Psychologist Francine Shapiro was a Ph.D. student when she first discovered in 1987 that moving her eyes in a certain way could take the emotional sting out of disturbing thoughts. Pressing her friends and acquaintances into service, she tried the technique on them and soon after conducted the first randomized controlled trial of the therapy in people with post-traumatic stress disorder (PTSD).
Today, Shapiro’s treatment — known as eye movement desensitization and reprocessing (EMDR) — is one of the most effective known therapies for PTSD. It looks strange because it involves therapists directing clients’ eye movements by waving their hands or tapping, but dozens of randomized controlled trials have demonstrated that it works.
Healthland spoke with Shapiro about her new book, Getting Past Your Past, which offers self-help methods based on EMDR.
Why did you decide to write this book?
It’s so important for people to realize that there’s help and [not] think that therapy has to be about years and years of talk.
People are walking around wounded and not understanding why they’re responding the way they are to the world. They are not understanding why they’re having negative feelings like ‘I’m not loveable, I’m not good enough,’ because of these unprocessed memories that they might not even remember. What happens is that when you get triggered, you get the emotions, but not the images, and then you buy into it.
When you’re feeling stuck, when you have negative beliefs about yourself — that’s not the cause of the problem, it’s the symptom. All those negative thoughts that push you into acting in ways that don’t serve you or prevent you from doing the things that you want — the basis is these unprocessed memories.
How did you first come up with EMDR?
I was using my mind and body as a laboratory to see what things worked. Around the time that I needed to do a dissertation, I was walking along one day and I noticed that some disturbing thoughts I was having were suddenly disappearing. When I thought to bring them back, they didn’t have the same charge any more.
What thoughts were you having?
I can’t remember! But what caught my attention was that they were the kind of thoughts that you generally had to do something about [in order to make them go away]. I started paying close attention and I noticed that when that thought came to mind, my eyes started moving in a certain way and the thoughts shifted from consciousness and when I brought them back, it wasn’t that intense.
What eye movements were you making?
It was rapid diagonal movements, very rapid, what they call saccadic movements. So, I wanted to see if it could work deliberately. I brought up something that bothered me and moved my eyes in the same way and I found the same thing. I reached out to all my friends, basically every warm body I could find, and asked them if they had something they wanted to work on. Everyone did.
I started having them follow my hand in order to make the same eye movements and that’s how I developed the process. Then I did a controlled study, which was published in the Journal of Traumatic Stress in 1989.
There was an enormous amount of resistance to EMDR and for a long time many researchers simply didn’t believe that it worked. There’s still controversy about it. Why do you think that’s so?
Because whole field of PTSD was new. The diagnosis of PTSD was only made official in 1980. And what you had were all these Vietnam vets who were still struggling and suffering 20 years after the war. The view of field was that PTSD was pretty impossible to treat and here I published an article on a randomized controlled study showing positive effects after one session and with eye movements, which didn’t make any sense.
For me, I felt I stumbled on the brain’s natural processing. I started thinking about REM sleep [when dreaming typically takes place] where you also get those kinds of eye movements. At this point, the research [suggests] that the REM state is when the brain is processing survival-related information. Back in 1989, the view was that the eye movement was the dreamer scanning the dream environment. They had no idea what it was actually doing.
Right now, there are 20 randomized controlled trials on just the eye movements alone and all of them show a positive effect. About half of the studies have been done by memory researchers who believe that the eye movements disrupt working memory [one theory about how it works]. Harvard researcher Robert Stickgold has written [about how EMDR] links into the same process that occurs during REM sleep.
These ideas aren’t mutually exclusive?
I think both are correct. What’s quite interesting at this point in the whole field of PTSD is that in order to have the official diagnosis, you need to have a major trauma like rape or combat experience, but the latest research indicates that general life experience can [produce traumatic memories].
Do you mean things like child abuse?
Not even. Children can hear parents fighting. They had a study showing that children can get PTSD from falling off a bicycle.
Is this because people who are very sensitive to experience can be traumatized by things that wouldn’t affect other people?
There’s a genetic [piece] and there’s also what kind of foundation has been laid. A lot of research lately indicates that childhood adversity can set the groundwork for vulnerability to a lot of later problems.
What we’re really looking at in general is that you have an information processing system in the brain that’s supposed to be geared to digest experience, to make sense of it [so that] what’s useful is incorporated [into memory] and what’s useless is let go. When something is too disturbing, it overwhelms that processing system and the memory gets stored along with the emotions and physical sensations and beliefs that occurred at the time, and that’s what gets triggered [in PTSD].
Robert Stickgold says that [the experience] is inappropriately stored in episodic memory — the memory of emotions, physical sensations and beliefs — and through EMDR, it gets shifted to semantic memory [narrative or verbal memory]. It is stimulating the information processing systems of the brain so that the appropriate links are made. So a rape victim may start out saying that she feels shameful, ‘I should have done something’ and has all those emotions; at end, she is saying, The shame is his not mine, and I’m a resilient woman. That’s the digested version: what needs to be learned is incorporated and what’s useless is let go.
Some people claim that EMDR is most helpful for single traumatic memories, but less so for people who have experienced ongoing trauma over a long period of time.
It’s not that it works better, it takes longer when you have multiple traumatic experiences because there are more memories that need to be processed. And if it was childhood onset, because of the traumatic experience, they didn’t necessarily [learn the] socialization and skills and that are needed at the time.
Within EMDR, we have a three-pronged approach. First, identify and process the earlier memories that set the groundwork [for the problem], then process current stimuli that trigger distress, and third, incorporate whatever skills and education are necessary to overcome developmental deficits and provide what the person needs for the future.
It’s often really hard to find evidence-based therapies, but you seem to have very successfully disseminated EMDR. What’s the secret?
It really has been word of mouth. When I first developed it, I gave a lot of presentations throughout the country. People would give me their cards and say, When you are ready to teach it, I want to learn it. I made sure I had people who were able to give and receive it under supervision so they actually learned it. It was not just me as a talking head. I did small group practice and had one trainer for nine people. At end of that, they wanted other clinicians to learn it because they went back and used it, saw results and were getting results that they hadn’t gotten with anything else and wanted their colleagues to learn it. They often volunteered to train others because they wanted more people to be helped and that’s really the way it went.
I write a lot about addiction and many, many addicted people have suffered traumatic experiences, which unfortunately are often not dealt with appropriately in treatment.
I think the literature is very clear that there’s a large connection with trauma and the person trying to self-medicate. We tried to do an randomized controlled trial with EMDR in Washington state’s drug court and we had to drop the randomized part because the people treated with EMDR started talking about how much it helped so the others were really upset that they couldn’t get. We ended up being able to do the evaluation: graduation from these courts is supposed to be a major indicator of recidivism, and 91% of those who got EMDR graduated, compared to 60% of those who didn’t.
So why do we always think that every emotion we experience is real and connected to what’s happening now, not the past?
Because we’re feeling it and, therefore, seeing world in that way. That’s what’s so funny about it. We don’t even get that. When we’re going into a social situation and start feeling insecure, we’re feeling and acting on it. What the book is trying to do is give people an understanding of where this is coming from, so they can step back and use techniques to [cope better]. For a lot of people, that’s all they need, not therapy. But for other people, if you are always needing to use this, O.K., you’ve done most of the work to prepare and you go get helping processing it. These are the techniques clinicians would be teaching a client.
What should someone look for in an EMDR therapist?
Make sure they’ve been trained by a program approved by the EMDR International Association. We also have a nonprofit called the EMDR Humanitarian Assistance Programs — they’re getting the royalties from the book. We provide pro bono treatment for underserved populations worldwide, after every natural and man-made disaster.
People can take control of their lives, they don’t have to be buffeted by these unprocessed memories.