The treatment known as eye movement desensitization and reprocessing (EMDR) was developed in 1987 by an American psychologist, Dr. Francine Shapiro, for the remediation of trauma symptoms and post-traumatic stress disorder (PTSD). Though numerous empirical studies (including several randomized control trials, or RCTs) have demonstrated the efficacy of EMDR for the treatment of PTSD (Bisson et al., 2013; Oren & Solomon, 2012), some researchers dismiss EMDR as a “purple hat therapy” (i.e., a therapy that adds novel, scientifically unverifiable, components to an established treatment with claims that its success is due to the novel components, not the established treatment).
Despite long-held critiques of EMDR among some clinicians and researchers (Herbert et al., 2000), in the 25-plus years of my career, I have encountered numerous patients with PTSD who have been helped by it after other treatments—including CBT, psychodynamic psychotherapy, and pharmacotherapy—were unsuccessful. Furthermore, in that time, I have yet to meet anyone, clinically, who was harmed by EMDR. Of course, anecdotal evidence like this is not on par with evidence from RCTs, so I would advise people to do their own research. In addition, it’s still possible that improvement in the cases referenced above was due to the established treatment components that EMDR uses (e.g., exposure therapy), not anything unique to EMDR (e.g., bilateral eye tracking of moving objects), but that doesn’t mean that EMDR can’t be a helpful tool for various clinical challenges, including performance enhancement in areas like sports, test-taking, and public speaking.
Research into EMDR as a tool for performance enhancement is at a nascent stage, and it’s much less developed than research for EMDR as a treatment for PTSD, but some evidence has begun to trickle in (Foster, 2012). Clinicians in most health care fields are constantly trying to balance the safety of their patients with practical considerations, like the need for improvement, and as most clinicians will attest, sometimes the science takes time to catch up to what clinicians have discovered, off-label. Such is the case with ketamine treatment and other psychedelic therapies that have only begun to acquire empirical research validation for the treatment of mental health conditions after decades of off-label experimentation by psychiatrists.
With this in mind, I offer the following summary of my interview with psychologist Dr. Carla Natalucci-Hall, Psy.D., PC, on the expanded use of EMDR for performance enhancement, including improvement in athletics, test-taking, public speaking, and many other areas beyond trauma remediation. Dr. Natalucci-Hall has nearly three decades of experience treating PTSD and a decade of experience applying EMDR to performance enhancement. She is a certified EMDR therapist, an approved EMDR consultant, and she has worked with the United States Olympic Committee (USOC) to help train athletes preparing for the Olympics.
I initially asked Dr. Natalucci-Hall for an interview after I was intrigued by an online talk she gave at Fordham University on the use of EMDR for performance enhancement, and during our discussion (shown here), she gave me a demonstration of the process.
According to Dr. Natalucci-Hall, the protocol for using EMDR for performance enhancement often begins with identifying the “small-t traumas” that give rise to their performance impediments. These small-t traumas might include a salient failure in a performance-related activity, like a pitcher giving up a game-losing home run. The next task is to create a script that contextualizes or reframes the failure (e.g., “I’m usually a very good pitcher, but I didn’t have my best fastball that day.”). It’s also common to add a visualization plan that includes preparatory activities, the typical performance activity, and any relevant post-performance activities.
After the script and visualization plan have been established, the treatment components unique to EMDR—bilateral sensory stimulation—are paired with the recitation of the script and the visualization protocol. The most common EMDR paradigm involves eyeball tracking of visual stimuli from left and right (as shown at minute 44:00 of the video here), but other paradigms involve bilateral sounds, vibrating handheld devices, and other forms of bilateral stimulation.
As per Dr. Natalucci-Hall, though the specific neurological mechanisms are not completely understood (as is also the case with many pharmacotherapies, like SSRIs, psychotherapy, and psychedelic treatments, among others), the leading hypothesis is that bilateral sensory stimulation helps individuals get into a flow state, possibly mediated by the frontal lobe. When paired with such flow states, the recitation of one’s script and visualization plan is able to penetrate the mind more deeply, especially when practiced on a daily basis and before performance events.
In closing, EMDR is a tool—similar to exposure therapy, antidepressants, and psychedelic drugs—that offers clinicians an option when all others fail. Like many forms of treatment, including all forms of psychotherapy, EMDR began as a means to help remediate a type of dysfunction, but in the spirit of Maslow’s hierarchy of needs, it has evolved to help people approach their own self-actualization. Such is the case with Dr. Natalucci-Hall’s work and that of other EMDR practitioners.
