult memory and fragments it, helping to process and make it less disturbing.

Is EMDR 2.0 better than standard EMDR?

We need more research. A highlight of a recent study concluded that

“EMDR 2.0 requires fewer desensitization sets than EMDR to reach the same effect, suggesting more efficiency”.

see: The effect of EMDR versus EMDR 2.0.., European Journal of PSychotraumatology 2021

As a long-time practitioner of EMDR, discovering and implementing the EMDR 2.0 protocol has been a significant breakthrough for both my clients and me at EMDR Therapy Sydney. The protocol has allowed us to complete more profound and challenging work in fewer sessions for some cases. However, it depends on the client and where they are in their processing of disturbing memories.

An experienced EMDR practitioner will use both protocols as needed.

EMDR 2.0 is based on the clinical experience of therapy providers lead by Dr Ad de Jongh and Dr Suzy Matthijssen using scientific research on how our working memory affects the recall of traumatic experiences. The premise behind EMDR 2.0 is that by increasing a patient’s motivation, activating their memory more effectively, and challenging their working memory more strongly, the therapy can be even more helpful in treating PTSD.

After a long two days of EMDR 2.0 training with Dr Ad de Jongh and Dr Suzy Matthijssen in Sydney early 2023.

Dr. Suzy Matthijssen is a clinical psychologist-psychotherapist who specializes in trauma treatment. She is also a senior researcher and teaches at the university. Her research focuses on improving trauma treatments, including using intensive trauma treatments and working memory theory. Dr. Matthijssen is the head of the Altrecht Academic Anxiety Centre and the intensive trauma treatment program. She holds leadership roles in the Dutch EMDR association and EMDR Europe, as well as the Future of EMDR project.

Dr. Ad de Jongh is a clinical psychologist and professor of Anxiety and Behavior Disorders at the University of Amsterdam. He is also a professor at several other universities. Ad helped create the Psychotrauma Expertise Center (PSYTREC) and is in charge of the research department. He is an expert in treating anxiety disorders and conducts research on the effectiveness of treatments for various patient groups, including traumatized children, people with intellectual disabilities, and those with complex psychiatric conditions like psychosis. Dr. de Jongh is a recognized EMDR trainer and involved in the Future of EMDR project. He has won multiple awards for his research.

COVID-19 and rising PTSD Cases

12/01/2022 By Des Leave a Comment

Were you hospitalised with a COVID-19 or suffered severe symptoms? You may have COVID PTSD.

Have you woken up feeling exhausted despite an average amount of sleep? Are you having vivid nightmares? Do you find yourself feeling angry, depressed, or anxious more often than usual? Are you feeling isolated and withdrawn? If you answered yes, you might be suffering from the less-talked-about, long-lasting impact of your COVID-19 PTSD.

I’ve been noticing increasing clients who had COVID appearing in my office with all the PTSD symptoms of having suffered a life threatening trauma. I have been treating them with EMDR (Eye Movement Desensitation and Reprocessing) Therapy and seeng the symptoms markedly diminished. A quick look at recent research shows:

Rates of PTSD Symptoms in Hospitalized COVID-19 Patients

A study (Post-traumatic Stress Disorder in Patients After Severe COVID-19 Infection) published in 2021 observed COVID-19 patients 30-120 days after their recovery . Out of the 381 study participants, 309 had been hospitalised. Here are the diagnostic rates the researchers found within the experimental group:

PTSD: 30.2%
Depression: 17.3%
Generalised Anxiety Disorder: 7%
Hypomanic Episode: 0.7%

Women experienced PTSD symptoms the most. These findings led the researchers to determine that factors associated with COVID PTSD are gender, delirium, agitation, and persistent medical symptoms (Janiri, D. et al.).

Another study (Mental health outcomes after hospitalisation with or without COVID-19) observing COVID-19 patients found 25% tested positive in PTSD screeners compared to 7% of patients experiencing similar physical symptoms without a COVID-19 diagnosis. Researchers at Michigan University Health Lab also found that COVID-19 hospitalisation and feelings of social isolation led to an increased risk of developing PTSD, what is worse is that no-one is recognising it as PTSD and treating for it. (Imhoff, 2021).

How Do I Know If I’m Experiencing COVID PTSD?

If you’re concerned about yourself or your loved one, look out for the following symptoms of PTSD listed in the DSM-5 (APA, 2013):

Difficulty falling and staying asleep
Nightmares
Difficulties concentrating; brain fog, short-term memory challenges
Diminished interest in pleasurable or daily activities
Easily changed mood
Inability to relax and feel calm
Reduced socialisation
Flashbacks to traumatic moments while hospitalised
Hypervigilance
Fatigue
Avoidance of external reminders (people talking about COVID)

Seeking treatment as soon as possible is vital to a full recovery. While it may feel scary to seek help, know that nonjudgmental care is available and that you do not have to suffer alone.
COVID PTSD Treatment

As a clinical psychologist and accredited practitioner, I use Eye Movement Desensitization and Reprocessing (EMDR) treatment to support patients healing from COVID PTSD. EMDR helps treat COVID PTSD by lessening the stressor’s impact, decreasing intrusive thoughts, reducing emotional reactivity, and more (Lazzaroni et al., 2021). I can guide you through emotional recovery through my empathetic, nonjudgmental approach. Contact me today to learn more about EMDR and see if we are a good fit.

Sources COVID-19 PTSD:

Burgos, C. (2021). Why PTSD May Plague Many Hospitalised COVID-19 Survivors. Smithsonian Magazine. https://www.smithsonianmag.com/science-nature/why-ptsd-may-plague-many-covid-19-survivors-180976715/
Janiri D, Carfì A, Kotzalidis GD, et al. (2021). Post-traumatic Stress Disorder in Patients After Severe COVID-19 Infection. JAMA Psychiatry;78(5): 567–569. doi:10.1001/jamapsychiatry.2021.0109
Spencer-Segal, J.L. (2021). Mental health outcomes after hospitalisation with or without COVID-19. General Hospital Psychiatry; Vol 72 p. 152-153.
Imhoff, J. (2021). Risk of PTSD, anxiety, loneliness after COVID-19 hospitalisation. Michigan University Health Lab. https://labblog.uofmhealth.org/lab-report/risk-of-ptsd-anxiety-loneliness-after-covid-19-hospitalization
Kaseda, E.T. & Levine, A.J. (2020) Post-traumatic stress disorder: A differential diagnostic consideration for COVID-19 survivors. The Clinical Neuropsychologist; 34(7-8): 1498-1514.
Lazzaroni, E., et al. (2021). Coronavirus Disease 2019 Emergency and Remote Eye Movement Desensitization and Reprocessing Group Therapy with Adolescents and Young Adults: Overcoming lockdown with the butterfly hug. Frontiers in Psychology.

You are not alone, and help is available from EMDR therapy Sydney.