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The eyes have it
Controversial therapy treats trauma disorders through eye movement

By Brian Fitzgerald

Bessel van der Kolk does not mince words when describing the effectiveness of a controversial therapy that started becoming popular among psychologists a decade ago. "It's the greatest thing since sliced bread," he says about eye movement desensitization and reprocessing (EMDR).

	Bessel van der Kolk is conducting a study on EMDR and post-traumatic stress disorder. Those interested in participating should visit www.traumacenter.org/emdr. Photo by Vernon Doucette

His initial reaction to the therapy wasn't as glowing. Van der Kolk, a MED professor of psychiatry, first heard about EMDR 12 years ago. The treatment is a complex method of psychotherapy that integrates many of the successful elements of a range of therapeutic approaches in combination with eye movements and other forms of rhythmical stimulation in ways that excite the brain's information processing system.

"I was told that a patient wiggles his eyes and he gets better," he says. "It sounded like the biggest bunch of nonsense ever."

However, several of van der Kolk's patients -- who had been victims of sexual abuse when they were children -- told him that traditional psychotherapy didn't help them, but EMDR did. "They said, 'You were very good to me, but three treatments of EMDR have produced more results than three years of therapy,' " says van der Kolk. "My own patients had gotten better with this therapy, so I watched some videotapes of people using EMDR to resolve issues that had plagued them all their lives."

After he received EMDR training, van der Kolk treated a woman who was suffering from post-traumatic stress disorder (PTSD). "She had been involved in an ambush in Africa in which a number of people were killed," he recalls. "She got better after three sessions, and I still hear from her every year, on the anniversary of the massacre that she survived."

The scientific study of trauma gained much ground a quarter-century ago, when significant breakthroughs were being made for the first time since 1889, the year psychologist Pierre Janet first wrote about the relationship between trauma and memory. In the 1970s, PTSD was being considered as a diagnosis for many Vietnam veterans, and then the disorder was formally recognized in the psychiatric nomenclature in 1980. Van der Kolk, who was co-principal investigator of the Diagnostic Statistical Manual IV field trials for PTSD, wrote about the disorder in his book Psychological Trauma (American Psychological Press, 1987).

"EMDR became part of the clinical vocabulary because patients were being treated successfully," says van der Kolk. Victims of car accidents, rape, incest, criminal assaults, and illness were being cured at a rate of 80 to 90 percent. "After three sessions, when they talked about their traumas, they were exclaiming, 'It's over. It's not bothering me any more,' " he says.

Over the years, van der Kolk became a leading proponent of EMDR, which is generating enormous interest today. More than 60,000 therapists have been trained to use the new therapy, and more than a million patients have been treated.

"We discovered that people who are traumatized don't quite remember the event in an ordinary way," he says. The memories are often disassociated from other life experiences and stored outside of ordinary awareness. "When the victims remember the trauma, they feel as if they're living it all over again," he says. "The memories take on a life of their own."

Van der Kolk says that people who suffered traumas as children are particularly susceptible to problems because trauma in early life fundamentally affects the maturation of the systems in charge of psychological and biological processes.

Why does EMDR work? One theory is that the back-and-forth eye movements mimic the rapid eye movements (REMs) we make when we dream. "Dreams contain the residue of daytime experiences," he says. "This is how we process everyday unpleasantness. So the hypothesis is that EMDR induces a daytime dreamlike state." Another explanation is that the eye movements stimulate both hemispheres of the brain -- the left, the more verbal, and the right, the more intuitive.

Van der Kolk bristles at assertions from skeptics that EMDR lacks credibility because it is not clear exactly how it works. "We don't know how aspirin works," he says. "How does Prozac work? It supposedly stimulates the body's production of serotonin, but how does that make one feel better? When one is upset, why does talking to a friend seem to make things better? Many processes in science aren't fully understood."

He points out that EMDR is not a cure-all, but seems to be vastly more effective than traditional psychotherapy. "The traditional model is that the more people talk about the trauma, the more acceptable the symptoms become," he says. "This has many virtues, but many traumatic memories are in the part of the brain that is inaccessible to verbal recall. EMDR frees up those memories."

Besides treating PTSD, EMDR now is used for such problems as panic attacks, depression, addiction, and low self-esteem. "This doesn't mean that EMDR is the only answer for these problems," he says. "But I think that the old paradigms are entirely too limited."

17 January 2001
Boston University
Office of University Relations