Neurofeedback Versus EMDR (Eye Movement Desensitization and Reprocessing)

Neurofeedback versus EMDR (Eye Movement Desensitization and Reprocessing)

Eye Movement Desensitization and Reprocessing (EMDR) is a common way to assist clients struggling with symptoms of Post-Traumatic Stress Disorder (PTSD) (Solomon & Heide, 2005). In this treatment, clients are asked to bring the traumatic event to mind, focusing on cognitive, emotional, and somatic aspects of the memory (Solomon & Heide, 2005). Meanwhile, the therapist engages the client in some type of bilateral stimulation, such as eye movements that cross the midline, tapping alternate knees, or asking the client to hold paddles that vibrate alternately in each hand (Solomon & Heide, 2005). After receiving this treatment, many individuals experience rapid and profound relief from their symptoms (Solomon & Heide, 2005). Although it is not definitively known how EMDR works, there are several brain-based theories that makes sense. For instance, BLANK and BLANK found that bilateral stimulation increases the amount of delta waves in the brain, thereby simulating a Rapid-Eye-Movement (REM) state that is normally created during deep sleep (Harper, Rasolkhani-Kalhorn, & Drozd, 2009). Because one of the functions of REM sleep is memory consolidation, the bilateral stimulation component of EMDR may assist clients to consolidate previously unresolved and unconsolidated memories (Tilley & Empson, 1978; Rasch, Buchel, Gais, & Born, 2007). Similarly, BLANK AND BLANK found that during an EMDR session, the volume (i.e. size) of the amygdala (a region of the brain known to be associated with fear, hyperarousal, and “fight or flight” states) decreases, while the volume of the hippocampus (a brain region associated with long term memory storage) increases (CITATION). Thus, it appears that EMDR actually moves memories from the fear-based region of the brain into storage, where it loses the emotional intensity that has previously been associated with the event.

Despite the amazing benefits that many people experience as a result of receiving EMDR treatment, there are many individuals who either do not benefit from the treatment, or experience a negative reaction, known within the field as an abreaction (Rubin, 2003). Although the causes of such differential effects are not currently understood, many practitioners note that while EMDR is a powerful tool, it is also a dangerous and unpredictable one. In this practitioner’s experience, for instance, while some people respond to only a few bilateral stimulation movements (one to three), some people require many more to effectively enter a state in which effective processing can occur (say, 40-60). However, if given too many movements, client’s coping resources can quickly and easily become overwhelmed, leaving them vulnerable to an abreaction. Additionally, treatment with EMDR requires clients to directly think about, or relive, the traumatic event. For many individuals, the thought of facing the event is in and of itself overwhelming, and they can’t find the courage or inner resources to start this type of treatment. Other individuals (such as young children or severely brain-injured patients) may have a difficult time verbalizing, or even identifying important aspects of the memory, making EMDR difficult to engage in effectively.

Alternatively, neurofeedback, a type of treatment that helps people learn how to improve brain functioning, has also been found to be helpful for people suffering from PTSD, even in traditionally difficult-to-treat populations such as young children (Huang-Storms, Bodenhamer-Davis, Davis, & Dunn, 2007). In this treatment, sensors are attached to the client’s scalp, and changes in electrical activity displayed to the client in the form of audiovisual feedback, usually presented within the format of a video game of movie (International Society for Neuronal Regulation, n.d.). This treatment usually involves increasing the brain’s theta waves (a type of activity closely related to the delta waves mentioned above), and creates a state that is helpful for processing traumatic memories and/or intense emotions (Gruzelier, 2009). However, neurofeedback systems generally allow the clinician to directly observe the activity of the brain throughout treatment, making it easier to determine the client’s mental state, adjusting as necessary to control the intensity of the experience. Another benefit of neurofeedback is that the individual is not asked to directly talk about, think about, or relive the traumatic event. Instead, the client is generally asked to move through some basic relaxation exercises or some type of guided visualization activity (Peniston & Kulkosky,1991). Although neurofeedback trauma processing can also be emotionally intense, for many individuals, it is less daunting to begin than EMDR. For individuals who wish to experience some symptom relief without experiencing an emotionally intense processing session guided by neurofeedback, or for those who can’t sit still enough to meaningfully engage in relaxation/visualization exercises, neurofeedback can also be used to simply calm the hyperarousal of the central nervous system normally observed in individuals with PTSD (Huang-Storms et. al., 2007).

Despite the benefits of utilizing neurofeedback in the treatment of PTSD, there are some drawbacks to this treatment approach as well. For some individuals with overly sensitive sensory systems, placement of the sensors on the scalp can be irritating and uncomfortable. While successful EMDR treatment often happens very quickly, sometimes within only one or two sessions, neurofeedback treatment can often take twenty to thirty sessions, although initial symptom relief often occurs within the first two to five sessions. Finally, EMDR is generally offered by many clinicians, while neurofeedback is still considered a relatively new treatment approach, and therefore only offered by a few practitioners familiar with its use.

While both EMDR and neurofeedback are effective, integrated, mind-body treatment options for individuals seeking relief from symptoms of PTSD, they each have potential benefits and drawbacks that should be carefully considered by both the treating clinician and the individual seeking treatment.

References

Gruzelier, J. (2009). A theory of alpha/theta neurofeedback, creative performance enhancement, long distance functional connectivity and psychological integration. Cognitive Processing, 10(1), 101-109.

Harper, M.L., Rasolkhani-Kalhorn, T., & Drozd, J.F. (2009). On the neural basis of EMDR therapy: Insights from qEEG studies. Traumatology, 15(2), 81-95.

Huang-Storms, L., Bodenhamer-Davis, E., Davis, R., & Dunn, J. (2007). QEEG-guided neurofeedback for children with histories of abuse and neglect: neurodevelopmental rationale and pilot study. Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback, and Applied Neuroscience, 10(4), 3-16.

International Society for Neuronal Regulation (n.d.). What is neurofeedback? [Brochure]. McLean, VA: International Society for Neuronal Regulation.

Peniston, E.G. & Kulkosky, P.J. (1991). Alpha-theta brainwave neuro-feedback for Vietnam Veterans with combat-related Post Traumatic Stress Disorder. Medical Psychotherapy, 4, 47-60.

Rasch, B., Buchel, C., Gais, S., & Born, J. (2007). Odor cues during slow-wave sleep prompt declarative memory consolidation. Science, 315(5817), 1426-1429.

Rubin, R. (2003). Unanswered questions about the empirical support for EMDR in the treatment of PTSD: A review of research. Traumatology, 9(1), 4-30.

Solomon, E.P. & Heide, K.M. (2005). The biology of trauma: Implications for treatment. Journal of Interpersonal Violence, 20(1), 51-60.

Tilley, A.J. & Empson, J.A.C. (1978). REM sleep and memory consolidation. Biological Psychology, 6(4), 293-300.