Transcript of Most Replayed Moment: Can Eye Movements Heal Trauma? Bessel Van Der Kolk Explains EMDR Therapy!

How many people do you think... I mean, this is maybe a ridiculous question, but how many people, what percentage of people do you think have trauma in some form? How you define it?

The figures are a quarter of people get physically abused, one of five people got sexually abused, one of eight kids witnessed as far as being their parents, et cetera. So If I sit in a room, it's not a binary issue. It's not either you were traumatized, you didn't get traumatized. But when I talk to a room of professionals, which I do a lot, I assume that at least half the group viscerally knows what trauma means.

What is trauma doing to my brain? You said you've done a lot of neuroimaging scans. If I was traumatized and you scanned my brain, is there something you could see?

Not necessarily. I can see how So your brain may be different from other people's brains. I may take a particular population, you can average it out, and you can say, Oh, there's a little more activation of the periaquidart to gray, a little bit less of the bite Insulin. So you see certain patterns of connectivity in the brain. But to some degree, I think we learn a lot about the brain, but we don't know much about the brain. And I think people to overstate how much the brain pictures can teach us. I love the Hubels telescope or the Webb telescope. Our brain is like a universe, and our technology is very inadequate to really know about all the unbelievably complex connection the brain has. But we have learned a few things in the last 20 years.

How does trauma affect the brain?

It affects the brain that you tend to... There's one part of your brain that I call the cockroach center of your brain, the periaquius gray, that lights up. It's underneath the amygdala. Everybody knows the word amygdala these days. The part of your brain that tells you that you're in danger. When you're traumatized, you're likely that That little part of your brain, way back in your brainstem, is firing all the time. All the time you go like, I'm in danger, I'm in danger, I'm in danger. That's where it starts in a very elementary sense three level. You don't know what the danger is, but you just feel that you should be scared. Then there's certain other parts of your brain, for example, your insula, which makes the connection with your physical sensations and your body awareness that for many people get shut down because basically the experience of trauma is a visceral experience of heartbreak and gut revenge. And if you have a lot of that, you can learn to shut that part of your brain down so you don't feel your body so much anymore. You don't feel your body so much. You don't feel very alive either.

You don't feel so scared all the time. But it's likely that you will undertake some drugs to make yourself feel alive sometimes. Stuff like that.

The part of my brain, you said just around the amygdala. Below the amygdala. People that are traumatized, they have some dysfunction in that, typically.

The dysfunction is that it keeps firing.

Keeps firing.

How does that make you feel? And then the amygdala, so there's a constant sense of subliminal dread.

Is that anxiety?

Anxiety is already too high of a mental function. It's more elementary. It's like your dog shaking. My daughter has adopted a dog. She was at time. Two years later, the dog still walks to my You've adopted a dog and it shakes in your house still. Yeah, but still never quite comfortable. That's how many times you meet her, never quite comfortable.

When someone says they're triggered?

No, trigger isn't a higher level thing.

Okay.

Then the next level is indeed the trigger that is in part mediated by the amygdala. If your amygdala is your smoke detector, that tends to become hypersensitive so that minor things get blown up and A minor thing that you may say to me, I take as the most insulting thing in the world. And so you're constantly triggered by things and that makes you feel like you are doing terrible things to me. It's It's not like I'm hypersensitive, and when you have an off day, that is your issue and not my issue. No, when you have an off day, I feel your off day, and we start getting into trouble together.

I've got a picture here of what the what the brain looks like when the brain's smoke detector goes off. Is that what it looks like on the brain?

That is one particular guy, and nobody is exactly the same as everybody else.

Can you explain this to me?

But basically, what you see here is This is a guy who is reliving a terrible car accident he was involved in. What you see here is that the right posterior part of the brain, this temporal parietal junction on the right side of the brain fires, and that's the feeling part of your brain. So you go, oh, my God, oh, my God, I'm terrified. But there's no cognition. Basically, the left side of the brain shuts down. So when you're in your trauma, you're not a reasonable person. You actually become a little bit of a blabbering idiot. All of us, when we really are angry, upset, are not very articulate, but we have a lot of feelings. And then the piece that I show this is that As this guy is reliving his trauma, these two parts of your brain go offline. This is the dorsal lateral prefrontal cortex. That's the part of the brain that's the timekeeper of your brain. So if something unpleasant happens between us, let's say. I'll go, Oh, it's not a half hour and I'll be okay. So let me just put up with this. But when you get traumatized, the timekeeper disappears, and this is all there is.

You lose your sense of perspective, and that is What happens in your trauma. You don't know the difference between the past and the present because the timekeeper of your brain goes offline and whatever your feeling is real as opposed to feeling like a memory.

Do you get it? Yeah. For people that can't see it in this brain scan, what I'm basically seeing is the right side is extremely activated, the left side looks like it's off. Off, yeah. Then there's these two blank empty spaces that aren't activating It's called the dorsal lateral prefrontal cortex.

Dorsal lateral prefrontal cortex. That's part of the system in the brain that give you a sense of time.

Okay.

As long as you have a sense, it's like little babies don't have a sense of time either. It's like whatever happens, it happens totally. Then you see a child slowly grow and they get a sense of perspective. It's happening right now, but tomorrow it will be different.

Okay, so that's when... I mean, presumably that's when you get anxiety, right? When you start thinking about the future.

It is about having a perspective of this is happening right now, right now I'm really scared, but the moment I go home, the moment I call my friend, I'll feel better. You need to have that capacity for perspective, and that perspective goes offline when you're in your trauma and you become a trauma-dyspareuse.

So this particular person, this brain scan that I have here, this guy was in a car accident, and the triggered brain that I'm looking at here is he was basically put in a an fMRI scanner, and he was intentionally triggered to see what would happen in his brain. Exactly. So he was shown maybe a car accident or something. No, no.

Specifically, his car accident.

Oh, you showed him a picture of his car.

What did you see? What did you hear? What did you smell? What were you thinking? Very specific sensory details. Okay, so you are-Not somebody else's sensory. Your sensory details.

And the right side of his brain was illuminated.

Yeah, his light side of the brain became very active, but got inactivated was the timekeeper of his brain. So he could not lie there and say, Oh, I'm remembering what happened to me yesterday. He's reliving what happened yesterday.

Instantly?

You feel like it's happening right now. And that's the nature of trauma. Trauma is not a memory, it's a reliving.

Are you consciously reliving it or is your subconscious reliving it?

You feel like it's happening right now.

With all forms of trauma.

But it's happening right now. But my feeling is happening right now. You don't know that the feelings actually belong to the time that your dad used to beat you. It is now I feel the same way because I disagree with you.

So I've been triggered in the past and I felt that instant fight or flight response because something's happened or whatever, and it's instantaneous. So although I don't feel like I'm back there, my body does feel like it's back there.

So people are confused about it. They say, Oh, you relived the past. No, actually, you're not aware that you relived the past because the past is the present. So you don't think, Oh, this reminds me about the time that my dad used to beat me when I was four years old. No, it feels like you are beating me right now.

And is there a way for this particular gentleman here who's been through that car crash to ever stop this triggering?

Yeah, he's done quite well. He's done quite well? He did EM We are actually. We have high movement descentization.

And what was his results?

He's an all right guy. He's functioning. He's fine. He's no longer a traumatized by the same.

What's the most radical improvement you've seen in your clinical practice?

Oh, really people really coming to life. People just saying it's over.

Give me the best example.

A good example is the videotape I showed you people yesterday of a woman, again, terrible car accident, freezing, upset, flicked out. And then three sessions later, we got to talk about it. She said, Yeah, this shitty thing happened to me. I was in this car accident and jolted for it and my head was And boy, that was terrible back then. But I have a granddaughter, and I drive my car to my granddaughter, and I'm fine.

Three sessions it took.

Three sessions, yeah. And we saw it in psychedelic therapy all the time.

What did you do in those three sessions?

Wiggle your fingers in front of people's eyes. For me, EMDR was really the gage made work. Sorry, I've written three books about PTSD. I actually wrote a very first book in which the word PTSD exists in 84 or something. But they didn't know how to treat it. So I'm a world renowned expert, but I have no idea how to treat it because people keep reliving their trauma and they don't know how to stop that. And somebody starts telling me about EMDR, and I don't believe a word of it. They said, Yes, you move your fingers in front of people's eyes. You move your eye from side to side as you relive the trauma. I go, That's crazy. Everybody who hears it, that's crazy. Then people start doing it, and they show me how it works. I go like, Wow. A subsample of people we studied, indeed, after a few sessions of EMDR, go like, Yeah, that really sucked. But it's over. It belongs to the past. It's not happening right now.

You're telling me that wiggling your fingers in front of people's eyes can help heal their trauma?

Well, then, of course, we had to do a little research, which took us 15 years to get enough funding to do it, to see what happens when you move your eyes back and forth. And then we discovered that if you move your eyes back and forth, as you recall a traumatic experience, if you activate certain pathways, It's between the temporal-partial junction, which is your sense of self and your insular, your sense of your body. So your brain is able to say, Oh, yeah, this is what happened to me, but it happened to me in the past. So these are pathways that makes it possible for your brain to make that distinction.

And in the research that's been done on this, what did the outcome? What was the conclusion in terms of its efficacy?

In terms of in our research, 78% of the people who had adult onset trauma, so being assaulted or raped by a stranger, 78% of them were completely cured. But that's not the majority of people we see, because most people we see have early childhood trauma, which is much more complicated as a treatment.

Early childhood trauma is much more stubborn and resistant to this treatment.

Yeah, because your early childhood experiences create who you are. If you go to a fancy college when you're 18, you do become identified by that college, but it doesn't radically change you into a new person. It becomes part of your identity. But if you grow up in a certain family early on in your life, you actually become that. The imprint is very deep early on.

It's called eye movement desensitation and reprocessing treatment. I was just looking up some stats about it. It says it's been extensively studied with evidence supporting its efficacy across various conditions. With PTSD, a 2014 meta-analysis of 26 randomized control trials found that EMDR significantly reduced PTSD symptoms with a large effect size. Depression, a 2024 systemic review and meta-analysis encompassing 25 studies and more than a thousand participants reported that it alleviated depressive symptoms. The same 2014 meta-analysis noted that EMDR led to significant reductions in anxiety symptoms among PTSD patients with a large effect. Finally, a 2024 systemic review and individual participation data meta-analysis concluded that EMDR is as effective as other psychological treatments for PTSD, achieving comparable symptom reduction and remission rates. Can you show me how it works? Can you do it on me?

I could. Can I move my chair?

Of course you can. You're going to come closer.

Can you bring to mind, and It's really about an unpleasant experience you have had not too long ago? Can you bring to mind what you saw at that point? Can you remember what the voice sounded like at that point? Or whatever it was. Any sounds come to mind?

Yeah.

Do you remember what your body felt like back then?

Yeah.

Can you remember what you were thinking or bring to mind what you were thinking?

Yeah. Okay.

How vivid is your feeling right now by collecting it?

Like a 6, 7 out of 10.

Okay, so stay there. Now, follow my finger with your eyes. Look at me right now. Deep breath. What comes to your mind right now as we're doing this?

I feel calm. Yeah, I just don't feel calm.

When you go back to what you were just feeling, what's it like now?

It's It's hard to recall why I was bothered. That's the best way to describe it.

That is the weird stuff.

Why is that? Is that just because... Why is that?

No, see, that is what's so great about this work. We don't know the linearity. We don't know where the hell the emotional imprint is gone now, but it is. Of course, if you bring up something much worse than what you're going to, it takes much longer and a lot of other stuff comes up. But somehow EMDR seems to do it creates new associative processes in the brain. Let's say for some people did EMDR me, something really very nasty had happened to me, and I started off being very upset. Then during the EMDR, I don't know if this happened to you, I had images of sitting in my dining room table as a kid and had images of playing in a playground in primary school. Don't come in my mind. Then we stopped it, and indeed, that really sucked. Time to go on. An important part of this, you did not tell me what you were going through. Because I'm suspicious of language, because language is always an interactive process. If I would ask you to tell me what happened, you will filter yourself because certain things may be embarrassing or you don't want me to know about it.

We circumvent this whole verbal process of your making meaning out of it. We organized some core ways in which your brain is perceiving this. You saw a little bit of this in a minor way. For me, when I first saw this, I was blown away by it and thought, I need to study this. When they quote the studies, study was done by me. Nih funded it. But I was also the last time that somebody could fund it for EMDR.

What you just listened to was a most replayed moment from a previous episode. If you want to listen to that full episode, I've linked it down below. Check the description. Thank you.