A Sydney Newspaper from 1993 Describes the Experience of EMDR: "FINGERS OF THERAPY”
It seems too good to be true, yet it’s claimed to work in more than 50 per cent of difficult cases. Not for everyone but Ron Hicks looks into the treatment that is revolutionizing psychotherapy in Australia.
Burly Navy Diver Bob Taylor religiously moves his eyes backwards and forwards, following the two fingers of the psychiatrist who rapidly passes them across his face 20 to 30 times at a distance of about 30 centimetres.
Taylor does as instructed and thinks of the most terrifying experience of his life, an event that he constantly relives in his dreams – he would talk about it in his sleep and wake his wife. It even intruded into his everyday life when some seemingly inconsequential thing, like seeing a rope, brought a flashback – that feeling of terror and sheer panic as if it were happening again there and then.
The flashback is to a reef off Queenscliff Beach in Sydney – and what should have been a routine dive. But that day, while he as 25 metres below the surface, a blood vessel in Taylor’s sinuses burst and blood flooded into his goggles so he could not see. Then the blood flowed down his throat so he could not breathe. In his bloodied darkness and with no-one to help him, Taylor desperately searched for the guide rope that was literally his lifesaver.
“I can’t grab it … come here you bastard!” Taylor screams as he relives that black terror after Dr Kevin Vaughan’s fingers stop moving in front of his eyes. Again, there in that office, the blinded, choking Taylor desperately grabs for the rope. The seconds tick away; each seems like eternity. Finally, his hands find the rope … and he pulls himself to safety.
“You’re at the top now … you’re safe … you’re safe,” Dr Vaughan, head of the Post-Traumatic Stress Disorder Unit at Hornsby Hospital in Sydney, reassures Taylor, who mind is still at sea.
“How do you feel now?” Vaughan asks. “I feel safe … I feel good … I feel relaxed … I feel relaxed all over my body … and in my mind.” The treatment is that easy. There would be four sessions and each time Taylor relived that stressful situation Dr Vaughan would pass his fingers in front of his face and get him to follow them with his eyes.
This simple movement is revolutionizing psychotherapy in this country. Therapists are claiming an astounding success rate – anywhere between 50 to 90 per cent – in some of the most difficult areas of psychiatry and healthcare generally: fields littered with failure. This new treatment is being used primarily for post-traumatic stress patients: people who have been psychologically scarred by accidents, by rape and sexual molestations, by robberies, by wars and by massacres, including victims of Sydney’s Strathfield massacre. But following its success with these patients it is now being used in a wide variety of anxiety conditions, including phobias, such as agoraphobia. And the professionals are looking to extend it to even more complex areas, such as treating multiple-personality patients.
As the story, already lore, goes, the treatment was discovered by a Californian psychologist, Dr Francine Shapiro. In 1987, soon after a divorce, she was in a park in San Francisco, very upset. In this charged state she noticed that her eyes began to move rapidly and, to her surprise, “the disturbing thoughts began to lose much of their power”. Shapiro, a psychologist, began to experiment on herself by repeatedly passing her hand before her face. She felt better. She decided to see what would happen if she used the eye-movement technique on some volunteer patients, mainly rape-molestation victims and Vietnam veterans. It was similarly successful.
The technique was introduced to Australia by Don Heggie, a semi-retired Sydney multi-millionaire. Over the years, Heggie had experienced unexplained problems such as extreme anger when anyone questioned him (see end of article), which was not in keeping with his character. Heggie had repeatedly sought different types of psychiatric treatment, but to no avail.
In 1990, after hearing about Shapiro’s new treatment, he went to California. After just one treatment session Shapiro was able to trace his problems back to the trauma he had suffered as a bomber pilot shot down over Germany at the end of World War II. Heggie was so impressed with the success of her treatment, especially after so many failures, that he took his psychiatrist back to California with him for the next sessions, so he could learn the technique. Indeed, Heggie has so far spent $180,000 promoting the treatment in Australia, including paying for the directors of the Vietnam veteran’s counselling services in each State to travel to California to learn the method.
Shapiro named the technique Eye Movement Desensitisation and Reprocessing, (EMDR), which ostensibly describes what is thought to happen. The theory is that the rapid eye movement brings on abreaction: the reliving of traumatic events in a way that allows the mind to process and accept them.
At the end of his sessions, Bob Taylor told Vaughan: “I never used to talk about what happened because it always put me on edge. I now realise that what was upsetting me more than anything else was the feeling of embarrassment and guilt. I had a slight head cold and there was a build-up of mucus in the sinuses. I should not have dived that day. I did not tell anybody what happened. But now I think: ‘Why didn’t I tell somebody I made a mistake.’ It is no longer a threat. I can look back on it now and accept it and learn from it.”
Vaughan, who has been interested in post-traumatic stress disorder since he practised as a psychiatrist in Sydney’s Macquarie Street, explains what happens to people who experience extreme trauma: “If you undergo a trauma, the real problem is that you re-experience it again and again … you continually relive it. It haunts you. If you are shot, for instance, you continually dream about it, or you may have flashbacks where you actually re-experience it – pain and all.
“What the people who believe in EMDR theorise is that … because of the highly charged emotion that accompanies trauma, it does not get put in the right place in the mind. It gets stored very close to the surface of the mind, that is why it pops to the surface, out of the blue. And that is why it has such a sense of recency …
“So, in eye-movement desensitisation and reprocessing … you get the patients to think about the trauma and move their eyes about at the same time (and) it somehow causes the mind to re-sort some of these memories and helps them slot them into the right place.”
Well, anyway, that’s the theory. But, with a laugh, Vaughan later concedes: “I tell that to the patients who come to see me and it makes sense to them … but I’m not sure it’s true. The reality is that we have not got to first base as far as the mind is concerned. Our understanding is really at a primitive stage. We are really at the stage of looking at the back of a television set. No-one has ever localized where the memories are in the brain, so it is all very well to hypothesise about tings being stored in the wrong place or in the wrong form, when you don’t even know where the bloody things are.” For all that, Vaughan believes in EMDR because “it works”. He carried out a test to prove it to himself – and, he hopes, to the rest of the scientific community. He and another psychiatrist, Dr Michael Armstrong, looked at 36 post-traumatic stress disorder patients and randomly put them into three groups, with each given a different treatment.
The first group of 12 has the traditional “exposure” treatment for post-traumatic stress disorder, where a tape is made of the patient retelling the traumatic incident. The patient then, over a long period, repeatedly plays the tape while using coping techniques to try to overcome his or her anxiety and accept the incident. (This exposure technique, without tapes and other aids but with the use of positive reinforcement and anti-anxiety relaxation methods to “detoxify the emotions” caused by the trauma, is actually part of the full clinical EMDR treatment). The second group was, basically, taught different forms of relaxation therapies.
The third was the EMDR group. The test showed that after only three months of treatment, the EMDR patients fared better on every criteria – they had fewer nightmares and flashbacks; they had less depression; they could accept the memory more readily; they had more self-esteem.
Vaughan and other psychiatrists and psychologists know that, by itself, the EMDR does not “cure”, and that these other clinical techniques, exposure and relation, must be used by skilled practitioners to make it work. But, according to Vaughan, who is also a lecturer in psychiatry at Sydney University, the test and his own experience show that EMDR significantly speeds up the process and seemingly makes curable cases that seemed intractable.
Gary Fulcher, who has a masters degree in psychology and is successfully treating Vietnam veterans with EMDR at the Concord Hospital in Sydney, believes he knows, roughly, how EMDR works. He researched the technique with colleagues and believes EMDR stimulates three sections of the brain: the brain stem, which focuses attention; the limbic system, which controls emotion; and the cortex, the thinking part of the brain.
“Because of the saccadic (rapid) eye movement, the patient can focus on the distressing incident,” says Fulcher. “But, most important, the door stays open because of the eye movement. Therefore the patient is exposed to the full emotion, and they are able to rethink it (because of the involvement of the cortex). As a result, the memory is released. Led through it properly, the person can become detached and think about it in a rational way, rather than just be overcome by emotion, as normally happens.”
One of the tests that Fulcher and his colleagues carried out was to do EEGs, or electroencephalograms, which measure the brain’s electrical waves before, during and immediately after EMDR. The researchers found that during the rapid-eye-movement stage, the subject’s EEG was like that of someone who was completely relaxed – for instance, someone meditating or doing yoga. This feeling of relaxation accords with how the patients themselves say they felt straight after the EMDR. Another finding was that the EEG reading of people after EMDR was similar to those taken of people during rapid-eye-movement, or REM, sleep.
As with any new method, there is controversy and doctors point out that REM eye movement is basically up and down, not sideways, and not all practitioners accept the REM analogy. But the finding does accord with Fulcher’s theory.
In meditation, the mind focuses in an ever-deepening fashion on something, whether it be on a traditional mantra or something else in more modern techniques. Fulcher believes that when patients re-experience the trauma in this more relaxed mode of EMDR, it has a calming effect, and people can accept it more readily.
A development from this research is that the Shapiro back-and-forth movement of the finger is not the only way to induce the EMDR effects. Psychologist Robbie Corbett, who is doing her masters thesis on EMDR and uses the method in the counselling service at Sydney University where she works, tested two groups of patients using different stimuli. Using a television monitor, the first group was shown a programmed moving stimulus similar to the usual regular horizontal hand movements used by Shapiro and other therapists. The second was made to watch a pulsating, but static, regular flash on the screen. There was no difference between the two groups – they both had the same EMDR effect. While she maintains an open mind, Corbett believes EMDR may be similar to the effect brought about by Eastern meditation techniques. So how new is Eye Movement Desensitisation and Reprocessing? Is it really something old – even ancient – that is new again?
Critics, such as Dr Chris Clarke, senior lecturer in psychology at the University of NSW, who has written a book on hypnosis and regularly uses hypnosis in treatment – he used it to help discover the multiple personalities of Tracey Wigginton, the so-called vampire killer of Brisbane who picked up a man on the street in Brisbane, killed him and then drank his blood – believe EMDR may be hypnotism. Clarke carried out his own “preliminary” EMDR research on 10 subjects. Five were resistant to hypnotism but the others who, by well-established international standards were “highly hypnotizable”, fared far better under EMDR.
But most of the rest of the psychiatric and psychological profession do not want EMDR classified as hypnotism. Says Vaughan: “The people who are doing it (under EMDR) do not seem to be in a hypnotic trance,” although he does not rule it out. “The essential thing about a hypnotic trance is that people are highly suggestible. But in EMDR people are in control, they are not in a highly suggestible state. They seem to be in some other type of mental state whereby all these memories can be re-sorted.”
Corbett, who has used both EMDR and hypnotism, believes they are different. “In hypnotism the person is basically passive – receptive to suggestion. But in EMDR, the person is active – they talk it through and process the information.”
Clarke is highly critical of the way EMDR has been promoted as “a new Jerusalem”. “Some years ago neurolinguistic programming – NLP – was all the rage and there were workshops held all over the place for this new miracle treatment. Now nobody hears about it. I am wary of this new treatment which is often promoted like a “miracle cure” or the new ‘magic bullet’, particularly because of the absence of a coherent explanation of how it works and the dearth of proper, independent comparative research which replicates the reported success rates.
“It is too early to tell yet how successful EMDR really is and how long the benefits will last. There may be numerous reasons why the treatment may have helped patients. It could be just the relaxation it produces or it even could be a placebo or bandwagon effect – it is amazing what can happen if people believe a treatment is going to be successful. And the enthusiasm of the clinician for a new technique can be a very powerful therapeutic tool in itself.” Clarke says that what particularly disturbs him is the secrecy surrounding the method, which he finds repugnant and against the values of the scientific brotherhood.
EMDR is now popular with nearly 1000 Australian psychiatrists and psychologists – more than 12 percent of the total. Given that the treatment of post-traumatic stress disorder is a specialized field, the figure is high. All of EMDR’s practitioners were taught the technique by Shapiro, who came here in 1992 and 1993. Discussions are now under way to introduce a system of authorized Australian teachers.
Participants at the two 1992 and 1993 workshops, each attended by nearly 500 professionals from all over Australia, signed a pledge stipulating the workshops were for professional purposes only and would not qualify the participant to train others in EMDR. They were also forbidden to tape proceedings and were enjoined not to talk to the popular media about the technique, but to continue any written work to professional publications.
Proponents such as Fulcher and Corbett say this approach has been taken for safety reasons. They fear the consequences, for example, of somebody experiencing a deeply repressed trauma, such as sexual abuse, after EMDR given by somebody not properly trained – or not trained at all.
Says Fulcher: “The eye movement is only 20 per cent of the therapy, which involves things like teaching patients how to relax and giving them positive reinforcement to lead them out of difficult situations. EMDR can lead to very tricky situations. In one case I had a woman who panicked so much when she relived a repressed trauma that her throat closed over and she began to asphyxiate.
“It is an extremely powerful technique which can be dangerous in the hands of people who do not have the proper training. Imagine someone who had suicidal tendencies being left in this traumatized state. The last thing we want is for this to be used as a party trick.” The problem is that anyone can wave his or her fingers back and forth 20 times.
Freedom for prisoner of war
Don Heggie, normally an easy-going person, would throw a fit of anger whenever anybody questioned him. “I would suddenly start screaming at people,” says the founder and chairman of the Heggie Transport Australia company. “One day I started screaming at my wife in the kitchen and I did not know why. It was then that I knew I needed help.”
He would also have unexplained screaming fits when he felt cold. He saw numerous psychiatrist and psychologists in Australia, but got nowhere. Then he heard of EMDR, and flew to California for an intensive course of six treatments in eight days. “It was like peeling back the layers of an onion. I realised that all my problems dated back more than 40 years to the time I was a prisoner in World War II.”
At first, Dr Shapiro had Heggie concentrate on the feelings he had during his last violent outburst. Then, after she employed her eye-movement technique by passing her fingers backwards and forwards across his face, Heggie’s mind went back to the war, in which he was the pilot of a Lancaster bomber. Six weeks before the armistice, he was returning from a mission over Germany when his plane exploded not far from Allied lines.
He was not under enemy fire but he believes a bomb from one of his squadron’s own planes somehow dropped on his, ripping off the tail section in a massive explosion. Five of the seven crew died, and Heggie was sure he was going to be the sixth. The front section of the bomber went into a violent spin and when he tried to jump free to deploy his parachute, centrifugal force kept him pinned to the side of the plummeting plane. With one last effort he managed to free himself only a few thousand feet above ground. He injured his leg on impact and, after hiding out for a day, was captured.
German Air Force chief Hermann Goering has ordered that no captured aircrews were to be retaken by advancing Allied troops. There was also tremendous ill-feeling towards bomber crews among the German guards, many of whom had lost family through the bombing. “They moved us around from place to place for six weeks and I was always afraid that I would be shot,” says Heggie. “One man was shot just because he walked off the path to relieve himself. One guard, who family had been killed in the bombing, shot any bombardier he found.”
Advancing British troops finally caught up with the constantly moving column of prisoners and Heggie’s six-week nightmare, “which had more stress than most people have in their entire lives”, ended.
Although he deliberately pushed those memories to the back of his mind, the reverberations from his wartime experience and the trauma and guilt over losing his crew remained. It was only after the EMDR treatment that he realised what caused his problems, finally re-integrating and accepting them after Shapiro’s treatment. “I am a different person today. I feel whole and free. My family is amazed with the changes in me.”
Following the success of the treatment, the semi-retired millionaire committed himself to bringing the benefits of EMDR to the many people who suffer similar problems, particularly Vietnam veterans.