Things that wire together fire together
Trauma is an adaptive response distinguished by emotional volatility, anxiety, hyperarousal, and pervasive fear. The evolutionary purpose of trauma is to prevent people from re-experiencing these dangerous situations in the future, a very helpful response when learning to avoid lions on the savannah. But when taken out of a useful context it can leave people in this state of hyperarousal, always victim to a useless vigilance.
PTSD is a disorder of both association and generalization, where stimuli such as sounds, smells, somatic sensations, images, thoughts, and emotions related to the traumatic event are wired together through neural networks. A trigger of one of these associated senses or perceptions can create an automatic and overwhelming fight-or-flight emotional response, long after the original trauma has passed. This can be an everyday torture for people who can’t avoid their triggers.
Historically people have treated PTSD with talk and exposure therapy directed at these associations. The premise of talk therapy is that by repeatedly talking about the trauma you can externalize and defuse it to a certain extent: you can explore feelings, notice patterns, develop an ability to sit with the discomfort, to differentiate the present from the past, and you can receive validation for your reaction to the experience thereby normalizing it.
Exposure therapy is still lauded today as one of the best ways to work with PTSD. With exposure therapy you expose the client in various ways to the traumatic stimuli in a safe and controlled environment. You do the exposure so slowly that the client never reaches a panic state, and then you maintain that level of exposure until the client becomes acclimated, and the body and mind relax. You gradually escalate the degree of exposure over time until the fear is gone. Both of these methods have been proven to work well, over time. The problem I have with both of them is that when used independently the process can take a LONG time, years even. And the process can be so grueling, that it can be difficult for clients to maintain the level of motivation necessary to endure it over that amount of time.
EMDR is in many ways an expedited exposure therapy, where the exposure takes place in your mind through the use of your memories and imagination. I wish that I could explain to you exactly how it works, but the truth is that in spite of the many studies done on EMDR, no one has quite figured it out yet.
There are various theories that involve activating the parasympathetic nervous system (the calming one), to defuse a sympathetic nervous system response (the anxious one). This seems plausible because we know that you can’t stimulate both systems at the same time, if you’re having an anxious response but then are being soothed that’s a very natural way of emotional healing. The bilateral stimulation can be seen as similar to the rocking that one might receive as a baby, rocking being such an intrinsic rhythm that neglected infants still learn to self-soothe that way. Another theory is that bilateral stimulation, and the resultant eye movements mimic the eye movements of REM sleep. This sounds reasonable because it is well known that REM sleep is necessary for some kinds of long-term memory processing.
What is clear is that when someone is experiencing a trauma, the brain doesn’t process that memory the same way it would a neutral memory. Do you remember what you had for lunch exactly one month ago? Unless you ate somewhere special, the likelihood is that you don’t. Traumatic memories don’t fade the way neutral ones do. Someone with PTSD can have perfect recall, as if the trauma is happening right now. All those associations connected by that neural network are stimulated together, and the strong emotion is as real today as it was in the moment of the original trauma. Memories like this can have a profound and destructive effect on a person’s life.
EMDR is an exposure therapy in that you light up that same neural network. This part can be difficult for the client, although there are distancing techniques and other safeties that should be put in place to regulate the difficulty. It is not like traditional exposure therapy in that it’s possible to process the trauma very quickly. It’s not a magic pill, and the efficacy is related to other aspects of therapy like trust between the client and therapist, or readiness of the client to tap into the pain, or even the degree to which the client has a cognitive understanding of the trauma. I have seen traumas resolved in seconds (literally), but I’ve also seen it take months of difficult processing to find the right link to the neural network (and then it resolved quickly). More often than not processing tends to go pretty quickly, which is why I'm such an advocate for EMDR.
To be continued...