Eye Movement Desensitization and Reprocessing (EMDR)

A structured therapy designed to help individuals process and recover from traumatic experiences using bilateral stimulation.

Overview

EMDR (Eye Movement Desensitization and Reprocessing) is an evidence-based psychotherapy developed by Dr. Francine Shapiro in the late 1980s. Originally designed to alleviate the distress associated with traumatic memories, EMDR integrates elements from multiple therapeutic approaches with bilateral stimulation, typically in the form of side-to-side eye movements. This unique therapy facilitates the reprocessing of disturbing memories that may be stored in an unprocessed or maladaptive form in the brain.

Bottom-Up Therapy Approach

Is This You?

"I'm so tired of being haunted by memories that won't go away no matter how much I talk about them."

"I logically know I'm safe now, but my body and emotions still react as if I'm in danger."

"I've tried traditional therapy for years, but still get triggered by reminders of my past trauma."

"I want to move forward, but feel stuck in patterns related to things that happened long ago."

Who Benefits Most

EMDR has shown effectiveness for a range of conditions, with particularly strong evidence for trauma-related disorders:

  • Post-Traumatic Stress Disorder (PTSD) - including combat trauma, sexual assault, accidents, and natural disasters
  • Complex trauma - resulting from childhood abuse, neglect, or prolonged exposure to threatening environments
  • Phobias and anxiety disorders - particularly when connected to specific triggering events
  • Grief and loss - especially complicated or traumatic grief
  • First responders and military personnel - processing job-related trauma exposure
  • Depression - particularly when related to past negative experiences
  • Addiction - addressing underlying trauma that may drive substance use
  • Performance anxiety - related to past negative experiences

Especially Effective For:

EMDR is particularly well-suited for individuals who:

  • Have difficulty talking about traumatic experiences in detail
  • Experience strong physical or emotional reactions to trauma reminders
  • Find that cognitive understanding of their trauma hasn't reduced emotional distress
  • Have tried talk therapy with limited improvement in trauma symptoms
  • Want a treatment approach that can work efficiently for some types of trauma
  • Experience trauma symptoms primarily as bodily sensations rather than narratives

How It Works

EMDR works through a structured eight-phase protocol that helps clients process disturbing memories and develop new adaptive associations. As a bottom-up therapy, it engages the brain's natural information processing systems to transform how traumatic memories are stored in the nervous system.

The Eight Phases of EMDR:

Phase 1: History Taking

The therapist collects detailed information about the client's history and identifies potential targets for EMDR processing.

Key components:

  • Comprehensive trauma history
  • Assessment of current symptoms
  • Identification of specific memories to target
  • Establishment of treatment goals

Phase 2: Preparation

The therapist ensures the client has adequate resources and coping skills to manage emotional distress during processing.

Key components:

  • Explanation of EMDR process
  • Development of therapeutic relationship
  • Teaching self-regulation techniques
  • Creating a "safe place" visualization

Phase 3: Assessment

The specific target memory is activated and assessed using standardized measures.

Key components:

  • Identifying the worst part of the memory (image)
  • Articulating the negative belief about self
  • Identifying desired positive belief
  • Rating emotions and body sensations

Phase 4: Desensitization

The client focuses on the target memory while experiencing bilateral stimulation, allowing the memory to be processed.

Key components:

  • Sets of bilateral stimulation (eye movements, taps, or tones)
  • Brief reports of what's being experienced
  • Following associations wherever they lead
  • Continuing until distress is reduced

Phase 5: Installation

The positive belief is strengthened and connected to the original memory.

Key components:

  • Linking positive belief with the original memory
  • Strengthening with bilateral stimulation
  • Increasing conviction in the positive belief
  • Creating new neural connections

Phase 6: Body Scan

The client attends to physical sensations while thinking of the target memory and positive belief.

Key components:

  • Scanning the body for tension or discomfort
  • Processing residual physical sensations
  • Ensuring complete processing
  • Integration of cognitive and somatic aspects

Phase 7: Closure

The session is closed in a way that ensures the client's stability, regardless of whether processing is complete.

Key components:

  • Returning to an emotionally regulated state
  • Using self-calming techniques if needed
  • Preparing for possible continued processing between sessions
  • Journal keeping instructions

Phase 8: Reevaluation

At the beginning of subsequent sessions, progress is assessed and additional targets identified as needed.

Key components:

  • Checking stability of previous results
  • Identifying any new material that emerged
  • Assessing overall progress toward treatment goals
  • Planning next targets

Theoretical Mechanisms:

Several theories explain how EMDR works, including:

  • Adaptive Information Processing Model - Traumatic memories are stored in isolation without proper integration; EMDR facilitates connections to adaptive information
  • Working Memory Theory - Bilateral stimulation taxes working memory, reducing the vividness and emotionality of memories during recall
  • REM-Like Processing - The eye movements may simulate REM sleep mechanisms that naturally process emotional experiences
  • Orienting Response - Bilateral stimulation activates an investigatory reflex that overrides the trauma response

Example Case: Dog Bite Phobia

The Situation:

David was bitten by a dog when he was 10 years old. Now at 35, he experiences intense anxiety around all dogs, regardless of size or breed. He crosses the street when he sees someone walking a dog, avoids visiting friends with pets, and experiences panic symptoms (racing heart, sweating, difficulty breathing) when a dog approaches him. This phobia has significantly limited his social life and ability to enjoy outdoor activities.

How EMDR Would Approach This:

  1. History and treatment planning (Phase 1): The therapist would collect information about David's history, including the original dog bite incident, any earlier adverse experiences that might contribute to his reactivity, and subsequent experiences that reinforced his fear. They would identify how the phobia affects his life currently and establish treatment goals.
  2. Preparation (Phase 2): David would learn about the EMDR process and develop self-regulation techniques to manage potential distress during sessions. These might include guided imagery, breathing exercises, and creating a "safe place" visualization. The therapist would ensure David has adequate coping resources before beginning processing.
  3. Assessment and target identification (Phase 3): The therapist would help David identify specific "touchstone" memories related to his fear of dogs:
    • The original dog bite incident (primary target)
    • The most distressing subsequent encounter with a dog
    • The most recent triggering event

    For the original memory, David would:

    • Identify the worst moment or image from the memory
    • Articulate the negative cognition he associates with this experience (e.g., "I am in danger" or "I am helpless")
    • Identify a preferred positive cognition (e.g., "I am safe now" or "I can handle it")
    • Rate how true the positive cognition feels (Validity of Cognition or VOC scale)
    • Identify emotions triggered by the memory and rate distress level (Subjective Units of Disturbance or SUD scale)
    • Notice where in his body he feels the distress
  4. Processing the trauma (Phases 4-6):
    • David would hold in mind the image of the dog bite, the negative belief, and the physical sensations while following the therapist's finger movements with his eyes (or alternatively, experiencing tactile or auditory bilateral stimulation)
    • After each set of eye movements (typically 20-30 seconds), he would report what he noticed (thoughts, images, sensations, emotions) without analyzing it
    • The therapist would instruct him to "just notice" whatever arises and then continue with another set of bilateral stimulation
    • This process would continue as associations naturally emerge and transform, with the therapist offering minimal direction
    • Processing would continue until the distress associated with the memory is significantly reduced (ideally to 0-1 on the SUD scale)
    • The therapist would then help strengthen David's connection to his positive belief while thinking of the original memory
    • A body scan would ensure no residual physical distress remains when thinking of the event
  5. Addressing current triggers and future situations (Phase 7-8):
    • After processing the original trauma, therapy would address current situations that trigger fear
    • David might use EMDR to process the anticipatory anxiety he feels about encountering dogs
    • The therapist might guide him through visualizing successfully navigating future scenarios with dogs while applying his new positive beliefs
    • Between sessions, David might practice gradual real-world exposure to dogs at a comfortable distance

Expected Outcomes:

Through EMDR, David would likely experience a significant reduction in the emotional intensity associated with the dog bite memory. Rather than feeling the same fear and helplessness as his 10-year-old self, he would begin to view the experience from an adult perspective with access to his current coping resources. As the foundation of his fear is reprocessed, his automatic physiological and emotional responses to dogs would typically diminish. While he might maintain a healthy caution around unfamiliar dogs, the debilitating phobic response would be expected to resolve, allowing him to engage in normal activities without avoidance. EMDR can work relatively quickly for single-incident traumas like a dog bite, potentially resolving the phobia in 3-6 sessions in many cases.

Clinical Research

EMDR is recognized as an evidence-based treatment for trauma by numerous international organizations including the American Psychological Association, the World Health Organization, and the International Society for Traumatic Stress Studies.

Key Findings:

  • Comparable effectiveness to trauma-focused CBT for PTSD
  • Rapid symptom reduction in some clients
  • Sustained treatment effects at follow-up
  • Less reliance on detailed verbal accounts of trauma
  • Effective across cultures and age groups

Strengths:

  • Does not require extensive detailed discussion of trauma
  • Can be efficient for single-incident trauma
  • Addresses cognitive, emotional, and physiological aspects
  • Client doesn't need to do homework between sessions

Limitations:

  • May not be suitable for individuals uncomfortable with eye movements
  • Requires adequate emotional regulation capacity
  • May be challenging for individuals with dissociative disorders
  • Requires specialized training for practitioners

Key Research Papers:

Professional Organizations and Resources: