Jason N. Linder, PsyD

posted July 19, 2020

 

Despite being four times more likely than women to die from suicide and two to three time more likely to abuse drugs and alcohol, men are slow to seek help for mental health problems. Psychologists have a pretty good notion of why this is. Men who fail to live up to the norms of traditional masculinity — protecting and providing without complaint — feel emasculated and tend to see talking about that feeling as further emasculating. 

 

Because psychoanalysis traditionally requires lending voice to emotion, it remains less popular with men, who currently constitute only a third of therapy patients. This is why a growing number of therapists looking to expand or right-size the male patient base are getting excited about eye movement desensitization and reprocessing therapy, which might offer the benefits of traditional therapy without requiring the same amount of disclosure.

 

“EMDR is not your traditional psychotherapy experience, and may actually be ideal for a man who is not comfortable talking,” psychotherapist Tara Bulin explains. Bullin, who has been practicing EMDR with men since 2005, describes it as solution-focused therapy that happens mostly silently. “There is minimal talking because the work is really about the internal processing of the trauma. There also isn’t that pressure to talk about thoughts and feelings, which might feel more uncomfortable for men initially.”

 

What is EMDR?

 

EMDR was developed by psychologist Francine Shapiro in the late 1980s, when she realized rapid eye movements alleviated her own psychological distress. Even after decades of case studies perfecting and demonstrating the technique, EMDR struggled to become legitimized beyond a “pseudoscience,” mostly because it seemed too good to be true.

 

However, subsequent studies highlight a number of biases in the research debunking EMDR, and there’s evidence that efficacy can be hindered by lack of proper training and skepticism of clinicians facilitating the session. Despite criticism, the efficacy of EMDR has been demonstrated by over 30 randomized clinical studies with PTSD remission rates ranging from 77 to 100 percent, depending on the type of trauma and number of sessions.

 

The Department of Veterans Affairs, the International Society for Traumatic Stress Studies, and the American Psychiatric Association all recommend EMDR as a viable treatment option for PTSD. In 2017, the American Psychological Association also recommended EMDR for brief use in their Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. 

 

Used since the early 2000s, it has been a game-changer for combat veterans and sexual assault survivors. The question now is whether or not EMDR can work for people who haven’t suffered profound trauma. EMDR can provide relief for those who can pinpoint their psychological distress. 

 

How Does EMDR Work?

 

Traumatic experiences map to the brain, training the amygdala and limbic system to respond to memories as though they were present threats. This means that, once triggered, traumatized people lose access to reason. This is the underlying dynamic of PTSD, which is how post-traumatic stress disorder develops. For a person with PTSD, it does not matter if they rationally understand that they’re not being attacked because their amygdala is overriding executive function.  They remain under constant neurological fire.

 

EMDR addresses psychological distress by treating the neurological sources of confusion the way physical therapy treats sources of physical pain. More specifically, the technique uses bilateral stimulation, often in the form of rapid eye movements from right to left, to repair the brain’s processing system and quell the psychological effects of the trauma.

 

Picturing a painful memory while engaging with bilateral stimulation has been found to decrease psychological arousal and anxiety enough that traumatized people can recover access to coping mechanisms unavailable to them when in fight or flight mode. Therapists are not able to delete trauma, but they can turn down the intensity of memories so they’re more manageable.

 

Scientists suspect it’s so effective because it essentially combines exposure therapy with rapid eye movements associated with sleep. During REM sleep, the brain eliminates unnecessary information, in a process known as reverse-learning, which might also help to dampen intrusive thoughts. “This analytical approach can eliminate the stigma of weakness or hypersensitivity and that is commonly associated with psychotherapy,” psychotherapist Jessica Jefferson explains.

 

Why Men Need It

 

Trauma comes in many forms. Psychotherapist, podcaster, and author Esther Perel recently identified trauma as one of the five key pillars of the male identity in her keynote address at her conference “The Paradox of Masculinity.” According to Perel, most men experience a significant rejection of their masculinity that comes to shape who they are. Men are told they’re not strong, competent, or manly enough by their peers or their fathers. This seems like an individual experience that wouldn’t qualify as traumatic, but is actually incredibly common and does because it creates the same unreasoning reaction to memory.

 

What EMDR represents for men may be the opportunity to move past memories of exclusion and isolation in order to move past harmful masculinity. And men don’t ultimately need to consider the effort to do this as being about trauma. It’s much more about putting specific, unwanted feelings to bed. It’s a targeted attack. That may allow many men to feel better without giving up a sense of control or handing over a lot of money to a psychotherapy.

 

“There is tremendous misinformation on what qualifies as a traumatic event and how individuals should or should not be impacted,” Bulin says, noting that trauma is any event that cognitively affects someone’s ability to cope. “Traumatic exposure often manifest themselves more discreetly in men as difficulty communicating, marital or relationship challenges, employment related challenges, anger, and self-medication with drugs and alcohol. There is an added pressure to be strong and to not allow themselves to be impacted by events in their lives.”

 

What Patients Can Expect

 

EMDR starts with an introductory appointment where a person talks about what brought them into therapy and what’s bothering them in that moment. Unlike a standard intake, patients don’t have to go into details about disturbing events. They just have to be able to identify what happened, how it made them feel, and how they’d like to feel instead, with help from their therapist.

 

Before bilateral stimulation starts, patients are trained in calming techniques, which may vary depending on the individual and clinician. Jefferson guides her patients through breathing exercises and instructs them to visualize safe spaces with specific sounds, smells, and sensory details, along with a container that they can fit anything into for later, including emotions. These images may sound trivial but serve as a line of defense against more primitive parts of the brain attempting to override it.

 

Patients then identify a scene or image that’s disturbing them — this can be anything from a traumatic childhood event to a spousal spat earlier that day. From there, they make one simple statement about how they felt, such as “I’m weak,” “I’m unlovable,” or “I’m less of a man. Alternatively, they can articulate a feeling of looming threat, saying something along the lines of “I’m in danger” or “I can’t protect my family” and rating how much they feel this in the moment on a scale of zero to ten. Finally, they pick a positive self-statement they’d rather believe such as “I’m in control,” “I’m a good person,” or “I’m safe now,” and rate how much they believe that on a scale of one to seven. Clinicians then guide them through rapid eye movements while they play the disturbance back through their brain like a movie, before discussing what feelings came up, and giving their SUD and VOC scores again.

 

When people aren’t treating an isolated trauma, other related disturbances often come up during this time, which can be scored and addressed the same way at future sessions, which last for between 45 and 90 minutes. The goal is to get the SUD score down to a zero and VOC scores up to a seven, but this can vary depending on the severity of the trauma. Before the session concludes, patients reflect on how they felt prior to the appointment versus after, and review relaxation techniques for when disturbances. And with a minimum of three sessions, the goal is for the positive cognition to eventually replace the negative one as a matter of habit.

 

Breaking down feelings into numbers may have further appeal to men who are more comfortable expressing their emotions in more concrete terms. And as much as EMDR may be more efficient that more traditional forms of psychotherapy, what they have in common is that patients need to be honest with themselves and their therapists for it to be effective — whether they’re sharing their most painful memories in gruesome detail, or simply the number seven.

 

But for men who genuinely want to feel better but are less open to talk therapy, or have tried it without results, EMDR might offer them another way. Much like certain psychotropic medications alleviate psychological symptoms for some and not others, there are many different types of therapy that may be more effective particular personalities. EMDR could be that for otherwise treatment-resistant men, not because its a quick fix that requires little talking, but because it’s a viable option that lets patients maintain a sense of control.   

 

 “EMDR gives men the opportunity to take off their Superman capes without feeling vulnerable or powerless,” Jefferson says. “By cutting through years of ignoring or masking traumatic experiences, men can take an objective view of their past, present, and future and identify opportunities to learn, heal and grow stronger in all of their roles.”

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