The longer a person lives, the greater is the time span in which they may have had a traumatic experience that they never fully recovered from. Classic examples are traumas suffered in war, catastrophic car accidents, sustaining severe injuries in a natural disaster, being a victim of a violent crime, etc. A long life in and of itself means there have been more chances for exposure to a trauma. The possibility for trauma to occur in one’s life has no end date, and trauma does not happen only to the young or middle-aged.
A traumatic experience often leads to anxiety, depression, or similar mental health symptoms, up to and including cognitive decline. When such symptoms are identified in older adults, pharmaceutical interventions are tried in many cases. Behavioral therapy and other counseling may enter the picture as well. Another intervention not as well known, and one that is the subject of ongoing study, is a non-drug treatment known as Eye Movement Desensitization and Reprocessing, or EMDR.
The first clinical trial investigating EMDR happened in 1989. There have been many more since. The Cleveland Clinic describes EMDR as “a mental health treatment technique” that involves moving your eyes a specific way while you mentally process traumatic memories. “EMDR’s goal is to help you heal from trauma or other distressing life experiences,” the Cleveland Clinic says. “Dozens of clinical trials since EMDR’s development show this technique is effective and can help a person faster than many other methods. . . . It’s an option for people of all ages that can make a big difference for people struggling with painful events in their past.”
Citing one study of the technique as used with patients beset by post traumatic stress disorder (PTSD), the National Institutes of Health concluded that “EMDR therapy should be available for adults who present with PTSD and co-morbid symptoms including depression and anxiety. As the global burden of psychological trauma continues unabated, the need for more research and investigation into treatment interventions that are both effective and efficient is essential. It is clear from extensive, robust evidence that EMDR therapy is an effective treatment.”
Commenting on a different study, Cambridge University Health said it’s been proven that EMDR is effective in people with intellectual impairment. Cambridge went on to note that “older people are often faced with loss, death of a spouse, friends, or relatives, [and] a new trauma can reactivate old traumatic experiences.” Based on study findings, Cambridge called EMDR “highly effective in the elderly.”
Forbes Health in 2023 said there is “significant research finding EMDR to be beneficial for people with anxiety disorders, panic disorder, depression, addiction and eating disorders.”
How does EMDR work?
If you and a therapist, after consultation, believe EMDR might be a good fit, the two of you would work through what are called “phases.” These occur over a series of one-on-one sessions. For a single disturbing event or memory to be dealt with, it usually takes between three and six sessions. More complex or longer-term traumas may take eight to 12 sessions (or sometimes more). Sessions usually last between 60 and 90 minutes. The goals in the initial phases are to learn about disturbing events and memories that you want your therapy to focus on, and what you want your therapy to achieve. You’ll describe both negative beliefs about how the trauma has affected you as well as positive beliefs that you want to have about yourself going forward.
Ensuing phases will involve activating your memory by helping you identify one or more specific negative images, thoughts, or feelings and helping you notice any new thoughts or insight you have about what you’re experiencing. You will focus on the positive belief you want to build as you reprocess a memory. You will also pay attention to physical symptoms you feel when you think about the negative memory. If EMDR is working for you through these phases, your negative symptoms should decrease until you don’t have any (or as close to none as possible). Once your symptoms are gone, your reprocessing is complete. At that point your therapist will discuss how to stabilize yourself, especially if you might have had negative thoughts or feelings during the time between sessions. The overriding aim is to make you feel calmer on a continuing basis.
The final phase of EMDR therapy involves your therapist going over your progress and assessing how you’re doing. This can help determine if you need additional sessions or how to adjust your goals and expectations. They’ll also help you explore what you might experience in the future and how you would like to handle things at that time, knowing what you’ve learned about yourself and your past trauma.
What is unique to an EMDR session?
Unlike a number of therapies that involve one-on-one conversing and consultative advice, EMDR adds a stimulation component. As mentioned, during an EMDR therapy session, your therapist will ask you to briefly focus on a trauma memory. Then, they will typically instruct you to perform side-to-side eye movements while thinking of the memory. In the early years of EMDR, therapists would hold up a hand with two fingers extended and have you follow the tip of their finger from side to side with your eyes only. (This eye movement has been described as comparable to the back-and-forth movement of a car’s windshield wipers.) Later methods may use specialized light devices — a moving light that you follow with your eyes in place of your therapist’s hand. Other devices might use sound, where speakers on either side of your body play tones. Therapists might also use your sense of touch (if you’re comfortable with this), tapping on your hands or arms to activate your sense of touch on both sides of your body, or holding a device that pulses in your hands.
EMDR targets how the brain functions and stores memories
The dual side-to-side movement just described is said to engage both sides of your brain and is termed “bilateral stimulation.” One theory behind how EMDR works is that it helps the two sides of the brain to communicate with one another — the left side, which specializes in logic and reason, and the right side, which specializes in emotion.
Also according to this theory, EMDR works through competition between where the brain stores information on sight and sound and where it processes working memory. According to the EMDR International Association (EMDRIA), the bilateral stimulation in this therapy reduces emotions associated with trauma memories by relying on what’s called the Adaptive Information Processing (AIP) model, a theory about how brains store memories. This theory holds that your brain stores normal and traumatic memories differently.
A basic tenet of the theory is that during normal events, your brain stores memories smoothly and also networks them so they connect to other things you remember. But during disturbing or upsetting events, that networking doesn’t happen correctly. The brain can go “offline,” and there’s a disconnect between what you experience (feel, hear, see, smell) and what your brain stores in memory. Recalling a memory at the same time your eyes are moving back and forth forces your brain to split its resources. You can’t dedicate all of your focus to memory recall because you’re also focusing on visual or tactile stimulation. This split-focus can make any disturbing images you recall less vivid, and you may feel comfortably distanced from them. In this way, you might feel the emotional impact of the memories less strongly.
Relaxation in place of shock
The bilateral brain stimulation can help you feel more relaxed. As the memories grow less and less vivid, your brain might start to associate the memory recall with relaxation rather than emotional shock, which results in desensitization. Some researchers have found that performing eye movements in EMDR can actually lead to physiological changes in your body, such as a lowered heart rate and slower breathing, which are markers of relaxation. Researchers say this suggests that something about bilateral eye movements can alter how your nervous system is responding, allowing you to move away from the anxiety of what’s called the fight-flight-or-freeze response and better regulate your nervous system.
“Healing” the brain
EMDRIA contends our brains often store trauma memories in ways that don’t allow for healthy healing. As the Association puts it, “Trauma is like a wound that your brain hasn’t been allowed to heal. Because it didn’t have the chance to heal, your brain didn’t receive the message that the danger is over.” One result is that sights, sounds and smells that have a connection or similarity to a trauma event will “trigger” those improperly stored memories and cause feelings of fear, anxiety, anger or panic to surface again. A negative experience can be reinforced over and over. This can happen not only with events you can remember, but also with suppressed memories.
EMDR therapy theoretically allows the brain to resume its natural healing process. When you undergo EMDR, you access memories of a trauma event in very specific ways. Combined with eye movements (or other stimulus) and guided instructions, accessing those memories helps you reprocess what you remember from the negative event. That reprocessing helps “repair” the mental injury from that memory. Remembering what happened to you will no longer feel like reliving it, and the related feelings will be much more manageable.
What conditions can EMDR treat?
According to the Cleveland Clinic, mental healthcare providers use EMDR to treat conditions including anxiety disorders, phobias, depression symptoms, dissociative disorders, eating disorders, obsessive-compulsive disorder, sleep disturbance, substance abuse, and, of course, trauma disorders, with PTSD being a common target for EMDR therapy. In fact, the Department of Veterans Affairs and Department of Defense list EMDR as a “best practice” in treating veterans experiencing PTSD.
Advantages and disadvantages of EMDR
Those who have used or studied EMDR say that not only is it effective for certain patients but it also works faster than other forms of therapy. It does not require talking in detail about the distressing issue. So for most patients it is less stressful than counseling that requires actually “reliving” a trauma.
A typical therapy session lasts from 60 to 90 minutes. It does not require the homework other forms of therapy typically involve (e.g., journaling) outside of therapy sessions. EMDR usually involves only writing down any thoughts or ideas you want to bring up at a subsequent session, if you have any. EMDR therapy may be used within a standard talking therapy, as an adjunctive therapy with a separate therapist, or as a treatment all by itself.
But EMDR is not for everyone. It generally works only with conditions related to traumatic experiences and emotions that flow from them. If you have a mental health issue because of an inherited condition, an injury or other physical effect on your brain, EMDR is unlikely to help. But bear in mind that a trauma in some cases could be something that has reactivated from your past, even a memory you may have suppressed without realizing it.
It’s also true that while many studies have been done with EMDR, why it works is still quite theoretical. Experts can’t fully explain it. Other forms of therapy have been in use for much longer. More research is necessary before experts know if EMDR is a long-term solution or if people might need additional therapy later. To date, EMDR has been seen to have very low risk. Patients who go through EMDR are simply encouraged to discuss with their therapist any concerns that might arise, such as negative feelings between therapy sessions or troubling memories that are affecting their life.
What about costs for EMDR? And how are they paid?
The rates for EMDR without insurance can often be more than standard psychotherapy because it requires the clinician to have substantial, specialized training. The pricing can also vary depending on the session length, the location, and other factors. Online sources say uninsured patients should plan on spending between $100 and $250 for each hour or each session of EMDR therapy. Rates could be higher in some instances.
According to Athena Care, original Medicare (Medicare Parts A and B) covers EMDR therapy “if your therapy is deemed medically essential.” Medicare coverage requires a referral from your health care practitioner. American Addiction Centers (AAC) agrees but adds that to be eligible for Medicare coverage, the therapy must be performed by a behavioral health provider specifically licensed and certified in EMDR therapy.
AAC says Medicaid, the federal insurance program that provides coverage for lower income families and individuals, covers EMDR “because Medicaid covers any therapy with a trained and licensed therapist that is evidence-based, clinically rigorous, and appropriate for the diagnosis.” Also as noted earlier in this article, the Department of Veterans Affairs lists EMDR as a “best practice” in treating veterans experiencing PTSD.
With regard to any of these government insurance programs — and also with any private insurance — you should confirm ahead of time whether your individual circumstances make you eligible for paid EMDR therapy.
Where Coloradans can find EMDR therapists
Therapists trained in EMDR can be found throughout Colorado. Two sources that offer directories of therapists by location are:
EMDR International Association at https://www.emdria.org/. Click on the “Find a Therapist” box.
Psychology Today provides a Colorado roster of EMDR therapists at https://www.psychologytoday.com/us/therapists/colorado?category=emdr.