Updated: Jul 14, 2021
EMDR stands for Eye-Movement Desensitization and Reprocessing Therapy. Yeah, it’s a mouthful. It is named this way because one of the unique features of EMDR is what is termed “bilateral stimulation” (or BLS for short). In the original iteration of EMDR, bilateral stimulation was accomplished through side-to-side eye-movements, which were facilitated by asking the client to follow the therapist’s back-and-forth hand motions with their eyes (hence the eye-movement). EMDR now also includes other forms of BLS, such as tapping (touch) or alternating tones (sound). What is the deal with the BLS? It seems a little woo-woo, but there are a few theories on why it is an important treatment component.
The first theory is that BLS creates an orienting response. “The orienting response is a natural, innate response of interest that is elicited when attention is drawn to a new stimulus…[it is the] ‘what-is-it’ reflex in humans and animals, in which the slightest change in the world around them causes them to stop what they are doing and focus” (Eye-Movement Desensitization and Reprocessing Therapy, pg. 371). The orienting response is associated with physiological de-arousal (a decreased stress response), lowered avoidance, adaptive learning, and counterconditioning, all of which are super helpful in counteracting anxiety and depression symptoms.
The second theory is that BLS taxes working memory (temporary storage of information). EMDR protocol involves bringing distressing memories into the working memory while simultaneously completing BLS. Because clients must attend to both the external stimulus of the BLS and the internal stimulus of the targeted negative event, their attention is then divided. This is a good thing, because when the attention is divided in this way, the visual and emotional vividness of the distressing memory is reduced, and the memory can then be renegotiated and consolidated in that less disturbing format.
The third theory is that BLS approximates REM sleep (during which BLS occurs naturally in the form of eye-movements). REM sleep has been shown to promote information processing and memory consolidation, and plays a key role in emotional regulation (which anyone who has ever been sleep deprived can attest to!). Therefore, this theory suggests that BLS supports similar functions, and fosters the integration of episodic memories into existing semantic networks, eliminates negative affect, and increases insight and comprehension. So, this explains the “EM” in EMDR, but what about desensitization and reprocessing?
Well, EMDR is a trauma-based therapy at its core. It operates under the basic assumption that traumatic experiences are at the root of current psychological dysfunction. EMDR has a rather broad definition of trauma; it is any painful event experienced with a sense of helplessness. Though EMDR was originally developed to treat Post-Traumatic Stress Disorder (PTSD), it has shown good treatment effects with a range of other disorders, including anxiety, phobias, panic disorder, obsessive-compulsive disorder, depression, addiction, and pain conditions. The supposition is that earlier traumatic experiences are in fact at the root of these disorders as well.
Painful or traumatic experiences typically nudge the experiencer to hide from, conceal, or avoid the memory of the painful experience or anything associated with it, often rather unconsciously (in fact, it can be quite difficult for people to realize where their current reactions and painful feelings actually began). There are multiple physiological reasons for this, but for the sake of brevity, let me just highlight that this causes anything connected to the painful experience to be highly sensitized. It’s similar to scraping your knee, and then not wanting anything to come near that knee after the skin has been peeled away from it. You are keenly aware of the slightest touch to the unprotected flesh. So, the “desensitization” in EMDR means the process of looking at all that sensitive psychological content, and taking the sting out of it, so that it no longer hurts so much.
“Reprocessing” in EMDR means targeting painful events in the past or present in such a way that the dysfunctional aspects of the memory become functional and healthy. It can also mean targeting future events that cause apprehension. EMDR does not involve endlessly rehashing events from the past. The goal is to reprocess, not re-experience. In fact, an EMDR client doesn’t necessarily even have to talk about what happened in any great detail, but they do allow the brain to reprocess what it needs to so that relief is possible. The reason why reprocessing is necessary is that memories with painful content typically get stored differently than other memories, becoming siloed and isolated from the broader neural network, which contains more adaptive material. The idea is that EMDR allows the isolated, maladaptive memories to “link up” with more adaptive neural networks, thereby moving the psychological material from a maladaptive to an adaptive state.
It is not unusual for an EMDR client to be able to relinquish inappropriate responsibility, feel emotionally safer, and adopt a broader sense of self-efficacy and choice as a result of reprocessing. Many clients also find themselves becoming increasingly compassionate toward themselves, showing greater resilience, and responding in a relaxed way to situations that used to cause significant stress. In short, many find the experience to be life changing, and I say, “Yay for brain plasticity!”