By Derin Kubilay - Clinical Psychologist & EMDR Therapist
EMDR therapy is a psychotherapy approach that helps heal traumas and recover from disturbing emotional events like PTSD in a shorter time than with many other therapy methods.
But there’s more to it, and this article will give you a good introduction and answer the most common questions.
Trauma is an emotional response to an adverse event such as sexual or physical abuse, an accident, or a natural disaster.
It may cause short-term responses like shock and denial or long-term responses resulting in post-traumatic stress disorder.
Therefore, one of the main goals of the psychology world is to develop effective psychotherapeutic approaches to find answers. As a result of this need, one of the prominent approaches is called Eye Movement Desensitization and Reprocessing Therapy (EMDR).
The symptoms are mostly relieved thanks to EMDR therapy that seeks to resolve these experiences by focusing on what are called target memories.
It is believed that a resolution will occur as new connections are made by stimulating different brain areas with bilateral stimuli.
This can be eye movements or other stimuli such as light, sound, or tapping while simultaneously recalling the target memory.
Moreover, technological devices for bilateral stimulation have been developed during the pandemic. Online therapies can be applied via online platforms, and therapists can use different devices like a light bar, headphones, or pulsers in both face-to-face and online settings (EMDR UK, 2020).
Read on to learn more about what EMDR therapy is, how it works, and whether you should try it yourself.
EMDR therapy is a form of psychotherapy approach that has been developed around the late 1980s. According to van den Hout (2012), it was developed by Francine Shapiro, a research psychologist.
She discovered a connection between eye movements and disturbing memories, which provides an alternative explanation for traumatic memory networks (Shapiro, 1995). It was initially designed to help those who have experienced a traumatic event exceeding their coping skills and consequently developed post-traumatic stress disorder (PTSD).
However, over time, it has been used for mental health disorders such as anxiety disorders, depressive disorders, dissociative disorders, and eating disorders (Valiente-Gómez et al., 2017).
EMDR stands for Eye Movement Desensitization and Reprocessing Therapy. It is an evidence-based psychotherapy approach that effectively treats mental, emotional, and behavioral disorders.
It uses bilateral stimulation (BLS), which includes eye movements, taps on the skin, or tones to create a sense of internal safety and self-control while recalling traumatic memories. The main goal of EMDR therapy is to activate both hemispheres of the brain while information is processed.
It facilitates the processing of distressing psychological experiences by reducing emotional overactivation as vividness and emotionality (Engelhard et al., 2010). Over time, clients report that the target memory feels detached or distant. In other words, it loses its emotional or vivid components.
EMDR works on the notion that the brain’s natural tendency is to heal the traumatic memory by keeping things in balance. It is based on the theory of Adaptive Information Processing, abbrevation AIP (Shapiro, 2002).
Traumatic experiences are stored and stuck in the neural network of some brain regions. Therefore, when a person has a traumatic event, it may cause him to connect the event with irrational beliefs, negative emotions, or disturbing bodily sensations. This dysfunctional association may create symptoms.
Hence, the goal of EMDR is to add adaptive emotions and cognitions into the neural network via bilateral stimulation. Put in another way, bilateral stimulation is a tool to allow complete processing of the memory, which leads to a reduction of related symptoms (Hill, 2020).
Consequently, individuals can access their stored trauma by reprocessing. Unfortunately, there are basically mental blocks that keep our minds from achieving this goal, and this can lead to various problems like anxious states, overwhelming stress, depressive symptoms, or phobic states.
EMDR therapy helps the client to go through a specific process of thinking about their traumatic event while simultaneously focusing on a different stimulus.
For example, finger movements or tapping until all disturbing thoughts of the traumatic event have changed into an adaptive ones. After reprocessing and returning to the target memory, clients usually state that the memory gets either blur or distant.
However, it does not mean the memory itself is erased; the associated channels (cognition, emotion, body, and image of memory) are changed. And the burden gone.
Shapiro (2018), the founder of EMDR, construct 8 stages of therapy in a structured way:
The therapist takes the client’s detailed history, including major life events, symptoms, and main issues. Then, the therapist plans the treatment by focusing on the main problem, related memories, triggers, internal and external resources, and treatment goals.
The therapist forms a secure therapeutic relationship with the client, explains the the EMDR process and teaches specific coping strategies through stabilization.
The therapist decides target memory, and they jointly evaluate the negative cognition, the worst image, emotions, bodily sensations, and positive cognition associated with memory. The client gives a score out of 10 for the memory on how disturbing the memory is (SUD score).
Subjective Units of Distress (SUD)
SUD is a unit to describe how much disturbance or distress a person is experiencing subjectively at the moment. It’s rated on a scale from 0 to 10, where 0 is no distress, and a 10 is “Feels unbearably bad”.
Read our article What Is EMDR Cognition & EMDR Cognitions List to learn more about cognitions, why they are crucial and if you have some.
Here, while the client focuses on memory therapist applies bilateral stimulation with tapping, eye movements, or another stimulus. The client tells whatever comes to his mind after each set. The aim of these sets is to decrease the SUD score. The desensitization of memory means that all of the client’s channels relieve, and the SUD score reaches zero.
After desensitization of memory, the therapist attempts to install positive cognition. Again, the client scores her validity of cognition out of 7, and the aim is to make this belief as top.
After the installation phase, the client thinks about memory and her positive cognition while focusing on her body. If she notices any disturbing feeling, then there will be more bilateral stimulation sets to diminish this disturbance.
When the client reports no disturbing channel about memory and a positive feeling about it without any bodily disturbance, then the closure phase is completed.
Finally, they jointly evaluate the memories and continue to the next one.
After an EMDR session, people feel calmer and safer. They’re better able to regulate emotions. They’re less likely to become traumatized by bad memories. And as time passes, bad memories don’t come up so often.
A study by Shapiro (2014) found that EMDR therapy has been shown to help with many conditions. These include but are not limited to trauma, PTSD, phobias, and obsessive-compulsive disorder. EMDR therapy results in a transformation of negative feelings and beliefs.
It also seems to be effective for people who have problems with anxiety and depression.
After EMDR therapy, you might expect some modest headache or discomfort at the location of the trauma. You may feel shaky or irritable, have difficulty sleeping, have vivid or realistic dreams, or experience an overwhelming sense of numbness.
In therapy sessions, heightened emotions or physical sensations are expected.
New traumatic memories can come up and bed added to the treatment plan. However, a competent therapist knows how to deal with these cases. The professional may want these symptoms to occur so that he can follow this pathway to the main source.
All these feelings are normal and can last for a few days to a few weeks after treatment. However, some people experience intense trauma memories during this time and find it difficult to talk about their experiences. It is essential to give yourself permission to be fully present with these memories and not push them away as they arise in your mind.
EMDR focuses on the present and here-and-now. It has a three-prolonged approach, a combination of past, present, and future.
The first component relates to memories collected by the float-back technique to detect negative cognition.
The second relates to present disturbance when the individual focuses on the memories. Also, the client’s present complaints and symptoms are important. For example, a therapist may ask what words go best with that picture expressing your negative belief about yourself now.
In the future level, the actions and behaviors clients will show matter. How she copes with a problem in the future is focused (Oren and Solomon, 2012). So, it aims to reduce distress by following a systematic approach of bringing awareness back to the here-and-now.
For this treatment to work well, a competent therapist can guide you through the process while identifying any negative beliefs, emotions, bodily sensations, and images related to traumatic memories that may keep you stuck in some feelings.
Unfortunately, if the therapist has no professional background with accredited EMDR training, he can hurt the client easily.
Malpractice or incompetent therapist may leave the client vulnerable with all these distressing, unfinished (undesensitizated) memories without any stabilization exercise.
Both EMDR and Brainspotting employ eyes and eye movements. EMDR therapy allows the patient to move eyes side by side or up and down patterns by following the therapist’s fingers. With Brainspotting, the therapist moves their fingers to where the patient eyes are focused while they are looking at a particular point.
In addition, both EMDR and Brainspotting use grounding and resources to help with PTSD symptoms and negative beliefs. Besides, both focus on memories, emotions, thoughts, and physical sensations related to the event that caused trauma.
For example, someone who experienced a car accident will be asked to recall what happened. They might also be asked to remember how they felt after it happened and before any treatment took place (i.e., if there was any guilt, anger, or sadness).
Although both therapies have similarities, they also differ significantly from one another. First, they use different tools to elicit responses. EMDR therapy focuses on bilateral stimulation to create new, positive neural pathways including adaptive information.
Therefore, individuals may feel relief from tension, a release of negative feelings, and explore rational beliefs.
Meanwhile, Brainspotting primarily relies on dual-hemisphere stimulation through gentle touch and tactile stimulation.
Another difference between the two approaches is that Brainspotting does not use cognitive restructuring, whereas EMDR does. Cognitive restructuring is a technique that helps people to notice, change and confront negative thinking patterns.
When the individual reshapes his dysfunctional beliefs, he can reframe the world around him more accurately (Clark, 2013). In EMDR literature, it can be done by cognitive interweaves. Sometimes, there can be clients with complex traumas who may be stuck in reprocessing. So, the therapist may help these individuals to access different neural networks (Bryan, 2021)
Furthermore, EMDR uses the protocol session method while Brainspotting employs Set up Session, which means that the EMDR session is lengthier and more rigid than Brainspotting.
Therefore, some resources yield that Brainspotting can provide faster effects than EMDR due to its speed. However, despite its length, EMDR may have longer-lasting effects.
Generally, EMDR sessions last for 1 hour; however, some sessions may last about 60-90 minutes, depending on the severity of the problem being addressed.
Meanwhile, the Brainspotting session may last for 60 minutes.
EMDR therapy is used for many reasons now, even it was initially created for treating PTSD, including;
Post-traumatic stress disorder (PTSD) is a mental health disorder that may form after a severely traumatic event. It causes negative, anxious emotions to which people react differently. Some relive the event repeatedly, while others avoid anything that reminds them of it.
PTSD interferes with life, work, and relationships. EMDR can help heal the trauma and thus remove symptoms affecting people’s lives. It was specially developed for treating PTSD.
Some people who have experienced trauma in their lives can be caught in a cycle of re-experiencing the traumatic event through flashbacks, nightmares, and intrusive thoughts. When do traumatic symptoms cause post-traumatic stress disorder?
A traumatic event is time-based, while PTSD is a longer-term condition where one continues to have flashbacks and re-experience the traumatic event.
The symptoms must last more than a month and be severe to disrupt one’s life areas for being considered as PTSD. According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), the individual must fulfill the criteria of re-experiencing, avoidance, arousal and reactivity, and cognition and mood symptoms for at least one month (American Psychiatric Association, 2013)
In PTSD patients, the high level of arousal triggered by distressing life events causes them to be stored in memory with the original emotions, physical sensations, and beliefs. The flashbacks, nightmares, and intrusive thoughts of PTSD are primary symptoms resulting from triggering these memories.
The AIP model claims that a wide range of adverse life experiences can also be stored in a dysfunctional manner. Providing the basis for diverse symptomology that includes negative affective, cognitive, and somatic responses in PTSD patients (Shapiro, 2014).
Sufficient processing of those accessed memories within the standard three-pronged EMDR therapy protocol (remember past-present-future) brings about adaptive resolution and functioning.
The originally experienced negative emotions, physical sensations, and beliefs are altered as the targeted memory is integrated with more adaptive information.
What is useful is learned and stored with appropriate affective, somatic, and cognitive concomitants. Consequently, the disturbing life experience becomes a source of strength and resilience (Shapiro, 2014).
To learn more, click the link to get more details from this Cleveland Clinic article:
Different brain areas are functioning in EMDR processing. Amygdala is responsible for anxiety and stressful event responses, the hippocampus is related to memories and learning. Finally, the prefrontal cortex is the controlling center of behavior and emotion.
The traumatic memories are stuck in these areas and can be triggered easily in daily life. Clients may feel that they experience them as like the past event happens now. Therefore, the stuck memories shape unprocessed memories (Pagani, 2012).
Similar to PTSD and other mental health issues, EMDR follows the standard 8-step protocol for anxiety with more stabilization and relation exercises. During an EMDR session, the client focuses on target memory and follows the therapist’s fingers or bilateral sounds as they move back and forth.
If the movement is too fast, it can cause more materials to come up or dissociation if the client is inclined to. However, the slower pace can be a choice of installation, safe place, or resourcing stages.
The treatment targets will be unique to the client’s fears, worries, and anxiety-producing situations. Therapists want clients to stay in a window of tolerance (the amount of disturbance one can manage without going into severe distress).
They jointly explore anxiety-related memories, traumatic memories, and/or agoraphobic (as an example) situations. For example, panic disorder symptoms are expected to reduce or dissolve after processing the underlying traumatic memories.
Therapists can install additional resources, such as calm place imagery and present place mindfulness. In general, EMDR effectively decreases panic complaints and increases a calming state (Horst and de Jongh, 2015).
Eye movements can also be used as a form of self-help for people suffering from obsessive-compulsive disorder (OCD). After learning how to use the technique, individuals may choose to do it daily until their symptoms lessen over time.
For instance, the butterfly hug is another self-administered bilateral stimulation method. It is commonly used with traumatic clients to process memories.
Clients process current obsessions and compulsions, envision future situations, and recall their past traumatic memories as a cornerstone of these symptoms. For example, in the following OCD Protocol, targets are desensitized with the following sequence:
Starting with the current triggers (common compulsions and obsessions).
Followed by past-related mostly disturbing memories.
And then by the future template that clients imagine a successful future action without showing these symptoms.
EMDR therapy also plays a role in treating depression as well. According to Shapiro (2014), people who experience post-traumatic stress syndrome and depression were often found to have decreased activity in the frontal lobe region during treatment sessions compared to those who did not suffer from these conditions.
It is believed that EMDR helps stimulate areas of the brain related to memory storage and emotional processing, thereby improving your mood overall!
EMDR for depressive-related issues usually aims to identify the powerful, negative cognition that triggers the client’s symptoms. For example, the common negative beliefs of clients with a depressive disorder are being unlovable, unworthy, weak, or incompetent.
By working with these specific thoughts and identifying the underlying life events, experiences, or traumatic memories that led to the development of those beliefs, they can begin to alleviate symptoms of depression.
During sessions, the therapist focuses on the reprocessing and desensitization of the event where the depression started. Also, the focus will be on strong emotions, body sensations, negative self-beliefs, and disturbing stimuli like imagery, sound, or smell.
These memories cause cognitive distortions, and the negative thinking style can be altered by processing the memory.
While some people may feel more comfortable meeting with a therapist in person, you can actually do EMDR therapy virtually.
You’ll need to ensure a good internet connection and a quiet, private space to do the sessions. You can do it virtually because it’s short-term and available online to complete at your own pace.
In the virtual setting, therapists choose a convenient platform (Zoom, Skype, Google Teams, etc.).
It is crucial that the client and therapist have a good internet connection, position their laptop or phone for the eye-contact level, and have a silent place to focus on therapy (EMDR UK, 2020).
Although you can self-administer some stabilization or relation techniques recommended by your EMDR therapist, the therapy itself cannot be held yourself. The person must be a licensed therapist who has received proper training in EMDR therapy.
It is not recommended to do EMDR therapy sessions with someone who is not a competent, accredited EMDR therapist. If you are not a mental health professional who has been fully trained in EMDR therapy, you should not do this.
Also, doing it with friends or family is not recommended. Most of the memories are related to them, and it does not only harm relationships but is also very unethical.
In addition, it is possible to trigger a panic attack or other severe reaction that you aren’t prepared to respond to professionally. It can lead to potentially permanent damage.
In short, no. If done by a professional.
Please read our Dangers of EMDR Therapy & Side Effects & Misconceptions article for a more nuanced answer.
EMDR is NOT harmful. It is safe and effective for all age groups. In fact, Shapiro (2014) has indicated that EMDR therapy can help with a wide range of mental health issues such as anxiety, post-traumatic stress disorder (PTSD), depression, and eating disorders.
There are no adverse side effects of this treatment. Many patients report positive changes in their mood and a reduction in the frequency of their trauma-related symptoms after a series of sessions.
The recommended frequency for EMDR treatment is 1-2 times per week for a duration of three months. In general, 60-90 mins are enough.
However, the length of treatment varies from person to person, especially since there are so many different factors that decide the length of treatment.
For instance, some clients can reach their therapy goal in 10-12 sessions; however, there can also be other clients with complex traumas who come to sessions for 6 months.
EMDR can also be performed in longer sessions with extended durations or as occasional treatments when needed. The frequency depends on how the patient feels comfortable and what they are willing to commit to.
The therapist should collaborate with the client to determine the specific goals for therapy and treatment. This includes frequency of sessions, length of sessions, prioritization of memories to focus on, and any preparation work needed.
It depends on the type of trauma, and how severely you have been affected will determine how many sessions are needed. Moreover, it also depends on the individual, and how affected they are by their traumatic event will ultimately determine how long it will take EMDR therapy to work.
When looking for an EMDR therapist, it is crucial to find one that is experienced and has been certified by the National Association of their country.
Therapists offering EMDR are licensed mental health professionals who have received specialized and certified training through approved EMDR Europe trainers and training organizations.
It is also very important to be able to talk openly about what happened in a session without feeling judged or uncomfortable. If any of these are not met, it may be better to find another therapist who might be more suited for your needs.
In a nutshell, EMDR Therapy is an effective therapy for many conditions that helps heal quickly and safely. If done by a professional EMDR therapist.
EMDR combines psychotherapy with body-based practices to promote emotional well-being. In short, if you’re experiencing symptoms of anxiety or depression and want to see improvements in your condition, then EMDR therapy may be the best option.
With the proper guidance from a trained therapist, this therapy will provide positive results and help you recover from past trauma.
Clinical Psychologist & EMDR Therapist
Our reference section for further reading:
EMDR UK. (2020, April 3). Online EMDR therapy Associaton Guidance during Covid-19 outbreak. Https://Emdrassociation.Org.Uk/. https://emdrassociation.org.uk/wp-content/uploads/2020/04/Association-Online-EMDR-Guidance-April-2020-V2.pdf
Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. New York: The Guilford Press.
Valiente-Gómez A, Moreno-Alcázar A, Treen D, et al. EMDR beyond PTSD: A Systematic Literature Review LINK Front Psychol. 2017;8:1668. 2017 Sep 26. Accessed 3/29/2022.
Engelhard, I. M., van den Hout, M. A., Janssen, W. C., & van der Beek, J. (2010). Eye movements reduce vividness and emotionality of “flashforwards”. Behaviour research and therapy, 48(5), 442–447. https://doi.org/10.1016/j.brat.2010.01.003
Shapiro, F., & Maxfield, L. (2002). Eye movement desensitization and reprocessing (EMDR): Information processing in the treatment of trauma. Journal of clinical psychology, 58(8), 933-946.
Hill, M. D. (2020). Adaptive Information Processing Theory: Origins, principles, applications, and evidence. Journal of Evidence-Based Social Work, 17(3), 317-331.
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). New York, NY: The Guilford Press
Shapiro F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente journal, 18(1), 71–77. https://doi.org/10.7812/TPP/13-098
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). LINK
Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71
Psychiatry, A. (2022). Brainspotting vs. EMDR: Arcara Personalized Psychiatry. Arcara Personalized Psychiatry | Boston & Westborough, MA. Retrieved September 6, 2022, from https://arcarapsychiatry.com
Bryan, H. (2022). When should we use cognitive interweaves in EMDR therapy? The EMDR Supervisor. Retrieved September 6, 2022, from https://theemdrsupervisor.com
Oren, E. M. D. R., & Solomon, R. (2012). EMDR therapy: An overview of its development and mechanisms of action. European Review of Applied Psychology, 62(4), 197-203.
Clark, D. A. (2013). Cognitive restructuring. The Wiley handbook of cognitive behavioral therapy, 1-22.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). LINK
Pagani, M., Di Lorenzo, G., Verardo, A. R., Nicolais, G., Monaco, L., Lauretti, G., et al. (2012). Neurobiological correlates of EMDR monitoring – An EEG study. PLOS ONE 7:e45753. doi: 10.1371/journal.pone.0045753
Horst, F., & de Jongh, A. (2015). 2 EMDR Therapy Protocol for Panic Disorders With or Without Agoraphobia. Eye Movement Desensitization and Reprocessing (EMDR) Therapy Scripted Protocols and Summary Sheets: Treating Anxiety, Obsessive-Compulsive, and Mood-Related Conditions, 51.
Artigas, L. & Jarero, I., (2014). The Butterfly Hug Method for Bilateral StimulationThe EMDR Foundation. EMDR UK. (2020, April 3). Online EMDR therapy Associaton Guidance during Covid-19 outbreak. Https://Emdrassociation.Org.Uk/.
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