The inner subjective world of the mind was historically relegated to the margins of social science, confined instead within the traditional domains of psychology and psychoanalysis. In recent years, its study has emerged from the shadows. The advent of functional neuroimaging and the emergence of molecular biology have given these areas of interest a place in the spotlight of leading neuroscience laboratories throughout the world. In the seven years since the first edition of this book was written, many developments in the fields of neuroscience and psychotherapy that were just beginning to appear on the horizon have received a massive increase in interest and study.

Neuroscience’s renewed embrace of emotion as an important research topic has led to a keener understanding that the rudiments of emotion are thoroughly biological. Raw affects are generated by complex right hemispheric neural networks that generate instinctual emotional drives and behavior, rather than by higher left hemispheric brain regions that mediate the abstract and cognitive awareness of our existence. When our bodies and nervous systems converse with one another, these embodied emotions enter consciousness, thereby generating our feelings. Accordingly, research neurologists like Antonio Damasio are championing the notion that human psychological functioning needs to be understood as the body and emotions in the making of consciousness. Meanwhile, in a parallel development, neuroscience’s increased understanding of the significance of mirror neurons and their implications for embodied simulation has led to an emerging interest in subjectivity and intersubjectivity.

Following over a century of mutual neglect and disdain, contemporary neuroscience and psychotherapy have at long last begun a fruitful dialogue with one another. The investigation of neuroplasticity has given us new insights vis-à-vis our understanding of therapeutic change. Neuroplasticity is now viewed as a prerequisite for any enduring change in cognition, behavior, and emotion. It is the underlying mechanism of trait change. If psychotherapy is to produce lasting effects, it must be optimized for restructuring neural networks, particularly in the subcortical brainstem, midbrain, and limbic areas that mediate unconscious emotional drives, motivations, and dispositions.

More recently, the intersubjective nature of the human brain, once the sole domain of relational psychoanalysis, has been given emphasis and credibility by our increased understanding of the neural mirroring system in the premotor and various other areas of the brain. This system serves as the neurobiological correlate of embodied understanding, nonverbal communication, and empathy. Mirror neurons appear to embody a system that matches the intentional behaviors of others to one’s own experience, and in this way form a link of mutual understanding through bodily simulation or resonance.

These convergent influences of the various research bases represent a clarion call for change in the overall framework of EMDR, and for that matter for all psychotherapies. The newly established role of procedural memory and emotional learning and the implicit nature of early acquired relational patterns, intercorporality, and empathy—in contrast to a de-emphasis of repression, left hemispheric cognition, and declarative memory—have shifted the emphasis away from insight-oriented, interpretive, or cognitive techniques and toward techniques that promote procedural and emotional learning. In this paradigm shift, the core of therapeutic interaction lies in the affective communication mediated by intersubjective bodily resonance, rather than symbolic and interpretive language. This warrants a shift from our previous emphasis on left hemispheric communication to that of right hemispheric communication.

Consequently, theories of psychotherapy have begun to shift their focus and emphasis from models of cognitive development to (instead) the primacy of affect and intersubjectivity, thereby redefining psychotherapy as the “affect communicating cure” rather than the “talking cure.” In these models, emotion is the force that is fundamentally linked with change. Diana Fosha notes that emotion acts as the experiential arc between the problem and its solution.

In synergy with the changes noted earlier, the dynamic unconscious, previously the traditional domain of psychoanalysis, has recently become of vast interest to neuroscience. In the early years of this millennium, the research of Marcus Raichle and Rodolfo Llinás revealed that the overwhelming majority of the energy utilized by the brain appeared to be for our ongoing intrinsic inner reality, whereas only a small amount was utilized to deal with any aspect of our outer reality. Marcus Raichle, who is considered the father of functional neuroimaging, initially referred to this as the “brain’s dark energy,” in reference to Freud’s dynamic unconscious. Eventually, he came to call this neural circuitry the Default Mode Network (DMN).

The DMN is an interconnected and anatomically defined brain system that includes areas of the medial temporal lobe; part of the medial prefrontal cortex; areas of the posterior cingulate cortex; the ventral precuneus/hippocampal formation; and the medial, lateral, and inferior parietal cortices. Taken together, this neural network is, at a minimum, responsible for the mediation of procedural self-referential memory, internal imaging, internal self-representations, schemas, object representations, affective regulation, the integration of affect and cognition, somatosensory representations, and the experience of an embodied sense of self. The language of this network is composed of an alphabet of somatosensory neural images. Prior to 2007, the total number of DMN articles published was 12. Between 2007 and 2017, there were over 1,500 DMN articles published in neuroscience journals.

Twenty-nine years of EMDR practice has made it clear that in order to truly understand, practice, and research this astonishing and mysterious form of psychotherapy, one needs to be aware of and appreciate the neural mechanisms underlying consciousness and information processing, human development, attachment, disorders of information processing that manifest in the majority of the psychopathology treated by clinicians, trauma and dissociation, and the relationship of stress and trauma on immune function and health.

Given that EMDR is so profoundly guided by the adaptive information processing (AIP) model, it is crucial to examine how it measures up to researched neurobiological models of consciousness and information processing. The more that this model is seen to be consistent with neurobiological research (illustrated in Chapter 9, Linking Consciousness, Neural Development, and Treatment), the more the model will be improved and embraced. The best way to generate truly comprehensive neurobiological theoretical models of EMDR, which provide the best blueprints for research, is through a comprehensive consideration and understanding of the neural underpinnings of information processing. If we can ask how EMDR’s sensory stimulation and treatment protocol impact the central neural circuitry of information processing and facilitate its repair, we can generate detailed theories that are more amenable to research.

For centuries, society has recoiled from the notion that trauma and neglect are pervasive. A great deal of confusion exists in both our society and our profession regarding trauma, the extent and pervasiveness of familial neglect, and the nature of dissociative processes. Rather than understanding that our history as a human race is profoundly traumatic, we choose to believe that we have simply survived and adapted. We apply the same lack of vision to our children, believing that come what may, they are resilient.

Within our various professions, academicians at the most prestigious universities tell us that traumatic and dissociative disorders are the creations of suggestive therapists and false memory syndromes. We in the traumatology community try to shed light on this darkness, but psychological and phenomenological explanations are insufficient. It is only through a neurobiological understanding that our ideas will be given the utmost credibility. We must, with respect to our practice, be able to understand and illustrate clearly to others that the unusual and often bizarre symptoms that we label as traumatic and dissociative disorders are the outcomes of dysregulated, evolutionarily based, neural action systems that are completely predicated by the nature of the attachment between infants and their caretakers. This can be accomplished only by a neurobiological foundation that informs our understanding of human development, attachment, disorders of attachment, and information processing.

Finally, given the myriad manifestations of somatic symptoms and medical illnesses that many of our patients present with, it is imperative that we understand the relationship between stress, trauma, and immune function. It is crucial for us to recognize and be able to differentiate somatic or somatoform symptoms from immunoinflammatory illnesses, which until recently were referred to as medically unexplained symptoms: fibromyalgia, systemic lupus erythematosus, reflex sympathetic dystrophy, Crohn’s disease, Graves’ disease, chronic fatigue syndrome, and others, which are detailed in this book.

Understanding these illnesses and their differentiation from other somatoform symptoms has its greatest import with respect to treatment implications. Somatic symptoms, often conceptualized as manifestations of trauma in the body, are often effectively targeted and treated with EMDR, as part of a comprehensive and phased trauma treatment. However, patients presenting with psychological difficulties and hyperimmune symptoms must also be referred for evaluation and treatment to endocrinologists, oncologists, or immunologists in order to attempt to re-regulate the hyperimmune function in these patients, which is apparently causative with respect to their illnesses.

It is my hope that the information presented in this writing will be received as informative and clearly integrated, while the presentation of the subject matter provides for an ease of understanding.