Eye Movement Desensitization And Reprocessing (EMDR)

Eye movement desensitization and reprocessing therapy (EMDR) is a type of psychotherapy introduced in the late 1980s to treat post-traumatic stress disorder (PTSD). EMDR often reduces trauma symptoms by helping the brain reprocess challenging memories as they are recalled without experiencing unpleasant symptoms. 

This treatment mimics the process your brain goes through during REM (rapid eye movement) sleep, which is believed to help the mind process in a way that does not harm those experiencing it. Although developed to treat post traumatic stress disorder, it may treat various conditions and symptoms. 

What is REM?

There are two distinct sleep stages, REM (rapid eye movement) and NREM (non-rapid eye movement). Involving jerky eye movements, the REM cycle makes up approximately 25% of your sleep time and occurs every 90 minutes. Research suggests that it is during this stage that people dream. 

Imaging studies have revealed that the human brain is almost as active during REM sleep as it is when people are awake. This stage is often marked by a faster, somewhat shallow breathing pattern that can become fast and inconsistent. Several lifestyle factors, such as a lack of sleep, low physical activity, or an unhealthy diet, may negatively impact REM sleep. 

Effects of REM sleep

REM sleep may play a role in learning and information processing. For example, studies show that if someone is studying before they sleep, they may not be able to recall the information as quickly if they did not get enough REM sleep the night before. 

Concomitantly, research reveals that REM sleep deprivation can alter critical structures in the brain and affect long-term memory processing and retrieval. In infants, REM sleep is needed for brain development which is one of the reasons babies sleep so much.

What is REM therapy?

Eye movement desensitization and reprocessing therapy (EMDR), also known as rapid eye movement therapy, is a modern form of therapy that gained popularity in the 20th and 21st centuries. Eye movement desensitization and reprocessing is primarily used to treat PTSD or mental health concerns impacted by traumatic events. However, it can also be utilized for anxiety, depression, stress, and sleep disorders. 

REM therapy for trauma

The American Psychological Association (APA) conditionally recommends EMDR as a treatment for PTSD in their practice guidelines. Many forms of counseling rely on talking, medication, mindfulness techniques, behavior modification, or journaling. EMDR therapy uses eye movements in addition to talk therapy to help treat a person experiencing negative thoughts or sensations from past trauma.

Many forms of counseling rely on talking, medication, mindfulness techniques, behavior modification, or journaling. EMDR uses eye movements in addition to talk therapy to help treat a person experiencing negative thoughts or sensations from past trauma.

What to expect

EMDR consists of eight structured phases, including the following: 

• Phase 1: History-taking
• Phase 2: Preparing the client
• Phase 3: Assessing the target memory or memories
• Phases 4-7: Processing the memory to an adaptive resolution
• Phase 8: Evaluating treatment results

Phase one 

EMDR sessions may last from 30 minutes to a couple of hours. Before your first session, meet with a therapist to discuss your concerns, mental health, and goals for treatment. During this initial session, your therapist may explain the process and pause to allow you to ask any questions. 

Phase two 

Stage two can involve preparing yourself for treatment. The client's readiness can have an impact on how well EMDR works. During the second phase, the therapist and client will work together to set expectations for these sessions.

During this phase, your therapist might teach you techniques to manage and cope with unwanted emotions and sensations. At the same time, you and your therapist will also decide which specific memories to target.

Phase three 

During the EMDR session, the therapist may ask you to focus on any negative thoughts, emotions, or sensations that arise from recalling the traumatic event. At the same time, the provider may perform repetitive motions or sounds, such as moving their fingers back and forth, tapping, or blinking lights in front of your eyes.

Phases four through seven 

During the session, you might be asked to empty your mind and notice any spontaneous thoughts or images. As you identify them, the therapist may guide you toward separating the thought from unwanted emotions so that the next time you think about the event or memory, it may not trigger unpleasant sensations or symptoms of post traumatic stress disorder.

As you recall the trauma, you may be asked to think of positive thoughts to replace the challenging ones. Doing so may help you associate the treatment with positive feelings. The therapist may monitor your levels of distress during the treatment. This observation may allow them to figure out how powerful the treatment can be and how best to progress. They might also decide to alter the treatment path or take more time for processing and desensitization of the memories if you struggle with emotional responses. 

Although EMDR is considered a safe therapy with few unwanted effects, this approach focuses heavily on talking about and recalling traumatic events and might trigger distressing feelings or symptoms. Distressing memories may bring up negative emotions and body sensations. Treatment affects people differently, so the EMDR therapist should prepare the client for potential treatment effects. Like other forms of psychotherapy, EMDR may cause treatment effects, such as :

• Vivid dreams
• Recurrent nightmares
• Resurfacing of traumatic memories
• Lightheadedness
• Trouble sleeping
• Heightened sensitivity
• Crying 

These effects may disappear on their own as the treatment progresses. If you become distressed during your sessions, your therapist can help you move past the uncomfortable sensations and return to the present moment. 

While EMDR was developed as a treatment for PTSD, practitioners today use it for a variety of mental health conditions with success, including:

• Depression
• Phobias
• Obsessive-compulsive disorder (OCD)
• Chronic pain
• Anxiety
• Bipolar disorder
• Dissociative identity disorder
• Chronic stress
• Performance anxiety
• Sleep problems
• Substance use disorder
• Unresolved grief
• Panic attacks and panic disorder

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

During eye movement reprocessing therapy, the client focus on external stimulus while thinking about the targeted memory. Although empirical evidence supports the benefits of EMDR, research has not found the specific cause of why EMDR therapy works to change how your brain processes disturbing memories. One theory is that the repetitive sounds or images may help divert attention away from the emotions associated with PTSD. Adaptive Information Processing Theory (AIP) is one theory for how EMDR works.

There are some principles EMDR borrows from, including prolonged exposure therapy, which is also used to treat PTSD. Other theories mention that EMDR therapy mimics the eye movements and brain functions involved during REM sleep, which helps to process and store memories and information effectively.

One 2016 study found that EMDR stimulated both sides of the brain in a process called bilateral stimulation. In this process, positive cognitive function is often achieved, which may aid in the processing of memories.

Living with unresolved trauma may cause quality-of-life struggles or distressing symptoms. However, there are many ways to treat PTSD and traumatic memories, including talk therapy, medication, coaching, exposure therapy, and EMDR. If you are living with PTSD or another mental health condition, a counselor can teach you strategies to cope with triggers or self-defeating thoughts. 

EMDR can be conducted in person and online, and research suggests that these methodologies are equally as effective when performed by an experienced provider. If you have been considering online therapy for PTSD or another mental health condition, consider speaking with a counselor through a platform like BetterHelp. 

With online therapy, you can control your sessions by choosing the appointment time that works best for you. You can also choose between phone, video, or live chat sessions. Painful events are a part of life, but client reports have shown that PTSD symptoms can be treated successfully with EMDR therapy.