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Bilateral Stimulation – A Powerful Ingredient for Therapeutic Integration

In the late 1980’s a therapist named Francine Shapiro discovered that by moving her eyes right and left, she could affect the intensity of negative thoughts. More surprising, she found that even hours or days later, the thoughts that previously had been quite disturbing no longer bothered her. This led her to continue to explore, develop and refine a therapy called Eye Movement Desensitization and Reprocessing (EMDR), which has become one of the most researched and utilized modalities in treating the effects of traumatic incidents. The original EMDR used only bilateral eye movements, but with time it was discovered that tactile BLS such as tapping or vibrating on either side of the body, or auditory BLS, sound or music that alternates between the two ears, can also be effective therapeutic forms of bilateral stimulation.

Since Shapiro’s initial discovery, other therapeutic techniques have also defined protocols that use the power of bilateral stimulation to effect lasting healing and change, such as Brainspotting, ART (Accelerated Resolution Therapy), and some tapping or EFT− Emotional Freedom Techniques. When I began learning the power of integrating bilateral stimulation (BLS) into the therapy that I was doing with my clients, I was surprised to learn that the Ba’al Shem Tov taught about the power of BLS about 300 years earlier. The book Tzavaat HaRivash says:

ולפעמים צריך להסתכל לכאן ולכאן כדי להדביק מחשבתו בבורא ית' מפני חומריות גופו שהוא מסך מבדיל על הנשמה:

“There are times when one needs to look this way and that in order to attach his thoughts to the Creator. This is because of the physicality of the body, which can be a barrier to the soul.”

This short definition and application of BLS is fascinating, and gives us a glimpse of what can be accomplished using BLS. It seems that the Ba’al Shem Tov understood that bilateral eye movements could help the mind overcome the barriers that exist between the soul and the body, creating a more unified experience of prayer and meditation.

More recent clinical and neuroscience gives us a clearer picture of what can happen when we use BLS techniques. I have compiled here a list of ways that I have found BLS to be helpful to my clients in their therapeutic processes.

·        BLS can create an embodied sense of calm. BLS calms the amygdala, and other parts of the brain and body that cause a threat response. Trauma sets off a whole cascade of neurochemicals and physiological responses known as the fight/flight/freeze effect. Remembering traumas that occurred even many years earlier can retrigger this effect, making it terrifying for the client to process memories of the trauma. Adding BLS can calm this effect, helping the client stay oriented to the present and able to resolve the trauma.

·        BLS can activate and empower the prefrontal cortex. The prefrontal cortex, or PFC, is the most highly developed and uniquely human part of the brain. It is responsible for higher-order thinking, decision-making, and emotional regulation. When the amygdala is calmed, the PFC is able to take the lead, with clear and focused executive function skills.

·        BLS can activate the power of the Anterior Cingulate Cortex (ACC). The ACC plays a key role in emotional regulation, decision-making, and cognitive control. BLS may help reduce the intensity of emotional reactions by enhancing the ACC's ability to modulate the emotional responses generated by the amygdala. This can result in a more balanced and less reactive emotional state. The ACC is also associated with cognitive flexibility, or the ability to shift thinking and adapt to new situations. BLS may enhance cognitive flexibility by facilitating communication between the ACC and other brain regions, helping individuals process and reframe traumatic memories in a less distressing way.

·        BLS can turn on the ‘selfie cam’. Part of what the PFC does is monitor our internal experience. Most of the time when we are interacting with the world, we have more awareness of what’s going on around us than what’s going on within us. We are constantly scanning our surroundings, watching and listening to the people around us. In order to effectively treat trauma, we need emotional presence and self-awareness. We need to be able to feel and share what’s going on inside of us. We need to be able to stay within a range of emotional intensity that feels safe and present. In order to do that, it is essential to turn our awareness inward and pay more attention to the internal experience than the external experience. Using bilateral stimulation can facilitate this shift to internal awareness. Some clients like to close their eyes at this point, making auditory or tactile BLS preferable.

·        BLS can unravel a chain of related traumatic experiences. Sometimes clients come for help with trauma related symptoms and high distress, but aren’t fully aware of what the traumatic experience was. Sometimes the client is aware of negative beliefs about themselves, life or relationships, but not quite sure where they learned them. In order to effectively treat deep-seated trauma we need to first fully access the memories. Just as pulling the yarn on an old sweater can unravel a whole sleeve, accessing a traumatic memory or belief in an embodied way, and then adding BLS can help us unravel a number of related negative experiences, processing the whole batch together. It seems that in doing so we are accessing the hippocampus, which is crucial for memory formation and retrieval.

·        BLS is like transforming an Excel into a PDF. When traumatic memories are accessed, they feel alive, they move within our bodies and activate our response systems, similar to an Excel file that can add and change numbers based on its own calculations. Once we have accessed the memories in the hippocampus, we can use BLS to help neutralize or digest memories that we hadn’t had the resources to digest in the past, similar to person taking digestive enzymes to help digest something that would otherwise not sit well with them. Once processed, it’s as if the memory has now been saved as a PDF. It still contains the relevant information, but it no longer feels as distressing and activating as it did before. In other words, BLS is believed to help the hippocampus reprocess traumatic memories, transforming them from a hyper-emotional state to more neutral, narrative memories, thus reducing the emotional charge.

·        BLS can erase or lessen the impact of intrusive images. In our modern world, we don’t need to be exposed to trauma in order to witness images that can be highly disturbing and intrusive, popping up in our memories and causing distress. Bilateral stimulation, especially eye movements, can quickly and effectively wipe out the intensity, and even the clear memory of such issues. The occipital, temporal, and parietal lobes of the brain are all involved in processing and understanding what we see. When added to the other parts of the brain involved, 30-40% of our brains are involved in visual processing! We don’t yet understand how and why BLS is able to effectively wipe out negative visual input, but research together with 10 years of my own clinical experience have shown me that it can. This can be lifechanging for people who were exposed to explicit or violent images.

·        BLS can stimulate brain activity that is similar to REM sleep. Under normal circumstances, we experience a lot each day, and as part of our natural sleep cycle each night, our brains process our experiences during REM sleep when we dream. The brain activity during BLS is very similar to REM sleep; calming the amygdala and activating the hippocampus that is crucial for memory formation and consolidation, and the ACC is involved in cognitive control and emotional regulation. Experientially, BLS processing can feel a little bit like lucid dreaming, with vivid dreamlike images, and full waking cognitive awareness. This can allow the client to have positive and healing corrective experiences that feel very real, and can have real, lasting therapeutic impact.

·        BLS can help fill in trauma gaps in developmental history. Because BLS processing feels so real, and activates brain activity in areas that don’t differentiate between reality and imagination, it is possible to offer clients healing developmental experiences. Keep in mind that some traumas are a result of something painful that happened, and other traumas are a result of necessary emotional building blocks, or developmental experiences that, sadly, didn’t happen, such as the feeling of being supported and encouraged in crucial moments, or being held, understood and nourished in painful moments. If a person’s childhood lacked in these essential interactions, BLS can allow the client to have experiences that will fill in those gaping holes and lead to an improvement in symptoms and overall wellbeing. This same process can be used to connect clients to their current internal and external resources, bringing a sense of strength and empowerment.

·        BLS can restore order to our human meaning-making mechanisms. Humans are constantly taking in information about the world around us, and organizing it internally to make sense. Most of the time our internal capacity to make meaning works well, but sometimes we experience things that are beyond our capacity to make sense of. It’s as if we have an internal filing system; as long as we know how to file away our experiences, we feel safe and settled. Sometimes we experience things that upset our filing system; nothing makes sense anymore, and we don’t know how to organize our thoughts around the experience. Consider the fallout of October 7th, a freak accident, or the sudden and tragic loss of a loved one. We just don’t know how to make sense of what we are experiencing, and the “cogs of the wheels of our brains” feel jammed. BLS, as part of compassionate and professional therapy, can help us have the calm and perspective needed to reorganize our meaning-making systems, and find ways to live adaptively within our new realities.

·        BLS can activate the thalamus. The thalamus acts as a relay station for sensory information. BLS may influence the thalamus by helping to redirect attention away from distressing sensory cues associated with trauma, thus aiding in desensitization. If a client is getting distressing trauma cues from the parts of the brain and body that are feeling distress, and simultaneously the thalamus is processing the neutral and even pleasant feeling of bilateral stimuli, that distracts the brain and body from the distress to a certain degree, making it feel safer to remember the trauma.

·        BLS can tax the working memory. Have you ever tried remembering a phone number by repeating it over and over in your mind, only to have something distract you and cause you to forget the numbers? Our working memory can hold relatively little information at one time. Accessing the traumatic memory, bringing it into the desktop of the working memory and then adding multiple forms of BLS eye movements, sound and tactile stimuli together, can so-to-speak wipe the emotional intensity of the trauma off of the table, leaving the client feeling calmer. This technique was developed by Ad DeJong, an EMDR therapist and trainer from Holland. To intensify the effect of taxing the working memory, he adds other forms of distraction as well. This can be an extremely effective way of processing intense shock trauma and life-threatening memories.

·        BLS can turn on the mismatch detectors. The human brain contains approximately 86 billion neurons, each of which can form thousands of synaptic connections with other neurons. We have an intense multitude of information in our brains. Some of that information is incongruent with other information contained in the same brain. For instance, a self-conscious teen may at times know that she is good enough, and at other times she might fully know and experience herself as being defective, embarrassing, or pathetic. In therapy, BLS can help the client access both beliefs simultaneously and activate the brain’s mismatch detectors, the right ventral lateral prefrontal cortex and hippocampus, and help them to scan and find discrepancies. When both beliefs are activated simultaneously, “I’m good enough,” and “I’m defective,” and both are held in an embodied way, with enough activation and enough regulation, we can bring lasting change. The mismatch detectors will see the discrepancy, and the calm self-awareness can allow the client’s system to update and integrate the experience of being good enough. The ACC is also involved in detecting errors and resolving cognitive conflicts. BLS may engage the ACC in a way that helps the brain reconcile conflicting emotions or thoughts associated with traumatic experiences, leading to a more integrated and coherent memory.

·        BLS can help maintain dual awareness. Most of the time we are either in an activated trauma state, when our amygdala is sending us high stress messages that we aren’t safe, or we are in a calm, relaxed, curious state, when our prefrontal cortex is taking the lead and the amygdala is relatively calm. One factor that all effective trauma-processing techniques have in common is that they help the client maintain dual awareness, having a relatively activated amygdala ‘online’ together with the calm and containing presence of the PFC. The corpus callosum may be one of the key players in making that possible, as it connects the left and right hemispheres of the brain. BLS may enhance communication between the two hemispheres, facilitating the integration of emotional and cognitive processing. Having the right balance between activation of the distress, and calm, present awareness is an essential factor for effective trauma processing. Too much presence and calm without activating the amygdala won’t touch the distress of the traumatic memories enough to heal them. Too much amygdala activation without the calm presence of the PFC, and the person will be retraumatized. Getting the right balance of the two is essential for healing. There are many therapeutic modalities that offer tools to do this effectively, and all of them can be combined with BLS in order to safely and effectively create the balance between activation and regulation that allows healing to happen. By adding BLS, the treatment can be faster, easier, more lasting and less distressing to the client.

As you can see, there is much overlap between the different brain functions involved in processing memories with BLS. BLS seems to activate many adaptive functions simultaneously, allowing the brain to achieve fast, effective and lasting healing, which can be integrated in many different types of therapies and healing modalities.

To learn more about adding BLS skills to your trauma treatment practice, please join us in the upcoming course in Attuned Integrative Reconsolidation, beginning Wednesday November 6th, 2024 on Zoom. For more information, please be in touch. Shalvila@gmail.com or +972-524242234 on WhatsApp.