Following on from our recent piece which looked at Multiple Sclerosis (MS), trauma and post-traumatic stress disorder (PTSD), we take a closer look at Eye Movement Desensitisation and Reprocessing (EMDR) therapy.
In short, EMDR uses the concept of bilateral stimulation, in the form of rhythmic movements that are thought to help people effectively process traumatic events. Theoretically, these movements mimic what occurs during rapid eye movement (REM) sleep. During REM the eyes move from side to side, using different elements of the brain whilst simultaneously processing information. When a person experiences a traumatic event, the brain struggles to process it effectively, leaving it ‘stuck’, festering and thus causing chronic psychological distress. EMDR therapy attempts to kickstart the processing of traumatic memories, lessening the emotional toll that they take on the individual.
There has been a fair amount of mostly positive publicity for this ‘new kid on the block’ in the world of trauma focused therapies during the past decade. Not least as its virtues have been sung by many high profile public figures such as Prince Harry and actress Sandra Bullock.
EMDR was developed by the late Francine Shapiro PhD. who was a psychologist based in the United States. Originally a teacher, she noticed the positive therapeutic effect that rapid eye movements had upon traumatic thoughts which she was re-experiencing whilst on a walk in May 1987. This initial experience was so impactful for Shapiro that it sparked her interest in the therapeutic properties of bilateral stimulation for trauma management. It formed the basis of her PhD for which she studied at the Californian School of Professional Psychology and spawned the development of Eye Movement Desensitisation therapy (EMD). This therapy was the forerunner to EMDR – more on that later!
One of Shapiro’s first studies was undertaken in 1989 and focused on twenty-two people who had experienced traumatic incidents during the Vietnam War. It was a controlled study which was looking at the potential for EMD therapy to help lessen the impact of trauma in individuals. The types of traumas they were exposed to differed for each participant, but included emotional, sexual and physical abuse.
In this study, half of the participants were assigned to a group that received EMD therapy, whilst the other half were presented with a placebo treatment which involved the participant verbally describing a particularly traumatic event in detail. Follow-up sessions were held in the coming months for all participants in order to measure the therapeutic effects of their treatments. The study found that the individuals who were assigned to the EMD group were more desensitised to the detrimental impact of their traumatic memories, in comparison to their placebo counterparts. The effect was noticeable after just one session of EMD and lasted throughout the study’s 3-month lifespan.
It was from this initial study, underpinned by additional research, that Shapiro developed the concept of EMDR in 1990. As the name suggests, there is no difference between the two approaches until we get to the ‘R’! This stands for ‘reprocessing’ and was a significant breakthrough, as this extension of EMD therapy was found to help people affected by more complex PTSD.
We’ll attempt to provide a simplified overview of EMD and EMDR to underpin the importance of Shapiro’s finding.
Fundamentally, a session of EMD focuses on a single traumatic event. The therapist asks the client to and re-experience their associated thoughts and feelings, whilst undergoing a form of bilateral stimulation. The focus is on the deep negative core beliefs which the client may hold about themselves. These will shift to become less impactful as they are processed.
After a short while the therapist asks the client to stop what they are doing and then score their level of associated distress on a scale of zero to ten, with ten signifying significant distress. This is called a SUD Scale or Score. The therapist will then ask the client to repeat this process several times, with the aim being that they report lower levels of associated distress each time. For some, distress levels may increase temporarily until they have processed the event. This therapy is ideal to help a client manage the impact of a traumatic event in isolation, desensitising them from the emotional damage it has caused.
A single session of EMDR therapy should incorporate eight specific phases. It will begin with a therapist following the fundamentals of EMD, which includes speaking with the client to detail a history of events, providing support to help them stay within their window of tolerance and planning the memory processing path. This is followed by the desensitisation process applied to a particular instance of trauma.
When the client is ready, the therapist will then ask their client to delve deeper into their memory channels and focus on other experiences associated with the trauma. This could be a combination of sounds, images, feelings – anything which reignites the destructive memories of the traumatic event. They will then ask their client to apply the desensitisation technique to these new channels, which in turn supports the brain to process the complex map of trauma that is affecting them.
Once the therapist is happy that desensitisation has been effective, the session moves onto further stages, which involve supporting the client to install positive associations to the trauma, a review of what has been resolved, and closure. The latter is vital when ending an EMDR session as it helps the client to feel safe, calm and free from distress. It is important to note that throughout the EMDR process the client should be afforded full control and feel comfortable to cease therapy at any time.
We have documented the relationship between MS, trauma and PTSD, including a summary of ways it can be managed, in our dedicated article which explores this complex subject. As we noted, EMDR is the most recent therapy that has been approved by the National Health Service (NHS) to help people manage the devastating impact of PTSD. It was introduced after the National Institute for Health and Care Excellence (NICE) reviewed a catalogue of evidence that underpins its efficacy in helping people manage the impact of PTSD. But what scientific evidence is available to show how EMDR can support people with MS whose trauma is linked to the condition? The answer is that is so far very little, but what has been found is encouraging.
Currently the largest and most significant study of EMDR and MS related trauma took place in Italy, with the findings being published in 2016. This was a randomised controlled trial which involved 50 people with MS aged between 18 and 65 years old. Each participant had also been diagnosed with associated PTSD. The participants were split into two groups equally with half assigned to receive EMDR intervention and the other half being provided with Relaxation Therapy (RT). The latter had been used previously to support people affected by PTSD and chronic medical conditions. Both therapies were administered by psychotherapists who were experienced in utilising these techniques.
The results of this study were fascinating. While both therapies were shown to have a positive impact in the management of PTSD, participants in the EMDR group were able to overcome their PTSD diagnosis after only ten therapy sessions. Subsequently, and upon expert evaluation six months after their final EMDR therapy session, each and every member of the EMDR group did not meet the PTSD diagnostic criteria. This is compared to just over two-thirds of the RT group participants who had benefitted similarly. The study’s authors accepted certain limitations, in that this was only a small-scale study, and more longer-term evaluation is much needed. However, the results were encouraging and showed the potential of EMDR as an effective therapeutic solution to MS related PTSD.
At the beginning of this article we cited our piece which looked at PTSD and its link to MS. This included information about how traumatic experiences during the diagnosis journey, and the impact of diagnosis itself, can lead to PTSD. However, another psychological problem that can impact us after being diagnosed with a life impacting condition such as MS is known as adjustment disorder (AD).
AD occurs when we struggle to adapt to major changes in our lives. For some, adapting to these changes, accepting the impact they have on our lives is an organic process that may take anything from a few weeks to a number of months. For others, this process of adaptation can be difficult to manage, and without appropriate support can manifest into AD. Symptoms of AD can include depression, suicidal ideation, anxiety, avoiding contact with others, sleep difficulties and loss of appetite – to name but a few.
While AD shares some common symptoms with PTSD, it differs in many ways. For example, PTSD is usually linked to specific traumatic events and is sparked by clear triggers that are associated with those events. AD however is related to the changes which occur as a result of a major life event, adapting to these and accepting the new normal. The symptoms of PTSD are usually felt more intensely by the person affected. It has been estimated that almost one quarter of people will experience AD soon after an MS diagnosis.
Since its birth in the late 1900s, several studies have found that EMDR is an effective therapy to help people overcome AD. One of the larger studies, incorporating 180 participants, all of whom were affected by AD, concluded that EMDR was a superior treatment method when compared in isolation with group behavioural therapy and medication.
Rather interestingly, a single-person case study which was published in 2022 has highlighted how EMDR can support people who develop AD soon after their MS diagnosis. The participant in the study was a female in her mid-20’s. A neurological and psychological period of evaluation found she was experiencing cognitive impairment in the form of verbal and working memory deficit. It was also found that she presented with classic AD symptoms such as mild depression, anxiety and dissociative functioning. The latter was specifically regarding how she talked about MS, the language she used and distancing herself from emotional involvement. This is known as ‘dissociation’ and is a way of coping with stress in situations where the person feels they have little control – such as when receiving news of a life-affecting diagnosis.
Taking everything into account and given the overall impact on the participant’s quality of life, it was decided that EMDR therapy would be the most efficient and immediately effective therapeutic intervention. Therefore, she was prescribed with one-hour long weekly EMDR sessions for a period of six months. The full EMDR eight-stage protocol was followed as a rule. Additional neurological and psychological support was provided to focus on the misunderstandings and doubts that she had expressed just after her MS diagnosis.
At the end of the six-month treatment period the neurological and psychological tests that were conducted previously were undertaken again. This was used to help gauge the treatment’s effectiveness. The results were not just promising from an emotional perspective, but also in terms of the impact on the participant’s cognitive functioning. Not only was she able to manage the psychological impact of her MS diagnosis and be free from AD, her verbal and working memory had improved to the extent that it was no longer impacting her quality of life. The study’s authors suggest that this improvement in memory shows that its root cause in this instance was psychological, because of AD, rather than neurological.
As is usually the case with many relatively new treatments and therapies, more clinical trials and studies are needed to demonstrate just how powerful and wide-reaching EMDR therapy can be. While there is a growing body of evidence that underpins how effective EMDR can be to help people manage the destructive impact of psychological problems such as PTSD and AD, more evidence is required to demonstrate its full potential for people with MS. For example, a longitudinal study detailing how EMDR has supported people through their MS journey, one which could highlight further its efficacy and how it has helped people manage resultant psychological issues in the longer-term, would be of great interest. These may come with time, but until then what we know now is that EMDR has been a life-affirming therapy for millions of people affected by psychological traumas worldwide.
EMDR therapy is available throughout the UK via the NHS as part of their talking therapies treatment options. Your GP or other healthcare professional can refer you to your local service. Self-referral is also available in some areas.
Therapists who practice EMDR can also be found privately. The EMDR Association UK is the professional body for EMDR clinicians and researchers seeking the highest standards of EMDR clinical practice in the United Kingdom. Their website provides a searchable directory of EMDR therapists all of whom are accredited, having undertaken authorised training.
When seeking a therapist privately always check the British Association of Counselling and Psychotherapy’s (BACP) directory to ensure that they are registered. BACP members must demonstrate that they work in accordance with a set of professional standards and that they will commit to comply with these ongoing.
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