Eye Movement Desensitization and Reprocessing (EMDR) is an integrative approach. EMDR therapy is effective for the treatment of trauma and PTSD.
Developed by psychologist and educator Francine Shapiro, EMDR therapy has grown in popularity. EMDR can heal the emotional distress from trauma. Therefore, this approach has helped millions find relief from trauma-related mental health issues.
EMDR therapy for PTSD shows that the mind can heal from psychological trauma. In addition, the body can recover from physical trauma. Moreover, it has been shown to relieve symptoms of psychological trauma faster than other forms of psychotherapy.
Conditions That EMDR Therapy Addresses
EMDR treatment for anxiety and depression are also effective. Overall, it has been used as a treatment for the following conditions, among others:
- Panic attacks
- Eating disorders
- Stress caused by chronic disease
Moreover, the following populations have used EMDR to heal from trauma:
- People who have been a victim of a disaster (such as a violent crime, accident, natural disasters, fire, etc.)
- Clients who experience discomfort with social situations, public speaking, or medical procedures
- People dealing with grief and loss, due to death, divorce, or loss of a home
- Police officers and other frontline providers
- Children and adolescents who have experienced sexual abuse or rape
- Accident or burn victims.
Consequently, EMDR has a broad range of applications. Moreover, it can be effective for children and teens, as well as adults.
The Development of EMDR
In 1987, Francine Shapiro was walking in the park when she observed something. Moving her eyes from side to side seemed to reduce negative thoughts brought on by distressing memories. Subsequently, Shapiro began to investigate this through research.
In her first study, she worked with 70 volunteers to determine whether they had the same experience. As a result, she discovered that eye movements alone did not offer therapeutic benefits. Therefore, she added additional treatment elements.
Additionally, Shapiro conducted a controlled study and published the results in the Journal of Traumatic Stress. The study involved 22 people suffering from traumatic memories. These memories related to a range of traumatic incidents. These included military combat, childhood sexual molestation, sexual or physical assault, and emotional abuse. Moreover, the subjects suffered intense symptoms. These included intrusive thoughts, flashbacks, sleep disturbances, low self-esteem, and relationship problems.
Half of the subjects received EMDR therapy, and the other half received therapy that did not include eye movements. Following therapy for trauma, the EMDR group’s traumatic memories were successfully desensitized. Furthermore, the way they thought about their past experiences had shifted as well. Participants in the EMDR group reported larger changes than those in the imagery group.
After further research and elaboration of the methodology, Shapiro published books and a textbook detailing the eight phases of EMDR psychotherapy. Her book Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures includes a full description of the theory, sequence of treatment, and research on EMDR.
International Recognition of EMDR
Today, the EMDR International Association (EMDRIA) comprises more than 4,000 mental health professionals. In addition, more than 100,000 clinicians worldwide have completed formal training in order to receive EMDR certification.
How Does EMDR Work?
EMDR experts often explain the technique by using the analogy of a physical wound. For example, when we cut ourselves or get a splinter, the body works to heal. However, if a foreign object or repeated injury keeps the wound from healing, we experience more pain. Once the splinter or other blockage is removed, healing can occur.
In EMDR theory, a traumatic event is like a mental and emotional wound. Therefore, just as the body tries to heal a physical wound, the brain’s information processing system tries to heal the emotional wound.
However, if the healing process is blocked or imbalanced by the ongoing negative impact of trauma, the emotional wound can cause intense suffering. Once the blocks are removed, the natural healing processes can go into effect.
The Healing Work of EMDR
The goal of EMDR therapy is to process the experiences that are causing pain and suffering. However, processing does not involve talking about the past, as in traditional talk therapy. Instead, EMDR helps resolve and release traumatic experiences through specific techniques.
As a result, individuals are able to integrate negative emotions, behaviors, and bodily sensations. Furthermore, these negative experiences and emotions are replaced by coping skills. These include positive emotions, healthy behaviors, and an increased understanding.
EMDR uses the Adaptive Information Processing (AIP) model. This model posits that sustaining mental health requires positive experiences. Hence, these prepare an individual to handle new challenges. Moreover, the AIP model maintains that the brain is equipped to manage and process difficult events.
What Happens in an EMDR Session
Below, we look at the eight phases of the EMDR treatment approach. First, however, let’s examine how this approach integrates eye movement.
To begin, clients identify a visual image related to the traumatic memory. Moreover, they focus on a negative belief about themselves, and any difficult emotions and bodily sensations related to the belief and/or event.
In addition, the client identifies a positive belief. Next, the practitioner instructs the client to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing.
To clarify, the client focuses on the troubling image or negative thought while simultaneously moving their eyes back and forth. To prompt this eye moment, EMDR practitioners might move their fingers from side to side, tap their hand from side to side, or wave a wand. As a result, the client moves their eyes back and forth to follow the prompt.
During this processing, the client notices whatever thoughts, feelings, images, memories, or sensations might arise. Subsequently, the client repeats these steps numerous times throughout the session. Additionally, if the client becomes distressed or has difficulty, the therapist follows procedures to help the client return to the processing work.
EMDR and Dream States
Some researchers believe that EMDR works by engaging similar brain mechanisms as those that are involved in rapid eye movement (REM) sleep.
Specifically, research by Dr. Robert Stickgold suggests that the repeated redirection of attention caused by the eye movements used in EMDR creates a neurobiological state that resembles REM sleep. Therefore, traumatic and emotionally charged memories can be processed so they are no longer as overwhelming.
“EMDR induces a fundamental change in brain circuitry, similar to what happens in REM sleep, that allows the person undergoing treatment to more effectively process and incorporate traumatic memories. This helps the individual integrate and understand the memories within the larger context of [their] life experience.”
—Robert Stickgold, PhD, Harvard Medical School
The Goals of EMDR
Throughout these sets of eye movements, the brain makes associations and neural connections that help integrate the disturbing memory. Eventually, the distress associated with the memory dissolves.
At this point, the practitioner directs the client to focus on the positive belief they identified at the beginning of the session. Next, the client may adjust the positive belief if necessary. Then they focus on this positive belief while processing the next set of targeted memories.
When EMDR therapy is successful, the meaning of a painful, traumatic event is transformed at the emotional level. For instance, victims of violent crime move from fear and self-blaming to feelings of strength and possibility. Therefore, EMDR is an empowering approach that allows the client’s own intellectual and emotional healing processes to go into effect.
Discussing the details of a traumatic experience is not required in EMDR sessions. Therefore, the anxiety associated with confronting and revealing those details is not as extreme. Hence, EMDR can be an effective treatment for teens that are resistant to talk therapy.
An Alternative to Talk Therapy
Furthermore, EMDR side effects, as well as the after-effects, are less severe than those of some PTSD medications or more extreme therapies. EMDR clients might experience some discomfort when focusing on trauma-related memories or beliefs. However, these feelings are typically short-lived. Moreover, they are outweighed by the benefits.
The Eight Phases of EMDR Treatment
An EMDR therapy session involves an eight-phase treatment process. However, the number of sessions needed varies according to the client’s needs and history. The age of PTSD onset and the number of times the person experienced traumatic events or incidents determine how long they will be in treatment.
According to some experts, clients with a single incident of trauma, such as a one-time assault or accident, may need only five hours to integrate the event. By contrast, people who have experienced childhood trauma or multiple incidents of trauma may require a longer treatment time.
The EMDR approach includes the following eight phases.
Phase 1: History Taking and Treatment Planning
In the first phase, the EMDR therapist assesses the client’s readiness and establishes trust. In addition, they work with them to develop a treatment plan. Together, the client and therapist identify distressing memories and current situations that could benefit from EMDR processing. Moreover, the treatment plan focuses on helping the client develop skills. This helps them establish healthy behaviors for coping with future situations.
Phase 2: Preparation
During the Preparation phase, the clinician explains the theory of EMDR, how it is done, and what to expect during and after treatment. Moreover, the therapist helps the client learn ways of handling emotional distress. Consequently, the therapist may teach the client a variety of imagery and stress-reduction techniques to use during and between sessions. Therefore, the client has a greater chance of emotional stability throughout.
Phase 3: Assessment
Subsequently, the practitioner and the client use EMDR therapy techniques to process particular “targets.” That is, traumatic incidents or memories. Moreover, they identify positive replacements for these negative memories. The client rates their belief in these positive replacements using the Validity of Cognition (VOC) scale, in which 1 equals “completely false,” and 7 equals “completely true.”
Phase 4: Desensitization
This phase focuses on desensitization. This includes the eye movement technique described above. This process continues until the client reports that the memory is no longer distressing.
Phase 5: Installation
In this phase, the client focuses on positive emotions and beliefs to replace those created by the trauma. In addition, they again use the VOC scale to determine whether they accept the positive statements as truth. Ideally, the client accepts the full truth of their positive self-statement at a level of 7 (completely true).
Phase 6: Body Scan
The client performs a body scan to assess sensations and tension. Therefore, they can determine whether the trauma has been processed. This phase references research indicating that trauma is stored in the body, not just the mind.
Phase 7: Closure
In this phase of closure, the therapist assists the client in using a variety of self-calming techniques. Hence, the goal is to regain a sense of equilibrium. Moreover, the therapist may ask the client to keep a log during the week. In addition, the log documents any related symptoms, thoughts, etc. that the client may experience. Furthermore, it is a reminder for the client of the coping strategies and self-calming activities.
Phase 8: Reevaluation
Finally, in phase eight, the client and practitioner examine the progress. Typically, they do this at the beginning of each session. Therefore, they can evaluate progress and determine which targets to address next.
The Efficacy of EMDR
More than 30 controlled studies have assessed the EMDR success rate. As a result of the research, it is well recognized. Furthermore, many mental health organizations recognize it as an effective form of treatment for trauma and other conditions. Specifically, organizations that recognize it as an effective modality include the American Psychiatric Association, the World Health Organization, the Department of Veterans Affairs, and the Department of Defense.
Here is a sampling of the research done on EMDR outcomes.
- Research conducted at a Veterans Affairs facility reported a 78 percent remission in PTSD after 12 treatment sessions.
- Another study, funded by Kaiser Permanente, found that 100 percent of single-trauma victims and 77 percent of multiple-trauma victims participating were no longer diagnosable with PTSD, after only six 50-minute sessions.
- Participants received treatment two weeks following a 7.2 earthquake in Mexico. Researchers found improvement in symptoms of post-traumatic stress. Moreover, these results maintained at a 12-week follow-up, despite the fact that frightening aftershocks continued to occur.
- Transportation employees who had experienced “person-under-train” accidents or had been assaulted at work participated in an EMDR study. Following six sessions, 67 percent experienced remission of PTSD, compared to 11 percent in the control group.
- The second-ever randomized EMDR study of civilians reported a 90 percent PTSD remission in sexual assault victims after just three 90-minute sessions.
- Controlled studies of EMDR have also shown benefits for children with self-esteem and behavioral problems. In one study, PTSD symptoms in children decreased to 25 percent in the EMDR group. But it remained at 100 percent among children who were wait-listed for the treatment.
In conclusion, the evidence shows that EMDR is a powerful tool. Thus, it can eliminate symptoms that result from disturbing or life-threatening events. Therefore, this approach is an effective modality in supporting teen mental health.
EMDR Institute, Inc.EMDRIA: EMDR International Association
US Department of Veterans Affairs
American Psychological Association
J Traum Stress. 1989 April;2(2);199–223.
J Clin Psychol. 2002 Jan;58(1):61–75.
Eur J Psychotraumatol. 2015 May 18;6:27414.
Perm J. 2014 Winter; 18(1):71–77.
J EMDR Practice Research. 2008 Nov;2(4):289–299.
Nord J Psychiatry. 2007;61(1):54–61.
J Trauma Stress. 1998 Jan;11(1):3–24.
Psychotherapy: Theory, Research, & Practice. Fall 1997;34(3):307–315
J Traum Stress. 2005 Dec;18(6):607–16.
J EMDR Practice Research. 2008 Aug;2(3):180–189.
J EMDR Practice Research. 2012 Feb; 6(2):50–61.