Interview with Shenhui Lin: this is how EMDR therapy is applied to trauma

Shenhui Lin, an expert psychologist in EMDR therapy, explains how it is used to help overcome trauma

The human mind has a great capacity to store information, but this process is not only a purely intellectual phenomenon: much of the human memory is composed of emotions.

This makes sense, since it makes it much easier for us to learn quickly: the emotional orients us to want to repeat certain experiences and to avoid others, depending on the consequences they had for us in the past. But this logic is a double-edged sword.

Some experiences are capable of leaving very painful emotional marks, traumas, which constitute a psychological problem. Fortunately, there are psychotherapeutic resources that allow us to overcome these traumas, such as EMDR therapy. Therefore, here we will interview a psychologist expert in its use: Shenhui Lin..

Shenhui Lin: harnessing the potential of EMDR for trauma intervention

Shenhui Lin is an expert psychologist in EMDR therapy, a field in which she has been helping her patients for many years from her practice, Iniciativa Kintsugi, located in Providencia, Santiago de Chile. On this occasion she will talk to us about how this type of therapeutic intervention is used to treat psychological trauma.

What is EMDR therapy and what is the main characteristic that distinguishes it from other forms of psychological intervention?

EMDR Therapy, which stands for Eye Movement Desensitization and Reprocessing, was created in 1987 by Francine Shapiro, Ph.D. in Psychology. It is a psychotherapy treatment that was originally designed to alleviate distress associated with traumatic memories.

Shapiro's adaptive information processing model postulates that EMDR therapy facilitates the accessing and processing of traumatic memories and other adverse life experiences to bring them to an adaptive resolution.

EMDR Psychotherapy initially emerged for the treatment of Post Traumatic Stress Disorder, being used with great success with U.S. war veterans in Iraq, Afghanistan and Vietnam.

In fact, EMDR is currently the therapy recommended by the WHO for these effects and with which veterans are treated in the Department of Veterans Affairs and Department of Defense of the United States, among others.

EMDR therapy is a psychotherapeutic current that reconciles from neuroscience different theoretical frameworks of psychology, such as psychoanalysis, humanistic, or cognitive behavioral, allowing to conceptualize the human being as an integrated whole, placing special attention on the functioning of their emotions, beliefs, somatizations, level of consciousness, bonding systems, types of attachment, life experiences, under the umbrella of neurobiology.

EMDR therapy facilitates access to the traumatic memory network, so that information processing is enhanced, forging new associations between traumatic memory and more adaptive memories (SPIA). It has been studied that these new associations result in complete processing of information, new learning, reduction of distress, along with other disturbing emotions and perception of the world without distortions from the trauma.

One of the aspects I like most about EMDR therapy is that it uses a three-pronged protocol, which allows addressing the person's past, present and future. That is, past events that have laid the foundation for dysfunction are reprocessed, forging new associative links with adaptive information; current circumstances that cause distress or other symptoms are worked on and internal and external triggers are desensitized; and finally future events are worked on, to acquire the skills necessary for adaptive and healthy functioning.

In your daily work with patients, what are the main problems with which you use this type of therapy?

EMDR is more than a psychotherapeutic technique, it is a theoretical approach that also has specific techniques and protocols for its application in the psychotherapeutic process. EMDR is my psychotherapeutic current under which I conceptualize and address the problems of my patients.

My consultations at Iniciativa Kintsugi are usually attended by people suffering from various problems, symptoms and disorders. Low self-esteem, significant difficulty in relating to others, especially with partners, feeling of loneliness, fear of not being loved, excessive anxiety and previous diagnoses of depression...

People also arrive who, despite the years that have passed, continue to feel tormented by the events related to the coup d'état in my country, in Chile in 1973. Experiences that many people have relived with the events of the so-called Social Outburst that occurred recently in our country on October 18, 2019, arising the emergence of new disruptive processes on the individual and collective psyche, which have triggered re-victimization and pre-existing traumatic conditions.

On the other hand, the COVID-19 pandemic situation and the quarantines in which we have been affected globally, are detonating varied discomforts that we are attending to. Both in front-line professional staff, with whom we have worked directly from the Kintsugi Initiative, as well as in the general population, high levels of anxiety, stress symptoms, insomnia, perception of loneliness, insecurity, fear, confinement, panic attacks, depressive symptoms and post-traumatic stress disorder are being presented.

What are the characteristic aspects of trauma that make it respond well to this type of treatment?

It is known that emotional trauma has a neurological correlate. When we are exposed to traumatic situations, and even more so if they are repeated, our neuronal activity is affected.

Both a traumatic stimulus and a continuum of traumatic stimuli, are an input of information that enters the amygdala, which is over stressed, generating an alert to the hypothalamus, to produce hormones that activate the process of fight and flight, such as corticotropin, which has direct interference in our cardiac, motor and pulmonary systems. And the hormone noradrenaline, which affects the functioning of the brain stem, lymphatic system and neocortex.

On the other hand, the hippocampus secretes dopamine, which helps to fix attention and contributes to the loss of its temporal and contextual capacity when we are exposed to traumatic events.

This hyper secretion of hormones over-consolidates traumatic events, inhibits the ability to access positive memories, over unpleasant ones, and begins to generate a feeling of hyper traumatization from which it is very difficult to escape, since the order of the amygdala has also activated the opioid centers in the cortex generating endorphins that produce anhedonia, and numbness, the frontal cortexes are disabled and with it the ability to turn off the emergency system.

Accordingly, EMDR becomes a real revolution, because we work with this natural system that we all have to process information in adaptive modes (SPIA) that as described above has been blocked.

EMDR therapy stimulates the SPIA so that the person can process and reprocess the painful experiences in an adequate and healthy way and thus move forward in their life for their subjective wellbeing, overcoming the trauma in a permanent way.

Is it complicated to make the patient understand what is the type of EMDR intervention? Is it necessary something like a "training" stage?

Not at all complicated, in general most of them understand very well what this psychotherapeutic approach implies, and already working as a team, patient and EMDR therapist in the sessions, they respond spontaneously about what they are experiencing as they understand how EMDR works in them.

As EMDR therapy progresses, there are stages in which the patient attends to emotionally disturbing material in short sequential doses while simultaneously concentrating on an external stimulus. Lateral eye movements directed by the psychotherapist are the most commonly used external bilateral stimuli, but a variety of other stimuli are often used, such as manual tapping and auditory stimulation.

On the other hand, EMDR therapy allows us to be very protective with the patient, that is, we are concerned with developing resources in the person so that he/she learns to see him/herself and his/her problems, without fear, in the safe environment provided by the therapeutic bond, and to regulate him/herself with his/her own tools. For them, we work in a gradual way, observing their progress, supporting them during the process, and at the pace of each patient.

Let's say for example that an adult person has gone through a traumatic experience two years ago, due to a traffic accident. How is EMDR therapy used to prevent that emotional mark that has remained in their memories from continuing to cause them discomfort?

For the example case you mention, we would work with the traumatic memories specifically associated with the accident. Although the accident itself is the traumatic moment, it is also constituted by all the events that occurred prior to the accident and the subsequent consequences, considering all the intrusive fragments of memory that make up the "traumatic episode".

Understanding this, one looks for the memory fragments that continue to disturb, and that trigger them or cause them to relive the discomfort in the present, which can be an image, a smell, a particular sound, negative thoughts of oneself, overwhelming emotions and bodily correlates. To work with each of these points of disturbance until the disturbance is extinguished and the facts are perceived in a less overwhelming way.

How are the first positive effects of this type of intervention usually noticed from the patient's point of view?

The positive effects that a patient may experience are varied, since it will depend on the person himself, his initial symptoms, what is being worked on and the objectives set, each patient is different and has understood in a subjective and unique way his life history.

However, there are effects that are reiterated, such as feeling relief, relaxing, being cheerful and commenting in some way that "the heavy backpack that was carried is no longer there", feeling that now it makes sense to think positively about oneself, reformulating one's own negative beliefs into positive ones, accepting oneself and believing in one's abilities or skills... some patients even report a decrease in psychosomatic physiological discomfort.

Thus, patients begin to notice a change in the way they perceive themselves and the world and their relationship with their environment. And they begin to feel self-love and that they can also be loved.

Do you think there are areas of research in which, in the future, EMDR therapy may prove useful for new problems and needs to be met?

Most probably. Since the emergence of this psychotherapeutic current, there has been so much research on EMDR therapy that it is now recognized as a priority treatment for trauma and other disturbing experiences, being officially recognized by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense of the United States of America and several ministries of health in Europe.

It is already possible to find favorable studies of the effects of EMDR in the treatment of Borderline Personality Disorder, bipolar disorder, depression, panic crisis, for various phobias, or for Obsessive-Compulsive Disorder, among others.

In recent years, authors such as Miller have investigated clinical cases of severe depression with psychosis, delusional dysmorphophobia and schizophrenia that have been successfully treated with EMDR. With clinical follow-up of more than 4 years after EMDR therapy, where the patient presenting with schizophrenia continues to be medication and symptom free.