Therapy believed to be effective in treating PTSD
By Eva Briggs, MD
Post-traumatic stress disorder, PTSD, is a psychological disorder caused by experiencing or witnessing a distressing event.
It’s normal to have trouble coping and adjusting after a disturbing event.
If troubling symptoms worsen, persist for months or years and interfere with daily functioning, it could be PTSD. Symptoms usually begin within three months of the event but can start years after the event.
The Diagnostic and Statistical Manual first officially recognized PTSD as a disorder in 1980. Since then, multiple possible treatments have been developed including psychotherapy, medications and service dogs.
One intriguing therapy is EMDR, eye movement desensitization and reprocessing therapy. At first glance it sounds and looks strange.
In 1987, psychologist Francine Shapiro developed EMDR to attempt to manage her own PTSD symptoms. Her idea was to experience bilateral sensory input while recalling the traumatic event. The input could be visual by performing certain eye movements, touch by gently tapping the body or sound from a beep alternating between the left and right ears.
The EMDR process begins with a therapist learning a patient’s history to identify treatment targets. Possible targets are current symptoms, past memories and future goals. The therapist then helps the patient prepare by explaining the treatment plan and practicing the bilateral sensory input.
The next step involves activating the targeted memory. The therapist can use validated scales to measure emotional impact as well as the patient’s thinking (cognition) about the memory.
In the desensitization phase, the patient focuses on the memory while simultaneously experiencing the bilateral sensory input. Additional steps of the process help the patient strengthen positive responses and plan how to keep safe until the next session. Most people undergo six to 12 sessions.
So how does this work?
One component is believed to be desensitization. Going back to the traumatic memory can trigger sensations such as racing heart and can spike stress hormone levels. Doing so repeatedly causes these reactions to gradually lessen. Adding the bilateral sensory input theoretically anchors the patient in the present even as they recall the past.
The sensory input should not be so overwhelming that it completely blocks out the memory.
For example, performing mental math calculations would be too distracting. One conjecture is that trying to recall the memory while distracted degrades the memory, so that when that memory is returned to storage it becomes less stressful and therefore less triggering.
But does EMDR really work?
Scientists are still debating. One critic, Richard McNally of Harvard, dismissed it “as merely one of the many therapeutic fuzz-balls that litter the landscape of psychology today.”
Studies suggest that it works but the quality of the studies is weak. It may be no more effective than other psychological techniques. And there is probably a risk of creating false memories, but whether that is more likely than with other treatments is unknown.
It’s possible, but unknown, whether EMDR can help with other mental health conditions such as eating disorders, phobias and depression.
The E.M.D.R. International Association trains and certifies practitioners. One can search their directory to find a trained provider to pursue this therapy.
Eva Briggs is a retired medical doctor who practiced in Central New York for several decades. She lives in Marcellus.