Eye Movement Desensitization and Reprocessing (EMDR) is a fascinating treatment modality for Post-Traumatic Stress Disorder (PTSD) and continues to demonstrate efficacy in treating these patients (Kim et al., 2017). Francine Shapiro developed EMDR in 1987 and connected it to the adaptive information processing (AIP) model (Hase & Brisch, 2022). The adaptive information processing model holds that memories are usually appropriately consolidated but that traumatic memories are stored improperly, creating obstacles to pre-frontal cortex functions (Hill, 2020). EMDR utilizes bilateral stimulation, and it is thought that this action removes the barrier of the maladaptive thought, provides relief from the symptoms of PTSD and trauma (Hill, 2020), and adequately consolidates the negative memory.
The AIP model is widely used to explain “observed results” (Hill, 2020) of EMDR therapy. The AIP model is a good start for understanding why EMDR is demonstrating efficacy in patients with PTSD, as well as patients with PTSD with a comorbid severe mental illness (Hase & Brisch, 2022
However, there is still much unknown about EMDR, and even though the AIP model helps researchers understand what is happening, there are still great questions as to why this modality helps with PTSD and provides immense relief for patients. Two schools of thought are worth noting here and are the lynchpins of EMDR. First, EMDR is thought to mimic slow-wave sleep (Pagani et al., 2017). Slow-wave sleep is of much interest to researchers as professionals become more aware of the importance of sleep for general health and memory consolidation (Putilov et al., 2017). During slow-wave sleep, memories are consolidated as more recent research describes the brain (in slow-wave sleep) as an “optimizing memory consolidator” versus the waking brain working to process stimuli (Rasch & Born, 2013). The mechanism of slow-wave sleep is much more complicated than is presented here; slow-wave sleep involves much of the brain’s anatomy and neurotransmitters (Rasch & Born, 2013). Slow wave sleep is recorded using an electroencephalogram (EEG), and brain waves during bilateral stimulation in EMDR are almost identical to slow wave sleep on the EEG (Pagani et al., 2017). These findings help researchers understand the mechanisms of bilateral stimulation on the brain and help explain why EMDR is effective for PTSD, as negative memories are consolidated during bilateral stimulation, much like sleep memory consolidation (Putilov et al., 2017). Understanding how the brain consolidates memory and under which conditions is essential for researchers—this study by Pagani et al. (2017) supports the hypothesis that memory consolidation during these slow brain waves explains why EMDR effectively treats trauma, as bilateral stimulation mimics slow wave sleep. Still, researchers still do not understand much about EMDR. However, there is a second point of interest to researchers. EMDR is thought to tax working memory, making reprocessed memories less vivid and traumatic for patients (Van Den Hout et al., 2011).
Before addressing how EMDR taxes working memory, it is prudent to summarize the hypothesis of why EMDR works to reduce symptoms of PTSD. It is thought maladaptive memories are consolidated less vividly under bilateral stimulation conditions, causing less distress for the patients. Patients are asked to focus on some of their worst memories during bilateral stimulation. It is thought that dual taxation of working memory causes the memory to consolidate less vividly than before bilateral stimulation (Manzoni et al., 2018). Symptoms are measured using Subjective Units of Disturbance (SUD); the Manzoni study demonstrated a reduction in SUD scores.
PTSD can be debilitating, and EMDR demonstrates great promise in helping patients live everyday lives without traumatic flashbacks and other ills of PTSD.
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