Finding our inner strength: Trauma and EMDR

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By Dr. Claudia Carrara, Ph.D., Psychologist, EMDR Certified therapist

Except for Carl, who keeps looking around the classroom with a big smile on his face (he seems to have grown 5cm taller in the last couple of minutes), all other kids are barely breathing. Let alone moving on their small chairs. The only sound in the frozen air comes from the window where a fly frantically hits the glass – THUD. THUD. THUD. Even the small creature seems to panic in its attempt to escape the room.

In the dead silence, Mrs. Carlyle´s eyes are still perusing her computer screen. After having read a few sentences that highlighted the beauty of Carl´s “exceptional essay”, she is about to pronounce the name of the kid whose work is the farthest from all reasonable expectations: The worst essay that will show us what we absolutely should NOT have done in our assignment. The fly is not giving up – THUD. THUD. THUD.

“Here it is! Albert, can you please stand up?” As I slowly raise from my chair, the walls of the room seems to tighten around my chest, I cannot hear a word of what Mrs Carlyle is saying even though I can see her lips moving, my heart is pounding, my hands are sweating, my shoulders are shrinking, and I can feel my face burning. And as I hear the other kids giggling, all I can think of is “I am a failure, I am ridiculous and pathetic. Everything about me is wrong, and everyone can see this”. THUD. THUD. THUD.

Many years have now passed since that terrible day in the classroom. I am the CEO of a large company, and I am well aware of my professional competence. And yet. Every time I have to stand up in front of the stakeholders of my company, my face turns red, my hands begin to sweat and, as people turn to look at me, my usually deep and well modulated voice turns into an embarassing squeak, and my thoroughly prepared speech vanishes from my mind. All I can think is “I am ridiculous and pathetic, …. And everyone is going to see this”. Besides the heavy beats of my heart pounding its way out of my chest, in those moments another sound always fills my head and drags me deeper into my panic attack. THUD. THUD. THUD….. Like a fly hitting a window. 

What is trauma?

A trauma is an intense emotional response to an event, or to a series of events, that have had a profound impact on our psychological and emotional wellbeing. The death of a dear one, a car accident, adverse childhood experiences, being the victim of violence or bullied at school (or humiliated in front of the classroom!) are all life situations that can lead to trauma.

However, whether the experience leads to trauma does not depend directly on the severity of the event, rather on the subjective perception of the circumstances and on the meaning the victim assigns to it. For these reasons, trauma cannot be objectively evaluated based on “what happened to me”, rather based on “how I felt when it happened to me”.

Clinically, there is however a distinction between simple and complex trauma: While the former addresses one specific event (e.g. a car crash or an assault), the latter refers to multiple episodes that can take place over a longer period of time (e.g. child neglect or ongoing violence like war or domestic abuse). However, the severity of the impact of both types of traumas is always subjective to the individual experiencing the events.

What happens in our brain when we experience trauma?

Trauma can determine long-lasting changes in the brain, particularly in the amygdala (organ involved in processing emotions), in the hippocampus (organ involved in memory processing), and in the medial prefrontal cortex (structure involved in encoding the associations between context, locations, events, and our corresponding responses, particularly emotional responses1).

Trauma is also associated with increased levels of stress hormones in our brain (especially cortisol and catecholamines) which act as “neural glue” by strengthenting the neural connections tying together the given events and our responses. Since the overall role of our brain is to protect our physical, psychological and emotional wellbeing, it is of utmost importance for us to learn which situations we need to avoid at all costs in order to survive, and also which responses can increase the likelihood of our survival. Events that we perceive as threatening, and our relative emotional response, will therefore be rapidly and effectively encoded in our brain, so that we can promptly retrieve them when the same emergency occurs.

How is trauma stored in our brain?

A traumatic memory is a composite mental picture embracing the constellation of sensory input that reached our brain at the time of the event. In Albert´s case, any individual aspect of that terrible day – thanks also to the strengthening effect operated by the increase in his stress hormones – is strongly linked to all others (this is called associative learning).

Concretely, this means that a specific sound (e.g. a fly hitting the glass) or visual detail (e.g. standing up and feeling the eyes of people on him), when detected today are able to trigger the overall perception of threat experienced by Albert that day in the classroom. In sum, although when he is standing in front of the stakeholders he knows that he is safe and has nothing to fear, the detection of the trauma-stored details unconsciously triggers the memory of that day in the classroom, and will make him feel the presence of an immediate danger, and react accordingly.

Well, but since he knows that he has nothing to worry about, why does he still experience the full blow of the fear response? The reason is that the intense emotion evoked by the perceived threat determines his brain’s temporary inability to distinguish the difference between the traumatic memory and the present context2.

How is trauma treated?

The focus of therapy in the treatment of trauma is to remove the association between the traumatic events we experienced in the past and the emotional response we re-enact in the present. We can say that the aim is to defuse our internal emotional bomb before this explodes into a maladaptive behavior (e.g. panic, fear, depression, aggressivity, etc).

A number of therapeutical approaches can be applied to tackle the consequences of trauma (e.g. cognitive behavioral therapy, narrative therapy and exposure therapy). However, in recent years a growing number of studies3,4,5 has suggested that EMDR (Eye Movements Desensitization and Reprocessing) is a more effective treatment for trauma compared to other types of therapies.

EMDR and the brain

Humans have an innate information processing system that merges new experiences into existing memory networks and stores them in an adaptive manner. Thanks to this mechanism, we learn how to handle different situations so to achieve the best results and/or to avoid negative outcomes.

Unresolved trauma emerges when new information is inadequately processed and then stored in a maladaptive manner in the memory networks, along with associated distorted thoughts, sensations and emotions. EMDR aims at 1) dissolve the link between the sensory stimuli detected at the time of trauma and the emotional response experienced during the event, and 2) enhance  the activity in brain structures involved in emotional regulation6 .

During an EMDR session, the individual is asked to focus on specific details of the traumatic event meanwhile the therapist´s hand movements induce lateral eye movements. The bilateral brain stimulation enables the individual to perceive the memory with more detachment, to feel the emotions less intensely, to reduce the negative physical sensations, and ultimately, to change the negative beliefs about themselves.

In re-experiencing the classroom event during the EMDR session, Albert will therefore be able to form new connections between the traumatic event and other memories, thoughts, and information stored in his brain7. By acquiring a broader perspective on the classroom event, he will feel the emotional pain of the little boy, but he will also be able to see the event in its larger meaning. The negative belief “I am a failure” will then probably turn into “I was just a little boy!” as he acknowledges the unfairness of the situation.  The belief “I am ridiculous and pathetic, and the other kids are laughing at me” will merge with the memories of the fun times spent with his classmates, and he might recall that he had indeed many great friends among them.

Albert might then realize that “They were not laughing at me …. I guess they were probably just expressing their relief for having been spared”. Finally, the negative emotion “I feel ashamed” will turn into a caring “I feel sorry for him”, as Albert-the-adult might experience the urge to protect Albert-the-boy against Mrs. Carlyle very arguable pedagogical skills.

Albert has not forgotten that day in the classroom and, as he walks with long and steady strides into the spacious meeting room, followed by the attentive eyes of the stakeholders summoned around the large table, a sound gets his attention and he suddenly stops. THUD. THUD. THUD. While Albert´s right hand reaches for the presentation´s clicker, his left one grabs the handle and opens the window. Poor fly, it was about time someone set the little creature free.

References

  1. Euston DR, Gruber AJ, McNaughton BL. The role of medial prefrontal cortex in memory and decision making. Neuron. 2012 Dec 20;76(6):1057-70. doi: 10.1016/j.neuron.2012.12.002. PMID: 23259943; PMCID: PMC3562704.
  2. Keefe, J.R.,  SuarezJimenez, B.,  Zhu, X.,  Lazarov, A.,  Durosky, A.,  Such, S.,  Marohasy, C.,  Lissek, S., &  Neria, Y. (2022).  Elucidating behavioral and functional connectivity markers of aberrant threat discrimination in PTSD. Depression and Anxiety,  39,  891–901. https://doi.org/10.1002/da.23295
  3. Vereecken S, Corso G. Revisiting Eye Movement Desensitization and Reprocessing Therapy for Post-traumatic Stress Disorder: A Systematic Review and Discussion of the American Psychological Association’s 2017 Recommendations. Cureus. 2024 Apr 22;16(4):e58767. doi: 10.7759/cureus.58767. PMID: 38779227; PMCID: PMC11111257.
  4. Chen L, Zhang G, Hu M, Liang X. Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: systematic review and meta-analysis. J Nerv Ment Dis. 2015 Jun;203(6):443-51. doi: 10.1097/NMD.0000000000000306. PMID: 25974059.
  5. Driessen HPA, Morsink S, Busschbach JJV, Hoogendijk WJG, Kranenburg LW. Eye Movement Desensitization and Reprocessing (EMDR) treatment in the medical setting: a systematic review. Eur J Psychotraumatol. 2024;15(1):2341577. doi: 10.1080/20008066.2024.2341577. Epub 2024 May 15. PMID: 38747113; PMCID: PMC11097707.
  6. Landin-Romero R, Moreno-Alcazar A, Pagani M, Amann BL. How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action. Front Psychol. 2018 Aug 13;9:1395. doi: 10.3389/fpsyg.2018.01395. PMID: 30166975; PMCID: PMC6106867.
  7. Ruvalcaba-Delgadillo Y, Martínez-Fernández DE, Luquin S, Moreno-Alcázar A, Redolar-Ripoll D, Jauregui-Huerta F, Fernández-Quezada D. Visual EMDR stimulation mitigates acute varied stress effects on morphology of hippocampal neurons in male Wistar rats. Front Psychiatry. 2024 May 13;15:1396550. doi: 10.3389/fpsyt.2024.1396550. PMID: 38803673; PMCID: PMC11129278.