Now Follow My Fingers... Wait, Do What?
In our previous posts, we’ve discussed what EMDR therapy is and what the 8 phases consist of -- but what will you actually do in a session that’s using bilateral or dual attention stimulation? Or, in other words, what is this whole “eye movement” thing all about? And I hear you! This sounds like a bunch of “Wooy-ness” and there's a lot of controversy over this in the field. BUT - it's in the science!
Bilateral stimulation, by itself, is simply using something you can see, hear or feel and crossing the body in a rhythmic pattern. Bilateral stimulation has been used for a very long time in different ways because it is found to be soothing to the body. Bilateral stimulation is all around you; if you look around, it can be anything that you see, hear or feel as long as it moves from side to side, crossing the body in a rhythmic pattern. Some common activities are walking, jogging, tapping on a drum with alternating hands (like bongo drums) or when people are listening to a song and they alternate tapping on their legs or tapping their fingers on the steering wheel.
In EMDR therapy, we started off using eye movements as bilateral stimulation when Francine Shapiro, Ph.D., stumbled upon the positive effects of this stimulation while she walked through a park in the 1980s. She had been feeling the negative effects of a distressing memory, but began to feel better after her eyes spontaneously blinked rapidly. She conducted research based on that experience and later discovered the link between her eye movements and bilateral stimulation – as well their ability to defuse a stress response.
Since Dr. Shapiro went on that walk that day, EMDR has evolved and EMDR clients will be asked to focus on their own distressing or desired experiences at the same time as they attend to a dual attention stimulus, or bilateral stimulation. You’ll find your therapist can provide no frills bilateral eye movement approach by simply asking you to follow their fingers, or they may use a light bar to have more options for speed control, appealing colors, consistency (and because enough EMDR in one day and their arms might fall off, LOL!). While eye movements are the most commonly used dual attention stimulus, tapping, tactile stimulation, and auditory tones are also used. These are usually presented in an alternating bilateral fashion, either in conjunction with eye movements or alone.
Studies have explored various theories about the effects of eye movements, and two dominant theories have emerged: that eye movements (1) interfere with working memory processes (van den Hout et al, 2011) and (2) link into the same processes that occur during R.E.M. sleep (Stickgold, 2002). In support of these theories, eye movements have been shown to decrease the emotionality and vividness of memories, create physiological relaxation responses, facilitate access to associative memories, and lead to an increase in recognition of information that is true.
According to the working memory theory, benefits occur when the limited capacity of the working memory is taxed by the simultaneous focus on the dual attention task (eye movements) and the negative memory. Because of the limited resources, the memory becomes less vivid, less complete, and less emotional. This theory is supported by numerous randomized studies that have all shown that lateral eye movements reduce the self-rated vividness or emotional effect of unpleasant autobiographical memories (for example, Barrowcliff et al., 2003, 2004; Engelhard et al., 2010. 2011; Kavanagh, Freese, Andrade and May, 2001; Maxfield, Melnyk and Hayman, 2008; Schubert et al., 2010; Van den Hout et al., 2001, 2011).
The second theory that eye movements link into the same processes that occur during R.E.M. sleep is supported by research demonstrating the effects of eye movements on physiological states and memory retrieval. Eye movements have been demonstrated to induce a state of relaxation, or decreased psychophysiological arousal, in nonrandomized (Elofsson et al., 2008; Sack et al., 2008) and randomized (Barrowcliff et al., 2004; Schubert et al., 2011) studies using physiological measures. One hypothesis is that this relaxation response is a reaction to changes in the environment, part of an orienting response that is elicited by the shifts of attention caused by the repeated bilateral stimulation, which links into processes similar to what occurs during R.E.M. sleep (Stickgold 2002, 2008). Further support for the R.E.M. theory is found in numerous randomized trials that indicate that bilateral saccadic eye movement enhances retrieval of episodic memory, increases recognition of true information and improves certain measures of attention (for example, Christman et al., 2003, 2006; Kuiken et al., 2002; 2010; Parker, Relph and Dagnall, 2008; Parker, Buckley and Dagnall, 2009; Parker and Dagnall, 2010)
Still, controversy remains regarding why EMDR works. It’s possible that both the working memory and R.E.M. theories are correct and that the mechanisms interact synergistically. We await the results of randomized controlled trials to further determine what role eye movements and other bilateral stimulation, or what makes the treatment outcome independent of the rest of EMDR procedures.
In this blog, we’ve covered what a dual stimulus EMDR session looks like and why eye movement is used and has shown to be beneficial. In the next blog, we’ll take a deeper dive into who can benefit from EMDR. You may be surprised that an approach developed largely to work with those suffering from PTSD has shown to be effective in various populations!