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 was developed by American psychologist Dr. Francine Shapiro.
During sessions, a therapist uses bilateral stimulation techniques, stimulating both sides of a client's brain. These can include eye movements or hand buzzers. To find an EMDR therapist, you can search an online directory based on your location and access their profile listing to determine their services, availability, training, and education.
The History of EMDR
EMDR therapy has been shown to positively affect the process of overcoming unwanted negative beliefs, memories, or emotions. EMDR is now one of the first recommended treatments for PTSD symptoms by the American Psychiatric Association.
Psychologist Francine Shapiro developed EMDR 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 this, 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.
The EMDR 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, 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 was active in various organizations, facilitating and teaching the usage of EMDR and supporting further research for EMDR and effective treatments for PTSD. She 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 application. There are certain requirements needed to be approved for EMDR basic training.
For more information about Shapiro's work, visit the EMDR International Association or the Journal of EMDR Practice and Research. This peer-reviewed journal covers basic principles, protocols, and procedures associated with EMDR.
Emdr for post-traumatic stress disorder, depression, anxiety, and more
EMDR therapy relies on the adaptive information processing model. Although commonly used in the treatment of PTSD or traumatic experiences, it can also provide 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 its effectiveness for treating symptoms of substance use disorder (previously known as substance abuse).
Anyone who has experienced a traumatic or disturbing event, whether accompanied by post-traumatic stress, may benefit from this rapid eye movement. Acute stress disorder may also benefit from EMDR, as well as certain health conditions that impact mental health, such as chronic pain.
EMDR can also be described as a form of exposure. By having a client describe a distressing memory and imagine that event during a session, the client faces experiences that may be distressing or challenging to address. However, due to how EMDR works, treating PTSD or trauma in this way may reduce the emotional impact of exposing oneself to these memories.
According to the International EMDR Institute, the prolonged exposure during EMDR allows a client to reprocess thoughts without feeling retraumatized or experiencing severe negative emotions. Afterward, 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.
What can you expect in an EMDR session
Before an EMDR session begins, an EMDR therapist will talk with the client about a treatment plan, discussing timelines, the client’s readiness, the EMDR process, and whether or not other therapies, such as meditation or talk therapy, will be used in addition to EMDR. EMDR sessions 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. Other forms of bilateral stimulation 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.
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. They might move into other memories as they talk.
EMDR therapy has eight phases. Bilateral stimulation or eye movements are part of the first session, and after this first session, clinicians may decide which activity or technique to try next.
Understanding eight phases: Eye movement desensitization reprocessing
Often, EMDR therapy is practiced in eight distinct phases. These phases make up the treatment process.
Phase one
This first phase of EMDR 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 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 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.
Phase three
The third phase involves the assessment of a client's memories. They are guided to focus on details of these memories that stand out, imagining visuals and beliefs that have become associated with it. 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.
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 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 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 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 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 includes closure. In this closure state, the therapist ensures the client is getting back into equilibrium. They may be guided through a meditation exercise 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 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.
What generally happens after EMDR sessions?
After a session and before the next session, therapists may ask clients to keep a record of what happens during their week at home and how often they can use the relaxation techniques they learned. Some clients may keep a journal to track their progress over time, noting the occurrence of a particular negative thought or memory, as well as their overall emotional state.
Using imagery in EMDR
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. 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 mind, and let therapists know what memories or thoughts appear. Images they see might not make sense to them. However, discussing these images or acknowledging them 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?
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 while actively remembering it during EMDR can help people struggling learn to imagine these events without feeling their impact. Note that no image is wrong, silly, or shameful to have.
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 for PTSD, traumatic memories
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 resources for those looking to find EMDR if you're considering trying this type of treatment.
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.
Options for EMDR therapy and how EMDR therapy works
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 local therapist practicing EMDR, you can also try online EMDR therapy. 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.
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 reaching out to a therapist through a platform like BetterHelp, which offers over 30,000 therapists 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).