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

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00:29How many people do you think—this is maybe a ridiculous question—but how many people, what percentage of people, do you think have trauma in some form, however you define it?

00:43You know, the figures are: a quarter of people get physically abused, one out of five people get sexually abused, one out of eight kids witness violence between their parents, etcetera, etcetera. So, if I sit in a room of professionals, which I do a lot, I assume that at least half of the group viscerally knows what trauma means. It's not a binary issue; it’s not like you either got traumatized or you didn't.

01:22And 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?

01:34Not necessarily. I can see how your brain may be different from other people's brains. I may take a particular population, average it out, and say there is a little more activation of the periaqueductal gray, or a little bit less of the right insula. You see certain patterns of connectivity in the brain.

01:59To some degree, we learn a lot about the brain, but we don't know much about the brain. I think people tend to overstate how much brain pictures can teach us. Our brain is like a universe, and our technology is very inadequate to really know about all the unbelievably complex connections there are. But we have learned a few things in the last 20 years.

02:31So, how does trauma affect the brain?

02:34It affects the brain such that you tend to... there is one part of your brain that I call the "cockroach center" of your brain, the periaqueductal gray. It lights up; it’s underneath the amygdala. Everyone knows the word amygdala these days. It is the part of your brain that tells you that you’re in danger. When you’re traumatized, it’s likely that that little part of your brain, way back in your brainstem, is firing all the time.

03:01All the time, you go like, "I’m in danger, I’m in danger, I’m in danger." And that starts at a very elementary sensory level. You don’t know what the danger is, but you just feel that you should be scared. Then there are other parts of your brain, for example, your insula, which makes the connection with your physical sensations and your body awareness.

03:26For many people, that gets shut down because the experience of trauma is a visceral experience of heartbreak and gut-wrench. 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 very alive either, because you don’t feel so scared all the time. But it’s likely that you will want to take some drugs to make yourself feel alive sometimes—stuff like that.

04:02So, the part of my brain around the amygdala, people that are traumatized, they have some kind of dysfunction in that typically?

04:13The dysfunction is that it keeps firing. And so, the amygdala creates a constant sense of subliminal dread.

04:22Is that anxiety?

04:23Anxiety is already a higher mental function. This is more elementary. It’s like your dog shaking. My daughter has an adopted dog that was traumatized, and two years later, the dog still walks through my house never quite comfortable. That’s how many traumatized people you meet are: never quite comfortable.

04:54So when someone says they are "triggered"?

04:56Trigger is on a higher level. Then the next level is indeed the trigger that is in part mediated by the amygdala. Your amygdala is your "smoke detector" that tends to become hypersensitive so that minor things get blown up. A minor thing that you may say to me, I take as the most insulting thing in the world. You’re constantly triggered by things, and that makes you feel like you are doing terrible things to me. It's not like I am hypersensitive; it's like "you're having an off day, and that's your issue, not mine." No, when you have an off day, I feel your off day, and we start getting into trouble together.

05:40I’ve got a picture here of what the brain looks like when the brain’s smoke detector goes off. Is that what it looks like on the brain?

05:48That is one particular guy, and nobody is exactly the same as everybody else. But basically, what you see here is a guy who is reliving a terrible car accident he was involved with. What you see here is that the right posterior part of the brain, the temporal-parietal junction on the right side of the brain, fires. That is the feeling part of your brain. So you go, "Oh my god, oh my god, I’m terrified."

06:21But there’s no cognition, and basically, the left side of the brain shuts down. So, when you’re in your trauma, you don’t become... you’re not a reasonable person. You actually become a little bit of a blabbering idiot. All of us, when we really are angry or upset, are not very articulate, but we have a lot of feeling.

06:44And then the piece where I show this is that as this guy is reliving his trauma, these two parts of the brain go offline: this is the dorsolateral prefrontal cortex. That's the part of the brain that’s the timekeeper of your brain.

07:05So, if something unpleasant happens between us, let’s say, I’ll go, "Oh, in another 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 when you’re in your trauma. You don’t know the difference between the past and the present because the timekeeper of your brain goes offline. Whatever you’re feeling is real, as opposed to feeling like a memory.

07:44So 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, and then there are these two blank, empty spaces that aren’t activated called the dorsolateral prefrontal cortex.

08:04That’s part of the system in the brain that gives you a sense of time. As long as you have a sense of time—it’s like little babies don't have a sense of time either—whatever happens, happens totally. Then you see a child slowly grow, and they can have a sense of perspective: "This is happening right now, but tomorrow it will be different."

08:33And that’s when, I presumably, that’s when you get anxiety, right? When you start thinking about the future?

08:37It is about having the 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 traumatized person.

09:04So 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 an fMRI scanner and he was intentionally triggered to see what would happen in his brain?

09:22No, we specifically said: "What did you see? What did you hear? What did you smell? What were you thinking?" Very specific sensory details. Not somebody else’s sensory details, your sensory details.

09:40And the right side of his brain was illuminated.

09:42The right side of the brain became very active, but what got inactivated was that timekeeper of his brain. So he could not lie there and say, "I am remembering what happened to me yesterday." He is reliving what happened yesterday. You feel like it’s happening right now. And that’s the nature of trauma. Trauma is not a memory; it’s a reliving.

10:13Are you consciously reliving it, or is your subconscious reliving it?

10:16You feel like it’s happening right now. With all forms of trauma. But not your... "it's happening right now," but my feeling is happening right now. You don't know that the feeling actually belonged to the time that your dad used to beat you. It is just "now, I feel the same way because I disagree with you."

10:44I’ve been triggered in the past, and I’ve felt that sort of instant fight or flight response because something’s happened. And it’s instantaneous. So, although I don’t feel like I’m back there, my body does feel like it's back there.

11:00People are confused about this. They say, "Oh, you relive the past." No, actually you’re not aware that you relive 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.

11:21And is there a way for this particular gentleman here who’s been through that car crash to ever stop this triggering?

11:28Oh yeah, he's done quite well. He did EMDR, actually. Eye Movement Desensitization and Reprocessing.

11:39And what was his result?

11:41He is an all-right guy. He’s functioning, he's fine. He’s no longer a traumatized person.

11:48What’s the most radical improvement you’ve seen in your clinical practice?

11:53Oh, really people coming to life. People just saying, "It’s over."

11:59Give me the best example.

12:01A good example is the videotape I showed people yesterday of a woman, again, a terrible car accident. Freezing, upset, freaked out. And then three sessions later, we go talk about it and she says, "Yeah, this shitty thing happened to me. I was in this car accident and I was jolted for it, and my head was swollen, and boy, that was terrible back then. But I’m fine now. I have a granddaughter and I drive my car to my granddaughter and I’m fine."

12:35Three sessions it took.

12:37Three sessions, yeah. We see it in psychedelic therapy all the time.

12:43What did you do in those three sessions?

12:45Wiggle your fingers in front of people’s eyes. For me, EMDR was really the "gateway drug." I’ve written three books about PTSD; I actually wrote the very first book in which the word PTSD exists in '84 or something. But I didn’t know how to treat it. So I’m a world-renowned expert, but I had no idea how to treat it because people keep reliving their trauma and they don’t know how to stop that.

13:16Then somebody starts telling me about EMDR, and I don’t believe a word of it. They say you just move your fingers in front of people's eyes, and you move your eye from side to side as you relive the trauma. And I go, "That's crazy." Everybody who hears it thinks that’s crazy. And then people start doing it, and they show me how it works, and I go like, "Wow." And people indeed—a certain sub-sample 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."

14:02You’re telling me that wiggling your fingers in front of people's eyes can help heal their trauma?

14:07Well, 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. Then we discovered that if you move your eyes back and forth as you recall a traumatic experience, you activate certain pathways between the temporal-parietal junction, which gives you a sense of self, and your insula, which is a 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 make it possible for your brain to make that distinction.

14:52And in the research that’s been done on this, what was the conclusion in terms of its efficacy?

15:00In 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 to treat.

15:30Early childhood trauma is much more stubborn and resistant to this treatment then?

15:36Because your early childhood experiences create who you are. If you go to a fancy college when you’re 18, you do become identified with that college, but it doesn't radically change you into a new person. 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.

16:05So it’s called Eye Movement Desensitization 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 found that EMDR significantly reduced PTSD symptoms. Depression, a 2024 systemic review reported that it alleviated depressive symptoms. The same 2014 meta-analysis noted that EMDR led to significant reductions in anxiety symptoms. And finally, a 2024 systemic review concluded that EMDR is as effective as other psychological treatments for PTSD.

16:55So, can you show me how it works? Can you do it on me?

16:59I could. Can I move my chair?

17:03Of course you can. You’re going to come closer?

17:06So, can you bring to mind a really unpleasant experience you’ve had not too long ago?

17:15Yeah.

17:16And can you bring to mind what you saw at that point?

17:21Yeah.

17:22Can you remember what the voice sounded like at that point? Or whatever it was, any sounds come to mind?

17:33Yeah.

17:34Do you remember what your body felt like back then?

17:38Yeah.

17:39Can you remember what you were thinking, or bring to mind what you were thinking?

17:46Yeah.

17:47Okay. So, how vivid is your feeling right now of recollecting it?

17:53Like a six or seven out of ten.

17:56Okay, so stay there. Now, follow my finger with your eyes. So, look at me right now.

18:05*[00:18:05 - 00:18:25: Silence in the audio as the demonstration takes place, accompanied by rhythmic tapping sounds as the eyes move back and forth.]*

18:25Take a deep breath.

18:28*[00:18:28 - 00:18:32: Sound of deep exhaling.]*

18:32So what comes to your mind right now as we’re doing this?

18:36I feel calm. Yeah, I just do, I feel calm.

18:43Okay. So when you go back to what you were just feeling, what’s it like now?

18:49It’s hard to recall why I was bothered. That’s the best way to describe it.

18:59See, that is the weird stuff.

19:03Why is that?

19:04See, 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 has gone now, but it is gone. And you know, of course, if we bring up something much worse than what you had gone through, it takes much longer and a lot of other stuff comes up. But somehow EMDR seems to do it, it creates new associative processes in the brain.

19:34For example, people did EMDR on me. Something really, really nasty had happened to me, and I started off being very upset. And then during the EMDR, I had images of sitting at my dining room table as a kid, and I had images of playing in a playground in primary school. Stuff that ordinarily doesn't come into my mind. And then we stopped it, and indeed it was like, "Yeah, that really sucked, time to go on."

20:09And the important part is, you did not tell me what you were going through. Because I’m suspicious of language. Language is always an interactive process, and if I were to 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 that. And so we circumvent this whole verbal process of your making meaning out of it, and we reorganize some core ways in which your brain is perceiving this.

20:46So 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. So when they quote the studies, the main study was done by me. NIH funded that, but that was also the last time that somebody could get funded from NIH for EMDR.

21:13What 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.

21:26*The Diary of a CEO* is brought to you by Progressive Insurance. Do you ever think about switching insurance companies to see if you could save some cash? Progressive makes it easy. Just drop in some details about yourself and see if you’re eligible to save money when you bundle your home and auto policies. The process only takes minutes, and it could mean hundreds more in your pocket. Visit progressive.com after this episode to see if you could save. Progressive Casualty Insurance Company and affiliates. Potential savings will vary, not available in all states.