Eye movement desensitization and reprocessing therapy (EMDR)
Eye movement desensitization reprocessing therapy (EMDR) is often used to help clients revisit past trauma, adverse events, or other distressing memories or life experiences by desensitizing them to the memory. Developed to treat post-traumatic stress disorder (PTSD), EMDR treatment can help clients process trauma. EMDR therapy was developed by American psychologist Dr. Francine Shapiro. Today, therapists listed as EMDR-certified are in demand.
EMDR therapists during sessions
During sessions, a therapist uses bilateral stimulation techniques, stimulating both sides of a client's brain to provide EMDR therapy. These can include eye movements or hand buzzers. To find an EMDR therapists, you can search an online directory based on your location/city and access their profile listing to determine their services, availability, training, and education. In some cases, your insurance company may provide a directory of therapists in your city or a city nearby, where you may also search for EMDR specialists.
History of EMDR therapy
Psychologist Francine Shapiro developed EMDR therapy as a Harvard researcher. She was investigating rapid eye movement and sleep (REM sleep). She noticed that sensations and disturbing memories would often occur during REM. She hypothesized that recreating REM while clients are awake could allow them to discuss those memories in the part of the brain that processes them.
After practicing EMDR therapy, Dr. Shapiro noticed that clients could come in for an initial session with extreme fear over a traumatic event, or the sense of being in immediate danger. After being treated successfully, they learned to accept that the event happened and didn't experience as many distress-related symptoms. They were able to process events without retraumatizing themselves. She found that clients could work through traumatic events once the memories had less power over them. They could process their thoughts, sit with them, and move through the traumatic memory and emotional distress with EMDR therapy.
The EMDR therapy process is guided by the adaptive information processing model, which describes how our current perceptions are automatically linked to memories. By addressing any upsetting memories, we can shift our current cognitions, replacing a negative belief or memory with a new, positive belief.
Francine Shapiro has become a worldwide speaker on EMDR processing and has co-authored many articles and books on this subject. She also founded the EMDR Institute and has won awards for her contributions to ongoing research regarding EMDR therapy, which include:
- The International Sigmund Freud Award
- The American Psychological Association Trauma Division Award for Outstanding Contributions to Practice in Trauma Psychology
- The Distinguished Scientific Achievement in Psychology Award by the California Psychology Association
Shapiro, who was one of the active members in various organizations, facilitated and taught the usage of EMDR therapy and supported further research for EMDR therapy and effective treatments for PTSD. She went from city to city and completed workshops and consultation programs to assist clinicians in mastering this technique. Members of these organizations had access to resources that helped them determine appropriate criteria and points for EMDR therapy application. There are certain requirements needed to be approved for EMDR basic training.
For more information about Shapiro's work, visit the website of the EMDR International Association or the Journal of EMDR Practice and Research website. This peer-reviewed journal covers basic principles, protocols, and procedures associated with EMDR therapy.
EMDR therapy for mental health challenges
EMDR therapy relies on the adaptive information processing model, which a therapist uses to guide clients through healing. Although commonly used in the treatment of PTSD or traumatic experiences, a therapist may find it effective treatment for symptoms of anxiety, panic attacks, depression, stress, eating disorders, and other mental health conditions. For example, the Journal of EMDR Practice and Research has published studies showing how a therapist can use EMDR therapy's effectiveness for treating symptoms of substance use disorder (previously known as substance abuse). A therapist specializing in this kind of treatment can often see significant improvements in their clients.
EMDR therapy for trauma guided by an EMDR therapist
Anyone who has experienced a traumatic or disturbing event, whether accompanied by post-traumatic stress, may benefit from this rapid eye movement guided by a therapist. Acute stress disorder may also benefit from working with a therapist through EMDR therapy, as well as certain health conditions that impact mental health, such as chronic pain. A therapist trained in EMDR can tailor the approach to suit individual needs.
EMDR therapy as exposure therapy
EMDR therapy can also be described as a form of exposure. By having a client describe a distressing memory and imagine that event during an EMDR therapy session, the client faces experiences that may be distressing or challenging to address. However, due to how EMDR therapy works, treating PTSD or trauma in this way may reduce the emotional impact of exposing oneself to these memories. Consulting with a therapist can help determine if this is right for you.
EMDR therapy for PTSD
According to the International EMDR Institute, prolonged exposure during EMDR therapy allows a client to reprocess thoughts without feeling retraumatized or experiencing severe negative emotions. After EMDR therapy, the way they frame the event may change, and their reaction to triggering stimuli may be more manageable, strengthening their mental health. The U.S. Department of Veterans Affairs covers how EMDR can help treat symptoms of PTSD.
Sessions with EMDR therapists
Before an EMDR therapy session begins, an EMDR therapist will talk with the client about a treatment plan, discussing timelines, the client’s readiness, the EMDR therapy process, and whether or not other therapies, such as meditation or talk therapy, will be used in addition to EMDR. EMDR therapy sessions with trained clinicians often last from 60-90 minutes. During a session, a therapist moves their fingers in front of a client's eyes, and the client follows their movements visually as they recall a traumatic incident. The therapist may also use other forms of bilateral stimulation which might include hand buzzers in both hands, throwing a ball back and forth between two hands, or watching lights move back and forth on a screen, which the therapist supervises closely. With the help of a therapist, every session can be tailored to the client’s needs.
How does EMDR with a licensed EMDR therapist work?
During the practice, clients think about their physical sensations as they recall the memory. The EMDR therapist might also guide the client through meditation. Often, the session starts with the client remembering the traumatic event they came to discuss, with the therapist facilitating the exploration. They might move into other memories as they talk.
Eight phases of EMDR therapy
EMDR therapy has eight phases. Bilateral stimulation or eye movements are part of the first session where the therapist explores the client's needs, and after this first session, clinicians may decide which activity or technique to try next. Throughout the process, the therapist ensures the approach aligns with the client’s needs.
Eight phases of eye movement desensitization and reprocessing therapy (EMDR)
Often, EMDR therapy is practiced in eight distinct phases by a licensed therapist, online or at an agreed-upon location. These phases make up the treatment process.
This first phase of EMDR therapy involves treatment planning and determining a clinical practice guideline. During this treatment planning phase, a certified EMDR therapist may request information about a client's history, diagnoses, and negative symptoms. They may create a map of goals for treatment. Trauma treatment may begin at varying levels, depending on an individual and their past experiences. Therapists and clients might spend a few sessions of EMDR therapy discussing their goals for treatment (for example, to treat symptoms of PTSD) or learning meditation strategies before starting this process.
Phase two
The second phase of EMDR therapy involves preparation. The therapist helps clients learn how to maintain stability in between and during sessions and specific signals for stopping treatment if it feels too intense. Considering that EMDR therapy can be intense, you must also practice your response, giving prompt signals to your therapist to stop it.
Phase three
The third phase of EMDR therapy involves the assessment of a client's memories. They are guided by clinicians to focus on details of these memories that stand out, imagining visuals and beliefs that have become associated with them. While facilitating EMDR therapy, therapists may ask clients to envision positive aspects of an incident, like any lessons they've learned from the experience or what made them feel safe during that time. During this phase, bilateral stimulation practices may be used by clinicians.
Phase four
In the fourth phase of EMDR, a target event that was discussed in the third phase is explored on a more profound level. This phase of EMDR therapy is often called "desensitization." In this phase, trauma-related sensations and sensory experiences may be discussed in detail and might be challenging for clients. Bilateral stimulation is often used in this stage for targeted memories.
Phase five
The fifth phase of EMDR therapy is the installation phase, where a therapist can bring in positive cognition, which is aimed at replacing or challenging unwanted or negative thoughts or beliefs about an event. After processing a distressing targeted memory and feeling no distress, clients are asked by clinicians to identify positive beliefs with which they'd like to replace unwanted beliefs.
Phase six
The sixth phase of EMDR is the body scan phase. During this body scan phase, clients are asked if any physical sensations are left from painful events in any location or part of their body. If there is, therapists can target specific body sensations through guided relaxation and meditation with clients to help them soothe symptoms.
Phase seven
The seventh phase of EMDR includes closure. In this closure state, the therapist ensures the client is getting back into equilibrium. They may be guided through a meditation exercise by clinicians to control their nervous system before ending sessions. Therapists might also ask them to remember any positive thought or visualization they selected at the beginning of the session.
Phase eight
The eighth phase of EMDR therapy is reevaluation. In this phase, therapists can ask clients how effective sessions were and if there are any remaining distressing symptoms or disturbing thoughts. Based on these evaluations, they can make a plan for future sessions. The client may undergo further EMDR therapy with their clinicians or graduate from it.
What happens after sessions with EMDR therapists?
After an EMDR therapy session and before the next session, therapists may ask clients to keep a record of what happens during their week at home (or another location like work) and how often they can use the relaxation techniques they learned. Some clients may keep a journal regarding their EMDR therapy experience to track their progress over time, noting the occurrence of a particular negative thought or memory, as well as their overall emotional state.
What do EMDR therapists do when using imagery in EMDR therapy?
In EMDR therapy, clients often visualize traumatic memories and other distressing experiences. This focus may be through visualization exercises, where therapists ask clients to focus on what they saw during distressing events. During EMDR therapy, they imagine those moments as the therapist takes their fingers and moves them back and forth in front of their eyes or uses another form of stimulation.
Afterward, clients might be asked to close their eyes, empty their minds, and let their therapist know what memories or thoughts appear. Images they see might not make sense to them. However, discussing these images with clinicians or acknowledging them during EMDR therapy can help clients reprocess memories. They do not necessarily have to explain or understand what memories mean to heal them.
How does imagery work during EMDR therapy?
Since trauma lives in parts of our brains that impact memory and emotions, it can be hard to process trauma without stimulating our minds. Discussing trauma with clinicians while actively remembering it during EMDR can help people imagine these events without feeling their impact. Note that no image is wrong, silly, or shameful to have. EMDR therapy is designed to help patients recover from trauma through imagery. Hence, don’t be afraid to communicate whatever thoughts you have during each imagery session.
During a visualization process, clients may feel anxious, and their hearts might race. If they become dysregulated, a therapist guides them to imagine a peaceful or relaxing image, such as a beach scene or a comforting person. They can imagine this until they feel their distressing symptoms reducing.
EMDR therapy for PTSD
The United States Department of Veterans Affairs encourages and recommends EMDR to treat PTSD in combat veterans experiencing trauma from past events. In addition, a recent study of 30 veterans found EMDR effective in treating PTSD. In this study, treatment effects showed that delusions, anxiety, and depression were improved after completing multiple sessions.
EMDR client reports show an external stimulus of lateral eye movements is effective long-term in reframing unwanted beliefs to positive ones. Increasing evidence in traumatic stress studies shows that this process can be as effective via online EMDR therapy as in person. The Veterans Health Administration offers a directory of resources for those looking to find EMDR if you're considering trying this type of treatment.
Other mental health challenges Eye Movement Desensitization and Reprocessing (EMDR) therapy can help treat
EMDR can also be an effective treatment for a range of mental health concerns and life stressors, including grief, anxiety, panic attacks, gender dysphoria, and more.
According to the World Health Organization, EMDR therapy is the first and most effective recommended treatment for PTSD. If you're still looking for proof of the efficacy of EMDR, the American Psychiatric Association has multiple case examples on its website. Some may find EMDR controversial, but more research, including controlled trials, can be found online.
Finding an EMDR therapist online
Trauma may feel insurmountable at times. However, there are several types of therapies available to treat symptoms. EMDR is an effective form of support for trauma and can provide lasting benefits; many people have successfully treated various mental health concerns with this therapeutic method. If you cannot find a therapist practicing EMDR in your local directory or city or one that’s covered by your insurance, you can also try online EMDR therapy. Online therapy might benefit those who have a hectic schedule. To learn more about its process in general, continuing education courses may be helpful. Usually, online platforms for EMDR range from $65 to $90 per week (billed monthly), while in-person sessions can range from $100 to $200 per session. You can ask your insurance company whether or not this service is covered.
Effectiveness of online eye movement desensitization and reprocessing therapy (EMDR)
Studies have also found statistically significant and clinically meaningful reductions in symptoms in clients using EMDR via an Internet intervention.
If you're interested in trying EMDR, consider a therapist directory like BetterHelp, which offers over 30,000 therapists to date who can provide therapy trained in various modalities, including online EMDR. You can also explore other trauma-informed therapies, like internal family systems (IFS) or cognitive-behavioral therapy (CBT).