Garry A. Flint, Ph.D.
Eye movement Desensitization and Reprocessing (EMDR) is a treatment phenomena that has yet to be adequately explained. This is a procedure that usually obtains rapid cognitive and/or perceptual changes of remembered trauma. A chaos model of the process of the olfactory system was extrapolated to a theory for the whole brain process. The interesting results provided an explanation of EMDR and other treatment phenomena. The key elements of the theory are that experience changes behavior, small stimuli evoke massive responses and change takes place in active body experience. Case studies are presented that demonstrate the application of the theory.
Psychological literature traditionally defines learning in terms of behavior change, including acquisition of "new" behavior and extinction of "old" behavior. In this light, symptomatic behavior may be seen as learned. Traumatic symptoms can be learned quickly. If our physiology has the capacity to learn very quickly, perhaps the elimination of symptoms can similarly occur quickly. How might we accomplish quick change? Recent research in memory and perception has afforded a plausible explanation of learning and change in behavior that appears applicable to the EMDR process, a process that obtains rapid change.
The purpose of this paper is to describe the EMDR process and to review and account for the effectiveness of the procedure in terms of the findings from basic research in the area of olfactory perception. The result is a theoretical accounting of the locus of behavioral change and an identification of the parameters required for treatment change. Clinical examples will be used to support the theory. Three case studies using the theory in unique treatment interventions lends some credence to the validity and/or applicability of the theory.
A brief description of the EMDR process
The recently developed technique of Eye Movement Desensitization and Reprocessing (EMDR) appears capable of rapidly changing symptoms learned during a trauma (Shapiro, 1989). In the EMDR procedure, the patient is required to hold his/her attention on a traumatic picture or body feeling while watching the therapist's fingers move back- and- forth at eye level. One repetition of this finger- movement process consists of 20- 40 such oscillations. Repetitions of this process have been shown to eliminate the painful qualities associated with a traumatic picture or feeling quite rapidly.
Hypothetically, when a patient maintains attention on the memory of a painful traumatic experience, a unique pattern of neurological activity (a neural network) is activated in the brain. When, at the same time, the perceptual system is stimulated visually by attending to the finger- moving process, the additional neurological activity elicited in the brain gives rise to change in the neurological pattern of the traumatic memory. Usually, the change results in a perceived reduction of the painful affect formerly associated with the traumatic memory.
However, the change in the initial pattern of neurological activity sometimes evokes additional relevant or associated neurological activity and, thus, a more complete neurological representation of the traumatic event may be obtained. In the simplest case, the patient may initially experience an increase in the intensity of the affect associated with the traumatic picture. This change can continue until the intensity reaches its peak. Continued repetitions of the process, then, changes the neurological pattern of the traumatic picture, ultimately resulting in an reduction of the affective components of the picture. By this process, the neurological pattern of the traumatic memory is changed, initially to a more full representation of the trauma, followed by a more adaptive, less painful or painless representation. Note that the more full representation can include stimulation of other senses and/or other pictures, emotions, or beliefs associated with the trauma. This process has to do with learning and memory.
The Chaos Model and the Physiology of Perception
In a recent article summarizing 30 years of his research on the physiology of perception, Freeman presented data and a theoretical analysis that appear relevant to the EMDR process and to the observed rapid changes in memory and behavior (Freeman, 1991). In a study of perception, an explanation based on Chaos Theory (Crutchfield, Farmer, Packard, & Shaw, 1987) was offered that dealt with rapid acquisition and change. In this research, the phenomena of recognition was studied in the olfactory system. Freeman and his colleagues wanted to know what neural pathways and structures were involved in learning to recognize a smell. Initial research dealt with identifying the neural pathways that were activated by smell. Later research examined the parameters of the neural activity that were observed during the acquisition of the recognition of smell. This involved the study of the impact of sensory activation and/or experience on memory and the change of memory.
There are receptor neurons in the nasal passages that are specialized and respond to specific olfactory stimuli. Activated neurons carry information to the olfactory bulb. The olfactory bulb synthesizes the information and sends it, with some additional information, to the olfactory cortex. Neurons carry this information from the olfactory cortex to structures in the midbrain and other cortical areas. The firing of all these neurons generates an electrical field associated with the neurological activity. Recording from one site on the olfactory bulb or cortex and observing the electrical activity in the brain reveals a very complex representation of apparently random neurological activity which is observed to be in constant change. The electrical activity appears random even when the olfactory system is stimulated and, except for gross stimulation, the connection to learning and memory is obscure.
How is a scent represented in the olfactory bulb? To answer this question, Freeman implanted a square matrix of about 60 EEG electrodes on the olfactory bulb of rabbits. Each electrode recorded the sum of electrical activity of thousands of neurons located beneath the electrode. A rise in electrical potential indicated an overall neural excitation. A drop in electrical potential indicated an overall inhibition of activity The animals were conditioned to recognize a number of smells. The obtained EEG recordings were submitted to a computer analysis. The analysis showed the neural activity to be orderly while the animal inhaled and to return to random activity when the animal exhaled.
Freeman found that all of the neurons in the olfactory bulb are affected by the input of a relatively small number of neurons in the nose. The small input resulted in a strong, instantaneous response in the bulb involving many neurons. This massive bulbar response, representing a unique smell, yielded a synchronous pattern of response which was sent to the olfactory cortex. This synchronous representation was found to include other input from the bulb itself. Freeman concluded that a legitimate, synchronous response from the olfactory bulb is discriminated from background neural activity by the olfactory cortex. The response of the olfactory bulb evokes a massive, instantaneous response by the olfactory cortex, synchronized in a different form with less meaningless activity than the input. This response is then sent to other regions of the brain. Again, the synchronized output of the olfactory cortex, carrying information, sets it apart from random noise. This property, namely, small stimuli evoke massive responses, is a property of chaos models and is crucial in accounting for human behavior. Further analysis revealed properties relevant to memory, learning, and behavior change.
Using a computer, it was possible to analyze the data from the 60 electrodes to develop what looked like a topographical map consisting of concentric elevations. The rabbits were conditioned to respond to smells, e.g., banana and saw dust, for food reinforcement. With repeated conditioning trials with a particular smell, a unique topographical pattern of electric potentials was obtained. The highest pattern, the plateau or peak representing electrodes with a high electrical potential, was shown to be representative of the particular smell. When another smell is conditioned over a number of trials, a re- exposure to the original smell yielded a modified pattern for the smell. This showed that the stored or remembered neurological response of the bulbar structure to the first conditioned smell was affected by later experience as well as by current stimuli, viz., the first pattern was modified after some intervening experience. Freeman argues that since the obtained banana topography changes following conditioning a response to saw dust, the change of memory occurs following experience rather than by a process involving stimulus control. It will be demonstrated that these properties of the brain, viz., small stimuli evoke large responses and experience changes memory, is the basis for not only observed changes with the EMDR process, but all positive therapeutic interventions.
Chaos Theory, a recent development in mathematics and physics (Gleich, 1987), has accounted for many heretofore unexplainable random phenomena. The process observed in the olfactory system process appears to be an example of a nonrandom, self- organized, chaotic system. The olfactory system shows electrical activity during both bursts and quiet periods. Because this neural activity appears generated by the olfactory bulb without any stimulation, it is evidence for self- organization, a criteria for this chaotic system. Another criteria for a chaotic system is that massive responses can result from weak input. This non- random property of the brain was found in the olfactory system; a weak neural input from the nose to the olfactory bulb evoked a massive response which, in turn, evoked a massive response in the olfactory cortex.
Exploring this phenomenon, Freeman (1991) constructed a mathematical model based upon Chaos Theory and was able to replicate the EEG activity of the olfactory system with a computer model. Each topographical pattern was found to be unique to a specific smell. During inhalation, the olfactory system destabilizes which means that "basins" previously reinforced to respond to unique smells, became activated. When a smell is presented, the chaotic system, neural activity, is said to immediately "fall" to the "basin" associated with that particular smell. The "basin," a "neural network" formed after reinforcement or punishment, in the presence of a known smell, destabilizes the system giving rise to a massive system- wide response, a bifurcation. The computer generated patterns described above, the results of massive neural responses, are representative of "chaotic attractors" to which the chaotic system bifurcates, rapidly changes, when there is a stimulus present, viz., a stimulus that has been conditioned to have meaning. "Attractors" are established with reinforcement, punishment and repetition.
An "attractor" is an evoked massive neurological response which can evoke a hierarchy and/or series of attractors giving rise to behaviors that operate on the environment, internal or external. In more complex behavior, the massive response provides information that give rise to additional bifurcations in a hierarchy or series of attractors that are observed as evoked responses - sensory experience and motor responses. Behavior, therefore, is a hierarchy of self- organized, self- determined neural processes in a series of state transitions.
Motivation is a state in which environmental conditions, internal or external, destabilize the brain to evoke low level background activity of "neural networks," basins, that have been previously learned and are meaningful in that environmental condition. When a known stimulus is present, then a massive response is generated that sends information to all regions of the brain. This results in some activity or operation on the environment.
This notion of motivation can be expanded to explain the state dependent behaviors described by Bower (1993). After teaching paired associates in different mood states, while the patient was under hypnosis, recall of learnings in disparate mood states was observed to be poor (Bower 1993). His experiments demonstrated that state dependent learning and various degrees of "amnesic barriers" can be obtained between learning states. Motivation, therefore, is caused by any internal or external condition that increases the probability of or sets the occasion for responses learned in the presence of that condition. Water and hunger deprivation are special cases of global motivation. "States" in state dependent learning are examples of global motivation. Motivation is the destabilization of the brain that activate basins created in a unique condition to give rise to attractors that have been previously reinforced to operate on the environment in a way beneficial to the organism.
With this chaos model, one can assert that the in utero condition in the child is the first learning state and that the birth experience gives rise to the second learning state better known as the conscious experience. The second learning state, the body experience, is obtained with the birth trauma. The body experience can include any internally or externally generated perceived sensations, attractors, from all modalities and muscle activity. The body experience, perceived sensations, is the locus of change in overt, conscious, therapeutic interventions. The use of hypnosis and brain processes in treatment is more complex and will not be addressed in this paper. The body experience is the locus, however, where rapid change of traumatic memory takes place. The rapid change obtained by the EMDR method takes advantage of this property of the brain.
A Look at Phenomena Obtained by EMDR
The EMDR process produces a number of varied phenomena which are consistent with the chaos model. When the stimulus is presented, e.g., "Visualize your trauma," the request sets the occasion for or activates basins that are related to "your trauma." "Your trauma" is a small stimulus that can give rise to attractors related to the trauma. Some attractors will occur causing the patient to experience traumatic symptoms. When the memory, evoked attractors, and present perceptual stimulation occur simultaneously in the body experience, viz., holding the traumatic memory and having the fingers move back and forth across the visual field, other attractors occur both because symptoms are evoked from memory, attractors of the same neural network of the trauma, and attractors evoked by sensory input obtained from the therapeutic setting. Consistent with Freemen's observation that experience changes memory, the experience of the eye movement and the immediate sensory input, then, evokes attractors that serve as experience that modifies the traumatic "basins" and/or attractors simultaneously elicited. Since this is a chaotic system, the attractors of the traumatic memory change because of the neutral and/or positive sensory perceptual input of the present experience, in this example, of the therapists office, are attached by means of reinforcement to the visual, auditory, taste, smell or muscle action components of the traumatic memory. This is the reason the EMDR process works so rapidly. The experience of the trauma and the present experience are specifically and simultaneously evoked which leads to rapid change of the memory. Also, it is probable that in changing perceptual experience such as repetitive stimulation like eye movement, finger tapping, touch, verbal stimulation, etc., seems important because it activates the brain or learnings which facilitate the memory change.
Traumatic memories are often combinations of both thoughts and various sensory memories that reflect the experience of the remembered trauma, e.g., pictures, sounds, tastes, smells, feelings in muscles, mouth, genitalia, etc. Most of the observed experience usually appears to reflect appropriate attractors learned during the remembered trauma. EMDR processing frequently evokes unremembered pictures or beliefs related to the trauma in an understandable sequence as the remembered pain is lowered with continued processing. This is an example of the hierarchical organization of our memory and is consistent with the hierarchical chaotic process observed in Freeman's research. This experience of emerging memories, in conjunction with change in experienced body sensations, validates the EMDR process in the experience of the patient.
Unusual sensations are occasionally experienced in the brain or body during or following successful eye movement processing of a trauma. These feelings, described as shooting pain, "soda pop feeling" down the center, numbness or headaches in different areas, muddy feeling, confusion, etc., are simply the experience of neurological activity that accompanies change; perhaps, the rapid reintegration of the basins or attractors connected to the remembered trauma. These feelings, described as sensations inside the brain, are probably 3 dimensional projections caused by pain receptors stimulated in the scalp by brain activity.
THE CHAOS MODEL AND THERAPEUTIC CHANGE
The most significant property of this theory for therapeutic change is that experience changes memory. Change takes place in the "body experience," the locus of all traumatic learning states. Abreactions and reading this paper are two different body experiences. Body experience can be obtained by attractors evoked from memory or it can be obtained by attractors evoked by present sensory stimulation, current thoughts, etc. These latter experiences are based primarily upon stimuli from the present reality. Abreactions and night terrors are examples where the body experience is totally controlled by memory. These body experiences controlled by memory do not rapidly change the memory because there is no present experience in the body experience. The body experience is the "window" through which experience can change memory.
During the EMDR process, the patient simultaneously experiences symptoms of the painful trauma and the present experience which includes the safe quality of the therapist and the environment. The EMDR protocol specifically instructs the patient to have this body experience. With an appropriate balance of the traumatic memory and present experience in the body experience and with eye movement, the therapeutic process proceeds orderly, that is, positive present kinesthetic and/or other present sensory experience change the attractors that formerly gave rise to painful, traumatic sensory experience. The pain of the traumatic memory is neutralized. The remembered painful kinesthetic and muscle responses of the trauma are replaced with the present kinesthetic and muscle experience, often, leaving the visual and/or auditory memories of the traumatic experience intact. The picture of the trauma can be recalled but the feeling is neutral. Auditory, taste and smell experiences tend to diminish in the same way.
Total neutralization of a trauma or painful cognition within a session is important. The neural representation of the painful kinesthetic experience of the trauma is still present in the brain even though the picture has been neutralized. If any neural networks of the traumatic pain are connected to the neutralized image, a mild pain can be evoked by remembering the image. This can lead to re- establishing a painful memory.
To prevent traumatic pain from reestablishing, an appropriate positive cognition is attached to the traumatic memory. It is best for the positive cognition to be already well established in the persons experience. Attaching the positive cognition to the neutral traumatic memory is done by holding the neutralized memory of the trauma and the positive cognition in memory at the same time while doing the eye movement process. Thus, by linking a neutralized painful memory with a positive cognition, a whole neural network reorganizes in a way that changes the traumatic memory by including the positive cognition. The positive cognition is connected to the basin and joins the hierarchy of responses of the attractor. The positive cognition blocks the reestablishment of pain to the trauma by preempting the evocation of the painful response with a strong positive cognitive response. The thought of the painful memory will give rise to the strong positive cognition and no lingering connections to the pain will be reestablished.
Case Studies Demonstrating Unusual Interventions
Based Upon the Chaos Model
The following are 3 case vignettes that illustrate the use of the chaos model in obtaining change in traumatic memories. An example using EMDR in the normal application is not being presented because it has been described in many publications. The following unusual interventions demonstrate that by holding the traumatic experience and present experience in the body experience, one can modify the traumatic memory.
Case 1. This vignette demonstrates the use of spinning in a chair instead of finger oscillations to obtain change in traumatic memory. Also, there is a brief example of the use of hypnotic techniques to facilitate therapy. The patient was an 11 year old girl who had been referred to me because of symptoms suggesting sexual abuse. She had stayed the night with a friend and the symptoms developed from that point in time. Symptoms included having difficulty getting to sleep at night, difficulty concentrating, nightmares, rushes of anger at her mother, and isolating herself.
During the first session, I read, A Very Touching Book (Hindman, 1983), a book that teaches children about sexual abuse. In five of the following 10 sessions, the child asked to have the book read to her again. She pointedly avoided dealing with any issues and refused to allow me to do EMDR. The last part of each session was spent playing solitaire on a computer. I was using this activity as leverage for therapy.
Prior to the 12th session, her mother confirmed no change in the above symptoms. Early in this session, at her request, I was spinning her around in a leather swivel chair. It occurred to me that this activity might be used to obtain change in her traumatic memory. I said to her, "While you're spinning, keep your eyes open and think of that traumatic experience that you don't want to talk to me about." Then I spun her for 30 spins and stopped her. I then said "I'm going to spin you again and as I spin you, think of that traumatic experience. Keep your eyes open." I spun her another 30 times. I did eight repetitions of spinning her. At the end of the session, I asked her, "When you think of that trauma, is the pain very painful?" She said that the pain went down. Relative to a starting pain level of 10, she rated the current pain at "about 2."
Two weeks later her mother reported that the patient was sleeping at night, concentrating better, having good dreams, and no longer had rushes of anger with her. In this session, the patient agreed to try EMDR. We spent ten repetitions neutralizing the trauma and attached a positive belief to it.
In an earlier session she had mentioned that there was an angry part and a little girl part. Her mother had mentioned that she sometimes became angry and looked like a different child. So, in the waking state, I asked that angry part if she would be willing to work on the source of her anger and the patient said, "yes." I asked "that part that was guiding your healing" or her guide if she could help the angry little girl work through her anger. I explained the EMDR process again and how parts are formed and parts are healed. We used the next ten EMDR repetitions, using eye movement, working with the angry little girl. She alternated between having stomach aches and dizziness in her head. By the tenth repetition, according to the guide, we had allegedly neutralized the trauma of the angry little girl. The final repetitions were used to resolve confusion that she was experiencing. Mother reported no further regressive angry states.
Case 2. This MPD patient had been treated by this therapist for four years before cult programming had been recognized. Severe, enduring, unavoidable trauma, in general, can create a new learning state called a part. A fragment is explicitly programmed during a controlled trauma during relatively brief durations like minutes or hours. Fragments are programmed within or layered upon parts of the memory that, in most cases, include longer durations of time, like days, weeks, or months, etc. Unknown to the host personality, she had been programmed to participate in cult meetings for over 30 years.
Unknown fragments continued to emerge in therapy and were deactivated over several months. At one point, after 30 or more fragments had been deactivated, I learned that a cult member had been triggering suicidal fragments since the beginning of therapy. She had made over 20 suicidal attempts by overdose and had numerous suicidal crises. When I suggested to the patient to stop seeing the cult member, I triggered over 20 fragments who were collectively homicidal towards the therapist. The patient was in a hypnotic trance and a hypnotic restraint was in place; her arms and legs were like blocks of lead. Strong, healthy parts or alters were ready to step into the body experience when I said a prearranged word in order to displace the homicidal fragments if they got out of control. The primary learning state, called the "Guide," was accessed to help orchestrate therapeutic interventions. With the Guide's help, I confirmed that the belief, "I have to kill the therapist," could be neutralized with EMDR in all 20 fragments at the same time.
I asked the fragments to look out her eyes, thus connecting them to the body experience. While she held my hand, a "safe hand," EMDR processing was started. Sensing that something was amiss, I checked with the Guide to see whether all the active fragments were watching. One was not. This was a particularly problematic fragment, Bobby. I asked this fragment if he would watch, and he said, "Go to hell!" His response triggered over 60 fragments who were homicidal. The patient had a very intense focused look on her face with an unswerving gaze. Her left hand was moving back and forth looking for a knife. Her body experience was almost totally driven by her powerful memory, the programmed fragments.
Recognizing a difficult situation, I attempted to offer a "safe hand." I was ignored. I attempted eye movement and offered hand tapping. The patient again ignored the request. Faced with this problem, the theory offered a solution. To effect change, it was necessary to maintain, simultaneously, a positive present experience and the fragments homicidal behavior, past memory, in the body experience. I stuck my hand in front of her, about 18 inches from her face, and said, "This is a safe hand. You are 42 years old. You have two children. You are a good mother. You protected your children well. You are a college graduate and you have to kill the therapist." I repeated this continuously for about 20 minutes while rotating my hand. Checking the strength of the homicidal belief periodically, the intensity of the belief. "I have to kill the therapist," eventually decreased to "not true." The guide said that I could safely put all the fragments to sleep. While this did not heal the fragments or cause them to "cease to exist," the theory afforded me an option to handle the situation satisfactorily.
A month later, I managed to evoke a similar crisis with 60 or more homicidal fragments. My rotating "safe hand" intervention did not work. In this case, I used a picture of the patient and her two children to obtain eye movement. The picture was a strong, present time, anchor that disrupted the intense programmed behavior by evoking attractors giving rise to behavior that would follow the picture with her eyes as I moved it back and forth. Again, talking to her as I did above, further EMDR processing resulted in neutralizing the homicidal belief and behavior in the fragments.
Case 3. This 40 year old woman had been in therapy for about 18 months. She showed symptoms of a dissociative disorder. The first 12 months were spent dealing with the immediate crises of divorce, children, ex- husband and chronic illness. She had severe Lyme disease of about 7 years duration. She was quite labile and easily slipped from issue to issue. Having been discounted and disbelieved about Lyme symptoms by over 20 doctors, she did not trusting the therapist.
She had a peculiar style of responding. She would close her eyes when she was thinking and talking. Also, when she started talking, she was unavailable until she finished, that is, she appeared to dissociate into her thoughts. She talked slowly, often having difficulty retrieving the words she wanted. She put her fingers to her lips, like "hush," as an anchor to fully attend to what someone was saying to her.
Eye movement processing was not usually possible with this patient because it elicited a rush of emotions. I resorted to hand tapping. It appeared that moving her eyes back and forth, EMDR style, evoked memories of a preverbal trauma. Once, when I was hand tapping, she decided to move her eyes back and forth, with her eyelids closed, following the tapping. This resulted in an enormous surge of terror. I instructed her to not move her eyes when I did the hand tapping. The patient continued to make slow progress with these treatments.
Abreactions involving the entire body experience are ineffective as a means to obtain therapeutic change. In one session, an abreactive process started spontaneously. She closed her eyes and slowly moved her hands to her face as other emotional symptoms increased in intensity, viz., rapid breathing, expressions of fear, etc. She was losing contact with the therapist and both eye movement and hand tapping interventions were not possible. I managed to control the abreaction in the following way, again, testing the chaos model of the brain. I said assertively, "Your in a safe place with Dr. Flint. You are 39 years old. You have two boys and you are a good mother. You live in your own home. You are experiencing a traumatic memory." I repeated this statement, more or less, again and again. Initially her hands continued to raise to her face. I interspersed, "As you listen to me, you will gradually lower your hands and begin tapping on your legs." Her hands gradually moved to her legs and she started tapping. This process continued for 30 minutes. The level of the emotional response gradually decreased. After the processing, she expressed relief. While the traumatic memory was not totally neutralized and "healed," I brought her out of an abreactive state and some measure of symptom reduction was obtained.
The above cases describe the application of the chaos model to obtain therapeutic change. The deliberate theory based interventions were unusual but appeared to work with a positive outcomes. These cases demonstrate that traumatic memories are neutralized when they are experienced in the body experience simultaneously with the present experience. While processing using eye movement appears to be the most efficient approach to neutralizing trauma and changing beliefs, it, too, is an example of using more basic properties of brain function, memory, and body experience to obtain therapeutic change.
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