EMDR Treatment. What is it and How Does it Work – Podcast

Asian professional female psychologist speaking with client
By LifeStance Health on December 1, 2020

Dwight Thompson (00:00):
Hi. Welcome to Reset Your Mindset by LifeStance Health. Myself, Dwight Thompson, and my cohost Nicolette Lianza will bring you conversations with leading LifeStance Health professionals who will help guide you on your journey to positive mental health and wellbeing. At LifeStance, we believe in the three pillars of mental health. Mental flexibility, mindfulness, and resilience.
Dwight Thompson (00:35):
Welcome back everyone to another episode of reset your mindset by LifeStance Health. Myself, Dwight Thompson is joined by my cohost Nikki Lianza and we are really excited to have a returning guest in Dr. Carol O’Connell, who’s one of our clinicians here and Carol, we sincerely appreciate you joining us again and we got such great feedback when you were initially on from the topic we had covered. And I think that it’ll be just the same with what we’re going to be talking about today.
Dwight Thompson (01:03):
So for those who maybe don’t know you or didn’t hear you the first time you made an appearance with us, would you mind just kind of telling us a little bit about yourself?
Carol O’Connell (01:11):
Sure. Well, thank you for having me again. My name is Carol O’Connell. I’m a licensed clinical psychologist and I think I’ve been in this field for over 25 years. Doesn’t seem possible. So I’ve done a lot of different work clinically. I’ve worked in inpatient units and I’ve worked on outpatient and done programs and worked with adolescents and adults. So kind of have the gamut.
Carol O’Connell (01:33):
So I do a lot of work with people with anxiety and depression, but I also have a specialty in trauma and that’s where the EMDR of course fits in.
Dwight Thompson (01:40):
Yeah. Thank you for telling us a little bit about that. And you brought us right into it. We’re going to have a conversation today centered around trauma and centered around treatment modalities for trauma. And I think that we really couldn’t have picked anyone better. So Nikki I’ll certainly I’ll defer to you to go ahead and kick it off with a question.
Nicolette Lianza (01:59):
Yeah, I think my first question is EMDR. What does it even stand for?
Carol O’Connell (02:05):
Well, it’s a mouthful, which you can see why we quickly call it EMDR. It stands for eye movement desensitization and reprocessing. So again, that’s a mouthful. So we all call it EMDR.
Dwight Thompson (02:17):
And before we get a little bit deeper into EMDR, I know that this is just to keep kind of just the centerpiece going of talking about treatments for trauma and kind of the different approaches for that. Can you talk about a little bit about kind of what trauma looks like to you in a session and in a client of yours and kind of what it looks like and then where you go from there?
Carol O’Connell (02:41):
Sure. That could be a whole podcast in and of itself but in a nutshell, people who’ve experienced trauma do have common symptoms no matter what the trauma is. Some of them are about reliving the trauma. So we have people who have flashbacks and nightmares and just thoughts about it.
Carol O’Connell (02:59):
Some of whom kind of avoid the trauma. They either don’t literally don’t remember it or they don’t feel it or they just kind of push it in the back. So you have these kinds of extreme responses to really reliving it or pushing it away. And of course, again, we could go on and on, but trauma also impacts how the person sees themselves in the world, how they relate to others in the world and just how they see sort of their world in general. So there’s a lot of different impacts in how trauma can impact a person.
Nicolette Lianza (03:29):
And so EMDR is one avenue a person can go and seek out to help them navigate this trauma.
Carol O’Connell (03:36):
Yes. Yeah. Exactly. For sure.
Dwight Thompson (03:39):
So Carol, if you don’t mind, can you tell us a little bit about what EMDR is? You obviously gave us the [inaudible 00:03:48] down from an acronym perspective, but what is it? And in general, how does it work?
Carol O’Connell (03:52):
Sure. So EMDR is a treatment to help process trauma. To order to understand that, let me talk just a little bit about how trauma, how we think trauma is stored. So, you go to a grocery store, you go out to dinner with your friend or whatever, you kind of file that away. You remember bits and pieces of it, but it kind of gets filed away. Well, what we’re learning about trauma is that it gets frozen.
Carol O’Connell (04:17):
It doesn’t really get filed away. And so it often gets frozen with high emotion. It often gets frozen without much language. The scared speechless. It doesn’t always get frozen in a nice linear story. It’s kind of fragmented. And so it can pop up in all kinds of ways. Nightmares, flashbacks, just intense feelings. And so what seems to help with EMDR is that we take that frozen memory and we process it. We add a cognitive, a thought understanding of it if you will, to this highly emotional and blending those two together that allows people to kind of file it away. Not forget about it, but file it away. So it doesn’t have that emotional disturbance that it has. That’s kind of in a nutshell.
Nicolette Lianza (05:05):
Oh, that’s a great, really great explanation of it. I think that definitely describes the reprocessing of it. Where does the eye movement part come in?
Carol O’Connell (05:14):
Yeah. So I’ll tell you a little bit about the history of it because it’s kind of an interesting story. It’s kind of like how we discovered penicillin off off a moldy orange. Sometimes science, you just discover things. And Francine Shapiro who’s a brilliant psychologist. Who was. Sadly, she died a few years ago was literally walking in the park, thinking of her own traumatic memory. I think it was a medical trauma. And she realized that the memory wasn’t nearly as traumatizing.
Carol O’Connell (05:38):
It just wasn’t as disturbing. It just wasn’t as powerful. And she said, “I don’t know why.” And she literally went back and retraced her steps. Most of us could not do this. But she retraced her steps and figured out she had moving her eyes back and forth rapidly while she was thinking of this memory, so she did it again with a different memory. Same thing happened, not quite as traumatizing.
Carol O’Connell (06:00):
So she kind of sucked in her friends to do it. So they had a hard time doing it on their own. So she took her fingers and kind of went from side to side in front of their eyes and they had the same reaction. And she being a hardcore researcher said, “I could be on to something or I might not be, but let’s do some hardcore research.” So she developed a whole protocol and she published her first study in 1987.
Carol O’Connell (06:26):
And so it’s hard to know what actually happens. And she would literally say she may not know in her lifetime, the physiological mechanism and that’s actually true, but that doesn’t mean you can’t study it. You can’t sort of have your control group and study it. So there’s different theories about it. Is it like rapid eye movement sleep?
Carol O’Connell (06:48):
That’s sort of one theory. Is there something about if you occupy one part of your brain with eye movement, you can process it with the back. So it’s still unclear at what it does. I will tell you during that time, I don’t do much else except watch the person. And just one other thing. We don’t necessarily have to use eye movements. What we also, where she also discovered is that you can basically do alternating sensory experiences.
Carol O’Connell (07:18):
We call it bilateral stimulation. There’s a lot of lingo in our field. So you can do alternating tones or now a lot of people have these buzzers that they buzz. I’ve been doing it via tele-health, which I never thought I’d be able to do, but [inaudible 00:07:33] breeds necessity and people actually alternate tappings. They just take their hands and just alternate tapping. And I was like, “That’s never going to work.” And it totally works. So yeah.
Dwight Thompson (07:47):
Well, if there’s a silver lining in 2020, it’s taught us that there’s a lot of things that you are going to have to experiment with. Some might work, so might not.
Carol O’Connell (07:54):
Right. Exactly.
Dwight Thompson (08:00):
It’s fascinating in so many ways. And I think that you will, and not to be cynical, but I think just to be candid, there are going to be people that hear EMDR, kind of hear it described and will think, “That sounds a little sketchy,” I guess for lack of a better word and don’t understand kind of the background on it.
Dwight Thompson (08:23):
And like you said, you kind of gave us some of it. How do you translate it to someone like that who has some apprehensiveness about beginning this or even trying it? Kind of what do those conversations look like? Because I have to imagine they arise.
Carol O’Connell (08:37):
They do, but not as frequently as what you think. I’m always sort of amazed. This sounds really strange and people are going to do it. So it’s to be honest with you about relationships. So every once in a while, I’ll talk about in the first session with someone, because it is getting more out there in the sort of culture I think. I think Grey’s anatomy actually has someone go through EMDR. So I would say most people kind of are willing to try it, probably because they’re in a fair amount of pain and sort of it’s worth trying anything.
Carol O’Connell (09:07):
But I do point out some of the research. So this has been around [inaudible 00:09:11] would say 27 years now, 28 years now. And it really could have been sort of this weird blip and we never heard about it again, but led [crosstalk 00:09:21] yeah well, led by Francine Shapiro. She insisted on people doing a large amount of research.
Carol O’Connell (09:25):
So the good news is there’s a really good body of research. And the good news for the average person is that they don’t have to read all the studies. And so there are organizations like American Psychiatric Association and The World Health Organization, the VA system and they look at all the studies and they actually do a study about the studies called meta analysis on the studies.
Carol O’Connell (09:50):
And they take studies about treatments and they put them in tiers. And so these organizations have done that and really say EMDR is in the top tier treatment for PTSD. So I talk about that too. Some people don’t care about that. Other people really love it.
Nicolette Lianza (10:09):
But it’s important though. It’s important to know that it is a evidence-based technique.
Carol O’Connell (10:13):
Yeah. It’s not experimental.
Nicolette Lianza (10:15):
Which is really important for people to recognize. Are there other disorders besides PTSD that it could be helpful with?
Carol O’Connell (10:21):
Well, it was really interesting as we started to do EMDR. I got trained in 1996. [inaudible 00:10:26] a long time when it was a little bit of the rogue days and I was sort of like, “Let’s try stuff.” So I’m glad we sort of honed in on it. So definitely phobias are really well treated by EMDR. We think of trauma, what we call big T traumas or the big traumas. Combat and abuse and car accident, but there’s a lot of little traumas that people go through.
Carol O’Connell (10:51):
There’s a lot of less intense. I had a client who had a learning disability that wasn’t diagnosed when he was a little kid. So therefore he was always told he was stupid or lazy. And then they finally found learning disability. Well, that was a trauma when he was an eight year old kid. So is it a big T trauma, like going through combat? No, but to an eight year old, it’s huge. So we really broaden the definition of trauma. It really can be anything that’s not processed that’s really disturbing.
Carol O’Connell (11:21):
So that really has shifted I think and sort of broadening it. And again, some very specific protocols for things like phobia. Some people are using it to help with pain management. Some people are using it to help with addiction. So there’s a wide variety of applications.
Nicolette Lianza (11:44):
Dr. O’Connell, can you walk us through a session and what it looks like?
Carol O’Connell (11:46):
Absolutely. So have the person come in and you have them think of an image that best sort represents the trauma that that they’re thinking about. And so they come up with an image, you ask a few more questions about rating how disturbing is that. Where they feel it in their body and what kind of emotions come up. And one of the most important things that you ask them is what is a thought?
Carol O’Connell (12:08):
Because people, when they go through a trauma, they often had a negative thought, believe it or not about themselves. It could be, I wasn’t good enough or it was my fault. Sometimes they have a negative thought about the world. The world is unsafe and it’s a way that people manage understanding trauma, especially if it’s with little kids. When your child abuse, but it actually can happen with adults too.
Carol O’Connell (12:31):
So have them label that thought and then you have them lightly hold all this in their mind. And then basically you tell them just to let their mind go where they need to go. So for some people, that’s the hardest part. They keep saying, “Oh, I’m not trying hard enough.” And this is one place where you literally don’t have to try. You just let it go.
Carol O’Connell (12:48):
And what ends up happening, people get into it pretty quickly. It’s almost like they kind of drift from thought to thought or image to image. The emotions do get more intense during it. It’s kind of like they get more intense during it before they end up getting less intense. And so-
Nicolette Lianza (13:03):
Do you have to warn your clients about that [crosstalk 00:13:07] just to kind of give them a heads up on that?
Carol O’Connell (13:09):
Yeah. You give them a heads up on that. You also give them the heads up on you’re not quite sure where it’s going to go. So you can’t guarantee where it’s going to go. We can stop it at any time. I always tell people, “The ball is in your cart. This is a very client centered treatment. If you want to stop at any time we stop.’ I just hold my little gadget to turn it on and off so they don’t think about it, but it really, really, really is in their hands.
Carol O’Connell (13:29):
So people kind of go through it. Some of their images changes, the emotions. I never say this is what’s going to happen because everybody’s EMDR experience is slightly different. And so you don’t want to predict that. Oftentimes I don’t think I’d never had one session completed it. So oftentimes sessions are what we call incomplete.
Carol O’Connell (13:46):
So I always end my session a little bit early. We do a relaxation exercise, which people really appreciate. Encourage them to make sure that they’re just going home and doing a good self-care because people often feel very tired. I say it’s like running an emotional marathon. So don’t have a big speech planned that night or a test that you’re going to do. Just relax and do tons of self care. And then when we come in, there’s some thought that the processing continues even after the session so that when you come in the next session, you may be at a really different spot. So that’s what a session looks like.
Dwight Thompson (14:20):
Thank you. And so, this is not only insightful, but I appreciate you kind of giving us a peek behind the curtain of what it looks like for folks that maybe have heard of it. You’d be surprised often you hear people talk about it and just really don’t know what it is. So I think maybe breaking down some of those misnomers and letting people know how it works is really helpful because we know how heavy trauma is and how hard it is to kind of navigate.
Nicolette Lianza (14:53):
Dr. O’Connell, how many sessions can someone expect [inaudible 00:14:55]?
Carol O’Connell (14:55):
It’s such a wide variety. If someone has a trauma that they’ve experienced as an adult, like a car accident that could take two. Maybe one to three, I would say. If someone has sort of extensive history in their childhood, obviously that’s going to take more over a significant period of time. And you’re also going to do other things besides EMDR. You’re not just going to do EMDR. There’s coping skills to develop and helping people with relationships and all kinds of things. So I would say, again, it’s sort of hard to … Depends on the level of trauma.
Nicolette Lianza (15:27):
Got you. Can you tell us a little bit more about the cognitive restructuring part?
Carol O’Connell (15:30):
Yeah. So as I said, people do have thoughts that come with them when they have a traumatic experience. And this is actually my favorite part about EMDR is an addition to sort of decreasing nightmares and flashbacks and just people not feeling as gripped by the trauma of it, their thoughts just change.
Carol O’Connell (15:48):
So for example, I had a client whose stepfather physically abused her and in the middle of EMDR and she blamed herself, which is really, really common. Her adult mind didn’t blame herself, but her child mind did. And so I literally remember in the middle of the EMDR, she just completely … She goes, “Oh, it’s not my fault. It’s his. He did this.”
Carol O’Connell (16:08):
And it was the cognition shift from the top of her head down to her toes in every cell of her being. Whereas we try to sort of help people understand that in cognitive therapy with EMDR just shifts. And it’s so powerful when that happens.
Nicolette Lianza (16:27):
Dr. O’Connell, thank you so much for sharing all this information for us. I think you did an amazing job reaching those people who maybe didn’t know anything about EMDR and maybe now they can understand how this could be something helpful in their own life. So thank you so much for sharing this information with us. I think it’s going to be very helpful.
Carol O’Connell (16:43):
Well, thank you for giving me this opportunity. It’s such a very powerful and amazingly helpful treatment. So to be able to share that with anybody is just always so heartwarming for me. So thank you so much.
Dwight Thompson (16:56):
We can sense your passion and we sincerely appreciate you joining.