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Eye Movement Desensitization and Reprocessing (EMDR) is a simple but efficient evidence-based treatment for various mental health conditions.
Using bilateral stimulation (BLS) such as tapping, auditory tones and/or eye movements, EMDR accelerates the brain's capacity to desensitize triggers and reprocess troubling thoughts.
Who can benefit from EMDR?
Originally developed for the treatment of psychological trauma, EMDR is a therapeutic modality which has grown extensively. Variations of the original evidence-based protocol have been developed for not just diagnoses like PTSD, but also:
- Depression
- Anxiety & Panic Attacks
- OCD
- Chronic Pain
- Addiction
- and more!
EMDR can be performed via telehealth or in person, with adults and with children.
What's EMDR therapy like?
EMDR therapy involves eight phases which may not necessarily occur sequentially.
Your therapist will meet with you to explore why you're seeking therapy and identify associated "targets" -- isolated memories, thoughts, feelings, or sensations -- which will be used as focal points for desensitizing and reprocessing. For example, if a patient seeks to recovery from social anxiety, they may have the following targets:
- A memory of embarrassment from childhood
- A concern for public speaking in the future
- A memory of being bullied
- A reoccurring trigger of riding public transit
Typically targets fall into three categories: past memories, current triggers, future anxieties.
You and your therapist will identify skills and resources necessary for tolerating any potential distress associated with giving attention to the difficult targets. Like many forms of therapy, some discomfort at the beginning is customary, but you should always inform your therapist if it seems EMDR is making things unbearable. This is a sign that additional preparation work is necessary before continuing onward. As such, this phase may be revisited over time.
To assess progress over time, your therapist will ask you to identify and rate several items:
- A negative cognition: a thought that you at least partially believe about yourself related to the target;
- A positive cognition: a thought you would like to replace the negative cognition; this will be rated on the Validity of Cognition (VOC) Scale which assesses how true the positive cognition feels to you throughout the course of EMDR treatment.
- A rating of Subjective Unites of Distress (SUD) Scale: this measures how much distress the target currently causes you to think about.
During the desensitizing phase, you are asked to think of a still-frame or short mental reel of your target memory, thought, or situation while your therapist applies BLS in the form of tapping your hands, providing a pace for you to administer your own tapping, playing binaural sounds, or moving their fingers from side to side. Some therapists also use a light bar which simulates the therapist moving their fingers. During desensitization (which may span several sessions), the hope is that your SUDS rating will go down and you will begin to feel less triggered by the target.
Installation is when you and your therapist will work more diligently on increasing the VOC score of your positive cognition. This will also involve BLS, and it is not uncommon that patients will move between Phases 4 and 5 until optimal scores are achieved in both areas.
Once it seems that your SUDS is sufficiently reduced and your VOC is successfully installed, your therapist will lead you in a guided meditation called a "body scan" to assure that no part of the target still triggers physical reactivity such as sensations of heaviness, dizziness, tingling, or tension. Often trauma gets stored in the body, so this is a necessary step to assure the BLS was effective. Should physical reactions be found when recalling the target still, your therapist will instruct you to focus on those sensations while you complete additional BLS.
Every EMDR session, regardless of whether a target is "cleared" or reduced to a 0 on the SUDS, will end with some form of a closing activity. This may involve practicing some sort of coping skill such as deep breathing with your therapist, reflecting on a place you feel safe, or identifying additional resources available to you between sessions. Some EMDR sessions can be intense, so closure is an important step to temporarily turning off the movie in your head and reorienting you to your daily life.
All sessions after Phase 4 begin with a brief reevaluation to assess any change in symptoms, SUDS rating, and VOC. Your therapist will also reevaluate your ratings between targets as sometimes clearing one target leads to lower distress in other targets naturally.
Phases 3-8 are repeated until all targets are addressed and SUDS is sufficiently reduced.
How does EMDR work?
Clearing Old Wounds
Not every stressor produces psychological trauma just like not every bee sting causes a big reaction. However, sometimes, parts of a stressful situation overwhelm our body and mind's ability to cope and pieces of that event get stuck in our psyche much like the occasional stinger gets stuck deep within our skin. Similarly, some people are pre-disposed to more intense reactions due to their biology or genetics; the same is true with trauma and other mental health disorders that may cause a person to react differently than others.
Often, psychotherapy and psychiatry focus solely on minimizing symptoms rather than addressing the core issues. This approach works well as an initial treatment for certain disorders such as episode depression or occasional panic attacks, however patients with more complex cases may find themselves still struggling. EMDR is different in that it traces symptoms back to the source, often into childhood memories, and engages the brain's natural healing abilities by supporting patients in directing attention to the parts of themselves most needing attention.
Bilateral Stimulation and Dual-Attention
As mentioned above, EMDR is distinguished by the use of bilateral stimulation (BLS) such as tapping, binaural sounds, and/or eye movements. Why BLS works is still being researched, but one mechanism of action believed to be the development of dual-attention. Patients experiencing BLS are asked to maintain focus on a present moment stimuli (BLS) and on a target memory, thought, or sensation that is in the past or future. This allows a person to mentally enter otherwise overwhelming scenarios with additional resources such as their grown self and the support of the therapist.
Parallels to REM Sleep
It is also believed that EMDR may function similarly to rapid eye movements (REM) which occur naturally during sleep. Crick & Michison's (1995) model of "reverse learning" proposes that REM sleep is when our brains process daily events, sorting experiences into helpful and unhelpful categories. This mirrors EMDR's ability to recategorize distressing targets to be associated instead with positive cognitions. What was once a terrible thing that happened becomes a great example of resilience and an exercise in compassion.
What are the risks associated with EMDR?
As with any other therapeutic approach, reprocessing traumatic memories can be uncomfortable. Most often this discomfort can be mitigated by additional preparation, offered by the therapist, before processing distressing thoughts or memories using EMDR.
Possible difficulties specific to EMDR treatment include the following:
- Reprocessing a memory may bring up associated memories. This is normal and those memories will also be reprocessed.
- During the EMDR, the patient may experience physical sensations and retrieve images, emotions and sounds associated with the memory.
- The reprocessing of the memory normally continues after the end of the therapy session. Other memories, flashbacks, feelings and sensations may occur. The patient may have dreams associated with the memory. Frequently the brain is able to process these additional memories without help, but arrangements for assistance will be made in a timely manner if the participant requires additional support. Whenever new symptoms arise, it is best to inform your clinician.
What results can I expect from EMDR therapy?
EMDR works quicker than many other forms of therapy because it harnesses your brains natural healing mechanisms. Patients who participate in EMDR therapy can expect that target memories are remembered but the painful emotions and physical sensations and the disturbing images and thoughts are no longer present. Some patients may see results after one session, others over several months.
About the Author
Jordan A Dobrowski, LCSW received her Master’s in Social Work with concentrations in trauma-informed care and global social development from the University of Chicago in 2018. Jordan has also completed special training in trauma-focused modalities, EMDR, yoga, visual art, crisis intervention, and both suicide prevention and postvention (grief). Jordan is LGBTQ-affirming and has experience working with individuals from a variety of spiritual and cultural backgrounds.
