Finding parallels: EMDR and art therapy intersections in clinical post-traumatic recovery
What is the importance of clinical flexibility in trauma-healing neuroplasticity?
Trauma impacts both our brains and our bodies through fundamentally interconnected systems. Treating trauma successfully allows clients opportunities to reactivate and reintegrate these systems after being disrupted. EMDR therapy and art therapy both bring powerful tools to the work of treating psychological trauma through non-verbal and multi-sensory integrated frameworks. The areas of intersection between these modalities continue to be interesting to me in providing multiple options to clients in working through charged and intense prior traumatic experiences in ways that are safe, client-directed, and effective. Trauma treatment is most successful if clinicians are equipped with flexibility to help client’s move between states of exploration and safety, between talk and bodily sensations, and between visiting the past while feeling alive and active in the present and able to imagine a healthy future.
What is the adaptive information processing model?
EMDR therapy presupposes an innate psychological system called the “adaptive information processing model,” or simply “information processing.” This describes to an inherent tendency for our bodies to maintain homeostasis/neurological balance in a distinct physiological system that allows incoming information to be processed to an “adaptive resolution”— meaning that the neural connections to appropriate associations are made following each experience, and the information and is used constructively and is integrated into a balanced emotional and cognitive schemas. Essentially, what is useful is learned, and is stored neurologically with the appropriate mood and affect and is available for future use.
When someone experiences trauma, an imbalance may occur in the nervous system, disrupting the information-process system and leaving the sensory information encoded during the trauma—including the images, sounds, affect, and physical sensations—is held psychologically in its disturbing and potentially distorted/amplified state. Therefore, the original traumatic material, which is held in this distressing, excitatory state-specific form can be triggered by a variety of internal and external stimuli and may be expressed in the form of nightmares, body pain, flashbacks, and intrusive-thoughts. This traumatic memory material, when triggered, can push a person outside of their psychological “window of tolerance.” This conceptual “window of tolerance” is reflective of the brain’s optimal physiological arousal level for the useful functioning of the adaptive information processing system. In therapy, clients and clinicians can make use of the mind map below to help visualize the space that exists between “HYPO arousal” and “HYPER arousal”.
When hypoaroused, we can experience and absence of sensation and apathy. We may also experience the following:
Relative absence of stimulation
Numbing of emotions
Disabled cognitive processing
Reduced physical movement
With hyperarousal, our cognitive processing tends to be disorganized and in disarray. We may also experience the following:
Increased sensation
Emotional reactivity
Hypervigilance
Intrusive imagery
Disorganized cognitive processing
How can trauma therapy help expand the window of tolerance?
As trauma sensitive practitioners, we want to make sure that survivors are practicing in a safe and stabilizing way. This means helping people enhance their ability to self-regulate rather than having them having them spin out of control. The window of tolerance offers a framework to do this, and can inform interventions. Both EMDR therapy and art therapy offer unique ways of helping clients to expand their window of tolerance and regulate their nervous systems to more successfully process areas of prior trauma. Two important areas of overlap between these two frameworks involve the interconnected concepts of “dual attention awareness,” and “dynamic attention anchors".
Dual attention awareness: The ability to simultaneously be aware of present safety in the here-and-now, including their positive personal qualities, and various strengths, while accessing disturbing traumatic memory material.
Dynamic attention anchors: An emotionally neutral reference point that helps support mental stability through mindful focus on dynamic sensory information under one’s control/agency.
According to EMDR, dual attention stimuli trigger a psychological state that facilitates information processing. The hypothesis states that the target information is metabolized and transmuted along associated memory channels through the progressive states of self-healing through the EMDR protocol. In this framework, transmutation (or conversion/transformational shift) is seen in all elements of the information—images, emotions, sensations, beliefs. As the information moves from dysfunctional to functional form, the negative manifestations of the target dissipate and the positive manifestations become vivid. The bilateral movements or bilateral tactile stimulation allows an apparent titration of the negative affect of the target traumatic memory network while simultaneously giving the client a task they can accomplish effectively. On a physiological level, this dual focus of attention may alter the stereotypical trauma response and aid in the therapeutic adaptation. On a conscious level, the dual attention awareness allows the client to maintain a sense of the present along with the connection to the resource of the therapist.
Art making in the context of art therapy functions as a mindfulness practice, providing a flexible and dynamic “anchor of attention”, a neutral reference point that helps support mental stability. When we become lost or distracted in our minds and disconnected from our bodies and sensations, we can return to our sensory art making as an anchor, and fix our attention on the stimuli of visual mark making and the associated sensations in ways that are visual, tactile, and kinesthetic. Attention anchors can potentially intensify trauma if they are associated with aspects of the trauma itself, so in selecting an anchor, the client and art therapist may experiment with various artistic media to find what combinations of mark making and materials best bring a “stabilizing anchor of attention”. Clients are encouraged to tap into dual attention awareness to attend to both their somatic sensations to gauge their nervous system regulation or dysregulation, while also focusing in a “single pointed” manner on the anchor point of the connection point of the mark making tool (such as the tip of the paintbrush or the marker and art surface of paper or canvas). Art making as an mindfulness attention anchor is particularly powerful as it connects several perceptive senses and involves both movement, tactile stimuli, and visual/optical feedback—all of which can help to hold attention more easily than an anchor that is more subtle or static. The more tangible the anchor, the easier it is to return to it when the mind wanders.
The watercolor painting above is an example of an art therapy painting that was created as a dynamic attention anchor within a trauma processing setting. The combination of using watercolor pigments with a water dropper pipet provided the artist with a dynamic attention anchor of visual “flow” as they witnessed the pigments and water blending together in unexpected ways, which was followed with a more controlled drawing process using a ball point pen to outline the dried color shapes. The flexibility and experimental nature of this application allowed the artist to build a sense of mindfulness while also maintaining a sense of autonomy and personal control, which helps to reestablish safety within the body.
Seeing natural synergies between EMDR and art therapy continues to be an enjoyable part of my therapeutic practice, and I find these two therapy frameworks hold overlapping knowledge as seen through different lenses that reinforce the strengths of each model while allowing for new connections to be drawn and explored.
References:
Shapiro, F. (2001) Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures, Second Edition. New York, NY: Guilford.
Treleaven, D. A. (2018) Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing. New York, NY: Norton.
