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I wanna salute all of you who are still here
and, you know, I can kind of see
your prefrontal cortices smoking and smoldering
from all the information you've been given.
And I wanted to say how much I appreciate
being here and being asked to be here.
I have the best job in the world.
I get to see severely traumatized individuals
get better really quickly through EMDR.
My talk this afternoon is like the others 20 minutes.
And I realized as I put this talk together
that if I explained the slides
that I would be showing would never get through this.
So I'm gonna pretty much ask you
to just give me your attention
and I will point out a few things on a few slides,
but mostly I'm gonna talk about EMDR.
I also noticed where I appeared on the program
being the second last speaker,
and I was thinking, what am I gonna do?
How am I gonna start this out?
So I decided to start out with a story,
and this story has a metaphoric relationship with EMDR.
And I'm not gonna tell you what
that metaphoric relationship is.
I'll let you decide what it is as we go through this.
But the story goes, this guy is walking
through a rural Ireland
and he passes the cottage that has a sign on it that says,
talking dog for sale.
So he thinks that's kind of interesting.
He knocks on the door and says, "Excuse me,
do you really have a talking dog for sale?"
And the owner says, "Yeah, he's in the backyard.
You can have a look if you want."
And so he goes to the backyard and there's a dog
and he says, "Excuse me, are you the talking dog?"
And the dog says, "Yeah, that's me."
And he says, "Well, this is really pretty amazing.
How did you ever become a talking dog?"
And the dog says, "Well, when I was just a puppy,
I realized that I had the capacity
to understand the spoken word.
So I worked really assiduously
to acquire the ability to speak it.
And one thing led to another,
and pretty soon I was working for a local constable
and we made a few drug busts and caught
a few terrorists and word spread.
I started working for Interpol, you know, bigger drug busts,
more arrest of terrorists.
And then I got sent to the United States
and I worked for the CIA and the DIA
and Department of Homeland Security.
And now I'm back at home.
A dog's life is short, you know?
And it's been a good life.
And I'm in retirement now."
And so the man rushes up to the owner
and says, "That dog is amazing.
How much do you want for that talking dog?"
And the owner says, "I don't know," he says, "10 pounds."
And he says, "10 pounds?
That dog is worth thousands.
Why is so cheap?"
And the owner says, "Well, it's all bullshit.
He never did any of that stuff."
(audience laughing)
Okay, now that I have your attention,
(all laughing)
I would like to say that I have a white paper
that will be available online.
It's about 50 pages
and goes into much more detail about the research
that we've done that I really am not able to go into here.
And also the slides will be available.
And so I'm just gonna talk without going into details
about those things so we can get through
what I think is really important.
For those who don't know too much about EMDR,
and I think there are a lot of people that fit into that.
EMDR is a form of therapy that is extremely
powerful with persons who've been
psychologically traumatized.
It also is useful in cases
where people are emotionally stuck,
whether they're stuck in anxiety or depression
or anger or rage or fearfulness.
EMDR can be useful, even though no trauma has been found.
It helps people get unstuck.
And it's been around for about 25 years.
The first research appeared in 1989,
and in that study they took a group of Vietnam veterans
who back then, 20 to 30 years after Vietnam,
still had PTSD symptoms, nightmares, flashbacks,
and intrusive thoughts.
And these guys had been in every form
of therapy known they'd been in every different kind
of medication possible, but they still had their symptoms
and they put 'em through one session of EMDR
and they lost their PTSD symptoms.
So it was a really striking kind of finding.
And then my associates and myself
expanded on that original research only now
with a much larger sample
and much more strict scientific controls.
And so in a 1995 study,
we got 80 adult individuals who were severely traumatized
and we provided them with, first of all,
an intense battery of psychological instruments
and found that they were normally high in anxiety
and depression and PTSD symptoms.
And then we provided them with three sessions of the EMDR.
And when we remeasured them
after those three sessions, we've now found
that they fell in normal limits on anxiety,
depression, and PTSD symptoms.
And we followed up three months later,
found the results held and got that published
in the most scientifically rigorous
journal in Clinical Psychology.
And then 15 months later, we went back to see
how these individuals were doing
15 months after just those three sessions.
And at that point found that 84%
were functioning normally as they had before their traumas.
And the other 16% showed some improvement,
but almost definitely needed more than the three studies,
three sessions we provided in that study.
And we got that published in the same journal.
And since then we've continued doing research with children,
with children of war, with children on a group basis,
with police officers.
And in this arcane area of phantom limb pain,
I also did a case series
with 108 consecutive motor vehicle accident victims,
all of whom had PTSD, most of whom had injuries.
And in that case, series of 108,
it took an average of five sessions
for them to be able to drive comfortably again
and lose their nightmares and flashbacks
and intrusive thoughts.
Now, if anything indicates neuroplasticity,
it's this kind of model
where you have normal brain functioning,
you have a trauma, and following the trauma,
the entire nervous system is dysregulated.
And then you have a method of treatment
that helps to reregulate the nervous system.
Now this particular slide, the SUD scale.
SUDS is a unit of, or a scale from zero to 10
that indicates the amount
of psychological distress a person has.
And so with these 80 individuals,
you can see that they started out
at a very high level of distress.
And after the first session,
okay, high level of distress
between eight and nine, we have immediate treatment
and we have delayed treatment.
And initially they're between eight and nine.
And after the first session,
at the end of the first session,
they're down between three and four.
We have the second session goes,
goes down further at the end of the third session,
really quite low.
VOC is a measure of,
really self-efficacy more than anything else.
And so initially these people asked what they'd like
to believe about themselves in relation to the trauma.
And they said things like,
I'd like to think that I was competent.
I did the best I could.
I learned from it, it wasn't my fault.
And initially on this measure,
it didn't seem very true,
but increased in in how much
they could believe that was true
on a scale from one to seven.
So that was one of the process measures.
Actually two of the process measures,
and I'm gonna skip over these.
On one of those tests.
This is fairly typical.
One of the major classes, I'm sorry.
One of the major symptom groups in PTSD
as symptoms of intrusion, such things
as nightmares and flashbacks and intrusive thoughts.
And these individuals in both the treatment
and delayed treatment groups started
standard deviation above the mean.
And by the end of treatment
and three month follow up,
they were pretty much at the mean
in terms of intrusive symptoms.
And with avoidance,
another major symptom group, we found the same thing.
It went down, stayed down for both groups,
A measure of anxiety.
They started out really between
two and three standard deviations of the mean.
And then within the mean, within a standard deviation
of the mean
at the end of the three month follow up.
Same effect with depression,
they started quite high on depression.
Three standard deviations of above the mean
between two and three.
And within a standard deviation of the mean,
after their three sessions,
we did a 15 month follow-up study,
which I mentioned that 84% were functioning normally.
We then divided the groups into those who had complete PTSD
and those who had partial PTSD,
meaning those who had PTSD symptoms
but didn't meet the full diagnosis.
Those persons having full PTSD got as much benefit
as and change as those who had partial PTSD.
And again, we see how they did on intrusion
and avoidance symptoms.
And now I'll move into phantom limb pain.
It may not be intuitively obvious,
but phantom limb pain has a lot in common with PTSD.
For example, 20 years after amputation,
70% of amputees still have phantom limb pain.
Less than 8% show any kind of permanent benefit
from any treatment that's available.
And our work with phantom limb pain,
With leggy amputees, we got elimination of phantom limb pain
with 80% in our case series.
And this illustrates our first two clients
with phantom limb pain that
their pain levels started at about six
on a zero to 10 pain scale.
And after three sessions,
our first client went down to zero pain.
Our second client went down to pain level of two.
The reason that she stated two
was that she had to have stump revision surgery,
which is where they cut off another inch
or two of the stump so that they can re pad the end
of the stump because the bone had started coming
through the end of the stump.
So it was reparative revision surgery.
And she was facing that
and was afraid that she would develop phantom limb pain
again and couldn't quite believe she'd gotten rid of it.
But at one year follow up,
then they both are down at zero.
So that took a total of three sessions.
In fact, they really both lost
their phantom limb pain within the first session.
We then did a case series with phantom limb pain
with six more individuals.
And this chart shows
that we got large reduction in distress,
even greater reduction in pain itself,
reductions in depression
and post-traumatic stress disorder symptoms
on a scale that relates to how large a change,
large changes are in this area.
Medium changes here.
So we got huge changes in subjective disturbance
and an elimination of pain.
And what we learned is there was one place in the world,
and it happened to be the University of Tubingen,
where they could measure phantom limb pain in the brain,
its existence in the first place in its disappearance.
And they had shown this with arm amputees using the MEG,
that's the magnetoencephalogram
of which measures the magnetic emanations from the brain.
It's like a multimillion dollar improvement
on the EEG as it's measuring the magnetic emanations,
which give better localization.
And what they had found is, say, with an army amputee that,
if the arm amputee was,
who had the phantom limb pain,
if their arm was anesthetized
with a brachial block anesthesia,
then the brain would normalize
as measured by the MEG.
And...
when the anesthesia were off,
the brain would reorganize
in a way that showed the pain had returned.
We thought, since we're getting success with EMDR
and phantom limb pain, then we ought to be able
to go there and use EMDR with these amputees
and find the same results,
only more long lasting with EMDR.
So my late wife and I went
to the University of Tubingen
and this is the MEG itself.
It looks like a giant hairdryer
and has to be in a room
that's protected from the earth's magnetic radiation
in order to measure these minute
emanations that come out
and are able to show the presence
or absence of phantom limb pain.
I think that,
well, let me, let's say that my right arm is amputated,
then on the contralateral side of my brain,
those neurons have nothing to do
and they get recruited
when the lip is stimulated
and the more the lip is stimulated
and the person then,
they can figure out where it ought to be
located on the contralateral side.
And if it's located somewhere different,
the degree of that angle, the greater the angle,
the greater the phantom limb pain.
So I'm gonna back up for a minute
and talk a little bit
about what we actually do in an EMDR session.
Let's take a fairly neutral case,
like an automobile accident victim.
I would ask the individual
to get an image in their brain
of the worst part of the accident.
As they held the image in mind,
I would ask them a few questions about the thoughts
and the feelings that that image brings up.
And then I would ask them to hold all of that in mind,
the image and the thoughts and the feelings
and move their eyes rapidly back
and forth for about 30 seconds.
Now, just about everybody has difficulty doing that.
So I help out by just having 'em track on the end
of my pen for 30 seconds.
At the end of the 30 seconds,
I would ask them to let the image go
and take a deep breath
and look inward and see what was there in their brain
at that point, whatever is there,
I would ask them to hold that in mind.
Again, go through the eye movements.
So we follow the the individual's train
of associations, wherever they go,
using the eye movements each step of the way.
There is one other part to what we do,
and that is because we're dealing
with people who are traumatized,
we want this to be safe as well as effective.
And so the first thing we actually do is set up
what's called a safe place.
And a safe place is any place
that they can think of where they feel safe,
comfortable, a sense of
ease or wellbeing.
And then they're instructed that if any point
in the rest of what we do,
if they feel overwhelmed by their feelings,
they give us a hand signal
to stop and then we stop and bring up the safe place.
So it acts as an escape patch if we need it.
Now that's the entire procedure
and it's very simple, but it's simple
like chess is simple, the basic moves are simple,
but as you go through it, it gets more complex
because everybody's different.
Everybody has different chains of association.
And the therapist's basic rules are if the process
is flowing, you stay out of the way.
If it gets stuck in some way,
then you intervene in some highly prescribed ways
to help it get unstuck.
So that is
what happens in EMDR.
And it leads to questions such as
why does a strange sounding procedure
like that do anything?
And we have some scientific evidence
and we have some educated guesses.
Now, the scientific evidence has to do with,
first of all, 20 years of
brain imaging,
where with brain imaging you can show initially
that when the person thinks of their trauma,
their brain lights up in a way
that shows their under intense distress.
And after successful treatment,
their brain now lights up in a way
that shows this is a normal memory,
not associated with intense distress.
So it documents the changes,
but it doesn't say why those changes occurred.
And actually in the last two to three years,
we are now able to use brain imaging
that not only shows the beginning
of an EMDR session in the end,
but actually those brain recordings all the way through.
And so you get to see how the brain changes
during the course of
the treatment.
And so this has been done.
We worked with a group in Italy who followed our protocols
and they were able to,
with PTSD in a single session,
show how the brain lights up
with PTSD and how it changes.
So at the end of the session,
PTSD is no longer there. okay?
We worked with a group in Japan
and they did a similar kind of brain imaging.
Only now with phantom limb pain,
an individual is that has phantom limb pain.
We see how the brain lights up at the beginning
with the pain and then we see how the brain changes
during the course of the session to the endpoint
where the person no longer has limb pain.
What this means, and this is really the headline,
what this means is that EMDR is the only form of therapy
that has a proven neurobiological effect on the brain,
not only with PTSD, but also with phantom limb pain.
And so from this,
we really are pushing the frontiers of science.
This kind of work needs to be replicated,
needs to be studied further.
And
the things that my late wife and I
and others in the EMDR field have been able to do
in terms of pushing those frontiers,
we feel very excited about.
We feel very grateful for.
And the last 25 years of my life working with EMDR
and with my friend, my lover,
my helpmate, my partner, have been really the most
exciting 25 years of my life.
And I feel thoroughly
blessed and grateful to have been able
to be a part of pushing
the edges of science.
So thank you very much.
(audience applauding)
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